The Relationship Between Suicidal Behavior and Metacognitive Characteristics in Male Patients with Antisocial Personality Disorder

Objective: Antisocial personality disorder (ASPD) is a mental disorder with impaired psychosocial functioning and carries a high risk for suicide. Previous studies have investigated the role of metacognitive considerations in individual behavioral differences and provided ample evidence of significant relationships between emotional processes, cognition, metacognitive beliefs, and behavior. A close relationship between metacognitive functions and personality disorders was suggested. This study investigated the relationship between the metacognitive characteristics of male patients with ASPD and suicidal behavior. Method: We included seventy-four patients diagnosed with ASPD according to DSM-5 criteria, who applied to Çukurova University Faculty of Medicine Balcalı Hospital, Department of Psychiatry, as the patient group and 74 healthy volunteers as the control group. Sociodemographic data form, Metacognition Questionnaire (MCQ), Beck Suicidal Ideation Scale (BSIS), Suicidal Behaviors Questionnaire (SBQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the participants. Results: The control and ASPD groups were similar in terms of age, years of education, educational and marital status, and place of residence (p>0.05 for each). The MCQ and its subscales, BSIS, SBQ, BDI, and BAI scale scores, were significantly higher in the patient group (p<0.05 for each). Patients who have previously attempted suicide have significantly higher MCQ- uncontrollability and danger (p=0.028), MCQ- need to control thoughts subscales (p=0.016), and BSIS, SBS, BDI, BAI (p<0.001 for each) mean scores than those who have not attempted suicide. There was a positive correlation between SBQ and MCQ-cognitive confidence (p=0.04) and MCQ- need to control thoughts (p=0.01) subscales in the patient group. Conclusions: Metacognitive beliefs may be associated with the severity of suicidal behavior, depression, and anxiety symptoms in male patients with ASPD. The negative metacognitive functions, especially beliefs about the need to control thoughts, may help determine the risk of suicide in individuals with ASPD, and metacognitive therapy methods may be beneficial for those patients.