Don’t discount suicide attempts in borderline patients

No matter how many times borderline personality disorder patients seem to “cry wolf”, the threat of suicide is real and needs to be taken seriously.

Don’t discount suicide attempts in borderline patients

By: M. ALEXANDER OTTO, Clinical Psychiatry News APR. 22, 2014

AT THE ANNUAL AAS CONFERENCE

VITALS

Major finding: Following suicide attempts, patients with borderline personality features scored a mean of 14.51 points and nonborderline patients a mean of 12.96 on the Beck Suicide Intent Scale. Borderline patients scored a mean of 2.25 points and nonborderline patients a mean of 2.39 on the Medical Lethality Rating Scale. The differences were not significant.

Data Source: Surveys of 90 patients admitted within 24 hours of a suicide attempt.

Disclosures: The lead investigator has no disclosures. The senior investigator has funding from the National Institute on Alcohol Abuse and Alcoholism and the Military Suicide Research Consortium.

LOS ANGELES – No matter how many times borderline personality disorder patients seem to cry wolf, the threat of suicide is real and needs to be taken seriously, according to investigators at the University of Mississippi Medical Center in Jackson.

“A common clinical assumption” about borderline patients “is that their suicide attempts are not … medically serious. The assumption … is not supported by our findings,” they said during a presentation at an alcohol rehab in St Louis.

The team surveyed patients admitted to the university’s level 1 trauma center in Jackson within 24 hours of a suicide attempt and found no statistical difference in demographics, medical lethality, suicide intent, or problematic alcohol use between 62 patients with borderline features and 28 without them.

Meanwhile, patients with borderline features – defined as a score of at least 38 points on the Personality Assessment Inventory-Borderline Features Scale – were significantly more depressed and had higher problematic drug use (43.55% vs. 10.71%) and more previous attempts (70.97% vs. 46.43%).

“It’s very common to hear medical providers say attempts” by borderline patients “are just a gesture.” In fact, “people presenting with these features need to be helped in the same way as people who present without them,” and might need more help with depression and drug use in particular, lead investigator Jalessa Perez said at the annual conference of the American Association of Suicidology.

“If you are writing off their attempts, you are not really treating what needs to be treated,” said Ms. Perez, a research assistant at the medical center.

The mean score on the Center for Epidemiologic Studies Depression Scale was 22.93 points in the borderline group, suggesting possible clinical depression, but 15.43 points among other patients, indicating milder symptoms.

Borderline patients scored a mean of 14.51 points and nonborderline patients a mean of 12.96 on the Beck Suicide Intent Scale, a nonsignificant difference indicating moderate intent. Borderline patients scored a mean of 2.25 points and nonborderline patient a mean of 2.39 on the 8-point Medical Lethality Rating Scale, indicating physical harm in both cases; with a score of 8 indicating death.

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