"Ms. R" is a 32-year-old woman of normal intelligence with over 50 psychiatric hospitalizations in the past 8 years, most for cutting behavior deemed dangerous to self because of the quantity and severity of the wounds. She had a diagnosis of recurrent major depressive disorder superimposed on borderline personality disorder, with micro-psychotic episodes and poor impulse control. The patient had failed to benefit from multiple adequate trials with various combinations of antidepressants, atypical antipsychotics, conventional antipsychotics, mood stabilizers, benzodiazepines, alpha1 antagonists, intensive case management, and elements of dialectical behavioral therapy. We discussed with the patient the risks and the potential benefits of a trial of naltrexone to reduce her urges to cut. Liver function test results were mildly elevated from fatty liver secondary to metabolic syndrome. Other psychotropic medications were not changed. The patient was treated with naltrexone, 25 mg/day, titrated up to 50 mg after 1 month. Her medications were given by her home health nurses or her grandmother, and she was compliant with taking them.Ms. R noted decreased urges to cut after 1 week of treatment, with a reduced frequency of cutting behavior after her dosage was increased to 50 mg/day. The patient stated that she used to think about cutting "constantly" and would cut one to three times per day, but now will go "days" without thinking about it and only cut one to two times per week at most. After 5 months of continuous treatment, she had a 6-month period with only one superficial cutting episode. Liver function tests improved from baseline, with the exception of a 16-point increase in aspartate aminotransferase, which was stable over the course of several months.