Characterological Suicidality in Comorbidity With Bipolar Spectrum Pathology: Its Psycho-Structural Diagnostic Evaluation and Therapeutic Approach

The contemporary incorporation of the alternative model of the DSM-5-Section III (2013), a hybrid system that combines categorical and dimensional considerations for the evaluation of personality disorders, in terms of levels of self and interpersonal functioning; as well as the current proposal of the ICD-11 (2018), which also integrates dimensional aspects; have allowed the alignment of conventional psychiatric nosology, with psychodynamic theoretical-clinical frameworks, which have long used the same dimensions in the diagnostic assessment and empirical research of personality disorders. In this regard, the contemporary systematized operationalization of Transference-Focused Psycho-therapy‒Extended (TFP-E), as a supraordinating and transdiagnostic theoretical-clinical framework allows, not only its correlation closely aligned with DSM-5 and the ICD-11; but also provides a conceptual bridge between neurobiologically mediated dimensions of personality, on the one hand, and the psychostructural organization of personality, on the other. In this work, TFP-E is applied to the methodology of Kernberg´s “Structural Interview”; as well as to illustrate its use in a clinical vignette. Subsequently the differential diagnosis between characterological suicidality and depressive and bipolar spectrum suicidality is explored; and finally, treatment considerations, as well as frequent errors and inaccuracies in this difficult task are underscored.