Suicide and deliberate self-harm in personality disorders

Current Opinion in Psychiatry

Volumn 19, Issue 1, 2006, Pages 95-101

  Krysinska, Karolina ^a   Heller, Travis S ^a   De Leo, Diego ^a  

^a GRIFFITH UNIVERSITY   (Australia)

Author keywords

Co morbidity; Deliberate self harm; Personality disorders; Self mutilation; Suicidal behaviour

Indexed keywords

ATYPICAL ANTIPSYCHOTIC AGENT; CLOZAPINE; OLANZAPINE; QUIETIAPINE; RISPERIDONE; UNCLASSIFIED DRUG;

ANTISOCIAL BEHAVIOR; ANXIETY DISORDER; AUTOMUTILATION; BEHAVIOR THERAPY; BORDERLINE STATE; CHILD ABUSE; CLINICAL TRIAL; COGNITIVE DEFECT; COGNITIVE THERAPY; COMORBIDITY; HOSPITALIZATION; HUMAN; LIFE EVENT; MEDICOLEGAL ASPECT; MOOD DISORDER; PERSONALITY DISORDER; RANDOMIZATION; REVIEW; RISK FACTOR; SEXUAL ABUSE; SOCIOPATHY; SUBSTANCE ABUSE; SUICIDAL BEHAVIOR; SUICIDE; ADDICTION; EATING DISORDER; STATISTICS; SUICIDE ATTEMPT;

COMORBIDITY; EATING DISORDERS; HUMANS; MOOD DISORDERS; PERSONALITY DISORDERS; SELF-INJURIOUS BEHAVIOR; SUBSTANCE-RELATED DISORDERS; SUICIDE; SUICIDE, ATTEMPTED;

EID: 33646853682     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.yco.0000191498.69281.5e     Document Type: Review

References (59)

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Text revision. Washington, DC: APA; 2000.
2. Linehan MM, Rivzi SL, Welch SS, Page B. Psychiatric aspects of suicidal behaviour: personality disorders. In: Hawton K, Van Heeringen K, editors. The international handbook of suicide and attempted suicide. Chichester, UK: John Wiley & Sons; 2000. pp. 147-178.
3. Pompili M, Ruberto A, Girardi P, Tatarelli R. Suicidality in DSM-IV cluster B personality disorders: an overview. Ann Ist Super Sanita 2004; 40:475-483. A review of literature published from 1980 to 2004 on the subject of suicidality in borderline, narcissistic and antisocial personality disorders, and other co-morbid disorders.
4. Lieb K, Zanarini MC, Schmahl C, et al. Borderline personality disorder. Lancet 2004; 364:453-461.
5. Black DW, Blum N, Pfohl B, Hale N. Suicidal behaviour in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Pers Disord 2004; 18:226-239. A review paper summarizing current knowledge concerning the prevalence and risk factors for suicidal behaviours in BPD, as well as treatment and prevention of suicide in this diagnostic group.
6. Isometsä ET. Psychological autopsy studies: a review. Eur Psychiatry 2001; 16:379-384.
7. Schmidtke A, Bille-Brahe U, De Leo D, et al. Sociodemographic characteristics of suicide attempters in Europe: combined results of the monitoring part of the WHO/EURO Multicentre Study on Suicidal Behaviour. In: Schmidtke A, Bille-Brahe U, De Leo D, Kerkhof A, editors. Suicidal behaviour in Europe: results from the WHO/EURO Multicentre Study on Suicidal Behaviour. Göttingen, Germany: Hogrefe & Huber; 2004. pp. 29-43.
8. Bertolote JM, Fleischmann A, De Leo D, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis 2004; 25:147-155. A comprehensive review of 31 studies published worldwide between 1959 and 2001 examining psychiatric diagnoses in completed suicides in the general population and among psychiatric inpatients. Personality disorders were found in 15.2% of psychiatric inpatients and in 3.2% of suicides in the general population, with the number increasing to 13.1% when multiple diagnoses were allowed. The implications of the findings are discussed for suicide prevention in the global perspective.
9. Arsenault-Lapierre G, Kim C, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 2004; 4:37. A quantitative analysis of 27 psychological autopsy studies conducted worldwide since 1986, looking at psychiatric diagnoses in completed suicide and analysing geographical and gender differences related to this topic. Personality disorders accounted for 16.2% of diagnoses, with the risk for personality disorders two times higher in male than female suicides, indicating the possibility of gender-specific clinical risk factors for suicide.
10. Ernst C, Lalovic A, Lesage A, et al. Suicide and no axis I diagnosis. BMC Psychiatry 2004; 4:7.
11. Schneider B, Maurer K, Sargk D, et al. Concordance of DSM-IV axis I and II diagnoses by personal and informant's interview. Psychiatry Res 2004; 127:121-136. This paper comprehensively investigated the utility of determining diagnoses of personality disorders via the psychological autopsy method of suicide research, showing that the SCID can be used with good reliability in detecting personality disorders of any kind or cluster. Many previous studies had poor reliability in diagnosing personality disorders due to unstructured instruments, with small sample sizes restricting the power of other studies.
12. First MB, Spitzer RL, Gibbons M, et al. Structured Clinical Interview for DSMIV Axis II Personality Disorders (SCID-II, Version 2.0). Biometrics Research Department, New York State Psychiatric Institute, New York; 1994.
13. Verona E, Sachs-Ericsson N, Joiner TE. Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry 2004; 161:444-451.
14. Jenkins R, Bhugra D, Meltzer H, et al. Psychiatric and social aspects of suicidal behaviour in prisons. Psychol Med 2005; 35:257-269. A report from the British National Psychiatric Morbidity Survey including samples of prisoners from all prisons in England and Wales. This paper examines the prevalence of suicidal ideation and behaviour, as well as psychosocial correlates of suicidality in prisoners.
15. Yen S, Shea MT, Sanislow CA, et al. Borderline personality disorder criteria associated with prospectively observed suicidal behaviour. Am J Psychiatry 2004; 161:1296-1298. A report from the Collaborative Longitudinal Personality Disorders Study looking at predictors of suicidality in schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders with a comparison group of major depressive disorder patients. It is a 2-year follow-up study comparing correlates of suicidal behaviour regardless of intent to die and suicide attempts with at least some intent to die and resulting in at least mild medical threat.
16. Chioqueta AP, Stiles T. Assessing suicide risk in cluster C personality disorders. Crisis 2004; 25:128-133. A study looking at the prevalence of suicidal behaviour in individuals diagnosed with cluster C personality disorders, indicating that assessment of suicide risk in this diagnostic group is not necessary as long as co-morbid depressive disorder is appropriately identified and managed.
17. Mohino Justes S, Ortega-Monasterio L, Planchat Teruel LM, et al. Discriminating deliberate self-harm in young prison inmates through personality disorder. J Forensic Sci 2004; 49:137-140. A Spanish study examining psychosocial, cognitive and penitentiaries correlates of deliberate self-harm defined as injurious acts upon one's own body without the apparent intent to kill among young (18-25 years old) inmates, with a special focus on personality disorders.
18. Aghanwa H. The determinants of attempted suicide in a general hospital setting in Fiji Islands: a gender specific study. Gen Hosp Psychiatry 2004; 26:63-69. A study conducted in Fiji examining the sociodemographic and clinical characteristics of individuals who attempt suicide, with a special focus on gender-specific risk factors and cross-cultural comparisons.
19. Yen S, Pagano ME, Shea MT, et al. Recent life events preceding suicide attempts in a personality disorder sample: findings from the collaborative longitudinal personality disorders study. J Consult Clin Psychol 2005; 73:99-105. Another report from the longitudinal Collaborative Longitudinal Personality Disorders Study looking at predictors of suicidality in schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. It is the first study in the literature reporting the association between specific types of negative life events and suicidal behaviour using time-varying analyses and prospective design.
20. Söderberg S, Kullgren G, Renberg ES. Childhood sexual abuse predicts poor outcome seven years after parasuicide. Soc Psychatry Psychiatr Epidemiol 2004; 39:916-920.
21. Sansone RA, Songer DA, Miller KA. Childhood abuse, mental health care utilization, self-harm behaviour, and multiple psychiatric diagnoses among inpatients with and without a borderline diagnosis. Compr Psychiatry 2005; 46:117-120.
22. McKay D, Gavigan CA, Kulchycky S. Social skills and sex-role functioning in borderline personality disorder: relationship to self-mutilating behaviour. Cogn Behav Ther 2004; 33:27-35. A study comparing social communication skills and femininity/masculinity personality characteristics in female inpatients diagnosed with BPD with and without a history of self-mutilation.
23. Mac Leod AK, Tata P, Tyrer P, et al. Personality disorder and future-directed thinking in parasuicide. J Pers Disord 2004; 18:459-466. A psychological study looking at deficits in future-directed thinking as a background vulnerability factor linking personality disorders and suicidality in a sample of individuals engaging in parasuicidal behaviour. The results indicate that lack of positive future thinking is associated with cluster B personality disorders, especially BPD and APD, and may be related to impulsiveness and emotional dysregulation.
24. Kim CD, Seguin M, Therrien N, et al. Familial aggregation of suicidal behaviour: a family study of male suicide completers from the general population. Am J Psychiatry 2005; 161:1017-1019.
25. Berlin HA, Rolls ET. Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients. J Pers Disord 2004; 18:358-378.
26. Hawton K, Houston K, Haw C, et al. Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry 2003; 160:1494-1500.
27. Black DW, Noyes R, Pfhol B, et al. Personality disorders in obsessive-compulsive volunteers, well comparison subjects, and their first-degree relatives. Am J Psychiatry 1993; 150:1226-1232.
28. Sullivan PF, Joyce PR, Mulder RT. Borderline personality disorder in major depression. J Nerv Ment Dis 1994; 21:83-87.
29. Bellino S, Patria L, Paradiso E, et al. Major depression in patients with borderline personality disorder: a clinical investigation. Can J Psychiatry 2005; 50:234-238.
30. Oquendo M, Brent DA, Birmaher B, et al. Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry 2005; 162:560-566.
31. Oquendo MA, Friedman JH, Grunebaum MF, et al. Suicidal behavior and mild traumatic brain injury in major depression. J Nerv Ment Dis 2004; 192:430-434.
32. Kim CD, Lesage AD, Seguin M, et al. Seasonal differences in psychopathology of male suicide completers. Comp Psychiatry 2004; 45:333-339. This study revealed that a seasonal variation in suicides by persons with affective disorders is only evident when co-morbid cluster B personality disorders are not present. The importance of factors such as impulsive-aggressive tendencies appear to mediate the variations in suicides across seasons, implying that suicide risk assessment must include the presence or absence of personality disorders.
33. Ozkan M, Altindag A. Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity? Comp Psychiatry 2005; 46:20-26.
34. Iketani T, Kiriike N, Stein MB, et al. Patterns of axis II comorbidity in early-onset versus late-onset panic disorder in Japan. Compr Psychiatry 2004; 45:114-120.
35. Milos G, Spindler A, Hepp U, Schnyder U. Suicide attempts and suicidal ideation: links with psychiatric comorbidity in eating disorder subjects. Gen Hosp Psychiatry 2004; 26:129-135.
36. Bruce KR, Steiger H, Koerner NM, et al. Bulimia nervosa with co-morbid avoidant personality disorder: behavioural characteristics and serotonergic function. Psych Med 2004; 34:113-124.
37. Kessler RC. The epidemiology of dual diagnosis. Biol Psychiatry 2004; 56:730-737.
38. Darke S, Williamson A, Ross J, et al. Borderline personality disorder, antisocial personality disorder and risk-taking among heroin users: findings from the Australian Treatment Outcomes Study (ATOS). Drug Alcohol Depend 2004; 74:77-83.
39. Mills KM, Teeson M, Darke S, et al. Young people with heroin dependence: findings from the Australian Treatment Outcomes Study. J Subst Abuse Treat 2004; 27:67-73.
40. Darke S, Ross J, Lynskey M, Teesson M. Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcomes Study (ATOS): prevalence and risk factors. Drug Alcohol Depend 2004; 73:1-10.
41. McGlashan TH, Grilo CM, Sanislow CA, et al. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders. Am J Psychiatry 2005; 162:883-889. A report from the Collaborative Longitudinal Personality Disorders Study including a detailed analysis of base rate and stability of 'self-injury' as a DSM-IV diagnostic criterion for BPD. Results indicate that although suicidality is among the least frequent and most remitting BPD symptoms, it is easily observable and its diagnostic efficiency is high.
42. Grilo CM, Becker DF, Anez LM, McGlashan TH. Diagnostic efficiency of DSMIV criteria for borderline personality disorder: an evaluation in Hispanic men and women with substance use disorders. J Consult Clin Psychol 2004; 72:126-131. A Hispanic study contributing to the literature on personality pathology and DSMIV diagnostic criteria for BPD across ethnic populations and gender groups.
43. Botvinik L, Ng C, Schweitzer I. Audit of antipsychotic prescribing in a private psychiatric hospital. Australas Psychiatry 2004; 12:227-233.
44. Ferrerri MM, Loze J-Y, Rouillon F, Limosin F. Clozapine treatment of a borderline personality disorder with severe self-mutilating behaviours. Eur Psychiatry 2004; 19:177-178.
45. Grootens KP, Verkes RJ. Emerging evidence for the use of atypical antipsychotics in borderline personality disorder. Pharmacopsychiatry 2005; 38:20-23. A comprehensive review of literature published since 1993 on the use of atypical antipsychotics in the treatment of BPD.
46. Robins CJ, Chapman AL. Dialectical behaviour therapy: current status, recent developments, and future directions. J Pers Disord 2004; 18:73-89. A comprehensive review of literature on the topic of dialectical behaviour therapy, including a description of standard treatment and its recent modifications for a variety of settings and clinical populations.
47. Bohus M, Haaf B, Simms T, et al. Effectiveness of inpatient dialectical behavioural therapy for borderline personality disorder: a controlled trial. Behav Res Therapy 2004; 42:487-499.
48. Brown GK, Newman CF, Charlesworth SE, et al. An open clinical trial of cognitive therapy for borderline personality disorder. J Pers Disord 2004; 18:257-271. A report from an open clinical trial examining the efficacy of cognitive therapy in treatment of suicidal BPD patients.
49. Stevenson J, Meares R, D'Angelo R. Five-year outcome of outpatients psychotherapy with borderline patients. Psychol Med 2005; 35:79-87.
50. Chiesa M, Fonagy P, Holmes J, Drahorad C. Residential versus community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2004; 161:1463-1470.
51. Tyrer P, Tom B, Byford S, et al. Differential effects of Manual Assisted Cognitive Behaviour Therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT Study. J Pers Disord 2004; 18:102-116. A report from the POPMACT study. This large-scale randomized controlled trial of the effectiveness of this therapy in treating suicide attempters with a diagnosis of personality disorder yielded mixed results. Although there was no statistically significant reduction in the repetition of deliberate self-harmover the follow-up period, treatment was cost-effective and related to fewer self-harm episodes and suicides.
52. Ellenhorn R. Parasuicidality and patient careerism: treatment recidivism and the dialectics of failure. Am J Orthopsychiatry 2005; 75:288-303.
53. Paris J. Half in love with easeful death: the meaning of chronic suicidality in borderline personality disorder. Harv Rev Psychiatry 2004; 12:42-48. An article reviewing clinical and empirical literature on chronic suicidality in individuals with BPD. Difficulties in defining suicidality in this clinical group are discussed, as well as prevalence and risk factors for completed and attempted suicide in BPD. Important psychological and interpersonal functions of chronic suicidality are presented, recommended approaches to treatment are discussed and difficulties related to hospitalization are examined.
54. Sansone RA. Chronic suicidality and borderline personality. J Pers Disord 2004; 18:215-225.
55. Paris J. Is hospitalization useful for suicidal patients with borderline personality disorder? J Pers Disord 2004; 18:240-247.
56. Krawitz R, Jackson W, Allen R, et al. Professionally indicated short-term risk-taking in the treatment of borderline personality disorder. Australas Psychiatry 2004; 12:11-17. A theoretical paper defining the professionally indicated short-term risk-taking as a decision-making process in the clinical management of adults with a BPD diagnosis, prerequisites for applying this approach and its inherent difficulties, as well as its medicolegal context.
57. Gutheil TG. Suicide, suicide litigation, and borderline personality disorder. J Pers Disord 2004; 18:248-256. A review paper discussing the theoretical, practical and psychological aspects of suicide litigation in the US and their application to clinical risk management of suicidal BPD patients. The author examines the unique dynamics of BPD, including psychotic transferences, 'golden fantasy' and 'date with death', and clarifies its role in the context of suicide malpractice litigation.
58. Carter GL, Lewin TJ, Stoney C, et al. Clinical management for hospital-treated deliberate self-poisoning: comparisons between patients with major depression and borderline personality disorder. Aust N Z J Psychiatry 2005; 39:266-273.
59. Boggild AK, Heisel MJ, Links PS. Social, demographic, and clinical factors related to disruptive behaviour in hospital. Can J Psychiatry 2004; 49: 114-118. An empirical retrospective case-control study examining disruptive behaviour in mental hospital in BPD patients and individuals with other psychiatric diagnoses.