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Our understanding of personality disorders has come of age since the mid-1990s. At a time of frequent change, some of the issues discussed in this chapter will be likely to be incorporated into the core of learning about these conditions, whereas others may well be abandoned. There are five common ways of classifying personality disorder, namely, category, cluster, severity, impact on social functioning, and attribution. The Personality Assessment Schedule gives social function priority in creating a hierarchy in which the personality disorder creating the greater social dysfunction is given primacy over others in a subsequent description of personality disorder. Social function is affected by many other aspects of mental functioning apart from that of personality. Environmental and genetic factors interweave to influence personality development almost equally, and many genes interact to create different trait groupings. The main treatments for personality disorders are psychological, drug and alternative or complementary treatments.
Recognition is increasing that suicide in young people
poses an important public health challenge. Suicide in
prepubertal children is very rare, but it increases for both
genders in each of the adolescent years (McClure, 1994).
In England and Wales, for example, the 1990 suicide rates
per million for males and females aged 15 to 19 years were
57 and 14 respectively (McClure, 1994). Mortality rates in
this age group were higher only for accidents. Since the
Second World War, there has been an increase in male
youth suicide rates in most European countries and in
North America. In England and Wales, the suicide rate of
males aged 14 to 24 years increased by 78% between 1980
and 1990! (Hawton, 1992). This increase is particularly
striking when seen in comparison to the stable rates for
other age groups and for young females (Diekstra,
Kienhorst, & De Wilde, 1995).
Based on hospital statistics, it is estimated that the rate
of nonfatal suicide attempts is 50 to 100 times higher than
fatal attempts (Flisher, Ziervogel, Chalton, Leger, &
Robertson, 1993). Evidence is emerging that the increase
in rate of completed suicide is accompanied by an increase
in the rate of attempted suicide (Hawton, Fagg, Simkin,
Bale, & Bond, 1997). The rates of 15–24-year-olds presenting
at the general hospital in Oxford with deliberate
self-harm increased by 194% for males and 36% for
females between 1985 and 1995 (Hawton et al., 1997).
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