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Little is currently known about the presence and impact of personality
disorder in adolescents who self-harm.
To evaluate personality disorder in repeated self-harm in adolescence and
its impact on self-harm psychopathology and adaptation outcomes over 1
A clinical referral sample (n = 366) of adolescents
presenting with repeated self-harm aged 12–17 years, as part of a
randomised controlled trial (Assessment of Treatment in Suicidal
Teenagers study, ASSIST). Personality disorder was assessed using the
Structured Clinical Interview for DSM-IV Axis II (SCID-II). One-year
outcomes included frequency and severity of repeat self-harm,
self-reported suicidality, mood and functional impairment.
About 60% of the referred adolescents showed one or more forms of
personality disorder. Personality disorder was associated with
significantly greater severity of self-harm, overall psychopathology and
impairment. There was a complex association with treatment adherence.
Personality disorder predicted worse 1-year outcomes in relation to
self-harm frequency and severity, as well as impairment, suicidality and
Personality disorder can be reliably measured in adolescence and showed
high prevalence in this clinical self-harm sample. Controlling for other
variables, it showed a strong independent association with self-harm
severity at referral and predicted adherence to treatment and clinical
outcomes (independent of treatment) over 1 year. Consideration of
personality disorder diagnosis is indicated in the assessment and
management of adolescents who repeatedly self-harm.
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