The 10‐year course of physically self‐destructive acts reported by borderline patients and axis II comparison subjects

Abstract

Objective-The purpose of this paper was to determine the frequency and methods of two forms of physically self-destructive acts (i.e., self-mutilation and suicide attempts) reported by borderline patients and axis II comparison subjects over ten years of prospective follow-up.Methods-290 borderline patients and 72 axis II comparison subjects were interviewed about their physically self-destructive acts during their index admission and at five contiguous two-year follow-up periods.Results-It was found that a high percentage of borderline patients reported multiple acts and methods of each of these two forms of physically self-destructive behavior prior to their index admission. It was also found that the percentage of borderline patients reporting multiple acts and methods declined significantly over time. However, these acts remained significantly more common among borderline patients than axis II comparison subjects. Conclusions-The course of self-mutilation and suicide attempts among borderline patients is initially more serious and ultimately more benign than previously recognized.Self-mutilation and suicide attempts are among the most dramatic symptoms of borderline personality disorder (BPD). Clinical experience suggests that they are also one of the main reasons for psychiatric hospitalizations and other costly forms of treatment, such as day or residential programs. Numerous studies have found that these symptoms are common among borderline patients when assessed cross-sectionally (1-15). More specifically, crosssectional rates of self-mutilation have ranged from 17-80% (median=53%) (1, 2, 6-8, 10, 12-15), while cross-sectional rates of suicide attempts have ranged from 46-92% (median=76%) (1-13). In contrast, very few longitudinal studies have assessed the prevalence of these troubling symptoms over time (5-7, 16, 17). The follow-up rate of selfmutilation in the only study to assess this outcome was 50% at five-year follow-up (7). However, follow-up rates of suicide attempts have ranged from 6-40% (median=24%) in post-baseline periods ranging from 2-14 years (5-7, 16, 17).The current study is the first longitudinal study to assess the prevalence of these symptoms over 10 years of prospective follow-up in a large and well-defined sample of borderline patients and axis II comparison subjects. It is also the first study to assess the number of episodes/attempts within each time period and the methods used to self-mutilate or attempt suicide.Address reprint requests to Dr. Zanarini, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478; phone: 617-855-2660; fax: 617-855-3580; zanarini@mclean.harvard MethodsAll subjects were initially inpatients at McLean Hospital in Belmont, Massachusetts. Each patient was first screened to determine that he or she: 1) was between the ages of 18-35; 2) had a known or estimated IQ of 71 or higher; 3) had no history or current symptoms of schizophrenia, schizoaffective disorder, bipolar I disorder, or an organic condition that could cause psychiatric sympto...

The Role of Scar Origin in Shaping Men’s Body Image

“…Up to 90% of BPD patients report repeated NSSI (Zanarini et al, 2008), which may result in scars. BPD patients also frequently engage in high-risk behavior and impulsive aggression (Lieb et al, 2004;Rüsch et al, 2007), which can also result in bodily harm and scars.…”

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“…Although as many as 46-92 % of BPD patients attempt suicide during their lifetime, completed suicide is relatively rare (3-10 %) (Soloff and Chiappetta 2012a ). Sixty percent report multiple suicide attempts (Zanarini et al 2008 ), and indeed the repetition of suicide attempts, compared to single attempters, is associated with this diagnosis (Forman 2004 ). Despite their bad reputation, there is evidence of a positive evolution for many BPD patients in the long term (Shea et al 2002 ;Tracie Shea et al 2009 ;Zanarini et al 2010 ), underlining the importance of supportive and preventive interventions in the period of high suicidal risk of SB.…”

Selvskading og personlighetsforstyrrelser

“…James & Taylor fant imidlertid at ustabile personlighetstrekk medierte det meste av sammenhengen mellom antisosiale personlighetstrekk og selvskading og suicidalitet hos kvinner i et studentutvalg (19). I et utvalg bestående av 290 døgninnlagte pasienter med ustabil personlighetsforstyrrelse rapporterte over 70 % multiple selvskadingsepisoder (uten suicidal intensjon) ved behandlingsstart, mot 20 % i en sammenlikningsgruppe av pasienter med andre personlighetsforstyrrelser (20). Selvskadingen startet svaert tidlig i dette kliniske utvalget.…”

“…De må få behandling for de fysiske konsekvensene med lokalbedøvelse ved suturering. Zanarini og medarbeidere viste i sin oppfølgingsstudie av innlagte pasienter med ustabil personlighetsforstyrrelse at den rapporterte forekomsten av multiple selvskadingsepisoder hadde falt fra 70 % til 15 % etter ti år (20). Majoriteten av pasientene hadde fått behandling i løpet av de ti årene.…”