One of the most common forms of treatment for borderline personality (BPD) is dialectic behavioral therapy (DBT). DBT focuses on targeting symptoms and behaviors, and aims to reduce symptom severity and negative outcomes. One of the major goals of DBT is to improve overall well-being and thus minimize the chances of self-harm, suicidal ideation, and suicide attempts in those with BPD. The rate of suicide is extremely high among people with BPD, and their overall mortality rate as a result of suicide is nearly 50 times higher than that found in the general population. Therefore, it is imperative that DBT be assessed for effectiveness and compared with other forms of treatment currently being used to treat individuals with BPD.
Paul S. Links of the Department of Psychiatry at the Schullich School of Medicine and Dentistry at the University of Western Ontario in Canada recently led a study comparing DBT to general psychiatric management (GPM) in a sample of 180 participants with BPD. Links evaluated the participants at baseline and over a 12-month treatment period. They were then assessed regularly for two more years to determine the levels of suicidal ideation, attempts, and completion. Links found that over one quarter of the participants attempted suicide during the one-year treatment period and just over 15% tried to commit suicide in the follow-up phase. The strongest predictors of suicide attempt in this sample were number of recent attempts, hospitalization, and childhood sexual abuse.
However, none of the participants died from suicide during the study period. In fact, the rates of attempts were lower than in studies that did not provide follow-up. Also, the participants in both the DBT and GPM groups had similar reductions in suicide attempts. When Links looked at other factors that could increase suicidal tendency, such as the presence of depression, he found that clients with comorbidity did not have higher rates of suicide attempts. It was only the previously mentioned factors including history and severity of sexual abuse, previous hospitalization, and recent attempts that directly predicted the risk for suicide during the study period. Links believes these findings emphasize the importance of exploring previous behavior and family history for clinicians working with individuals with BPD. He added, “Patients with a history of recent attempts, recent hospitalizations, and severe childhood sexual abuse should be closely monitored as outpatients.”
Links, Paul S., Nathan J. Kolla, Tim Guimond, and Shelley McMain. Prospective risk factors for suicide attempts in a treated sample of patients with borderline personality disorder. Canadian Journal of Psychiatry 58.2 (2013): 99-106. Print.
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