associated with an 8.2% risk of suicide during 5 years of follow-up, as compared to 4.6% in those diagnosed with depression with no personality disorder. He also noted that approximately 99% of those who attempted suicide during the follow-up period of this study, qualified as having an affective disorder at the time, including those diagnosed with a personality disorder. As described by Dr. Beck, the clinical hallmark of borderline personality disorder is emotional volatility in response to minimal, or perceived, environmental stimuli, with heightened sensitivity to abandonment. Emotional modulation, inhibition, controls, and coping skills are inadequate in these patients. They are not able to maintain normal mood states (euthymia), in other words not depressed, nor excessively elated. They experience little or no control over their depressive and suicidal feelings. Eighty percent of the people with borderline personality disorder in the study also had substance abuse problems, as opposed to 65% of those people who did not have this diagnosis.
Learning the problem solving methods is a kind of an antidote to this trait-like hopelessness.
Dr. Beck reported that in people with personality disorders, suicide occurred at times of acute distress. He reported that cognitive therapy significantly reduces suicides and suicide attempts in patients with borderline personality disorder. As little as 10 weeks of therapy was effective. Some of the therapeutic effect occurs after the cessation of the therapy sessions, during follow-up, which involves lower frequency, briefer, and less interpersonally intensive clinic appointments. The conference attendees discussed possible mechanisms for the continued efficacy after therapy sessions ended, including generalization of learned coping skills to more life-situations over time, or reduction in dependence when therapy ends.
Risk for suicide with depression shows a different clinical course, compared with borderline personality disorder. According to Dr. Beck, suicide attempts associated with depression occur during periods of severe depressive symptoms. These periods of severe depression are associated with profound hopelessness and generalized cognitive distortions. Those who survive a suicide attempt can recover form the depression and achieve an euthymic state again, although the hopelessness persists for some of these individuals. Cognitive therapy, Dr. Beck reports, significantly reduces hopelessness and was more effective than imipramine (an antidepressant medication). Dr. Beck also reported that cognitive therapy “has a significant impact on suicide ideation, as well as hopelessness, as compared to placebo.” A number of studies in more than one country, according to Dr. Beck, show that cognitive problem-solving techniques significantly reduce the rate of suicide attempts per month, and delay the time period to next attempt.
In summary, according to Dr. Beck, cognitive therapy is effective in reducing suicidal behaviors in two disorders, borderline personality disorder and depressive disorder. Suicidal behaviors in both of these disorders is associated with hopelessness and cognitive distortions. The reduction in suicide, according to Dr. Beck, is mediated through remedying the cognitive distortions and/or learning coping skills to reduce their negative effects.