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The association between personality disorder and an act of deliberate self harm in the older person

Published online by Cambridge University Press:  15 September 2010

C. W. Ritchie ,
M. B. King ,
F. Nolan ,
S. O'Connor ,
M. Evans ,
N. Toms ,
G. Kitchen ,
S. Evans ,
C. Bielawski  and
D. Lee
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C. W. Ritchie*
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
M. B. King
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
F. Nolan
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
S. O'Connor
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
M. Evans
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
N. Toms
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
G. Kitchen
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
S. Evans
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
C. Bielawski
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
D. Lee
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
M. Blanchard
Affiliation:
Department of Psychological Medicine, Imperial College London, U.K.
*
Correspondence should be addressed to: Dr Craig W. Ritchie, Department of Psychological Medicine, Imperial College, Claybrook Centre, 37 Claybrook Road, Hammersmith, London W6 8LN, U.K. Phone: +44 (0)207 386 1240; Fax: +44 (0)207 386 1216. Email: [email protected].
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Abstract

Background: Suicide rates are higher in the over 65s than in younger adults and there is a strong link between deliberate self harm (DSH) and suicide in older people. The association between personality disorder (PD) and DSH in older adults remains uncertain. Our objective was to describe this association.

Methods: A case control study was conducted in which participants were: (i) those who had undertaken an act of DSH and (ii) a hospital-based control group drawn from a geographical contiguous population. PD was assessed using the Standardised Assessment of Personality (SAP)

Results: Seventy-seven cases of DSH were identified; 61 (79.2%) of these participants were interviewed. There were 171 potential controls identified of whom 140 (81.9%) were included. An SAP was completed in 45/61 (73.8%) of cases and 100/140 (71.4%) of controls. The mean age was 79.8 years (SD = 9, range 65–103). The crude odds ratio for the association between PD and DSH was 5.91 [(95% CI 2.3, 14.9) p<0.0001]. There was a strong interaction with age stratified at 80 years. There was no association between PD and DSH after age 80. The adjusted odds ratio for PD in the group <80 years was 20.5 [(95% CI 3, 141) p = 0.002]. Borderline and impulsive PD traits tended to be associated with an episode of DSH more than other personality types.

Conclusions: PD appears to be a strong and independent risk for an act of DSH in people aged between 65 and 80 years and should be looked for as part of any risk assessment in this population. Access to specialist services may be required to optimally manage this problem and reduce the subsequent risk of suicide.

Keywords

deliberate self harmpersonality disorderolder personepidemiologycase control
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 2 , March 2011 , pp. 299 - 307
Copyright
Copyright © International Psychogeriatric Association 2010

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