An Examination of DSM-IV Borderline Personality Disorder Symptoms and Risk for Death by Suicide: A Psychological Autopsy Study

Abstract

Objective:

To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by suicide, and thereby better predict suicide risk.

Method:

A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD (n = 62), and BPD control subjects (n = 35).

Results:

BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation–dissociative symptoms. The negative association between paranoid ideation–dissociative symptoms and suicide was independent of all other BPD symptoms, Cluster B comorbidity, and alcohol dependence.

Conclusions:

We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD.