Which Borderline Personality Disorder Patients Are at Increased Risk for Suicide Attempts?

sad older woman
sad older woman
The researchers examined the association of a borderline personality disorder diagnosis and the specific criteria for its diagnosis with suicide attempts in US adults.

Suicide attempts were associated with borderline personality disorder (BPD) with chronic emptiness, according to results of a cross-sectional study published in JAMA Network Open.

Researchers from Yale University School of Medicine and the State University of New York at Albany analyzed data from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III). Noninstitutionalized adults (N=36,309) living in the US were surveyed between 2012 and 2013 for their demographic information, clinical characteristics, and history of attempted suicides.

Participants were 56.3% women, had a mean age of 45.6 (standard deviation [SD], 17.5) years, and 52.9% were non-Hispanic White.

Stratified by BPD (n=2060) status, nearly a quarter of participants with BPD (22.7%) indicated they had attempted suicide at some point during their life, and 2.1% during the previous year. Among those not meeting BPD diagnosis requirements (n=34,111), 3.8% indicated they had a history of suicide attempt and 0.2% during the previous year. BPD significantly associated with any suicide attempt (adjusted odds ratio [aOR], 1.59; 95% CI, 1.35-1.88) and an attempt the previous year (aOR, 2.48; 95% CI, 1.56-3.97).

Stratified by the 9 criteria of BPD, chronic emptiness was associated with lifetime suicide attempts (aOR, 1.66; 95% CI, 1.23-2.24) and attempts in the previous year (aOR, 2.45; 95% CI, 1.18-5.08). The other 8 criteria were not significantly associated with suicide attempts in the fully adjusted model.

Among patients who reported they had attempted suicide on 2 or more occasions, self-injurious behavior (aOR, 40.38; 95% CI, 23.62-69.03; P <.001), emptiness (aOR, 2.15; 95% CI, 1.41-3.29; P <.001), and impulsivity (aOR, 1.57; 95% CI, 1.03-2.41; P =.04) were associated with increased risk compared with individuals who had not attempted suicide.

This study may have included some recall bias. These findings are likely not generalizable to individuals who are institutionalized, incarcerated, or transient.

The study authors concluded individuals with BPD were at increased risk for suicide attempts compared with the general population, especially among those who fit the criteria for chronic emptiness. Multiple suicide attempts were more likely to occur among patients with self-harm and impulsive behaviors.

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.


Grilo CM, Udo T. Association of borderline personality disorder criteria with suicide attempts among US adults. JAMA Netw Open. Published online May 11, 2021. doi:10.1001/jamanetworkopen.2021.9389