Pathways to High-Lethality Suicide Attempts in Individuals with Borderline Personality Disorder

Abstract

The purpose of this study was to develop and test a model of high-lethality suicide attempts (HLSA) in individuals with Borderline Personality Disorder (BPD). An increased number of prior suicide attempts, substance use immediately prior to the attempt, and objective planning were proposed to lead directly to a HLSA, while aggression and impulsivity were hypothesized to lead indirectly to a HLSA through their associations with prior attempts. Path analysis revealed a revised model in which impulsivity was found to be significantly associated with both the lethality of the most recent attempt and the number of prior attempts. These results are discussed in terms of trait and crescendo models of suicidal behavior and their implications for suicide risk assessment among individuals with BPD.

Seriousness and lethality of attempted suicide: A systematic review

“…Borderline personality disorder surely increases the risk of attempted suicide, but the relation with the lethality of such attempts is unclear. According to some studies, the lethality of suicide attempts committed by borderline patients results from an interaction between impulsivity (Chesin, Jeglic, & Stanley, 2010) and violent-aggressive features (McGirr, Paris, Lesage, Renaud, & Turecki, 2007), but other studies have ascertained that the presence of impulsive and aggressive traits is unrelated to the lethality of the suicidal behavior (Brodsky, Groves, Oquendo, Mann, & Stanley, 2006;Horesh, Orbach, Gothelf, Efrati, & Apter, 2003).…”

Suicide Risk and Acute Psychiatric Readmissions: A Prospective Cohort Study

“…The corresponding risk was nearly threefold in patients whose PAU admissions were related to suicide attempt or suicidal ideation. Since non-suicidal self-harm has been suggested to function as a means to regulate emotions, relieve distress, and communicate with, or elicit help from, others (46), it has often been dismissed as manipulative and hence is considered less serious than suicide attempt (27,33). Therefore, findings from Study II related to the non-suicidal self-harm variable may support those from a previous study (97), which found no significant difference between the objective lethality of non-suicidal self-harm and that of suicide attempt.…”

“…Despite clinical guidelines (24), as well as BPD experts (25,26), have suggested that inpatient treatment has the potential to reinforce, rather than prevent, repetitive suicidal behaviour in BPD patients they are often admitted to psychiatric acute units due to suicide risk. Although a large proportion of selfharm in BPD patients is not suicidal and does not require somatic inpatient treatment, there is also a high prevalence of serious self-harm (27) and suicide (28) among individuals with BPD. Therefore, it can be reasonably assumed that BPD patients admitted to a psychiatric acute unit due to suicide risk would have an increased risk for self-harm-induced somatic admission after discharge from the psychiatric hospital.…”

Alcohol Use Disorders among Patients Examined in Emergency Departments after a Suicide Attempt

“…In addition, patterns of personality currently associated with the risk of SA, i.e. antisocial [8] and borderline personality [9] and sensation seeking [10] , were studied. SA with and without AUD (SA-AUD+ and SA-AUD-) were compared.…”