Individual Factors Underlying Suicidal Behaviors in Patients with Borderline Personality Disorder: A Qualitative Study

Abstract

Background: Borderline personality disorder (BPD) is associated with a high risk of suicide. Limited information is available on the individual factors underlying suicidal behaviors, especially suicide attempts (SAs), in Iranian patients with BPD. Objectives: This study aimed to analyze the individual factors underlying suicidal behaviors in patients with BPD. Methods: This was a qualitative descriptive study that was conducted from May 2020 to February 2021 in Tehran and Karaj, Iran, on 23 participants, including 14 patients with BPD and seven mental health professionals, as well as two members of their families. The research environment included psychiatric inpatient wards, psychiatric emergencies, and psychiatric clinics. Participants were selected through purposive sampling. Data were collected using semi-structured interviews and were analyzed using conventional content analysis. Results: Data analysis revealed five main themes and 15 sub-themes related to the individual factors underlying the identification and prediction of the risk for suicidal behaviors and SAs. The extracted themes included “psychological pain and loneliness”, “defects in the distinction and integration of emotions”, “unconventional behavior and emotion”, “pervasive incompatibility”, and “breakdown of the self-integrity”. Conclusions: The BPD is a complex and challenging disorder in which patients with BPD usually tend to engage in suicidal behaviors, and with the emergence of individual factors underlying the occurrence of such behaviors, appropriate preventive measures and interventions can be taken to reduce suicide-related behaviors such as suicidal thoughts and planning, as well as SAs.

The multifaceted role of emotion regulation in suicidality: Systematic reviews and meta-analytic evidence.

“…The problem solving dimension was the most frequently investigated by qualitative studies. Four contributions (Beekrum et al, 2011; Hajfiroozabadi et al, 2022; Herrera et al, 2006; Younesi et al, 2022) administered interviews to individuals with past suicide attempts and/or suicide ideation to clarify the nature of psychological mechanisms underlying suicidality. The authors framed their results by asserting that suicidal behavior is the result of a failure in problem-solving capacity or that suicidal behavior itself may be understood as a (maladaptive) form of problem solving.…”

“…The authors framed their results by asserting that suicidal behavior is the result of a failure in problem-solving capacity or that suicidal behavior itself may be understood as a (maladaptive) form of problem solving. Specifically, poor problem-solving capacities would lead to hopelessness, which in turn would lead to the idea that suicide is the unique solution to escape from problems (Hajfiroozabadi et al, 2022; Younesi et al, 2022). Then, a study (Barnes et al, 2017) conducted among U.S. veterans with a history of traumatic brain injury and a current high level of hopelessness (as evidenced by the scores obtained on the Beck Hopelessness Scale) documented the acceptability and feasibility of an intervention based on problem solving to prevent suicide.…”