Self-injurious behaviors, chronic emptiness increase suicide attempt risk in BPD

Borderline personality disorder diagnosis and related criteria of self-injurious behaviors and chronic emptiness significantly increased suicide attempt risk, according to results of a cross-sectional study published in JAMA Network Open.

“The present study aimed to examine whether a lifetime BPD diagnosis and specific criteria of BPD are associated with lifetime and past-year [suicide attempts] in U.S. adults after adjusting for other known sociodemographic and clinical variables associated with [suicide attempts], including childhood adverse experiences and psychiatric comorbidity,” Carlos M. Grilo, PhD, of the department of psychiatry at Yale University School of Medicine, and Tomoko Udo, PhD, of the department of health policy, management and behavior at the University at Albany in New York, wrote. “This study applied a more rigorous BPD diagnostic scoring method than was used in all [three National Epidemiological Survey on Alcohol and Related Conditions (NESARC)] waves given substantial clinical and empirical concerns.”

Grilo and Udo analyzed data from 36,309 randomly selected individuals (mean age, 45.6 years; 56.3% women; 52.9% non-Hispanic white) included in the NESARC-III, a psychiatric epidemiological survey of U.S. adults who were noninstitutionalized and aged 18 years or older between April 2012 and June 2013. Prevalence of DSM-5 psychiatric and personality disorders, BPD and related criteria and adverse childhood experiences, evaluated via structured diagnostic or clinical interviews, served as main outcomes and measures. The researchers compared the risk for lifetime and past-year suicide attempts by BPD diagnosis and by each BPD-specific criterion using multivariable-adjusted logistic regression. They adjusted analyses for demographic clinical factors that included comorbidity, age at onset of BPD and adverse childhood experiences.

Results showed a prevalence of lifetime suicide attempts of 22.7% (adjusted OR = 8.4; 95% CI, 7.53-9.37) and of past-year suicide attempts of 2.1% (aOR = 11.77; 95% CI, 7.86-17.62) among individuals with a lifetime BPD diagnosis according to original NESARC-III diagnostic codes. They also showed a prevalence of lifetime suicide attempts of 30.4% (aOR = 9.15; 95% CI, 7.99-10.47) and of past-year suicide attempts of 3.2% (aOR = 11.42; 95% CI, 7.71-16.91) when using diagnostic codes that required five BPD criteria to meet social-occupational dysfunction. The lifetime prevalence was 28.1% (aOR = 7.61; 95% CI, 6.67-8.69) and the past-year prevalence was 3% (aOR = 9.83; 95% CI, 6.63-14.55) when the researchers excluded the BPD criterion of self-injurious behavior, meant to eliminate criterion overlap.

Grilo and Udo noted that BPD diagnosis and specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness were significantly linked to increased risk for lifetime suicide attempts and past-year suicide attempts in analyses that adjusted for sociodemographic variables, psychiatric disorders, age at BPD onset and adverse childhood experiences. Chronic feelings of emptiness appeared significantly linked to increased risk for lifetime suicide attempts (aOR = 1.66; 95% CI, 1.23-2.24) and past-year suicide attempts (aOR = 2.45; 95% CI, 1.18-5.08) in an analysis that simultaneously entered BPD criteria, excluding self-injurious behavior.

“The findings suggest that although BPD is a complex diagnostic construct, the specific BPD criteria of self-injurious behaviors and chronic feelings of emptiness should be routinely considered in suicide risk screenings and assessments in clinical and nonclinical settings,” Grilo and Udo wrote.