Impact on suicidality of the borderline personality traits impulsivity and affective instability
Department of Clinical and Theoretical Mental Health, Faculty of Medicine, Semmelweis University, Budapest, HungaryFranco Benazzi, MD, PhD, DTMH†
Hecker Psychiatry Research Center, University of California at San Diego, Collaborating Center at Forli (Italy), Forli, ItalyDepartment of Psychiatry, National Health Service, Forli, ItalyDepartment of Psychiatry, University of Szeged, Szeged, Hungary
† Dr. Benazzi died August 22, 2009
BACKGROUND: The aim of this study was to test the impact on suicidality (suicide threats, attempts) of the borderline personality disorder (BPD) traits impulsivity and affective instability in mood disorders.
METHODS: In a general psychiatry private practice (nontertiary care), consecutive remitted, non-substance-abusing outpatients—138 with bipolar II disorder (BP II) and 71 with major depressive disorder (MDD)—self-assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) Questionnaire.
RESULTS: The frequency (higher in BP II) of suicidality was 14%; impulsivity, 37%; and affective instability, 58%. The suicidality-positive patients (n = 30), when compared with the suicidality-negative patients (n = 179), had more BP II, more impulsivity (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.3 to 13.3), and more affective instability (OR, 2.4; 95% CI, 0.99 to 6.0). Logistic regression of suicidality vs impulsivity and affective instability (controlled for BP II; age; and interactions among BP II, age, impulsivity, and affective instability), showed that impulsivity was a strong independent predictor of suicidality (OR, 4.3; 95% CI, 1.7 to 10.6), and that affective instability was not an independent predictor of suicidality (OR,1.6; 95% CI, 0.6 to 4.1). BP II showed neither confounding nor interactions.
CONCLUSION: Results showed a strong independent impact of impulsivity—but not affective instability—on suicidality in BPD. No confounding by mood and substance disorders supported the BPD nature of these associations.
KEYWORDS: borderline personality disorder, bipolar II disorder, suicide attempts, impulsivity, affective instability
ANNALS OF CLINICAL PSYCHIATRY 2010;22(2):121–128CORRESPONDENCE: Zoltán Rihmer, MD, PhD, DSc, Kútvölgyi út 4, 1125 Budapest, Hungary E-MAIL: firstname.lastname@example.org