1
|
Sprio V, Mirra L, Madeddu F, Lopez-Castroman J, Blasco-Fontecilla H, Di Pierro R, Calati R. Can clinical and subclinical forms of narcissism be considered risk factors for suicide-related outcomes? A systematic review. J Psychiatr Res 2024; 172:307-333. [PMID: 38437765 DOI: 10.1016/j.jpsychires.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical and subclinical forms of narcissism may increase suicide risk. However, little is known and there are controversies on this topic. This systematic review aims at providing an overview of studies investigating this association. METHODS We used PubMed, Scopus, and PsycInfo databases and followed PRISMA. We focused on cohort, case-control, cross-sectional and case series studies. We referred to both clinical (i.e., narcissistic personality disorder (NPD) and/or NPD criteria) and subclinical forms (i.e., grandiose and vulnerable narcissistic traits) of narcissism. Moreover, we considered: Suicidal Ideation (SI), Non-Suicidal Self-Injury(s) (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt(s) (SA), Suicide Risk (SR), and Capability for Suicide. RESULTS We included 47 studies. Lack of association between NPD diagnosis/criteria and suicide-related outcomes (SI) or mixed results (SA) were found. Higher homogeneity emerged when considering narcissistic traits. Vulnerable narcissism was associated with SI, less impulsive NSSI, and DSH. Grandiose narcissism was associated with severe NSSI and multiple SA with high intent to die, but it was protective against SI and SR. Vulnerable narcissism seemed to be associated with suicide-related outcomes characterized by low intent to die, while grandiose narcissism seemed to be a risk factor for outcomes with high planning and severity. LIMITATIONS Between-study heterogeneity and lack of longitudinal studies. CONCLUSIONS Assessing suicide risk in subjects with clinical or subclinical forms of narcissism may be useful. Moreover, considering the most vulnerable form of narcissism, and not just the grandiose one, may contribute to a more nuanced risk stratification and to the identification of distinct therapeutic approaches.
Collapse
Affiliation(s)
- Veronica Sprio
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Lucia Mirra
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Fabio Madeddu
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France; Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain; PSNREC, University of Montpellier, INSERM, CHU Montpellier, Montpellier, France
| | - Hilario Blasco-Fontecilla
- Center of Biomedical Network Research on Mental Health (CIBERSAM), Carlos III Institute of Health, Madrid, Spain; UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid, Spain
| | | | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France.
| |
Collapse
|
2
|
Predescu E, Sipos R. Self-Harm Behaviors, Suicide Attempts, and Suicidal Ideation in a Clinical Sample of Children and Adolescents with Psychiatric Disorders. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040725. [PMID: 37189974 DOI: 10.3390/children10040725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Suicidal ideation and self-harm behaviors have been found to be important risk factors for suicide. The aim of this study was to explore the rates of psychiatric disorders among different groups of patients with suicidal ideation, suicide attempts, and non-suicidal self-harm behaviors and to identify the associated socio-demographic and clinical variables. We conducted a cross-sectional study with emergency-admitted patients presenting with non-suicidal self-harm behaviors, suicide attempts, or suicidal ideation to the emergency room of the Child and Adolescent Psychiatry Clinic in Cluj-Napoca, Romania. Data were collected from the patients' charts using a questionnaire that contained socio-demographic and clinical variables. A total of 95 patients aged between 6 and 18 years were included in the study. Ingesting medication and cutting were the most frequently used methods to attempt suicide. Depression and mixed affective and conduct disorders were the diagnoses most commonly associated with suicidal behavior. Girls with depressive symptoms were more probable to have suicide attempts than boys, and girls with depressive symptoms and behavioral problems registered more self-harm behaviors. Further research should systematically examine the relationship between self-harm behaviors and suicide attempts and the profile of patients at risk of future suicide attempts.
Collapse
Affiliation(s)
- Elena Predescu
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, "IuliuHatieganu" University of Medicine and Pharmacy, 400460 Cluj-Napoca, Romania
| | - Roxana Sipos
- Department of Neuroscience, Psychiatry and Pediatric Psychiatry, "IuliuHatieganu" University of Medicine and Pharmacy, 400460 Cluj-Napoca, Romania
| |
Collapse
|
3
|
Alberdi-Páramo Í, Díaz-Marsá M, Saiz González MD, Carrasco Perera JL. Antisocial traits and neuroticism as predictors of suicidal behaviour in borderline personality disorder: A retrospective study. REVISTA COLOMBIANA DE PSIQUIATRÍA (ENGLISH ED.) 2023; 52:11-19. [PMID: 36997367 DOI: 10.1016/j.rcpeng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. METHODS A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ2 test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. RESULTS Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. CONCLUSIONS The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.
Collapse
|
4
|
Communicating distress: suicide threats/gestures among clinical and community youth. Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01960-5. [PMID: 35226164 PMCID: PMC10326133 DOI: 10.1007/s00787-022-01960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/11/2022] [Indexed: 11/03/2022]
Abstract
Although self-injurious thoughts and behaviors are a global health concern, little is known about suicidal threat/gesture(s) where a person leads others to believe they want to end their lives when they have no intention to do so. This study assessed the lifetime prevalence of self-injurious thoughts and behaviors among both community adolescents (n = 1117) and in clinical youth (n = 191). Suicide threats/gestures were common among youth; 12.2% of community adolescents and 18.0% of clinical youth reporting having made a suicide threat/gesture, most commonly in the context of other self-injurious thoughts and behaviors. Across both samples, suicide threats/gestures were not uniquely associated with suicide attempts, and youth who reported suicide threats/gestures in the context of a history of self-harm or suicide plan(s) were no more likely to report a history of suicide attempt(s). Suicide threats/gestures were distinguished from suicide attempts in that they primarily fulfilled positive social functions, rather than autonomic functions. Findings suggest that suicidal threats/gestures are common in both community and clinical youth, and are not uniquely associated with suicide attempts, but rather function to communicate distress to others.
Collapse
|
5
|
Pinheiro TDP, Warmling D, Coelho EBS. Characterization of suicide attempts and self-harm by adolescents and adults notified in Santa Catarina, Brazil, 2014-2018. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021337. [PMID: 34878004 DOI: 10.1590/s1679-49742021000400026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To characterize adolescent and adult suicide attempts and self-harm reported in Santa Catarina, Brazil, from 2014 to 2018. METHODS This was a cross-sectional descriptive study with data from the Notifiable Health Conditions Information System. The sociodemographic, clinical and type of self-inflicted violence characteristics among adolescents and adults were compared. RESULTS Among the 8,859 notifications analyzed, suicide attempts predominated in relation to self-mutilation; self-inflected violence was more frequent in females, those of white skin color and with mental disorders; it occurred more at home, in both age groups. Among adolescents, repeated self-mutilation (83.3%) stood out, while among adults, repeated suicide attempts (50.6%) and suspected alcohol use (18.3%) at the time of violence stood out. CONCLUSION We identified high prevalence of attempted suicide among adolescents and adults; the characteristics of violence were similar between the age groups analyzed.
Collapse
Affiliation(s)
| | - Deise Warmling
- Secretaria de Estado da Saúde de Santa Catarina, Florianópolis, SC, Brasil
| | | |
Collapse
|
6
|
Alberdi-Páramo Í, Díaz-Marsá M, Saiz González MD, Carrasco Perera JL. Antisocial Traits and Neuroticism as Predictors of Suicidal Behaviour in Borderline Personality Disorder: a Retrospective Study. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00045-7. [PMID: 33840500 DOI: 10.1016/j.rcp.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. METHODS A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ2 test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. RESULTS Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. CONCLUSIONS The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.
Collapse
Affiliation(s)
- Íñigo Alberdi-Páramo
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Marina Díaz-Marsá
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBERSAM, Departamento de Psiquiatría, Universidad Complutense de Madrid, Madrid, España
| | - María Dolores Saiz González
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - José Luis Carrasco Perera
- Instituto de Psiquiatría y Salud Mental, Hospital Clínico San Carlos, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; CIBERSAM, Departamento de Psiquiatría, Universidad Complutense de Madrid, Madrid, España
| |
Collapse
|
7
|
Iliachenko EK, Ragazan DC, Eberhard J, Berge J. Suicide mortality after discharge from inpatient care for bipolar disorder: A 14-year Swedish national registry study. J Psychiatr Res 2020; 127:20-27. [PMID: 32450359 DOI: 10.1016/j.jpsychires.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.
Collapse
Affiliation(s)
- Elena K Iliachenko
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Dragos C Ragazan
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Jonas Eberhard
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden.
| |
Collapse
|
8
|
Kroll DS, Stanghellini E, DesRoches SL, Lydon C, Webster A, O'Reilly M, Hurwitz S, Aylward PM, Cartright JA, McGrath EJ, Delaporta L, Meyer AT, Kristan MS, Falaro LJ, Murphy C, Karno J, Pallin DJ, Schaffer A, Shah SB, Lakatos BE, Mitchell MT, Murphy CA, Gorman JM, Gitlin DF, Mulloy DF. Virtual monitoring of suicide risk in the general hospital and emergency department. Gen Hosp Psychiatry 2020; 63:33-38. [PMID: 30665667 DOI: 10.1016/j.genhosppsych.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/15/2018] [Accepted: 01/11/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether continuous virtual monitoring, an intervention that facilitates patient observation through video technology, can be used to monitor suicide risk in the general hospital and emergency department (ED). METHOD This was a retrospective analysis of a protocol in which select patients on suicide precautions in the general hospital and ED received virtual monitoring between June 2017 and March 2018. The primary outcome was the number of adverse events among patients who received virtual monitoring for suicide risk. Secondary outcomes were the percentage of patients for whom virtual monitoring was discontinued for behavioral reasons and the preference for observation type among nurses. RESULTS 39 patients on suicide precautions received virtual monitoring. There were 0 adverse events (95% confidence interval (CI) = 0.000-0.090). Virtual monitoring was discontinued for behavioral reasons in 4/38 cases for which the reason for terminating was recorded (0.105, 95%CI = 0.029-0.248). We were unable to draw conclusions regarding preference for observation type among nurses due to a low response rate to our survey. CONCLUSIONS Suicide risk can feasibly be monitored virtually in the general hospital or ED when their providers carefully select patients for low impulsivity risk.
Collapse
Affiliation(s)
- David S Kroll
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA.
| | - Escel Stanghellini
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Stephanie L DesRoches
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Charles Lydon
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Allison Webster
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Molly O'Reilly
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Patricia M Aylward
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Jennifer A Cartright
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Elizabeth J McGrath
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Linda Delaporta
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Anna T Meyer
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Michael S Kristan
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Laurie J Falaro
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Colin Murphy
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Jennifer Karno
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Division of Social Work, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Adam Schaffer
- Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Sejal B Shah
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Barbara E Lakatos
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Monique T Mitchell
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Christine A Murphy
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - Janet M Gorman
- Department of Nursing, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA
| | - David F Gitlin
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02125, USA; Harvard Medical School, 250 Longwood Ave, Boston, MA 02115, USA
| | - Deborah F Mulloy
- Massachusetts Board of Registration in Medicine, 200 Harvard Mill Square, Wakefield, MA 01880, USA
| |
Collapse
|
9
|
Evans CM, Simms LJ. The latent structure of self-harm. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 128:12-24. [PMID: 30589306 DOI: 10.1037/abn0000398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The underlying structure of self-harm behaviors is not well-understood; for example, whether suicidality and nonsuicidal self-injury (NSSI) lie on a single dimension or two separate dimensions is unknown. We used confirmatory factor analyses to examine the factor structure of self-harm items in a clinical/community sample (N = 641). Of three alternative factor structures (one-factor, correlated-factors, bifactor), the bifactor model fit best. The general factor, representing overlap between suicidality and NSSI, captured the majority of model variance and was the strongest predictor of psychosocial correlates. The NSSI-specific factor captured a moderate amount of variance and correlated uniquely with both antagonistic traits and obsessive-compulsive tendencies; this factor was named NSSI. The suicidality-specific factor explained little model variance and was weakly associated with external criteria; this factor was named low attraction to life. Results are interpreted as preliminary evidence for the utility of bifactor modeling in understanding the latent structure of self-harm. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
10
|
Young C, Habarth J, Bongar B, Packman W. Disorder in the Court: Cluster B Personality Disorders in United States Case Law. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2018; 25:706-723. [PMID: 31984047 PMCID: PMC6818303 DOI: 10.1080/13218719.2018.1474816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Previous research has shown that antisocial, borderline, narcissistic and histrionic personality disorders, also known as the Cluster B personality disorders in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), are commonly raised in lawsuits. Cluster B disorders are characterized by problems with emotion regulation, impulsivity and interpersonal conflicts. Without question, individuals diagnosed with a Cluster B disorder possess traits that make them more susceptible to becoming involved in litigation; however, to date there has been no research on how the disorders interact with the judicial system. This study surveyed litigant success of Cluster B personality disorders in United States federal and state case law. Results showed that both criminal and civil litigants tended to be unsuccessful in their cases. Overall, this study demonstrated that court opinions can provide a window into the psychology of trial litigants and how personality can affect trial outcomes.
Collapse
Affiliation(s)
- Catherine Young
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Janice Habarth
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Bruce Bongar
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
| | - Wendy Packman
- Clinical Psychology, Palo Alto University, Palo Alto, CA, USA
| |
Collapse
|
11
|
Balázs J, Győri D, Horváth LO, Mészáros G, Szentiványi D. Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender. BMC Psychiatry 2018; 18:34. [PMID: 29409473 PMCID: PMC5801900 DOI: 10.1186/s12888-018-1620-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/28/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology. METHODS Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13-18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann-Whitney U test, chi-square test and mediator model were used. RESULTS Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n = 10 (28.60%), girls: n = 25 (71.40%) ((χ2(1) = 10.643 p < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls. CONCLUSIONS ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.
Collapse
Affiliation(s)
- Judit Balázs
- Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064, Hungary. .,Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.
| | - Dóra Győri
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary
| | - Lili Olga Horváth
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gergely Mészáros
- Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary ,0000 0001 0942 9821grid.11804.3cSemmelweis University, School of Ph.D. Studies, Budapest, Hungary
| | - Dóra Szentiványi
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
12
|
Abstract
Few studies have examined associations between pathological narcissism and self-harm, but those that do indicate that narcissistic vulnerability (not narcissistic grandiosity) relates to self-harm. The current study extends this literature by investigating how facets of pathological narcissism assessed by the Pathological Narcissism Inventory relate to specific nonsuicidal self-injury (NSSI) behaviors assessed by the Inventory of Statements About Self-Injury using statistical models appropriate for non-normally distributed count data. In a sample of 1,023 undergraduate students, results revealed that facets of both narcissistic vulnerability and narcissistic grandiosity were differentially related to the endorsement and frequency of specific NSSI behaviors and higher-order latent NSSI factors (repetitive and impulsive), even after accounting for levels of borderline pathology. The clinical implications of these results are discussed.
Collapse
Affiliation(s)
- Sindes Dawood
- Pennsylvania State University, University Park, Pennsylvania
| | | | | | - Aaron L Pincus
- Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
13
|
Turner BJ, Jin HM, Anestis MD, Dixon-Gordon KL, Gratz KL. Personality pathology and intentional self-harm: cross-cutting insights from categorical and dimensional models. Curr Opin Psychol 2017; 21:55-59. [PMID: 29017093 DOI: 10.1016/j.copsyc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023]
Abstract
This paper reviews current literature on the links between personality pathology and intentional self-harm, including nonsuicidal self-injury (NSSI) and suicidal behaviors. Specifically, this review highlights recent advances stemming from longitudinal, epidemiological, and health registry studies, as well as emerging research on pathological personality traits and intentional self-harm, and integrates current knowledge across dimensional and categorical frameworks to provide recommendations for clinical practice and future research. This review provides strong evidence that personality disorders marked by intense and unstable negative affect, detachment/low extraversion, aggression/hostility, and specific facets of impulsivity may be considered risk factors for suicidal behaviors. Further, there is some evidence of a stronger relation between maladaptive personality traits and suicidal versus non-suicidal intentional self-harm.
Collapse
Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
| | - Hyejin M Jin
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606, USA.
| |
Collapse
|
14
|
Meszaros G, Horvath LO, Balazs J. Self-injury and externalizing pathology: a systematic literature review. BMC Psychiatry 2017; 17:160. [PMID: 28468644 PMCID: PMC5415783 DOI: 10.1186/s12888-017-1326-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/24/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. METHODS A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). RESULTS Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. CONCLUSIONS Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing and externalizing pathologies are both presented.
Collapse
Affiliation(s)
- Gergely Meszaros
- Semmelweis University, Mental Health Sciences School Of Ph.D., Üllői út 26, Budapest, 1085, Hungary. .,Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021, Hungary.
| | - Lili Olga Horvath
- 0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
| | - Judit Balazs
- Vadaskert Child Psychiatry Hospital and Outpatient Clinic, Lipótmezei út 1-5, Budapest, 1021 Hungary ,0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella utca 46, Budapest, Hungary
| |
Collapse
|
15
|
Abstract
Between 10 and 20 million people attempt suicide every year worldwide, and suicide attempts represent a major economic burden. Suicide attempters suffer from high rates of comorbidity, and comorbidity is the rule in suicide re-attempters. Comorbidity complicates treatment and prognosis and causes a more protracted course. In the present narrative review, we included these patterns of comorbidity: intra-Axis I disorders, intra-Axis II disorders, Axis I with Axis II disorders, and psychiatric with physical illnesses. We also briefly reviewed the patterns of comorbidity in suicide re-attempters. We concluded that comorbidity at different levels appears to be the rule in suicide attempters, particularly in those who re-attempt. However, several issues deserve further research regarding the patterns of comorbidity in suicide attempters.
Collapse
|
16
|
Fresán A, Camarena B, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez L, González-Ramón AE, Hernández-Díaz Y. Risk-factor differences for nonsuicidal self-injury and suicide attempts in Mexican psychiatric patients. Neuropsychiatr Dis Treat 2016; 12:1631-7. [PMID: 27462155 PMCID: PMC4939986 DOI: 10.2147/ndt.s110044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The present study compared sociodemographic characteristics, comorbidities with substance use, and impulsivity features in three groups of psychiatric patients - suicide attempters, nonsuicidal self-injury, and nonsuicidal without self-injury - to determine the predictive factors for nonsuicidal self-injury or suicide behavior. PATIENTS AND METHODS Demographic features and self-reported substance use were assessed in 384 Mexican psychiatric patients. Impulsivity features were evaluated using the Plutchik Impulsivity Scale. Comparison analyses between groups were performed and a logistic regression model used to determine the factors associated with nonsuicidal with self-injury behavior and suicidal behavior. RESULTS Different predictive factors were observed for nonsuicidal self-injury and suicidal behavior. Females were more likely to present nonsuicidal self-injury behaviors (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.18-0.93; P=0.03). For suicide attempters, the factors associated were younger age (OR 0.89, 95% CI 0.85-0.93; P<0.001), less than 6 years of schooling (OR 0.2, 95% CI 0.06-0.6; P=0.004), and higher impulsivity traits, such as self-control (OR 1.19, 95% CI 1.03-1.36; P=0.01), planning of future actions (OR 0.79, 95% CI 0.66-0.95; P=0.01), and physiological behavior (OR 1.34, 95% CI 1.01-1.78; P=0.03). CONCLUSION Our results show that in a Mexican population, impulsivity features are predictors for suicide attempts, but not for self-injury. Other factors related to sociocultural background and individual features (such as personality) may be involved in this behavioral distinction, and should be studied in future research aimed at better understanding of both self-harmful behaviors.
Collapse
Affiliation(s)
- Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City
| | - Beatriz Camarena
- Departamento de Genética Psiquiátrica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México City
| | | | | | | | | | - Alicia E González-Ramón
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco
| | - Yazmín Hernández-Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez
| |
Collapse
|
17
|
Blasco-Fontecilla H, Baca-García E, Courtet P, García Nieto R, de Leon J. Horror Vacui: Emptiness Might Distinguish between Major Suicide Repeaters and Nonmajor Suicide Repeaters: A Pilot Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:117-119. [PMID: 25720355 DOI: 10.1159/000369937] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital, IDIPHIM, CIBERSAM, Autonomous University of Madrid, Madrid, Spain
| | | | | | | | | |
Collapse
|