The Impact of Homeostatic and Circadian Sleep Processes on Non-Suicidal Self-Injury and Suicide Urges in Borderline Personality Disorder

Abstract

Objective

Borderline personality disorder (BPD) involves high rates of non-suicidal self-injury (NSSI) and suicidal behaviors, which are often preceded by urges. Disrupted sleep processes have been linked to NSSI and suicidal behaviors. However, it is unclear which specific sleep processes influence NSSI and suicide urges at rest (i.e., baseline) or in response to distress (i.e., reactivity) in BPD, and thus require targeting in BPD-specific interventions. This study examined whether two distinct homeostatic sleep processes (i.e., total sleep time [TST] and time in bed [TIB]), and one circadian sleep process (i.e., chronotype, or tendencies toward early versus late bed and rise times) predict baseline NSSI and suicide urges and urge reactivity in BPD.

Methods

Forty adults with BPD completed a seven-day sleep diary to measure average TST and TIB. They then completed a questionnaire to measure chronotype and underwent an experiment wherein they rated NSSI and suicide urges at baseline and following an emotion induction.

Results

Generalized estimating equations revealed that higher TST was associated with lower baseline NSSI urges, and lower suicide urge reactivity. Additionally, higher TIB predicted higher NSSI urge reactivity.

Conclusions

Sleep deprivation and extended time in bed may increase proclivity toward NSSI and/or suicide. Targeting these variables in BPD interventions may ultimately facilitate the reduction of NSSI and suicidal acts.

Highlights

• Higher total sleep time predicts lower baseline NSSI urges, suicide urge reactivity

• Higher time in bed predicts higher NSSI urge reactivity

• Reducing sleep deprivation in BPD may facilitate reductions in suicide, NSSI urges

Keywords:

• Borderline personality disorder
• suicide
• non-suicidal self-injury
• sleep
• circadian

ETHICAL STATEMENT

This work received approval from all relevant institutional research boards. All participants provided informed consent prior to participation.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

AUTHOR NOTES

Skye Fitzpatrick, PhD and Sonya Varma, Department of Psychology, York University, Toronto, Ontario, Canada. Jennifer Ip, Department of Psychology, Ryerson University, Toronto, Ontario, Canada.

Notes

1 To improve interpretability of analyses and avoid entering a categorical variable with small cell sizes into analyses, the race/ethnicity variable was collapsed into three categories: Caucasian (40%), Asian (40%), and other (20%).

2 These estimates were calculated based on this formula: y' = B₁ + 2 × B₂ × x, wherein B₁ and B₂ reflect parameter estimates of the linear and quadratic TST effects, respectively, and x reflects the varying values of TST (UCLA Statistical Consulting Group, 2020).

Additional information

Funding

The Canadian Institutes of Health Research (grant numbers: 201210GSD-304038-229817 and 201711MFE-395820-229817), the American Psychological Association Dissertation Research Award, and the Ontario Mental Health Foundation Studentship Award funded this work.