اختلال شخصیت مرزی در مجرمان مرد و زن که به تازگی به زندان محکوم شده اند

Abstract Background The objective of the study was to estimate the rate of borderline personality disorder (BPD) in male and female offenders newly committed to the Iowa Department of Corrections. We also compared clinical and demographic characteristics of offenders with and without BPD. Methods A random sample of 220 offenders entering Iowa's prison system were evaluated by using a version of the Mini International Neuropsychiatric Interview, the BPD module of the Structured Interview for DSM-IV Personality Disorders, the Medical Outcome Survey Short Form-36 Health Survey, and the Level of Service Inventory-Revised. Results Borderline personality disorder was present in 65 (29.5%) subjects, although 93.2% had at least one Diagnostic and Statistical Manual of Mental Disorders-IV BPD trait. The percentage of women meeting criteria for BPD was more than twice that for men. Subjects with BPD were more likely than those without to be married, employed, and to have a high suicide risk score. Offenders with BPD were more likely than others to report prior mental health treatment, and to have reported high levels of interference from their mental disorder. Offenders with BPD had worse quality of life than offenders without BPD as assessed with the Medical Outcome Survey Short Form 36 Health Survey, and higher rates of mood, anxiety, psychotic, and eating disorders; antisocial personality disorder; and attention deficit hyperactivity disorder. Borderline personality disorder was also associated with higher Level of Service Inventory-Revised total scores, which indicates their having a greater risk for recidivism than nonborderline offenders. These relationships were observed after adjusting for sex, age, race/ethnicity, and presence of antisocial personality disorder. Conclusion Borderline personality disorder is relatively common among both male and female offenders in prison, and is associated with substantial psychologic stress and impaired quality of life. Early recognition and treatment of BPD in prisons may be warranted.

1. Introduction Borderline personality disorder (BPD) is increasingly being recognized as a major public health problem. Research in clinical settings shows that BPD affects as many as 15% of psychiatric outpatients, and community surveys suggest that it has a prevalence of between 1% and 2% of the general population in the United States [1], [2] and [3]. Research has shown that BPD substantially impairs quality of life. In addition to being associated with comorbid psychiatric disorders, psychosocial impairment, and suicide [1], [4], [5] and [6], BPD has also been associated with disrupted relationships and excessive health care use [1] and [7]. Despite these concerns documented in psychiatric and community settings, little is known about BPD in correctional settings. In fact, work by several independent research groups suggests that the prevalence of BPD in these settings is even higher than in clinical psychiatric settings [8], [9], [10], [11], [12] and [13]. Further, in none of these studies were direct comparisons made between borderline and nonborderline offenders, nor was an effort made to assess the effect of BPD on quality of life. An important implication to be drawn from this work is that offenders with BPD have special treatment needs that correctional systems may not be currently addressing. We recently had an opportunity to assess the prevalence of BPD and other psychiatric disorders in a group of offenders newly committed to the Iowa Department of Corrections (IDOC). This study represents one of the first opportunities to directly assess BPD in randomly selected men and women in this setting. Subjects were assessed with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria, and with standardized instruments of known reliability. Our expectation was that we would find BPD in both men and women, and that offenders with BPD would have poorer quality of life ratings, higher rates of psychiatric comorbidity, and overall worse functioning than offenders without BPD.

Conclusions Although the current study was not developed as an epidemiologic study and involved only newly committed offenders who had no special security or medical designation, the findings suggest that BPD and its many symptoms occur frequently in a prison setting. This finding is important because BPD has been mostly ignored in previous corrections-based research. As in clinical samples, this study shows that the presence of BPD is associated with poorer quality of life, is more likely to be found in women, and is often associated with prior psychiatric treatment. The fact that it is frequent in male offenders is surprising, yet many of the common symptoms of BPD undoubtedly contribute to criminal behavior, including impulsivity and anger dyscontrol. Another important finding is the positive association between the BPD diagnosis and presence of psychiatric comorbidity and psychosocial dysfunction. That is, offenders with BPD are more likely to report evidence suggestive of psychologic distress and impairment in functioning than offenders without BPD. A critical implication of these findings is that correctional systems need to improve screening for BPD. In particular, the diagnosis should no longer be overlooked in male offenders. Offenders with BPD are likely to require more intensive mental health services in prison. Early identification and treatment of BPD including medication [31] and psychotherapy [32], [33], [34] and [35] may help to minimize its impact. In fact, several group psychotherapies have been developed specifically for the treatment of BPD and appear to be effective, including dialectical behavior therapy [32], schema-focused therapy [33], the mentalization program of Bateman and Fonagy [34], and Systems Training for Emotional Predictability and Problem Solving [35]. The developers of dialectical behavior therapy and Systems Training for Emotional Predictability and Problem Solving have adapted their models to suit correctional settings [36] and [37]. A simple questionnaire developed by our group could assist in identifying persons with BPD [38].