scholarly journals Assessing Suicidal Youth with Antisocial, Borderline, or Narcissistic Personality Disorder

2003 ◽  
Vol 48 (5) ◽  
pp. 301-310 ◽  
Author(s):  
Paul S Links ◽  
Brent Gould ◽  
Ruwan Ratnayake
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicidal Behaviour ◽  
Borderline Personality ◽  
Narcissistic Personality Disorder ◽  
Narcissistic Personality ◽  
Key Words Suicide ◽  
Increased Risk ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Objective: This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide. Method: We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents. Results: Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse. Conclusions: For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.

Prediction of suicide attempts in a prospective cohort study with a nationally representative sample of the US population

2021 ◽  
pp. 1-12
Author(s):  
Cristiane dos Santos Machado ◽  
Pedro L. Ballester ◽  
Bo Cao ◽  
Benson Mwangi ◽  
Marco Antonio Caldieraro ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Suicide Attempt ◽  
Representative Sample ◽  
Borderline Personality ◽  
Predictor Variables ◽  
Major Depressive ◽  
Nationally Representative ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Abstract Background There is still little knowledge of objective suicide risk stratification. Methods This study aims to develop models using machine-learning approaches to predict suicide attempt (1) among survey participants in a nationally representative sample and (2) among participants with lifetime major depressive episodes. We used a cohort called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) that was conducted in two waves and included a nationally representative sample of the adult population in the United States. Wave 1 involved 43 093 respondents and wave 2 involved 34 653 completed face-to-face reinterviews with wave 1 participants. Predictor variables included clinical, stressful life events, and sociodemographic variables from wave 1; outcome included suicide attempt between wave 1 and wave 2. Results The model built with elastic net regularization distinguished individuals who had attempted suicide from those who had not with an area under the ROC curve (AUC) of 0.89, balanced accuracy 81.86%, specificity 89.22%, and sensitivity 74.51% for the general population. For participants with lifetime major depressive episodes, AUC was 0.89, balanced accuracy 81.64%, specificity 85.86%, and sensitivity 77.42%. The most important predictor variables were a diagnosis of borderline personality disorder, post-traumatic stress disorder, and being of Asian descent for the model in all participants; and previous suicide attempt, borderline personality disorder, and overnight stay in hospital because of depressive symptoms for the model in participants with lifetime major depressive episodes. Random forest and artificial neural networks had similar performance. Conclusions Risk for suicide attempt can be estimated with high accuracy.

Clinical Characteristics of Comorbid Narcissistic Personality Disorder in Patients With Borderline Personality Disorder

2018 ◽  
Vol 32 (4) ◽  
pp. 562-575 ◽  
Author(s):  
Susanne Hörz-Sagstetter ◽  
Diana Diamond ◽  
John F. Clarkin ◽  
Kenneth N. Levy ◽  
Michael Rentrop ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Characteristics ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Narcissistic Personality Disorder ◽  
Narcissistic Personality ◽  
Psychiatric Hospitalizations ◽  
General Functioning ◽  
Axis I

This study examines psychopathology and clinical characteristics of patients with borderline personality disorder (BPD) and comorbid narcissistic personality disorder (NPD) from two international randomized controlled trials. From a combined sample of 188 patients with BPD, 25 also fulfilled criteria for a comorbid diagnosis of NPD according to DSM-IV. The BPD patients with comorbid NPD, compared to the BPD patients without comorbid NPD, showed significantly more BPD criteria (M = 7.44 vs. M = 6.55, p < .001), fulfilled more criteria of comorbid histrionic (M = 3.84 vs. M = 1.98, p < .001), paranoid (M = 3.12 vs. M = 2.27, p = .014), and schizotypal (M = 1.64 vs. M = 1.02, p = .018) personality disorders, and were more likely to meet criteria for full histrionic PD diagnosis (44.0% vs. 14.2%, p < .001). The BPD-NPD group also reported significantly fewer psychiatric hospitalizations in the previous year (M = 0.40 vs. M = 0.82, p = .019) and fewer axis I disorders (M = 2.68 vs. M = 3.75, p = .033). No differences could be found in general functioning, self-harming behavior, and suicide attempts.

Economic Evaluation of a Mobile Diary App versus Paper-based Diary Cards for Patients with Borderline Personality Disorder (Preprint)

2021 ◽  
Author(s):  
Sidsel Lund Laursen ◽  
Astrid Langergaard ◽  
Jesper Søndergaard ◽  
Sabrina Storgaard Sørensen ◽  
Stig Helweg-Jørgensen ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Data Collection ◽  
Suicidal Behaviour ◽  
Borderline Personality ◽  
Healthcare Sector ◽  
Qaly Gain ◽  
Depression Severity ◽  
Advantages And Disadvantages ◽  
Psychiatric Outpatient

BACKGROUND The use of mobile diary applications (apps) in dialectical behaviour therapy (DBT) could entail several positive consequences, such as allowing therapists to follow their patients during treatment. OBJECTIVE The objective of this study was to examine the costs and consequences of using a mobile diary app compared to paper-based diary cards in DBT treatment for patients with borderline personality disorder (BPD) in a psychiatric outpatient facility to develop the current knowledge. METHODS The study was conducted alongside a pragmatic, multicentre randomized controlled trial. Participants were recruited at five Danish psychiatric outpatient facilities and were randomized to register emotions, urges, and skills use in a mobile diary app or on paper-based diary cards. Participants in both groups received DBT delivered by therapists. A cost-consequence analysis with a time horizon of 12 months was undertaken. Consequences included quality-adjusted life years (QALY), depression severity, borderline severity, suicidal behaviour, healthcare use, and treatment compliance. Moreover, advantages and disadvantages of using a mobile diary app were studied. All relevant costs were included. RESULTS In total, 78 participants were included in the analysis. Participants in both groups had a QALY gain, and a decrease in depression severity, borderline severity, and suicidal behaviour. Significant differences were found between the app group and the paper group for both QALY gain (adjusted difference -0.054, SE 0.03) and depression severity (adjusted difference -1.11, SE 1.57). The use of services in the healthcare sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5, general practice -1.32, SE 3.68 and 2.02, SE 3.19). An insignificantly higher number of participants in the paper group dropped out before treatment start (P value .07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and registered an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. The mobile diary app was considered timesaving as it was expected to be 1 minute faster to complete. Advantages of the app were the opportunity to choose between different methods of registering; comparative ease of use; increased self-insight; and a new type of data collection. Disadvantages were a negative influence on the therapist-patient interaction; worries about performance goals; reduced flexibility in data collection; and implementation issues. The between-group difference in total costs ranged from £78.15-234.44 per participant during the 12-months. CONCLUSIONS A mobile diary app can potentially entail several positive consequences for patients suffering from BPD although at a higher cost than paper-based diary cards. A mobile diary app might contribute with new information on the patients, which is not available from the paper diary. Further research is encouraged, as this is still a new field. CLINICALTRIAL ClinicalTrials.gov NCT03191565 INTERNATIONAL REGISTERED REPORT RR2-

scholarly journals Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

2017 ◽  
Vol 44 ◽  
pp. 53-60 ◽  
Author(s):  
K.I. Aaltonen ◽  
T. Rosenström ◽  
I. Baryshnikov ◽  
B. Karpov ◽  
T. Melartin ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Childhood Maltreatment ◽  
Suicidal Behaviour ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Mediation Effect ◽  
Mediation Analyses ◽  
Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

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