Modeling the suicidal behavior cycle: understanding repeated suicide attempts among individuals with borderline personality disorder and a history of attempting suicide
Open accessAbstract
OBJECTIVE: Suicide remains a leading cause of death in the United States, and recent reports have suggested the suicide rate is increasing. One of the most robust predictors of future suicidal behavior is a history of attempting suicide. Despite this, little is known about the factors that reduce the likelihood of reattempting suicide. This study compares theoretically derived suicide risk indicators to determine which factors are most predictive of future suicide attempts. METHOD: = 97, mean age = 30.3 years, 100% female, 71% White) met criteria for borderline personality disorder and had repeated and recent self-injurious behavior. Assessments occurred at 4-month intervals throughout 1 year of treatment and 1 year of follow-up. Time-lagged generalized linear mixed models (GLMMs) were used to evaluate relationship satisfaction, emotion dysregulation, and coping styles as predictors of suicide attempts. RESULTS: Both univariate and multivariate models suggested that higher between-person variance in problem-focused coping and lack of access to emotion regulation strategies were weakly associated with additional suicide attempts over the 2-year study. Within-person variance in the time-lagged predictors was not associated with subsequent suicide attempts. CONCLUSIONS: Among individuals with a recent suicide attempt, problem-focused coping and specific deficits in emotion regulation may differentiate those likely to reattempt from those who stop suicidal behavior during and after psychotherapy. These results suggest that treatments for recent suicide attempters should target increasing problem-focused coping and decreasing maladaptive emotion regulation skills. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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A second factor that potentially determines whether people enter the transition phase or leave the transition phase unscathed is the (cognitive) availability of (professional/private) supporters, reasons to live and skills in dealing with emotional turmoil.
“A second factor that potentially determines whether people enter the transition phase or leave the transition phase unscathed is the (cognitive) availability of (professional/private) supporters, reasons to live and skills in dealing with emotional turmoil (62).”
From Ambivalence model of suicidality [ABS-model]: an orientation model for the treatment of suicidal individuals (2024) · cites this paper as [62]
The Results and Discussion report that access to emotion-regulation strategies and problem-focused coping were associated with subsequent suicide attempts among patients with borderline personality disorder. They do not address reasons to live or a distinct transition phase. The Results also found no significant association between relationship satisfaction and subsequent attempts; that measure is not the same as the availability of supporters. Page numbers were not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn a longitudinal study of adults with a recent suicide attempt who received DBT treatment, participants with higher problem-focused coping and poorer access to emotion regulation strategies were more likely to reattempt suicide over the course of 2 years.
“In a longitudinal study of adults with a recent suicide attempt who received DBT treatment, participants with higher problem-focused coping and poorer access to emotion regulation strategies were more likely to reattempt suicide over the course of 2 years (Kuehn, King, Linehan, & Harned, 2020).”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Kuehn, King, Linehan, & Harned, 2020
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Experimental — accuracy not yet measuredPreliminary research provides tentative support for mechanisms of change in DBT-A.
“Preliminary research provides tentative support for these mechanisms of change.”
From Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis (2021) · cites this paper as Kuehn, King, Linehan, & Harned, 2020
The Discussion reports a weak association between access to emotion-regulation strategies and subsequent suicide attempts, offering limited support for one proposed DBT mechanism. But the Method describes an adult BPD sample receiving DBT, not DBT-A, and the Discussion says no within-person changes predicted subsequent attempts. The findings therefore do not establish mechanisms of change in DBT-A. (LLM, conf=0.87)
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- Authors
- Kuehn, K. S., King, K. M., Linehan, M. M., & Harned, M. S.
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2020-06
- Volume
- 88
- Issue
- 6
- Pages
- 570-581
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC7228857
- OpenAlex
- W3010885614
- Cited by
- 28
- References
- 40
- Citations by year
- 2025: 2 · 2024: 7 · 2023: 8 · 2022: 2 · 2021: 5 · 2020: 4
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ResearchWorks at the University of Washington (University of Washington) (submittedVersion)
- Funders
- National Institutes of Health (R01MH034486, F31MH117827-01A1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- repeated suicide attempts, borderline personality disorder, suicide risk factors, problem-focused coping, emotional dysregulation, relationship satisfaction, self-harm, suicide attempters
- MeSH terms
- Dialectical Behavior Therapy, Emotional Regulation, Adaptation, Psychological, Adolescent, Adult, Borderline Personality Disorder, Female, Humans, Middle Aged, Risk Factors, Suicide, Attempted, Self-Injurious Behavior, Young Adult, Suicidal Ideation
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