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The current study aimed at predicting suicide attempts among BPD patients during disorder\u2010specific psychotherapeutic interventions exploiting machine learning techniques. The study took into account several potential predictors relevant to BPD psychopathology: emotion dysregulation, temperamental and character factors, attachment style, impulsivity, and aggression. The sample included 69 patients with BPD who completed the Temperament and Character Inventory, Attachment Style Questionnaire, Difficulties in Emotion Regulation Scale, Barratt Impulsiveness Scale, and Aggression Questionnaire at baseline and after 6 months of psychotherapy. To detect future suicide attempts, baseline questionnaires were entered as predictors into an elastic net penalized regression, whose predictive performance was assessed through nested fivefold cross\u2010validation. At the same time, 5000 iterations of a non\u2010parametric bootstrap were used to determine predictors\u2019 robustness. The elastic net model discriminating BPD suicide attempters from non\u2010attempters reached a balanced accuracy of 64.09% and an area under the receiver operating curve of 70.44%. High preoccupation with relationships, harm avoidance, and reward dependence, along with low motor impulsiveness, verbal aggression, cooperativeness, and self\u2010transcendence were the most contributing predictors. Our findings suggest that interpersonal vulnerability and internalizing factors are the strongest predictors of future suicide attempts in BPD. Machine learning on self\u2010report psychological scales may be helpful to identify individuals at suicidal risk, potentially helping clinical settings to develop individualized preventive strategies.<\/jats:p>","DOI":"10.1002\/jclp.23763","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T07:18:34Z","timestamp":1735888714000},"page":"222-236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Longitudinal Prediction of Suicide Attempts in Borderline Personality Disorder: A Machine Learning Study"],"prefix":"10.1002","volume":"81","author":[{"given":"Lidia","family":"Fortaner\u2010Uy\u00e0","sequence":"first","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"},{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Monopoli","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Cavicchioli","sequence":"additional","affiliation":[{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Calesella","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"},{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Colombo","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"},{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Carretta","sequence":"additional","affiliation":[{"name":"Associazione GET Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Tal\u00e8","sequence":"additional","affiliation":[{"name":"Associazione GET Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Benedetti","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"},{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Visintini","sequence":"additional","affiliation":[{"name":"Associazione GET Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Maffei","sequence":"additional","affiliation":[{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0748-4656","authenticated-orcid":false,"given":"Benedetta","family":"Vai","sequence":"additional","affiliation":[{"name":"Psychiatry and Clinical Psychobiology Unit, Division of Neuroscience IRCCS Ospedale San Raffaele Milan Italy"},{"name":"University Vita\u2010Salute San Raffaele Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/00332941221087911"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2016.00344"},{"issue":"9","key":"e_1_2_7_4_1","first-page":"792","article-title":"Attachments Across the Life Span","volume":"61","author":"Ainsworth M. 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