title: Clinical associations of deliberate self-injury and its impact on the outcome of community-based and long-term inpatient treatment for personality disorder.
abstract: BACKGROUND
  Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge 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.
  
  
  METHODS
  We 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. We 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.
  
  
  RESULTS
  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, we 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cassel Hospital, West London Mental Health Trust, London, UK. m.chiesa@ucl.ac.uk
authors.forename: Marco
authors.initials: M
authors.lastname: Chiesa
authors.forename: Rachel
authors.initials: R
authors.lastname: Sharp
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008134:Long-Term Care; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D010343:Patient Admission; D010348:Patient Care Team; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy; D011615:Psychotherapy, Group; D016728:Self-Injurious Behavior / Q000523:psychology* / Q000628:therapy*; D013222:State Medicine; D013808:Therapeutic Community; D006113:United Kingdom