Predictors of self-mutilation in patients with borderline personality disorder: A 10-year follow-up study.
BACKGROUND
Self-mutilation is a common and serious problem in patients with borderline personality disorder (BPD). The purpose of this study was to determine the most clinically relevant baseline and time-varying predictors of self-mutilation over 10 years of prospective follow-up among patients with BPD.


METHODS
Four semistructured interviews assessing axis I disorders, childhood adversity, adult experiences of abuse, and experiences of self-mutilation were administered at baseline to 290 patients meeting DIB-R and DSM-III-R criteria for BPD. Three of these interviews (all except for the childhood adversity interview) and two self-report measures pertaining to dysphoric affects and cognitions were administered at each of five contiguous two-year follow-up periods.


RESULTS
Eleven variables were found to be significant bivariate predictors of self-mutilation over the five follow-up periods. Six of these predictors remained significant in multivariate analyses: female gender, severity of dysphoric cognitions (mostly overvalued ideas), severity of dissociative symptoms, major depression, history of childhood sexual abuse, and sexual assaults as an adult.


CONCLUSIONS
Taken together, the results of this study suggest that factors pertaining to traumatic experiences throughout the lifespan are significant risk factors for self-mutilation over time. These results also suggest that major depressive episodes and cognitive symptoms, particularly overvalued ideas and dissociation, significantly heighten the risk of self-injurious behaviors tracked for a decade.
McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States. zanarini@mclean.harvard.edu
Mary C
MC
Zanarini
Corina S
CS
Laudate
Frances R
FR
Frankenburg
D Bradford
DB
Reich
Garrett
G
Fitzmaurice
D000328:Adult; D001883:Borderline Personality Disorder / Q000523:psychology*; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology; D003073:Cognitive Dissonance; D003865:Major Depressive Disorder / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D012720:Severity of Illness Index; D012737:Sex Factors; D012742:Sex Offenses / Q000523:psychology*