Nearly 10 percent of all patients with BPD commit suicide and up to 75 percent make at least one suicide attempt. While many of these attempts are low in medical lethality, 50 percent of individuals with BPD have made at least one suicide attempt that is highly lethal. Despite this severity, the frequency of low lethality suicide attempts and non-suicidal self-injury in BPD leads clinicians to consider suicide attempts as merely """"""""gestures,"""""""" or manipulative and attention-seeking behaviors. Also, clinicians tend to treat suicidality in BPD by treating the symptoms of depression, when, in fact, impulsivity appears to be a stronger risk factor. We will examine clinical and neurobiological factors related to suicide attempts in subjects with borderline personality disorder using a prospective design. Through the administration of structured clinical interviews and lumbar puncture, we plan to measure various state and trait variables that pose risk for suicidal behavior in a cohort of 300 subjects: 200 with BPD (100 attempters, 100 non-attempters) between the ages of 18-35, the period of highest suicide risk in BPD and 100 attempters with Major Depression without an Axis II diagnosis.
The specific aims are to: 1. examine clinical state and trait predictors of suicide attempts during a two year follow-up; and 2. examine serotinergic function (e.g., CSF-5HIAA) and other biological indices of suicide attempt behavior in BPD during a two year follow-up. Exploratory aims include: 1. identify the risk factors for high lethality versus low lethality attempts in BPD; 2. determine co-morbidity of Major Depression at time of attempts; 3. apply a stress-diathesis model to examine the interaction of state and trait factors in determining risk for suicidal behavior in BPD; 4. explore the relationship of self-mutilation and dissociation with suicidal acts, and with state and trait risk factors. The difficulty in predicting suicidal behavior in the treatment of BPD leads to either under-recognition of the seriousness of suicidal risk in BPD, or alternatively, over-utilization of hospitalization. These findings may have important clinical application for more accurate prediction of high lethality attempts within the context of frequent low lethality suicidal behaviors.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH062665-04
Application #
6844903
Study Section
Special Emphasis Panel (ZRG1-BBBP-5 (01))
Program Officer
Breiling, James P
Project Start
2002-02-08
Project End
2007-01-31
Budget Start
2005-02-01
Budget End
2006-01-31
Support Year
4
Fiscal Year
2005
Total Cost
$303,062
Indirect Cost
Name
New York State Psychiatric Institute
Department
Type
DUNS #
167204994
City
New York
State
NY
Country
United States
Zip Code
10032
Rizk, Mina M; Galfalvy, Hanga; Singh, Tanya et al. (2018) Toward subtyping of suicidality: Brief suicidal ideation is associated with greater stress response. J Affect Disord 230:87-92
Wilson, Scott T; Chesin, Megan; Fertuck, Eric et al. (2016) Heart rate variability and suicidal behavior. Psychiatry Res 240:241-247
Miano, Annemarie; Fertuck, Eric A; Arntz, Arnoud et al. (2013) Rejection sensitivity is a mediator between borderline personality disorder features and facial trust appraisal. J Pers Disord 27:442-56
Fertuck, Eric A; Grinband, Jack; Stanley, Barbara (2013) Facial trust appraisal negatively biased in borderline personality disorder. Psychiatry Res 207:195-202
Wilson, Scott T; Stanley, Barbara; Brent, David A et al. (2012) Interaction between tryptophan hydroxylase I polymorphisms and childhood abuse is associated with increased risk for borderline personality disorder in adulthood. Psychiatr Genet 22:15-24
Fertuck, Eric A; Keilp, John; Song, Inkyung et al. (2012) Higher executive control and visual memory performance predict treatment completion in borderline personality disorder. Psychother Psychosom 81:38-43
Lizardi, Dana; Stanley, Barbara (2010) Treatment engagement: a neglected aspect in the psychiatric care of suicidal patients. Psychiatr Serv 61:1183-91
Stanley, Barbara; Sher, Leo; Wilson, Scott et al. (2010) Non-suicidal self-injurious behavior, endogenous opioids and monoamine neurotransmitters. J Affect Disord 124:134-40
Stanley, Barbara; Siever, Larry J (2010) The interpersonal dimension of borderline personality disorder: toward a neuropeptide model. Am J Psychiatry 167:24-39
Wilson, Scott T; Stanley, Barbara; Brent, David A et al. (2009) The tryptophan hydroxylase-1 A218C polymorphism is associated with diagnosis, but not suicidal behavior, in borderline personality disorder. Am J Med Genet B Neuropsychiatr Genet 150B:202-8

Showing the most recent 10 out of 20 publications