Momentary interpersonal processes of suicidal surges in borderline personality disorder

Abstract

Background Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. Methods A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. Results Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. Conclusion This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.

Integrating a functional view on suicide risk into idiographic statistical models

“…To bring this approach to life, appropriate data are needed. Sometimes referred to as ambulatory assessment, ecological momentary assessment, or experience sampling, intensive longitudinal sampling in naturalistic settings or real-time monitoring techniques are ideal for the study of suicidal progression (David et al, 2018;Haynes et al, 2009;Kaurin et al, 2020;Kleiman et al, 2017;Roche et al, 2014) 3 . Because of the repeated sampling of an individual, such data return more proximate estimates of relevant processes in a person's daily life.…”

Interpersonal, Affective and Compulsive Features of Driven Exercise in Anorexia Nervosa

“…We used multilevel structural equation modeling (MSEM; Kaurin et al, 2020;Sadikaj et al, 2021), to test whether affect regulation and driven exercise were linked to each other across time, and whether that covariation pattern was more pronounced among those who indicated higher compulsivity scores. MSEM can accommodate repeated assessments nested within persons and allows for decomposing the total variance into the latent Level 2 (between-person) variance and the Level 1 (within-person) residual variance.…”

“…Our sample size was sufficient at both levels for MSEM, but rather small compared to other studies using similar analysis strategies (e.g., Kaurin et al, 2020). Thus, power might have been too small to capture cross-level moderation effects of compulsivity on the link between affect regulation and driven exercise, although we used a Bayesian approach for obtaining more reliable estimates.…”

Attachment Manifestations in Daily Interpersonal Interactions

“…Participants completed a seven-day event-contingent ambulatory assessment protocol and were asked to fill out a survey following any interpersonal interaction that lasted at least 5 minutes. In addition to situational attachment expectations, participants reported on perceptions of their interaction partner's behavior and their own interpersonal behavior and affective experience during interactions (Kaurin et al, 2020a(Kaurin et al, , 2020bWright et al, 2017).…”

“…This number is based on extensive prior use of these methods. It reflects the average amount that people have reported in earlier studies and matches a cutoffs of ~70% used in related studies (e.g., Kaurin et al, 2020b). Because the number of excluded participants was substantial, we re-ran our analyses based on data obtained from all participants.…”