Unstable Personality Research Articles

Accelerated epigenetic aging in women with emotionally unstable personality disorder and a history of suicide attempts

Emotional unstable personality disorder (EUPD; previously borderline personality disorder, BPD) is associated with excess natural-cause mortality, comorbid medical conditions, poor health habits and stress related epigenomic alterations. Previous studies demonstrated that GrimAge – a state-of-the-art epigenetic age (EA) estimator – strongly predicts mortality risk and physiological dysregulation. Herein, we utilize the GrimAge algorithm to investigate whether women with EUPD and a history of recent suicide attempts exhibit EA acceleration (EAA) in comparison to healthy controls. Genome-wide methylation patterns were measured using the Illumina Infinum Methylation Epic BeadChip in whole blood from 97 EUPD patients and 32 healthy controls. The control group was significantly older (p < 0.0001) and reported lesser exposure to violent behavior in both youth and adulthood (p < 0.0001). Groups were otherwise comparable regarding gender, BMI, or tobacco usage (p > 0.05). EA estimator DNAmGrimAge exceeded chronological age by 8.8 and 2.3 years in the EUPD and control group, respectively. Similarly, EAA marker AgeAccelGrim was substantially higher in EUPD subjects when compared to controls, in both univariate and multivariate analyzes (p < 0.00001). Tobacco usage conferred substantial within-group effects on the EA-chronological age difference, i.e., 10.74 years (SD = 4.19) compared to 6.00 years (SD = 3.10) in the non-user EUPD group (p < 0.00001). Notably, past alcohol and substance abuse, use of psychotropic medications, global assessment of functioning, self-reported exposure to violent behavior in youth and adulthood, later completed suicide (N = 8) and age at first suicide attempt did not predict EAA in the EUPD group (p > 0.05). These results underscore the importance of addressing medical health conditions along with low-cost preventative interventions aimed at improving somatic health outcomes in EUPD, such as efforts to support cessation of tobacco use. The independency of GrimAge to other EA algorithms in this group of severely impaired EUPD patients, suggest it may have unique characteristics to evaluate risk of adverse health outcomes in context of psychiatric disorders.

The Impact of Stopping Risk Assessment Checklists at a Specialist Personality Disorder Unit.

Aim This study was conducted in Springbank Ward, a specialist ward for patients with emotionally unstable personality disorder, based in Cambridge, United Kingdom. We aimed to assess any change in incident frequency following the introduction of a new protocol for leaving the ward, in which patients are offered an optional conversation with staff in place of a formal risk assessment checklist. We also aimed to assess patient and staff perceptions of the change. Methods We used data routinely collected by Springbank Ward to compare incident frequency in the year before and after the change in protocol. We conducted structured interviews with patients and staff to obtain qualitative data on the new protocol and used thematic analysis to interpret the interview data. Results There were 466 incidents during the period before the change in protocol and 408 incidents in the period after. Adjusted for occupancy rate, there was no statistically significant difference in the frequency of incidents. Patients and staff were generally satisfied with the new protocol, with an average satisfaction rating of 4.1 out of 5. Thematic analysis generated five main themes: 'taking ownership', 'autonomy versus restriction', 'staff-patient interaction', 'staff expertise' and 'protocol efficiency'. Conclusions Our study reveals high satisfaction with the new way risk is assessed and managed for patients leaving Springbank Ward, with an appreciation for its holistic and minimally restrictive approach. This was achieved without significantly increasingincident frequency.

Increased Methylation of Brain-Derived Neurotrophic Factor (BDNF) Is Related to Emotionally Unstable Personality Disorder and Severity of Suicide Attempt in Women.

Brain-derived neurotrophic factor (BDNF) has previously been associated with the pathogenesis of both emotionally unstable personality disorder (EUPD) and suicidal behavior. No study has yet investigated BDNF-associated epigenetic alterations in a group of severely impaired EUPD and suicidal patients. The discovery cohort consisted of 97 women with emotionally unstable personality disorder (EUPD) with at least two serious suicide attempts (SAs) and 32 healthy female controls. The genome-wide methylation pattern was measured by the Illumina EPIC BeadChip and analyzed by robust linear regression models to investigate mean BDNF methylation levels in a targeted analysis conditioned upon severity of suicide attempt. The validation cohort encompassed 60 female suicide attempters, stratified into low- (n = 45) and high-risk groups (n = 15) based on degree of intent-to-die and lethality of SA method, and occurrence of death-by-suicide at follow-up. Mean BDNF methylation levels exhibited increased methylation in relation to EUPD (p = 0.0159, percentage mean group difference ~3.8%). Similarly, this locus was confirmed as higher-methylated in an independent cohort of females with severe suicidal behavior (p = 0.0300). Results were independent of age and BMI. This is the first study to reveal emerging evidence of epigenetic dysregulation of BDNF with dependence on features known to confer increased risk of suicide deaths (lethality of suicide-attempt method and presence of EUPD diagnosis with history of recent SAs). Further studies investigating epigenetic and genetic effects of BDNF on severe suicidal behavior and EUPD are needed to further elucidate the role of epigenetic regulatory mechanisms and neurotrophic factors in relation to suicide and EUPD, and hold potential to result in novel treatment methods.

How Effective are Current Joint Working Practices between Children and Family Social Workers and Mental Health Care Coordinators, in Supporting Families in which there is a Primary Care-giver, with a Diagnosis of Emotionally Unstable Personality Disorder?

Abstract Emotionally Unstable Personality Disorder (EUPD) is a complex and often stigmatising diagnosis. Although falling under the remit of mental health services, it is not always seen as a mental health need, and research suggests that if parents or carers are not provided with more holistic support, parental mental health will deteriorate with children likely to have poorer outcomes, placing them at an increased risk of harm. This likelihood of harm increases with compounding factors such as substance misuse and domestic abuse. One organisation alone cannot effectively address the complex difficulties that people with this diagnosis may experience, thus inter-agency working is necessary. This article explores the barriers and facilitators to inter-agency working to support parental care-givers with a diagnosis of EUPD between Children’s Social Care and a Community Mental Health Team within the same English area. Five mental health care coordinators and two children and families’ social workers who had experience working with this client group were interviewed. Participants identified the challenges and benefits of working with their partner agency around communication, knowledge, stigmatisation and resources. The research provides suggestions to develop current inter-agency working relationships and to enhance care and support available to people experiencing the diagnosis.

Sistem Pakar Skrining Gejala Gangguan Kepribadian Ambang Menggunakan Metode Certainty Factor

Borderline Personality Disorder is a type of personality disorder characterized by an overall unstable personality pattern, excessive impulsivity, which often confuses sufferers with their own identity. An expert system is a system developed to assist in making decisions on a particular problem. This expert system aims to help screen symptoms of borderline personality disorder and provide solutions to relieve these symptoms. The method used by the expert system is the certainty factor. The expert system development stage uses the waterfall method and uses the PHP programming language. The results of this study are in the form of an accuracy value of 80% with test data of 10 people, these results are obtained by comparing the results of experts with the results of the system that has been designed

Borderline personality disorder in ICD-11 and DSM-5 – the relational nature of the criteria for the disorder

The paper illustrates the relational nature of the psychiatric category of borderline personality disorders based on the analysis of symptomatic criteria set out in the International Classification of Diseases and Related Health Problems, 11th Revision (ICD-11) issued by the World Health Organization (WHO), as well as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) developed by the American Psychiatric Association (APA). We point to the appreciation of the relational nature of the phenomenon, which is noticeable already in a very cursory analysis, in the latest WHO and APA classification systems. The clinical manifestations of these criteria seem not only to be interconnected, but also to result from one another, suggesting a fundamentally structural nature of the phenomenon. All the described difficulties relate to interpersonal relationships – both in terms of the direct causes of disfunctions and long-term family and social consequences. This particularly applies to the borderlinetype emotionally unstable personality disorder, which is inseparably linked to emotional volatility and instability, and which is difficult to define using criteria in a way that does not give rise to diagnostic challenges. Therefore, we draw attention to difficulties with relationships, which are an important diagnostic criterion. Both ICD-11 and DSM-5 contain separate diagnostic categories for relationship problems, which, as it turns out, not necessarily coexist with other disorders. Linking relationship pathology with personality disorders may be of great importance for establishing the correct diagnosis and therefore choosing an appropriate treatment strategy.

Perceived social support as related to social wellbeing in patients with Emotionally Unstable Personality Disorder (EUPD)

BackgroundPeople diagnosed with EUPD also known as borderline personality disorder (BPD) experience different challenges in their lives. These challenges include compulsive behavior, irritability, depression, sadness, guilt, shame, loneliness, grandiosity, and feeling of worthlessness. It is noteworthy that such challenges trigger among them a self-destructive behaviour, in addition to social isolation, and impaired social relationships. It is also found to significantly impact their physical, mental, and social wellbeing. This study is a humble attempt to examine the role of perceived social support in improving the social wellbeing of BPD outpatients. Through the purposive sampling technique, 100 BPD outpatients were selected for the study. The mean age of the participant was 25 years.ResultsIt was found that perceived social support (family, friends, and significant others) plays a vital role in the wellbeing of these participants. The correlation between the two is positive as well as statistically significant. This means higher the support these patients experience from their relatives, the better is their social wellbeing.ConclusionsThis study has practical implications for counselors, clinical psychologists, and psychiatrists working in the field.

Behandlungsvereinbarungen in der Psychiatrie – reale Praxis in einem Verbund psychiatrischer Kliniken

Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them. To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of aJCP. We carried out aretrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of aJCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24months before index admission. Out of atotal of 117,662 inpatients 467 (0.4%) had completed aJCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with aJCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with aJCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24months preceding the first documentation of aJCP. Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of aJCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail.

Antipsychotics and emotionally unstable personality disorder: a literature review

Introduction This reviews aim was to explore the evidence base for the use of antipsychotic medications in the management of acute symptoms in patients with emotionally unstable personality disorder. Methods Relevant databases and grey literature were searched for relevant papers. Inclusion/exclusion criteria were applied which resulted in the retrieval of eight papers pertinent to the literature review. The papers were critically appraised, and a thematic analysis was undertaken to collate relevant data. Findings Five themes emerged from this literature review: different outcome measures, symptom domains (anger, impulsivity, mood instability, pseudopsychotic symptoms, self-harm and suicidal behaviours, adverse effects, the quality of the evidence and bias). Conclusions The evidence base is not robust enough to allow conclusions to be drawn. Any positive results must be weighed up against the potential for adverse events. This review lays the foundations for further research, which is needed to explore antipsychotic treatment.

The influence of psychiatric comorbidities on the duration of compulsory nasogastric tube feeding of children and adolescents with restrictive eating disorders

Background/aims The authors' clinical experience found that some patients required the intervention of compulsory nasogastric tube feeding for a significantly longer amount of time than others. The aim of this study was to identify whether different psychiatric comorbidities are associated with different durations of nasogastric tube feeding under restraint in children and young people with restrictive eating disorders. Methods A retrospective case-note analysis was conducted in 2018. Data were collected from electronic medical records and hospital incident forms, focusing on diagnosis, length of stay and on the number of episodes of nasogastric tube feeding under restraint. Results A total of nine patients required nasogastric tube feeding under restraint, of which four patients had psychiatric comorbidities (emerging emotionally unstable personality disorder, autism spectrum disorder and complex trauma). Length of stay was not significantly greater in patients with psychiatric comorbidities (median=302 vs 241 days, Mann-Witney U=16.00, P=0.20). However, the number of episodes of nasogastric tube feeding under restraint was significantly greater in those with psychiatric comorbidities (median=31.00 vs 2 episodes, Mann-Whitney U=20.00, P=0.02) than those without. Conclusions This study suggests that psychiatric comorbidities are associated with more prolonged episodes of nasogastric tube feeding under restraint and therefore patients with these comorbidities will have greater treatment planning needs.

Cannabis-Based Medicinal Products in the Management of Emotionally Unstable Personality Disorder (EUPD): A Narrative Review and Case Series

Emotionally unstable personality disorder (EUPD) is a common mental health disorder, manifesting with a range of chronic and debilitating symptoms, including impaired social functioning, unstable mood, and risky impulsive or self-injurious behaviour. Whilst the exact aetiology has not been fully elucidated, implicated factors seem to include genetic factors, environmental causes such as trauma, and neurotransmitter deficits. The literature suggests that impaired functioning of the endocannabinoid system in key brain regions responsible for emotional processing and stress response may underlie the manifestation of EUPD symptoms. The National Institute for Health and Care Excellence (NICE) 2009 guidelines state that "no drugs have established efficacy in treating or managing EUPD", and yet, patients are commonly prescribed medication which includes antipsychotics, antidepressants, and mood stabilisers. Here we present a case series of seven participants diagnosed with EUPD and treated with cannabis-based medicinal products (CBMPs). Participants were given an initial assessment and followed up one month after CBMPs prescription. Improvement in symptoms was assessed by the completion of ratified rating scales by the participant and psychiatrist. Our results indicate that CBMPs were effective and well tolerated, as six participants reported a noticeable improvement in their symptoms and functioning. Although promising, further research is needed to ascertain the long-term tolerability, efficacy, and dosing strategy for CBMPs in EUPD.

An evaluation of value-based outcomes for women admitted to a dialectical behaviour therapy integrated practice unit: a follow-up study.

An earlier evaluation (Fox et al., ) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted. To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service. Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes. Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period. Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients' perceptions of recovery.

Interaction of job-related psychological flexibility, coping style and personality types in depression in Chinese physicians: A cross-section study.

To investigate the associations of job-related psychological flexibility, coping style and personality types with and their interactions in depression in Chinese physicians. A cross-sectional survey of 444 physicians was conducted by using the convenience sampling method in the municipal hospitals in Zhengzhou, Henan province. Center for Epidemiological Studies Depression, Work-related Acceptance and Action Questionnaire, the Simplified Coping Style Questionnaire and Eysenck Personality Questionnaire-Revision Short Scale of China were administered to each participant. Depression tendency scores were significantly higher in healthcare workers with intermediate title, age 31 and older, introvert unstable personality than other counterparts, (P < .01). Female and extrovert stable healthcare workers had significantly higher coping score than male and other personality types (P < .05). The scores of job-related psychological flexibility in healthcare workers with Introvert Stable or working in emergency department were significantly higher than their counterparts (P < .01). General linear model algorithm of machine learning showed that Extrovert Unstable was the main risk factor for depression (β = 6.74), followed by Extrovert Stable (β = −4.90), negative coping, positive coping, and length of service. Multivariate regression models showed that a significant interaction existed between coping style, work-related psychological flexibility and Extroversion (β = −0.103, P < .05), independently explaining 0.7% variance of depression, and that a significant interaction existed between coping style, work-related psychological flexibility and neuroticism (β = 0.116, P < .05), independently explaining 1.0% variance of depression. Interactions existed between personality types, coping style and work-related psychological flexibility in depression tendency in Chinese healthcare workers, with neuroticism (extrovert unstable) being a risk factor and extroversion (extrovert stable) being a protective factor. Precision prevention strategies could be made based on personality types to reduce depression in health workers.

‘Commanded to be ill, accused of being well’ a lived-experience-led, qualitative investigation of service user perspectives on the impact of emotionally unstable personality disorder diagnosis on self-concept

Background Emotionally unstable personality disorder (EUPD) is a mental disorder impairing health and functioning and increasing suicide risk and it is a stigmatised condition among healthcare professionals. EUPD diagnosis may significantly affect self-concept, yet no previous investigation has explicitly examined this. Aims To explore service user perspectives on (a) the impact of EUPD diagnosis on self-concept and (b) mediators of positive and negative impacts. Methods Service user-led, qualitative semi-structured interviews with n = 10 participants with EUPD. Results Perceived impacts of diagnosis on self-concept were, broadly, negative. Factors mediating between positive and negative impacts included: exposure to online stigma and public understanding, the responses of relatives, friends, intimate partners and trusted communities, and the attitudes and behaviours of healthcare staff. There were indications that recent guideline and practice developments (guidelines recommending alternatives to inpatient admissions for people with EUPD and “recovery-focused” approaches to self-harm) may have worsened inpatient staff attitudes and led to more rejecting service user experiences. Conclusion Mitigating negative impacts of EUPD diagnosis on self-concept may require addressing hateful, online content related to EUPD; revisiting use of the personality disorder label; improving medical communication around diagnosis and improving practice and policy in the management of EUPD in inpatient settings.

Anxious Personality Traits: Perspectives from Basic Emotions and Neurotransmitters.

Objective: Recently, many emotional diseases, such as anxiety and depression, have prevailed, and it is expected that emotional disease will be the leading cause of social and economic burden in 2030. These emotional diseases may be due to certain personality traits, which could be the reasons for the development of mental illness. Personality theories have been constantly developed over the past hundreds of years, and different dimensions of personality traits corresponding to different physiological bases and emotional feelings have been proposed. However, personality may be the least studied area in psychology. Methods: In this paper, we will give a short review on the development of personality theories as well as dimensional emotional theory. Then, we will compare the similarities between the emotional dimension and personality dimension. Furthermore, we will also investigate the neural mechanisms of personality and emotions, focusing on neuromodulators for anxiety-related personality traits, in order to provide a clear relationship between different neurotransmitters and anxiety-related personality traits. Results: The results of our study suggest that the emotional dimension and personality dimension may be somewhat related, for example, the extrovert/introvert dimension of personality might be related to the hedonic dimension, which includes happiness/sadness, and the neurotic dimensions might be related to emotional arousal. In addition, our study found that personality traits are also related to basic emotions, for instance, people who are too self-centered are prone to feeling a mood of disgust or depression, while anger and fear correspond to unstable personality traits. The analysis suggested that the neural substrates of both personality and emotions might be described as follows: extroverted–joy–dopamine (DA); introverted–disgust–5-hydroxytryptamine (5-HT); unstable (neuroticism)–anger/fear–noradrenaline (NE); stable–calmness. Conclusions: The results of this study suggest that there is a correlation between personality traits and emotions, and both depend on monoamine neurotransmitters (dopamine, norepinephrine and serotonin). In addition, personality disorders can be interfered via the regulation of emotions and neurotransmitters. This paper opens up a whole new perspective for future research on personality traits and emotional diseases and has great clinical value and practical significance.

Commentary: Bringing together lived experience, clinical and research expertise - a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?).

There is a wealth of evidence to suggest that the Borderline Personality Disorder (BPD, or similar Emotionally Unstable Personality Disorder, EUPD) construct is harmful. We provide a commentary on the ideas expressed in the May Debate issue, highlighting both concerns and alternatives. We bring together lived experience, clinical and research expertise. This commentary was written collaboratively drawing on all these sources of evidence. We outline evidence that the BPD construct is invalid, harmful, not necessary for effective treatment and a potential block to the development and evaluation of alternatives. We ask readers to consider these concerns, perspectives and ideas.

Which complex PTSD symptoms predict functional impairment in females with comorbid personality disorder needs? Research and treatment implications

BackgroundEmotionally unstable personality disorder (EUPD) and complex post-traumatic stress disorder (CPTSD) reflect complex and highly comorbid disorders that bear significant impacts on a person's functioning. Despite the significant treatment needs of people with EUPD and complex trauma histories, the differential effects of trauma symptomology on functioning remain unexplored in this population. Prioritizing the most impactful symptoms is critical for providing timely and efficient treatment, over a reduced intervention period. AimsThe current study sought to explore the relative associations of CPTSD symptoms with functional impairment in a clinical inpatient EUPD population. MethodsA convenience sample of 45 females with a primary diagnosis of EUPD, admitted to a specialist inpatient DBT service, completed the International Trauma Questionnaire, as a measure of CPTSD symptomology and associated functional impairment. ResultsAt a diagnostic level, with the exception of affective dysregulation, meeting any of the CPTSD symptom clusters was significantly associated with meeting the functional impairment criterion. At a dimensional level, the severity of all CPTSD symptoms were significantly positively associated with the severity of functional impairments. However, only sense of threat and disturbances in relationships were significant predictors of functional impairment severity when controlling for other symptom clusters. ConclusionsTrauma symptoms bear differential impacts on a person's ability to function in important domains of their lives. A persistent sense of threat and interpersonal difficulties stemming from traumatic experiences may reflect particularly crucial targets in interventions for individuals with EUPD and complex trauma needs. Implications for both research and clinical practice are discussed.

Prescribing for emotionally unstable personality disorder: clinicians’ views

Emotionally unstable personality disorder (EUPD) has become a public health challenge due to its prevalence, cost to health care services and comorbidities. Prescribers are faced with a clinical conundrum when offering medication to patients with EUPD due to the risk of deliberate overdose. Here, the authors analyse clinicians’ views and experiences pertaining to prescribing medications for EUPD within the context of the NICE guidelines, with resulting messages to enable positive change in future clinical guidelines and policies.

Relationship between Emotionally Unstable Personality Disorder and Remembered Parenting Style - A Pilot Study from Private Tertiary Care Center

Introduction: Emotionally unstable personality disorder (EUPD) is a type of personality disorder which is characterized by symptoms, such as highly volatile mood, high impulsivity, unstable relationships, and self-harming behavior. Studies indicate that an individual's personality is an outcome of various factors, their parental upbringing being one of the major factors. Materials and Methods: The study aimed at exploring remembered parental style in patients diagnosed with EUPD. Ten patients were recruited from a tertiary care psychiatric hospital, and parental bonding instrument and clinical global impressions scale were administered. Results: The mean age of the patients with EUPD was 28.8 ± 7.77 years, and the mean years of education was found to be 15.4 ± 1.66. Mean age of onset of illness was 23.71 years, and the mean severity score was found to be 4.8. The mean mother's care score was found to be 25.6 ± 7.17 and mother's overprotection score was found to be 11.2 ± 5.53. The mean father's care score was found to be 20 ± 11.28 and father's overprotection score was 12.1 ± 6.38. Conclusions: The study findings reveal involvement of authoritarian parenting style in fathers and neglectful parenting style in mothers in the development of EUPD. However, a more comprehensive study with larger sample size is needed to throw more light over this finding.

Attention deficit hyperactivity disorder in adults who present with self-harm: a comparative 6-month follow-up study

BackgroundADHD is common in psychiatric populations. This study aimed to compare clinical characteristics in adults with and without ADHD who presented with self-harm, and to compare later risk of suicidal behaviour within 6 months.MethodsEight hundred four adults presented with self-harm (with and without suicidal intent) at psychiatric emergency services at three Swedish hospitals. Persons with a discharge ICD-10 diagnosis F90.0-F90.9 or a prescription for ADHD medication were considered to have ADHD (n = 93). Medical records were reviewed for evidence of subsequent suicide attempts (SA) within 6 months; suicides were identified by national register.ResultsRecent relationship problems were more prevalent in the ADHD group. While the index episodes of those with ADHD were more often non-suicidal, and actual SAs more often rated as impulsive, medical lethality at presentation did not differ in attempters with and without ADHD. Subsequent SAs (fatal or non-fatal) were observed in 29% of the ADHD group and 20% in all others (P = .005). A logistic regression model showed elevated risk of suicidal behaviour during follow-up in the ADHD group (OR = 1.70, CI 1.05–2.76), although a final regression model suggested that this association was partly explained by age and comorbid emotionally unstable personality disorder.ConclusionsFindings highlight the need for clinicians to take self-harm seriously in adults with ADHD.