Alcoholics Face Much Greater Risks of Suicide

Alcoholics With Borderline Personality Disorder at Much Greatest Risk

Tormented Man
Alcoholics at Risk for Suicide. © Getty Images

Alcoholics who live alone, and those who have personality disorders, are up to ten times more likely to attempt suicide than the general population, according to a study of people in treatment for alcohol use disorders in Germany.

On study reported as high as 40 percent of treatment-seeking patients with alcohol-use disorders report having attempted suicide, which is six to 10 times greater than suicide attempts among the general population.

"We knew from previous research that both alcohol dependence and personality disorders are significant risk factors for suicidal behavior," said Ulrich W. Preuss, assistant professor of psychiatry at Martin-Luther-University of Halle, Germany. "However, how each affects the other or interact together, this was not researched."

A High-Risk Population for Suicide

"There are meager data on the contribution of most personality disorders to attempted suicide among individuals treated intensively for alcohol dependence, a high-risk population," said Kenneth R. Conner, associate professor of psychiatry at the University of Rochester Medical Center. "This study is highly unusual in that all of the current personality disorders were assessed using a credible research interview in a large alcohol-dependent sample."

The researchers studied 376 patients at an alcohol-dependence treatment program in Germany.

They were extensively tested for personality disorders. Results of the testing indicated that 55 percent of those patients had some personality disorder and 25 percent had attempted suicide at least once, according to a news release.

Variety of Personality Disorders

The types of personality disorders found in the group were divided into three clusters:

All Types Are Risk Factors for Suicide

"All personality disorders, from all the clusters, increase the risk for suicidal behavior among alcoholics," said Preuss. "Subjects who have cluster B personality disorders – which include narcissistic, histrionic, borderline and antisocial PDs – are at particular risk."

"Furthermore, taking into account several known risk factors – such as depression, marital status, aggression and impulsive traits – statistically speaking, subjects with borderline personality disorde and those who live alone are at highest risk," Preuss said.

Borderline Personality Disorder

Preuss and Conner described a borderline personality disorder as a pervasive or enduring pattern of self-destructive behavior characterized by:

  • Instability of interpersonal relationships
  • A propensity to experience acute negative emotions such as sadness or anger
  • Poor self-image
  • Marked impulsivity beginning by early adulthood
  • Uncertainty of one's values and goals.

"Alcohol-dependent individuals who live alone often are separated or divorced from their spouses due to their alcoholism," noted Preuss.

"Furthermore, they are significantly more often unemployed and have a poor perspective in life. This might lead to an even higher intake of alcohol and subsequently to more hopelessness, depression and social isolation.

High Intent to Die

"Together with their difficult socio-economic situation, often a minor event – such as trouble with the authorities or neighbors – is enough to precipitate suicidal behavior. Very often these subjects get drunk before the suicide attempt."

"Among individuals with a history of one or more suicide attempts," added Conner, "analysis of the characteristics of the most serious attempt suggests that alcohol-dependent individuals with borderline personality disorder had high intent to die, indicating that suicide attempts in this population can not be taken lightly.

In other words, alcohol-dependent individuals with a borderline personality disorder are likely to be at high risk for completed suicide, in addition to the well-known fact that they are at high risk for attempted suicide."

Prevention Strategies Needed

"I hope these findings might provide some insights for clinicians on how to assess suicide risk in these double-diagnoses subjects," said Preuss. "Clinicians and personnel who have frequent contacts with these patients in outpatient clinics or community clinics should be able to offer long-term suicide prevention strategies to subjects with known risk factors.

"I also hope that members of the public will realize that alcohol dependence is a psychiatric disease and not a habit, that personality disorders in alcoholic subjects occur very often, and that alcoholics with comorbid conditions are at high risk for suicidal behavior."


Preuss, UW, et al. "Suicidal Behavior in Alcohol-Dependent Subjects: The Role of Personality Disorders." Alcoholism: Clinical & Experimental Research May 2006

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