The relationship between borderline personality disorder, suicidal ideation, impulsivity, and the Castelli index

Aim

Borderline Personality Disorder is characterized by emotional fluctuations, unstable relationships, distorted self-image, and intense impulsivity. There is a very strong and fundamental relationship between Borderline Personality Disorder and impulsivity, the most prominent aspects of the disorder at both the emotional and behavioral levels. When suicide attempts and self-harming behaviors are evaluated in Borderline Personality Disorder, impulsivity is observed to have a large share. Low HDL levels and a high total cholesterol/HDL cholesterol ratio (Castelli Index-I) have been associated with increased psychiatric sensitivity and impulsive behavior in recent studies(1,2). It is suggested that impulsivity and emotional instability, may affect lipid metabolism through the hypothalamus-pituitary-adrenal axis and that this may lead to changes in the Castelli index(3). We aim to evaluate the relationship between the Castelli index, impulsivity and suicide risk in individuals with Borderline Personality Disorder. The aim is to evaluate whether blood lipid profiles of individuals followed with borderline personality disorder are related to suicidal thoughts or impulsivity.

Method

In this cross-sectional study, 26 patients aged 18-65 years diagnosed with borderline personality disorder according to DSM-V criteria were administered the Sociodemographic Data Form, the Barrett Impulsivity Scale, the Suicide Probability Scale, and the Beck Depression Scale. Blood tests including HDL, LDL, total triglycerides, and hemogram results were used to calculate the Castelli index. Descriptive statistics were used for the demographic and clinical data of the participants included in the study. The relationship between the assessment tools and demographic and clinical data was examined using Spearman correlation analysis. Hierarchical linear regression analysis was used to predict the suicide probability level. Power analysis was performed using G*Power software. Other analyses were performed using SPSS software.

Results

The study included 26 participants with an average age of 26.62 (SD=9.48), predominantly female (n=25) and single (n=15). Mean scale scores were: Suicide Probability Scale (SPS) 55.00 (SD=10.57), Beck Depression Scale (BDS) 23.27 (SD=13.32), Barratt Impulsivity Scale (BIS) 40.12 (SD=8.62), Castelli Risk Index I (CRI-I) 3.74, and CRI-II 2.25.

Using Spearman rank correlation, significant positive relationships were found between SPS and BDS (ρ=.54, p<.01), BDS and CRI-II (ρ=.42, p<.05), and strongly between CRI-I and CRI-II (ρ=.90, p< .01). Relationships between impulsivity, SPS, and other variables, including BDS and CRI-I, were not significant.

A multiple regression analysis evaluating BDS, BIS, CRI-I, and CRI-II to predict suicide probability was statistically significant (F(4,21)=2.94, p=.045), explaining 36% of total variance (R²=.36). Ultimately, only BDS scores significantly and positively predicted suicide probability (β=.54, p=.016); the other variables did not contribute significantly to the model.

Conclusions

Identification of parameters that can provide predictions about suicide risk will be useful in the follow-up and treatment process of individuals with borderline personality disorder. The finding that the ratio of Beck Depression scores to Castelli Risk Index II was significant in the study, and that Beck Depression scores positively predicted suicide probability scores in multiple regression analyses, is consistent with studies in the literature (1,2,3). More comprehensive studies are needed to reveal the causal relationships between borderline personality disorder, impulsivity, suicide risk, and Castelli indices.

References

Reference

1. Rabe-Jabłońska, J., & Poprawska, R. (2000). Levels of serum total cholesterol and LDL-cholesterol in patients with schizophrenia, unipolar depression and bipolar affective disorder. European Psychiatry, 15(1), 37–41. Reference
2. Troisi, A. (2009). Cholesterol in coronary heart disease and psychiatric disorders: Same or opposite effects on morbidity risk? Neuroscience & Biobehavioral Reviews, 33(2), 125–132. Reference
3. Trofimova, I. N., & Gaykalova, A. A. (2021). Emotionality vs. other biobehavioural traits: a look at neurochemical biomarkers for their differentiation. Frontiers in Psychology, 12, 781631.