Behind the scars: adolescents with non-suicidal self-injury disorder show profound personality pathology

Abstract Background Non-suicidal self-injury is a significant clinical concern in adolescent psychiatry and frequently co-occurs with a range of psychiatric disorders, including mood disorders, eating disorders, substance use disorders, and personality disorders. With the inclusion of non-suicidal self-injury disorder (NSSID) as a distinct diagnosis in the DSM-5, growing attention has been directed toward its relationship with established psychopathological constructs. This study investigates the association between personality pathology and NSSID in adolescent psychiatric in-patients. In particular, we analyzed the prevalence of personality disorders and impairments of personality functioning (identity, self-direction, empathy, intimacy) according to the AMPD of the DSM-5. Methods Our sample consisted of 439 inpatients (mean age = 15.2 years, SD = 1.37; 87 males, 352 females). We used the Structured Clinical Interview for Personality Disorders, the Levels of Personality Functioning questionnaire and the Semi-Structured Interview for Personality Functioning to assess personality pathology, and a structured clinical interview to evaluate the DSM-5 criteria for NSSID. Results Our results show that adolescents with an NSSID show more severe impairments in all areas of personality functioning and are significantly more likely to be diagnosed with a personality disorder (54%) than adolescents with no NSSID (27%). Conclusion These results highlight the critical role of personality pathology in adolescents with NSSID and underscore the importance of targeted diagnostic and treatment approaches. Disorder-specific interventions for adolescent personality disorders may also be effective for those with severe NSSI.