Demographic and clinical caracteristics of self-harmers
A controlled study
KOURTIS A., PATSIKA E., KARAOULANI P., PAVLIDIS I., PETRIKIS P., ZLATANOS D., SAITIS M., ADAMOPOULOU A. GARYFALLOS G.
Community Mental Health Center of N/W District of Thessaloniki
Acts of suicide or attempts to this effect or self-harming acts are an issue of prime importance, which is of interest not only to the mental health workers but also to all those involved in health in general as well as to the national authorities related to living and cultural standards.
The notional set of these acts is considered to be multi-faceted. This is a complex condition that relates to psychological, biological and social factors. It may result from a wish to escape from difficult situation, it can indicate an effort to injure a person or a social structure or it could possibly appear as the result of a generic predisposition of certain persons. More commonly, it seems to emanate from a patient's depressive disposition in the psychological framework that life is not at all desirable and death is the only escape outlet from greater pain, financial ruin or other unpleasant situations. A person who has such an inclination experiences desperation, helplessness, an ambivalence about life and its interminable intensity and a feeling that there are apparently no possibilities for change and improvement.
The purpose of the present study is to investigate demographic and clinical characteristics of psychiatric outpatients. The sample of the study consisted of 36 patients, 3 males and 33 females, with a history of recent and/or past suicide attempt and/or self-injury attending the Community Mental Health Center of N/W District of Thessaloniki from 1995 to 2000. An equal number of outpatients matched for sex and age that did not report a history of self-harming acts was used as a control group. The psychiatric diagnoses of Axis I (Clinical Syndromes) were following a clinical interview according to the DSM-III-R/DSM-IV criteria. For the diagnoses of Axis II (Pesonality Disorders) the Stractured Clinical Interview was used for DSM-III-R, axis II (SCID-II), combined with SCID Personality Questionnaire. The above research “tools” have been translated and standarised to the Greek population. The final diagnoses as well as the decision to choose a specific therapeutic intervention are reached by the whole therapeutic team of the Center in the established weekly meetings (Disposition Conference).
The findings of the present are summed-up to the following points. The mean age of the study sample and that of the control is 39,1±9,9 years. The greatest percentage of the persons who took part in the study had a secondary education level, that is 11 out of 36 (30%) of the study group and 15 out of 36 of the control group (42%). In their majority, the samples of both the study group and the control group were single, 18 in the study group (50%) and 20 in the control group (55%). The study group included as well 9 married (25%), while in the control group the number of the married was 14 (39%). The comparison of the democratic characteristics of the two groups reveals no statistically significant differences between the two groups, except that in the study group there was a significantly larger percentage of divorced/widowed persons than in the control group (x2=5,25 p<0,05). There was a significant occurence of Disposition/Mood Disorders on the whole as well as in the various subcategories, with prevalent in both cases the diagnosis of Major Depressive Disorder in percentages that are 36% and 39% for the study group and the control group respectively, with no significant statistical differantiation between them. The persons of the study group manifested significantly more frequently “any” pesonality disorder compared to the persons in the control group (p<0,05). Borderline Personality Disorder appeared in statistically significantly greater frequency in the patients of the study group (p<0,01). Dependent Personality Disorder appeared in statistically significantly greater number of patients in the study group (15 out of 36, percentage of 42%) discontinued the proposed treatment which comprised either Cognitive Analytical Psychotherapy or Supportive Psychotherapy combined or not with pharmacotherapy or Cognitive Behavioural Psychotherapy of finally Family Psychotherapy compared to the control group (5 out of 36, a percentage of 14%) (x2=5,61, p<0,05). Commenting on the findings of the study, the following points should be noted: the number of females is 11 times greater than that of the males with respect to the ratio of the number of the males to that of the females who took part in the study as the study group and the control group respectively; the statistically significant difference between the study group and the conrol group with respect to the diagnosis of any personality disorders on the whole and Borderline Personality Disorder in particular; the statistically significant difference of occurrence of Dependent Personality Disorder in the control group compared to the study group; and finally, the fact that it is difficult for persons who exhibit self-harming behaviour to complete the proposed therapy.
Key words: Self harmers, demographic caracteristics, clinical caracteristics.