THE BIOLOGY OF IMPULSIVITY AND SUICIDALITY

Abstract

Borderline personality disorder (BPD) is associated with significant morbidity and mortality as a consequence of impulsivity , self-mutilation, and suicidal acts. Impulsivity is a core symptom of BPD and has been defined as a tendency toward having a short latency to acting on urges. This impulsivity may lead to self-destructive behavior, such as spending sprees, sexual indiscretions, temper outbursts, physical fights, self-mutilation, and suicidal behavior . Self-mutilation is a behavior distinct from suicidal behavior and can be conceptualized as a physically damaging act without the intention to die. It tends to involve repetitive, minor, self-damaging acts and often has a compulsive quality. The patient often performs the act in a dissociative state, feeling no pain. Common forms of self-mutilation include superficial cutting or burning. Patients with BPD may attribute this behavior to an attempt to manage distressing affects, such as anxiety, anger, or feeling dissociated. Patients with BPD who practice self-mutilation often also manifest suicidal behavior. Suicidality includes thoughts and acts. Suicidal thoughts, or thoughts about wanting to be dead, may be active (i.e., thoughts about the method or timing of killing oneself) or passive (i.e., thoughts or wishes to be dead). These suicidal thoughts may lead to suicidal acts. Suicidal acts are defined as self-destructive behaviors with at least some intent to end one's life. Suicidal acts that end in death are termed suicide or completed suicide . Because suicidal behaviors, attempts, and completion bear a close relationship to impulsivity and aggression, this article discusses the biology of impulsivity, aggression, and suicide. Impulsivity and aggression are discussed together because of significant overlap in phenomenology and studies available. Because of the association with suicidal behavior, the biology of self-mutilation is also discussed. This article provides an overview of the animal and human studies of impulsivity and aggression. Studies of impulsivity and aggression in patients with BPD, the biology of self-mutilation, from human and animal studies, and biological correlates of suicide, completed and attempted, are also reviewed.