Inclusion Criteria:  English-speaking Age 13 years, 0 months to 23 years, 11 months Meet diagnostic criteria for BD by KSADS-PL If BD-I, taking ≥1 mood stabilizing medication (i.e., antimanic anticonvulsant, antipsychotic, and/or lithium) Followed by a CAMH psychiatrist who provides ongoing care At least 1 lifetime suicide attempt (actual, interrupted, and/or aborted as measured by the C-SSRS) -OR- ≥ 3 lifetime non-suicidal self-injurious (NSSI) behaviors, with one behavior occurring in the past 3 months (as measured by the C-SSRS and ALIFE) -OR- a score of ≥ 24 on the SIQ -OR- 6b) Severe emotion dysregulation (score of ≥ 105 on DERS or score of ≥ 20 on the CALS (youth report) -OR- Meet youth threshold for at least 2 impulsive behavior categories on question #4 from the SIDP-IV or 1 category is identified as severe (through case discussion that will focus on level of risk, persistence, and impairment) Able and willing to give informed consent/assent to participate  Exclusion Criteria:  Evidence of mental retardation, moderate to severe pervasive developmental disorder, or organic central nervous system disorder by the K-SADS-PL, parent report, medical history, or school records A life-threatening medical condition requiring immediate treatment Current victim of sexual or physical abuse Current substance use disorder other than mild cannabis or alcohol use disorder