Clinical correlates of self-mutilation in borderline personality disorder

Rebecca A. Dulit · Minna R. Fyer · Andrew C. Leon · ALLEN J. FRANCES

203 citations0/0 files storedAmerican Journal of Psychiatry

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Personality Disorders and Psychopathology Suicide and Self-Harm Studies Bipolar Disorder and Treatment

Abstract

OBJECTIVE: This exploratory study sought demographic and clinical correlates of self-mutilation (self-injury without suicidal intent) in borderline personality disorder. METHOD: Among 124 consecutively admitted inpatients with borderline personality disorder, there were 62 who did not mutilate themselves, 23 who mutilated themselves infrequently (fewer than five lifetime events), and 39 who mutilated themselves frequently (five or more lifetime events); each received ratings on numerous measures of psychopathology. RESULTS: Compared to nonmutilators, frequent mutilators were significantly more likely to be in outpatient treatment at the time of admission and had more weeks of prior outpatient and inpatient treatment; they were also more likely to receive comorbid diagnoses of current major depression, anorexia nervosa, and bulimia nervosa. Frequent mutilators had significantly higher group means on the Beck Scale for Suicidal Ideation, were more likely to have attempted suicide, and were more likely to have attempted suicide more often than both infrequent mutilators and nonmutilators. The adjusted odds ratios from logistic regression analyses demonstrated that major depression, bulimia nervosa, number of prior suicide attempts, and acute suicidal ideation were each associated with greater risk of frequent mutilation. CONCLUSIONS: Borderline patients who frequently mutilate themselves may represent a subgroup of especially high utilizers of psychiatric treatment who are at particularly high risk for suicidal behavior and for comorbid major depression and eating disorders. Clinicians should consider aggressive treatment of comorbid axis I disorders and careful assessment of suicide risk in these patients.

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References

1960A RATING SCALE FOR DEPRESSION 1959THE ASSESSMENT OF ANXIETY STATES BY RATING 1974The measurement of pessimism: The Hopelessness Scale.1976The Global Assessment Scale 1979Assessment of suicidal intention: The Scale for Suicide Ideation.1978SOCIAL ADJUSTMENT BY SELF-REPORT IN A COMMUNITY SAMPLE AND IN PSYCHIATRIC OUTPATIENTS 1981The diagnostic interview for borderline patients 1992Self-mutilation in personality disorders: psychological and biological correlates

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1996Impulsivity or Comorbidity in Bulimia Nervosa 1998Impulsive and Compulsive Self-Injurious Behavior in Bulimia Nervosa: Prevalence and Psychological Correlates 2007The role of emotional responding and childhood maltreatment in the development and maintenance of deliberate self-harm among male undergraduates.2006Reported Childhood Onset of Self-Mutilation Among Borderline Patients 2009Non-suicidal self-injury and eating pathology in high school students.2012

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