Risk factors for suicidal behavior in borderline personality disorder

Soloff, Paul H.; Lis, Judith A.; Kelly, Thomas M.; Cornelius, Jack R.; Ulrich, Richard F.

doi:10.1176/ajp.151.9.1316

Cited by 204 publications

(33 citation statements)

References 17 publications

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“…First, consistent with the suicide literature (Soloff et al, 1994), attempters had a higher rate of comorbid depression than non-attempters. However, depression did not predict activation in brain regions showing group effects.…”

Section: Discussionsupporting

confidence: 79%

Suicide attempters with Borderline Personality Disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories

Silvers

Hubbard

Chaudhury

et al. 2016

Journal of Psychiatric Research

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Suicidal behavior and difficulty regulating emotions are hallmarks of Borderline Personality Disorder (BPD). This study examined neural links between emotion regulation and suicide risk in BPD. 60 individuals with BPD (all female, mean age=28.9 years), 46 of whom had attempted suicide, completed a fMRI task involving recalling aversive personal memories. Distance trials assessed the ability to regulate emotion by recalling memories from a third-person, objective viewpoint. Immerse trials assessed emotional reactivity and involved recalling memories from a first-person perspective. Behaviorally, both groups reported less negative affect on Distance as compared to Immerse trials. Neurally, two sets of findings were obtained. The first reflected differences between attempters and non-attempters. When immersing and distancing, attempters showed elevated recruitment of lateral orbitofrontal cortex, a brain region implicated in using negative cues to guide behavior. When distancing, attempters showed diminished recruitment of the precuneus, a region implicated in memory recall and perspective taking. The second set of findings related to individual differences in regulation success – the degree to which individuals used distancing to reduce negative affect. Here, we observed that attempters who successfully regulated exhibited precuneus recruitment that was more similar to non-attempters. These data provide insight into mechanisms underlying suicide attempts in BPD. Future work may examine if these findings generalize to other diagnoses and also whether prior findings in BPD differ across attempters and non-attempters.

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Section: Discussionsupporting

confidence: 79%

Suicide attempters with Borderline Personality Disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories

Silvers

Hubbard

Chaudhury

et al. 2016

Journal of Psychiatric Research

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show abstract

“…Therefore, effects of comorbid bipolar disorder on ASPD appear to result from increased impulsivity rather than bipolar disorder per se . This is consistent with results implicating antisocial characteristics and impulsivity in suicidal behavior in personality disorders [127,128]. …”

Section: Combination Of Bipolar Disorder and Aspdsupporting

confidence: 92%

Antisocial personality and bipolar disorder: interactions in impulsivity and course of illness

Swann¹

2011

Neuropsychiatry

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SUMMARY Antisocial personality disorder (ASPD) and bipolar disorder are both characterized by impulsive behavior, increased incarceration or arrest, addictive disorders and suicidal behavior. These characteristics appear more severe in the combined disorders. Individuals with ASPD who also have bipolar disorder have higher rates of addictive disorders and suicidal behavior and are more impulsive, as measured by questionnaires or behavioral laboratory tests. Those with bipolar disorder who have ASPD have higher rates of addictive, criminal and suicidal behavior, earlier onset of bipolar disorder with a more recurrent and predominately manic course and increased laboratory-measured, but not questionnaire-rated, impulsivity. These characteristics may result in part from differential impulsivity mechanisms in the two disorders, with bipolar disorder driven more by excessive catecholamine sensitivity and ASPD by deficient serotonergic function.

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“…Our sample included many participants diagnosed with BPD. These participants are at heightened risk for suicide, with as many as 73% of individuals with BPD attempting suicide (Soloff, Lis, Kelly, Cornelius, & Ulrich, 1994). …”

Section: Overview Of Current Studymentioning

confidence: 99%

Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

Law

Furr

Arnold

et al. 2015

Psychological Assessment

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Assessing suicidality is common in mental health practice and is fundamental to suicide research. Although necessary, there is significant concern that such assessments have unintended harmful consequences. Using a longitudinal randomized control design, we evaluated whether repeated and frequent assessments of suicide-related thoughts and behaviors negatively affected individuals, including those at-risk for suicide-related outcomes. Adults (N = 282), including many diagnosed with Borderline Personality Disorder (BPD), were recruited through psychiatric outpatient clinics and from the community at large, and were randomly assigned to assessment groups. A Control Assessment group responded to questions regarding negative psychological experiences several times each day during a 2-week Main Observation phase. During the same observation period, an Intensive Suicide Assessment group responded to the same questions, along with questions regarding suicidal behavior and ideation. Negative psychological outcomes were measured during the Main Observation phase (for BPD symptoms unrelated to suicide and for BPD-relevant emotions) and/or at the end of each week during the Main Observation phase and monthly for 6 months thereafter (for all outcomes, including suicidal ideation and behavior). Results revealed little evidence that intensive suicide assessment triggered negative outcomes, including suicidal ideation or behavior, even among people with BPD. A handful of effects did reach or approach significance, though these were temporary and non-robust. However, given the seriousness of some outcomes, we recommend that researchers or clinicians who implement experience sampling methods including suicide-related items carefully consider the benefits of asking about suicide and to inform participants about possible risks.

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Risk factors for suicidal behavior in borderline personality disorder

Abstract: Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.

Cited by 204 publications

References 17 publications

Suicide attempters with Borderline Personality Disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories

Suicide attempters with Borderline Personality Disorder show differential orbitofrontal and parietal recruitment when reflecting on aversive memories

Antisocial personality and bipolar disorder: interactions in impulsivity and course of illness

Does assessing suicidality frequently and repeatedly cause harm? A randomized control study.

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