title: Deliberate self-harm and suicide attempt in custody: distinguishing features in male inmates' self-injurious behavior.
abstract: Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of "serious" vs. "non-serious" and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of "low seriousness" (i.e. low lethality and low suicidal intent) and of "high seriousness". Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.
authors.affiliation: Institute of Forensic Psychiatry -- Charité Universitätsmedizin Berlin, Limonenstrasse 27, 12203 Berlin, Germany. johannes.lohner@charite.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Lohner
authors.forename: Norbert
authors.initials: N
authors.lastname: Konrad
mesh_terms: D000293:Adolescent; D000328:Adult; D001604:Berlin; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008257:Machiavellianism; D008297:Male; D008875:Middle Aged; D010552:Personality Assessment; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology*; D013223:Statistics as Topic; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data