Skip to main content Accessibility help

The association between personality disorder and an act of deliberate self harm in the older person

  • C. W. Ritchie (a1), M. B. King (a1), F. Nolan (a1), S. O'Connor (a1), M. Evans (a1), N. Toms (a1), G. Kitchen (a1), S. Evans (a1), C. Bielawski (a1), D. Lee (a1) and M. Blanchard (a1)...


Background: Suicide rates are higher in the over 65s than in younger adults and there is a strong link between deliberate self harm (DSH) and suicide in older people. The association between personality disorder (PD) and DSH in older adults remains uncertain. Our objective was to describe this association.

Methods: A case control study was conducted in which participants were: (i) those who had undertaken an act of DSH and (ii) a hospital-based control group drawn from a geographical contiguous population. PD was assessed using the Standardised Assessment of Personality (SAP)

Results: Seventy-seven cases of DSH were identified; 61 (79.2%) of these participants were interviewed. There were 171 potential controls identified of whom 140 (81.9%) were included. An SAP was completed in 45/61 (73.8%) of cases and 100/140 (71.4%) of controls. The mean age was 79.8 years (SD = 9, range 65–103). The crude odds ratio for the association between PD and DSH was 5.91 [(95% CI 2.3, 14.9) p<0.0001]. There was a strong interaction with age stratified at 80 years. There was no association between PD and DSH after age 80. The adjusted odds ratio for PD in the group <80 years was 20.5 [(95% CI 3, 141) p = 0.002]. Borderline and impulsive PD traits tended to be associated with an episode of DSH more than other personality types.

Conclusions: PD appears to be a strong and independent risk for an act of DSH in people aged between 65 and 80 years and should be looked for as part of any risk assessment in this population. Access to specialist services may be required to optimally manage this problem and reduce the subsequent risk of suicide.


Corresponding author

Correspondence should be addressed to: Dr Craig W. Ritchie, Department of Psychological Medicine, Imperial College, Claybrook Centre, 37 Claybrook Road, Hammersmith, London W6 8LN, U.K. Phone: +44 (0)207 386 1240; Fax: +44 (0)207 386 1216. Email:


Hide All
Abrams, R. C. and Horowitz, S. V. (1999). Personality disorders after age 50: a meta-analytic review of the literature. In Rosowsky, E., Abrams, R. C. and Zweig, R. A. (eds.), Personality Disorders in Older Adults: Emerging Issues in Diagnosis and Treatment (pp. 5568). Mahwah, NJ: Erlbaum Associates.
Avlund, K., Lund, R., Holstein, B. E., Due, P., Sakari-Rantala, R. and Heikkinen, R. L. (2004). The impact of structural and functional characteristics of social relations as determinants of functional decline. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 59, S4451.
Beck, A. T. et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
Blixen, C. E., McDougall, G. J. and Suen, L. J. (1997). Dual diagnosis in elders discharged from a psychiatric hospital. International Journal of Geriatric Psychiatry, 12, 307313.
Blow, F. C., Brockmann, L. M. and Lawton, B. K. (2004) Role of alcohol in late life suicide. Alcoholism, Clinical and Experimental Research, 28, 48S56S.
Brock, A., Baker, A., Griffiths, C., Jackson, G., Fegan, G. and Marshall, D. (2006). Suicide trends and geographical variations in the United Kingdom, 1991–2004. Health Statistics Quarterly, 31, 622.
Brugha, T. S., Bebbington, P., Tennant, C. and Hurry, J. (1985). The list of life threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15, 189194.
Chiu, H. F. et al. (1996). Attempted suicide by Chinese older person in Hong Kong. General Hospital Psychiatry, 18, 444447.
Conwell, Y. et al. (1998). Age differences in behaviors leading to completed suicide. American Journal of Geriatric Psychiatry, 6, 122126.
De Leo, D. et al. (2001). Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behavior. International Journal of Geriatric Psychiatry, 16, 300310.
De Leo, D. et al. (2002). Repetition of suicidal behavior in older person Europeans: a prospective longitudinal study. Journal of Affective Disorders, 72, 291295.
Draper, B. (1996) Attempted suicide in old age. International Journal of Geriatric Psychiatry, 11, 577587.
Dumais, A. et al. (2005a). Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. American Journal of Psychiatry, 162, 21162124
Dumais, A. et al. (2005b). Psychiatric risk factors for motor vehicle fatalities in young men. Canadian Journal of Psychiatry, 50, 838844.
Fishbain, D. A. (1991). Personality disorder diagnoses in old age. Journal of Clinical Psychiatry, 52477–478
Forman, E. M. et al. (2004). History of multiple suicide attempts as a behavioral marker of severe psychopathology. American Journal of Psychiatry, 161, 437443.
Hawton, K. and Harriss, L. (2006). Deliberate self harm in people over 60 years: characteristics and outcome of a 20-year cohort. International Journal of Geriatric Psychiatry, 21, 572581.
Heikkinen, M. E. et al. (1997). Recent life events and suicide in personality disorders. Journal of Nervous and Mental Disease, 185, 373381.
Klonsky, E. D., Oltmanns, T. F. and Turkheimer, E. (2003). Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. American Journal of Psychiatry, 160, 15011508.
Koerner, K. and Linehan, , , M. M. (2000). Research on dialectical behavior therapy for patients with borderline personality disorder. The Psychiatric Clinics of North America, 23, 151167.
Kreitman, N., Philip, A. E., Greer, S. and Bagley, C. R. (1969). Parasuicide. British Journal of Psychiatry, 115, 746747.
Langley, G. E. and Bayatti, N. N. (1984). Suicides in Exe Vale Hospital, 1972–1981. British Journal of Psychiatry, 145, 463467.
Lynch, T. R., Morse, J. Q., Mendelson, T. and Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: a randomized pilot study. American Journal of Geriatric Psychiatry, 11, 3345.
Mann, A. H., Jenkins, R., Cutting, J. C. and Cowen, P. J. (1981). The development and use of standardized assessment of abnormal personality. Psychological Medicine, 11, 839847.
McClure, G. M. G. (2000). Changes in suicide in England and Wales, 1960–1997. British Journal of Psychiatry, 176, 6467.
Morgan, H. G. (1979). Death Wishes? The Understanding and Management of Deliberate Self Harm. Chichester: Wiley.
Moscicki, E. K. (1997). Identification of suicide risk factors using epidemiological studies. Psychiatric Clinics of North America, 3, 499517.
National Institute of Clinical Excellence (NICE) (2004). Self Harm: The Short-term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. Clinical Guidelines 16. London: NICE.
O'Carroll, P. W. et al. (1996). Beyond the Tower of Babel: a nomenclature for suicidology. Suicide and Life-threatening Behavior, 26, 237252.
O'Loughlin, S. and Sherwood, J. (2005). A 20-year review of trends in deliberate self-harm in a British town, 1981–2000. Social Psychiatry and Psychiatric Epidemiology, 40, 446453.
Osvath, P., Voros, V. and Fekete, S. (2004). Life events and psychopathology in a group of suicide attempters. Psychopathology, 37, 3640.
Parkin, D. and Stengel, E. (1965). Incidence of suicide attempts in an urban community. British Medical Journal, 2, 133138.
Paykel, E. S., Myers, J. K., Lindenthal, J. J. and Tanner, J. (1974). Suicidal feelings in the general population: a prevalence study. British Journal of Psychiatry, 124, 460469.
Pierce, D. (1987). Deliberate self-harm in the older person. International Journal of Geriatric Psychiatry, 2, 105110.
Prigerson, H. G., Desai, R. A., Liu-Mares, W. and Rosenheck, R. A. (2003). Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse. Social Psychiatry and Psychiatric Epidemiology, 38, 213219.
Rubenowitz, E., Waern, M., Wilhelmson, K. and Allebeck, P. (2001). Life events and psychosocial factors in older person suicides: a case control study. Psychological Medicine, 31, 11931202.
Ruths, F. A., Tobiansky, R. I. and Blanchard, M. (2005). Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North London. International Journal of Geriatric Psychiatry, 20, 106—112.
Salib, E., Tadros, G. and Cawley, S. (2001). History of deliberate self harm may predict methods of fatal self harm in the older person. Medicine, Science and Law, 41, 107110.
Saunders, J. B. et al. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption II. Addiction, 88, 791804
Sherbourne, C. D. and Stewart, A. L. (1991). The MOS social support survey. Social Science Medicine (Great Britain), 32, 705714.
Stengel, E. (1952) Enquiries into attempted suicide. Proceedings of the Royal Society of Medicine, 45, 613620.
Tsoh, J. et al. (2005). Attempted suicide in older person Chinese persons: a multi-group, controlled study. American Journal of Geriatric Psychiatry, 13, 562571.
Wilkinson, S. et al. (2002). Admissions to hospital for deliberate self-harm in England 1995–2000: an interim analysis of Hospital Episode Statistics. Journal of Public Health Medicine, 24, 179183.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed