Five-year prospective investigation of self-harm/suicide-related behaviors in the development of borderline personality disorder.

Abstract

Although borderline personality disorder (BPD) is frequently characterized by nonsuicidal self-injurious behavior (NSSI), suicide attempts (SA), suicidal ideation (SI), and/or suicide threats (ST), it is unclear whether these behaviors are precursors of BPD in adolescence. This study examined self-harm/suicide-related behaviors in the development of BPD from adolescence to adulthood in psychiatrically hospitalized adolescents. Participants were 116 adolescents consecutively admitted for a psychiatric hospitalization for self-harm/suicide-related behaviors. Adolescents completed self-report questionnaires assessing self-harm/suicide-related behaviors, maladaptive familial behavior, and peer victimization upon admission. Admission diagnoses and history of sexual/physical abuse were abstracted from medical/psychiatric records. Five years after index hospitalization, medical/psychiatric records were systematically reviewed and information on diagnoses was collected. Using multivariable logistic regression analyses, ST predicted BPD above and beyond NSSI, SA, and SI 5 years later (odds ratio = 1.31, 95% confidence interval [1.06, 1.62], p > .01). Traditional risk factors of BPD were not predictive of BPD at 5-year follow-up. Suicidal threats are an important risk factor in adolescents who engage in self-harm/suicide-related behaviors that may differentiate those adolescents who go on to develop BPD as adults. Implications for research and treatment are discussed. (PsycINFO Database Record

Reliability and clinical usefulness of the personality inventory for DSM-5 in clinically referred adolescents: A preliminary report in a sample of Italian inpatients

“…For instance, BPD features in adolescents have been related to clinically significant behaviors, such as suicidal thoughts and behaviors [e.g., 24]. Given the high prevalence of self-harm/suicide-related behaviors in the general adolescent population (mean lifetime prevalence of suicide-related behaviors =16.1%; [25]), and the fact that suicide-related behaviors may predict future PDs, life-threatening suicidal attempts have important implications for the conceptualization and treatment of PDs during early stages of the disorder, when targeted treatment is most effective [26].…”

Borderline personality disorder and emotion dysregulation

“…Another recent longitudinal study examined self-harm and suicidal behaviors as predictors of the development of BPD 5 years later among adolescent psychiatric inpatients (Homan, Sim, Fargo, & Twohig, 2017). Findings suggested that only suicide threats uniquely predicted BPD 5 years later (Homan et al, 2017). As one of the key functions of emotions is to communicate, suicide threats may indicate a combination of high ED and deficits in communication skills, along with a learning history reinforcing emotional escalation.…”

Longitudinal associations between non-suicidal self-injury and borderline personality disorder in adolescents: a literature review

“…NSSI is purported to be a developmental precursor of BPD pathology under the biosocial developmental model [16, 26, 28–30]. Though previous pivotal studies have mainly focused on the cross-sectional associations of NSSI and BPD in adolescent samples [16–23, 30], longitudinal associations between NSSI and suicide attempts to other mental disorders in adolescents [8, 31, 32], adulthood-spanned BPD samples or retrospective adult data [7, 10], and longitudinal assessment of suicidal behaviours to BPD [24, 33–36].…”

“…Though previous pivotal studies have mainly focused on the cross-sectional associations of NSSI and BPD in adolescent samples [16–23, 30], longitudinal associations between NSSI and suicide attempts to other mental disorders in adolescents [8, 31, 32], adulthood-spanned BPD samples or retrospective adult data [7, 10], and longitudinal assessment of suicidal behaviours to BPD [24, 33–36]. Thus, NSSI as a developmental precursor of BPD, which requires longitudinal assessment of at least two time points, remains largely underexamined [3, 7, 18, 26, 37, 38].…”

“…As illustrated above, there is an abundance of research on the development of BPD, yet there is still a gap in the literature assessing the developmental precursors of BPD, particularly as described in the biosocial developmental model [18, 26, 28, 29, 37]. Cross-sectional research has been valuable in providing us with prevalence rates and associations of NSSI and BPD, but longitudinal studies are necessary to be able to describe the developmental evolution of these phenomena in relation to each other [18, 38].…”