Psychodynamic study of suicide attempts in patients with personality disorders

Abstract

The objective of this study was to identify similarities and differences in the psychodynamics of patients with personality disorders who make suicide attempts and those who are hospitalized but have never attempted suicide. Twenty patients in each cateogry were interviewed by a psychiatrist, with the interview videotaped. The videotape was used to assess clinical diagnoses and to identify the precipitant for the suicide attempt or hospital admission, the associated effects, and the psychodynamic meaning. No statistically significant between group differences on diagnoses of depressive disorders, substance abuse, severe character pathology, or presence of other DSMIII-R Axis I psychiatric disorders were found. However, significantly more of the suicide attempters experienced acute interpersonal conflict and expressed feelings of hopelessness, whereas the affects of confusion, anxiety, sadness, and guilt unrelated to acute interpersonal conflict were significantly more associated with hospital admission for the controls. Rage toward a perceived abandoning object was an important psychodynamic factor in this group of suicide attempters, particularly in the serious attempters. Four male attempters and three female attempters, all with severe character pathology, made serious suicide attempts. Eleven of the fourteen females made low risk attempts, but an unexpected finding was that five were pregnant. The motivation for these low risk attempts in females was a maladaptive effort to communicate distress, and in the pregnant attempters also an expression of ambivalence about the pregnancy. Results of this study are of relevance in the assessment and treatment of patients with personality disorders in a variety of clinical settings. Depression 3:290–296 (1995/1996). © 1996 Wiley-Liss, Inc.