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Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population

Published online by Cambridge University Press:  16 April 2020

E. Gunilla Stålenheim*
Affiliation:
Dept. of Neuroscience, Psychiatry, University Hospital, SE 75185Uppsala, Sweden
*
*Correspondence and reprints.
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Summary

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects.

Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.

Type
Original Articles
Copyright
Copyright © European Psychiatric Association 2001

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References

Alm, Paf Klinteberg, BHumble, KLeppert, JSorensen, SThorell, L-H. et al. Psychopathy, platelet MAO activity and criminality among former juvenile delinquents. Acta Psychiatr Scand 1996; 94: 105–11.CrossRefGoogle ScholarPubMed
APA. Diagnostic and statistical manual of mental disorders. 3rd ed., rev. Washington DC: American Psychiatric Association; 1987.Google Scholar
Apter, AKotler, MSevy, SPlutchik, RBrown, SLFoster, H. et al. Correlates of risk of suicide in violent and nonviolent psychiatric patients. Am J Psychiatry 1991; 148: 883–7.Google ScholarPubMed
Asberg, M.Neurotransmitters and suicidal behavior. The evidence from cerebrospinal fluid studies. Ann N Y Acad Sci 1997; 836: 158–81.CrossRefGoogle ScholarPubMed
Asberg, MTraskman, LThorén, P.5-HIAA in the cerebrospinal fluid: a biochemical suicide predictor?. Arch Gen Psychiatry 1976; 33: 1193–7.CrossRefGoogle ScholarPubMed
Asberg, MSchalling, DTraskman-Bendz, LWagner, A.Psychobiology of suicide, impulsivity, and related phenomena. Psychopharmacol 1987; 65: 655–68.Google Scholar
Brodsky, BSMalone, KMEllis, SPDulit, RAMann, JJ.Characteristics of borderline personality disorder associated with suicidal behavior. Am J Psychiatry 1997; 154: 1715–9.CrossRefGoogle ScholarPubMed
Buchsbaum, MSCoursey, RDMurphy, DL.The biochemical high-risk paradigm: behavioural and familial correlates of low platelet monoamine oxidase activity. Science 1976; 194: 339–41.CrossRefGoogle ScholarPubMed
Buss, AH.The psychology of aggression. New York: Wiley; 1961.CrossRefGoogle Scholar
Coccaro, EF.Central serotonin and impulsive aggression. Br J Psychiatry 1989; 155: 5262.CrossRefGoogle Scholar
Engstrom, GAlsén, MGustavsson, PSchalling, DTraskman-Bendz, L.Classification of suicide attempters by cluster analysis: a study of the temperamental heterogeneity in suicidal patients. Pers Individ Differ 1996; 21: 687–95.CrossRefGoogle Scholar
Engstrom, GAlling, CBlennow, KRegnell, GTraskman-Bendz, L.Reduced cerebrospinal HVA concentrations and HVA/5-HIAA ratios in suicide attempters. Monoamine metabolites in 120 suicide attempters and 47 controls. Eur Neuropsychopharmacol 1999; 9: 399405.CrossRefGoogle ScholarPubMed
Engstrom, GPersson, BLevander, S.Temperament traits in male suicide attempters and violent offenders. Eur Psychiatry 1999; 14: 278–83.CrossRefGoogle ScholarPubMed
Freud, S.Trauer und Melancholie. Freud, ABibring, EHoffer, W, Eds.; Siegmund Freud – Gesammelte Werke. Fischer: Frankfurt am Main; 1973. 428446.Google Scholar
Gustavsson, JPPedersen, NLAsberg, MSchalling, D.Exploration into the sources of individual differences in aggression-, hostility- and anger-related (AHA) personality traits. Pers Individ Differ 1996; 21: 1067–71.CrossRefGoogle Scholar
Hallman, JOreland, LEdman, GSchalling, D.Thrombocyte amine oxidase activity and personality traits in women with severe premenstrual syndrome. Acta Psychiatr Scand 1987; 76: 225–34.CrossRefGoogle Scholar
Hare, RD.The Hare Psychopathy Checklist-Revised. Toronto, Ontario: Multi-Health Systems, Canada; 1991.Google Scholar
Haycock, J.Double jeopardy: suicide rates in forensic hospitals. Suicide Life Threat Behav 1993; 23: 130–8.Google ScholarPubMed
Kjoller, MHelweg-Larsen, M.Suicidal ideation and suicide attempts among adult Danes. Scand J Public Health 2000; 28: 5461.CrossRefGoogle ScholarPubMed
Kullgren, GTengstrom, AGrann, M.Suicide among personality-disordered offenders: a follow-up study of 1943 male criminal offenders. Soc Psychiatry Psychiatr Epidemiol 33(Suppl) 1 1998 102–6.CrossRefGoogle ScholarPubMed
Lidberg, LWiklund, NJakobsson, SW.Mortality among criminals with suspected mental disturbance. Scand J Soc M 1989; 17: 5965.CrossRefGoogle ScholarPubMed
Linnoila, MVirkkunen, MScheinin, MNuutila, ARimon, RGoodwin, FK.Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior. Life Sci 1983; 33: 2609–14.CrossRefGoogle ScholarPubMed
Mann, JJWaternaux, CHaas, GLMalone, KM.Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999; 156: 181–9.Google Scholar
Nordstrom, PAsberg, MAberg-Wistedt, ANordin, C.Attempted suicide predicts suicide risk in mood disorders. Acta Psychiatr Scand 1995; 92: 345–50.CrossRefGoogle ScholarPubMed
Nordstrom, PSamuelsson, MAsberg, M.Survival analysis of suicide risk after attempted suicide. Acta Psychiatr Scand 1995; 91: 336–40.CrossRefGoogle ScholarPubMed
Nordstrom, PGustavsson, PEdman, GAsberg, M.Temperamental vulnerability and suicide risk after attempted suicide. Suicide Life Threat Behav 1996; 26: 380–94.Google ScholarPubMed
Nordstrom, P.Survival analytic studies of suicide risk. Stockholm: Karolinska Institute; 1995.Google Scholar
Oquendo, MAMann, JJ.The biology of impulsivity and suicidality. Psychiatr Clin N Am 2000; 23: 1125.CrossRefGoogle ScholarPubMed
Oreland, LHallman, J.The correlation between platelet MAO activity and personality – a short review of findings and a discussion on possible mechanisms. In: Yu, PUTipton, KFBoulton, AA, Eds.; Progress in brain research. Vol. 106. Current neurochemical and pharmacological aspects of biogenic amines: their function, oxidative deamination and inhibition. New York: Elsevier; 1995. 7784.CrossRefGoogle Scholar
Plutchik, Rvan Praag, H.The measurement of suicidality, aggressivity and impulsivity. Prog Psychopharmacol Biolo Psychiatry 1989; 13: 523–34.Google ScholarPubMed
Plutchik, Rvan Praag, HMConte, HR.Correlates of suicide and violence risk: III. A two-stage model of countervailing forces. Psychiatry Res 1989; 28: 215–25.CrossRefGoogle ScholarPubMed
Pritchard, CCox, MDawson, A.Suicide and ‘violent' death in a six-year cohort of male probationers compared with pattern of mortality in the general population: evidence of accumulative socio-psychiatric vulnerability. J R Soc Health 1997; 117: 180–5.CrossRefGoogle Scholar
Roy, ALinnoila, M.Suicidal behavior, impulsiveness and serotonin. Acta Psychiatr Scand 1988; 78: 529–35.CrossRefGoogle ScholarPubMed
Schalling, D.Psychopathy-related personality variables and the psychophysiology of Socialization. Hare, RDSchalling, D, Ed.; Psychopathic behaviour: approaches to research. New York: Wiley; 1978. 85106.Google Scholar
Schalling, DAsberg, MEdman, GOreland, L.Markers for vulnerability to psychopathology: temperament traits associated with platelet MAO activity. Acta Psychiatr Scand 1987; 76: 172–82.CrossRefGoogle ScholarPubMed
Schalling, DEdman, G.The Karolinska Scales of Personality (KSP). An inventory for assessing temperament dimensions associated with vulnerability for psychosocial deviance. Manual. Stencil. Stockholm: The Department of Psychiatry, The Karolinska Institute; 1993.Google Scholar
Soloff, PHLis, JAKelly, TCornelius, JUlrich, R.Risk factors for suicidal behavior in borderline personality disorder. Am J Psychiatry 1994; 151: 1316–23.Google ScholarPubMed
Spitzer, RLWilliams, JBWGibbon, M.Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Biometrics Research. New York: New York State Psychiatric Institute; 1987.Google Scholar
Spitzer, RLWilliams, JBWGibbon, MFirst, MB.The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 1992; 49: 624–9.CrossRefGoogle ScholarPubMed
Stålenheim, EGvon Knorring, L.Psychopathy and Axis I and Axis II disorders in a forensic psychiatric population in Sweden. Acta Psychiatr Scand 1996; 94: 217–23.CrossRefGoogle Scholar
Stålenheim, EG.Karolinska Scales of personality in a forensic psychiatric population: stability over time and between situations. Nord J Psychiatry 1997; 51: 379–84.CrossRefGoogle Scholar
Stålenheim, EGvon Knorring, LOreland, L.Platelet monoamine oxidase activity as a biological marker in a Swedish psychiatric population. Psychiatry Res 1997; 69: 7987.CrossRefGoogle Scholar
Stålenheim, EGvon Knorring, L.Personality traits and psychopathy in a forensic psychiatric population. Eur J Psychiatry 1998; 12: 8394.Google Scholar
Tripodianakis, JMarkianos, MSarantidis, DIstikoglou, CAndara, ABistolai, E.Platelet monoamine oxidase in attempted suicide. Relations to sex, psychiatric diagnosis, mode of attempt, and previous attempts. Eur J Psychiatry 1995; 10: 4448.CrossRefGoogle ScholarPubMed
Tripodianakis, JMarkianos, MSarantidis, DLeotsakou, C.Neurochemical variables in subjects with adjustment disorder after suicide attempts. Eur Psychiatry 2000; 15: 190–5.CrossRefGoogle ScholarPubMed
Weissman, MMBland, RCCanino, GJGreenwald, SHwu, HGJoyce, PR. et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol M 1999; 29: 917.CrossRefGoogle ScholarPubMed
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