Suicidal Communications in Adults with Borderline Personality Disorder: Clinical Correlates and Treatment Response to Dialectical Behavior Therapy

ObjectiveSuicidal communications (SCs)-also known as suicide threats or "gestures," whereby an individual verbally or behaviorally signals suicidal intent-present a serious challenge to clinicians and loved ones, who may struggle to determine the appropriate level of response. Yet, few studies have examined clinical correlates of SCs, partly due to inconsistent operationalization. It is critical to identify mechanisms that maintain SCs and clarify associated suicide risk, especially among individuals with borderline personality disorder (BPD), among whom SCs are relatively common.MethodAdults (N = 108) with BPD receiving a 6-month course of dialectical behavior therapy (DBT) reported on SCs and other suicidal thoughts and behaviors (STBs) at intake, mid-treatment, and end-of-treatment. Participants also completed measures assessing BPD severity, emotion dysregulation, and DBT skills uptake.ResultsParticipants who endorsed lifetime SCs (53%) reported higher BPD severity and worse emotion dysregulation at baseline. However, dosage of DBT-conceptualized as both skills uptake and length of time in treatment-reduced the incidence of SCs. There were no significant associations between lifetime SCs and engagement in other STBs, both at baseline and during treatment.ConclusionCurrent findings support a conceptualization of SCs as an expression of severe emotion dysregulation, which may be alleviated by DBT. Specifically, DBT may protect against SCs by teaching alternative, more adaptive coping strategies, even in the presence of heightened emotion dysregulation. Finally, though results indicate a lack of association between SCs and other STBs, further researcher is needed before clinical recommendations can be made.