Population-based estimates of borderline personality disorder (BPD) prevalence in lesbian, gay, bisexual, and transgender (LGBT) individuals are lacking. However, epidemiologic data point to high rates of suicidality, including suicide attempts and self-harm, for LGBT individuals—likely due to the high levels of stigma and discrimination that sexual and gender minority individuals experience. The first-line treatment for BPD and suicidal behavior is dialectical behavior therapy (DBT)—a cognitive–behavioral treatment with an emphasis on skills training, based on a biosocial model of disordered behavior—which aims to help clients end suicidal behavior, improve emotion regulation capabilities, and build a “life worth living.” Despite a lack of empirical support, a DBT conceptualization is highly consistent theoretically with the tenets of LGBT-affirmative therapy. This chapter discusses areas of convergence between the biosocial model and the minority stress model, and it presents two case studies of the application of DBT to LGBT clients.
