Predicting suicide attempts in NSSI pateints: the role of suicidal motivations as an expression of borderline and narcissistic functioning.

Abstract Background: Although nosographically distinguished from sucidality, NSSI is one of the strongest predictor of sucidal conducts. This relationship has been interpreted as caused by a common state of mind characterized by a negative attitude toward life underlying both the spyral of NSSI and suicide attempts. To date, no specific hypothesis has been made as to the features that distinguish the states of mind of sucidal NSSI from only-ideators NSSI patients. In this study we propose that the peculiar motivations sustaining the sucidal process and their possible relations with single pathological personality functioning may help predict sucidal conducts in NSSI patients. Methods: A clinical sample of 88 adolescents diagnosed with NSSI were adminstered with the Columbia Suicide Severity Rating Scale (CSSRS), the Motivational Interview for Suicidality in Adolescence (MIS- A) and the SCID 5 for Personality Disorders. ANOVA and correlations were performed to analyze the associations between CSRSS variables and motivations as well as personality disorders. Results: All NSSI adolescents presented significant associations with suicidal ideation and conducts. The potential lethality and intensity of sucidal ideation was in particular associated with the increase in frequency of NSSI and lethality of sucidal attempts. Only the BPD and HPD were significantly associated with sucidal conducts. Motivations related to denial of the consequence of sucide and attempts at controlling and maniputating the relationships predicted suicidal conducts. Cliniciansinvolved in the management of suicidal risk in adolescence should consider that narcissistic features may play a key role in precipitating the suicidal crisis in BPD patients diagnosed with NSSI.