The influence of personality disorder on outcome in adolescent self-harm

Ayodeji, Eunice; Green, Jonathan; Roberts, Chris; Trainor, Gemma; Rothwell, James; Woodham, Adrine; Wood, A. Jamie

doi:10.1192/bjp.bp.113.138941

Cited by 29 publications

(28 citation statements)

References 23 publications

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“…The first objective of our review was to demonstrate associations between any PD and suicidal ideation and behaviours. Only one study [32] included in this review focused on the relationship between PD and suicidal ideation, showing how the diagnosis of any PD was significantly associated with the severity of suicidal ideation on a longitudinal basis. Regarding suicidal conduct, our data revealed a higher prevalence of PD diagnosis in the adolescent suicidal population than in community samples [28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Suicidality and Personality Pathology in Adolescence: A Systematic Review

Moselli

Casini

Frattini

et al. 2021

Child Psychiatry Hum Dev

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This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

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Section: Discussionmentioning

confidence: 99%

Suicidality and Personality Pathology in Adolescence: A Systematic Review

Moselli

Casini

Frattini

et al. 2021

Child Psychiatry Hum Dev

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“…Although our study focuses on adults with PD, previous studies have shown a negative outcome and an increase incidence of self-harm in patients as early as adolescence. 29 These patients are often seen by for routine preventive care and this can be a good opportunity to screen for mental disorders. Though these office visits are usually time constrained, early screening and careful history taking may be beneficial in alerting providers to potential mental health concerns that should be further explored.…”

Section: Discussionmentioning

confidence: 99%

Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care

Angstman

Seshadri

Marcelin

et al. 2017

J Prim Care Community Health

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Background:Individuals with personality disorders (PDs) are high utilizers of primary care and mental health services; however, they struggle to utilize the care effectively and studies have shown a strong association between having a PD and higher impairment in social role functioning. This is especially important because PDs are highly comorbid with a wide range of other mental health disorders. The collaborative care model (CCM) for depression was developed with an emphasis on patient engagement and aimed to reduce health care utilization, while improving treatment outcomes in primary care. We hypothesized that the diagnosis of a personality disorder in primary care patients will negatively affect 6-month depression outcomes after enrollment into a CCM. Methods: This retrospective chart review study was conducted on patients enrolled into CCM over a period of 7 years with collection of 6-month follow-up data. A total of 2826 patients were enrolled into CCM with a clinical diagnosis of depression and a baseline Patient Health Questionnaire–9 (PHQ-9) ≥10 were included in the study cohort. Using the depression database, baseline and 6-month follow-up data were obtained. Adjusted odds ratios (AORs) were determined for both remission and persistent depressive symptoms using logistic regression modeling for the 6-month PHQ-9 outcome; while retaining all the study variables. Results: Of the 2826 CCM patients with depression in our study, 216 (7.6%) were found to have a PD. Patients with PD were younger (37.7 vs 42.5 years, P < .001) and more likely to be unmarried (36.1% vs 55.6%, P < .001) than patients without a PD. While age, marital status, clinical diagnosis, and Mood Disorders Questionnaire (MDQ) score were significant predictors of remission; anxiety symptoms, gender, and race were not. The presence of a PD diagnosis was associated with a 60% lower likelihood of remission at 6 months (AOR = 0.39; 95% CI 0.28-0.54). Conversely, patients without a PD were 2.5 times as likely to experience remission at 6-month remission compared to patients with PD (AOR =2.57; 95% CI 1.85-3.56). Conclusion: Patients with a personality disorder were more likely to have a recurrent depressive disorder diagnosis, an abnormal MDQ score, increased anxiety symptoms, and higher baseline PHQ-9 score. Patients with PD had worse CCM outcomes at 6 months with only 25.0% able to achieve remission versus 54.3% (P < .001) without a PD. The presence of a PD with depression was associated with poor outcomes (reduced remission rates and increased persistent depressive symptoms rates) in comparison to patients without a diagnosis of PD, while treated within CCM.

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“…Self-harm in general, and NSSI in particular [ 13 ], are serious health problems [ 14 ]. However, roughly 50% of adolescent and adult patients with NSSI do not meet the diagnostic criteria for BPD (e.g., [ 15 ]). This has led to a discussion whether NSSI should be considered as a distinct and clinically significant diagnostic entity [ 15 ], and to the inclusion of the newly diagnostic entity of non-suicidal self-injury (NSSI) disorder in Section III of DSM-5 [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships

Hessels

Laceulle

Aken

et al. 2018

bord personal disord emot dysregul

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BackgroundAs borderline personality disorder (BPD) is increasingly considered a lifespan developmental disorder, we need to focus on risk factors and precursors in the developmental pathways to BPD, in order to enable early detection and intervention. Within this developmental pathway, adolescence is a crucial phase in the light of the manifestation of the disorder. Relational factors such as adverse childhood experiences and current relational problems can be considered important in adolescents who are at-risk for BPD. Nonsuicidal self-injury (NSSI) is a key precursor for adolescent BPD and one of the most promising targets for early detection and intervention of BPD.MethodsIn a clinical sample of 152 adolescents engaging in nonsuicidal self-injury (NSSI) disorder referred to mental healthcare in Germany, this study investigated whether we can differentiate who has BPD from 1) adverse childhood experiences; and 2) the quality of current relationships, both with parents and peers. BPD was assessed both categorically as a dichotomized score and dimensionally as a continuous score.ResultsMore adverse childhood experiences, but not low quality of current social relationships, were related to more BPD symptoms and an increased risk for meeting full criteria for BPD. In the dimensional model, current social relationship quality with parents and peers did not show a moderating (protecting or aggravating) effect on the association between adverse childhood experiences and BPD. Using a categorical approach, however, the association between childhood adversity and meeting full criteria for BPD was higher in individuals reporting higher quality of current parent-child relationship.ConclusionsThese results highlight adverse childhood experiences as risk factors of BPD, while the role of current social relationships seems more complex.

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The influence of personality disorder on outcome in adolescent self-harm

Cited by 29 publications

References 23 publications

Suicidality and Personality Pathology in Adolescence: A Systematic Review

Suicidality and Personality Pathology in Adolescence: A Systematic Review

Personality Disorders in Primary Care: Impact on Depression Outcomes Within Collaborative Care

Differentiating BPD in adolescents with NSSI disorder: the role of adverse childhood experiences and current social relationships

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