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BPD, Suicide, Attempted Suicide And ‘Smiling Depression.’ – Childhood Trauma Recovery

BPD, Suicide, Attempted Suicide And ‘Smiling Depression.’


It is a startling fact that those who suffer from borderline personality disorder (BPD) – a serious psychiatric condition which has been shown to be strongly associated with the experience of childhood trauma (click here to read one of my articles about this) – have a 1 in 10 chance of their lives ending by suicide.

Various reasons have been put forward in order to help to explain this alarming statistic. Of paramount importance is the utterly debilitating effect of the sheer, unremitting mental agony that BPD can entail that many eventually find impossible to continue to live with. And, because BPD is a chronic condition, suicidal ideation (a key feature of the disorder) can continue for years whereby the individual with BPD contemplates suicide as a ‘way out’ from unbearable emotional suffering on a daily basis.

Also, sufferers of BPD often experience, simultaneously, other very serious psychiatric disorders including severe clinical depression and bipolar disorder and, when such comorbidities exist, the individual’s chances of committing suicide increase yet further. Impulsivity, another hallmark symptom of BPD, also makes it more likely the sufferer will attempt suicide, especially if the individual is intoxicated due to a dependence on alcohol or drugs (substance abuse, to help escape emotional pain, is another very common symptom of BPD).

Finally, it is known, through the use of brain imaging studies, that BPD sufferers are frequently found to have brain abnormalities in terms of both the brain’s functioning and structure and these are thought to be caused by traumatic, early-life interpersonal adverse experiences with primary-carers interfering with normal brain development. One such abnormality that can occur is a reduction in the volume of gray matter in the brain and this is thought to be associated with impulsivity and aggression which are, in turn,  associated with suicidal ideation (e,g, Soloff et al., 2012 and 2014)

Suicide, Childhood Trauma, Self-Harm, Anxiety:

We are more likely to consider, attempt, or complete suicide if we have suffered severe childhood trauma in comparison to those who were fortunate enough to grow up in a relatively stable, loving, and secure environment. Indeed, my own most serious suicide attempt left me in a coma in the intensive care unit of a hospital for five days. I was given about a 50% chance of survival.

Suicide amongst men is about three times as common as it is amongst women. HOWEVER, females are about TWICE as likely to ATTEMPT suicide than are males.

A study by Rennie et al found that, of people who have been hospitalized with severe clinical depression, about 5% will eventually commit suicide. However, a study conducted by Moss and Hamilton, found that of those patients who had both been hospitalized for severe clinical depression AND HAD ALSO expressed strong suicidal intent, 11% eventually took their own lives.

In the USA, recent statistics report that approximately 30,000 individuals will die by suicide per annum. However, researchers believe that real figures are much higher (perhaps even seven or eight times higher). In other words, it is thought many suicides are concealed (eg as accidents) when relevant others do not wish, for their own private and highly sensitive reasons, for the real cause of death to become publicly known.

Tragically, sometimes those who commit suicide also kill others before they do so. For example, very rarely there are reports that a severely mentally ill mother has killed her children before killing herself, as, in her tortured frame of mind, she was of the belief that the world was too terrible a place for them to be left to cope without a mother. Of course, this can equally apply to fathers (indeed, such cases are also reported on rare occasions).

The risk that an individual will attempt or complete suicide is especially high if s/he is suffering an episode of major depression and :

– also has psychotic symptoms (click here to read my article about psychotic depression)

– has a family history of completed suicides

– has a concurrent substance misuse disorder

– has made previous suicide attempts

– expresses the intent to commit suicide

– expresses pessimism and hopelessness


Studies (eg Brown et al) suggest that the intervention of CBT can reduce a person’s likelihood of attempting suicide by about 50%.  (to read my article about CBT, click here).

Anxiety, self-harm, and suicidal behavior are all interrelated. Our anxiety and distress may lead us to self-harm (e.g. by self-cutting, self-poisoning, self-biting, obsessive skin scratching, picking and tearing, etc) and, of course, the ultimate form of self-harm is suicide.

It is theorized that non-fatal self-harm is a coping mechanism we employ to distract ourselves from the intense psychological pain we feel.

Also, the act stimulates the production of endorphins (endorphins are brain chemicals, sometimes referred to as ‘natural pain killers) in the brain which has a temporary soothing effect on our tortured psyche.

You can read my articles on childhood trauma and its link to anxiety here, its link to self-harm here, and its link to suicide.

Many of us are familiar with the statistic that 1 in 4 individuals will suffer from a mental health condition in their lifetime. However, below I present the statistics specifically linked to anxiety, self-harm, and suicide:

4.7℅ of population anxious at any one time

9.7℅ of the population are suffering from mixed anxiety/depression at any one time

1.2% suffer from panic disorder

1.9% suffer from phobias

2.3℅ suffer from agoraphobia

2.6% of men and 3.3% of women suffer from PTSD

2.5% suffer from obsessive-compulsive disorder (PTSD or Complex-PTSD – click here to read my article about the two conditions may be differentiated

3.5% suffer from generalized anxiety disorder (GAD)

Other Statistics Relating To Anxiety:

– 30% of all GP consultations are due to a person wishing to discuss his/her anxiety problem

– women are more likely to report being anxious than men (in part because they are more susceptible to anxiety but, also, because, in general, women are more willing to discuss their emotions than are men).

– of all age groups, those who fall into the category of 35 years to 59 years are the most prone to developing an anxiety condition

– those who are unemployed are more likely to suffer from an anxiety condition than are those in employment; this relates to the next statistic:

– those in the lowest income group are more likely to suffer from anxiety than are those in higher-income groups

– nearly half of employed individuals feel stressed about their work/job

– younger people are more likely to feel anxious about their personal relationships

– older people are more likely to be anxious about illness and the prospect of approaching death

– about one-quarter of anxious individuals report comfort eating (click here for help addressing this issue)

The above adapted from a survey by YouGov.

Statistics Relating To Self-Harm:

– in the UK about 1 in 250 of the population self-harm; this is one of the highest figures in the world

– however, it is far more prevalent than the above statistic suggests amongst young people. Indeed, an extremely worrying three-fold increase in self-harm cases in young people has occurred over the last decade:

– in 2002 approximately 7% of fifteen to sixteen-year-olds reported self-harming; however, by 2013 this figure had soared dramatically to almost triple that: 20% (figures from British Medical Journal and World Health Organisation).

– whilst this condition is treatable, sadly only about 15% of self-harmers ever seek clinical intervention.

– a person with a mental illness is 20 times more likely to self-harm than others

Statistics Relating To Suicide:

Males are over three times more likely to die by suicide than females (although females are more likely to attempt it).

In 2010 in the UK:

– 5981 people died by suicide

– of these, 4590 were male and 1391 were female

– males are most likely to commit suicide between the ages of 40 and 44

– females are most likely to commit suicide between the ages of 45 and 49

Suicide In Young People:

It is particularly tragic that every year some young people attempt or complete suicide :

15 – 19-year-olds – in this age group 4 in every 100,000 died by suicide in 2010

20 – 24-year-olds – in this age group 10 in every 100,000 died by suicide in 2010

These figures equate to 166 young people dying by suicide in the 15-19-year-old age group in 2010 and :

428 young people dying by suicide in the 20-24-year-old age group dying by suicide in 201

Above statistics from Samaritans.

Finally, it should be noted that these official figures are likely to be underestimates of the true rate of suicide in the UK. This is because if a person commits suicide it is not always possible to prove it together with the fact that some regard suicide as taboo and as a source of stigma.

‘Smiling Depression’ And Possible Increased Suicide Risk

Some people suffering from depression may outwardly give the impression to others that ‘everything’s fine’ whilst, on the inside, experiencing profound feelings of distress and despair. Whilst not a formal diagnosis, this is sometimes referred to as ‘smiling depression’.It can occur because those who suffer from it hide behind a facade/mask for various reasons that may include feeling ashamed about suffering from depression (e.g. they may be concerned that others will perceive them as weak) or not wishing to be a burden to others (e.g. their children or elderly parents).

Clinicians may categorize such depression as ‘derpression with atypical features.’ These features may include, as well as appearing outwardly well, having normal/high levels of energy and/or normal/high levels of motivation (in contrast to those who suffer from depression with typical features whose energy and motivation levels are likely to be at rock-bottom.

Ironically, it is these higher levels of energy and motivation that can actually make it more likely that a person with ‘smiling depression’ will attempt suicide than an individual whose depression incapacitates him/her to such a degree s/he is not even motivated enough, nor possesses enough energy, to get out of bed, wash and dress, let alone plan and execute a successful suicide.

For the same reasons, those suffering from depression with typical features may not attempt suicide when at their illest but, paradoxically, only attempt it when their symptoms of low energy, motivation. impaired planning and impaired decision-making are improving.

This means that it is important to keep in mind that those who do not appear to be depressed may still be at risk of suicide as may those who appear to be ‘getting better.’


N.B. It is recommended that anyone suffering from suicidal thoughts seek urgent treatment.

National Suicide Helpline UK 0800 689 5652 https://www.​
Apter A, Bleich A, King RA, et al. Death Without Warning? A Clinical Postmortem Study of Suicide in 43 Israeli Adolescent MalesArch Gen Psychiatry. 1993;50(2):138–142. doi:10.1001/archpsyc.1993.01820140064007
Brown GK, Ten Have T, Henriques GR, Xie SX, Hollander JE, Beck AT. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial. JAMA. 2005 Aug 3;294(5):563-70. doi: 10.1001/jama.294.5.563. PMID: 16077050.
Links, P. S., Gould, B., & Ratnayake, R. (2003). Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 48(5), 301–310
Soloff PH, Pruitt P, Sharma M, Radwan J, White R, Diwadkar VA. Structural brain abnormalities and suicidal behavior in borderline personality disorder. J Psychiatr Res. 2012 Apr;46(4):516-25. doi: 10.1016/j.jpsychires.2012.01.003. Epub 2012 Feb 14. PMID: 22336640; PMCID: PMC3307855.


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David Hosier BSc Hons; MSc; PGDE(FAHE). is reader-supported. When you buy through links on this site, I may earn an affiliate commission.