Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

Improve Borderline Personality Disorder and Reduce Suicidal Thoughts with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation encourages recognition of the wide palate of human emotions, but also keenly encourages one not to fixate on these temporary feelings. Work in mindfulness meditation includes labeling these emotions in a non-judgmental manner and allowing them to pass just as freely as they came. The misery and the suffering those with BPD experience in life often come from our denial of some of these emotions.” – Blaise Aguirre

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder (BPD). Mindfulness training has been found to be helpful intreating substance abuse and decreasing suicidal thoughts. Hence, there appears to be a relationship between mindfulness and Borderline Personality Disorder (BPD), substance abuse and suicidal thoughts.

 

In today’s Research News article “The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/, Shorey and colleagues recruited adult women with Borderline Personality Disorder (BPD) who were also undergoing treatment for substance abuse. The women completed measures of mindfulness, BPD features, including affective, identity problems, negative relationships, and self-harm, suicidal thoughts, alcohol abuse, drug use, and impression management. They then conducted regression analyses to investigate the relationship between mindfulness and BPD, suicidality, and drug use.

 

They found that in these patients the higher the levels of mindfulness the lower the levels of BPD features, including affective, identity problems, negative relationships, and self-harm, the lower the levels of suicidal thoughts, and the higher the levels of impression management. Hence, mindfulness was significantly negatively associated with BPD symptoms and suicidality. These relationships, with the exception of self-harm, remained significant even after statistically accounting for alcohol use, drug use, age, and impression management.

 

These results suggest that mindfulness may be an antidote to Borderline Personality Disorder (BPD) symptoms and suicidal thoughts. It is possible that this results from the ability of mindfulness to improve emotion regulation. Mindful people to experience their emotions deeply but are able to respond to them rationally and adaptively. Characteristically, patients with BPD avoid experiencing negative emotions. So, mindfulness, by promoting the experience of these emotions may counteract one of the core features of BPD.

 

It should be recognized that these results are correlational. So, causality cannot be determined. But, since Dialectical Behavior Therapy (DBT) which contains mindfulness training is the only known therapy that has been shown to be effective for BPD. It would seem reasonable to suggest that mindfulness causes changes in BPD symptoms. A randomized clinical trial of mindfulness training for BPD symptoms and suicidality should be conducted in the future to test these ideas. The potential for mindfulness training to improve the symptoms of this devastating and dangerous mental illness mandates that such a trial be conducted.

 

So, improve borderline personality disorder and reduce suicidal thoughts with mindfulness.

 

“Mindfulness meditation training can help people with BPD to feel less “stuck” in their emotions, and less judgmental of the emotions and themselves. Mindfulness meditation training may also help individuals with BPD be more effective in applying healthy coping skills in the midst of emotional pain, because mindfulness skills allow you to get just a little bit of space to be able to notice the emotion and be more strategic in terms of how you will act in the face of the emotion.” – Line Goguen-Hughes

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Shorey, R. C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (2016). The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122–128. http://doi.org/10.1016/j.psychres.2016.02.040

 

Highlights

  • Theory suggests mindfulness is inversely related to BPD/suicidal ideation
  • We investigated this in a sample of women in treatment for substance use
  • Dispositional mindfulness was negatively associated with BPD
  • Dispositional mindfulness was negatively associated with suicidal ideation

Abstract

Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834542/

Decreased Suicidality in Veterans with Spirituality

“there are certain moral reactions to war and the experience of combat training that indicate a violation of moral conscience in war can have devastating inner consequences in soldiers.” – Rita Nakashima Brock

 

It has been widely reported that there are extremely high levels of suicides among veterans. But these reports are based upon the entire veteran population which includes large numbers of elderly veterans. Looking only at veterans discharged since 2001, the rates suicide rates observed were much lower consisting of about one suicide per day. The actual annual suicide rate these veterans was 29.5 per 100,000 veterans. This is roughly 50% higher than the rate among similar civilians. Interestingly, the rates of suicide are lower in veterans who were deployed to combat than those who were not. Deployed Veterans had a 41% higher suicide risk compared to the general U.S. population while Non-Deployed Veterans had a 61% higher suicide risk.

 

These figures are still alarming, although less so than common reports of veteran suicides. It also suggests that the transition back to civilian life may be as difficult as dealing with combat produced Post Traumatic Stress Disorder (PTSD). Regardless, it is important to investigate the causes of these suicides and discover methods that might prevent them. Mindfulness training is one important potentially helpful method to lower suicidal thoughts and prevent suicide. Mindfulness has been shown to has been shown to reduce suicidality (see http://contemplative-studies.org/wp/index.php/category/research-news/suicidality/) and to reduce the impact of trauma on the individual (see http://contemplative-studies.org/wp/index.php/category/research-news/trauma/). Another potentially important factor is spirituality. Indeed, spirituality has been shown to reduce suicide tendencies in the elderly (see http://contemplative-studies.org/wp/index.php/2015/07/17/spirituality-improves-end-of-life/). Unfortunately, there has been very little systematic research on spirituality relationships to suicide in either the general population or in veterans.

 

In today’s Research News article “Suicidal behavior and spiritual functioning in a sample of Veterans diagnosed with PTSD”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1169673129723278/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729329/

Kopacz and colleagues studied the relationships between spirituality and suicidality in a veteran sample undergoing residential treatment for PTSD. They compared three groups, a no suicide group who had not even thought about suicide, an Ideation group who had contemplated suicide, and an Attempt group who had attempted suicide. They found that the Ideation and Attempt group had greater amounts of spiritual struggle and lower level of forgiveness. They also found that low levels of thoughts about suicide (ideations) were associated with involvement in a spiritual community and high levels of spiritual experiences.

 

It should be noted that these results were correlative and thereby do not demonstrated a causal connection between spirituality and lower levels of suicidality. In fact, less suicidal ideation may prompt veterans to seek out spiritual experiences of some third factor such as religious upbringing is associated with both. In order to demonstrate causation, it will be necessary to actively increase spirituality and observe its effects on suicidality.

 

With these caveats in mind, the results may signal that being spiritual protects the individual from suicidal thoughts. It may do so by providing other higher ideas about the meaning of life and its sacredness. Higher levels of spirituality may also provide a community that is supportive of the individual and thus helps them cope with difficult thoughts and experiences. It is also possible that a key factor may be spiritual struggles, where the inability to find higher meaning makes suicide more likely. It is also possible that inability to forgive is the key, where the individual cannot forgive, particularly themselves, making destroying the self are seemingly reasonable solution.

 

Regardless, it is clear that spirituality is an important factor influencing suicidality in veterans. This clearly suggests that further research is warranted and that spirituality may be an important factor in suicide prevention in veterans.

 

“The Army’s “spiritual fitness” encourages soldiers to see events in a neutral light, rather than labeling them as good or bad, and to create a nightly list of positive things that happened that day. The lack of awareness is startling regarding what it might mean to ask someone to think of killing a child, losing a close friend or torturing detainees as neutral or positive.”Rita Nakashima Brock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Disrupt Suicidal Thoughts with Mindfulness  

“Did you really want to die?”
“No one commits suicide because they want to die.”
“Then why do they do it?”
“Because they want to stop the pain.”
  ― Tiffanie DeBartolo

 

After cancer and heart disease, suicide accounts for more years of life lost than any other cause. Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Depression and other mood disorders are the number-one risk factor for suicide. More than 90% of people who kill themselves have a mental disorder, whether depression, bipolar disorder or some other diagnosis, according to the National Alliance on Mental Illness (NAMI). So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression. Mindfulness training has been shown to reduce suicidality in substance abusers (see http://contemplative-studies.org/wp/index.php/2015/11/30/decrease-suicidality-with-mindfulness/). Mindfulness training has also been shown to be effective for treating depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression and prevent relapse. So, it would seem reasonable to expect that MBCT would be effective in suicide prevention.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy (MBCT) Reduces the Association Between Depressive Symptoms and Suicidal Cognitions in Patients with a History of Suicidal Depression”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1158656587491599/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655869/

Barnhofer and colleagues treated patients with a history of suicidal depression with eight weeks of either MBCT, Cognitive Psychoeducation (CE), or Treatment as Usual (TAU). They found that at the end of treatment the participants treated with MBCT had a significant reduction in suicidal thoughts while the other groups did not. For the CE and TAU groups there were strong and significant correlations between depression and suicidal thoughts. That is, for these groups, the higher the level of depression the higher the levels of suicidal thought. In contrast for the MBCT group the correlations were significantly weaker That is, there was a much weaker relationship between depression and suicidal thoughts after Mindfulness-Based Cognitive Therapy (MBCT) than Cognitive Psychoeducation (CE), or Treatment as Usual (TAU).

 

These are interesting and potentially important findings that MBCT can reduce suicidal thoughts and that it weakens the link between depression and suicidal thoughts. This makes sense as MBCT is designed to reprogram depressive thought processes, helping the patient to see that their typical ways of thinking about and assessing their experiences are faulty and tend to heighten depression and that looking at and interpreting their experiences in a more rational way can reduce depression. This, in turn, appears to reduce suicidal thinking.

 

These results clearly suggest that Mindfulness-Based Cognitive Therapy (MBCT) may be an effective program to prevent suicide in people with high levels of suicidal thinking. Since mindfulness training has been shown to reduce suicidality in drug abusers, the second most likely group to commit suicide, it would appear that mindfulness training is potentially an important method to prevent suicide.

 

So, disrupt suicidal thoughts with mindfulness.

 

“The thought of suicide is a great consolation: by means of it one gets through many a dark night.” 
― Friedrich Nietzsche
CMCS – Center for Mindfulness and Contemplative Studies

 

Decrease Suicidality with Mindfulness

 

Killing yourself is a major commitment, it takes a kind of courage. Most people just lead lives of cowardly desperation. It’s kinda half suicide where you just dull yourself with substances.” – Robert Crumb

 

Suicide is the 10th leading cause of death in the US for all ages. It is much more prevalent with males who account for 79% of suicides. Every day, approximately 105 Americans die by suicide. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). Yet compared with other life threatening conditions there has been scant research on how to identify potential suicide attempters and reduce suicidality.

 

Depression and other mood disorders are the number-one risk factor for suicide, but alcohol and drug abuse – even without depression – are a close second. In fact, research has shown that the strongest predictor of suicide is alcoholism, not a psychiatric diagnosis. People with substance use disorders are about six times more likely to commit suicide than the general population. To make matter worse people with substance abuse are often incarcerated. In prison suicidality is even higher than outside. It is not the primary effects of the substances that promote suicide as the likelihood of suicide does not decline after complete withdrawal from the drugs or alcohol.

 

So there is a great need to study suicidality especially in conjunction with substance use disorders to identify predictors and potential methods to prevent actual suicide attempts. In today’s Research News article “Trait Mindfulness, Reasons for Living and General Symptom Severity as Predictors of Suicide Probability in Males with Substance Abuse or Dependence”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1123964037627521/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434430/

Mohammadkhani and colleagues studied incarcerated and outpatient substance abusers and measured mindfulness, psychiatric symptoms, reasons for living, and suicide probability. These groups were indeed high risk as 36% of the outpatients and 42% of the incarcerated participants had attempted suicide. They found that the strongest single predictor of suicide probability was the severity of the individuals’ psychiatric symptoms and the second was fear of social disapproval. Importantly, they found that the higher the level of mindfulness, the lower the probability of suicide.

 

These findings are interesting and suggest that mindfulness training might be an effective intervention to lower suicidality and the risk of attempting suicide in the high risk population of substance abusers. Of course, a randomized clinical trial is needed to establish effectiveness.

 

The findings also raise interesting questions as to why mindfulness might be an antidote to suicidality. There are a number of known effects of mindfulness that might account for its negative association with suicidality. Mindfulness has been shown to decrease psychiatric symptoms and depression, the leading causes of suicide attempts. Indeed, they found that high mindfulness was associated with lower levels of psychiatric symptoms. Mindfulness also improves emotion regulation allowing the individual to respond more adaptively to sometimes overwhelming emotions. In addition, it is known to reduce physiological and psychological responses to stress which might lower stress’ ability to prompt a suicide attempt. In addition, suicide is often associated with hopelessness about the future. Mindfulness by increasing focus on the present moment lowers worry and rumination about the future and may thereby reduce the likelihood of a suicide attempt. Finally, mindfulness is known to help prevent relapse after successful withdrawal from addiction and this may make the individual more hopeful about the future.

 

Regardless of the reasons, mindfulness appears to be able to buffer the individual against the forces that can promote and prompt suicide.

 

Suicide is a serious thing. And if you know anyone who is suicidal, you need to get them help. No one should be in pain. Everyone should love themselves. – Gerard Way

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Spirituality Improves End of Life

Death in inevitable, but that does not mean that it has to be awful. We don’t know how or when we will die, but we will die. It could be sudden or gradual or prolonged. We don’t know which it will be. But, regardless, how we approach it makes a huge difference.

Suzuki Roshi at the end of his life was in excruciating pain from cancer yet he told everyone around him “Don’t worry, It’s just Buddha suffering”. He passed with a smile on his face. Augustus Montague Toplady, the preacher author of the hymn “Rock of Ages” dying from tuberculosis said “”Oh, what delights! Who can fathom the joy of the third heaven? The sky is clear, there is no cloud; come Lord Jesus, come quickly!” These stories exemplify how our religiousness and spirituality can influence the quality of our passing.

In today’s Research News article “Religion, Senescence, and Mental Health: The End of Life Is Not the End of Hope”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1051111154912810/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357420/

Van Ness & Larson showed that individuals with high levels of religiousness/spirituality had significantly higher levels of well-being and were less likely to be depressed or suicidal at the end of life.

Americans 65+ portray themselves as more religious than do their younger counterparts. Hence it would appear that people understand that religiousness/spirituality can help in confronting end of life. But, how exactly does religiousness/spirituality help when dealing with eminent death?

Religiousness/spirituality can function by providing hope that helps the individual overcome increasing disease, disability, and emotional difficulties. Indeed, it has been shown that people high in religiousness/spirituality are significantly lower in hopelessness. This hope may take the form of belief in a life after death, reincarnation, or rebirth. Such a hope may be interpretable as a symbol of personal integrity that survives the indignities of illness, disability, and dissolution. This can be a great comfort to the dying person improving well-being and decreasing depression.

Religiousness/spirituality in older individuals is associated with a higher sense of well-being. This in turn can help the individual cope with the afflictions and challenges they face as death approaches. It can also help to bring families and communities to the dying process. It is often these connections that are the most important to the dying.

When approaching death, religiousness/spirituality can provide the structure to grapple with the basic questions of existence. Without it the person may experience spiritual distress. “When our bodies are under assault from disease or illness and our minds are reeling from the threat of disability or death, our spirit is there to hold it all together.” (Rev. Dr. Walter J. Smith).

So, practice religiousness/spirituality to be better prepared for death.

CMCS