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Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder

Chiesa, M; Sharp, R; Fonagy, P; (2011) Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder. Psychotherapy and Psychosomatics , 80 (2) 100 - 109. 10.1159/000320975. Green open access

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Abstract

Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. Results: PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Conclusions: Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating. Copyright (C) 2010 S. Karger AG, Basel

Type: Article
Title: Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder
Open access status: An open access version is available from UCL Discovery
DOI: 10.1159/000320975
Publisher version: http://dx.doi.org/10.1159/000320975
Language: English
Additional information: © 2011 Karger. This is the authors' accepted version of this published article.
Keywords: Deliberate self-injury, Personality disorder, Borderline personality disorder, Treatment outcome, Psychosocial treatment, Inpatient treatment, Community-based treatment, Empirical study, psychotherapy, mutilation, harm, population, prevalence, Rorschach, behavior, trial, women
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
URI: https://discovery.ucl.ac.uk/id/eprint/741062
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