An Examination of DSM-IV Borderline Personality Disorder Symptoms and Risk for Death by Suicide: A Psychological Autopsy Study

Objective: To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by Suicide, and thereby better predict suicide risk. Method: A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD (n = 62), and BPD control subjects (n = 35). Results: BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation-dissociative symptoms. The negative association between paranoid ideation-dissociative symptoms and suicide was independent of all other BPD Symptoms, Cluster B comorbidity, and alcohol dependence. Conclusions: We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific Subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD.