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Thought Control Strategies as Predictors of Borderline Personality

Disorder and Suicide Risk

Caitlin E. Titus M.S. , Hilary DeShong M.S., Ph.D.

PII: S0165-0327(19)32709-0
DOI: https://doi.org/10.1016/j.jad.2020.01.163
Reference: JAD 11612

To appear in: Journal of Affective Disorders

Received date: 5 October 2019

Revised date: 3 December 2019
Accepted date: 28 January 2020

Please cite this article as: Caitlin E. Titus M.S. , Hilary DeShong M.S., Ph.D. , Thought Control Strate-
gies as Predictors of Borderline Personality Disorder and Suicide Risk, Journal of Affective Disorders
(2020), doi: https://doi.org/10.1016/j.jad.2020.01.163

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Running head: THOUGHT CONTROL, BPD AND SUICIDE RISK 1

Highlights

 Results demonstrated that distraction was negatively associated with BPD symptoms and
suicide risk across all three measures of NPD.
 Reappraisal was positively related to BPD symptoms on two out of the three measures.
 Worry and punishment were positively related to BPD symptoms on all three measures
and suicide risk.
 Social control decreased suicide risk and was negatively related to one measure of BPD
symptoms.
 Study represents initial findings of thought control strategies as possible predictors of
BPD symptoms and suicide risk.
THOUGHT CONTROL, BPD AND SUICIDE RISK 2

Thought Control Strategies as Predictors of Borderline Personality Disorder and Suicide Risk

Caitlin E. Titus, M.S. & Hilary DeShong, M.S., Ph.D.

Mississippi State University

Address correspondence to Hilary L. DeShong

Department of Psychology
PO Box 6161 Mississippi State, MS 39759
Email: hld166@msstate.edu

Declarations of interest: none

THOUGHT CONTROL, BPD AND SUICIDE RISK 3

Abstract

Background: Borderline Personality Disorder (BPD) is characterized by a pattern of

instability in interpersonal relationships, affect, self-image and is marked by behavioral

impulsivity including suicidal ideation and attempts. Additionally, individuals with BPD tend to

engage in maladaptive ruminative thinking that is also related to suicidal ideation and attempts.

Given these relations, this study aims to understand the 5 strategies of thought control

(distraction, punishment, reappraisal, worry, and social control) as predictors of BPD symptoms

and suicide risk. Methods: The sample was collected at a Southeastern University using a

convenience sample of undergraduate participants. The final sample (n =403) had an age range

of 18 to 27 (M = 19.67, SD = 1.45), was 74.4% female and 25.6% male, and was primarily

Caucasian (69.7%) and African American (24.8%). Results: Results demonstrate that distraction

was negatively associated with BPD and suicide risk while worry and punishment were

positively associated with BPD and suicide risk across three different measures of BPD. Social

control was negatively associated with suicide risk and BPD but only on one of the BPD

measures. Lastly, reappraisal was positively related to BPD symptoms on two measures.

Limitations: Given the sample characteristics, there may be limitations in the generalizability of

the findings. Conclusions: The findings represent a first step towards examining thought control

strategies as possible predictors of BPD symptoms and suicide that can inform clinical

interventions designed to increase or decrease utilization of these specific strategies.

Key Words: Borderline Personality Disorder; Thought Control; Suicide Risk

THOUGHT CONTROL, BPD AND SUICIDE RISK 4

Thought Control Strategies as Predictors of Borderline Personality Disorder and Suicide Risk

Introduction

Borderline Personality Disorder (BPD) is characterized by a pattern of instability in

interpersonal relationships, affect, self-image and is marked by behavioral impulsivity that

begins in adolescence or early adulthood and occur across multiple life domains (e.g.,

interpersonally, occupationally; American Psychiatric Association, 2013). BPD is also

characterized by other maladaptive behaviors such as substance abuse (Trull et al., 2000),

suicidal gestures and non-suicidal self-injury (Andover et al., 2005; Paris, 2018), and rumination

(Martino et al, 2018). Considering the predominance of dysregulated behaviors in BPD,

individuals with this disorder have a higher rate of suicide as compared to community samples

(Pompili et al., 2005) with an average of 3.4 attempts in a lifetime (Soloff et al., 1994).

Additionally, death by suicide is estimated to occur in approximately 8-10% of individuals with

BPD (APA, 2013; Linehan et al., 2008). Given the high rates of suicidal behavioral within BPD,

understanding potential predisposing factors of suicide and BPD is imperative to intervention

work. One possible pathway to decreasing suicide risk and symptoms of BPD is by decreasing

rumination.

Broadly, rumination is a tendency to repetitively think about one’s own negative emotion

experience, including the causes, contextual factors, and consequences of the experience (Nolen-

Hoeksema, 1991). Rumination has been found to be a larger cognitive process that can

encapsulate more adaptive forms such as self-reflection or deliberate rumination which are

linked to post-traumatic growth and recovery from a depressive episode (Arditte and Joormann,

2011; García et al., 2017). The maladaptive forms of rumination are separate and involve

negatively valanced repetitive thoughts and include perseveration about one’s feelings and
THOUGHT CONTROL, BPD AND SUICIDE RISK 5

problems (Nolen-Hoeksema et al., 2008). More recent research indicates that not only is

rumination maladaptive, but it is a transdiagnostic process that underlies various forms of

psychopathology including depression, anxiety, and BPD (Nolen-Hoeksema and Watkins, 2011;

De Raedt et al, 2015). Although rumination is linked to several disorders, it has a particularly

strong connection with BPD. For instance, research has demonstrated that anger and depressive

rumination are strongly associated with borderline features, even after controlling for current

depressive symptoms, anxiety, and stress (Baer and Sauer, 2011).

A potential explanation for the role of rumination in BPD is through the Emotional

Cascade Model, which posits that emotional and behavioral dysregulation is due to intense

cycles of negative affect and repetitive negative thinking (Selby et al., 2009). Individuals with

BPD tend to experience more intense negative affect with greater reactivity, even when

controlling for current depressive symptoms (Selby et al., 2009). When this intense negative

emotion occurs, individuals may engage in a rumination process, which increases the intensity of

emotion, leading to more rumination. The repetitive aspects of this process may eventually lead

to dysregulated behavior to cope with the now overwhelmingly strong emotional affect (Selby et

al., 2009). A recent study also provides evidence that not only does this emotional cycle exist,

but it exists in a progressive self-amplifying relationship which subsequently predicted impulsive

behaviors (Selby et al., 2016). Overall, there have been several studies demonstrating these

relationships between rumination, emotional affectivity, and maladaptive behaviors (e.g.,

Martino et al., 2018; Moberly and Watkins, 2008). This pernicious cycle coupled with

dysregulated behavior illustrates the importance of better understanding the role of rumination as

it relates to BPD.
THOUGHT CONTROL, BPD AND SUICIDE RISK 6

Rumination has also been directly linked to suicide (e.g., Grassia and Gibb, 2009).

Morrison and O’Connor (2008) conducted a meta-analysis of studies examining rumination with

suicidal ideation and attempts using community and inpatient samples. Results indicated that all

studies demonstrated a significant positive link between rumination and suicidal thoughts and

behaviors, with one exception. There was one study that used a measure of rumination that

assessed adaptive forms of rumination. In a more recent meta-analysis of 27 unique study

samples examining suicide risk and rumination, Rogers and Joiner (2017) found that global

rumination, brooding rumination, and reflective rumination were significantly related to suicidal

ideation. Global and brooding rumination were also significantly related to suicide attempts, but

reflection was unrelated. Cumulatively, these findings suggest that rumination, especially

negative repetitive thinking styles such as brooding, are associated with suicidal ideation and

attempts across populations. Thought control is one potential pathway by which interventions

may be able to target ruminative thinking and thus may decrease the effects of rumination on

suicide risk and BPD.

The avoidance of negative and unwanted thoughts and experiences is considered a

relatively normal experience, it is the excessive and recurrent avoidance and suppression of these

thoughts and experience which is transdiagnostically related to psychopathology (Hayes et al,

1996). Since research has established a link between rumination with suicide and BPD (Grassia

and Gibb, 2009; Moberly and Watkins, 2008; Rogers and Joiner, 2017), understanding the

strategies that an individual may employ to control unwanted thoughts and feelings may offer

insight into possible factors that decrease or increase suicide risk. The Thought Control

Questionnaire was designed to be a measure of individual differences in the ability to control

unwanted thoughts or worries (TCQ; Wells and Davies, 1994). The TCQ includes five
THOUGHT CONTROL, BPD AND SUICIDE RISK 7

dimensions of thought control strategies including distraction (e.g., “I think about something

else”), punishment (e.g., “I tell myself to not be so stupid”), reappraisal (e.g., “I challenge the

thoughts validity”), worry (e.g., “I try to think about past worries instead”), and social control

(e.g., “I talk to a friend about the thought”). Dimensions of the TCQ, specifically punishment and

worry, have been positively linked with Generalized Anxiety Disorder and Major Depressive

Disorder among an inpatient sample, whereas distraction and social control were negatively

associated with trait-anxiety and more likely to be used by the control group (non-inpatients;

Wells and Carter, 2009). In another study looking at the TCQ and suicide outcomes, both

punishment and worry were positively correlated with suicidal ideation and worry was

significantly correlated with total suicide risk. Distraction was negatively correlated with both

suicidal ideation and total suicide risk (Tucker et al., 2017). Considering these different strategies

impact suicide risk in different ways, the present study aims to explore these specific strategies

as they relate to BPD and suicide risk.

Specifically, it may be that thought control strategies are one way that an individual may

attempt to disrupt rumination and in turn the emotional cascade process. Therefore, these

strategies may be one area that can be targeted by clinical interventions to potentially decrease

symptoms of BPD and suicidal ideation. To design such interventions, a better understanding of

the link between thought control strategies with BPD and suicide is needed. Therefore, the

current study will investigate which of the five control strategies predict BPD and suicide. It is

hypothesized that the reappraisal, distract, and social control strategies measured by the TCQ

would be negatively associated with suicide risk and BPD symptoms. The other two strategies,

worry and punishment, were hypothesized to be positively related to BPD and suicide risk.

Method
THOUGHT CONTROL, BPD AND SUICIDE RISK 8

Participants and Procedure

The sample was collected at a Southeastern University via the psychology SONA

participant research pool. All participants were provided with the link to the online survey on

Qualtrics. Participants earned 1.5 research credit hours for completing the study. Overall, 538

individuals signed up and began the study. Participants (n =132) who discontinued early or

completed less than 80% of the survey because they chose “prefer not to respond” for large

portions were screened out. Second, the Personality Assessment Inventory includes the

Infrequency Validity Scale which helps to detect random responding (Morey, 1991). Using this

scale, three participants had a score of five or higher and were dropped from subsequent

analyses. Overall, this resulted in a final sample of 403.

The final sample (n =403) had an age range of 18 to 27 (M = 19.67, SD = 1.45) with

74.4% female and 25.6% male. The participant ethnicities were primarily Caucasian (69.7%),

with the remaining sample including 24.8% African American, .7% Hispanic, 1.5%

Asian/Pacific Islander, .2% American Indian, with 2.5% identifying as multiracial and .5%

choosing not to respond. In the current sample, 14.9% were currently seeking treatment for a

psychological disorder and 12.2% were currently taking medication for a psychological disorder.

No pre-screening procedures or oversampling methods were used to obtain this sample.

Measures

Demographics Form. Basic demographic information was collected using a self-report

survey. The information includes age, gender, ethnicity, and psychological and psychiatric

treatment status (e.g., seeking treatment and/or taking medication).

Five Factor Borderline Inventory-Short Form (FFBI-SF; DeShong et al., 2016). The

FFBI-SF is a 48-item self-report measure that assesses BPD from the dimensional perspective of
THOUGHT CONTROL, BPD AND SUICIDE RISK 9

the Five Factor Model (FFM). The measure is based on the 120-item FFBI (Mullins-Sweatt et

al., 2012) and includes a total score and 12 subscale scores that are coordinated with respective

facets of the FFM. Previous research has demonstrated strong reliability and validity of the full

and short forms in student samples (Mullins-Sweatt et al., 2012; DeShong et al., 2015; DeShong

et al., 2016). For the current study, the internal consistency coefficient for the total score was

good (α=.97).

Personality Assessment Inventory (PAI; Morey, 1991). The PAI is a self-report inventory

that measures normal and abnormal personality traits and clinical constructs. The 344 items use a

four-point Likert response format that includes the following options: “False, not at all true,”

“Slightly true,” “Mainly True,” and “Very True.” The PAI contains 22 nonoverlapping scales

that break into four validity scales, 11 clinical scales, two interpersonal scales, and five

treatment-relevant scales. The current study utilized two scales from this measure for the

analyses: the borderline scale and the suicide scale.

The borderline personality features scale (BOR) contains 24 items which assess

borderline personality features from a categorical perspective. The BOR scale is further broken

into four subscales, though only the full scale is included within the following analyses. The

BOR scale has previously demonstrated good reliability and validity in college populations

(Kurtz et al., 1993; Trull, 1995, 1997). The internal consistency for the BOR scale in the current

sample was good (α=.86).

The suicidal ideation scale (SUI) is a clinical subscale of the PAI that consists of 12 items

that ask about feelings of hopelessness, vague thoughts about suicide, distinct plans, and

previous attempt. The current study used this subscale to measure suicidal risk. This subscale has

demonstrated convergent (Morey, 2007) and construct validity (Patry and Magaletta, 2015).
THOUGHT CONTROL, BPD AND SUICIDE RISK 10

Other studies have demonstrated good internal consistency ranging from α = .88 (Frazier et al.,

2006) to α=.90 (Boone, 1998). The internal consistency for the SUI scale in the current sample

was good (α=.86).

Personality Diagnostic Questionnaire-4 (PDQ-4; Bagby and Farvolden, 2004). The

PDQ-4 is a 99-item true/false self-report questionnaire that is designed to measure the DSM-IV-

TR/DSM-5 categorical personality disorders. Internal consistency for the PDQ-4 within

psychiatric outpatients has ranged from .54 (Histrionic) to .77 (Borderline; Trull and Goodwin,

1993). The analyses of the current study specifically used the BPD subscale of the PDQ-4. The

PDQ_BPD scale includes 9 items. The current study had poor internal consistency (α=.69). This

is likely in part due to the small number of items (Bagby and Farvolden, 2004); these are similar

values to other studies utilizing the same measure (DeShong et al., 2016; Mullins-Sweatt et al.,

2012; Sanon et al., 2018).

Thought Control Questionnaire (TCQ; Wells and Davies, 1994). The TCQ scale is a 30-

item scale assessing strategies for controlling unpleasant and unwanted thoughts. The items are

answered on a four-point Likert scale on how often a person uses each technique, ranging from 1

(never) to 4 (almost always). The scale is broken into five broad techniques: distraction (e.g., I

do something that I enjoy), social control (e.g., I ask my friends if they have similar thoughts),

worry (e.g., I focus on different negative thoughts), punishment (e.g., I get angry at myself for

having the thoughts), and re-appraisal (e.g., I analyze the thought rationally). Previous research

has demonstrated adequate test-retest reliability, internal consistency, and convergent validity

(Wells and Davies, 1994). The subscale internal consistency coefficients for this sample ranged

from fair (Social control α=.77) to good (Worry α=.84).

Results
THOUGHT CONTROL, BPD AND SUICIDE RISK 11

Analytic Strategy

Before analyses were conducted, all data were evaluated for normality and checked for

skewness and kurtosis, with skewness values over 3 (Chou and Bentler, 1995) and kurtosis

values higher than 10.00 considered problematic (Kline, 2005). All data were within normal

limits, Table 1 provides descriptive statistics. AMOS 25 was utilized to estimate path analyses

using maximum likelihood estimation to determine the model that offered the best fit to the data

as well as controlling for spuriousness (Kenny, 1975). Using a model trimming approach, three

models were tested using the Thought Control Questionnaire factors (i.e., distraction, social

control, worry, punishment, and reappraisal). These factors were evaluated as predictors of BPD

and the PAI suicide scale. In each model, a different BPD measure was used to assess for

replicability (i.e., FFBI, PDQ_BPD, and BPD_PAI). Each model was evaluated using CFI, TLI,

and RMSEA. CFI and TLI values between .90 to .94 and RMSEA values between .07 to .10

indicate adequate model fit (Browne and Cudeck, 1993). CFI and TLI values at .95 or above and

RMSEA values of .06 or below indicates good model fit (Hu and Bentler, 1999). Of note, in the

following models, the intercorrelations were included during analyses but were not included in

the figures for clarity and readability.

Correlations

Table 2 provides Pearson correlations between all variable. Overall, the TCQ distraction

significantly correlated with suicidal ideation and PDQ_BPD measure, whereas the social control

dimension was significantly correlated with suicidal ideation and PAI_BOR and FFBI.

Additionally, worry, punishment, and reappraisal were all significantly correlated with each

measure of BPD but not for suicidal ideation.

Path Analyses
THOUGHT CONTROL, BPD AND SUICIDE RISK 12

Next, path analyses were conducted using the 5 dimensions of the TCQ as predictors for

each of the BPD scales and PAI_SUI. This allowed for comparison of models across different

types of measurement of BPD including two categorical (PDQ_BPD, PAI_BOR) and one

dimensional (FFBI) measure of BPD. See Table 3 for a summary of the findings that were

consistent across all three measures presented below.

FFBI

The first path analysis was conducted to assess which factors of the TCQ are positively or

negatively related to the FFBI and suicide. As suggested by Kline (2011) and Joreskog (1993),

the model trimming approach was used so a model in which all paths were free to be estimated

was evaluated first. Given that this was a saturated model, fit indices were not evaluated. In

model 1, TCQ Reappraisal was not significantly related to suicide and thus this pathway was set

to zero. The model was then reanalyzed, and all pathways remained significant. In this final

model, fit indices demonstrate good fit, 2 (1) = , p = .95, CFI =1.00 , TLI = 1.04, RMSEA= .00

(see Figure 1.). This model suggests that when using the FFBI, the social control and distract

dimensions were negatively associated with suicide risk and BPD symptoms. Worry and

punishment positively related to BPD and suicide while reappraisal was positively related to

BPD symptoms only. Overall, this model accounted for approximately 34% of the variance in

the FFBI and 20% in suicide.

PDQ Borderline Subscale

The same procedure was used for the next two BPD measures. For the PDQ_BPD, social control

was not related to BPD and reappraisal was not related to suicide. Therefore, these two pathways

were set to zero. Upon reevaluation, this new model retained all significant pathways. The model

provided good fit to the data, 2 (2) = 1.21, p = .55, CFI =1.00 , TLI = 1.01 , RMSEA= .000 (see
THOUGHT CONTROL, BPD AND SUICIDE RISK 13

Figure 2.). Similar to the FFBI, distraction was negatively associated with both BPD symptoms

and suicide risk while social control was negatively related to suicide only. Similar to the FFBI,

worry and punishment were positively related to both borderline symptoms and suicidal ideation.

Reappraisal was also positively related to borderline, but not suicide risk. Overall, this model

accounted for 30% of the variance in the PDQ and 19% in suicide risk.

PAI Borderline Subscale

Finally, the PAI_BOR scale was tested within the model. The initial path analysis

conducted in the saturated model indicated that reappraisal was not linked to suicide or BPD, and

the social control dimension was not related to borderline and thus these pathways were trimmed

from the model. This final model indicated good fit, 2 (3) = 4.01, p = .26, CFI =1.00, TLI = .99,

RMSEA= .03 (see Figure 3.). More specifically, distraction was negatively associated with both

suicide and borderline symptoms while social control was associated with suicide risk only.

Punishment and worry were again positively related to both BPD and suicide. Overall, this

model accounted for 33% of the variance in BPD symptoms and 19% of the suicidal ideation

variance. Please see Table 2 for a summary of the consistent results across the three models.

Discussion

The results demonstrated partial support for the hypotheses in the current study. Across

all three measures of BPD, distract was negatively associated with symptoms of BPD and

suicidal ideation. These findings are consistent with other research indicating that focusing on

something positive (e.g., “I call to mind positive images instead,” “I do something that I enjoy”)

or moving away from recurrent thoughts would be beneficial overall and thus reduce both BPD

symptoms and suicidal ideation (Tucker et al., 2017; Wells and Carter, 2009). The worry strategy

was positively related to both BPD and suicidal ideation and is also consistent with other
THOUGHT CONTROL, BPD AND SUICIDE RISK 14

research (Tucker et al., 2017; Wells and Carter, 2009), and logically follows that continuing to

worry is highly linked to BPD symptoms and suicide risk.

Surprisingly, reappraisal was positively related to BPD symptoms on the FFBI and

PDQ_BPD. This finding is unexpected, given previous research demonstrating that individuals

with BPD utilize reappraisal techniques less often than non-BPD participants (Daros et al.,

2018). Additionally, there are targeted interventions designed to increase the use of reappraisal

amongst individuals with BPD to improve emotion regulation and overall measures of well-

being (Gross and John, 2013; Koenigsberg, et al., 2019). One possible explanation for this

finding is that the reappraisal dimension might overlap with rumination as both are cognitively

based processes which include thinking, focusing, and analyzing one’s own thoughts and

feelings. Therefore, reappraisal may generally function as a slightly more adaptive cognitive

strategy but may be related to rumination, and thus related to symptoms of BPD. A secondary

explanation may be that the reappraisal scale is not truly assessing reappraisal but instead may be

tapping into aspects of both rumination and reappraisal.

Another unforeseen finding related to reappraisal was that it was not negatively

associated with suicidal ideation in any of the three models. This is counterintuitive, given the

use of reappraisal in targeting emotional regulation and improving emotional experience and

wellbeing (Daros et al., 2018; Gross and John, 2013). Similarly, there is research demonstrating

that individuals with difficulty using cognitive reappraisal strategies were more likely to have a

history of suicidal ideation and may increase suicide risk (Kudinova et al., 2015). One reason

that may account for this null finding is the link between reappraisal and other thought control

domains, such that reappraisal was moderately to largely correlated to three of the other thought

control techniques. Thus, it may be that reappraisal is highly linked to other thought control
THOUGHT CONTROL, BPD AND SUICIDE RISK 15

domains that are more directly linked to suicide. Further research is needed to assess for these

potential relationships.

Consistent with the hypotheses, social control was negatively related to suicide risk and

BPD symptoms on the FFBI, but unexpectedly, was no longer significant on the BPD_PAI or

PDQ_BPD subscales. The PAI and PDQ Borderline subscales are both considered to be

categorical measures of BPD, whereas the FFBI is a dimensional measure of BPD. According to

Skodol and colleagues (2005), the threshold used to distinguish individuals with and without a

diagnosable personality disorder is subjective and does not capture nuances in the level of

impairment. Additionally, work by Zimmerman et al., (2013) demonstrated that across two

studies, dimensional ratings of borderline personality disorder were more strongly related to

indicators of illness severity than individuals with a dichotomous categorical measure of BPD

(diagnosis or not, according to DSM-IV criteria). This is an important finding because social

control may only be negatively related to certain symptoms linked to BPD and the overall

diagnosis of the disorder is not conclusive in determining the level of impairment. A secondary

explanation is that this may be a spurious finding and therefore future research is necessary to

determine whether social control is negatively associated with specific BPD symptoms whether

measured categorically or dimensionally. This is particularly relevant given the transitioning of

the diagnostic criteria of personality disorders broadly to a more dimensional approach (e.g.,

Widiger and Trull, 2007).

Overall, the findings suggest the distraction is negatively associated with all three

measures of BPD and suicide risk while social control was consistently negatively related to

suicide specifically. The importance of these findings is highlighted by the fact that they are

significant across three different measures of BPD symptoms demonstrating the robustness of the
THOUGHT CONTROL, BPD AND SUICIDE RISK 16

results. Also, both of these thought control strategies are skills that can be potentially targeted in

clinical interventions to reduce BPD symptoms and suicide risk. Currently, metacognitive

therapy (MCT) is being used as an intervention targeting transdiagnostic symptoms such as

rumination, perseverative thinking, and low control over negative thoughts and emotions

(Normann et al., 2014). In a trial using MCT targeting rumination, depression, anxiety, and

metacognitions, there was a large effect size in symptom reduction in depression worry, and

rumination (Hjemdal et al., 2017). Future research may benefit from investigating MCT as a

treatment for BPD.

Strengths, Limitations, and Future Directions

This study is the first of its kind to examine the specific thought control strategies as

predictors of BPD symptoms and suicide risk. Therefore, this is the first study to attempt to

identify strategies that may decrease or increase BPD symptoms and suicide risk. Future research

should be directed at replicating and expanding upon these findings. Furthermore, this line of

research may eventually lead to the development of new interventions that, like MCT, can target

dysfunction cognitive strategies to improve BPD symptoms and decrease suicide risk.

The present study examined an undergraduate sample and consisted of mostly white,

female participants with an average age of 19.67 years. Given the sample characteristics, there

may be limitations in the generalizability of the findings. However, the range of scores for each

of the measures indicates that there is a wide range of severity throughout the measures. The PAI

Borderline subscale indicates approximately 11.4% of the sample endorsed clinically significant

levels of symptoms. On the PDQ-4 subscale, 21.6% of participants endorsed 5 or more

symptoms of BPD indicating significant clinical difficulties (Bagby and Farvolden, 2004).

Moreover, the prevalence of BPD among outpatients is 10%, suggesting reasonable

THOUGHT CONTROL, BPD AND SUICIDE RISK 17

generalizability of the present findings (APA, 2013). The PAI suicide scale also demonstrated a

wide range of severity with 5.4% of the sample falling two standard deviations above the mean.

The range of severity across measures demonstrates that these findings can be generalized to a

community sample and may even conservatively generalized to a clinical sample. Future

research is needed to expand upon this study, particularly with clinical populations.

Finally, personality disorders cannot be diagnosed in individuals until the age of 18,

therefore the young sample may not be representing the full range of possible BPD symptoms or

might be reflecting emotional dysregulation and interpersonal instability related to emerging

adulthood rather than a personality disorder. While research has demonstrated that even one

symptom of BPD increased the likelihood of suicidal ideation, suicide attempt, and psychiatric

hospitalizations (Zimmerman et al., 2012), future research is needed to further understand the

link between thought control strategies and BPD within various populations. Therefore, future

research should seek to investigate these relations within clinical samples and among a more

diverse population (i.e., gender, ethnicity, age).

Conclusion

To summarize, the current study indicates that certain thought control strategies may help

to buffer against or increase symptoms of BPD and suicide risk. Therefore, treatments focusing

on increasing or decreasing these strategies may in turn help increase or decrease BPD symptoms

and suicide risk. Future research should continue to investigate the link between thought control

and psychopathology.
THOUGHT CONTROL, BPD AND SUICIDE RISK 18

Contributors

Dr. Hilary L. DeShong designed and implemented the study after acquiring IRB approval, collected and
cleaned the data, in addition to writing the methods section and providing feedback. Ms. Caitlin E. Titus
wrote the introduction, results, and discussion. Statistical analyses were conducted by both authors,
together. All authors have approved the final article.

Role of the Funding Source

This work was supported by the Office of Research and Economic Development at Mississippi State
University.

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Acknowledgments

The authors have no acknowledgements.

THOUGHT CONTROL, BPD AND SUICIDE RISK 19

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Table 1

Descriptive statistics of borderline, suicide risk, and thought control strategies

Measure Mean (SD) Skewness Kurtosis Min Max
FFBI 105.85 (38.02) .48 -.46 48.00 236.00
PDQ_BPD 2.70 (2.08) .73 -.19 0.00 9.00
BPD_PAI 25.02 (11.29) .50 .13 1.00 61.00
PAI_SUI 4.45 (5.58) 2.01 5.51 0.00 35.00
Distract 16.26 (3.81) -.02 -.16 6.00 24.00
Punish 10.52 (3.72) .98 .63 6.00 24.00
Reappraisal 13.82 (3.90) .08 -.31 6.00 24.00
Worry 11.33 (3.88) .52 -.06 6.00 24.00
Social Control 13.52 (3.97) -.12 -.36 6.00 24.00
 THOUGHT CONTROL, BPD AND SUICIDE RISK 27

Table 2

Correlations, Means, and Standard Deviations of borderline, suicide risk, and thought control strategies.
Social
FFBI PDQ_BPD BPD_PAI PAI_SUI Distract Punish Reappraisal Worry Control
FFBI -
PDQ_BPD .67** -
BPD_PAI .76*** .74** -
PAI_SUI .54** .47** .55** -
Distract -.09 -.12* -.08 -.15** -
Punish .47** .48** .48** .35** .12* -
Reappraisal .31** .27** .27** .01 .43** .46** -
Worry .51** .46** .52** .32** .09 .68** .52** -
Social Control -.13* -.01 -.13* -.16** -.01 -.10* .12* -.11 -
Mean 105.85 2.70 25.02 4.45 16.25 10.52 13.82 11.33 13.52
Std. Deviation 38.02 2.08 11.29 5.58 3.81 3.72 3.90 3.88 3.97
Note. *p <.05, two-tailed;** p <.01, two-tailed; Bold=Large Effect; Italics=Medium Effect.
THOUGHT CONTROL, BPD AND SUICIDE RISK 28

Table 3

Significant Results Across All Three Models

TCQ Strategy BPD Symptoms Suicide Risk
Distract — —
Punish + +
Reappraisal
Worry + +
Social Control —
Note. + = positively related, — = negatively related.
THOUGHT CONTROL, BPD AND SUICIDE RISK 29
THOUGHT CONTROL, BPD AND SUICIDE RISK 30
THOUGHT CONTROL, BPD AND SUICIDE RISK 31