The relationship between schema and metacognition and the possibility of suicide in individuals with borderline personality disorder

Borderline Personality Disorder (BPD) is a long-standing psychiatric disorder that disrupts essential psychological functions such as emotion regulation, impulse control, interpersonal functioning, and the perception of self, making it a significant public health issue. Recognized as one of the most frequently observed personality disorders in psychiatric clinics worldwide, BPD encompasses a broad spectrum of symptoms that substantially impair quality of life and are closely linked to recurrent suicide attempts. The present study aimed to investigate how suicide probability relates to early maladaptive schemas and metacognitive processes in individuals diagnosed with BPD. The study sample consisted of 120 participants meeting DSM-5 criteria for BPD and 120 healthy controls. All individuals who provided informed consent and met the inclusion criteria completed a sociodemographic questionnaire, the Young Schema Questionnaire, the Suicide Probability Scale, the Metacognition Questionnaire, the GAD-7, and the PHQ-9. A comparison of sociodemographic characteristics revealed that the BPD group had significantly higher rates of physical illness (p<0.05), longer education duration, higher unemployment rates, differing living conditions, more frequent family histories of psychiatric disorders, and more frequent self-harm histories (p<0.01). No meaningful differences were detected in marital status or gender. Regarding descriptive clinical features, the number of suicide attempts (p<0.01) and psychiatric hospitalizations (p<0.01) was notably higher among individuals with BPD, whereas age did not differ significantly between groups (p=0.49). Participants diagnosed with BPD scored significantly higher than controls on the YSQ, SPS, GAD-7, MCQ, and PHQ-9 (p<0.01). Additionally, total and subscale scores of the YSQ, MCQ, GAD-7, and PHQ-9 demonstrated strong, significant correlations with SPS total and subscale scores (p<0.01). In the hierarchical regression model, where the SPS served as the dependent variable, education level, number of suicidal behaviors, depression and anxiety severity, and schema and metacognitive variables all contributed significantly to the predictive model (p<0.01). In summary, the findings show that suicide probability in individuals with BPD is strongly associated with maladaptive schemas and metacognitive factors. Furthermore, current depressive and anxious symptom levels appear to be additional influential contributors to increased suicide risk. These results suggest that therapeutic approaches incorporating schema therapy and metacognitive therapy may play an important role in reducing suicide risk while enhancing overall functioning and quality of life in individuals with BPD. Based on these outcomes, strengthening psychosocial support systems is recommended to better understand the mechanisms underlying suicidal behavior and to improve functional capacity in this population. Keywords: Borderline Personality Disorder, Suicide Probability, Schema, Metacognition