BEHAVIORAL ACTIVATION AND THE PREVENTION OF SUICIDAL BEHAVIORS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER Derek R. Hopko, PhD, Lisa Sanchez, MA, Sandra D. Hopko, MA, LPC, Sharone Dvir, BA, and C. W. Lejuez, PhD Clinical approaches in treating and preventing suicidal behaviors in pa- tients with borderline personality disorder (BPD) have received limited at- tention. To stimulate further work in this area, we present a behavioral activation treatment for depression (BATD; Lejuez, Hopko, & Hopko, 2002) that has shown promising results in treating clinically depressed patients and a theoretical conceptualization for why BATD may prove particularly useful in reducing the frequency of suicide-related behaviors and other symptoms characteristic of patients with BPD. We also present theoretical consistencies between BATD and the well-established inter- vention of dialectical behavior therapy (DBT; Linehan, 1993), which may allow for their practical integration, and conclude with a case study that illustrates the assimilation of these strategies in the treatment of a patient with BPD. According to the Centers for Disease Control and Prevention (CDC, 1998), suicide was the third leading cause of death for adults aged 15 to 44 years. Demographic predictors include being male; Caucasian; divorced, widowed, or separated; living alone and in an urban area; and unemployment (Fremouw, de Perczel, & Ellis, 1990). Clinical risk factors include inade- quate social support, deficient coping strategies, chronic illness, family his- tory of suicide attempts, psychiatric problems, a history of physical or sexual abuse, and previous suicidal attempts (Fremouw et al., 1990). Sui- cide risk also is associated with certain psychiatric conditions including mood disorders, substance dependence, schizophrenia, and personality disorders (Kaplan & Sadock, 1998). Of the personality disorders, suicidal behaviors are most common among individuals with borderline personality disorder (BPD). The primary objectives of this article are to first outline the magnitude of the suicidality problem among patients with BPD. Second, we 460 Journal of Personality Disorders, 17(5), 460-478, 2003 © 2003 The Guilford Press From the University of Tennessee (D.R.H.), The University of Maryland - College Park (L.S., S.D., C.W.L.), and Covenant Behavioral Health (S.D.H.). Address correspondence to Derek R. Hopko, PhD, The University of Tennessee - Knoxville, De- partment of Psychology, Room 301D, Austin Peay Building, Knoxville, TN 37996-0900;E-mail: dhopko@utk.edu.