Extreme Challenges - Psychopathology & Treatment Experiences Among Severly Selfharming Inpatients in Norway

Plain-language summary

Patients who self-harm are a heterogeneous population. Outpatient treatments structured for borderline personality disorder are often recommended and hospitalization kept to a minimum. However, few studies have focused on the most severe, complex conditions with extreme suicide risk. A recent national investigation from Norway (2017) demonstrated a far larger cohort of extensively hospitalized inpatients with extreme self-harming behaviors than was expected (N=427) - identified in all health regions. Reported challenges were high-risk situations, severe medical sequelae, difficult collaborations across services, and uncertainty about psychiatric diagnoses. Severe, often bizarre, self-harm is thus a major challenge for both patients and health services. In hospitals, safety measures can involve restrictions and involuntary regimes. As research on this target population is sparse, the current project seeks further understanding of complex conditions - psychopathology, treatment experiences and service collaboration. The project is a national, multi-center cooperation including patients in psychiatric hospitals in all health regions. It is cross sectional. Data is based on diagnostic interviews, patients' self-reported symptoms and both patients and service providers treatment experiences. The inclusion period for inpatients (N=300) and a comparison sample of outpatients (N=300) is one year. The target group is inpatients with extreme hospitalization and severe self-mutilation. A comparison group is patients with personality pathology attending outpatient treatments. Recruitment is across health regions. Aim 1: Investigate psychopathology of patients in the target population and compare to a clinical sample admitted to outpatient treatment Aim 2: Investigate personality functioning in the target population and compare to a clinical sample admitted to outpatient treatment Aim 3: a) Investigate health service use in the target population and compare to a clinical sample admitted to outpatient treatment. b) Investigate treatment experiences and health service collaborations in the target population. The project will provide rational for future preventive treatment interventions

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