Variability in Suicidal Ideation is Associated with Affective Instability in Suicide Attempters with Borderline Personality Disorder

Abstract

Objective: Suicidal ideation (SI) is heterogeneous with different patterns and risk factors. SI can be persistent with stable severity, but may also fluctuate rapidly over a short period of time. The latter pattern is likely associated with affective instability and may consist of activation of SI at times of stress, that then subside. Although affective instability is a hallmark of borderline personality disorder (BPD), little is known about SI variability in BPD. We hypothesized that SI variability would be associated with affective instability in BPD suicide attempters. Method: Sample included 38 females with BPD and history of suicidal behavior. SI was assessed over 1 week using ecological momentary assessment (EMA) at six epochs daily. The relationship between SI variability (i.e., change of SI from one epoch to another) and SI severity (i.e., average scores across epochs), and affective instability, assessed using the Affective Lability Scale (ALS), were examined. Possible confounding effects of depression severity and impulsiveness were tested. Results: Participants demonstrated high ALS scores and wide range of SI variability. ALS scores predicted SI variability, even after controlling for depression severity. Although ALS also predicted SI severity, this association was driven by depression severity. ALS did not correlate with impulsiveness score. Conclusions: Affective instability may predict SI variability in BPD suicide attempters independent of depression severity. This supports our model of suicidal subgroups with different constellations of clinical aspects and risk factors. Future studies could examine these associations in larger samples and different populations to determine implications for suicide prevention.

ACKNOWLEDGMENTS

We thank the study participants and entire staff of the MIND Clinic for their time and effort.

DECLARATION OF INTEREST

Maria A. Oquendo, J. John Mann, and Barbara Stanley receive royalties for commercial use of the Columbia Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. Dr. Oquendo’s family owns stock in Bristol-Myers Squibb. Other authors have no conflicts of interest to declare.

Additional information

Notes on contributors

Mina M. Rizk

Mina M. Rizk, MD is a Postdoctoral Research Scientist, Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY. Tse-Hwei Choo, MPH, and Hanga Galfalvy, PhD, are affiliated with Division of Biostatistics, New York State Psychiatric Institute, New York, NY, and Department of Psychiatry, Columbia University, New York, NY. Emily Biggs, MA, Beth Brodsky, PhD, J. John Mann, MD, and Barbara Stanley, PhD, are affiliated with Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, and Department of Psychiatry, Columbia University, New York, NY. Maria A. Oquendo, MD, PhD, is affiliated with Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, PA.