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Am J Psychiatry 1994; 151:1316-1323
Copyright © 1994 by American Psychiatric Association
Risk factors for suicidal behavior in borderline personality disorder
PH Soloff, JA Lis, T Kelly, J Cornelius and R Ulrich
Western Psychiatric Institute and Clinic, University of Pittsburgh, PA 15213.
OBJECTIVE: This study identified potential risk factors for suicidal
behavior in patients with borderline personality disorder defined by the
Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for
patients who did and did not attempt suicide. METHOD: Histories of suicide
attempts and attempt characteristics were obtained by Schedule for
Affective Disorders and Schizophrenia interviews from 84 patients with
borderline personality disorder and were related to severity of borderline
pathology, diagnostic comorbidity, and state and trait symptoms. RESULTS:
There were 61 patients with a lifetime history of suicide attempts (72.6%),
with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were
significantly older than nonattempters, with more impulse actions,
antisocial personality disorder comorbidity, and state depression. State
depression was significantly less severe in patients who had attempted
suicide in the present episode (or past year) than in patients who had
attempted suicide only in the past. A comorbid diagnosis of major
depression, alcoholism, or drug use disorder did not distinguish attempters
from nonattempters. Suicide attempt in the present episode was best
predicted by the number of prior lifetime attempts. A highly serious intent
to commit suicide was predicted by the number of lifetime attempts and
subjective depression, while a low intent was predicted by a mixed subtype
of borderline personality disorder plus schizotypal personality disorder
and paranoid ideation. A high degree of medical lethality was predicted by
number of lifetime attempts, older age, and hysteroid dysphoria, while low
lethality attempts were associated with high degrees of anger. CONCLUSIONS:
Risk factors for suicidal behavior in patients with borderline personality
disorder include older age, prior suicide attempts, antisocial personality,
impulsive actions, and depressive moods but not comorbid affective
disorder, alcoholism, or drug use disorders.
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