Lori A. Sansone

The self-harm inventory (SHI): Development of a scale for identifying self-destructive behaviors and borderline personality disorder

Intentional self-harm behavior is an important clinical phenomenon that appears highly related to borderline personality disorder (BPD). Self-harm behavior in the context of borderline personality probably exists along a continuum from graphic, self-harm behavior to milder forms of self-sabotaging behavior that might be viewed as self-defeating Relatively little attention has been paid to developing a self-report measure of intentional self-harm, particularly as a screening device for detecting BPD. In Study 1, an initial list of self-harm behaviors encountered in clinical practice was narrowed to those behaviors related to BPD in a sample comprised of adults from both a mental health and non-mental health setting. All participants (N = 221) underwent a semistructured diagnostic interview for BPD. Using a cut-off score of 5 on the resulting 22-item Self-Harm Inventory (SHI), 83.7% of research participants were correctly classified as having BPD or not. In Study 2, women (N = 285) sampled from an outpatient medical setting completed the SHI and a widely used self-report measure of BPD. The SHI cut-off score resulted in correct classification of 87.9% of the individuals. In Study 3, using a sample of adults involuntarily hospitalized for psychiatric reasons (N = 32), the SHI performed at least as well as another self-report measure of BPD in diagnosing participants (the final diagnosis was based on a semistructured interview). The results are discussed with regard to potential advantages and utility of the SHI and need for further validation.

The Prevalence of Personality Disorders Among Those with Eating Disorders

The genuine prevalence of personality disorders among those with eating disorders is unknown. However, in this paper, we summarize the existing data, with careful acknowledgment of our approach to interpretation as well as the limitations of previous studies. Our findings indicate that obsessive-compulsive personality is the most common personality disorder in restricting-type anorexia nervosa, while borderline personality is the most common personality disorder in binge-eating/purging type anorexia nervosa. Borderline personality is the most common personality disorder in bulimia nervosa, as well. In those with binge eating disorder, obsessive-compulsive personality is the most common personality disorder although, compared with the preceding eating disorder diagnoses, there are broader clusters of personality disorders represented in this group. We discuss the implications of these findings.

Health Care Utilization and History of Trauma among Women in a Primary Care Setting

Participants were 150 women seen consecutively by a female family physician in an HMO setting for nonemergent medical care. Each participant completed a questionnaire that explored three areas of trauma. Twelve months after the administration of the questionnaire, medical records of each participant were reviewed for several measures of health care utilization (i.e., number of telephone contacts, physician visits, ongoing prescriptions, acute prescriptions, specialist referrals). Age, education, and current marital status were unrelated to medical utilization. Participants’ acknowledged history of physical and emotional abuse significantly correlated with most measures of health care utilization, whereas sexual abuse generally did not. The implications of these findings are discussed.

Bodily Self-Harm and Its Relationship to Childhood Abuse Among Women in a Primary Care Setting

Past research has demonstrated a relationship between childhood abuse and subsequent self-injurious behavior. However, this research typically has taken place in mental health settings, focused on childhood sexual or physical abuse, and has explored a limited number of self-injury variables (most commonly suicide attempts). Among 147 women in a primary care setting, the authors explored the relationship between five forms of childhood abuse or trauma and three types of bodily self-injury. In univariate analyses, all forms of abuse except physical neglect were related to an increased likelihood of bodily self-harm. In a logistic regression analysis, sexual abuse, physical abuse, and witnessing violence were uniquely related to an increased likelihood of bodily self-injury. The results suggest that the direct experience or observation of body violation may developmentally precede subsequent bodily self-injury in some individuals.

Adult somatic preoccupation and its relationship to childhood trauma.

Somatic preoccupation has been associated with a variety of comorbid psychiatric conditions including childhood trauma, personality disorder, and depression. The current study was undertaken to simultaneously explore the inter-relationship of these psychiatric variables as conceptualized in a path model. Participants (N = 120), both men and women, seen for nonemergent health care in a resident-staffed internal medicine clinic, were given questionnaires exploring the presence of childhood trauma, borderline personality symptomatology, current depression, worry, and somatic preoccupation. With one exception, all simple correlation coefficients among study variables were relatively substantial. By sequencing variables into an a priori model and using a path analytic approach, several indirect and direct relationships among variables were evident. Most important, childhood trauma exhibited a direct effect on somatic preoccupation as well as indirect effects through borderline personality disturbance and current depression. These data suggest that childhood trauma may be a precursor for somatic preoccupation during adulthood.

The prevalence of borderline personality disorder among individuals with obesity A critical review of the literature

Through a MEDLINE and PsycLIT database search, all US studies relating to the prevalence of borderline personality disorder (BPD) among obese individuals were reviewed. The highest rates of BPD among these individuals were found in samples recruited from psychologically oriented settings (i.e., eating disorders program, mental health setting). Lowest rates were found among those seeking weight loss in non-psychological programs or those in primary care settings. Among those studies examining individuals with binge-eating disorder (BED), all indicated a higher-than-community prevalence of BPD. These data suggest that the prevalence of BPD appears increased among those obese individuals seeking psychological care or who have BED.

Childhood trauma, borderline personality, and eating disorders: a developmental cascade

In this article, we discuss the nature and role of trauma in relationship to borderline personality disorder and eating disorders. As is clinically evident, trauma can result in a variety of psychological consequences. These consequences include both Axis I and II disorders. Among the Axis II disorders, trauma appears to heighten the risk for the development of borderline, antisocial, avoidant, paranoid, and even schizotypal personality disorders. Likewise, trauma may heighten the risk for developing an eating disorder. There appear to be complex inter-relationships among trauma, borderline personality disorder, and eating disorders. In this article, we attempt to summarize these inter-relationships.

The comorbidity, relationship and treatment implications of borderline personality and obesity.

Studies indicate that a significant minority of obese individuals in clinical studies meet criteria for borderline personality. Although the relationship between obesity and borderline personality remains unexplained, the following article discusses the implications of treating obesity among individuals with this personality disorder. Longitudinal intervention, normalizing or regulating eating patterns, and reframing weight plateaus are emphasized.

Personality disorders as risk factors for eating disorders: clinical implications.

Personality disorders are oftentimes comorbid with eating disorders. According to a review of the literature, obsessive-compulsive personality disorder is the most common Axis II disorder in eating-disordered individuals with restrictive eating behavior, whereas borderline personality disorder is the most common Axis II disorder in those with impulsive eating pathology. Because personality disorders developmentally precede eating disorders and the characteristics of the personality disorder oftentimes mirror the style of eating pathology (eg, highly controlled personality styles and highly controlled eating patterns; impulsive personality styles and impulsive eating pathology), it is reasonable to assume that personality disorders influence subsequent eating pathology. Therefore, it is likely that personality disorders function, to some degree, as risk factors for the development of specific types of eating disorders. The authors discuss the clinical implications of these relationships.

Sertraline-Induced Hyperglycemia: Case Report

Empirical studies with humans suggest that selective serotonin reuptake inhibitors (SSRIs) may, through increases in serotonergic activity [1], increase insulin secretion [2], increase insulin sensitivity [3], and lower serum glucose levels [1]. Indeed, the potentially beneficial effects of SSRI treatment in diabetics are documented. However, we describe the case of a female, with diet-controlled, type 2 diabetes, whose glucose levels increased with exposure to sertraline.