Understanding chronic suicidality in borderline personality disorder through comparison with depressive disorder: a systematic review

Abstract

ABSTRACT Objective Chronic suicide risk identification in borderline personality disorder (BPD) is fundamental to risk tolerant intervention. To further the clinical understanding of chronic risk in BPD, this systematic review examined studies which compared factors associated with suicidality in BPD with those in any depressive disorder (DD). Method Databases PsycINFO, Medline Complete, EMBASE, and Proquest Dissertations and Theses Global were systematically searched using a set of relevant search terms. Studies written in English between 1996 and 9th January 2023 meeting inclusion criteria (adult/adolescent participants; compared factors related to suicide attempts, ideation, intent, lethality or parasuicidal gestures in BPD and DD, or explored BPD traits within suicidality in DD; and used structured diagnostic assessments or expert interview based upon DSM) were reviewed and assessed for quality using Joanna Briggs Institute Checklists. Studies were grouped by how suicidality was operationalised, and organised by the constructs that were compared. Results Findings from 14 studies (5189 participants) indicated that interpersonal dysfunction, impulsivity, aggression, anger/hostility in adult samples, and early onset of depression and self-injury may discriminate suicidality in BPD from DD for recurrent suicide attempts only. Expressed suicidal intent is higher in BPD than DD, while lethality of attempts is the same. Discussion Comparison of suicidality in BPD and DD requires further investigation. Findings suggest associated factors that might support risk assessment in BPD.