Exploring Suicidal Ideation in Adolescents with Borderline Personality Disorder

Mental Health Nursing Theory Four
Evidence Based Practice and Complex Mental Health Needs
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This qualitative study has aimed to explore adolescents with Borderline Personality
Disorder (BPD). BPD is a complex psychiatric condition and individuals with this condition
have an unstable and insecure self-image, a dangerous tendency to self-harm, suicidal
behaviours, transient and dissociative symptoms that are intermittent and persistent
(Linehan, 2018). However, the research shows 8 - 10% of those diagnosed with BPD
commit suicide (Anderson, 2016). The study aimed is to investigate the relationship
between adolescent patients with BPD and the characteristics of suicidal ideation, for
example; frequency, period and starting age. This topic is examined using both clinician-
rated and adolescent-rated suicidal ideation, attempts to evaluate, assess qualitative and
numerical BPD. The results of this research indicate that earlier in their lives, adolescents
with BPD experience suicidal ideation, and more frequently than clinical controls. Notably,
the groups ranged not in terms of the adolescent-rated suicidal ideation magnitude or
length, intent to commit suicide.
The authors describe the case reports of a 19 – year - old girl who after a traumatic
childhood, began to deliberately self-harm often by cutting her forearms (Rashid and
Gosai, 2011). The authors mirrored a storey on the National Centre for Biotechnology
Information (NCBI). The authors had the opportunity to visit psychiatric hospital, recovery
college, day centres and other locations where groups of mental health patients meet for
day – to - day activities. Authors work closely with different patients to build trust and the
therapeutic relationship. Therefore, some of them shared their experience on how self-
harm affected their lives with deliberately negative thoughts and how meeting with other
peers with similar stories helps to build their confidence. Accordingly, the authors chose to
do more research.
They examined on what more can be of advantage rather than meeting for
activities, as the authors say that the psychosocial or pharmacological treatment for self-
harm (SH) in adolescents (up to 18 years of age) is not broadly utilised in practice, and the
BPD awareness of mindfulness must be used to classify all randomised controlled trials
(RCTs) of CBT. Moreover, the authors have been inspired as a future mental health
nursing to the attendant to advance non-medical intervention, and that drives the craving
of needing to build knowledge. Hence, the longing was to explore the subject on the
adequacy of care as therapeutic interventions for individuals who are self-harm or suicide
attempts. Venta and colleagues (2012) state that suicide ideation or attempts self-harm is
a significant health issue among young people where recent research has emerged that
borderline personality disorder (BPD) may pose a much greater risk to individuals alone
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without having depression. However, a few studies have examined the association
between BPD and attempted suicide among younger’s and little is known about the
attribute of suicidal ideation BPD at this time. However, for individuals with distressing self-
harm, there seems to be a prior lack of study or analysis formerly. While conducting the
literature Spirito (2002) found that facilitated therapy groups for continuing distressing self-
harm with healthy study outcomes and there is growing evidence recently. The problems
faced by the author were to find a research paper comparable to the choice of question.
The question formulated by the author was the intervention for young people, who self-
harm (SH), suicide attempt (SA) or suicidal ideation (SI). The subject closing the question
framed for a quantitative research paper was (Cognitive behavioural therapy for suicide
prevention in youth admitted to hospital following an episode of self-harm: A pilot
randomized controlled trial) and for the qualitative paper was (Psychosocial interventions
for self-harm, suicidal ideation and suicide attempt in children and young people).
Therefore, this qualitative study paper was also specifically designed for adolescents who
psychological distress and is considered one of the criteria for suicidal death that the
author reflects on.
However, the qualitative research on Short Cognitive Behavioural Therapy (BCBT)
for suicide prevention versus an attentional control group (minimally-directive supportive
psychotherapy) for adolescents hospitalised after SH examined (aged 16–26). Both
treatments involved ten acute 15-week cycles and three booster sessions taking effect at
three-month periods afterwards. The primary effectiveness result was more than 70%
retention at the endpoint of the analysis.
Though, it has been CBT's pros and cons. Cognitive Behavioural Therapy focused
on the biopsychosocial perspective of emotional reaction, such as feelings and behaviours
arising from patient thoughts, according to the Nationwide Association of Cognitive-
Behavioural Therapists. CBT, unlike its psychodynamic counterparts, is a goal-oriented
and problem-focused treatment. As a method, Cognitive Behavioural Therapy emphasises
on the present, rather than on a comprehensive examination of the developmental history.
A pilot randomised controlled study suggested that Trauma-Focused Cognitive-
Behavioural Treatment (TF-CBT) has numerous benefits for youth, such as devastating
occurrence CBT, which aims to reduce both emotional and behavioural symptoms
stemming from traumatic stress.
Research has found that Cognitive Behavioural Therapy can be as successful as
medicine in the treatment of self-harm and other psychological issues. CBT usually
completed over a brief period like other talking therapy. However, to benefit from Cognitive
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Behavioural Therapy, individuals need to dedicate themselves to the process. However,
they maintain the quality of Cognitive Behavioural Therapy; it may not be suitable for
people with more complex mental health needs or physical disabilities. As CBT can
include expressing their emotions and negative feelings, individuals may perceive initial
times where they feel more nervous or emotionally insecure. Other challenges might be
other terms that had been used primarily in quantitative paper, such as schizophrenia,
cognitive behavioural therapy for psychosis (CBTp), which contradicted the question
formulated. While constructing a research question, method of 'Population, Exposure and
Outcome (PEO) or Population Intervention, Comparison and Outcome (PICO)' is the
standard framework for planning the clinical question, particularly patients relating to the
effectiveness of (intervention) therapies and for identifying keywords of the search for
disorder emerging from the concern of a patient or population. Therefore, mainly used in
medical fields to support medical practitioners improve and recognise main terms that
make it simpler to look for evidence. (Stern, Jordan, and McArthur, 2014). These models
often concentrate on how to analyse the literature database and not just on science .
(Oermann, and Hays, 2015). The author used PEO framework to evaluate whether a pre-
existing disorder or exposure is likely to occur in or in progress from a specific diagnosis.
See Table 1, for main terms and the corresponding synonyms and then using the relevant
mental models of Boolean concepts (Goodwin and Johnson-Laird, 2011, p.34)
Table 1. Research theme utilising the PEO framework:
P Population Adolescents / young adults
experiencing self-harm (SH)
E Exposure Borderline Personality Disorder
(BPD) or psychological distress
or emotion dysregulation
O Outcome Preliminary effectiveness
success of Brief Cognitive
Behavioural Therapy (BCBT) for
suicide prevention or Dialectical
Behavioural Therapy (DBT)
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The PEO designed inclusion and exclusion criteria to support the accuracy of the
questionnaire collected in practice, for example; the inclusion criteria set limitations for the
researcher to specifying what theoretically included, entirely irrelevant to the subject or
component of the participation qualifications (Stern, Jordan and McArthur, 2014). Also,
inclusion models help minimise the specific inclinations of the reviewer, ensuring what
reports are selected independently from analysts relevant, bound into a biased framework
or align emerging outcomes on the predefined, rational criteria (Aromataris and Pearson,
2014).
The inclusion criteria typically comprise angles such as the method of analysis, type
of information (qualitative or quantitative), the phenomenon under review, year of research
or group of participants (Stern and colleagues, 2014). While exclusion serves as a tactic to
avoid much less optimised results and seeks to eliminate prejudice, for example; excluding
papers dependent on language bias may introduce into the survey, restricting the
adaptability of the outcomes (Geerligs et al., p36, 2018).
Nonetheless, this might be strenuous to avoid as translating articles is frequently
unrealistic. Whatever the inclusion criteria, they should be legitimate and adequately
documented in a protocol depending on the prerequisites of the sample. Kallio et al. (2016)
point out that inclusion and exclusion requirements are often crucial to their reflection on
the qualitative data of outcomes. The researchers establish criteria to decide whether a
person is eligible as a member of the population or excluded. Table 2 outlines the inclusion
criteria used by the hypothetical question and indicates the methodological forms of
justification used in a quantitative systematic review protocol.
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Table 2. Criteria for inclusion and exclusion:
INCLUSION EXCLUSION
Primary research study Secondary research study
By peer reviewed /academic journal are
used in the study for gathering data on
the topic.
Unclassified theoretical or non-academic
research on BPD awareness of mindfulness
is excluded.
2020 onwards Pre - 2020
Groups - Adolescents/Youth/Young
Adults
Adults / included children under the age of 12
years
Journals Articles - Journal of Affective
Disorders
Textbooks
Brief Cognitive Behavioral Therapy
(BCBT), Dialectial Behavioral Therapy
(DBT), or Minimally-Directive Supportive
Psychotherapy (Control)
Antidepressants, Antipsychotics or Mood
Stabilisers (including antiepileptics)
medications
A pilot randomized controlled trial (RCT) Meta-Analyses (MAs) to combine the
outcomes of multiple scientific studies is not
included.
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