https://doi.org/10.4081/ripppo.2024.814
Impairment in personality functioning predicts young adult suicidal ideation and suicide attempt above and beyond depressive symptoms
Submitted: July 17, 2024
Accepted: November 20, 2024
Published: December 31, 2024
Accepted: November 20, 2024
Abstract Views: 292
PDF: 80
SUPPLEMENTARY: 7
HTML: 0
SUPPLEMENTARY: 7
HTML: 0
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Interpersonal factors and depression are believed to be some of the main drivers of suicidal thoughts and behaviors, but other factors may be equally or more important. Drawing on psychodynamic (mentalization) theory, we propose that personality functioning, in particular an incoherent sense of self, may be an important driver of suicidal thoughts and behaviors over and above factors of interpersonal functioning and depression. To evaluate this, we examined associations between personality functioning and suicidal ideation and suicide attempt in young adults. Participants (N=153; Mage=20.93) were recruited from a college sample (N=90) and a clinical sample with borderline personality disorder (N=63). Personality functioning (self and interpersonal components) was measured with the Level of Personality Functioning Scale - Brief Form 2.0. Suicidal ideation was measured with the Personality Assessment Inventory. Suicide attempt history was assessed with the Columbia-Suicide Severity Rating Scale. Depression symptoms were measured with the Symptom Checklist 90. Regressions examined relationships between personality functioning, depression symptoms, and suicidal ideation or attempt while controlling for age and gender. Overall personality functioning was significantly associated with suicidal ideation (β=.584, p<.001) and suicide attempt (β=.384, p<.001). Overall personality functioning was a stronger predictor than depression symptoms, age, and gender when included in the same model predicting suicidal ideation or attempt. Both the self and interpersonal components of personality functioning were significantly associated with suicidal ideation and attempt, with larger effect sizes for self-functioning. Findings underscore the importance of considering personality functioning, especially self-functioning, in suicide risk assessment and treatment.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). doi: 10.1176/appi.books.9780890425596
DOI: https://doi.org/10.1176/appi.books.9780890425596
Bach, B., & Hutsebaut, J. (2018). Level of Personality Functioning Scale–Brief Form 2.0: Utility in Capturing Personality Problems in Psychiatric Outpatients and Incarcerated Addicts. Journal of Personality Assessment, 100(6), 660–670. doi: 10.1080/00223891.2018.1428984
DOI: https://doi.org/10.1080/00223891.2018.1428984
Ballesteros, M. F., Ivey-Stephenson, A. Z., Trinh, E., & Stone, D. M. (2024). Background and Rationale—CDC Guidance for Communities Assessing, Investigating, and Responding to Suicide Clusters, United States, 2024. MMWR Supplements, 73(2), 1–7. doi: 10.15585/mmwr.su7302a1
DOI: https://doi.org/10.15585/mmwr.su7302a1
Balzen, K. M., Goette, W. F., Sachs, R., Krantz, S. M., Heerschap, J., Kennard, B. D., Emslie, G. J., & Stewart, S. M. (2022). Borderline personality features influence treatment response to suicide prevention. Journal of Affective Disorders, 311, 515–522. doi: 10.1016/j.jad.2022.05.083
DOI: https://doi.org/10.1016/j.jad.2022.05.083
Balzen, K. M., & Sharp, C. (2024). The Contribution of Mentalization-Based Theory and Practice for Understanding and Treating Self-Injurious Behavior in Young People. Journal of Infant, Child, and Adolescent Psychotherapy, 23(1), 108–121. doi: 10.1080/15289168.2024.2311555
DOI: https://doi.org/10.1080/15289168.2024.2311555
Bateman, A., & Fonagy, P. (2009). Randomized Controlled Trial of Outpatient Mentalization-Based Treatment Versus Structured Clinical Management for Borderline Personality Disorder. American Journal of Psychiatry, 166(12), 1355–1364. doi: 10.1176/appi.ajp.2009.09040539
DOI: https://doi.org/10.1176/appi.ajp.2009.09040539
Bateman, A., & Fonagy, P. (2010). Mentalization based treatment for borderline personality disorder. World Psychiatry, 9(1), 11–15. doi: 10.1002/j.2051-5545.2010.tb00255.x
DOI: https://doi.org/10.1002/j.2051-5545.2010.tb00255.x
Bateman, A., & Fonagy, P. (2016). Mentalization-Based Treatment for Personality Disorders: A Practical Guide. Oxford University Press. doi: 10.1093/med:psych/9780199680375.001.0001
DOI: https://doi.org/10.1093/med:psych/9780199680375.001.0001
Bogaerts, A., Claes, L., Raymaekers, K., Buelens, T., Bastiaens, T., & Luyckx, K. (2023). Trajectories of adaptive and disturbed identity dimensions in adolescence: Developmental associations with self-esteem, resilience, symptoms of depression, and borderline personality disorder features. Frontiers in Psychiatry, 14, 1125812. doi: 10.3389/fpsyt.2023.1125812
DOI: https://doi.org/10.3389/fpsyt.2023.1125812
Boone, K., Choi-Kain, L., & Sharp, C. (2024). The Relevance of Generalist Approaches to Early Intervention for Personality Disorder. American Journal of Psychotherapy, appi.psychotherapy.20230050. doi: 10.1176/appi.psychotherapy.20230050
DOI: https://doi.org/10.1176/appi.psychotherapy.20230050
Caligor, E., Kernberg, O. F., Clarkin, J. F., & Yeomans, F. E. (with American Psychiatric Association Publishing). (2018). Psychodynamic therapy for personality pathology: Treating self and interpersonal functioning (First edition).
DOI: https://doi.org/10.1176/appi.books.9781615373529
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13(2), 153–160. doi: 10.1002/wps.20128
DOI: https://doi.org/10.1002/wps.20128
Chu, C., Buchman-Schmitt, J. M., Stanley, I. H., Hom, M. A., Tucker, R. P., Hagan, C. R., Rogers, M. L., Podlogar, M. C., Chiurliza, B., Ringer, F. B., Michaels, M. S., Patros, C. H. G., & Joiner, T. E. (2017). The interpersonal theory of suicide: A systematic review and meta-analysis of a decade of cross-national research. Psychological Bulletin, 143(12), 1313–1345. doi: 10.1037/bul0000123
DOI: https://doi.org/10.1037/bul0000123
Claes, L., Luyckx, K., & Bijttebier, P. (2014). Non-suicidal self-injury in adolescents: Prevalence and associations with identity formation above and beyond depression. Personality and Individual Differences, 61–62, 101–104. doi: 10.1016/j.paid.2013.12.019
DOI: https://doi.org/10.1016/j.paid.2013.12.019
Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evaluating Three Treatments for Borderline Personality Disorder: A Multiwave Study. American Journal of Psychiatry, 164(6), 922–928. doi: 10.1176/ajp.2007.164.6.922
DOI: https://doi.org/10.1176/ajp.2007.164.6.922
Crenshaw, K. (1991). Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color. Stanford Law Review, 43(6), 1241. doi: 10.2307/1229039
DOI: https://doi.org/10.2307/1229039
Cyrus, K. (2017). Multiple minorities as multiply marginalized: Applying the minority stress theory to LGBTQ people of color. Journal of Gay & Lesbian Mental Health, 21(3), 194–202. doi: 10.1080/19359705.2017.1320739
DOI: https://doi.org/10.1080/19359705.2017.1320739
Derogatis, L. R. (1994). Symptom Checklist-90-Revised: Administration, scoring, and procedures manual. NCS Pearson.
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale—Preliminary report. Psychopharmacology Bulletin, 9(1), 13–27.
Díaz-Oliván, I., Porras-Segovia, A., Barrigón, M. L., Jiménez-Muñoz, L., & Baca-García, E. (2021). Theoretical models of suicidal behaviour: A systematic review and narrative synthesis. The European Journal of Psychiatry, 35(3), 181–192. doi: 10.1016/j.ejpsy.2021.02.002
DOI: https://doi.org/10.1016/j.ejpsy.2021.02.002
Fonagy, P., Campbell, C., Constantinou, M., Higgitt, A., Allison, E., & Luyten, P. (2022). Culture and psychopathology: An attempt at reconsidering the role of social learning. Development and Psychopathology, 34(4), 1205–1220. doi: 10.1017/S0954579421000092
DOI: https://doi.org/10.1017/S0954579421000092
Fonagy, P., Gergely, G., Jurist, E. L., & Target, M. (2002). Affect Regulation, Mentalization, and the Development of the Self (P. Fonagy, G. Gergely, & E. L. Jurist, Eds.; 1st ed.). Routledge. doi: 10.4324/9780429471643
DOI: https://doi.org/10.4324/9780429471643
Fonagy, P., & Target, M. (1998). Mentalization and the changing aims of child psychoanalysis. Psychoanalytic Dialogues, 8(1), 87–114. doi: 10.1080/10481889809539235
DOI: https://doi.org/10.1080/10481889809539235
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. doi: 10.1037/bul0000084
DOI: https://doi.org/10.1037/bul0000084
Galione, J., & Zimmerman, M. (2010). A Comparison of Depressed Patients with and Without Borderline Personality Disorder: Implications for Interpreting Studies of the Validity of the Bipolar Spectrum. Journal of Personality Disorders, 24(6), 763–772. doi: 10.1521/pedi.2010.24.6.763
DOI: https://doi.org/10.1521/pedi.2010.24.6.763
Goldbach, J. T., Rhoades, H., Mamey, M. R., Senese, J., Karys, P., & Marsiglia, F. F. (2021). Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: A randomized controlled trial of Proud & Empowered. BMC Public Health, 21(1), 2315. doi: 10.1186/s12889-021-12357-5
DOI: https://doi.org/10.1186/s12889-021-12357-5
Goldhammer, H., Crall, C., & Keuroghlian, A. S. (2019). Distinguishing and Addressing Gender Minority Stress and Borderline Personality Symptoms. Harvard Review of Psychiatry, 27(5), 317–325. doi: 10.1097/HRP.0000000000000234
DOI: https://doi.org/10.1097/HRP.0000000000000234
Goodman, M., Tomas, I. A., Temes, C. M., Fitzmaurice, G. M., Aguirre, B. A., & Zanarini, M. C. (2017). Suicide attempts and self-injurious behaviours in adolescent and adult patients with borderline personality disorder: Suicide attempts and self-injurious behaviours. Personality and Mental Health, 11(3), Article 3. doi: 10.1002/pmh.1375
DOI: https://doi.org/10.1002/pmh.1375
Goth, K., Birkhölzer, M., & Schmeck, K. (2018). Assessment of Personality Functioning in Adolescents With the LoPF–Q 12–18 Self-Report Questionnaire. Journal of Personality Assessment, 100(6), 680–690. doi: 10.1080/00223891.2018.1489258
DOI: https://doi.org/10.1080/00223891.2018.1489258
Gregory, R., Sperry, S. D., Williamson, D., Kuch-Cecconi, R., & Spink, G. L. (2021). High Prevalence of Borderline Personality Disorder Among Psychiatric Inpatients Admitted for Suicidality. Journal of Personality Disorders, 35(5), 776–787. doi: 10.1521/pedi_2021_35_508
DOI: https://doi.org/10.1521/pedi_2021_35_508
Gunderson, J., Masland, S., & Choi-Kain, L. (2018). Good psychiatric management: A review. Current Opinion in Psychology, 21, 127–131. doi: 10.1016/j.copsyc.2017.12.006
DOI: https://doi.org/10.1016/j.copsyc.2017.12.006
Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice, 43(5), 460–467. doi: 10.1037/a0029597
DOI: https://doi.org/10.1037/a0029597
Hoertel, N., Sabatier, J., Blanco, C., Olfson, M., Schuster, J.-P., Airagnes, G., Peyre, H., & Limosin, F. (2020). Contributing Factors to Heterogeneity in the Timing of the Onset of Nonfatal Suicidal Behavior: Results From a Nationally Representative Study. The Journal of Clinical Psychiatry, 81(3). doi: 10.4088/JCP.19m13017
DOI: https://doi.org/10.4088/JCP.19m13017
Hutsebaut, J., Kamphuis, J. H., Feenstra, D. J., Weekers, L. C., & De Saeger, H. (2017). Assessing DSM–5-oriented level of personality functioning: Development and psychometric evaluation of the Semi-Structured Interview for Personality Functioning DSM–5 (STiP-5.1). Personality Disorders: Theory, Research, and Treatment, 8(1), 94–101. doi: 10.1037/per0000197
DOI: https://doi.org/10.1037/per0000197
Ilagan, G. S., & Choi-Kain, L. W. (2021). General psychiatric management for adolescents (GPM-A) with borderline personality disorder. Current Opinion in Psychology, 37, 1–6. doi: 10.1016/j.copsyc.2020.05.006
DOI: https://doi.org/10.1016/j.copsyc.2020.05.006
Johns, M. M., Lowry, R., J Andrzejewski, Barrios, L. C., Demissie, Z., McManus, T., Rasberry, C., Robin, L., & Underwood, J. M. (2019). Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students—19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep, 68(3), 67–71.
DOI: https://doi.org/10.15585/mmwr.mm6803a3
Joiner, T. (2007). Why people die by suicide (First Harvard University Press paperback edition). Harvard University Press.
DOI: https://doi.org/10.2307/j.ctvjghv2f
Kaufman, E. A., & Meddaoui, B. (2021). Identity pathology and borderline personality disorder: An empirical overview. Current Opinion in Psychology, 37, 82–88. doi: 10.1016/j.copsyc.2020.08.015
DOI: https://doi.org/10.1016/j.copsyc.2020.08.015
Kelly, T. M., Soloff, P. H., Lynch, K. G., Haas, G. L., & Mann, J. J. (2000). Recent Life Events, Social Adjustment, and Suicide Attempts in Patients with Major Depression and Borderline Personality Disorder. Journal of Personality Disorders, 14(4), 4. doi: 10.1521/pedi.2000.14.4.316
DOI: https://doi.org/10.1521/pedi.2000.14.4.316
Kerr, S., McLaren, V., Cano, K., Vanwoerden, S., Goth, K., & Sharp, C. (2023). Levels of Personality Functioning Questionnaire 12-18 (LoPF-Q 12-18): Factor Structure, Validity, and Clinical Cut-Offs. Assessment, 30(6), 1764–1776. doi: 10.1177/10731911221124340
DOI: https://doi.org/10.1177/10731911221124340
Koeter, M. W. J. (1992). Validity of the GHQ and SCL anxiety and depression scales: A comparative study. Journal of Affective Disorders, 24(4), 271–279. doi: 10.1016/0165-0327(92)90112-J
DOI: https://doi.org/10.1016/0165-0327(92)90112-J
La Guardia, J. G. (2009). Developing Who I Am: A Self-Determination Theory Approach to the Establishment of Healthy Identities. Educational Psychologist, 44(2), 90–104. doi: 10.1080/00461520902832350
DOI: https://doi.org/10.1080/00461520902832350
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Lingiardi, V., Di Cicilia, G., & Boldrini, T. (2019). Personality, mental functioning, and symptoms: Assessing suicidal risk with the Psychodynamic Diagnostic Manual, 2nd ed. (PDM-2). Journal of Psychopathology, 25(3), 132–138.
Lingiardi, V., & McWilliams, N. (2015). The psychodynamic diagnostic manual—2nd edition (PDM-2). World Psychiatry, 14(2), 237–239. doi: 10.1002/wps.20233
DOI: https://doi.org/10.1002/wps.20233
Liotti, M., Speranza, A. M., & Fortunato, A. (2024). The logic of the symptom: Using a complex assessment procedure to reformulate the psychotherapeutic plan of a 9-year-old suicidal child. Psychoanalytic Psychology, 41(3), 118–128. doi: 10.1037/pap0000506
DOI: https://doi.org/10.1037/pap0000506
Ma, J., Batterham, P. J., Calear, A. L., & Han, J. (2016). A systematic review of the predictions of the Interpersonal–Psychological Theory of Suicidal Behavior. Clinical Psychology Review, 46, 34–45. doi: 10.1016/j.cpr.2016.04.008
DOI: https://doi.org/10.1016/j.cpr.2016.04.008
McGough, J., & Curry, J. F. (1992). Utility of the SCL-90-R With Depressed and Conduct-Disordered Adolescent Inpatients. Journal of Personality Assessment, 59(3), 552–563. doi: 10.1207/s15327752jpa5903_9
DOI: https://doi.org/10.1207/s15327752jpa5903_9
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A Randomized Trial of Dialectical Behavior Therapy Versus General Psychiatric Management for Borderline Personality Disorder. American Journal of Psychiatry, 166(12), 1365–1374. doi: 10.1176/appi.ajp.2009.09010039
DOI: https://doi.org/10.1176/appi.ajp.2009.09010039
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi: 10.1037/0033-2909.129.5.674
DOI: https://doi.org/10.1037/0033-2909.129.5.674
Moradi, B., & Grzanka, P. R. (2017). Using intersectionality responsibly: Toward critical epistemology, structural analysis, and social justice activism. Journal of Counseling Psychology, 64(5), 500–513. doi: 10.1037/cou0000203
DOI: https://doi.org/10.1037/cou0000203
Morey, L. C. (1991). Personality Assessment Inventory. Psychological Assessment Resources.
DOI: https://doi.org/10.1037/t03903-000
Morey, L. C. (2007). Personality Assessment Inventory. (2nd ed.). Psychological Assessment Resources.
DOI: https://doi.org/10.4135/9781849200479.n30
Morey, L. C. (2017). Development and initial evaluation of a self-report form of the DSM–5 Level of Personality Functioning Scale. Psychological Assessment, 29(10), 1302–1308. doi: 10.1037/pas0000450
DOI: https://doi.org/10.1037/pas0000450
Morey, L. C., Good, E. W., & Hopwood, C. J. (2022). Global personality dysfunction and the relationship of pathological and normal trait domains in the DSM‐5 alternative model for personality disorders. Journal of Personality, 90(1), 34–46. doi: 10.1111/jopy.12560
DOI: https://doi.org/10.1111/jopy.12560
Nock, M. K. (2016). Recent and needed advances in the understanding, prediction, and prevention of suicidal behavior: Editorial. Depression and Anxiety, 33(6), 460–463. doi: 10.1002/da.22528
DOI: https://doi.org/10.1002/da.22528
Oitsalu, M.-L., Kreegipuu, M., & Hutsebaut, J. (2022). Psychometric evaluation of the Estonian version of the Semi-structured Interview for Personality Functioning DSM-5 (STiP-5.1). Borderline Personality Disorder and Emotion Dysregulation, 9(1), 28. doi: 10.1186/s40479-022-00197-7
DOI: https://doi.org/10.1186/s40479-022-00197-7
Parolin, L., Milesi, A., Comelli, G., & Locati, F. (2024). The interplay of mentalization and epistemic trust: A protective mechanism against emotional dysregulation in adolescent internalizing symptoms. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). doi: 10.4081/ripppo.2023.707
DOI: https://doi.org/10.4081/ripppo.2023.707
Pellicane, M. J., & Ciesla, J. A. (2022). Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clinical Psychology Review, 91, 102113. doi: 10.1016/j.cpr.2021.102113
DOI: https://doi.org/10.1016/j.cpr.2021.102113
Posner, K., Brent, D. A., Lucas, C., Gould, M., Stanley, G., Brown, G., Fisher, P., Zelazny, J., Burke, A., Oquendo, M. A., & Mann, J. (2008). Columbia-Suicide Severity Rating Scale (C-SSRS). The Research Foundation for Mental Hygiene.
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults. American Journal of Psychiatry, 168(12), 1266–1277. doi: 10.1176/appi.ajp.2011.10111704
DOI: https://doi.org/10.1176/appi.ajp.2011.10111704
Price-Feeney, M., Green, A. E., & Dorison, S. (2020). Understanding the Mental Health of Transgender and Nonbinary Youth. Journal of Adolescent Health, 66(6), 684–690. doi: 10.1016/j.jadohealth.2019.11.314
DOI: https://doi.org/10.1016/j.jadohealth.2019.11.314
Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M. J. (2015). Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study. Journal of Adolescent Health, 56(3), 274–279. doi: 10.1016/j.jadohealth.2014.10.264
DOI: https://doi.org/10.1016/j.jadohealth.2014.10.264
Ren, Y., Zhang, X., You, J., Jiang, Y., Lin, M., & Leung, F. (2018). The reciprocal associations between identity disturbance, relationship disturbance, and suicidal ideation among Chinese adolescents: A three‐wave cross‐lag study. Journal of Clinical Psychology, 74(7), 1174–1188. doi: 10.1002/jclp.22573
DOI: https://doi.org/10.1002/jclp.22573
Rosen, K. (2016). Social and emotional development: Attachment relationships and the emerging self. Palgrave.
DOI: https://doi.org/10.1007/978-1-137-57901-0
Sarhan, Z. A. E., El Shinnawy, H. A., Eltawil, M. E., Elnawawy, Y., Rashad, W., & Saadeldin Mohammed, M. (2019). Global functioning and suicide risk in patients with depression and comorbid borderline personality disorder. Neurology, Psychiatry and Brain Research, 31, 37–42. doi: 10.1016/j.npbr.2019.01.001
DOI: https://doi.org/10.1016/j.npbr.2019.01.001
Scala, J. W., Levy, K. N., Johnson, B. N., Kivity, Y., Ellison, W. D., Pincus, A. L., Wilson, S. J., & Newman, M. G. (2018). The Role of Negative Affect and Self-Concept Clarity in Predicting Self-Injurious Urges in Borderline Personality Disorder Using Ecological Momentary Assessment. Journal of Personality Disorders, 32(Supplement), 36–57. doi: 10.1521/pedi.2018.32.supp.36
DOI: https://doi.org/10.1521/pedi.2018.32.supp.36
Schneider, B., Schnabel, A., Wetterling, T., Bartusch, B., Weber, B., & Georgi, K. (2008). How Do Personality Disorders Modify Suicide Risk? Journal of Personality Disorders, 22(3), 233–245. doi: 10.1521/pedi.2008.22.3.233
DOI: https://doi.org/10.1521/pedi.2008.22.3.233
Sekowski, M., Gambin, M., & Sharp, C. (2021). The Relations Between Identity Disturbances, Borderline Features, Internalizing Disorders, and Suicidality in Inpatient Adolescents. Journal of Personality Disorders, 35(Supplement B), 29–47. doi: 10.1521/pedi_2021_35_501
DOI: https://doi.org/10.1521/pedi_2021_35_501
Sharp, C., Green, K. L., Yaroslavsky, I., Venta, A., Zanarini, M. C., & Pettit, J. (2012). The Incremental Validity of Borderline Personality Disorder Relative to Major Depressive Disorder for Suicidal Ideation and Deliberate Self-Harm in Adolescents. Journal of Personality Disorders, 26(6), 927–938. doi: 10.1521/pedi.2012.26.6.927
DOI: https://doi.org/10.1521/pedi.2012.26.6.927
Sharp, C., Vanwoerden, S., & Wall, K. (2018). Adolescence as a Sensitive Period for the Development of Personality Disorder. Psychiatric Clinics of North America, 41(4), 4. doi: 10.1016/j.psc.2018.07.004
DOI: https://doi.org/10.1016/j.psc.2018.07.004
Sharp, C., & Wall, K. (2018). Personality pathology grows up: Adolescence as a sensitive period. Current Opinion in Psychology, 21, 111–116. doi: 10.1016/j.copsyc.2017.11.010
DOI: https://doi.org/10.1016/j.copsyc.2017.11.010
Sharp, C., Wright, A. G. C., Fowler, J. C., Frueh, B. C., Allen, J. G., Oldham, J., & Clark, L. A. (2015). The structure of personality pathology: Both general (‘g’) and specific (‘s’) factors? Journal of Abnormal Psychology, 124(2), 387–398. doi: 10.1037/abn0000033
DOI: https://doi.org/10.1037/abn0000033
Söderholm, J. J., Socada, J. L., Rosenström, T., Ekelund, J., & Isometsä, E. T. (2020). Borderline Personality Disorder With Depression Confers Significant Risk of Suicidal Behavior in Mood Disorder Patients—A Comparative Study. Frontiers in Psychiatry, 11, 290. doi: 10.3389/fpsyt.2020.00290
DOI: https://doi.org/10.3389/fpsyt.2020.00290
Soloff, P. H. (2000). Characteristics of Suicide Attempts of Patients With Major Depressive Episode and Borderline Personality Disorder: A Comparative Study. American Journal of Psychiatry, 157(4), 601–608. doi: 10.1176/appi.ajp.157.4.601
DOI: https://doi.org/10.1176/appi.ajp.157.4.601
Tanzilli, A., Fiorentino, F., Liotti, M., Lo Buglio, G., Gualco, I., Lingiardi, V., Sharp, C., & Williams, R. (2024). Patient personality and therapist responses in the psychotherapy of adolescents with depressive disorders: Toward the Psychodynamic Diagnostic Manual - third edition. Research in Psychotherapy: Psychopathology, Process and Outcome. doi: 10.4081/ripppo.2024.752
DOI: https://doi.org/10.4081/ripppo.2024.752
Tilley, J. L., Molina, L., Luo, X., Natarajan, A., Casolaro, L., Gonzalez, A., & Mahaffey, B. (2022). Dialectical behaviour therapy ( DBT ) for high‐risk transgender and gender diverse ( TGD ) youth: A qualitative study of youth and mental health providers’ perspectives on intervention relevance. Psychology and Psychotherapy: Theory, Research and Practice, 95(4), 1056–1070. doi: 10.1111/papt.12418
DOI: https://doi.org/10.1111/papt.12418
Trinh, E., Ivey-Stephenson, A. Z., Ballesteros, M. F., Idaikkadar, N., Wang, J., & Stone, D. M. (2024). CDC Guidance for Community Assessment and Investigation of Suspected Suicide Clusters, United States, 2024. MMWR Supplements, 73(2), 8–16. doi: 10.15585/mmwr.su7302a2
DOI: https://doi.org/10.15585/mmwr.su7302a2
Turecki, G., Brent, D. A., Gunnell, D., O’Connor, R. C., Oquendo, M. A., Pirkis, J., & Stanley, B. H. (2019). Suicide and suicide risk. Nature Reviews Disease Primers, 5(1), 74. doi: 10.1038/s41572-019-0121-0
DOI: https://doi.org/10.1038/s41572-019-0121-0
Van Doeselaar, L., Becht, A. I., Klimstra, T. A., & Meeus, W. H. J. (2018). A Review and Integration of Three Key Components of Identity Development: Distinctiveness, Coherence, and Continuity. European Psychologist, 23(4), 278–288. doi: 10.1027/1016-9040/a000334
DOI: https://doi.org/10.1027/1016-9040/a000334
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. doi: 10.1037/a0018697
DOI: https://doi.org/10.1037/a0018697
Vizgaitis, A. L., & Lenzenweger, M. F. (2022). Identity and Personality Pathology: A Convergence Across the DSM-5 Personality Disorder Model and the Alternative Model for Personality Disorders. Journal of Personality Disorders, 36(5), 537–558. doi. 10.1521/pedi.2022.36.5.537
DOI: https://doi.org/10.1521/pedi.2022.36.5.537
Weekers, L. C., Hutsebaut, J., & Kamphuis, J. H. (2019). The Level of Personality Functioning Scale‐Brief Form 2.0: Update of a brief instrument for assessing level of personality functioning. Personality and Mental Health, 13(1), 3–14. doi: 10.1002/pmh.1434
DOI: https://doi.org/10.1002/pmh.1434
Weekers, L. C., Sellbom, M., Hutsebaut, J., Simonsen, S., & Bach, B. (2023). Normative data for the LPFS‐BF 2.0 derived from the Danish general population and relationship with psychosocial impairment. Personality and Mental Health, 17(2), 157–164. doi: 10.1002/pmh.1570
DOI: https://doi.org/10.1002/pmh.1570
Williams, R., Fiorentino, F., Lingiardi, V., Moselli, M., Sharp, C., & Tanzilli, A. (2024). The assessment of pathways towards suicide in adolescent patients: A PDM‐2‐ORIENTED approach. Psychology and Psychotherapy: Theory, Research and Practice, papt.12529. doi: 10.1111/papt.12529
DOI: https://doi.org/10.1111/papt.12529
Witt, K., Milner, A., Spittal, M. J., Hetrick, S., Robinson, J., Pirkis, J., & Carter, G. (2019). Population attributable risk of factors associated with the repetition of self-harm behaviour in young people presenting to clinical services: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 28(1), 5–18. doi: 10.1007/s00787-018-1111-6
DOI: https://doi.org/10.1007/s00787-018-1111-6
World Health Organization. (2022). International Classification of Diseases Eleventh Revision (ICD-11).
Wright, A. G. C., Hopwood, C. J., Skodol, A. E., & Morey, L. C. (2016). Longitudinal validation of general and specific structural features of personality pathology. Journal of Abnormal Psychology, 125(8), 1120–1134. doi: 10.1037/abn0000165
DOI: https://doi.org/10.1037/abn0000165
Wu, J., Allman, M., Balzen, K., Hutsebaut, J., & Sharp, C. (2024). First psychometric evaluation of the Level of Personality Functioning Scale—Brief Form 2.0 in adolescents. Personality Disorders: Theory, Research, and Treatment, 15(6), 492–503. doi: 10.1037/per0000674
DOI: https://doi.org/10.1037/per0000674
Yen, S., Peters, J. R., Nishar, S., Grilo, C. M., Sanislow, C. A., Shea, M. T., Zanarini, M. C., McGlashan, T. H., Morey, L. C., & Skodol, A. E. (2021). Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up. JAMA Psychiatry, 78(2), 187. doi: 10.1001/jamapsychiatry.2020.3598
DOI: https://doi.org/10.1001/jamapsychiatry.2020.3598
Zanarini, M. C., Frankenburg, F. R., Dubo, E. D., Sickel, A. E., Trikha, A., Levin, A., & Reynolds, V. (1998). Axis I Comorbidity of Borderline Personality Disorder. American Journal of Psychiatry, 155(12), 12. doi: 10.1176/ajp.155.12.1733
DOI: https://doi.org/10.1176/ajp.155.12.1733
Zanarini, M. C., Vujanovic, A. A., Parachini, E. A., Boulanger, J. L., Frankenburg, F. R., & Hennen, J. (2003). A Screening Measure for BPD: The McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Journal of Personality Disorders, 17(6), 568–573. doi: 10.1521/pedi.17.6.568.25355
DOI: https://doi.org/10.1521/pedi.17.6.568.25355
Zeng, R., Cohen, L. J., Tanis, T., Qizilbash, A., Lopatyuk, Y., Yaseen, Z. S., & Galynker, I. (2015). Assessing the contribution of borderline personality disorder and features to suicide risk in psychiatric inpatients with bipolar disorder, major depression and schizoaffective disorder. Psychiatry Research, 226(1), 361–367. doi: 10.1016/j.psychres.2015.01.020
DOI: https://doi.org/10.1016/j.psychres.2015.01.020
Zimmerman, M., & Mattia, J. I. (1999). Axis I diagnostic comorbidity and borderline personality disorder. Comprehensive Psychiatry, 40(4), Article 4. doi: 10.1016/S0010-440X(99)90123-2
DOI: https://doi.org/10.1016/S0010-440X(99)90123-2
Zisook, S., Goff, A., Sledge, P., & Shuchter, S. (1994). Reported Suicidal Behavior and Current Suicidal Ideation in a Psychiatric Outpatient Clinic. Annals of Clinical Psychiatry, 6(1), 27–31. doi: 10.3109/10401239409148836
DOI: https://doi.org/10.3109/10401239409148836
How to Cite
Boone, K., Balzen, K. M., & Sharp, C. (2024). Impairment in personality functioning predicts young adult suicidal ideation and suicide attempt above and beyond depressive symptoms. Research in Psychotherapy: Psychopathology, Process and Outcome, 27(3). https://doi.org/10.4081/ripppo.2024.814
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Marta Vigorelli, Gruppo di ricerca coordinato da Marta Vigorelli , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 13 No. 2 (2010)
- Vera Regina Rohnelt Ramires, Cibele Carvalho, Fernanda Munhoz Driemeier Schmidt, Guilherme Pacheco Fiorini, Geoff Goodman, Interaction structures in the psychodynamic therapy of a boy diagnosed with Asperger’s disorder: a single-case study , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 18 No. 2 (2015): Special issue on Qualitative and Quantitative Research in Child and Adolescent Psychotherapy: part 1
- Paolo Migone, The influence of pharmaceutical companies , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 20 No. 2 (2017)
- Elena Faccio, Ludovica Aquili, Michele Rocelli, What is therapeutic? Analysis of the narratives available on the websites of Italian addiction rehab centres to present the therapeutic programme , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 1 (2023)
- Laura Bonalume, Laura Corbelli, Mattia Ferro, Anna Lisa Mazzoleni, Maria Pia Roggero , Developing a prototype for relationship therapy psychoanalysis: an empirical study with the Psychotherapy Process Q-set , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 26 No. 1 (2023)
- Paul Schröder-Pfeifer, Alessandro Talia, Jana Volkert, Svenja Taubner, Developing an assessment of epistemic trust: a research protocol , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 21 No. 3 (2018)
- Francesco Gazzillo, Adriano Schimmenti, Ivan Formica, Alessandra Simonelli, Sergio Salvatore, Effectiveness is the gold standard of clinical research , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 20 No. 2 (2017)
- Giulia Bassi, Elisa Mancinelli, Daniela Di Riso, Adriana Lis, Silvia Salcuni, Separation anxiety in a community sample of Italian emerging adults and its relationship with dimensions of borderline personality , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 24 No. 1 (2021)
- Jung Ki Kim, Eileen M. Crimmins, Age differences in the relationship between threatening and coping mechanisms and preventive behaviors in the time of COVID-19 in the United States: Protection Motivation Theory , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 23 No. 3 (2020)
- Vittorio Lenzo, Maria Teresa Gargano, Massimo Mucciardi, Girolamo Lo Verso, Maria C. Quattropani, Clinical Efficacy and Therapeutic Alliance in a Time-Limited Group Therapy for Young Adults , Research in Psychotherapy: Psychopathology, Process and Outcome: Vol. 17 No. 1 (2014)
<< < 14 15 16 17 18 19 20 21 22 23 > >>
You may also start an advanced similarity search for this article.
