Pathways to High-Lethality Suicide Attempts in Individuals with Borderline Personality Disorder

Abstract

The purpose of this study was to develop and test a model of high-lethality suicide attempts (HLSA) in individuals with Borderline Personality Disorder (BPD). An increased number of prior suicide attempts, substance use immediately prior to the attempt, and objective planning were proposed to lead directly to a HLSA, while aggression and impulsivity were hypothesized to lead indirectly to a HLSA through their associations with prior attempts. Path analysis revealed a revised model in which impulsivity was found to be significantly associated with both the lethality of the most recent attempt and the number of prior attempts. These results are discussed in terms of trait and crescendo models of suicidal behavior and their implications for suicide risk assessment among individuals with BPD.

Keywords:

• borderline personality disorder
• high lethality suicide attempt
• impulsivity

Notes

⁺For this variable, the median value, as opposed to the mean value, of the distribution is provided.

⁺For these variables, median values, as opposed to mean values, of the distributions are provided.

¹The percentage of cases in which the most recent attempt met well-established criteria for designation as a high lethality attempt is provided for informational purposes. In analyses, all cases, including those cases in which the most recent attempt was scored 2 or lower on the Lethality Scale, were used. A continuous measure of lethality was used.

Note. * = p < .05, ** =p < .01, ⁺ =Spearman's Rank correlation computed, ⁺⁺ =Point Biserial correlation computed.¹