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Personality Disorders

Links:

Cluster A (odd or eccentric)

Cluster B (dramatic, emotional, or erratic)

Cluster C (anxious or fearful)

Research articles:

Blasco-Fontecilla, H. H., Baca-Garcia, E. E., Dervic, K. K., Perez-Rodriguez, M. M., Saiz-Gonzalez, M. D., Saiz-Ruiz, J. J., & ... de Leon, J. J. (2009). Severity of personality disorders and suicide attempt. Acta Psychiatrica Scandinavica, 119(2), 149-155. doi:10.1111/j.1600-0447.2008.01284.x

Objective: Severity of personality disorders (PDs) may be more useful in estimating suicide risk than the diagnosis of specific PDs. We hypothesized that suicide attempters with severe PD would present more attempts and attempts of greater severity/lethality. Method: Four hundred and forty-six suicide attempters were assessed. PD diagnosis was made using the International Personality Disorder Questionnaire – Screening Questionnaire. PDs were classified using Tyrer and Johnson’s classification of severity (no PD, simple PD, diffuse PD). Severity/lethality of attempts was measured with the Suicide Intent Scale, Risk-Rescue Rating Scale and Lethality Rating Scale. Results: Attempters with severe (diffuse) PD had more attempts than the other groups. After controlling for age and gender, this difference remained significant only for the younger age group and women. There was no relationship between severity of PDs and severity/lethality of attempts. Conclusion: Younger female attempters with severe PD are prone to repeated attempts. However, the severity of PD was not related to the severity/lethality of suicide attempts. [ABSTRACT FROM AUTHOR]

Blasco-Fontecilla, H., Baca-Garcia, E., Duberstein, P., Perez-Rodriguez, M., Dervic, K., Saiz-Ruiz, J., & ... Oquendo, M. A. (2010). An exploratory study of the relationship between diverse life events and specific personality disorders in a sample of suicide attempters. Journal of Personality Disorders, 24(6), 773-784. doi:10.1521/pedi.2010.24.6.773

Personality disorder (PD) increases risk for suicidal behavior. Certain life events (LE) can precipitate suicidal behaviors in patients with PD. A fundamental question is whether specific combinations of LE and PD increase suicidal risk. Four hundred forty-six suicide attempters (SA) were recruited from emergency rooms. We used a healthy control group ( n = 515) to identify the best cut-off point for the instrument used to diagnose PD. We used the DSM-IV version of the International Personality Disorder Questionnaire-Screening Questionnaire, the Mini International Neuropsychiatric Interview, and the Social Adjustment Scale to assess PD, Axis I disorders, and LE, respectively. After controlling for Axis I disorders, we found that 'Death of spouse' preceded suicidal acts in those with antisocial PD (FET p = 0.024) and patients with narcissistic PD attempted suicide after being Fired at work (FET p = 0.002), among others. Our data suggest the presence of particular LE-PD associations in suicide attempters. Some LE-PD relationships appear independent of Axis I disorders in suicide attempters. This may offer a basis for specific targeted therapies or prevention programs aimed at decreasing suicidal risk. [ABSTRACT FROM AUTHOR]

Lamis, D. A., Langhinrichsen-Rohling, J., & Simpler, A. H. (2008). The associations among personality disorder symptoms, suicide proneness and current distress in adult male prisoners. Personality and Mental Health, 2(4), 218-229. doi:10.1002/pmh.52

Suicide is the 11th leading cause of death in the United States, and the third leading cause of death in US jails and penitentiaries. Research has shown that the presence of an Axis II personality disorder (PD) increases the risk for suicidal behaviour. While many correctional institutions screen inmates for suicidal ideation upon intake, they can neglect to assess for the presence of PD symptoms other than those associated with criminality such as Antisocial PD. The current study examined whether symptoms of various PDs were associated with self-reports of current suicide proneness and distress in a small sample of adult male inmates residing in a medium or a maximum security facility. As hypothesized, elevated scores on numerous PD Millon Clinical Multiaxial Inventory-III scales (e.g. Schizoid, Depressive, Sadistic, Schizotypal, Borderline) were significantly associated with both self-reports of current suicide proneness and psychological distress. Once the nature of these associations in inmates is better understood, more effective suicide prevention programs can be designed and implemented in correctional facilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. Lancet, 377(9759), 74-84. Retrieved from EBSCOhost.

The article offers clinical information on borderline personality disorder. Characteristics of this disorder include severe functional impairments, a high risk of suicide and a negative effect on the course of depressive disorders. It says that genetic factors and adverse life events seem to interact to lead to the disorder. Information on its epidemiology, treatment and diagnosis is provided. INSET: Search strategy and selection criteria.

Lentz, V., Robinson, J., & Bolton, J. (2010). Childhood adversity, mental disorder comorbidity, and suicidal behavior in schizotypal personality disorder. Journal of Nervous & Mental Disease, 198(11), 795-801. doi:10.1097/NMD.0b013e3181f9804c

Schizotypal personality disorder (SPD) is a serious and relatively common psychiatric disorder, yet remains understudied among the personality disorders. The current study examines the psychiatric correlates of SPD in a representative epidemiologic sample, utilizing data from the National Epidemiological Survey on Alcohol and Related Conditions (N = 34,653). Multiple logistic regression compared people with SPD to the general population across a broad range of childhood adversities, comorbid psychiatric disorders, and suicidal behavior. SPD was strongly associated with many adverse childhood experiences. After adjusting for confounding factors, SPD was independently associated with major depression and several anxiety disorders, including post-traumatic stress disorder. Interestingly, SPD was more strongly associated with borderline and narcissistic personality disorders than cluster A personality disorders. Individuals with SPD were also more likely to attempt suicide. As a whole, these results suggest that individuals with SPD experience significant morbidity and may be at increased risk of mortality.

Loza, W., & Hanna, S. (2006). Is schizoid personality a forerunner of homicidal or suicidal behavior?: A case study. International Journal of Offender Therapy and Comparative Criminology, 50(3), 338-343. doi:10.1177/0306624X05285093

The authors believe that a relationship exists between schizoid personality disorder and violent acts. The following case study is presented to contemplate such a possible relationship. There is a paucity of research on this topic. The authors suggest that further research closely examine the relationship between violent behavior and those character traits associated with schizoid personality disorder. If such a relationship is found, these character traits could be integrated with other risk factors known to predict violence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

McGirr, A., Paris, J., Lesage, A., Renaud, J., & Turecki, G. (2007). Risk factors for suicide completion in borderline personality disorder: A case-control study of cluster B comorbidity and impulsive aggression. Journal of Clinical Psychiatry, 68(5), 721-729. doi:10.4088/JCP.v68n0509

Background: Borderline personality disorder is a major risk factor for suicidal behavior, yet prediction of suicide completion remains unclear. It has been proposed that impulsivity and aggression interact to increase suicide risk. Death by suicide in borderline personality disorder, then, may be the result of impulsivity, a core feature of the disorder, interacting with violent-aggressive tendencies. Using a case-control design, this study investigated clinical and behavioral risk factors for suicide completion in borderline personality disorder. Method: One hundred twenty subjects meeting DSM-IV criteria for borderline personality disorder, 50 controls and 70 who died by suicide between 2001 and 2005, were investigated by means of proxy-based interviews using structured diagnostic instruments and personality trait assessments. Results: Borderline personality disorder suicides had fewer psychiatric hospitalizations and suicide attempts than borderline personality disorder controls. Borderline personality disorder suicides were also more likely to meet criteria for current and lifetime substance dependence disorders. They had higher levels of current and lifetime Axis I comorbidity, novelty seeking, impulsivity, hostility, and comorbid personality disorders, while exhibiting lower levels of harm avoidance. Most importantly, borderline personality disorder suicides were more likely to have cluster B comorbidity. Impulsivity and aggression interacted to predict suicide, though not after controlling for cluster B comorbidity. Conclusions: Borderline personality disorder individuals who die by suicide differ from those borderlines typically encountered in acute psychiatric settings. Our results suggest that the lethality of borderline personality disorder suicide attempts results from an interaction between impulsivity and the violent-aggressive features associated with cluster B comorbidity. Further, the anxious trait of harm avoidance appears to be protective against suicidal behavior resulting in death. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

McGirr, A., Paris, J., Lesage, A., Renaud, J., & Turecki, G. (2009). An examination of DSM-IV borderline personality disorder symptoms and risk for death by suicide: A psychological autopsy study. Canadian Journal of Psychiatry, 54(2), 87-92. Retrieved from EBSCOhost.

Objective: To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by suicide, and thereby better predict suicide risk. Method: A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD (n = 62), and BPD control subjects (n = 35). Results: BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation-dissociative symptoms. The negative association between paranoid ideation-dissociative symptoms and suicide was independent of all other BPD symptoms, Cluster B comorbidity, and alcohol dependence. Conclusions: We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD. [ABSTRACT FROM AUTHOR]

Pompili, M., Girardi, P., Ruberto, A., & Tatarelli, R. (2005). Suicide in borderline personality disorder: A meta-analysis. Nordic Journal of Psychiatry, 59(5), 319-324. Retrieved from EBSCOhost.

Suicide is the major cause of death among patients with borderline personality disorder; however, the literature on completed suicides in such disorder is inconclusive, as suicide rates vary greatly among cohorts of patients. We searched MedLine , Excerpta Medica and PsycLit from 1980 to 2005 to identify papers dealing with suicide in borderline personality disorder. We also searched the World Health Statistics Annual to ascertain the suicide rate in the age groups for specific years and country. We selected eight studies comprising 1179 patients with a diagnosis of borderline personality disorder. Of these patients, 94 committed suicide. Results obtained for each study were processed together to calculate the mean figure for each year of suicides for 100,000 individuals suffering from borderline personality disorder. Our meta-analysis shows that suicide among patients with borderline personality disorder is more frequent when compared with the general population. All study analyses reported that patients with borderline personality disorder committed suicide more often than their counterparts in the general population. Suicide seems more alarming in the first phases of follow-up than during chronic phases of illness. [ABSTRACT FROM AUTHOR]

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