Personality disorders in parasuicide

To examine the prevalence of personality disorders in a representative sample of patients admitted to inpatient care after a parasuicide, 64 consecutive patients were investigated with structured interviews for DSM-IV personality disorders and clinical interviews for Axis I disorders and suicidal behaviour. We found a borderline personality disorder (BPD) as principal diagnosis in 55% of the subjects and some other personality disorder (OPD) in an additional 23%. Multiple Axis II disorders were significantly more common in the BPD group, in which 71% met criteria for three or more personality disorders, compared with 7% in the OPD group. In the BPD group 20% did not have a concomitant Axis I disorder, whereas this was very uncommon in the other groups. A relatively large proportion (34%) in the BPD group used other parasuicide methods than drug intoxication, whereas in the other groups this was rare. The mean number of previous parasuicidal acts was significantly higher in the BPD group, in which 57% had three or more previous parasuicides, and a high proportion (60%) also had repeated a parasuicidal act within the last year. In the BPD group 69% had ongoing outpatient treatment. Only 25% of these outpatients had a borderline personality disorder reported in the hospital records, suggesting that the personality disorder might go undiagnosed. The study gives support to the importance of a focused and structured personality disorder diagnosis in customizing treatment for the person with a recent parasuicide.