Elsevier

Current Opinion in Psychology

Volume 22, August 2018, Pages 54-58
Current Opinion in Psychology

Suicidal behavior and aggression-related disorders

https://doi.org/10.1016/j.copsyc.2017.08.010Get rights and content

Highlights

  • Suicide and aggression are highly comorbid and destructive behaviors.

  • Rates of suicidal behavior are increased among those with aggression-related disorders.

  • Aggression may serve as a facilitative factor for suicidal behavior.

  • Future directions for research on the suicide–aggression relationship are discussed.

Studies of suicidal behavior among those with aggression-related disorders (i.e. intermittent explosive disorder, borderline personality disorder, antisocial personality disorder, and conduct disorder) were examined. The presence of an aggressive disorder generally increased the risk of suicide attempts and mortality, with this effect (when examined) usually existing independent of other psychopathology. However, this may not be the case for antisocial personality disorder. Furthermore, with the exception of intermittent explosive disorder, the extant research suggests severity of aggression was associated with suicide attempt risk in aggression-related disorders. Future research is needed to better understand what mechanisms may influence the suicide–aggression relationship.

Section snippets

Intermittent explosive disorder and suicidal behavior

Intermittent explosive disorder (IED) is the only disorder for which excessive levels of aggressive behavior is a required for receiving the diagnosis. Within IED, excessive aggression is defined as frequent (two or more times a week, on average, over three months) acts of minor aggression in excess of provocation that does not cause physical harm, and/or less frequent (three or more acts in a year) acts of major aggression in excess of provocation that does cause physical harm [6]. IED is a

Borderline personality disorder and suicidal behavior

Borderline personality disorder (BPD) is a serious, chronic psychological disorder that affects approximately 1–2% of individuals in the community [16] and up to 20% of psychiatric inpatient samples [17]. Marked by an unstable self-concept and affective dysregulation, BPD is one of the psychological disorders most associated with suicidal behavior. Anywhere from 50% to 90% of BPD clients report engaging in suicidal behavior at some point [18], with up to 10% of individuals with BPD committing

Antisocial personality disorder and suicidal behavior

Aggression, specifically repeated physical assaults, is also a part of the criteria set for antisocial personality disorder (ASPD). Characterized by aggressiveness, impulsiveness, lack of social conformity and disregard for others, individuals with ASPD self-report high levels of aggression and display higher levels of aggressive responding on laboratory tasks (e.g. [35]). These individuals also demonstrate high rates of violent crime, with ASPD present in almost 50% of the prison population [36

Conduct disorder and suicidal behavior

Conduct disorder (CD) is the childhood disorder most associated with aggression, with bullying, physical fights, and use of a weapon representing three of the 15 possible CD symptoms [6]. Conduct disorder is also a required precursor to ASPD [6] and the presence of CD is significantly associated with adult aggression and other antisocial behavior (e.g. substance abuse), as well as educational problems, especially among those with callous-unemotional traits [45].

Several studies have shown a

Conclusions

As expected, aggressive disorders do appear to convey increased suicidal risk. The evidence is strongest for suicide attempts, with IED, BPD and CD all showing increased risk of suicide attempts independent of comorbid psychopathology, with more mixed findings among those with ASPD. Aggression-related disorders were also associated with completed suicide, with suicide rates in ASPD and BPD at approximately 5% and 10% respectively [19, 40], though studies on suicide mortality risk in IED are

Conflict of interest statement

Nothing declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

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    Both authors contributed equally to this article.

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