Association of Borderline Personality Disorder Criteria With Suicide Attempts

Abstract

IMPORTANCE Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions.OBJECTIVE To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. DESIGN, SETTING, AND PARTICIPANTSThe CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York,

Association of Borderline Personality Disorder Criteria With Suicide Attempts Among US Adults

“…Chronic feelings of emptiness remained significantly associated with elevated risk for lifetime and past-year SAs after controlling for all other BPD criteria as well. These findings are consistent with those of prior work with samples of treatment-seeking individuals that documented significant associations between BPD and self-injurious behaviors 9 , 13 and between chronic emptiness and increased risk for SAs. 13 These findings are complementary to those of a previous NESARC-III study reporting that among respondents with recent SAs, a significantly elevated rate of BPD was observed alongside elevated rates of other psychiatric disorders.…”

“…These findings are consistent with those of prior work with samples of treatment-seeking individuals that documented significant associations between BPD and self-injurious behaviors 9 , 13 and between chronic emptiness and increased risk for SAs. 13 These findings are complementary to those of a previous NESARC-III study reporting that among respondents with recent SAs, a significantly elevated rate of BPD was observed alongside elevated rates of other psychiatric disorders. 4 Of note, the analysis by Olfson and colleagues 4 of the complementary question concerning the association of SA with BPD relied on original NESARC-III BPD scoring (which, as shown in the present study, may produce divergent odds ratios) and did not consider BPD criteria.…”

“…This study’s findings regarding the significant association between the specific BPD criterion of chronic feelings of emptiness and increased SA risk are consistent with findings reported for a treatment-seeking clinical sample followed up over 10 years. 13 However, in contrast to Yen and colleagues, 13 we did not observe significant associations for 2 other specific criteria (identity disturbance and frantic attempts to avoid abandonment). This cross-sectional study retrospectively assessed lifetime and past-year SAs, whereas the study by Yen and colleagues 13 was based on 10 years of prospective follow-up to capture SA data.…”

“…Research with diverse clinical samples has produced isolated findings suggesting associations between SAs and some of these variables, including affective instability, 9 , 12 dissociation, 9 impulsivity, 17 and chronic emptiness. 18 Yen and colleagues, 13 in their analysis of all BPD criteria (adjusting for sociodemographic and related clinical variables), found that the specific criteria of identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with SAs.…”

“… 27 This first analysis with a nationally representative sample examined some of the potential confounds attributable to treatment-seeking clinical biases in the study by Yen and colleagues. 13 We hypothesized that BPD and the specific criterion of self-injurious behaviors would be significantly associated with elevated SA risk even after adjusting for relevant sociodemographic and clinical variables, including psychiatric and personality disorder comorbidity. We also sought to test whether the findings of Yen and colleagues 13 from a clinical sample regarding independent associations between SA risk and 3 additional specific criteria (identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment) would be found in a national sample of US adults.…”