Self-Mutilation and Suicidal Behavior in Borderline Personality Disorder

Abstract

The relationship of self-mutilation to suicidal behavior was studied in 108 borderline inpatients (defined by the Diagnostic Interview for Borderline Patients). Patients with histories of selfmutilation were compared to those with no self-mutilation on diagnostic comorbidity, symptom patterns, prior suicidal be haviors, and attempt characteristics, including number of at tempts, seriousness of intent, and medical lethality.Self-mutilation was found in 63% of patients, suicidal attempts in 75.7%. Patients with self-mutilation were significantly younger and more symptomatic than controls, and had more serious suicidal ideation and recent suicide attempts. On the DIB they had significantly more manipulative suicide threat or effort, depersonalization and drug-free hallucinations or delu sions. They tended toward more depression and schizotypal symptoms but less anger and assaultiveness compared to nonmutilating patients. Histories of manipulative suicide attempts were characteristic of self mutilating patients; however, self mutilation was not associated with increased seriousness of in tent or lethality of suicide attempts.Self-mutilation is a common clinical phenomenon, with a reported inci dence of 3.4-7.7% among general psychiatric admissions (Ballinger, 1971;Pao, 1969). Etiology is often described as "multifactorial," with psychologi cal, behavioral, and biologic determinants, though generally related to the disorder in which the symptom arises. The most bizarre and destructive acts arise from the thought disorder of the psychotic patient, including autocastration, enucleation, and amputations. The least severe acts, de scribed as syndromes of "wrist slashing," "delicate cutting," or "parasuicide," are generally attributed to personality-disordered patients, especially those with borderline personality disorder (BPD) (Grunebaum &

Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study.

“…However, in a study of BPD patients, depressed mood, but not cooccurring affective disorder, was found to be associated with a history of suicidal behavior (Soloff, Lis, Kelly, Cornelius, & Ulrich, 1994). These results suggest that severity of depressed mood, as assessed subjectively and on a continuum, may be a better predictor of suicide behavior than the MDD diagnosis.…”

Self-mutilative behaviors in male veterans with posttraumatic stress disorder

“…SMB has been shown to be related to higher levels of negative affect (Klonsky et al, 2003;Sampson et al, 2004); alcohol use (Roberts et al, 2004;Sansone, 2005); anger and hostility (Herpetz et al, 1997;Soloff et al, 1994); and impulsivity (Kingsbury et al, 1999;Maser et al, 2002;Simeon, 2006). Additionally, age may play an important role in the occurrence of SMB, with a higher incidence of SMB often found among younger individuals (Joyce et al, 2006;Sansone et al, 2002;Schmidtke et al, 1996).…”

Modèle de l’engagement et de l’abandon de traitement de l’adolescent avec trouble de personnalité limite

“…L'adolescence jusqu'à la trentaine serait la période de plus haut risque chez ces sujets . En comparaison aux patients souffrant de dépression, l'apparition des conduites suicidaires serait plus hâtive et le nombre de tentatives à vie plus élevé chez les patients présentant un TPL (Soloff, Lis, Kelly, Cornelius, & Ulrich, 1994). Enfin, lorsque le diagnostic de TPL s'ajoute à celui de la dépression, les conduites suicidaires tendent à s'aggraver.…”