[Risk factors of near-fatal deliberate self-harm behavior in self-cutting patients: a three-year follow-up study at a psychiatric clinic].Seishin Shinkeigaku Zasshi 2008; 110(6):475-87SS
Non-fatal self-injurious behavior such as cutting oneself is often performed without suicidal intent to cope with emotional distress, although it is well-known to have a close association with future suicidal behavior. However, it is unclear what kinds of clinical features are presented by such self-injuring patients with a higher suicidal tendency. In the present study, we conducted a three-year follow-up study of female self-injuring patients to examine the risk factors of "near-fatal" deliberate self-harm behavior (DSH). The subjects were 81 female outpatients who had cut themselves at least once, and who had consulted a psychiatric clinic from June 2004 to July 2004. Initial assessments included traumatic life events, clinical features of self-cutting, histories of self-poisoning, alcohol abuse (Alcohol Use Disorders Identification Test: AUDIT), impulsivity (Barratt Impulsiveness Scale, 11th version: BIS-11), symptoms of bulimia nervosa (Bulimia Investigatory Test, Edinburgh: BITE), dissociation (Adolescent Dissociative Experience Scale: ADES), Global Assessment of Functioning (GAF) score, and axis I diagnosis of DSM-IV (Diagnostic and Statistical Manual, 4th version). After three years, we investigated whether the subjects had committed fatal DSH during the follow-up term. We obtained information on fatal DSH from 67 subjects during the follow-up term. Fifteen of the 67 (22.4%) had committed near-fatal DSH at least once, and one subject committed suicide by fatal DSH. Monovariate analysis revealed that in the initial assessment, the subjects with near-fatal DSH episodes more frequently reported a history of victimization by rape in adulthood and a history of OTC (over-the-counter) drug self-poisoning, and had higher scores on the BITE and AUDIT than those without near-fatal DSH episodes. Further, multivariate analysis demonstrated that only the BITE score was a significant factor in predicting future near-fatal DSH. In conclusion, symptoms of bulimia nervosa may have important clinical implications. The BITE may be a useful tool to assess future suicidal behavior in female self-cutting patients.