Borderline personality disorder and mental health care utilization: The role of self-harm.

The current study examined the associations for borderline personality disorder (BPD) and a specific trait of the disorder, self-harm, with mental health care utilization. Our sample consisted of 145 psychiatric inpatients who completed 3 measures of BPD (Personality Diagnostic Questionnaire-4 [PDQ-4], McLean Screening Inventory for borderline personality disorder [MSI-BPD], Structured Clinical Interview for DSM-IV Axis II Disorders-Personality Questionnaire [SCID-II-PQ]) and the Self-Harm Inventory (SHI). In relationship to mental health care utilization, the correlation for the SHI was significantly larger than those for the PDQ-4, MSI-BPD, or SCID-II-PQ. Thus, self-harm was significantly better at detecting mental health care utilization than was the overall BPD construct, which indicates that some of the more severe manifestations of the disorder are the most predictive of impairment in functioning. These findings also call into question whether BPD (and by extension, personality pathology in general) is most useful in these symptom constellations as opposed to focusing on specific maladaptive traits. (PsycINFO Database Record

Elucidating the association between the self-harm inventory and several borderline personality measures in an inpatient psychiatric sample.

OBJECTIVE: The current study evaluated the utility of the self-harm inventory (SHI) as a proxy for and screening measure of borderline personality disorder (BPD) using several diagnostic and statistical manual of mental disorders (DSM)-based BPD measures as criteria. METHODS: We used a sample of 145 psychiatric inpatients, who completed the SHI and a series of well-validated, DSM-based self-report measures of BPD. RESULTS: Using a series of latent trait and latent class analyses, we found that the SHI was substantially associated with a latent construct representing BPD, as well as differentiated latent classes of 'high' vs. 'low' BPD, with good accuracy. CONCLUSIONS: The SHI can serve as proxy for and a good screening measure for BPD, but future research needs to replicate these findings using structured interview-based measurement of BPD.

Comparing External Correlates of DSM-5 Section II and Section III Dimensional Trait Operationalizations of Borderline Personality Disorder.

The current study evaluated the relative associations of the DSM-5 Section II operationalization of Borderline Personality Disorder (BPD) and dimensional traits included in a diagnosis of BPD in DSM-5 Section III with conceptually relevant external criterion variables. It is important to determine whether or not Section II BPD and constellation of Section III BPD traits have similar positions in the nomological network representing the BPD construct. Moreover, it is important to determine whether or not the trait-based Section III BPD diagnosis is an improvement upon the categorical Section II diagnosis in regard to its associations with external criteria. To evaluate this, we used two samples, a patient sample consisting of 145 psychiatric patients and a university sample consisting of 399 undergraduate students. We conducted a series of correlation and regression analyses in order to determine the relative associations of these two diagnostic methodologies with relevant external criteria. Correlation analyses did not favor either model, but indicated that both Section II and Section III BPD have associations with external criterion variables relevant to BPD. The regression analyses tended to favor the trait-based Section III model, supporting the construct validity and use of the trait profile for BPD in DSM-5 Section III. Generally, it was concluded that the Section II and Section III operationalizations have similar positions in a nomological network representing the BPD construct.

Convergence between DSM-5 Section II and Section III diagnostic criteria for borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a common mental health condition in psychiatric settings. The current study examined the overlap between the operationalization of BPD listed in Section II (Diagnostic Criteria and Codes) and the alternative, dimensional personality trait-based operationalization listed in Section III (Emerging Measures and Models) of the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Moreover, the unique contributions of specific personality traits for indexing the traditional BPD operationalization were also evaluated, including conceptually relevant traits not originally proposed for Section III BPD. METHOD: Participants were 145 consecutive patients from a psychiatric unit in a hospital in the USA. These individuals completed a series of questionnaires that index both traditional (DSM-IV/DSM-5 Section II) and alternative (DSM-5 Section III personality traits) diagnostic criteria for BPD. RESULTS: Structural equation modeling results revealed that latent constructs representing the Section II and Section III operationalizations of BPD, respectively, overlapped substantially (r = 0.86, p < 0.001). Hierarchical latent regression models indicated that at least five of the seven traits proposed to define Section III BPD uniquely accounted for variance (69%) in a latent Section II BPD variable. Finally, at least one other conceptually relevant trait (Perceptual Dysregulation) augmented the prediction of latent BPD scores. CONCLUSIONS: The proposed personality traits for Section III BPD are clearly aligned with traditional conceptualizations of this important personality disorder construct. At least five of the seven dimensional traits proposed to define Section III contributed uniquely to the characterization of Section II BPD, and these traits can be augmented by Perceptual Dysregulation. If replicated in other settings, these findings might warrant some modification to the operationalization of DSM-5 Section III BPD.

A naturalistic study of the relationship between self-harm behaviors and Axis I diagnostic groupings among inpatients.

Self-harm behavior is relatively common among psychiatric patients, but few studies have examined such behavior in the context of Axis I diagnoses. In this study among 110 psychiatric inpatients, we examined clinical psychiatric diagnoses and surveyed participants for self-harm behaviors. Surprisingly, using five diagnostic groupings, there were no between-group differences in the endorsement of individual, total number of, or high-lethal self-harm behaviors. Our results suggest that the number and character of self-harm behaviors does not relate to psychiatric diagnosis among psychiatric inpatients.

The relationship between suicide attempts and low-lethal self-harm behavior among psychiatric inpatients.

In this study, we examined the relationship between suicide attempts and low-lethal self-harm behavior in a sample of psychiatric inpatients. Using a cross-sectional approach, we surveyed 107 participants about their histories of suicide attempts, including overdoses, as well as various low-lethal self-harm behaviors. Compared with those without such histories, individuals with histories of suicide attempts, including overdoses, were significantly more likely to report a greater number of: 1) low-lethal self-harm behaviors; 2) specific symptom clusters of self-harm behavior (i.e., self-mutilation, substance abuse, medically self-defeating behaviors); and 3) specific individual self-harm behaviors (e.g., torturing oneself with self-defeating thoughts, abusing prescription medications). These data suggest that suicide attempts and low-lethal self-harm behavior are likely to co-exist in many psychiatric inpatients.

Childhood abuse, mental healthcare utilization, self-harm behavior, and multiple psychiatric diagnoses among inpatients with and without a borderline diagnosis.

Although borderline personality disorder (BPD) has defined diagnostic criteria, a number of other clinical features are associated with this diagnosis. These features may include childhood histories of abuse (eg, sexual, physical, and emotional abuse; the witnessing of violence), high mental healthcare utilization, self-harm behavior, and polysymptomatic presentations that result in multiple Axis I diagnoses. Although each of these variables has been described in the empirical literature, only 1 other study has explored all 4 of these variables in a single study population--the Collaborative Longitudinal Personality Disorders Study. Using clinical diagnoses and self-report surveys, we explored these variables among psychiatric inpatients in a community hospital. We found that, compared with patients with no BPD, those with BPD reported significantly more types of childhood trauma, higher utilization of particular mental health services (ie, number of times and days of hospitalization for mental health or substance abuse, number of psychiatrists and therapists ever seen, number of courses of psychotherapy treatment), and a higher number of self-harm behaviors. Although not significant, there were positive trends for the remaining variables. The authors discuss the implications of these findings as they relate to patients with BPD.

Multiple psychiatric diagnoses and self-harm behavior.

Objective The purpose of this study was to examine among psychiatric inpatients (N=110) the relationship, if any, between the number of Axis I diagnoses and the number of self-harm behaviors (SHBs). We also wished to explore the role of borderline personality disorder (BPD) in mediating this possible relationship. Method We examined discharge diagnoses in relationship to scores on the Self-Harm Inventory (SHI) for all participants as well as by BPD status. Results For the entire sample, there was a significant correlation between the number of Axis I disorders and the number of SHBs [Spearman's rho(110)=0.21, p=0.03]. When examining this relationship in terms of BPD status, there were no significant between-group differences in the number of Axis I diagnoses. While patients diagnosed with BPD endorsed significantly more SHBs (M=9.53, SD=3.89) than nonBPD patients (M=5.32, SD=3.89), there was only a significant correlation between the number of Axis I disorders and SHB for the nonBPD, but not the BPD subsample. Conclusions Among psychiatric inpatients, there is a relationship between the number of Axis I diagnoses and the number of SHBs.

The relationships among childhood abuse, borderline personality, and self-harm behavior in psychiatric inpatients.

The current study was undertaken to explore the relationships among childhood abuse subtypes (sexual, physical, and emotional abuse; witnessing violence), three diagnostic screenings for borderline personality disorder (BPD), and self-harm behavior. Psychiatric inpatients (N = 77) were evaluated for childhood abuse histories through a survey. Participants also underwent assessment for BPD using a self-report measure, clinical diagnosis, and a DSM-IV checklist. Finally, each was assessed for self-harm behavior using the 22-item Self-Harm Inventory (SHI). Compared with non-abused participants, those with abuse histories (with the exception of witnessing violence) had a significantly greater number of BPD confirmations (i.e., self-report, clinical diagnosis, DSM-IV checklist) as well as self-harm behaviors. When examining the total number of endorsed abuse subtypes, there was a significant correlation with the number of self-harm behaviors, but not the number of BPD diagnoses. Among psychiatric inpatients, childhood abuse demonstrates a complex relationship to BPD diagnoses and self-harm behavior.

Self-harm behaviors across the life cycle: a pilot study of inpatients with borderline personality disorder.

The purpose of this study was to explore, throughout the life cycle, the prevalence of self-harm behaviors among psychiatric inpatients with and without borderline personality disorder (BPD). Psychiatric inpatients with BPD (n = 43) were compared to those without BPD (n = 40) with regard to self-reported self-harm behaviors during their lifetime. The mean number of self-harm behaviors, including high-lethal behaviors (i.e., suicide attempts, cutting oneself, overdosing), among those with BPD dramatically increased between the ages of 18 and 24 years and was sustained through ages 50 to 59 years. Non-BPD patients showed a similar pattern, but the means were notably less. These data suggest that the behavioral "burn out" theory of personality disorders does not necessarily occur among inpatients with BPD.