Development of self-inflicted injury: Comorbidities and continuities with borderline and antisocial personality traits

Abstract

Self-inflicted injury (SII) is a continuum of intentionally self-destructive behaviors, including nonsuicidal self-injuries, suicide attempts, and death by suicide. These behaviors are among the most pressing yet perplexing clinical problems, affecting males and females of every race, ethnicity, culture, socioeconomic status, and nearly every age. The complexity of these behaviors has spurred an immense literature documenting risk and vulnerability factors ranging from individual to societal levels of analysis. However, there have been relatively few attempts to articulate a life span developmental model that integrates ontogenenic processes across these diverse systems. The objective of this review is to outline such a model with a focus on how observed patterns of comorbidity and continuity can inform developmental theories, early prevention efforts, and intervention across traditional diagnostic boundaries. Specifically, when SII is viewed through the developmental psychopathology lens, it becomes apparent that early temperamental risk factors are associated with risk for SII and a range of highly comorbid conditions, such as borderline and antisocial personality disorders. Prevention efforts focused on early-emerging biological and temperamental contributors to psychopathology have great potential to reduce risk for many presumably distinct clinical problems. Such work requires identification of early biological vulnerabilities, behaviorally conditioned social mechanisms, as well as societal inequities that contribute to self-injury and underlie intergenerational transmission of risk.

Strategies to Deal With Suicide and Non-suicidal Self-Injury in Borderline Personality Disorder, the Case of DBT

“…NSSI has a higher prevalence among adolescents and young adults, and is associated with an array of psychosocial issues and is believed to be a transdiagnostic manifestation arising from an underlying vulnerability inherent to the psychopathology (Crowell et al, 2009; Selby et al, 2015). NSSI differs from suicide in that it is not associated with suicidal inclinations: furthermore, the strategies implemented for behaviors aiming at regulating negative emotions are different from those used to manage behaviors aiming at causing death (Crowell and Kaufman, 2016). Unlike suicide, NSSI has an immediate and short-term impact, and must be carried out repeatedly to produce the desired outcome (Shaffer and Jacobson, 2009).…”

A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder

“…One of the major challenges in diagnosing, treating and studying BPD is the typically high levels of comorbid disorders [ 5 ], including anxiety [ 9 , 10 ], depression and other mood disorders [ 10 – 13 ], substance use disorders [ 2 , 4 , 14 , 15 ], suicidal and parasuicidal behaviour [ 13 , 16 ] and Antisocial Personality Disorder (ASPD) [ 5 , 17 – 19 ]. High levels of comorbidity not only make it difficult to diagnose and to treat BPD, but also to disentangle correlates and antecedents of BPD from those of comorbid disorders.…”

Prenatal Stress, Fearfulness, and the Epigenome: Exploratory Analysis of Sex Differences in DNA Methylation of the Glucocorticoid Receptor Gene

“…The effects of stress exposure on an expectant mother can have an early and enduring impact on her child’s functioning (Sandman et al, 2011 ). Exposure to prenatal stress has been associated with increased fearful behavior (Bergman et al, 2007 , 2008 ; Davis et al, 2007 ; Werner et al, 2007 ) and stress reactivity (Yehuda et al, 2005 ; Oberlander et al, 2008 ; Davis et al, 2011 ), placing these children at risk for developing internalizing symptoms later in life ( Crowell and Kaufman, in press ). For instance, longitudinal work from Davis and Sandman ( 2012 ) showed that children exposed to maternal anxiety and stress in utero exhibit more internalizing symptoms across childhood, with rank order stability persisting into adolescence (O’Donnell et al, 2014 ).…”