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Personality disorder and suicide

Published online by Cambridge University Press:  20 July 2018

Tomoyuki Kawada
Tomoyuki Kawada*
Affiliation:
Professor, Department of Hygiene and Public Health, Nippon Medical School, Japan. Email: kawada@nms.ac.jp
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Abstract

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Type
Correspondence
Information
The British Journal of Psychiatry , Volume 213 , Issue 2 , August 2018 , pp. 499
Copyright
Copyright © The Royal College of Psychiatrists 2018 

The discussion about the association between personality disorder and suicide is important.Reference Liu1 First, I want to present some information on the risk of suicide in patients with personality disorder with special reference to the subtype of personality disorder.

Coleman et al. conducted a cross-sectional study to understand the relationship between narcissistic personality disorder (NPD) and suicidal behaviour in 657 patients with mood disorders.Reference Coleman, Lawrence, Parekh, Galfalvy, Blasco-Fontecilla and Brent2 The adjusted odds ratio for suicide attempt in the participants with NPD was 0.41 (95% CI 0.19–0.88). In addition, being male, substance use disorder, aggression and hostility also presented a significant increase in odds ratio for suicide attempt. In contrast, the adjusted odds ratio for suicide attempt in those participants with borderline personality disorder (BPD) was 4.96 (95% CI 3.25–7.58). NPD in patients with mood disorders showed a protective effect for suicidal behaviour, which was different from that in participants with BPD. Sher reports that patients with NPD have a risk of suicide behaviour,Reference Sher3 and I recommend stratified analysis by subtype of personality disorder for risk assessment of suicide.

Second, there is a difference between suicidal ideation and attempt.Reference Lewitzka, Spirling, Ritter, Smolka, Goodday and Bauer4 In addition, mood disorder is a risk factor for suicidal behaviour.Reference Vilaplana, Richard-Devantoy, Turecki, Jaafari and Jollant5 Wang et al. conducted a prospective study to investigate the effect of stressful life events on subsequent suicidal behaviour in patients with major depressive disorder.Reference Wang, Sareen, Afifi, Bolton, Johnson and Bolton6 They clarified that financial stress was a strong predictor for suicide attempts after adjusting for sociodemographic variables, anxiety, substance use and personality disorder. As Liu also pointed out, comprehensive analysis is recommended for risk assessment of suicide.

References

1Liu, KY. Personality disorders and suicide in China. Br J Psychiatry 2017; 210: 167.Google Scholar
2Coleman, D, Lawrence, R, Parekh, A, Galfalvy, H, Blasco-Fontecilla, H, Brent, DA, et al. narcissistic personality disorder and suicidal behavior in mood disorders. J Psychiatr Res 2017; 85: 24–8.Google Scholar
3Sher, L. Narcissistic personality disorder and suicide. Psychiatr Danub 2016; 28: 307.Google Scholar
4Lewitzka, U, Spirling, S, Ritter, D, Smolka, M, Goodday, S, Bauer, M, et al. Suicidal ideation vs. suicide attempts: clinical and psychosocial profile differences among depressed patients: a study on personality traits, psychopathological variables, and sociodemographic factors in 228 patients. J Nerv Ment Dis 2017; 205: 361–71.Google Scholar
5Vilaplana, M, Richard-Devantoy, S, Turecki, G, Jaafari, N, Jollant, F. Insight into mental disorders and suicidal behavior: a qualitative and quantitative multimodal investigation. J Clin Psychiatry 2015; 76: 303–18.Google Scholar
6Wang, Y, Sareen, J, Afifi, TO, Bolton, SL, Johnson, EA, Bolton, JM. A population-based longitudinal study of recent stressful life events as risk factors for suicidal behavior in major depressive disorder. Arch Suicide Res 2015; 19: 202–17.Google Scholar
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