- Knowledge of BPD prevalence among soldiers is necessary for the development of treatment interventions
- Further studies are needed to discern the extent to which researcher’s findings are representative of suicidal service members 
- Investigation of undisclosed/untreated nonsuicidal self-injury among soldiers is essential for suicide risk mitigation 
- Military treatment providers may want to assess and treat BPD to reduce suicide risk, improve occupational functioning and reduce subjective distress of soldiers with BPD more directly.


Saint Louis University

- Background 
- Type 
- Participants
- Measures Utilized
- Statistical Analysis
- Results & Conclusions
- Limitations 
- Further Directions for Research 

Aspects of BPD in the Military Study

Fruhbauerova, M., DeCou, C. R., Crow, B. E., & Comtois, K. A. (2021). Borderline personality disorder and self-directed violence in a sample of suicidal army soldiers. Psychological Services, 18(1), 104–115. https://doi.org/10.1037/ser0000369

Borderline Personality Disorder and Self-Directed Violence in a Sample of Suicidal Army Soldiers 

- Risks for Suicide in the Military
- Borderline Personality Disorder (BPD)
- Prevalence of BPD in the Military
- Researcher’s Hypothesis


BPD in Military Setting

- Quantitative 
- Correlation 
- Examines only baseline data 
- Case report 


BPD & SE: Type of Study 

- Scale for Suicide Ideation-Current
- Suicide Attempt Self-Injury Count 
- Structured Clinical Interview for DSM–IV Axis II Border-line Personality Disorder
- University of Washington Risk Assessment Protocol


Measures Utilized 

- Descriptive statistics characterized the sociodemographic and military career characteristics of participants and their history of self-directed violence. These results were stratified by their BPD diagnostic status.
- X2 tests of independence were then conducted to test the association between BPD diagnostic status and participants’ sociodemographic, and psychiatric characteristics
- Binary logistic regression assessed the association between BPD diagnosis and attempted suicide. Age and gender were implemented in this regression as covariates since they are associated with suicidal outcomes.
- Then a quilt plot was used to visualize patterns of BPD symptoms for subgroups of participants past history of self-directed violence.


Statistical Analysis

This study revealed that a large proportion of suicidal soldiers met diagnostic criteria for BPD, despite the low prevalence of personality disorders in military medical records of soldiers who attempt or die by suicide.
- 27.7% of suicidal soldiers in a sample size of 137 met full diagnostic criteria for BPD
- Active-duty soldiers with BPD were less likely to be married, were of lower rank, and had fewer deployments
- Higher number of BPD symptoms were correlated with higher numbers of nonsuicidal self-injury but not with amount of suicide attempts.
- Efforts to avoid abandonment were higher among soldiers with BPD 
- The total proportion of participants who met each of the BPD criteria indicate that soldiers without BPD reported nontrivial experiences of BPD criteria and 1/3 met the impulsivity and/or paranoid ideation or severe dissociation criteria


Results & Conclusions

Further Directions for Research

- 137 men 
- Active-duty soldiers 
- English speaking 
- At least 18 years old 
- Had significant suicidal ideation (at least a 13 or higher on the Scale for Suicidal Ideation-Current)



Participants in Study on BPD in the Military

The study on borderline personality disorder (BPD) and self-directed violence in a sample of suicidal army soldiers has several limitations. First, the cross-sectional data does not support causal inference. Second, the results are not generalizable to nonsuicidal military members or suicidal individuals who did not seek treatment. Third, the accuracy of BPD diagnoses is uncertain because the study assessor was not a licensed clinician. Fourth, secondary analyses were unable to detect the number of suicide attempts. Finally, the study did not employ probabilistic sampling, and thus cannot provide an estimate of the prevalence of BPD among soldiers in general or suicidal soldiers in particular.

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