Leo Sher, M.D.
Individuals with borderline personality disorder (BPD) are at increased risk for suicidal behavior. In DSM-5, BPD is the only personality disorder with suicidal or self-injurious behavior explicitly included in the diagnostic criteria (1). BPD has been shown to have higher associations with suicidal behaviors than major depressive disorder, another disorder with a suicide-related criterion (2). In our recent study, we compared clinical features of BPD patients with or without a history of suicide attempts and healthy volunteers (3).We described the results of the study in a paper, “Clinical features and psychiatric comorbidities of borderline personality disorder patients with versus without a history of suicide attempt” that was published in the December 30, 2016 issue of Psychiatry Research (3).
Compared with healthy volunteers, both BPD groups had higher Affective Lability Scale, Affective Lability Scale – Depression-Anxiety Subscale, Barratt Impulsivity Scale, and Lifetime History of Aggression Scale scores and were more likely to have a history of temper tantrums. BPD suicide attempters had higher Affective Lability Scale, Affective Lability Scale – Depression-Anxiety Subscale and Lifetime History of Aggression scores and were more likely to have a history of non-suicidal self-injury or temper tantrums compared to BPD non-attempters. Also, BPD suicide attempters were more likely to have a history of comorbid major depressive disorder in comparison to BPD non-attempters. About 50% of study subjects in each BPD group had a history of comorbid substance use disorder.
BPD suicide attempters were less likely to have comorbid narcissistic personality disorder compared to BPD non-attempters. In our BPD sample, subjects with comorbid narcissistic personality disorder were less likely to have a history of non-suicidal self-injury. These are novel findings that need further study.
In summary, our study showed that compared with healthy volunteers, subjects in both BPD groups were more impulsive, aggressive, and affectively dysregulated. Our study also demonstrated that BPD patients with a history of suicide attempt were more aggressive, affectively dysregulated and less narcissistic than BPD suicide non-attempters.
1.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-5. American Psychiatric Association, Arlington, VA, 2013.
2. Yen S, Shea MT, Pagano M, Sanislow CA, Grilo CM, McGlashanTH, Skodol AE, Bender DS, Zanarini MC, Gunderson JG, Morey LC 2003. Axis I and axis II disorders as predictors of prospective suicide attempts: findings from the collaborative longitudinal personality disorders study. J Abnorm Psychol 2003;112(3):375-381.
3. Sher L, Fisher AM, Kelliher CH, Penner JD, Goodman M, Koenigsberg HW, New AS, Siever LJ, Hazlett EA. Clinical features and psychiatric comorbidities of borderline personality disorder patients with versus without a history of suicide attempt. Psychiatry Res 2016 Dec 30;246:261-266.