An Examination of DSM-IV Borderline Personality Disorder Symptoms and Risk for Death by Suicide: A Psychological Autopsy Study

Abstract

Objective: To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by suicide, and thereby better predict suicide risk. Method:A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD (n = 62), and BPD control subjects (n = 35).Results: BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation-dissociative symptoms. The negative association between paranoid ideation-dissociative symptoms and suicide was independent of all other BPD symptoms, Cluster B comorbidity, and alcohol dependence. Conclusions:We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD.Can J Psychiatry. 2009;54(2):87-92.Clinical Implications · Suicide attempts appear to be predicted by different factors than suicide deaths in people with BPD. · Affective instability and paranoid ideation-dissociative symptoms are not strongly associated with death by suicide in BPD. · DSM-IV BPD symptoms can improve suicide risk assessment in addition to comorbid conditions. Limitations· Information was obtained retrospectively. · Subjects could not be interviewed directly, and therefore we were limited to proxy-based interviews. · Males were overrepresented in this sample, compared with people with BPD encountered in clinical practice, yet this sex distribution is characteristic of those who die by suicide.

Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician

“…70 In a recent study about borderline personality symptoms and risk for death by suicide, McGirr et al showed that patients who completed suicide, borderline personality disorder symptoms were less likely to include affective instability and paranoid ideationdissociative symptoms, suggesting that these symptoms could be associated with suicide attempts but not with death by suicide. 74 These findings support the proposition that suicide attempts and death by suicide in patients with borderline personality and other disorders are phenomenologically distinct. 7) Impulsiveness, hostility, aggressiveness and hopelessness Impulsiveness, hostility and aggressiveness are risk factors for suicidal behavior in different psychiatric samples.…”

Familial Aggregation of Suicide Explained by Cluster B Traits: A Three-Group Family Study of Suicide Controlling for Major Depressive Disorder

“…Previous studies conducted by our investigator group (20,25,(45)(46)(47), as well as other researchers (30)(31)(32), on the validity of the proxy-based behavioral assessments used in the present study demonstrate the similarity between information obtained from an informant and information obtained from the subject.…”

Troubles mentaux et tentatives de suicide chez les détenus. Le rôle du trouble du déficit de l’attention avec hyperactivité

“…Ce trouble, caractérisé par une impulsivité et une instabilité de l'humeur, des relations interpersonnelles et de l'image de soi, est le seul trouble mental qui inclut les comportements autoagressifs récurrents dans ses critères diagnostiques (American Psychological Association [APA], 2013). La prévalence à vie de décès par suicide chez les personnes de la population générale qui ont un trouble de la personnalité limite se situe entre 5 et 10 % (Berk, Jeglic, Brown, Henriques et Beck, 2007 ;McGirr, Paris, Lesage, Renaud et Turecki, 2009). Ce trouble de personnalité est surreprésenté dans les milieux carcéraux, la prévalence variant de 25 à 50 %, selon la métho-dologie utilisée, avec une plus forte représentativité chez les détenues (Sansone et Sansone, 2009).…”