Suicidality in Borderline Personality Disorder

Research has shown that about 75% of people with borderline personality disorder (BPD) will make at least one suicide attempt in their lifetime, and many will make multiple suicide attempts.

People with BPD are also more likely to complete suicide than individuals with any other psychiatric disorder. An estimated 3% to 10% of people with BPD complete suicide, which is more than 50 times the rate of suicide in the general population.

Factors in BPD-Related Self-Harm and Suicide

Several factors related to BPD might explain why suicide, self-harm, and suicide attempts are so common.

Severe Emotional Pain

BPD is associated with intense negative emotional experiences. These experiences are so painful that many people with BPD report wanting to escape. They may use various strategies to try to reduce their emotional pain, such as deliberate self-harm, substance use, and even suicide.

Duration

BPD is a chronic condition and usually lasts for years. One of the most unique aspects of BPD is suicidal ideation. People with this condition may consider suicide daily for months, even years. This may leave people with BPD feeling that there is no other way out, despite the availability of effective treatments.

Comorbidity

BPD tends to co-occur with other mental disorders, such as bipolar disorder, major depression, and schizoaffective disorder. When there are other mental disorders present, the risk of suicide increases.

Impulsivity

BPD is associated with impulsivity, or a tendency to act quickly without thinking about consequences. Individuals with BPD may engage in suicidal behaviors in a moment of intense emotional pain without fully considering the consequences.

Substance Use

BPD often co-occurs with substance use, and the use of drugs or alcohol is a risk factor for suicide all by itself. When substance use issues are combined with BPD, this may be a particularly lethal combination. Substance use can lead to even greater impulsivity, and people who are using substances have access to a means for overdose.

Brain Abnormalities

Brain imaging has shown that compared to healthy people, individuals with BPD tend to have abnormalities involving the brain's structure, metabolism, and function. These abnormalities appear to contribute to BPD symptoms such as impulsivity and aggression, both of which are associated with suicidal behavior.

One study explored the relationship between impulsivity, aggression, and suicidal behavior in the brain structures of people with BPD who had attempted suicide. The participants were put into two groups depending on how lethal their suicide attempts had been. In the group labeled "high lethality," meaning their suicide attempts had been extremely harmful, there was less gray matter in multiple areas of the brain than in the "low lethality" group.

A similar study also showed a significantly reduced amount of gray matter in the brains of individuals with BPD when compared with healthy people. In people with BPD who had attempted suicide, there was less gray matter in eight out of nine areas.

In people with BPD who had not attempted suicide, there was less gray matter in five out of nine areas. And, similar to the other study, the higher lethality suicide attempters had notably less gray matter than the lower lethality attempters in certain areas.

Helping Someone With BPD Who Is Suicidal

You might pick up on signs of suicidality even if your loved one hasn't said anything about suicide. If you think your loved one may be thinking of suicide, talk with them. Let them know you're worried about them and ask whether your concerns are valid. Offer to help.

This can be hard because symptoms can make the person with BPD difficult to deal with. For the time being, however, the most important thing is to help your loved one stay safe. Showing care and concern can go a long way.