Negative affect is more strongly associated with suicidal thinking among suicidal patients with borderline personality disorder than those without

Abstract

Patients suffering from borderline personality disorder (BPD) are at elevated risk for suicidal thoughts and behaviors (STBs), but this well-described and clinically important association is not well-understood. Prior research suggests that STBs often function as an attempt to escape aversive affect, and that people with BPD experience stronger emotion reactivity and greater discomfort with emotion than those without BPD. Here, we tested whether negative affective states are more likely to predict suicidal thoughts among those with BPD than those without this disorder. Data on affective states and suicidal thoughts were collected several times per day from 35 psychiatric inpatients using their smartphones to capture real-time associations between negative affect and suicidal thoughts. Results revealed that the association between negative affective states (e.g., abandonment, desperation, guilt, hopelessness, loneliness, rage, self-hatred, and upset), and severity of suicidal thinking was stronger among those with BPD than among those without BPD. This finding has implications for risk assessment and intervention in the clinical setting: for a given degree of reported negative affect, patients with BPD experience more suicidal ideation than those without. Further research needs to be done to elucidate the mechanism of this effect.

Countertransference towards suicidal patients: a systematic review

“…These factors were not considered explicitly in the other studies, and their respective influence remains unclear. Future research is warranted: one study recently found that personality disorders play a role in explaining countertransference towards suicidal patients (Michaud et al, 2020) and another article showed that negative affects impact suicidal patients more when they suffer from a personality disorder (Mou et al, 2018), and such an interaction is probable regarding countertransference.…”

Insecure attachment and maladaptive emotion regulation mediating the relationship between childhood trauma and borderline personality features

“…Borderline personality disorder (BPD) is characterized by a pervasive pattern of emotion dysregulation, hyper‐intensity affect, unstable interpersonal relationships, and impulsive behavior (Gunderson, Herpertz, Skodol, Torgersen, & Zanarini, 2018; Leichsenring, Leibing, Kruse, New, & Leweke, 2011), which is a common and serious psychiatric disorder with an estimated prevalence of 0.7–5.9% in the general population, 10% in psychiatric outpatients and 15–25% in inpatients (Gunderson et al, 2018; Leichsenring et al, 2011). Long‐term follow‐up research confirmed that it's more difficult for BPD patients to attain and maintain the sustained remissions and recoveries than patients with other personality disorders (Gunderson et al, 2011; Mou et al, 2018). BPD is also regularly comorbid with axis I and other axis II disorders, especially mood disorders, anxiety disorders, and disorders related to substance abuse (Leichsenring et al, 2011).…”

Sleep and Next-Day Negative Affect and Suicidal Ideation in Borderline Personality Disorder

“…Relatedly, a recent set of findings implies that sleep disruption potentially charts the progression of BPD symptom severity and suicidality by impairing emotional functioning (Balestrieri et al, 2006;Fleischer et al, 2012;Grove et al, 2017;Lereya et al, 2017;Morales-Muñoz et al, 2020;Sjostrom et al, 2009;Wojnar et al, 2009;Wall et al, 2020). Understanding the clinical significace of sleep for affective dysregulation is particularly relevant to BPD, because cumulative evidence implies that the within-person association between negative affective states and the severity of suicidal ideation is particularly pronounced in BPD (Kaurin et al, 2020;Links et al, 2007;Mou et al, 2018).…”