The Effects of Borderline Personality Disorder and Panic Disorder on Suicide Attempts and the Associated Influence of Affective Dysregulation in the General Population

Importance: Clinicians treating borderline personality disorder (BPD) are often faced with the difficult challenge of assessing when, and for whom, risk for suicide is greatest. Addressing this dilemma requires longitudinal, prospective data from high-risk samples with an elevated base rate of suicide attempts.Objective: To test whether dispositional characteristics modulate the pathway from interpersonal dysfunction to suicide in BPD. Design: This longitudinal, observational study was conducted between 1990 and 2020. Data were analyzed between April and July 2020. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Setting: Participants were recruited from inpatient, outpatient, and community referral sources.Participants: 458 individuals (Mean age = 28.59, 77% female) diagnosed with BPD.Main Outcomes and Measures: Presence or absence of a suicide attempt within one year of each follow-up assessment. Multilevel structural equation modeling was used to 1) examine longitudinal, within-person transitions from interpersonal dysfunction to suicidal ideation to suicide attempts (i.e., the [I]nterpersonal-[I]deation-[A]ttempt pathway); and 2) evaluate whether two maladaptive personality dimensions, negative affect and disinhibition, moderated these transitions.Results: At the within-person level, there was support for the I-I-A pathway: suicidal ideation accounted for the association between interpersonal dysfunction and suicide attempts. Personality further moderated each component of the I-I-A pathway: negative affect was associated with a stronger coupling between interpersonal dysfunction and ideation; and disinhibition was associated with a stronger coupling between ideation and attempts. Conclusions and Relevance: The escalation from interpersonal difficulties to a suicidal crisis in BPD involves two psychologically distinct process. An internalizing process links interpersonal dysfunction to suicidal ideation and is facilitated by trait negative. An additional externalizing process links suicidal ideation to suicide attempts, and is facilitated by trait disinhibition. Assessment of these intra- and interindividual risk factors may inform clinical decisions about when, and for whom, crisis intervention is necessary.

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Self-esteem instability and affective instability in everyday life after remission from borderline personality disorder

10.21203/rs.3.rs-32450/v2 ◽

2020 ◽

Author(s):

Philip Samuel Santangelo ◽

Tobias D. Kokler ◽

Marie-Luise Zeitler ◽

Rebekka Knies ◽

Nikolaus Kleindienst ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Self Esteem ◽

Borderline Personality ◽

Specific Symptom ◽

Affective Dysregulation ◽

Daily Life Activities ◽

Diary Studies ◽

Affective Instability

Abstract Background: Borderline personality disorder (BPD) is defined by a pervasive pattern of instability. According to prior findings and clinical theories, self-esteem instability and affective instability are key features of BPD. Previous e-diary studies showed that instability in self-esteem is heightened and that it is highly intertwined with affective instability in BPD in comparison to healthy controls (HC). The present study sought to extend these findings by adding symptomatologically remitted BPD patients (BPD-REM), i.e. former patients with BPD who met four or fewer BPD criteria within the past year, as a comparison group.Methods: To examine differences regarding self-esteem instability and affective instability, we used e-diaries for repeatedly collecting data on self-esteem, valence, and tense arousal 12 times a day for four consecutive days while participants underwent their daily life activities. Determining three different state-of-the-art instability indices and applying multilevel analyses, we compared 35 BPD-REM participants with previously reported 60 acute BPD patients (BPD-ACU) and 60 HC.Results: Our results revealed that self-esteem instability was significantly lower in the BPD-REM compared to the BPD-ACU group, irrespective of the instability index. In contrast, there were no significant differences regarding affective instability between the BPD-REM participants and those in the BPD-ACU group. The comparison between the BPD-REM with the HC indicated both a significantly higher instability in self-esteem as well as significantly heightened affective instability in the BPD-REM participants. Moreover, even though the associations were not significant, we found tentative support for the assumption that affective changes that are accompanied by changes in self-esteem are experienced as more burdensome and negatively impact the quality of life of remitted BPD participants.Conclusions: This study builds on growing evidence for the importance of self-esteem instability in BPD. Whereas affective instability has been reported in various psychiatric disorders and might indeed constitute a transdiagnostic marker of affective dysregulation, our results indicate that self-esteem instability might be a specific symptom that construes the unique pathology in BPD.

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Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.03.011 ◽

2017 ◽

Vol 44 ◽

pp. 53-60 ◽

Cited By ~ 8

Author(s):

K.I. Aaltonen ◽

T. Rosenström ◽

I. Baryshnikov ◽

B. Karpov ◽

T. Melartin ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Childhood Maltreatment ◽

Suicidal Behaviour ◽

Suicide Attempts ◽

Borderline Personality ◽

Mediation Effect ◽

Mediation Analyses ◽

Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

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Differential Change of Borderline Personality Disorder Traits During Dialectical Behavior Therapy for Adolescents

Journal of Personality Disorders ◽

10.1521/pedi_2018_32_334 ◽

2019 ◽

Vol 33 (1) ◽

pp. 119-134 ◽

Cited By ~ 5

Author(s):

Arne Buerger ◽

Gloria Fischer-Waldschmidt ◽

Florian Hammerle ◽

Kristin von Auer ◽

Peter Parzer ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Behavior Therapy ◽

Dialectical Behavior Therapy ◽

Suicide Attempts ◽

Treatment Options ◽

Skills Training ◽

Borderline Personality ◽

Secondary Outcomes ◽

The Impact

Despite the expansion of treatment options for adults with borderline personality disorder (BPD), research on treatment options for adolescent BPD is scarce. The aim of this study was to investigate the impact of dialectical behavior therapy for adolescents (DBT-A) on the individual trait level as primary outcome; and the frequency of suicide attempts and nonsuicidal self-injury, self-reported BPD core pathology, and general psychopathology as secondary outcomes. Seventy-two adolescents (aged 12–17 years) with full- or subsyndromal BPD were treated with DBT-A (25 single sessions, 20 sessions of skills training), and 13 patients (18.1%) withdrew during treatment. From baseline to post-treatment, the number of BPD traits decreased significantly (p ≤ .001). All secondary outcomes decreased significantly as well (p ≤ .001). Results of this uncontrolled study suggest that beside self-harm, DBT-A may also have a beneficial impact on other features of BPD.

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Comorbid Bipolar Disorder and Borderline Personality Disorder and History of Suicide Attempts

Journal of Personality Disorders ◽

10.1521/pedi_2013_27_122 ◽

2014 ◽

Vol 28 (3) ◽

pp. 358-364 ◽

Cited By ~ 24

Author(s):

Mark Zimmerman ◽

Jennifer Martinez ◽

Diane Young ◽

Iwona Chelminski ◽

Theresa A. Morgan ◽

...

Keyword(s):

Bipolar Disorder ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Suicide Attempts ◽

Borderline Personality ◽

History Of

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Diagnosis of Borderline Personality Disorder

10.1093/med/9780199997510.003.0002 ◽

2017 ◽

Author(s):

Barbara Stanley ◽

Tanya Singh

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Interpersonal Relationships ◽

Affect Regulation ◽

Borderline Personality ◽

Affect Dysregulation ◽

Affective Dysregulation ◽

Mood Changes ◽

Self Image ◽

Persistent Pattern

The diagnosis of borderline personality disorder (BPD) can be devastating. BPD is characterized by instability on several domains: affect regulation, impulse control, interpersonal relationships, and self-image, and it affects about 1–2% of the general population—up to 10% of psychiatric outpatients, and 20% of inpatients. In addition to meeting the criteria set forth in DSM-5, BPD, like all personality disorders, is characterized by a pervasive and persistent pattern of behavior that begins in early childhood and is stable across contexts. Affective dysregulation (inappropriate, intense anger or difficulty controlling anger; affective instability due to a marked reactivity of mood), is one of the core domains associated with BPD and is characterized by erratic, easily aroused mood changes and disproportionate emotional responses. Affect dysregulation differs in BPD and mood disorders because in BPD it can shift rapidly and is affected by environmental triggers.

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Psychotherapies for Adolescents with Subclinical and Borderline Personality Disorder: A Systematic Review and Meta-Analysis

The Canadian Journal of Psychiatry ◽

10.1177/0706743719878975 ◽

2019 ◽

Vol 65 (1) ◽

pp. 5-15 ◽

Cited By ~ 6

Author(s):

Jennifer Wong ◽

Anees Bahji ◽

Sarosh Khalid-Khan

Keyword(s):

Systematic Review ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Suicide Attempts ◽

Meta Analysis ◽

Borderline Personality ◽

Treatment Retention ◽

Short Term ◽

Self Injury

Background: Evidence regarding the efficacy of psychotherapy in adolescents with borderline personality disorder (BPD) symptomatology has not been previously synthesized. Objective: To conduct a systematic review and meta-analysis of the randomized controlled trials (RCTs) in order to assess the efficacy of psychotherapies in adolescents with BPD symptomatology. Methods: Seven electronic databases were systematically searched using the search terms BPD, adolescent, and psychotherapy from database inception to July 2019. Titles/abstracts and full-texts were screened by one reviewer; discrepancies were resolved via consensus. We extracted data on BPD symptomatology, including BPD symptoms, suicide attempts, nonsuicidal self-injury, general psychopathology, functional recovery, and treatment retention. Data were pooled using random-effects models. Results: Of 536 papers, seven trials (643 participants) were eligible. Psychotherapy led to significant short-term improvements in BPD symptomatology posttreatment ( g = −0.89 [−1.75, −0.02]) but not in follow-up ( g = 0.06 [−0.26, 0.39]). There was no significant difference in treatment retention between the experimental and control groups overall (odds ratio [ OR] 1.02, 95% confidence interval [CI], 0.92 to 1.12, I 2 = 52%). Psychotherapy reduced the frequency of nonsuicidal self-injury ( OR = 0.34, 95% CI, 0.16 to 0.74) but not suicide attempts ( OR = 1.03, 95% CI, 0.46 to 2.30). Conclusions: There is a growing variety of psychotherapeutic interventions for adolescents with BPD symptomatology that appears feasible and effective in the short term, but efficacy is not retained in follow-up—particularly for frequency of suicide attempts.

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