Early Mortality in Patients With Borderline Personality Disorder

Patients with borderline personality disorder (BPD) are at high risk for early death from suicide and other causes, according to a study published in the Journal of Clinical Psychiatry.1

In a prospective study spanning 24 years, investigators followed 290 patients with BPD and 72 comparison patients who had other personality disorders (PDs). The study included adults aged 18 to 35 years who were evaluated every 2 years as part of the ongoing McLean Study of Adult Development. Participants had a known or estimated IQ of 71 or higher and no current or history of psychotic conditions. Of the participants, 87% were white. The mean patient age was 27 years, and 77% were women.

After 24 years, more patients with BPD died by suicide than patients with other PD (5.9% vs 1.4%). Similarly, rates of death from other causes were higher in patients with BPD (14.0%) compared with comparison patients (5.5%). Causes of nonsuicidal death included cardiovascular (n=11), substance-related complications (n=5), cancer (n=4), and accidents (n=4).

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Investigators found a disproportionately higher risk for suicide and nonsuicidal death in patients with BPD who did not achieve recovery. Recovery was defined as at least one 2-year follow-up period during which patients were in remission from their diagnosis of PD, showed good psychosocial functioning, and were engaged in full-time work or school.

Significant predictors of premature nonsuicidal death were male sex, lower socioeconomic status, being on government disability, history of drug use disorder, number of psychiatric hospitalizations before index hospitalization, body mass index greater than 30 kg/m2, and number of psychiatric medications (for all, P <.05).

Investigators noted a limited set of predictors in the study. Other limitations were excluding patients meeting criteria for bipolar I disorder at baseline, which may have affected mortality estimates. All participants were initially psychiatric inpatients, and most were involved in ongoing outpatient psychotherapy or psychopharmacologic treatment over the course of follow-up. Results might be different for non-inpatients or those not receiving ongoing treatment.

The clinical implications of the study center on “targeting factors found to predict premature death in patients with BPD (eg, poor health behaviors, number of psychiatric medications, substance abuse) in treatment,” which investigators noted, “may help prevent or delay this outcome.”

The researchers concluded, “[P]remature death (not due to suicide) is an adverse outcome that warrants additional clinical attention.”


Temes CM, Frankenburg FR, Fitzmaurice GM, Zanarini MC. Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. J Clin Psychiatry. 2019;80(1):18m12436.