Variability in Suicidal Ideation is Associated with Affective Instability in Suicide Attempters with Borderline Personality Disorder
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Objective: Suicidal ideation (SI) is heterogeneous with different patterns and risk factors. SI can be persistent with stable severity, but may also fluctuate rapidly over a short period of time. The latter pattern is likely associated with affective instability and may consist of activation of SI at times of stress, that then subside. Although affective instability is a hallmark of borderline personality disorder (BPD), little is known about SI variability in BPD. We hypothesized that SI variability would be associated with affective instability in BPD suicide attempters. Method: Sample included 38 females with BPD and history of suicidal behavior. SI was assessed over 1 week using ecological momentary assessment (EMA) at six epochs daily. The relationship between SI variability (i.e., change of SI from one epoch to another) and SI severity (i.e., average scores across epochs), and affective instability, assessed using the Affective Lability Scale (ALS), were examined. Possible confounding effects of depression severity and impulsiveness were tested. Results: Participants demonstrated high ALS scores and wide range of SI variability. ALS scores predicted SI variability, even after controlling for depression severity. Although ALS also predicted SI severity, this association was driven by depression severity. ALS did not correlate with impulsiveness score. Conclusions: Affective instability may predict SI variability in BPD suicide attempters independent of depression severity. This supports our model of suicidal subgroups with different constellations of clinical aspects and risk factors. Future studies could examine these associations in larger samples and different populations to determine implications for suicide prevention.
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Suicidal ideation variability is associated with mood instability.
“This pattern of suicidal ideation variability is associated with mood instability (254, 255)”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [254]
The most frequent primary co-morbid diagnoses in the reviewed studies were depressive disorders and borderline personality disorder, but inclusion was typically based on a recent history of self-reported suicidal thoughts and behaviors.
“Most frequent primary co-morbid diagnoses were depressive disorders (83, 84, 86) and borderline personality disorder [BPD (58, 64, 82)]; however, inclusion was typically based on (recent) history of self-reported STBs to ensure sufficient number of observations of STBs during the assessment period.”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [58]
Pseudo-random sampling schedules were most frequently used (57%, n = 13), followed by fixed sampling (26%, n = 6), and combined fixed and pseudo-random sampling (13%, n = 3).
“(pseudo)random sampling schedules were most frequently used [57%, n = 13 (42, 47, 51, 58, 61, 65, 69, 71, 79, 83, 85, 86, 88)], followed by fixed sampling [26%, n = 6 (45, 66, 67, 72, 80, 82)], and protocols that combined both fixed and (pseudo)random sampling [13%, n = 3 (47, 56, 60)].”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [58]
Studies frequently (57%, n = 13) reported that participants could provide input about their daily schedules, allowing EMA prompt windows to be adjusted for each participant.
“Studies frequently (57%, n = 13; (47, 51, 58, 60, 61, 69, 71, 79–81, 85, 86)) reported that participants could provide input about their daily schedules (incl. sleep and wake times), allowing EMA prompt windows to be adjusted for each participant”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [58]
Most individuals in the reviewed studies experienced substantial variability in suicidal ideation both between days and within days.
“Most individuals experienced substantial variability in suicidal ideation both between- (55) and within-days (47, 56, 58).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [58]
General affective instability was associated with suicidal ideation variability among female BPD patients and inpatient individuals diagnosed with MDD or bipolar disorder.
“General affective instability (i.e., tendency to experience frequent, sudden changes in mood) was associated with suicidal ideation variability among female BPD patients (58), and inpatient individuals diagnosed with MDD or bipolar disorder (66).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [58]
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References 15 · Cited by 74
- Authors
- Rizk, M. M., Choo, T.-H., Galfalvy, H., Biggs, E., Brodsky, B. S., Oquendo, M. A., Mann, J. J., & Stanley, B.
- Affiliations
- New York State Psychiatric Institute (US)
- Corresponding author
- Rizk, Mina M.
- Venue
- Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2019-04-03
- Volume
- 82
- Issue
- 2
- Pages
- 173-178
- ISSN
- 0033-2747 (ISSN-L)
- 1943-281X
- PMC
- PMC6554039
- OpenAlex
- W2942209888
- Cited by
- 74
- References
- 15
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 12 · 2023: 17 · 2022: 12 · 2021: 11 · 2020: 8
- FWCI
- 9.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r01mh062665-05)
- National Institute of Mental Health (P50MH090964, #R01 MH062665, R01MH109326, R01MH061017)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- suicidal ideation, neuroticism, borderline personality disorder, suicide attempters, depression severity, impulsivity, suicide prevention
- MeSH terms
- Adolescent, Adult, Affective Symptoms, Borderline Personality Disorder, Female, Humans, Male, Middle Aged, Severity of Illness Index, Suicide, Attempted, Young Adult, Suicidal Ideation
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