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Psychotic experiences occur in the population at a rate that is far higher than that of psychotic disorders with a prevalence of 8 to 17 percent of children and adolescents and 5 percent for the adults in a general community sample. The psychotic experiences are clinically important in the fact that they provide a link to the striking relationship between the psychotic experiences and the suicidal behavior. According to cohort studies, the psychotic experiences pre-diet high risks for the suicidal thoughts as well as suicide attempts and later deaths. Despite the presence of research connecting the relationship between psychotic experiences and suicidal behaviors, there has been no research or prior knowledge that assess the relationship between psychotic experiences and the suicidal behavior in individuals with borderline personality disorder.

The more confusing issue is whether the relationship between the psychotic experiences and the suicidal behavior in the persons suffering mental disorders is in fact explained by the comorbid borderline personality disorders or the borderline personality traits. It is a significant consideration provided that the borderline personality disorder is highly comorbid with other mental conditions and also tends to be associated with both the recurrent suicidal behavior and in some of the people, the psychotic symptoms that are commonly referred to as the quasi-psychotic phenomena. On the other hand, it might be the case that the relationship between the common mental disorders and the suicidal behavior is independent of the borderline personality disorder and indeed, that the psychotic experiences are risk marker for the suicidal behavior in the borderline personality disorder in the same way as they are in the rest of the population.

According to the 2007 Adult Psychiatric Morbidity Survey that was a nationally representative of the study of the mental health in England, a strong relationship between the psychotic experiences and the suicidal behaviors was demonstrated in the study. A unique feature of the study was that, in addition to the assessment for the psychotic experiences, the participants were also assessed for both common mental disorders and borderline personality disorders. The same data was used to investigate the relationship between the psychotic experiences and suicidal behavior among the individuals with the borderline personality disorders as well as those with the common mental disorders and to investigative whether the borderline personality disorders and subclinical borderline personality traits might explain the strong relationship between the psychotic experiences and the suicidal behavior.

The study aimed to investigate in the general population sample the relationship between psychotic experiences and suicidal attempts in; the total population, the individuals with a common mental disorder and the individuals with a borderline personality disorder or the subclinical borderline personality traits. The last objective of the study was to investigate the relationship in individuals with neither a common mental disorder nor borderline personality disorder. During the study, the 2007 Adult Psychiatry Morbidity Study, stratified, multistage probability sample of households in England was used in the methodology of the study. The sample of the households recruited a nationally representative sample aged 16 years and above. The study participants were assessed for common mental disorders, borderline personality disorders both clinical and subclinical, suicidal behavior as well as for psychotic experiences under the DSM-IV criteria of psychiatric conditions. Data collected were analyzed using the STATA version 11.2 for windows. Logic regression was first used to examine the relationship between psychotic experiences and suicide attempts. Afterward, the stratified logistic regression was used to look at the odds of suicide attempts among the individuals with psychotic experiences among all four groups. At the later stages, the Chi-square tests for interaction was the used to confirm as to whether there were any associations between the psychotic experiences and suicide attempts differed according to whether the individuals possessed or did not have a higher level of the borderline personality disorder and had or did not possess a common mental disorder. The prevalence and regression analyses were weighted using the APMS study sampling weights to account for the individual level sampling factors of the study.

Approximately 4 percent of the total sample population that was made of 323 individuals were reported to have psychotic experiences. The psychotic experiences were associated with the increased odds of suicide attempts in an individual with the borderline psychotic disorder having an odds ratio of 2.23 with 95 percent confidence Interval that was estimated to be represented by (1.03-4.85). The individuals who possessed a common mental disorder had an odds ratio of 2.47 and a confidence interval of 95 percent at (1.37-4.43). Those without a common mental disorder had an odds ratio of 3.99 with a 95 percent confidence interval at (2.47-6.43). Those who possessed neither a common mental disorder nor a borderline personality disorder had an odds ratio of 3.20 at 95 percent confidence interval at (1.71-5.98).

Through the use of a large population sample, the study found that the psychotic experiences were associated with increased odds of suicide attempts in the total sample, the individuals with higher borderline personality disorder traits. Also among the individuals with a common mental disorder, individuals without a common mental disorder and as well in individuals with neither a common mental disorder nor a high borderline personality trait. The mechanisms underlying the relationship between the psychotic experiences and the suicidal behaviors are not entirely clear, but a number of potentially significant factors have been identified to date. The individuals with the psychotic experiences, for instance, have been shown to possess more severe mental disorders, a higher degree of multi-morbid psychopathology, more cognitive and social dysfunction, neurobiological abnormalities, poor coping skills as well as poor response to the treatment than the individuals with psychopathology who don’t report psychotic experiences. Recent findings have also indicated that people with psychotic experiences tend to share multiple psychosocial risk factors that have been established for individuals with higher levels of suicidal behavior.

Accordant to the study, significant outcomes include; the individuals in the population with psychotic experiences have significantly increased odds of suicide attempts. Another outcome is that the risk is above and beyond the risk associated with the possession of a mental disorder or a borderline personality disorder. The outcome in respect to the study is that neither the borderline personality disorders nor the subclinical borderline personality traits accounted for the relationship between psychotic experiences and suicidal behavior in the population. The strength of the study is that the sample size was considerably large and trained clinicians conducted the assessment of borderline personality disorders. There existed several limitations of the research that included; the number of individuals who met the full diagnostic criteria for the borderline personality disorders was low and this limited the number of study population affecting the results. The study incorporated a cross-sectional study, and therefore it is difficult to determine the temporal nature of the relationships. Summing up on the limitations is that further research is necessary to determine whether the psychotic experiences predict suicide attempts over time in individuals with borderline personality disorder. In conclusion, the psychotic experiences are associated with higher odds of suicidal behaviors among the individuals who possess or does not possess psychopathology. The relationship is not explained by the clinical or the subclinical borderline personality disorders.

References

Kelleher, I., Ramsay, H., & DeVylder, J. (2017). Psychotic experiences and suicide attempt risk in common mental disorders and borderline personality disorder. Acta Psychiatrica Scandinavica, 135(3), 212-218.