A new study published in the current issue of Psychotherapy and Psychosomatics by a group of British investigators outlines the clinical characteristics of self-injury during treatment. Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). However, there are gaps 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.
In this study, the investigators 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. They 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.
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, the investigators 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.
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.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Reference / Abstract
Chiesa, M. ; Sharp, R. ; Fonagy, P. Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder. Psychother Psychosom 2011;80:100-109.