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The influence of personality disorder on outcome in adolescent self-harm

  • Eunice Ayodeji (a1), Jonathan Green (a2), Chris Roberts (a2), Gemma Trainor (a3), Justine Rothwell (a2), Adrine Woodham (a2) and Alison Wood (a4)...
Abstract
Background

Little is currently known about the presence and impact of personality disorder in adolescents who self-harm.

Aims

To evaluate personality disorder in repeated self-harm in adolescence and its impact on self-harm psychopathology and adaptation outcomes over 1 year.

Method

A clinical referral sample (n = 366) of adolescents presenting with repeated self-harm aged 12–17 years, as part of a randomised controlled trial (Assessment of Treatment in Suicidal Teenagers study, ASSIST). Personality disorder was assessed using the Structured Clinical Interview for DSM-IV Axis II (SCID-II). One-year outcomes included frequency and severity of repeat self-harm, self-reported suicidality, mood and functional impairment.

Results

About 60% of the referred adolescents showed one or more forms of personality disorder. Personality disorder was associated with significantly greater severity of self-harm, overall psychopathology and impairment. There was a complex association with treatment adherence. Personality disorder predicted worse 1-year outcomes in relation to self-harm frequency and severity, as well as impairment, suicidality and depressive symptoms.

Conclusions

Personality disorder can be reliably measured in adolescence and showed high prevalence in this clinical self-harm sample. Controlling for other variables, it showed a strong independent association with self-harm severity at referral and predicted adherence to treatment and clinical outcomes (independent of treatment) over 1 year. Consideration of personality disorder diagnosis is indicated in the assessment and management of adolescents who repeatedly self-harm.

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Copyright
Corresponding author
Eunice Ayodeji, Lecturer, School of Nursing, Midwifery and Social Work, University of Salford, Room 2.52, Mary Seacole Building, Frederick Rd, Salford M66PU, UK. Email: e.ayodeji@salford.ac.uk
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Declaration of interest

None.

Footnotes
References
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The influence of personality disorder on outcome in adolescent self-harm

  • Eunice Ayodeji (a1), Jonathan Green (a2), Chris Roberts (a2), Gemma Trainor (a3), Justine Rothwell (a2), Adrine Woodham (a2) and Alison Wood (a4)...
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eLetters

Self harm in an adolescent population

Emma L Sellers, Assistant Psychologist - Child and Adolescent Mental Health Services, Rotherham, Doncaster and South Humbershire NHS Trust
10 April 2017

Dear editor,

RE: Ayodeji et al (2015) The influence of personality disorder on outcome in adolescent self-harm.

I extremely enjoyed reading this large sample randomised control trial, which focused on such a significantly important area of research.

Despite the high quality of this research I have are few critiques and points which I believe are worth considering. The sample consisted of individuals between 12 and 17 years of age, which enables the authors to capture participants across the adolescent age group. However developmentally, adolescents who are 12 differ greatly from 17 year olds, both in terms of personality development and self-harming behaviours.

Secondly, the authors only included participants who had self-harmed twice or more. Although I commend the authors for their inclusion criteria, I also believe it would have been interesting to compare outcomes between groups of participants depending on frequency (e.g. <10 compared to >10) and severity of self-harm. Additionally, I would be interested to have known whether the sample included participants who had ever had a Tier 4 inpatient admission, as I believe this would have affected the diversity of the sample in terms of self harming severity and personality disorder characteristics.

I would like to commend Ayodeji et al. for this high quality study, in particular for using validated questionnaires and for expanding the literature in this area. Self-harm in adolescents is an important areas of research in mental health. This study provides novel insight into the relationship between personality disorder and self-harm.

Many thanks,

Emma Sellers

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Conflict of interest: None Declared

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