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Understanding the Link Between Borderline Personality Disorder and Suicide

Disclaimer: If you or a loved one are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor or call 911 in situations of immediate danger.

On average, 132 people in the U.S. commit suicide each day, making it the tenth leading cause of death for Americans. While there is no single cause of suicide, it often occurs when health issues and stressors meet to create feelings of hopelessness and despair. For individuals living with borderline personality disorder (BPD), the risk of suicide is even greater. One study found 75% of individuals living with BPD attempt suicide.

Borderline Personality Disorder Explained

According to the National Institute of Mental Health, borderline personality disorder is an illness that is manifested by an ongoing pattern of mood swings, self-image, and behavior. These symptoms can result in impulsive or reckless behavior and relationship difficulty.

  • Mood Patterns: People with BPD experience intense mood swings that result in uncertainty about the world around them. Because of this, their interests and outlook can rapidly change. People with borderline personality disorder also tend to view things in extremes, such as all good or all bad. Their opinions of other people can also change quickly.
    • An individual who is seen as a friend one day may be considered an enemy or traitor the next. These shifting feelings can lead to intense and unstable relationships. Fear of real or imagined abandonment and a pattern of intense and unstable relationships, and impulsive, dangerous behaviors such as substance use, reckless driving and self-harm are additional symptoms.
  • Occurrence: Like many personality disorders, it is often challenging to track statistics related to BPD as the condition can be misdiagnosed, underdiagnosed or individuals never seek treatment. However, it is estimated that 4% of people in the United States are living with the illness. While this number may seem small, it equates to approximately 3 million people living with the illness. Women are also disproportionately affected, making up approximately 75% of diagnoses.
  • Onset: Symptoms of BPD usually begin to appear in early adulthood and may decrease later in life as people in their 30s and 40s find stability.
  • Risk Factors: While there are currently no specific causes linked directly to borderline personality disorder, research suggests that social, environmental and genetic factors such as family history, a traumatic childhood and brain abnormalities may increase a person’s risk.

Borderline Personality Disorder vs. Bipolar Disorder

Borderline personality disorder can sometimes be confused with bipolar disorder and can co-occur as well. While both disorders can cause intense emotional responses, depression and impulsive behavior, BPD and bipolar disorder are separate illnesses with different symptoms and treatment options.

  • Bipolar disorder is a mood disorder that primarily affects a person’s emotional state altering thoughts, motivation and overall functionality in cycles that can last for days to months. It is more common than BPD and affects an estimated 8% of Americans.
  • BPD is a personality disorder that primarily affects a person’s inner experience and relationships causing individuals to think and act differently.
  • When diagnosing BPD and bipolar disorder, professionals can distinguish between the two illnesses by asking questions that relate to sleep, cycling mood time, relationships, mania and self-harm.

Higher Risk of Suicide Linked to BPD

Suicidal thoughts and self-harm behaviors can be associated with impulsive personality traits, putting individuals with BPD at higher risk for suicide. Suicidality in patients with BPD can be chronic and may continue for extended periods with as many as one in 10 affected individuals completing suicide.

Seeking Help Leads to Better Outcomes

Borderline personality disorder is a serious illness, but treatment is available and is important. Studies funded by the National Institute of Mental Health indicate that borderline personality disorder patients who don’t receive adequate treatment are more likely to develop other chronic medical or mental illnesses and are less likely to make healthy lifestyle choices.

Psychotherapy is the first line of treatment and there are two common types:

  • Cognitive behavioral therapy (CBT) can help people with borderline personality disorder identify and change core beliefs and behaviors that contribute to inaccurate perceptions of themselves and others, as well as social difficulties.
  • Dialectical behavior therapy (DBT), which was developed for individuals with borderline personality disorder, uses concepts of mindfulness and acceptance or being aware of and attentive to the current situation and emotional state. It also teaches skills to control intense emotions, reduce self-destructive behaviors and improve relationships.

Medications are sometimes recommended for mood swings, depression and impulsivity. Family involvement may also be encouraged. Individuals should contact their healthcare provider to learn more about treatment options related to borderline personality disorder.

Dr. Kristyn Gregory, DO, is a medical director of behavioral health at Blue Cross Blue Shield of Michigan. 

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