Abstract
Objective: Deliberate self-harm (DSH) is common in Borderline Personality Disorder, may be due to a variety of reasons, and is associated with different degrees of suicidal intent. Understanding the reasons for episodes of DSH in this population may be helpful in developing interventions to reduce the rate of DSH or to assist in the clinical judgement of suicidal intention after DSH has occurred.
Methods: The Parasuicide History Interview, version 2 (PHI-2) was used to determine the reasons for DSH events in 70 Australian women diagnosed with Borderline Personality Disorder. Factor analysis of the responses identified four empirically derived component factors. Multivariate models were developed to identify the independent predictors of suicidal deliberate self-harm (S-DSH) versus non-suicidal deliberate self-harm (NS-DSH) events.
Results: Participants and raters showed strong agreement in classifying S-DSH and NS-DSH events. Methods used that involved self-poisoning, jumping or stabbing showed increased risk for S-DSH, adjusted odds ratio 12.07 (95% CI 2.17, 67.29), compared to the referent group, external damage to skin with no rescue contact being sought. Although no grouping of reasons were independently significant, the lower the effectiveness of the DSH event to resolve the reasons for the event, the higher the risk of it having been a S-DSH event.
Conclusion: In clinical situations, any Borderline Personality Disorder patient seeking help or medical attention, using any method other than superficial external injury to skin, or reporting a failure to effectively resolve the reasons for the DSH event, should be considered as likely to have had a S-DSH event (greater suicidal intention). However, specific reasons for the DSH event, or individual subject characteristics, did not meaningfully distinguish S-DSH from NS-DSH events.
Acknowledgements
Our thanks go to several people for their contributions to the Hunter DBT Project; Dr Chris Hayes, University of Newcastle and Ms Susan Burgoyne as Investigators in the initial project development and to Peter Sneesby as Masters of Clinical Psychology student, University of Newcastle, assisting with initial phases of data collection. Our thanks also go to all the staff who contributed clinical services; Individual Therapists: Danielle Adams, Marianne Ayre, Dr Nick Bendit, Susan Burgoyne, Jennifer Evans, Dr Howard Johnson, Jennifer Koorey, Natalie McCall, Chris McCrory, Jane Taylor and Chris Willcox; and Skills Trainers: Marianne Ayre, Dr Nick Bendit, Linda Bragg, Michael Currie, Annabel Kelly, Michelle Meyer, Ruth Spence and Don Stewart; and also to Dr Howard Johnson, Dr Nick Bendit and Dr Neil Port who undertook the baseline clinical interviews. We also appreciated the input from external Honorary Consultants: Dr Marsha Linehan & Dr Kelly Koerner, University of Washington, USA, supplementary training of DBT therapists by Dr Kate Comtois and Dr Kelly Koerner University of Washington, USA and assistance with instrument scoring and data cleaning by Dr Kerrie Clover, University of Newcastle.
Declaration of interest: Professor Carter has been a member of the DBT Strategic Planning Meeting hosted by Professor Marsha Linehan since 2002.