Different Clinical Presentations in Eating Disorder Patients with Non-Suicidal Self-Injury Based on the Co-Occurrence of Borderline Personality Disorder.

Koen Luyckx,Brianna Turner,Katrien Schoevaerts,Margaux Verschueren,Eva Dierckx,Laurence Claes

doi:10.5334/pb.420

Abstract

Non-suicidal self-injury (NSSI) and borderline personality disorder (BPD) features are common in patients with eating disorders (ED), yet little is known regarding the clinical presentation of ED patients who present with NSSI with and without BPD. The current study compared self-injurious, female ED inpatients with (n = 98; NSSI+BPD) and without BPD (n = 45; NSSI-only) on different self-reported clinical features. Results suggest that ED patients with NSSI+BPD differ from those with NSSI-only with regard to frequency of suicidal ideation, alcohol, drug or medication abuse, internalizing/externalizing psychopathology, interpersonal problems, and coping strategies, with the NSSI+BPD group demonstrating more impairment in each of these domains. Despite these differences in clinical presentation, however, groups did not differ in NSSI features. In sum, while self-injurious ED patients may present with similar NSSI behavior regardless of BPD diagnosis, those with NSS+BPD represent a group with much higher clinical complexity and greater treatment needs.

Highlights

Non-suicidal self-injury (NSSI) refers to the direct injury of one’s own body tissue without suicidal intent, such as cutting, scratching, and hitting oneself (Claes & Vandereycken, 2007)
The self-injurious group without borderline personality disorder (BPD) diagnosis was clearly differentiated form the BPD group, with a mean of BPD criteria of 2.62. This indicates the presence of two distinct groups of self-injurious eating disorders (ED) patients: those who present with NSSI in the absence of significant BPD symptoms (NSSI-only), and those who present with NSSI and BPD symptoms (NSSI+BPD)
ED patients with NSSI+BPD did not differ from those with NSSI-only with respect to the recency, severity, versatility, or methods of their NSSI. This indicates that BPD symptomatology does not predict a more severe or persistent type of NSSI behavior in ED patients

Summary

Introduction

Non-suicidal self-injury (NSSI) refers to the direct injury of one’s own body tissue without suicidal intent, such as cutting, scratching, and hitting oneself (Claes & Vandereycken, 2007). § Department of Psychology, Harvard University, Cambridge, MA, US. Claes et al: NSSI and BPD in Eating Disorder Inpatients (DSM-5; APA, 2013), NSSI was solely listed as a possible symptom of the borderline personality disorder (BPD). Recently, Turner et al (2015) compared self-injurious adults with NSSI-only and NSSI+BPD on NSSI features and co-occurring psychiatric symptoms in a community sample. As far as we know, no studies have directly compared clinical symptoms between inpatients with NSSIonly and NSSI+BPD. One of the aims of the present study was to compare NSSI and clinical features of inpatients with NSSI-only and those with NSSI+BPD. Given that NSSI and BPD are both highly prevalent in inpatients with eating disorders (ED), this patient sample was selected to address the aforementioned question and to partially fill this gap in the existing literature

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