scholarly journals Daily Suicidal Surge and Attempted Suicide in Borderline Personality Disorder

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.

scholarly journals Momentary Interpersonal Processes of Suicidal Surges in Borderline Personality Disorder

2020 ◽  
Author(s):  
Aleksandra Kaurin ◽  
Aidan G.C. Wright ◽  
Michael Hallquist ◽  
Alexandre Dombrovski
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Equation Modeling ◽  
Interpersonal Processes ◽  
Interpersonal Perceptions ◽  
Affective Dysregulation ◽  
Assessment Protocol ◽  
Suicidal Crisis

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.

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

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.

Evidence for default mode network dysfunction in borderline personality disorder

2019 ◽  
Vol 50 (10) ◽  
pp. 1746-1754
Author(s):  
Salvatore Aguilar-Ortiz ◽  
Pilar Salgado-Pineda ◽  
Daniel Vega ◽  
Juan C. Pascual ◽  
Josep Marco-Pallarés ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Default Mode Network ◽  
Linear Models ◽  
Previous History ◽  
Memory Task ◽  
Borderline Personality ◽  
Healthy Controls ◽  
Default Mode ◽  
History Of

AbstractBackgroundAlthough executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.MethodsSixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.ResultsOn corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.ConclusionsIn this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.

scholarly journals Momentary interpersonal processes of suicidal surges in borderline personality disorder

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.

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

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.

scholarly journals Anomalous Amygdala Habituation to Unpleasant Stimuli Among Unmedicated Individuals With Borderline Personality Disorder and a History of Self-Harming Behavior

2020 ◽  
pp. 1-14
Author(s):  
Kim E. Goldstein ◽  
Abigail Feinberg ◽  
Morgan B. Corniquel ◽  
Jake R. Szeszko ◽  
Antonia S. New ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Diagnostic Criteria ◽  
Neural Correlates ◽  
Borderline Personality ◽  
Healthy Controls ◽  
Amygdala Activation ◽  
Affective Stimuli ◽  
Amygdala Activity ◽  
History Of

Self-harming behavior (SB) is one of the diagnostic criteria for borderline personality disorder (BPD). However, it is not exhibited by all individuals with BPD. Furthermore, studies examining the neural correlates of SB in BPD are lacking. Given research showing that BPD patients have difficulty habituating to affective stimuli, this study investigated whether anomalous amygdala activation is specific to BPD patients with SB. The authors used fMRI to compare amygdala activation in BPD patients with SB (n = 15) to BPD patients without SB (n = 18) and healthy controls (n = 32) during a task involving pleasant, neutral, and unpleasant pictures, presented twice. BPD patients with SB demonstrated greater amygdala activity during the second presentation of unpleasant pictures. Results highlight neurobiological differences in BPD patients with and without SB and suggest that anomalous amygdala habituation to unpleasant stimuli may be related to SB.

Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity

2013 ◽  
Vol 28 (8) ◽  
pp. 463-468 ◽  
Author(s):  
J.M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
R. Belzeaux ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Age At Onset ◽  
Borderline Personality ◽  
First Episode ◽  
Contributory Factor ◽  
Structured Interviews ◽  
Major Depressive ◽  
History Of ◽  
Depressive Patients

AbstractObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).ResultsCompared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.

Shame in Borderline Personality Disorder: Meta-Analysis

2021 ◽  
Vol 35 (Supplement A) ◽  
pp. 149-161
Author(s):  
Tzipi Buchman-Wildbaum ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Gabriella Vizin ◽  
Zsolt Demetrovics ◽  
...  
Keyword(s):  
Systematic Review ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Meta Analysis ◽  
Education Level ◽  
Borderline Personality ◽  
Healthy Controls ◽  
Moderator Variables ◽  
Core Feature ◽  
Ptsd Symptomatology

Shame has been found to be a core feature of borderline personality disorder (BPD). To date, there is no existing systematic review or meta-analysis examining shame in individuals with BPD as compared to healthy controls (HCs). A meta-analysis of 10 studies comparing reported shame in BPD patients to HCs was carried out. Demographic and clinical moderator variables were included to see if they have a relationship with the effect size. Results showed that those with BPD had more reported shame than healthy controls. In addition, in BPD patients and HCs, higher education level was related to lower reported shame. In HCs, it was found that those who were younger reported a higher level of shame. Finally, among BPD patients, there was a relationship between levels of reported shame and elevated PTSD symptomatology. These findings emphasize the clinical relevance of shame in individuals with BPD and the need to formulate psychotherapeutic strategies that target and decrease shame.

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