Momentary interpersonal processes of suicidal surges in borderline personality disorder

In models where impulsivity was included to account for the link between dominance and suicidal ideation, only a significant link between interpersonal perceptions and impulsivity emerged (a-Imp).

“In models where impulsivity was included to account for the link between dominance and suicidal ideation (Table 3C), only a significant link between interpersonal perceptions and impulsivity emerged (a-Imp).”

There is no between-person level association between perceived dominance and positive affect.

“Models including perceived dominance (Table 3B) revealed a similar pattern of results, with the only exceptions being an expectedly negatively association with positive affect (a-PA), and no between-person level association between perceived dominance and positive affect.”

At the within-person level, perceived dominance predicts negative affect.

“Relationships with perceived dominance were similar but somewhat weaker (Table 3A): interpersonal perceptions predicted negative affect (a-NA), and negative affect predicted suicidal ideation (b-NA).”

At the between-person level, higher average perceptions of dominance are associated with experiencing more impulsivity.

“At the between-person level, however, higher average perceptions of dominance were associated with experiencing more impulsivity, and higher average levels of impulsivity were associated with an increased likelihood for suicidal ideation.”

At the between-person level, higher average levels of negative affect are associated with an increased likelihood for suicidal ideation.

“At the between-person level, lower average perceptions of warmth were associated with experiencing more negative affect on average, and higher average levels of negative affect were associated with an increased likelihood for suicidal ideation; the link between perceptions of warmth and suicidal ideation, however, was no longer significant, suggesting individual differences in negative affect”

In the model including negative affect, perceived warmth predicts suicidal ideation at the within-person level (c path).

“while warmth now predicted SI (c; Table 2A).”

At the between-person level, the link between perceptions of warmth and suicidal ideation is no longer significant when negative affect is included.

“the link between perceptions of warmth and suicidal ideation, however, was no longer significant, suggesting individual differences in negative affect accounted for this association.”

At the between-person level, lower average perceptions of warmth are associated with feeling more impulsive on average.

“At the between-person level, lower average perceptions of warmth were associated with feeling more impulsive on average, and that higher average levels of impulsivity were associated with an increased likelihood for suicidal ideation.”

At the within-person level, when negative affect and impulsivity are included simultaneously, the path between perceived warmth and suicidal ideation is not significant.

“The path between perceived warmth and suicidal ideation, however, was not significant (c).”

At the within-person level, negative affect predicts suicidal ideation.

“At the within-person level, the fixed effect of perceptions of others’ warmth negatively predicted negative affect (a-NA), and negative affect predicted suicidal ideation (b-NA), while warmth now predicted SI (c; Table 2A).”

• Also stated in: § Model Set 3 · plain

  “Moreover, negative affect (b-NA), but not impulsivity (b-Imp), was related to suicidal ideation.”

Lower perceived warmth in others is associated with suicidal ideation when aggregated across interactions (between-person level).

“Aggregated across interactions, lower perceived warmth in others was associated with suicidal ideation.”

• Also stated in: § Model Set 1 · plain

  “we found no significant fixed effect at the within-person level (c = .187, CI [− .017,.404], but did at the between-person level (βSI.W = −.184, CI −.357, .000]).”

At the within-person level, perceived dominance is negatively associated with positive affect.

“Models including perceived dominance (Table 3B) revealed a similar pattern of results, with the only exceptions being an expectedly negatively association with positive affect (a-PA), and no between-person level association between perceived dominance and positive affect.”

At the within-person level, when dominance, negative affect, and impulsivity are included simultaneously, the path between perceived dominance and suicidal ideation is not significant.

“Again, negative affect (b-NA), but not impulsivity (b-Imp), was related to suicidal ideation, while the path between perceived dominance and suicidal ideation was not significant (c).”

At the within-person level, perceived warmth negatively predicts negative affect.

“At the within-person level, the fixed effect of perceptions of others’ warmth negatively predicted negative affect (a-NA), and negative affect predicted suicidal ideation (b-NA), while warmth now predicted SI (c; Table 2A).”

• Also stated in: § Model Set 3 · plain

  “At the within-person level, perceptions of others’ warmth negatively predicted negative affect (a-NA), and impulsivity (a-Imp).”

At the between-person level, impulsivity and negative affect are positively associated with each other.

“At the between person level, the same pattern of results emerged, and impulsivity and negative affect were positively associated with each other (Table 4A).”

At the between-person level, lower average perceptions of warmth are associated with experiencing more negative affect on average.

“At the between-person level, lower average perceptions of warmth were associated with experiencing more negative affect on average, and higher average levels of negative affect were associated with an increased likelihood for suicidal ideation; the link between perceptions of warmth and suicidal ideation, however, was no longer significant, suggesting individual differences in negative affect”

At the between-person level, higher average levels of impulsivity are associated with an increased likelihood for suicidal ideation.

“At the between-person level, lower average perceptions of warmth were associated with feeling more impulsive on average, and that higher average levels of impulsivity were associated with an increased likelihood for suicidal ideation.”

Perceiving interaction partners as more dominant is not associated with suicidal ideation at the within-person level.

“Similarly, perceiving interaction partners as more dominant was not associated with suicidal ideation at the within-person (c= −.014, CI [−.167,.145]), but was at the between-person level (βSI.D = .185, CI [.029, .331]).”

At the within-person level, perceived warmth is negatively associated with impulsivity.

“For models that included impulsivity (Table 2C), we found a significant negative within-person link between perceptions of warmth and impulsivity (a-Imp), while the effects for the b-Imp path and the c path were not significant.”

Interpersonal conflicts are linked to suicidal ideation indirectly via greater negative affect and lower positive affect.

“Instead, interpersonal conflicts were linked to suicidal ideation indirectly via greater negative affect and lower positive affect.”

At the within-person level, positive affect is negatively associated with suicidal ideation.

“A very similar pattern with opposing signs emerged for the model including positive affect (Table 2B), such that at the within-person level interpersonal warmth was positively associated with positive affect (a-PA), and positive affect negatively with suicidal ideation (b-PA).”

Perceiving interaction partners as more dominant is associated with suicidal ideation at the between-person level.

“Similarly, perceiving interaction partners as more dominant was not associated with suicidal ideation at the within-person (c= −.014, CI [−.167,.145]), but was at the between-person level (βSI.D = .185, CI [.029, .331]).”

At the within-person level, negative affect predicts suicidal ideation in the dominance model.

“Relationships with perceived dominance were similar but somewhat weaker (Table 3A): interpersonal perceptions predicted negative affect (a-NA), and negative affect predicted suicidal ideation (b-NA).”

In the warmth-impulsivity model, perceived warmth does not predict suicidal ideation at the within-person level (c path not significant).

“For models that included impulsivity (Table 2C), we found a significant negative within-person link between perceptions of warmth and impulsivity (a-Imp), while the effects for the b-Imp path and the c path were not significant.”

At the within-person level, interpersonal warmth is positively associated with positive affect.

“A very similar pattern with opposing signs emerged for the model including positive affect (Table 2B), such that at the within-person level interpersonal warmth was positively associated with positive affect (a-PA), and positive affect negatively with suicidal ideation (b-PA).”

Perceived warmth is not associated with suicidal ideation at the within-person level in Model 1.

“This direct relationship, however, did not extend to momentary within-person associations.”

• Also stated in: § Model Set 1 · plain

  “For models examining the effects of others’ perceived warmth on suicidal ideation (Model 1), we found no significant fixed effect at the within-person level (c = .187, CI [− .017,.404], but did at the between-person level (βSI.W = −.184, CI −.357, .000]).”

Impulsivity did not account for the relationship between interpersonal perceptions and suicidal ideation.

“While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and suicidal ideation.”

A robust within-person link between interpersonal perceptions and impulsivity emerged.

“While a robust within-person link between interpersonal perceptions and impulsivity emerged, impulsivity did not account for the relationship between interpersonal perceptions and suicidal ideation.”

In the warmth-impulsivity model, impulsivity does not predict suicidal ideation at the within-person level (b-Imp path not significant).

“For models that included impulsivity (Table 2C), we found a significant negative within-person link between perceptions of warmth and impulsivity (a-Imp), while the effects for the b-Imp path and the c path were not significant.”

Impulsivity exhibited a momentary relationship with interpersonal perception.

“However, impulsivity did exhibit a momentary relationship with interpersonal perception, consistent with previous work (Coifman et al., 2012).”

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The between-person association between perceived coldness and suicidal ideation did not extend to the within-person momentary timescale.

“However, this between-person association did not extend to the within-person momentary timescale.”

When aggregated across all interactions, perceived coldness was associated with suicidal ideation.

“When aggregated across all interactions, an association between perceived coldness and suicidal ideation emerged”

The path between perceived warmth and suicidal ideation was not significant.

“The path between perceived warmth and suicidal ideation, was not significant.”

Positive and negative affect each uniquely accounted for the link between interpersonal stressors and suicidal ideation, even after adjusting for their covariation, both at the within- and between-person level.

“Moreover, positive and negative affect each uniquely accounted for the link between interpersonal stressors and suicidal ideation, even after adjusting for their covariation, both at the within- and between-person level.”

Significant random effects indicated individual differences in within-person associations.

“Note that for these and all subsequently reported within-person paths, we found significant random effects indicative of individual differences in these associations.”

Positive and negative affect were negatively associated with each other.

“positive and negative affect were negatively associated with each other.”

The effect of interpersonal conflicts on suicidal ideation was indirect, such that greater negative affect or lower positive affect in the context of perceived conflict or withdrawal was associated with suicidal ideation.

“Instead, the triggering effect of interpersonal conflicts was indirect, such that greater NA or lower PA in the context of perceived conflict or withdrawal was associated with suicidal ideation.”

At the between-person level, the same pattern of results emerged.

“At the between person level, the same pattern of results emerged.”

Impulsivity did not explain the indirect effect of negative affect.

“and as such they did not explain the indirect effect of negative affect.”

The direct link between interpersonal perceptions and suicidal ideation was not significant at the within-person level.

“the direct link between interpersonal perceptions and suicidal ideation was not significant at the within-person level”

Perceptions of others' warmth negatively predicted negative affect (a-NA).

“we found that perceptions of others’ warmth negatively predicted negative affect (a-NA), and positively positive affect (a-PA).”

Average impulsivity was associated with average suicidal ideation.

“Average impulsivity was associated with average suicidal ideation”

For the a-NA and a-PA paths, a converse pattern emerged for the model including perceptions of dominance.

“For the a-NA and a-PA paths, a converse pattern emerged for our model including perceptions of dominance (Table 5B).”

The association between average impulsivity and average suicidal ideation was not significant after adjusting for negative affect.

“but not after adjusting for negative affect”

Perceptions of others' warmth positively predicted positive affect (a-PA).

“we found that perceptions of others’ warmth negatively predicted negative affect (a-NA), and positively positive affect (a-PA).”

Ratings of impulsivity were unassociated with suicidal ideation within-person.

“Ratings of impulsivity were unassociated with ideation within-person”

The indirect effect through affect was significant.

“though the indirect effect through affect was.”

Power would exceed .80 at an alpha level of .05 for each individual within-person effect with person-level sample sizes of N>50.

“These simulations indicated that power would exceed .80 at an alpha level of .05 for each individual within-person effect with person-level sample sizes of N>50, including tests of main effects and variance components.”

In BPD, perceptions of others' warmth do not necessarily translate to the same amount of increases in positive affect as in community controls.

“In BPD, positive affect may be essential for research on interpersonal precipitants of suicidal ideation, because perceptions of others’ warmth do not necessarily translate to the same amount of increases in positive affect in BPD as in community controls (Sadikaj et al., 2010).”

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Individual differences in negative affect account for the between-person association between perceptions of warmth and suicidal ideation.

“the link between perceptions of warmth and suicidal ideation, however, was no longer significant, suggesting individual differences in negative affect accounted for this association.”

Positive affect accounts for the link between interpersonal warmth and suicidal ideation at the within-person level.

“Again, the indirect effect (ab) was significant, while the c path did not reach significance.”

This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis.

“This intensive longitudinal study illustrates momentary interpersonal signatures of an emerging suicidal crisis.”

Negative affectivity has been more consistently related to the emergence of suicidal ideation.

“In contrast, negative affectivity has been more consistently related to the emergence of suicidal ideation (Hallquist & Pilkonis, 2012; Linehan et al., 1993; McGirr et al., 2007; Soloff et al., 2005; Wedig et al., 2012; Yen et al., 2004; 2009).”

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The within-person link between negative affect and suicidal ideation is enhanced among patients with BPD compared to those without.

“More recent work further suggests that the within-person link between negative affect and suicidal ideation is enhanced among patients with BPD compared to those without (Mou et al., 2018).”

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Suicidal ideation severity varies considerably from hour to hour.

“First, suicidal ideation severity varies considerably from hour to hour (Ben-Zeev et al., 2012; Hallensleben et al., 2017; Husky et al., 2017; Witte et al., 2006), and covaries with well-known precipitants, which are limited in their ability to predict prospective changes in suicidal ideation (Kleiman et al., 2017; Victor et al., 2019).”

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No study has illustrated how momentary contingencies among interpersonal perceptions and affect or state impulsivity in BPD propel real-life suicidal crises.

“Though a vast body of work has consistently reported momentary contingencies among interpersonal perceptions and affect or state impulsivity in BPD, no study has illustrated how those processes propel real-life suicidal crises.”

Negative affect accounts for the link between perceived coldness and momentary suicidal ideation at the within-person level.

“The indirect effect (ab) was also significant, suggesting that negative affect accounted for the link between perceived coldness and momentary suicidal ideation.”

Low positive affectivity is a stronger prospective predictor for suicidal acts than negative affectivity over six months.

“For instance, Yen et al. (2013) found that over a period of six months low positive affectivity was a stronger prospective predictor for suicidal acts than negative affectivity.”

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Negative affect accounts for the link between perceived dominance and momentary suicidal ideation at the within-person level.

“Although the total of the c path was not significant, an indirect effect (ab) emerged, suggesting that negative affect accounted for the link between perceived dominance and momentary suicidal ideation.”

Episodes of suicidal ideation tend to be brief, with most episodes shorter than an hour.

“Second, episodes of suicidal ideation tend to be brief, with participants reporting most episodes to be shorter than an hour (Nock et al., 2009).”

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Prediction of suicide attempts remains close to chance.

“Although correlates of suicidal behavior have been studied extensively in the past 30 years (Turecki et al., 2019), prediction of suicide attempts remains close to chance (Franklin et al., 2017; Nock, 2009).”

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In people diagnosed with BPD at high risk for suicide, situational interpersonal triggers do not directly elicit suicidal thoughts.

“The present study suggests that in people diagnosed with BPD at high risk for suicide, situational interpersonal triggers do not directly elicit suicidal thoughts.”

• Also stated in: § Discussion · plain

  “In people diagnosed with BPD at high risk for suicide, situational triggers do not directly elicit suicidal thoughts, but unfold indirectly via affective dysregulation.”

The BPD-specific association among negative affect and suicidal ideation is reinforced by reductions in negative affect.

“These findings are consistent with the notion that suicidal behaviors reflect efforts to escape intense aversive arousal or distress in response to acute stressors (Gratz et al., 2006; Millner et al., 2019), and that the BPD-specific association among both is reinforced by reductions in negative affect (Kleiman et al., 2018; Selby et al., 2009).”

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Inferences on intervening relationships are justified if the indirect effect carried by the X→M and M→Y paths is significant, regardless of whether the bivariate association between X and Y was significant.

“more recent writings note that inferences on intervening relationships are justified if the indirect effect carried by the X→M and M→Y paths is significant (MacKinnon et al., 2007), regardless of whether the bivaraite association between X and Y was significant.”

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Suicidal behaviors reflect efforts to escape intense aversive arousal or distress in response to acute stressors.

“These findings are consistent with the notion that suicidal behaviors reflect efforts to escape intense aversive arousal or distress in response to acute stressors (Gratz et al., 2006; Millner et al., 2019), and that the BPD-specific association among both is reinforced by reductions in negative affect (Kleiman et al., 2018; Selby et al., 2009).”

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Suicidal ideation in BPD is driven by distress (negative affect) giving rise to escape motivations.

“It also underlines the notion that suicidal ideation in BPD is driven not only by distress (NA) giving rise to escape motivations (Millner et al., 2019), but also by low PA, which may undermine a persons’ ability to find alternative solutions or put the current crisis in perspective (Baumeister, 1990).”

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The effect of negative interpersonal experiences on suicidal ideation unfolds indirectly via affective dysregulation.

“Instead, the effect of negative interpersonal experiences on suicidal ideation unfolds indirectly via affective dysregulation.”

• Also stated in: § Discussion · plain

  “In people diagnosed with BPD at high risk for suicide, situational triggers do not directly elicit suicidal thoughts, but unfold indirectly via affective dysregulation.”

Healthy controls, non-attempters, and attempters were pooled to represent a range of suicidal ideation severity consistent with dimensional conceptualizations of psychopathology.

“Thus, for the purpose of the current study, healthy controls, non-attempters, and attempters were pooled to represent a range of suicidal ideation severity consistent with dimensional conceptualizations of psychopathology (Stanton et al., 2020).”

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Interpersonal experiences are meaningfully related to suicidal ideation in BPD.

“supporting the notion that interpersonal experiences are meaningfully related to suicidal ideation in BPD (Brodsky et al., 2006; Brown et al., 2002).”

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BPD reflects a confluence of internalizing and externalizing psychopathology.

“BPD is a particularly informative population for the study of suicidal ideation, because it reflects a confluence of internalizing and externalizing psychopathology (Eaton et al., 2011; Crowell et al., 2009; James & Taylor, 2008)”

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