Elements of borderline personality disorder may increase risk for suicide attempts

Specific features of borderline personality disorder may increase risk for suicide attempts, according to study results published in JAMA Psychiatry.

Shirley Yen

“Because our study involved gathering 10 years of data, we had a unique opportunity to examine which aspects of borderline personality disorder predicted suicidal behavior over the 10 years of follow-up,” Shirley Yen, PhD, of the Massachusetts Mental Health Center at Harvard Medical School, told Healio Psychiatry. “What emerged in our study was that the criteria of identity disturbance, chronic feelings of emptiness and frantic efforts to avoid abandonment were very robust predictors, and these three criteria, which are also very specific to borderline personality disorder, are understudied relative to other features of the disorder.”

Identifying specific features of this disorder that increase risk could inform interventions, the researchers noted. They sought to examine factors linked to prospectively observed suicide attempts among participants of the Collaborative Longitudinal Study of Personality Disorders with a focus on borderline personality disorder and its criteria over 10 years of follow-up. The CLPS studies adults with four personality disorders, as well as a comparison group with MDD and minimal personality disorder features. A total of 701 individuals completed at least one follow-up assessment. Researchers conducted annual semi-structured diagnostic interviews and used a variety of self-report measures for up to 10 years, as well as used multiple logistic regression analyses to evaluate baseline demographic and clinical risk factors of suicide attempt assessed over 10 years of prospective follow-up.

Results showed borderline personality disorder was the most significant factor linked to prospectively observed suicide attempts (OR = 4.18; 95% CI, 2.68-6.52), which remained as such after controlling for significant factors, such as sex, employment, education, childhood sexual abuse and PTSD. Identity disturbance (OR = 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR = 1.63; 95% CI, 1.03-2.57) and frantic efforts to avoid abandonment (OR = 1.93; 95% CI, 1.17-3.16) were significant independent factors linked to suicide attempts over follow-up, when covarying for other significant factors and borderline personality disorder criteria.

“Identity disturbance, chronic feelings of emptiness and frantic efforts to avoid abandonment are really understudied and potentially overlooked risk factors for suicidal behavior,” Yen said. “This may also help us better understand why borderline personality disorder is so strongly associated with suicidal behaviors. In addition to affective instability and impulsivity (which are suicide risk factors shared with other disorders), the other three criteria that represent personality functioning disturbances in the Alternative Model of Personality Disorders in DSM-5 Section 3, are quite unique to borderline personality disorder and merit further consideration in suicide risk assessments.”