Personality dysfunction according to the DSM-5 Alternative Model of Personality Disorders (AMPD) predicts suicide attempts in clinical high-risk adolescents

Both personality traits and personality disorders have been linked to suicide risk in youth. The DSM-5 Alternative Model of Personality Disorders (AMPD) allows dimensional assessment of personality pathology, which may enhance prediction of suicide attempts. A recent study found that personality dysfunction (Criterion A of the AMPD) is associated with past suicide attempts in adolescents. Building on this, the present study aimed to investigate the longitudinal relationship between AMPD personality pathology and suicide attempts in adolescents. Data were drawn from a consecutive clinical cohort study including adolescent patients aged 12 to 18 years ( N = 252, 85% female) engaging in risk-taking and self-harming behaviors. Personality dysfunction, maladaptive personality traits, suicide attempts, and depression severity were assessed using standardized interviews and questionnaires at baseline and at two annual follow-ups. 66% of participants completed any follow-up. A Bayesian Structural Equation Modeling framework was used for data analysis. Personality dysfunction predicted suicide attempts over the two-year follow-up ( β = 0.38, 95% CI 0.01; 0.73, p = .046). Adding maladaptive personality traits did not add predictive value, while depression severity emerged as a slightly stronger predictor. The effect of personality dysfunction remained stable after accounting for these variables. These findings highlight the value of assessing personality dysfunction in adolescent suicide risk evaluation. Within the AMPD framework, personality dysfunction may be more important than maladaptive traits in predicting suicide attempts. However, analyzing distinct personality functioning domains or maladaptive traits may provide further insight into suicide attempt prediction. • Categorical (borderline) personality disorder diagnosis is a predictor of suicide attempts. • The alternative model of personality disorders (AMPD) describes personality functioning dimensionally. • Personality functioning predicts adolescent suicide attempts over two years. • Including personality functioning may improve early suicide-risk detection.