Distinguishing Suicidal from Non-Suicidal Deliberate Self-Harm Events in Women with Borderline Personality Disorder

Maddock, Gillian R.; Murrell, Elizabeth; Lewin, Terry J.; Conrad, Agatha M.

doi:10.1080/00048671003610104

Cited by 14 publications

(11 citation statements)

References 26 publications

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“…This is a key recommendation of the Royal College (Royal College of psychiatrists, 2010). The model supports recent claims that it is clinically more sensible to determine risk of suicide after any self-harm attempt by assessing the methods used rather than by asking patients the reasons for self-harming (Maddock et al, 2010). This is so since the model does not rely on subjective reports of patients in determining the severity of risks, but on a combination of objective lethality (method used and harm caused) and inimicality (situational risk factors) of a self-harm act.…”

Section: Discussionsupporting

confidence: 60%

“…It can also be referred as the 'how likely to die' question. It is impossible to determine the intensity of someone desire without asking that person but, given the unreliability in selfreports of intention around the time of an act (Klonsky, 2007) this could be inferred objectively from the nature and severity of selfharm (Maddock, Carter, Murrell, Lewin, & Conrad, 2010). A rule of thumb is that higher the intentionality, the greater the likely lethality of a self-harm act.…”

Section: Developing An Algorithmmentioning

confidence: 99%

“…best to depend on the observed lethality of the act rather than reported reasons (Maddock et al, 2010). (3) Inimicality (or the setting in which self-harm occurs) refers to those actions of patients that make the prevailing circumstances unfavourable or unduly complicated in order to avoid detection by others, and thus increase the likelihood of serious harm or death.…”

Section: Developing An Algorithmmentioning

confidence: 99%

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Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

Sarkar

Beeley

2011

Journal of Forensic Psychiatry & Psychology

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There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive selfharm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity.

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Section: Discussionsupporting

confidence: 60%

Section: Developing An Algorithmmentioning

confidence: 99%

Section: Developing An Algorithmmentioning

confidence: 99%

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Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

Sarkar

Beeley

2011

Journal of Forensic Psychiatry & Psychology

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“…In contrast, those with DSH behaviors have a greater tendency toward borderline personality disorder than those without DSH behaviors [21]. Furthermore, in women with borderline personality disorder, the method of DSH can distinguish DSH and ITS [22]. Therefore, the presence of a mental health condition and particular methods of DSH can also increase the risk of DSH and ITS.…”

Section: Introductionmentioning

confidence: 99%

Parental bonding and personality characteristics of first episode intention to suicide or deliberate self-harm without a history of mental disorders

2013

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BackgroundThere is substantial overlap between deliberate self-harm (DSH) and intention to suicide (ITS), although the psychopathologies and motivations behind these behaviors are distinctly different. The purpose of this study was to investigate (i) the pathway relationship among parental bonding, personality characteristics, and alexithymic traits, and (ii) the association of these features with ITS and DSH using structural equation modeling to determine the risks and protective factors for these behaviors.MethodsSixty-nine first-time DSH and 36 first-time ITS patients without medical or psychiatric illnesses, and 66 controls were recruited. The Parental Bonding Inventory (PBI), Eysenck Personality Questionnaire (EPQ), 20-item Toronto Alexithymia Scale (TAS-20), and the Chinese Health Questionnaire (CHQ) were filled out by the participants.ResultsOur structural equation models showed that parental bonding had the greatest influence on the development of DSH behavior in patients. On the other hand, participants who were younger, less extraverted, with a greater extent of the alexithymic trait of difficulty identifying feeling (DIF), and a worse mental health condition, were more likely to develop ITS behavior. Males were more likely than females to develop the alexithymic trait of DIF.ConclusionsAlthough there are many covariates that affect both ITS and DSH behaviors, these covariates may have different functions in the development of these behaviors, thus revealing the psychopathological difference between DSH and ITS. Policymakers should consider these differences and build intervention and prevention programs for gender- and age-specific high-risk groups to target the differences, with a focus on family counseling to treat DSH and a focus on attempting to increase emotional awareness to treat ITS.

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“…Thus, patients may have motivational reasons that are variable, multiple and often confusing to themselves (Klonsky 2007), even though the intention is the same: to self-harm. It is suggested that intention can be derived from the nature or the injury caused, for presumably that is the purpose of the act (Maddock 2010). Sometimes the act is not fully executed, when patients with suicidal urges make abortive attempts because they do not know what the lethal dose or lethal injury would be.…”

Section: Key Elements In Risk Assessmentmentioning

confidence: 99%

Short-term management of repeated self-harm in secure institutions

Sarkar¹

2011

Adv. psychiatr. treat

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SummaryThe challenge of managing repeated self-harm and the high risk of morbidity and mortality are compounded in forensic patients, where there are additional risks of harm to others, absconding and security breaches. There is an urgent need for clinically sound, practice-based and theoretically grounded strategies for managing these associated risks. This is essential as available UK guidelines appear inadequate for this group of patients. This article promotes a pragmatic approach to assessing the risk of self-harm clinically to arrive at hierarchical risk judgements. It further suggests an algorithmic approach to managing these risks and provides testable strategies that can be adapted for use in various secure institutions.

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Distinguishing Suicidal from Non-Suicidal Deliberate Self-Harm Events in Women with Borderline Personality Disorder

Cited by 14 publications

References 26 publications

Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

Parental bonding and personality characteristics of first episode intention to suicide or deliberate self-harm without a history of mental disorders

Short-term management of repeated self-harm in secure institutions

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