Narcissistic Personality Disorder and suicidal behavior in mood disorders.
The relationship of Narcissistic Personality Disorder (NPD) to suicidal behavior is understudied. The modest body of existing research suggests that NPD is protective against low-lethality suicide attempts, but is associated with high lethality attempts. Mood-disordered patients (N = 657) received structured interviews including Axis I and II diagnosis and standardized clinical measures. Following chi-square and t-tests, a logistical regression model was constructed to identify predictors of suicide attempt. While there was no bivariate relationship of NPD on suicide attempt, in the logistic regression patients with NPD were 2.4 times less likely to make a suicide attempt (OR = 0.41; 95% CI = 0.19 - 0.88; p < 0.05), compared with non-NPD patients and controlling for possible confounding variables. NPD was not associated with attempt lethality. NPD patients were more likely to be male, to have a substance use disorder, and to have high aggression and hostility scores. Limitations include that the sample consists of only mood-disordered patients, a modest sample size of NPD, and the data are cross-sectional. The multivariate protective effect of NPD on suicide attempt is consistent with most previous research. The lower impulsivity of NPD patients and less severe personality pathology relative to other personality disorders may contribute to this effect. No relationship of NPD to attempt lethality was found, contradicting other research, but perhaps reflecting differences between study samples. Future studies should oversample NPD patients and include suicide death as an outcome. Clinical implications include discussion of individualized suicide risk assessment with NPD patients.
Graduate School of Social Service, Fordham University, New York, NY, USA. Electronic address: dcoleman11@fordham.edu.
Daniel
D
Coleman
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Ryan
R
Lawrence
School of Social Work, Columbia University, New York, NY, USA.
Amrita
A
Parekh
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Hanga
H
Galfalvy
Department of Psychiatry, Puerta de Hierro University Hospital, Autonoma University, CIBERSAM, Madrid, Spain.
Hilario
H
Blasco-Fontecilla
Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
David A
DA
Brent
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
J John
JJ
Mann
Department of Psychiatry, Jimenez Diaz Foundation, Autonoma University, Madrid, Spain.
Enrique
E
Baca-Garcia
Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Maria A
MA
Oquendo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010554:Personality Disorders / Q000150:complications* / Q000453:epidemiology; D012306:Risk; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
Depression; Narcissistic Personality Disorder; Suicide attempt; Suicide attempt lethality