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The Interplay of Borderline Personality and Conduct Disorders Among Previously Suicidal Adolescents


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Viviani, T., Ahmadi, S., Tran, B., et al.
5th International Congress on Borderline Personality Disorder, Barcelona, Spain, 2018

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The Interplay of Borderline Personality and Conduct Disorders Among Previously Suicidal Adolescents

  1. 1. The Interplay of Borderline Personality and Conduct Disorders among previously suicidal adolescents Viviani T., M.A., Ahmadi S., Ph.D, Tran B., Boodaghians, L., Weiss M., PhD, Mishara B., Ph.D, De Castro F., Ph.D and Greenfield B., MD Introduction • Sixty to ninety percent of those with borderline personality disorder (BPD) engage in some form of suicidal behaviour [1], with up to 10% of them completing suicide [2]. • Suicide risk is high when such individuals have a comorbid diagnosis of BPD and antisocial personality disorder (ASPD) [3]. • It has been suggested that BPD mediates the relationship between externalizing disorders and suicide [4-6], however, there is a paucity of longitudinal research of these constructs in a pediatric population. • BPD has also been observed to be frequently comorbid with conduct disorder (CD), among previously suicidal adolescents [7- 10]. Objective To further explore the BPD and CD association in a population of adolescents undergoing a suicidal crisis evaluation at a Montreal hospital emergency room (ER). Methods o Procedure • A secondary analysis to a study that followed 286 suicidal youth presenting to a Montreal hospital ER for a psychiatric evaluation, between 1996 and 1998. A battery of tests and a standardized 3- hour interview was conducted with participants. • This study received ethics approval and abided by all guidelines outlined in the Tri-Council policy for ethical conduct in research. o Measures • Socio-demographic data • Diagnostic Interview Schedule for Children (DISC) • Spectrum of Suicidal Behavior (SSBS) • Children’s Global Assessment Scale (CGAS) • Codding Life Events Scale • Index of Family Relations (IFR) • Abbreviated Diagnostic Interview for Borderlines (Ab-DIB) • Temperament and Character Inventory (TCI-R) • Defense Style Questionnaire (DSQ) Conclusiono Sample Figure I: Population recruitment and sampling Discussion Data (T1 & T4) Measures T4: 4-year follow-up T2: 6-month follow-up T1: Recruitment n = 286 n = 263 (92%) n = 229 (80%) Completed n = 219 (77%) Completed n = 204 (71%) Unmatched n = 15 Incomplete n = 10 Attrition n = 34 1. Suicidal youth with CD (with or without BPD) will differ psychosocially from those without CD, at recruitment and at follow-up. 2. At recruitment, CD will be comorbid with BPD, and at follow-up, there will be a bifurcation of both pathologies as has been indicated in the literature. Hypotheses o Data analysis • T-test and Chi-squared, with Fisher’s exact test, for group differences between CD and non-CD. • Risk ratios: general linear model with log-link function. • Poisson distribution and standard error for bivariate and multivariate models. Results 1. Youth with CD are more vulnerable to BPD at recruitment (cognition and impulsivity) and follow-up (impulsivity) than non- CD subjects. 2. Prevalence of CD and BPD co-occurrence is higher than prevalence of CD alone at recruitment and follow-up. Table II: Group differences between those with and without Conduct disorder follow up Variable Conduct Disorder yes Conduct Disorder no p value Conduct Disorder at Follow-Up* 17 (7.87) 199 (92.13) BPD1 14 (87.50) 153 (80.53) Fisher’s exact= .742 Impulsivity2 14.88 (4.79) 7.09 (5.28) 5.87; p=.000β CGAS > 501 5 (29.41) 152 (76.77) 17.82; p=.000β Suicide1 5 (29.41) 13 (6.57) 10.65; p=.001β Defense Style Questionnaire (DSQ) Image Distorting (ID)2 67.00 (22.14) 54.26 (16.77) 2.92; p=.001β Temperament and Character Inventory (TCI) Novelty Seeking (NS)2 14.76 (2.80) 10.66 (3.59) 4.59; p=.000β Self-Directedness (SD)2 12.12 (4.57) 16.41 (5.75) 3.00; p=.002β Cooperativeness (CS)2 15.06 (5.15) 19.20 (3.75) 4.23; p=.000β Bonferroni correction: .05/28=.002 1: N (%) unit 2: Mean (SD) unit Table I: Group differences between those with and without Conduct disorder at recruitment Variable Conduct Disorder yes Conduct Disorder no p value Conduct Disorder at Recruitment* 67 (23.93) 213 (76.07) BPD1 61 (98.39) 172 (84.31) Fisher’s exact= .002β Cognitive2 8.6 (4.85) 6.13 (4.57) 3.74; p=.000β Impulsivity2 14.17 (4.99) 8.10 (4.96) 8.54; p=.000β Coddington Stress Life Events2 13.11 (7.85) 9.92 (6.21) 3.40; p=.000β 1. BPD distinguishes youth with CD from non-CD youth at recruitment and follow-up. 2. CD youth with BPD are more impaired and more suicidal at follow-up than youth without CD. 3. CD is highly comorbid with BPD until at least age 18. • Neither are proxies for the other disorder. • There is a start of divergence at follow-up. • Suicidal youth with CD are distinguishable from non-CD youth, mainly by virtue of BPD subscales. • There is a very high prevalence of BPD among youth with CD. • This may have significant impact on suicidal dynamics. • There is only a trend towards bifurcation of CD and BPD in pediatric population. • Treatment needs to address both the externalizing disorder and the axis-II disorder. Acknowledgments Special thanks to the Sir Wilfrid Laurier School Board and our research volunteers Zoe Atsaidis and Chanel Lafontaine for their dedication and assistance. References [1] Linehan MM, Heard H. Borderline personality disorder: costs, course, and treatment outcomes. In: Miller N, Magruder K, editors. The cost-effectiveness of psychotherapy: A guide for practitioners, researchers, and policy-makers. New York: Oxford Press; 1999. p. 291–305. [2] Paris J, Zweig-Frank H. A 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry. 2001;42(6):482–7. [3] Paris J. Antisocial and borderline personality disorders: Two separate diagnoses or two aspects of the same psychopathology? Compr Psychiatry. 1997;38(4):237– 42. [4] James LM, Taylor J. Associations between symptoms of borderline personality disorder, externalizing disorders, and suicide-related behaviors. J Psychopathol Behav Assess. 2008;30(1):1–9. [5] Paris J. The development of impulsivity and suicidality in borderline personality disorder. Dev Psychopathol [Internet]. 2005;17(4):1091–104. Available from: [6] Maloney E, Degenhardt L, Darke S, Nelson EC. Impulsivity and borderline personality as risk factors for suicide attempts among opioid-dependent individuals. Psychiatry Res. 2009;169(1):16–21. [7] Freestone M, Howard R, Coid JW, Ullrich S. Adult antisocial syndrome co- morbid with borderline personality disorder is associated with severe conduct disorder, substance dependence and violent antisociality. Personal Ment Health. 2013;7(1):11–21. [8] Zanarini MC, Frankenbourg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-Year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161(11):2108–14. [9] Ha C, Balderas JC, Zanarini MC, Oldham J, Sharp C. Psychiatric comorbidity in hospitalized adolescents with borderline personality disorder. J Clin Psychiatry. 2014;75(5). [10] Eppright TD Robinson BD, Reid JC KJH. Comorbidity of Conduct Disorder and Personality Disorders in an Incarcerated Juvenile Population. Am J Psychiatry. 1993;150:1233–6.