Skip to main content
SpringerLink
Log in

Exploring the boundaries between borderline personality disorder and suicidal behavior disorder

  • Original paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

Objective

To compare clinical traits of suicidal vulnerability among in-patients with suicidal behavior disorder (SBD) with and without borderline personality disorder (BPD).

Method

we recruited adult patients with SBD, consecutively and voluntarily hospitalized in a specialized unit for affective disorders and suicidal behavior between July and October 2016. Ninety-two inpatients having attempted suicide within the past 2 years were divided into two subgroups according to the presence or absence of BPD. Clinical vulnerability traits for suicidal behavior were assessed.

Results

Half of the patients with SBD also had BPD. Patients with BPD were nine times more likely to be major suicide repeaters compared to those without. They were also more likely to display clinical and psychological vulnerability traits for suicidal behavior, even after considering potential confounders. Emotional dysregulation, shame-proneness, impulsiveness, preoccupied attachment pattern, and childhood trauma were high in both groups, but significantly increased in those with (vs. without) BPD status. Psychological traits remained stable in SBD-BPD patients, regardless of the time since the last suicide attempt (i.e. SBD in recent vs. early remission).

Conclusions

Clinical and psychological traits associated with suicidal vulnerability are present in all SBD patients compared to non-suicidal populations, but comorbidity with BPD is associated with particularly high scores. BPD could be considered as a specifier for SBD diagnoses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. World Health Organization: Preventing suicide: a global imperative. 2014

  2. American Psychiatric Association: Diagnostic and statistical manual of mental disorders, fifth edition (dsm5). 2013

  3. Courtet P, Gottesman II, Jollant F, Gould TD: The neuroscience of suicidal behaviors: What can we expect from endophenotype strategies? Transl Psychiatry 2011;1

  4. Turecki G, Ernst C, Jollant F, Labonte B, Mechawar N (2012) The neurodevelopmental origins of suicidal behavior. Trends Neurosci 35:14–23

    CAS  Google Scholar 

  5. Kealy D, Ogrodniczuk JS, Rice SM, Oliffe JL (2017) Alexithymia, suicidal ideation and health-risk behaviours: a survey of canadian men. Int J Psychiatry Clin Pract 16:1–3

    Google Scholar 

  6. Hastings ME, Northman LM, Tangney JP:, Joiner T, Rudd MD (2000) Shame, guilt, and suicide. Suicide science: expanding the boundaries. Kluwer Academic Publishers, New York, pp 67–79

    Google Scholar 

  7. Milligan RJ, Andrews B (2005) Suicidal and other self-harming behaviour in offender women: The role of shame, anger and childhood abuse. Leg Criminol Psychol 10:13–25

    Google Scholar 

  8. Feiring C, Taska LS (2005) The persistence of shame following sexual abuse: a longitudinal look at risk and recovery. Child Maltreatment 4:337–349

    Google Scholar 

  9. Muzik M, Brier Z, Menke RA, Davis MT, Sexton MB (2016) Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories. J Affect Disord 1:138–145

    Google Scholar 

  10. Agrawal HR, Gunderson J, Holmes BM, Lyons-Ruth K (2004) Attachment studies with borderline patients: a review. Harv Rev Psychiatry 12:94–104

    Google Scholar 

  11. Oldham JM (2006) Borderline personality disorder and suicidality. Am J Psychiatry 163:20–26

    Google Scholar 

  12. Rogers ML, Joiner TE Jr (2016) Borderline personality disorder diagnostic criteria as risk factors for suicidal behavior through the lens of the interpersonal theory of suicide. Arch Suicide Res 20:591–604

    Google Scholar 

  13. Scott LN, Kim Y, Nolf KA, Hallquist MN, Wright AG, Stepp SD, Morse JQ, Pilkonis PA (2013) Preoccupied attachment and emotional dysregulation: Specific aspects of borderline personality disorder or general dimensions of personality pathology? J Pers Disord 27:473–495

    Google Scholar 

  14. Linehan MM (1993) Cognitive-behavioral treatment of borderline personality disorder. Guilford, New York

    Google Scholar 

  15. Westphal M, Olfson M, Bravova M, Gameroff MJ, Gross R, Wickramaratne P, Pilowsky DJ, Neugebauer R, Shea S, Lantigua R, Weissman M, Neria Y (2013) Borderline personality disorder, exposure to interpersonal trauma, and psychiatric comorbidity in urban primary care patients. Psychiatry 76:365–380

    Google Scholar 

  16. Bouvard M, Fontaine-Buffe M, Cungi C, Adeleine P, Chapoutier C, Durafour E, Bouchard C, Cottraux J (1999) Preliminary studies of the structured diagnostic interview for personality disorders. SCID II. Encephale 25:416–421

    CAS  Google Scholar 

  17. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The mini-international neuropsychiatric interview (m.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for dsm-iv and icd-10. J Clin Psychiatry 59(Suppl 20):22–33;quiz 34–57

    Google Scholar 

  18. Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, Janavs J, Dunbar GC (1997) The mini international neuropsychiatric interview (mini). A short diagnostic structured interview: reliability and validity according to the cidi. Eur Psychiatry 12:224–231

    Google Scholar 

  19. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ (2011) The columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 168:1266–1277

    Google Scholar 

  20. Posner K. The columbia lighthouse project.

  21. Mann JJ (1998) The neurobiology of suicide. Nat Med 4:25–30

    CAS  Google Scholar 

  22. Blasco-Fontecilla H, Fernandez-Fernandez R, Colino L, Fajardo L, Perteguer-Barrio R, de Leon J (2016) The addictive model of self-harming (non-suicidal and suicidal) behavior. Front Psychiatry 7:8

    Google Scholar 

  23. Asberg M, Traskman L, Thoren P (1976) 5-hiaa in the cerebrospinal fluid. A biochemical suicide predictor? Arch Gen Psychiatry 33:1193–1197

    CAS  Google Scholar 

  24. Giner L, Jaussent I, Olie E, Beziat S, Guillaume S, Baca-Garcia E, Lopez-Castroman J, Courtet P (2014) Violent and serious suicide attempters: one step closer to suicide? J Clin Psychiatry 75:e191–e197

    Google Scholar 

  25. Gratz KL, Roemer LR (2004) Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 26:41–54

    Google Scholar 

  26. Dan-Glauser ES, Scherer KR (2013) The difficulties in emotion regulation scale (ders): factor structure and consistency of a french translation. Swiss J Psychol 72:5–11

    Google Scholar 

  27. Tangney JP, Dearing RL, Wagner PE, Gramzow R (2000) The test of self-conscious affect-3 (tosca-3)

  28. Nugier A, Gil S, Chekroun P (2012) Validation of the french version of the test of self-conscious affect-3 (tosca-3): a measure for the tendencies to feel ashamed and guilty. Revue européenne de psychologie appliquée 62:19–27

    Google Scholar 

  29. Rusch N, Lieb K, Gottler I, Hermann C, Schramm E, Richter H, Jacob GA, Corrigan PW, Bohus M (2007) Shame and implicit self-concept in women with borderline personality disorder. Am J Psychiatry 164:500–508

    Google Scholar 

  30. Lester D (1997) The role of shame in suicide. Suicide life-threatening behavior 27:352–361

    CAS  Google Scholar 

  31. Billieux J, Rochat L, Ceschi G, Carre A, Offerlin-Meyer I, Defeldre AC, Khazaal Y, Besche-Richard C, Van der Linden M (2012) Validation of a short french version of the upps-p impulsive behavior scale. Compr Psychiatry 53:609–615

    Google Scholar 

  32. Billieux J, Rochat L, Ceschi G, Carré A, Offerlin-Meyer I, Defeldre AC, Khazaal Y, Besche-Richard C, Van der Linden M (2012) Validation of a short french version of the upps-p impulsive behavior scale. Compr Psychiatry 53:609–615

    Google Scholar 

  33. Guédeney N, Fermanian J, Bifulco A (2010) La version franc¸aise du relationship scales questionnaire de bartholomew (rsq, questionnaire des échelles de relation): Étude de validation du construit. L’Encephale 36:69–76

    Google Scholar 

  34. Bernstein DP, Fink L (1998) Childhood trauma questionnaire: a retrospective self-report manual. The Psychological Corporation, San Antonio

    Google Scholar 

  35. Paquette D, Laporte L, Bigras M, Zoccolillo M (2004) Validation of the french version of the ctq and prevalence of the history of maltreatment. Sante Ment Que 29:201–220

    Google Scholar 

  36. Blasco-Fontecilla H, Baca-Garcia E, Courtet P, Garcia Nieto R, de Leon J (2015) Horror vacui: Emptiness might distinguish between major suicide repeaters and nonmajor suicide repeaters: a pilot study. Psychother Psychosom 84:117–119

    Google Scholar 

  37. Weintraub MJ, Van de Loo MM, Gitlin MJ, Miklowitz DJ (2017) Self-harm, affective traits, and psychosocial functioning in adults with depressive and bipolar disorders. J Nerv Ment Dis 205:896–899

    Google Scholar 

  38. Rajappa K, Gallagher M, Miranda R (2012) Emotion dysregulation and vulnerability to suicidal ideation and attempts. Cogn Ther Res 36:833–839

    Google Scholar 

  39. Arria AM, O’Grady KE, Caldeira KM, Vincent KB, Wilcox HC, Wish ED (2009) Suicide ideation among college students: a multivariate analysis. Arch Suicide Res 13:230–246

    Google Scholar 

  40. Anestis MD, Kleiman EM, Lavender JM, Tull MT, Gratz KL (2014) The pursuit of death versus escape from negative affect: an examination of the nature of the relationship between emotion dysregulation and both suicidal behavior and non-suicidal self-injury. Compr Psychiatry 55:1820–1830

    Google Scholar 

  41. Sleuwaegen E, Houben M, Claes L, Berens A, Sabbe B (2017) The relationship between non-suicidal self-injury and alexithymia in borderline personality disorder: “actions instead of words”. Compr Psychiatry 77:80–88

    Google Scholar 

  42. Rogers ML, Kelliher-Rabon J, Hagan CR, Hirsch JK, Joiner TE (2017) Negative emotions in veterans relate to suicide risk through feelings of perceived burdensomeness and thwarted belongingness. J Affect Disord 208:15–21

    Google Scholar 

  43. Oexle N, Rusch N, Viering S, Wyss C, Seifritz E, Xu Z, Kawohl W (2017) Self-stigma and suicidality: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 267:359–361

    Google Scholar 

  44. Kiamanesh P, Dieserud G, Dyregrov K, Haavind H (2015) Maladaptive perfectionism: Understanding the psychological vulnerability to suicide in terms of developmental history. Omega (Westport) 71:126–145

    Google Scholar 

  45. Nathanson DL (1988) The many faces of shame, Guilford Press

  46. Unoka Z, Vizin G (2017) To see in a mirror dimly. The looking glass self is self-shaming in borderline personality disorder. Psychiatry research

  47. Rusch N, Corrigan PW, Bohus M, Jacob GA, Brueck R, Lieb K (2007) Measuring shame and guilt by self-report questionnaires: a validation study. Psychiatry Res 150:313–325

    Google Scholar 

  48. Brown MZ, Comtois KA, Linehan MM (2002) Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol 111:198–202

    Google Scholar 

  49. Nathanson DL (1994) Shame, compassion, and the “borderline” personality. Psychiatr Clin North Am 17:785–810

    CAS  Google Scholar 

  50. Wells GB, Hansen ND (2003) Lesbian shame: Its relationship to identity integration and attachment. J Homosex 45:93–110

    Google Scholar 

  51. Das P, Calhoun V, Malhi GS (2014) Bipolar and borderline patients display differential patterns of functional connectivity among resting state networks. Neuroimage 98:73–81

    Google Scholar 

  52. Bøen E, Hummelen B, Elvsåshagen T, Boye B, Andersson S, Karterud S, Malt UF (2015) Different impulsivity profiles in borderline personality disorder and bipolar ii disorder. J Affect Disord 1:104–111

    Google Scholar 

  53. Lopez-Castroman J, Jaussent I, Beziat S, Guillaume S, Baca-Garcia E, Genty C, Olié E, Courtet P (2014) Increased severity of suicidal behavior in impulsive aggressive patients exposed to familial adversities. Psychol Med 44:3059–3068

    CAS  Google Scholar 

  54. Bach B, Fjeldsted R (2017) The role of dsm-5 borderline personality symptomatology and traits in the link between childhood trauma and suicidal risk in psychiatric patients. Borderline Personal Disord Emot Dysregul 18:12

    Google Scholar 

  55. Teicher MH, Samson JA, Anderson CM, Ohashi K: The effects of childhood maltreatment on brain structure, function and connectivity. Nature reviews 2016:653

  56. Levy KN (2005) The implications of attachment theory and research for understanding borderline personality disorder. Dev Psychopathol 959–986

  57. Widom CS, Czaja SJ, Kozakowski SS, Chauhan P (2018) Does adult attachment style mediate the relationship between childhood maltreatment and mental and physical health outcomes? Child Abuse Negl 76:533–545

    Google Scholar 

  58. Zanarini MC (2000) Childhood experiences associated with the development of borderline personality disorder. Psychiatr Clin N Am 23:89–101

    CAS  Google Scholar 

  59. Gunderson JG (2007) Disturbed relationships as a phenotype for borderline personality disorder. Am J Psychiatry 164:1637–1640

    Google Scholar 

  60. Insel TR (2003) Is social attachment an addictive disorder? Physiol Behav 79:351–357

    CAS  Google Scholar 

  61. SAHDRA BK, SHAVER PR, BROWN KW (2010) A scale to measure nonattachment: a buddhist complement to western research on attachment and adaptive functioning. J Pers Assess 92:116–127

    Google Scholar 

  62. Stanley B, Siever LJ (2010) The interpersonal dimension of borderline personality disorder: Toward a neuropeptide model. Am J Psychiatry 167:24–39

    Google Scholar 

  63. HC (2007) K: Dsm categories and dimensions in clinical and research contexts. Int J Methods Psychiatr Res 16(Suppl 1):S8–S15

    Google Scholar 

  64. Craske MG (2012) The r-doc initiative: Science and practice. Depress Anxiety 29:253–256

    Google Scholar 

  65. Bender R, Lange S (2001) Adjusting for multiple testing—when and how? J Clin Epidemiol 54:343–349

    CAS  Google Scholar 

Download references

Acknowledgements

The authors thank Andrew Porter (English native speaker), and Elisabetta Andermarcher (MD, PhD, medical writer), for their careful reading of the manuscript.

Author information

Authors and Affiliations

  1. Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, CHU Montpellier, CHRU Montpellier, 371 Avenue Gaston Giraud, 34295, Montpellier, France

    D. Ducasse, D. Dassa, V. Brand-Arpon, K. Dupuy-Maurin, L. Lacourt, S. Guillaume, P. Courtet & E. Olié

  2. Neuropsychiatry: Epidemiological and Clinical Research, INSERM U1061, Montpellier, France

    D. Ducasse, J. Lopez-Castroman, S. Guillaume, P. Courtet & E. Olié

  3. FondaMental Foundation, Créteil, France

    D. Ducasse, K. Dupuy-Maurin, P. Courtet & E. Olié

  4. CHU Nîmes, Nîmes, France

    J. Lopez-Castroman

Authors
  1. D. Ducasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Lopez-Castroman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Dassa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Brand-Arpon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Dupuy-Maurin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Lacourt
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Guillaume
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Courtet
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Olié
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Ducasse.

Ethics declarations

Conflict of interest

None of the authors declares conflicts of interest related to this manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 19 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ducasse, D., Lopez-Castroman, J., Dassa, D. et al. Exploring the boundaries between borderline personality disorder and suicidal behavior disorder. Eur Arch Psychiatry Clin Neurosci 270, 959–967 (2020). https://doi.org/10.1007/s00406-019-00980-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-019-00980-8

Keywords

Search

Navigation