Differential Associations of Borderline Personality Disorder with Past and Recurrent Suicidal Behavior in Adolescents in a Specialized Early Intervention Setting

Objective: Adolescent borderline personality disorder (BPD) is associated with an elevated risk of suicidal behavior, with suicide reattempts often considered a hallmark of the disorder. However, empirical evidence linking BPD to suicide reattempts in youth remains limited and inconsistent. This study investigates whether BPD predicts suicide reattempts in a high-risk clinical adolescent sample. Method: We drew our data from two longitudinal clinical samples (n = 323, 87 % female, Mage = 15.11, SDage = 1.54) with specialized treatment for self-harm and risk-taking behavior. We assessed BPD and suicide attempts at baseline and two annual follow-ups, using multinomial logistic regression to test whether BPD at baseline predicted suicide reattempts. Results: Overall, 21 % of adolescents reported at least one suicide reattempt during the follow-up period. While a BPD diagnosis and a higher number of fulfilled BPD criteria were significantly associated with ever having attempted suicide, neither was significantly associated with suicide reattempts. Conclusion: Among adolescents receiving specialized care, BPD is linked to a history of suicide attempts but does not independently predict repeated attempts, challenging assumptions about chronic suicidal risk and treatment resistance as defining features of BPD and underscoring the need to differentiate between initial and recurrent suicidal behaviors.