title: High-lethality status in patients with borderline personality disorder.
abstract: Recurrent suicidal behaviors in patients with Borderline Personality Disorder (BPD) are often considered communicative gestures; however, 10% complete suicide. This study seeks to identify risk factors for suicide within a BPD sample by comparing patients with High- and Low-Lethality attempts. BPD attempters (n = 113) were assessed on demographic, diagnostic, and personality variables: clinical symptoms, suicidal behaviors; childhood, family, and treatment histories; social adjustment; and recent life events. Forty-four High-Lethality attempters, defined by a score of 4 or more on Beck's Medical Lethality Scale, were compared to 69 Low-Lethality attempters. Discriminating variables were entered in a multivariate logistic regression model to define predictors of High-Lethality status. High-Lethality attempters were older, with children, less education, and lower socioeconomic class (SES) than Low-Lethality attempters. They were more likely to have Major Depressive Disorder (MDD), co-morbid Antisocial Personality Disorder (ASPD), and family histories of substance abuse. They reported greater intent to die, more lifetime attempts, hospitalizations, and time in the hospital. High-Lethality status was best predicted by low SES, co-morbid ASPD, extensive treatment histories, and greater intent to die. These characteristics resemble profiles of patients who complete suicide, are not specific for BPD, and do not include impulsivity, aggression, or severity of BPD criteria.
authors.affiliation: University of Pittsburgh, Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA. soloffph@upmc.edu
authors.forename: Paul H
authors.initials: PH
authors.lastname: Soloff
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kelly
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Malone
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
mesh_terms: D000328:Adult; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000523:psychology; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology