ABSTRACT
Suicide attempt in patients diagnosed with Borderline Personality Disorder (BPD) is the most frequent cause of hospitalization in this clinical category and suicidal risks are usually the first manifestation of such disorder. Patients frequently relapse, thus generating high personal and family costs, including: treatments, hospitalization, medication, work disability in economically active people and even death. The American Psychiatric Association, through the DSM-IV, defines the Borderline Personality Disorder as <>. More specifically, criterion five of the disorder mentions self-mutilating behavior, threats, and recurrent suicidal behavior. DSM-IV reports that 8-10% of borderline patients commit suicide. In our country, however, there are no specific data about people diagnosed with BPD who actually have commited suicide. Prevalence of BPD among the general population ranks from 1 to 2%, from 11 to 20% of the psychiatric population; representing 20% of hospitalized patients. The gender distribution is 3:1, being more frequent among women than men. The objective of this study is the assessment of suicidal risk and lethality of 15 patients diagnosed with Borderline Personality Disorder. This research was conducted at the doctors' offices of the host institution, where 1.39% of a total of 1151 hospitalized patients in 2007 were diagnosed with BPD. The comorbidity of DSM-IV Axis I and BPD is frequent and can be found together with mood disorders (depression, dysthymia), substance-related disorders, eating disorders (bulimia nervosa), post-traumatic stress disorder, anxiety disorder and/or attention-deficit hyperactivity disorder. A research conducted in the USA with 504 patients diagnosed with BPD showed that 93% (n = 379) of the patients showed comorbidity of DSM-IV Axis I and mood disorders. Similar results were reported by other researchers. This study was designed to be a descriptive and transversal study. We went through the records of all the adult patients who had been hospitalized due to suicide ideation or attempt, diagnosed by psychiatrists as Borderline Personality Disorder, and confirmed by the SCID-II, and medicated by a psychiatrist. Selection criteria: 18 year-old patients or older, hospitalized due to suicide attempt or ideation, and diagnosed with BPD. The research was conducted in compliance with the regulations governing human research ethics set forth in the Declaration of Helsinki (1975). The instruments used were: the medical history of the patients, the ID file for clinical and epidemiological studies, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID -II), the Hopelessness Scale, the Depressive Syndrome Questionnaire, the Suicidal Ideation Scale, the Risk-Rescue Scale and some risk factors such as: sexual abuse, separation from partner, parental divorce, the suicide of a close relative, and alcohol and substance abuse. The results on the lethality of suicide attempts are similar to the results of other studies: women show a higher number of less lethal suicide attempts, and the methods used are also similar (medication intoxication and mutilation). The comorbidity with depressive disorders was of 86.6%, thus our results concur with those of other studies. Regarding risk factors, 86.6% (n = 13) mentioned they have experienced some type of sexual abuse, 46.6% (n = 7) separated from their partner, 40% (n = 6) had divorced parents, and 6.6% (n = 1) had a close relative who had committed suicide. During their last suicide attempt, one of the subjects had consumed alcohol and none of them had taken drugs; however, these behaviors did not appear to potentiate the suicidal risk. According to the scales applied, 46% of the subjects (n = 7) showed severe hopelessness, while 54% (n = 8) ranged between mild or moderate hopelessness; 13% (n = 2) had severe depression according to Calderon's scale. According to the Suicidal Ideation Scale, 93.3% (n=14) had a >10 score, which means patients show risk of attempting suicide again. The Risk-Rescue Scale suggests that most patients (n = 13) exhibited deliberate self-harming behavior (e.g. cutting superficially the skin around the wrist, taking prescription drugs or intoxicating near key people who could rescue them or provide help and rescue), which are not considered true parasuicidal behavior. The literature shows that BPD is the most prevalent of all personality disorders, both in the general and clinical population, the one with the highest number of suicide attempts in the DSM-IV Axis II, and the one with the highest comorbidity with Axis I mood disorders and Axis II personality disorders. The 15 patients in this sample carried out a total of 128 suicide attempts throughout their lives, which coincides with other research results, which describe that a history of multiple suicide attempts is a predictor of future suicidal behavior and increase the suicidal risk. As shown above, there were no cases obtaining high scores in all the scales applied (hopelessness, depression, suicidal ideation, high risk and low rescue), even in the result integration per subject, thus showing very few, high-lethality suicidal cases. It would be a mistake, however, to think that suicide attempts will always be less lethal, since there is always the risk of someone attempting a more lethal suicide that translates into the death of the patient. Suicide attempt assessment in dealing with Borderline Personality Disorder becomes a necessary condition to design better therapeutic strategies, since it allows health professionals to know the degree of lethality and timely treatment. The assessment of suicide attempts enables a more realistic prognosis, which backs up and guides clinical decisions.
El intento de suicidio en los pacientes diagnosticados con Trastorno Límite de la Personalidad (TLP) es la causa más frecuente de hospitalización en esta categoría clínica, los riesgos suicidas constituyen con frecuencia la presentación del padecimiento. Los pacientes recaen continuamente generando altos costos personales-familiares, de hospitalización en tratamientos, medicación e incapacidades laborales en personas económicamente activas, siendo el costo más alto, la pérdida de la vida humana. La Asociación Psiquiátrica Americana, en el Manual del DSM-IV, define el trastorno límite de la personalidad como: <>. El DSM-IV reporta que del 8 al 10% de los pacientes fronterizos llegan a consumar el acto suicida. La prevalencia del TLP en población general va de 1 al 2%, de 11 al 20% en población clínica psiquiátrica, representa 20% de los hospitalizados y desde el punto de vista de la distribución por sexos, es más frecuente entre las mujeres de 3:1 con respecto a los varones. El objetivo de esta investigación consistió en la evaluación del riesgo y la letalidad suicida, en pacientes diagnosticados con trastorno límite de la personalidad, en un hospital de psiquiatría del Valle de México, por medio de: la historia clínica, la ficha de identificación para estudios clínicos y epidemiológicos, la Entrevista Clínica Estructurada para los Trastornos de la Personalidad SCID-II, la Escala de Desesperanza, el Cuestionario del Síndrome Depresivo, la Escala de Ideación Suicida, la Escala de Riesgo-Rescate y algunos factores de riesgo, tales como el abuso sexual, la separación de la pareja, el divorcio de los padres, el suicidio de algún familiar cercano, el abuso de sustancias y alcohol. El diseño de este estudio fue descriptivo y transversal. Los resultados mostraron que la comorbilidad con los trastornos depresivos fue del 86.6%, esto concuerda con otras investigaciones. La letalidad del intento suicida coincide con los resultados de otras investigaciones en cuanto a que las mujeres presentan mayor número de tentativas suicidas de menor letalidad. La escala de Riesgo-Rescate sugiere que la mayoría de los casos (n = 13) realizó conductas de automutilación, ej., cortarse la piel superficialmente a la altura de la muñeca, ingerir medicamentos o intoxicarse en presencia de personas-clave que estaban en posibilidad de rescatarlas o solicitar el rescate. Con relación a los factores de riesgo, el 86.6% (n = 13) respondió haber vivido algún tipo de abuso sexual, 46.6% (n = 7) separación de la pareja, 40% (n = 6) padres divorciados, y 6.6% (n = 1) suicidio de algún familiar cercano. El consumo de alcohol y drogas no potencializaron el riesgo suicida. Conclusiones Los métodos más utilizados en pacientes con TLP fueron el uso de fármacos y la mutilación de la piel de manera superficial en las muñecas. La letalidad de los intentos de suicidio en general fue baja. Las conductas de riesgo suicida en TLP como el consumo del alcohol y drogas, el abuso sexual, la separación de la pareja, los padres divorciados, el suicidio de algún familiar cercano, no incrementaron la gravedad suicida en la mayoría de los casos, por lo que se puede hablar de intentos de suicidio, y no de suicidios frustrados o verdaderos comportamientos que comprometan la vida. La evaluación del intento de suicido en el trastorno límite de la personalidad, es una condición necesaria para diseñar mejores estrategias terapéuticas y con ello reducir el riesgo suicida.
