Those with personality disorders face an elevated risk of suicidal thoughts, attempts, and deaths.
Factors like childhood trauma and substance use issues may partially explain this vulnerability.
While treatments like dialectical behavior therapy show promise for prevention, more research is still needed.
Key Facts:
- 17 of 24 studies found personality disorders tied significantly to suicidal outcomes
- Substance use consistently helped account for greater suicide mortality
- Past trauma and interpersonal problems were commonly associated with suicide risk
- Psychosocial interventions may reduce attempts but optimal duration is unclear
Source: Curr Psychiatry Rep. (2023)
Overview of Personality Disorders & Suicide Risk
Personality disorders are characterized by persistent difficulties in emotions, behaviors, and relationships that cause significant distress and impairment.
They often emerge in adolescence or early adulthood and follow a chronic course.
Of all mental health conditions, personality disorders confer one of the highest risks for suicidal ideation, suicide attempts, and suicide death.
Borderline and antisocial personality disorders show particularly strong links with suicidal behavior.
In borderline personality disorder, chronic emptiness, impulsivity, and frequent suicidal threats and attempts are diagnostic criteria.
Among those with the disorder, around 75% have attempted suicide at least once and up to 10% will go on to die by suicide.
For antisocial personality disorder marked by lack of empathy, defiance of norms, and deceitfulness, around 5% will die by suicide.
Given the heightened vulnerability in these groups, researchers have been investigating what specifically drives suicidal behavior.
The goal is to clarify risk and protective factors to inform prevention and intervention efforts.
Rates of Personality Disorders (Prevalence)
Personality disorders are relatively common, occurring globally in around 8% of community samples and 30-67% of clinical samples.
The most recent research suggests that in the general population, 1.6% of people have borderline personality disorder.
Solid prevalence estimates for other specific types of personality disorders remain difficult to obtain.
For instance, accurately diagnosing antisocial personality disorder requires evidence of conduct disorder prior to age 15.
Related data challenges and the widespread use of general “personality disorder” diagnoses have hindered precise tracking of prevalence rates.
Nonetheless, these disorders are clearly not rare, highlighting the public health significance of suicide prevention in these groups.
Personality Disorders & Suicide Outcomes (Systematic Review)
A recent systematic review found generally consistent links between having a personality disorder and increased risk for suicidal ideation, suicide attempts, and suicide death.
Across the 18 studies measuring this direct association, 14 showed personality disorders to be significantly associated with suicide attempts and 3 out of 4 found significant ties to suicide death.
Effect sizes varied, but typically indicated around double the risk relative to healthy controls or psychiatric groups with other diagnoses.
Comparisons of suicide attempt rates for personality disorders versus mood disorders like depression produced mixed results, however.
Two studies actually found lower prevalence of attempts among those with personality disorders.
Such inconsistencies demonstrate the complex, multifactorial nature of suicide risk.
Mental illness is not the only piece of the puzzle.
Psychosocial Risk Factors in Suicide with Personality Disorders
When analyzing recent research on explanatory mechanisms, several psychosocial factors emerged as probable contributors to the elevated suicide risk seen in personality disorders.
Substance Use & Abuse
Substance use issues consistently arose as a partial mediator explaining greater suicide mortality.
All four studies investigating it found significant associations between substance use disorders and suicide death among those with personality disorders.
This aligns with past findings that dual diagnosis clients show earlier onset of substance problems and higher risk for self-harm behaviors.
Problematic use of drugs and alcohol may worsen impulse control issues already common in disorders like borderline and antisocial PDs. Intoxication can also trigger suicidal crises.
Childhood Trauma & Interpersonal Issues
Interpersonal models posit social and developmental factors as the root cause of personality pathology and related problems like suicidality.
Supporting this, the review highlighted childhood trauma and insecure attachment styles as prominent historical factors linked to suicide attempts in borderline personality disorder.
Ongoing interpersonal difficulties featuring high hostility and sensitivity also connected to suicide risk.
Emotion Regulation Difficulties
Finally, consistent with borderline PD symptomology, the review noted emotion dysregulation as an important associated feature in relation to suicide attempts.
Alongside substance use and past trauma, intense and fluctuating emotions may overwhelm already strained coping abilities in those with personality disorders.
This could presumably precipitate suicidal states for some. However, depression and anxiety themselves showed less conclusive ties to suicide outcomes in studies to date.
Protective Factors: The Potential of Psychosocial Interventions
Encouragingly, the analysis indicated psychosocial treatments can potentially buffer clients with personality disorders against suicide risk.
Dialectical behavior therapy (DBT) is presently the frontline approach.
It teaches emotion regulation and distress tolerance techniques while fostering new coping skills.
Across five recent intervention trials, DBT reduced suicide attempts over follow-up periods ranging from 10 weeks to 2 years.
Conversational model therapy and skills training based in cognitive-behavioral therapy (CBT) also showed initial promise for suicide prevention.
Main factors linked to greater success included longer duration of treatment engagement and regular direct contact with clinicians.
This suggests that personality disorder clients may require continuity of care and ongoing support to sustain treatment gains related to suicidality.
Researching Suicide Risk for Those with Personality Disorders
While adding to knowledge on this issue, review authors noted research gaps remaining around personality disorders and suicide prevention.
First, most studies focused narrowly on borderline PD, so less is understood about specific risk profiles and interventions for other personality disorder types.
Broad clusters of personality disorders showed overall ties to suicide outcomes, but unique factors connected to schizoid, dramatic, anxious, and odd presentations require clarification.
Secondly, research has relied predominantly on quantitative methodology, so experiential insights are lacking.
More qualitative work could enrich understanding of how personality pathology and associated social difficulties subjectively interrelate with suicidal states on an individual basis.
Focusing less exclusively on risk factors and also exploring potential protective qualities may likewise further suicide prevention science and practice.
Finally, reviewers highlighted biology and pharmacology as additional key areas warranting more research attention regarding suicidality in the context of personality disorders.
Currently available studies reveal minimal about genetic underpinnings, neurotransmitter activities, inflammatory processes, or other biological mechanisms that could critically inform risk assessment and treatment innovations.
Takeaways: Personality Disorders & Suicidality
In sum, a recent surge of research continues highlighting personality disorders as a priority area for suicide prevention efforts.
These conditions clearly confer greater vulnerability.
Psychosocial interventions show initial effectiveness in reducing suicide risk, but demand further testing.
Knowledge gaps also remain around bio-psychosocial mechanisms linking personality pathology to suicidal behaviors.
Ultimately, the complex heterogeneity of personality disorders means understanding suicidality risk factors at an individualized level is essential.
Collectively though, findings support strengthening continuity of clinical care and social support systems for these groups.
Going forward, diversifying research methodology and targets will help deepen understanding of this major public health issue.
The goal is to keep clarifying both risks and protections to make suicide prevention strategies as tailored and proactive as possible.
References
- Study: Suicide risk in personality disorders: a systematic review
- Authors: McClelland et al. (2023)
