Distinguishing suicidal from non-suicidal deliberate self-harm events in women with Borderline Personality Disorder

Comparison of clinical and demographic characteristics among borderline personality disorder patients with and without suicidal attempts and non-suicidal self-injury behaviors

Research has shown that both suicidal and Non-Suicidal Self-Injury (NSSI) behaviors are co-morbid phenomena that are present in BPD patients, considered phenomenologically distinct, and associated with different methods, motives, frequency, and severity of psychopathology. This study is aimed at extending previous research by examining differences in demographical, clinical and psychological characteristics of BPD patients with or without a history of Suicide Attempts (SAs) and/or NSSI behaviors. Our sample included 89 outpatients with a BPD diagnosis assessed through clinical, structured interviews, and self-reports. The major findings showed that patients with a history of suicide attempts and non-suicidal self-injury were characterized by major number of lifetime suicide attempts and more severe feelings of hopelessness than patients with NSSI. Additionally, more violent thoughts towards others were observed in patients with NSSI. These results support a relatively more severe profile inherent in patients with SA and NSSI and allow us to differentiate NSSI from suicide attempts, highlighting the importance of evaluating and treating hopelessness and exploring the tendency to have violent thoughts towards others in this clinical population.

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

Background

There 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.

Methods

Sixty-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.

Results

Our 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.

Conclusions

Although 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.

The journey from despair to hope: an exploration of the phenomenon of psychological distress in women residing in British secure mental health services

This paper reports the findings of a descriptive phenomenological study that aimed to elicit and describe the experience of psychological distress as expressed by a group of women compulsorily detained within secure mental health services in the U.K. A fundamental objective of the study was to contribute to the existing evidence base that supports the care and treatment needs of this severely traumatized and challenging patient group. We argue that service providers and clinical practitioners could be better informed about the unique care and treatment needs of this severely traumatized and challenging patient group when working with them. A descriptive phenomenological approach developed by Giorgi was used to elicit the lived experiences of 'psychological distress' from a sample of female patients resident within a high secure hospital and an independent medium secure hospital. The findings indicate that a treatment plan which includes a combination of prescribed medication, informal support networks, intensive individual therapy and active engagement in a therapeutic life skills programme can be extremely beneficial. Most notably in helping to reduce the frequency of both internally and externally directed violent behaviour in this vulnerable client group.

Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model

Self-injurious behaviors (SIB) refer to behaviors that cause direct and deliberate harm to oneself, including nonsuicidal self-injury (NSSI), suicidal behaviors, and suicide. Although in recent research, NSSI and suicidal behavior have been differentiated by intention, frequency, and lethality of behavior, researchers have also shown that these two types of self-injurious behavior often co-occur. Despite the co-occurrence of NSSI and suicidal behavior, however, little attention has been given as to why these self-injurious behaviors may be linked. Several authors have suggested that NSSI is a risk factor for suicidal behavior, but no comprehensive review of the literature on NSSI and suicidal behavior has been provided. To address this gap in the literature, we conducted an extensive review of the research on NSSI and suicidal behavior among adolescents and adults. First, we summarize several studies that specifically examined the association between NSSI and suicidal behavior. Next, three theories that have been proposed to account for the link between NSSI and suicidal behavior are described, and the empirical support for each theory is critically examined. Finally, an integrated model is introduced and several recommendations for future research are provided to extend theory development.

Measuring self-harm in adults: a systematic review

PURPOSE

To identify from the literature, and to critically evaluate, all validated instruments currently available to measure self-harming behaviour in adults.

MATERIALS AND METHODS

Medline, Embase, PsycInfo, Health and Psychosocial Instruments and Google scholar were searched, grey literature was sought and the reference lists of relevant articles were checked to identify instruments.

RESULTS

A total of seven validated instruments which met our inclusion criteria were identified and data were extracted regarding each instrument's format, administration method, psychometric properties and number of items and domains included. Considerable variation was observed in the overall quality of these instruments. Fourteen other instruments were identified which did not describe their psychometric properties or had not been published and were subsequently excluded from our review.

DISCUSSION

Although many instruments were identified in our search, only a small number had been validated with published psychometric properties. Of the identified instruments, the Suicide Attempt Self-Injury Interview (SASII) appears to be the most robust and comprehensive instrument currently available. Despite the absence of psychometric data, numerous other instruments have been used in published studies, including clinical trials.

CONCLUSION

Our results highlight the pressing need for a standardized, empirically validated and versatile measure of intentional self-harming behaviour for use in both clinical and research settings. The optimum characteristics of such an instrument are discussed.