nteraction between genetic factors and adverse childhood experiences. Social factors such as physical and sexual abuse during childhood as well as intrafamilial trauma (e.g. violence, neglect and losses) have been specifically associated with the diagnosis of BPD and may build the foundation for dysfunctional behaviours and psychological deficits present in patients (Gado, 2016). BPD patients come across as impulsive risk-takers, and being temperamental, which may result in angry outburst and overreactions. Consequently, these characteristics frequently lead to volatile interpersonal relationships being formed with people in their lives (Sack, 2015). Clinical signs of the disorder commonly include emotional dysregulation and impulsive aggressions; however, the most useful indication for a correct diagnosis is repeated self-injury or chronic suicidal tendencies (Lieb, et al., 2004). Patients with this complex illness also usually meets DSM criteria for other psychiatric disorders.

Numerous studies revealed that comorbidity in patients with BPD is a common occurrence. In fact, Soloff and colleagues (2005) found that suicide attempts in patients with comorbidity resulted in higher levels of lethality compared to patients that experience BPD on its own. The high rates of suicide in patients with comorbid BPD suggest that the self-destructive behaviour of these patients may not predominantly be due to the personality disorder itself, but instead be triggered by a secondary coexisting psychiatric disorder. For instance, an experiment comparing suicidal behaviour between BPD and comorbid BPD and major depressive episode, resulted in the latter generating a greater frequency of suicide attempts and a higher degree of lethal intent (Soloff, et al., 2000). By the same token, increased suicide attempts were exhibited in patients with a comorbid BPD and antisocial personality disorder compared to those without such comorbidity (Soloff, et al., 1994). While comorbidity of BPD with other high risk disorders may be a possible causal factor to suicidality, there is still insufficient information available to deduce whether particular combinations of disorders correlate with a higher lethality of suicidal behaviour. Additionally, comorbid BPD does not offer an explanation for the high mortality rates still present in individuals with BPD alone.

Other than external factors, features often found to be consistent with suicide risk in most psychiatric populations are individual personality traits, such as impulsivity and aggression, hence Brodsky and colleagues (1997) proposed that these characteristics also effect suicidal behaviour in BPD. Yen, et al. (2009) aimed to determine whether facets of impulsivity (e.g. urgency, lack of perseverance and lack of premeditation) could be predictor variables of suicide attempts over a seven-year follow-up evaluation. They used an interview rating system to collect data from a personality disorder sample to observe the course of the disorders – including suicidal behaviours – and ran correlation analyses between the predictor variables. The evaluation of impulsivity facets showed that lack of planning and premeditation was significantly associated with suicide attempt status. In my view, an important point to note is that Yen’s, et al. (2009) study measured impulsivity through self-harm and substance abuse. If these components were to be removed and tested individually, it could possibly reveal that these aspects specifically may be the predictors of suicide attempts rather than an impulsive character personality. Hence, a multivariate an