Suicide and Self-Injury
Understanding differential features in the presentations of acutely suicidal adults with and without Borderline Personality Disorder.
Jessica Stubbing, Ph.D.
Postdoctoral Fellow
Anxiety Disorders Center, The Institute of Living
West Hartford, Connecticut
Gretchen Diefenbach, Ph.D.
Senior Scientist
Anxiety Disorders Center, The Institute of Living
Hartford, Connecticut
Kate Everhardt, B.S.
Research Assistant
Anxiety Disorders Center, The Institute of Living
Hartford, Connecticut
Kimberly T. Sain, Ph.D.
Psychologist
Anxiety Disorders Center, The Institute of Living
West Hartford, Connecticut
Tyler B. Rice, B.S.
Clinical Research Assistant
Anxiety Disorders Center, The Institute of Living
west Hartford, Connecticut
David Rudd, ABPP, Ph.D.
University President
University of Memphis
Memphis, Tennessee
David F. Tolin, ABPP, Ph.D.
Director
Anxiety Disorders Center, The Institute of Living
Hartford, Connecticut
Among adults with mental health challenges, those with traits of Borderline Personality Disorder (BPD) are one of the highest risk populations to both attempt and die by suicide. Additionally, clinicians frequently report that their clients with BPD present with more frequent suicidal ideation than others. Past research suggests that this increased risk may relate to substance use, emotional reactivity, non-suicidal self-injury (NSSI), and histories of trauma which are characteristic of BPD. However, little is known about the differences in presentation between those who have made suicide attempts with and without BPD. Exploring features that may distinguish these two populations at high risk of future suicidal behavior may contribute to developing specific treatment targets for suicide prevention. 95 participants aged 18-65 (52.7% Female incl. 5.4% Transgender Women, 4.3% Non-Binary; 31.3% Sexual Minority; 21.5% Hispanic; 41.2% Racial Minority) who were admitted to an inpatient unit were recruited for a suicide prevention clinical trial. All participants presented with either a suicide attempt prior to admission, or an attempt within the past 2 years and active suicidal ideation with a plan on admission. Participants completed an intake assessment including a diagnostic interview and self-report measures. 61.7% of participants met the Mclean Screening Instrument for Borderline Personality Disorder threshold for clinically significant BPD symptoms (MSI-BPD ≥ 7). We found that within this extremely high risk population, participants with clinically significant BPD had significantly higher suicidal ideation (M = 97.09, SD = 31.90), suicidal beliefs (M = 28.29, SD = 8.47), impulsivity when emotionally distressed (M = 19.93, SD = 6.14) and drug abuse severity (M = 7.07, SD = 6.64) than those without (t(92) = -2.99, p = .004 ), (t(91) = -4.77, p < .001 ), (t(90) = -4.19, p < .001 ), and (t(90) = -2.41, p = .018 ) respectively. There was a relationship between BPD traits and NSSI, such that participants with clinically significant BPD traits were significantly more likely to have engaged in NSSI (X2(1, N = 94) = 6.84, p = .009). However, there were no significant differences in number of lifetime suicide attempts and alcohol use severity between groups and no significant relationship between PTSD diagnosis and BPD. These results indicate that within a very high-risk inpatient population, clients with significant BPD traits represent a distinct group with important distinguishing characteristics including more severe suicidal ideation, drug use, emotional reactivity, and a greater likelihood of NSSI. This highlights the value of considering both the unique and common features underlying the presentations of acutely suicidal adult inpatients with and without BPD traits in identifying specific treatment targets and mechanisms of change.