Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder

Background: Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation, and how those links vary over time in people’s daily lives. Methods: 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 BPD individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling (MSEM) was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. Results: Aggregated across interactions, lower perceived warmth in others was associated with suicidal ideation. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to suicidal ideation indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and suicidal ideation. Conclusion: This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to suicidal ideation.

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Momentary interpersonal processes of suicidal surges in borderline personality disorder

Psychological Medicine ◽

10.1017/s0033291720004791 ◽

2020 ◽

pp. 1-11

Author(s):

Aleksandra Kaurin ◽

Alexandre Y. Dombrovski ◽

Michael N. Hallquist ◽

Aidan G. C. Wright

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Structural Equation ◽

Borderline Personality ◽

Equation Modeling ◽

Interpersonal Processes ◽

Interpersonal Perceptions ◽

Affective Dysregulation ◽

Assessment Protocol ◽

Suicidal Crisis

Abstract Background Suicide rates are high in borderline personality disorder (BPD) where interpersonal problems trigger intense affective dysregulation and impulses to act on suicidal thoughts. To date, however, no study has examined how interpersonal stressors contribute to momentary within-person links among affect and impulsivity with suicidal ideation (SI), and how those links vary over time in people's daily lives. Methods A total of 153 individuals diagnosed with BPD and 52 healthy controls completed a 21-day ecological momentary assessment protocol. Of these 153 individuals with BPD, 105 had a history of suicide attempts. Multilevel structural equation modeling was used to examine dynamic links among interpersonal perceptions, affect, state impulsivity, and suicidal intent. Results Aggregated across interactions, lower perceived warmth in others was associated with SI. This direct relationship, however, did not extend to momentary within-person associations. Instead, interpersonal conflicts were linked to SI indirectly via greater negative affect and lower positive affect. While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and SI. Conclusion This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis. Among people with BPD at high risk for suicide, interpersonal triggers initiate a cascade of affective dysregulation, which in turn gives rise to SI.

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Progression from interpersonal problems to suicidal ideation and suicidal behavior in borderline personality disorder

10.31234/osf.io/qa3m5 ◽

2020 ◽

Author(s):

Timothy Allen ◽

Michael Hallquist ◽

Aidan G.C. Wright ◽

Alexandre Dombrovski

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Negative Affect ◽

Structural Equation ◽

Suicide Attempts ◽

Borderline Personality ◽

Equation Modeling ◽

Interpersonal Dysfunction ◽

Suicidal Crisis

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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Daily Suicidal Surge and Attempted Suicide in Borderline Personality Disorder

10.31234/osf.io/hswea ◽

2020 ◽

Author(s):

Aleksandra Kaurin ◽

Alexandre Dombrovski ◽

Michael Hallquist ◽

Aidan G.C. Wright

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Positive Affect ◽

Attempted Suicide ◽

Borderline Personality ◽

Equation Modeling ◽

Healthy Controls ◽

Assessment Protocol ◽

History Of

Suicidality is a defining feature of borderline personality disorder (BPD), yet little work has accounted for why only a small subset of those that have thoughts of suicide, commit suicide. In this study we compared early stage suicidal crises, where affective disturbance is linked to suicidal ideation at the within-person level (i.e., suicidal surges) across suicide attempters and non-attempters. We used multilevel structural equation modeling to test the hypothesis that a history of attempted suicide predicts a stronger dynamic link of daily affect and impulsivity with suicidal ideation. 141 patients diagnosed with BPD, 97 of which had a history of medically serious suicide attempts, and 52 healthy controls completed a 21-day ecological momentary assessment protocol (N=3790 days). All models suggested that people generally experiencing more negative and less positive affect and high in impulsivity, also tend to ideate more about suicide on average. Moreover, within-person associations of negative and positive affect with suicidal ideation (i.e., suicidal surges) were greater among attempters in comparison to non-attempters, and healthy controls. This suggests that the diathesis for suicidal behavior is expressed in the dynamic processes linking affect and suicidal ideation. Because these within-person links were amplified in attempters compared to non-attempters, suicidal surges may index specific, potentially lethal, processes that generalize beyond BPD and may have clinical value as predictors of suicidal risk.

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Negative Affectivity and Disinhibition as Moderators of an Interpersonal Pathway to Suicidal Behavior in Borderline Personality Disorder

Clinical Psychological Science ◽

10.1177/21677026211056686 ◽

2022 ◽

pp. 216770262110566

Author(s):

Timothy A. Allen ◽

Michael N. Hallquist ◽

Aidan G. C. Wright ◽

Alexandre Y. Dombrovski

Keyword(s):

Borderline Personality Disorder ◽

Suicidal Ideation ◽

Personality Disorder ◽

Suicidal Behavior ◽

Structural Equation ◽

Suicide Attempts ◽

Negative Affectivity ◽

Borderline Personality ◽

Equation Modeling ◽

Interpersonal Dysfunction

In this longitudinal study, we examined whether personality traits moderate the link between interpersonal dysfunction and suicidal behavior in a high-risk sample of 458 individuals diagnosed with borderline personality disorder. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Using multilevel structural equation modeling, we examined (a) longitudinal, within-persons relationships among interpersonal dysfunction, suicidal ideation, and suicide attempts and (b) moderation of these relationships by negative affectivity and disinhibition. Negative affectivity predicted a stronger within-persons coupling between interpersonal dysfunction and suicidal ideation. Disinhibition predicted a stronger coupling between ideation and suicide attempts. Assessing negative affectivity and disinhibition in a treatment setting may guide clinician vigilance toward people at highest risk for interpersonally triggered suicidal behaviors.

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Attachment and Borderline Personality Disorder: Differential Effects on Situational Socio-Affective Processes

10.31234/osf.io/fncjg ◽

2019 ◽

Author(s):

Aleksandra Kaurin ◽

Aidan G.C. Wright ◽

Paul A. Pilkonis ◽

Lori Scott ◽

William C. Woods ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Affect Regulation ◽

Discriminant Validity ◽

Community Sample ◽

Borderline Personality ◽

Insecure Attachment ◽

Interpersonal Processes ◽

Assessment Protocol ◽

Ecological Momentary

Insecure attachment and borderline personality disorder (BPD) are defined by similar affective and interpersonal processes. Individuals diagnosed with BPD, however, represent only a subset of those described as insecurely attached, suggesting that attachment may hold broader relevance for socio-affective functioning. Based on a 21-day ecological momentary assessment protocol in a mixed clinical and community sample (N=207) oversampled for BPD, we demonstrate the discriminant validity of each construct as it influences daily interpersonal interactions. We illustrate how insecure attachment is associated with elevated perceptions of interpersonal disaffiliation and maladaptive strategies for affect regulation, whereas enacted interpersonal hostility is more distinctive for BPD. We further highlight potential caveats, when studying both constructs concurrently. Together, our results suggest that both contribute to problematic affective and interpersonal processes, but that they do so at different stages of the unfolding social interaction, which has important implications for the maintenance and treatment of these constructs.

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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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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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