title: Self-mutilation and suicide attempts: relationships to bipolar disorder, borderline personality disorder, temperament and character.
abstract: OBJECTIVE
  Self-mutilation has traditionally been associated with borderline personality disorder, and seldom examined separately from suicide attempts. Clinical experience suggests that self-mutilation is common in bipolar disorder.
  
  
  METHODS
  A family study was conducted on the molecular genetics of depression and personality, in which the proband had been treated for depression. All probands and parents or siblings were interviewed with a structured interview and completed the Temperament and Character Inventory.
  
  
  RESULTS
  Fourteen per cent of subjects interviewed reported a history of self-mutilation, mostly by wrist cutting. Self-mutilation was more common in bipolar I disorder subjects then in any other diagnostic groups. In multiple logistic regression self-mutilation was predicted by mood disorder diagnosis and harm avoidance, but not by borderline personality disorder. Furthermore, the relatives of non-bipolar depressed probands with self-mutilation had higher rates of bipolar I or II disorder and higher rates of self-mutilation. Sixteen per cent of subjects reported suicide attempts and these were most common in those with bipolar I disorder and in those with borderline personality disorder. On multiple logistic regression, however, only mood disorder diagnosis and harm avoidance predicted suicide attempts. Suicide attempts, unlike self-mutilation, were not familial.
  
  
  CONCLUSIONS
  Self-mutilation and suicide attempts are only partially overlapping behaviours, although both are predicted by mood disorder diagnosis and harm avoidance. Self-mutilation has a particularly strong association with bipolar disorder. Clinicians need to think of bipolar disorder, not borderline personality disorder, when assessing an individual who has a history of self-mutilation.
authors.affiliation: Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand. peter.joyce@otago.ac.nz
authors.forename: Peter R
authors.initials: PR
authors.lastname: Joyce
authors.forename: Katrina J
authors.initials: KJ
authors.lastname: Light
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Rowe
authors.forename: C Robert
authors.initials: CR
authors.lastname: Cloninger
authors.forename: Martin A
authors.initials: MA
authors.lastname: Kennedy
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D001883:Borderline Personality Disorder / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005190:Family / Q000523:psychology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012652:Self Mutilation / Q000453:epidemiology / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013694:Temperament