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Australas Psychiatry. 2017 Oct;25(5):460-465. doi: 10.1177/1039856217707390. Epub 2017 May 10.

Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder.

Author information

1
Executive Clinical Director, Spectrum, Eastern Health, Ringwood East, VIC, Australia.
2
Senior Research Fellow, Spectrum, Eastern Health, Ringwood East, VIC, Australia.
3
Senior Research Fellow, Orygen, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
4
Associate Director, Spectrum, Statewide Service for Personality Disorder, Eastern Health, Ringwood East, VIC, and; current affiliation: Psychoanalytic Practice, Melbourne, VIC, Australia.
5
Consultant Psychiatrist, Mental Health Program, Monash Health, Melbourne, VIC, Australia.
6
Executive Clinical Director, Mental Health Program, Eastern Health, Box Hill, VIC, Australia.
7
Associate Clinical Director, Spectrum, Eastern Health, Ringwood East, VIC, and; Lecturer, Centre for Psychiatric Nursing, University of Melbourne, Melbourne, VIC, Australia.

Abstract

OBJECTIVES:

Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods.

METHODS:

Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category.

RESULTS:

Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( p<.01) and high lethality, chronic risk ( p<.005). Overall, psychiatrists were more likely than their junior colleagues to correctly assess risk and management options.

CONCLUSIONS:

Although standard and BPD-specific methods are well aligned for assessing self harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD.

KEYWORDS:

Borderline Personality Disorder; physician education; risk assessment; self-harm; self-injury

PMID:
28488884
DOI:
10.1177/1039856217707390

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