Pathways toward suicide in adolescent patients with emerging borderline and narcissistic personality syndromes: A PDM-2-oriented empirical investigation.

Introduction: Adolescent suicide is the fourth leading cause of death in the youth population worldwide. The Psychodynamic Diagnostic ManualSecond Edition (PDM-2) devoted a specific attention to the suicidality in adolescence. According to its diagnostic framework,the suicidal motivation is strongly associated with the patient’s subjective experience, and should be understood only within the context of the adolescent’s psychopathological functioning. The present study aimed at exploring the suicidal process by connecting the specific emergence of suicidal motivations and strategy for affective regulation characterizing particular emerging personality syndromes in two single cases. Method: Louis and Gael, two 17-year-old adolescents, were assessed using the Psychodynamic Chart-Adolescent of the PDM-2, and the Motivational Interview for Suicidality in Adolescence. Results: Diagnostic assessment showed the presence of several impairments in various mental capacities and a borderline personality organization. Notably, Louis and Gael presented the emerging narcissistic and borderline personality syndromes respectively. Each patient also reported prevailing suicidal motivations that are coherent with the regulative strategies typically employed in their pathological organization of personality. Notably, the specific declinations of the suicidal motivations for interpersonal influence as assessed through the MIS demonstrated the function played by suicidal ideation and conducts within the relational strategy typical of emerging personality syndromes in adolescence. Conclusions: The case discussion suggests the need to understand and monitor the prevailing suicidal motivations in adolescents considering the unique characteristics of their personality functioning. These findingssupport the importance for providing accurate assessment to plan individualized treatments in youth populations at high suicide risk.