Melbourne School of Psychological Sciences - Theses

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    The features, correlates and phenomenology of non-suicidal self-injury in youth with borderline personality disorder
    Andrewes, Holly ( 2017)
    Background. Non-suicidal self-injury (NSSI) is a core feature of Borderline Personality Disorder (BPD). The normative peak in NSSI during middle adolescence highlights youth with BPD as a high-risk population for NSSI. This behaviour is often a focus for intervention because of its relationships with lasting physical injury and suicide attempts. Despite this, the precise nature of the relationships between features of NSSI (their frequency, severity and patterns) and suicide attempts is currently unknown in youth with BPD. Furthermore, the real-time motives for NSSI and emotional changes, which precede and follow this behaviour, have not been investigated in this population. Aims. Two primary aims were addressed in this thesis. The first was to identify the relationships between the frequency, severity and patterns of NSSI and suicide attempts in youth with BPD. The second was to examine the real-time motives for NSSI and the changes in the intensity and number of emotions experienced prior and following NSSI in youth with BPD. Method. Participants were 107 youth (15-25 years) with BPD, presenting for treatment for the first time at two public mental health services in Melbourne, Australia. Participants first took part in an interview (Demographic questionnaire, Structured Clinical Interview for DSM-IV Axis I and Axis II) and completed a number of self-report measures (Borderline Personality Disorder Severity Index, Difficulties in Emotion Regulation Scale, Montgomery–Asberg Depression Rating Scale, Suicide Attempt Self-Injury Interview). Second, participants were provided with a mobile phone, programmed to prompt them to identify their affect, self-injurious thoughts and behaviours, 6 times a day for 6 days. Results. The 12-month frequency of NSSI revealed neither a linear nor quadratic relationship with the frequency of suicide attempts. Additionally, participants who engaged in more severe NSSI over the prior 12-months did not report more suicide attempts. Two patterns of NSSI were identified from the 12-month reports of NSSI: random (one or more NSSI act inconsistently spaced from the next act) and habitual (at least four NSSI acts at regular intervals) patterns. Participants who engaged in random patterns of NSSI identified their NSSI as more severe and reported more suicide attempts than those who engaged in habitual patterns. In the month prior to a suicide attempt, the frequency, severity and proportion of NSSI occurring in a random pattern increased compared with a random month of NSSI without a suicide attempt. An investigation of the phenomenology of NSSI showed that a quarter of participants were unable to identify their motives. Furthermore, negative affect increased before NSSI and reduced after, while positive affect reduced before NSSI and increased after, both approximating a quadratic curve. The number of negative emotions also increased before NSSI. This increase was associated with lower trait levels of emotional acceptance. Conclusions. Findings suggest that patterns (random and habitual) of NSSI more accurately distinguish individuals engaging in different frequencies of suicide attempts than the frequency or severity of NSSI. Despite this, an increase in the frequency, severity and random patterns of NSSI occurring over a 1-month period might be suggestive of a forthcoming suicide attempt. Research investigating the phenomenology of NSSI indicates that poor metacognitive capacities and both negative and positive reinforcement might perpetuate NSSI. Additionally, improved emotional acceptance might reduce the quantity of negative emotions experienced during distress, and therefore the chances of NSSI.