1
|
Smothers M, Hill C, Lawrence D, Bagshaw R, Watt A. Predictors of recovery in a medium secure service: Influence of the Welsh Government's Mental Health (2010) Measure. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101935. [PMID: 37717488 DOI: 10.1016/j.ijlp.2023.101935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Research to date has failed to examine the effectiveness of MSUs in facilitating recovery, or the influence that mental health policy may have on this process. Examining predictors of short-term clinical outcomes during inpatient admission and the effects of policy changes may inform future policy, treatment planning and may improve service user outcomes. AIMS To examine whether service user admission characteristics and length of stay predicted recovery status at discharge from medium secure care and whether a recovery-focused change in policy (introduction of the Mental Health (Wales) Measure (2010)) impacted either on recovery or the relationship between service user characteristics and recovery. METHODS The study adopted a retrospective analysis of quantitative data obtained from healthcare records from a Welsh MSU between 2007 and 2017 (n = 198). The DUNDUM-4 scale assessed recovery whilst DUNDRUM-2 assessed security need at admission. Service user admission characteristics included HCR-20 subscale scores, previous security-level transitions, adverse childhood experiences, substance misuse histories. RESULTS Shorter inpatient stays and higher scores on the dynamic HCR-20 clinical subscale were associated with poorer recovery outcomes. The relationship between admission characteristics and recovery endured despite changes in policy. Implementation of recovery focused legislation was associated with improved recovery. CONCLUSIONS The findings suggest that treatment should focus on dynamic risk factors to improve service user outcomes and highlights the need for long-term medium-secure provision for some. Further research is needed to evaluate the success of MSUs and the validity of the DUNDRUM-4 across UK secure services.
Collapse
Affiliation(s)
- Marie Smothers
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| | - Charlotte Hill
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Daniel Lawrence
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; Psychology Department, Priory Healthcare, Llanarth Court, Monmouthshire, UK.
| | - Ruth Bagshaw
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK; South Wales Forensic Psychiatry Service, Swansea Bay University Health Board, Pen-Y-Fai, Bridgend, UK
| | - Andrew Watt
- Department of Applied Psychology, Cardiff Metropolitan University, Western Avenue, Cardiff, UK
| |
Collapse
|
2
|
James R, Daukantaité D, Nilsson M. A validation of the Swedish self-concept and Identity Measure (SCIM) and its association with mental health problems. Heliyon 2023; 9:e18151. [PMID: 37519721 PMCID: PMC10372226 DOI: 10.1016/j.heliyon.2023.e18151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/20/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
Pathological disturbance to one's identity is closely linked with mental illness and in particular personality disorders. Current measures of identity pathology within clinical research are nevertheless inconsistently used and present with substantial limitations such as disproportionate focus on adolescence. The Self-Concept and Identity Measure (SCIM) identifies pathological and non-pathological identity disturbance by implementing a measurement for clinical components of identity, as well as introducing the Lack of Identity concept. This study thus explores the psychometric properties (factor structure, internal consistency, and criterion validity) of the Swedish SCIM in a large sample of Swedish university students (N = 1500). Model fit indices for the three-dimension model of identity pathology consisting of consolidated-, disturbed-, and lack of identity subscales were deemed acceptable and the Swedish SCIM scores correlated with measures of psychopathology in the expected direction, together concluding that the Swedish SCIM was satisfactorily valid and reliable. The results further reveal a significant positive correlation between identity pathology and non-suicidal self-injury, two concepts that co-occur in psychopathologies, such as borderline personality disorder, but have not yet been studied in a Western population with this tool. The potential clinical use of this translated dimensional tool needs to be tested in a Swedish clinical population, however, we conclude that it already offers insight into the complexities of identity functioning and correlations with clinical symptoms.
Collapse
Affiliation(s)
- Rosie James
- Faculty of Medicine at Lund University, Sweden
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden
| | | | - Magnus Nilsson
- Department of Clinical Sciences Lund, Psychiatry, Lund University, Sweden
- Clinical Psychiatric Research Centre, Region Skåne, Lund, Sweden
| |
Collapse
|
3
|
Qian X, Townsend ML, Tan WJ, Grenyer BFS. Sex differences in borderline personality disorder: A scoping review. PLoS One 2022; 17:e0279015. [PMID: 36584029 PMCID: PMC9803119 DOI: 10.1371/journal.pone.0279015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/28/2022] [Indexed: 12/31/2022] Open
Abstract
Borderline Personality Disorder (BPD) is often perceived to be a female-predominant disorder in both research and clinical contexts. Although there is growing recognition of possible sex differences, the current literature remains fragmented and inconclusive. This scoping review aimed to synthesize available research evidence on potential sex differences in BPD. PsycINFO, PubMed, Scopus and Web-of-Science were searched from January 1982 to July 2022 surrounding the key concepts of sex and BPD. Data searching and screening processes followed the Joanna Briggs Institute methodology involving two independent reviewers, and a third reviewer if necessary, and identified 118 papers. Data regarding BPD symptoms, comorbid disorders, developmental factors, biological markers, and treatment were extracted. Data was summarized using the vote counting method or narrative synthesis depending on the availability of literature. Males with BPD were more likely to present externalizing symptoms (e.g., aggressiveness) and comorbid disorders (e.g., substance use), while females with BPD were more likely to present internalizing symptoms (e.g., affective instability) and comorbid disorders (e.g., mood and eating disorders). This review also revealed that substantially more research attention has been given to overall sex differences in baseline BPD symptoms and comorbid disorders. In contrast, there is a dearth of sex-related research pertaining to treatment outcomes, developmental factors, and possible biological markers of BPD. The present scoping review synthesized current studies on sex differences in BPD, with males more likely to present with externalizing symptoms in contrast to females. However, how this might change the prognosis of the disorder or lead to modifications of treatment has not been investigated. Most studies were conducted on western populations, mainly North American (55%) or European (33%), and there is a need for future research to also take into consideration genetic, cultural, and environmental concomitants. As the biological construct of 'sex' was employed in the present review, future research could also investigate the social construct 'gender'. Longitudinal research designs are needed to understand any longer-term sex influence on the course of the disorder.
Collapse
Affiliation(s)
- Xinyu Qian
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle L. Townsend
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wan Jie Tan
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Brin F. S. Grenyer
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- * E-mail:
| |
Collapse
|
4
|
Yang C, Wang J, Shao Y, Liu M, Geng F. Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation. CHILD ABUSE & NEGLECT 2022; 132:105822. [PMID: 35944450 DOI: 10.1016/j.chiabu.2022.105822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/10/2021] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD. METHODS A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD. RESULT Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD. CONCLUSION ASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.
Collapse
Affiliation(s)
- Chenxiao Yang
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuan Shao
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Mingfan Liu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, China.
| |
Collapse
|
5
|
Yousefi F, Talib MA. Predictors of personality disorders in prisoners. J Med Life 2022; 15:454-461. [PMID: 35646191 PMCID: PMC9126463 DOI: 10.25122/jml-2021-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
Personality disorders can lead to difficult social or occupational functional processes rooted in chronic maladaptive thoughts, feelings, and behaviors. This study aimed to investigate factors of personality disorder in prisoners from the central prison of Sanandaj, Iran. We conducted a cross-sectional study, which included all prisoners in the central prison of Sanandaj, Iran. The study sample includes 343 prisoners, of which 329 were male, and 14 were female, selected by randomized multistage sampling method. Participants filled in Millon's multi-axis clinical questionnaire. The data were analyzed using Chi-square, multiple logistic regression, and bootstrap analysis. There were 183 participants without personality disorders (53.4%) and 99 participants (28.9%) with cluster B personality disorders (narcissistic, histrionic, anti-social, and borderline). Male gender (OR=0.07) and elementary education level (OR=0.18) have a significant relationship with cluster A personality disorders (paranoid, schizoid, schizotypal). Cluster B has a significant relationship only with the elementary education level (OR=0.27). Cluster C (avoidant, dependent, obsessive-compulsive personality disorder) has a significant relationship with male gender (OR=0.20), elementary education level (OR=0.30), unemployment (OR=2.64), theft crime types (OR=0.38) and disputes and assaults (OR=0.18). Based on these results, psychological and psychiatric interventions in prisoners are suggested.
Collapse
Affiliation(s)
- Fayegh Yousefi
- Department of Psychiatry, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran,Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mansor Abu Talib
- Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, Malaysia,Corresponding Author: Mansor Abu Talib, Department of Psychology, Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, Malaysia. E-mail:
| |
Collapse
|
6
|
Geiss L, Beck B, Hitzl W, Hillemacher T, Hösl KM. Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder. Neuropsychobiology 2022; 80:359-373. [PMID: 33582662 DOI: 10.1159/000511543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). METHODS In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. RESULTS During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. CONCLUSION Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.
Collapse
Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany,
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| |
Collapse
|
7
|
Brooker C, Sirdifield C, Marples R. Mental health and probation: A systematic review of the literature. FORENSIC SCIENCE INTERNATIONAL. MIND AND LAW 2020; 1:100003. [PMID: 35136864 PMCID: PMC7612333 DOI: 10.1016/j.fsiml.2019.100003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Charlie Brooker
- Centre for Sociology and Criminology, Royal Holloway, University of London, UK
| | - Coral Sirdifield
- School of Health and Social Care, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
| | - Rebecca Marples
- Centre for Criminal Justice Studies, School of Law, University of Leeds, Leeds, LS2 9JT, UK
| |
Collapse
|
8
|
Cardona N, Berman AK, Sims-Knight JE, Knight RA. Covariates of the Severity of Aggression in Sexual Crimes: Psychopathy and Borderline Characteristics. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2020; 32:154-178. [PMID: 30394860 DOI: 10.1177/1079063218807485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Whereas risk assessment literature on sexual offending has primarily focused on prediction of subsequent sexual crimes, and not the severity of those crimes, the first aim of the present study was to identify variables that predict the amount of damage to victims in sexual crimes compared with those that predict general aggressiveness. The second aim was to ascertain whether adding emotional instability measurements, as in borderline personality disorder (BPD), would add incremental variance to that captured by the facets of the Psychopathy Checklist-Revised (PCL-R). Trained raters assessed on the PCL-R, BPD, and measures of severity of sexual and nonsexual violence 302 adults who had sexually offended. PCL-R's Antisociality and two externalizing BPD factors (one from the standard and one from the alternative criteria) were significant predictors of violence both in sexual and nonsexual crimes. In contrast, deficits in the PCL-R's Affective facet (2) predicted victim damage in sexual contexts only, whereas the Lifestyle Impulsivity facet (3) of the PCL-R predicted violence in nonsexual contexts only. These findings suggest that adding measures of emotional dysregulation to commonly used instruments like the PCL-R, which assesses callousness and antisociality, may be beneficial for predicting violence.
Collapse
|
9
|
Wetterborg D, Dehlbom P, Långström N, Andersson G, Fruzzetti AE, Enebrink P. Dialectical Behavior Therapy for Men With Borderline Personality Disorder and Antisocial Behavior: A Clinical Trial. J Pers Disord 2020; 34:22-39. [PMID: 30355023 DOI: 10.1521/pedi_2018_32_379] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In addition to suicidal behaviors, men with borderline personality disorder (BPD) often display antisocial behavior that could impair contacts with mental health services. While research has established effective treatments for women with BPD, this is not yet the case for men. The authors evaluated 12 months of dialectical behavior therapy (DBT) for 30 men with BPD and antisocial behavior, using a within-group design with repeated measurements. The authors found moderate to strong, statistically significant pre-to posttreatment reductions of several dysfunctional behaviors, including self-harm, verbal and physical aggression, and criminal offending (rate ratios 0.17-0.39). Symptoms of BPD and depression were also substantially decreased. The dropout rate was 30%, and completing participants reported high satisfaction with treatment and maintained their improvements at 1-year follow-up. The authors conclude that DBT could be an effective treatment alternative for men with BPD and antisocial behavior, and it merits future studies with more rigorous design.
Collapse
Affiliation(s)
- Dan Wetterborg
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Dehlbom
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Sciences, Epidemiology of Mental Health Division, Karolinska Institutet
| | - Niklas Långström
- Department of Neuroscience, Uppsala University, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Alan E Fruzzetti
- McLean Hospital and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Pia Enebrink
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
10
|
Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners. METHODS Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance). RESULTS Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models. CONCLUSIONS Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.
Collapse
Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| |
Collapse
|
11
|
Mundt AP, Baranyi G. The Unhappy Mental Health Triad: Comorbid Severe Mental Illnesses, Personality Disorders, and Substance Use Disorders in Prison Populations. Front Psychiatry 2020; 11:804. [PMID: 32922316 PMCID: PMC7456858 DOI: 10.3389/fpsyt.2020.00804] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Information on the comorbidity of mental health problems in prison populations is scarce. The aim of the present study was to assess the prevalence of comorbidities at intake to prison between three diagnostic groups: severe mental illnesses (SMIs), personality disorders (PDs), and substance use disorders (SUDs). The co-occurrence of those disorders in prison populations may require the integration of differential treatment approaches and novel treatment trials. METHODS A consecutive sample of N = 427 (229 male and 198 female) individuals committed to imprisonment in Santiago de Chile was assessed with the Mini Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV (module for borderline personality disorders) on arrival at prison. Diagnoses were a priori grouped as SMI including psychosis, bipolar disorder and major depression, PD including borderline and antisocial PD and SUD including alcohol and drug abuse or dependence. Sex stratified multivariate binary logistic regression analyses were conducted to assess sociodemographic, criminal and treatment characteristics of individuals with at least one diagnosis from each of the three diagnostic groups. RESULTS The triad of SMI, PD, and SUD was present in n = 138 (32.3%; 95% IC: 28.0-36.9) study participants, n = 105 (45.9%; 95% CI: 39.4-52.4) of the men and n = 33 (16.7%; 95% CI: 12.1-22.6) of the women. Among those with the disorder triad, n = 129 (30.2%; 95% CI: 26.0-34.8) had major depression, PD and SUD; n = 54 (12.6%; 95% CI: 9.8-16.2) had psychosis, PD and SUD. The disorder triad was more common in men (OR = 4.86; 95% IC: 2.63-8.95), younger age (OR = 0.94; 95% CI: 0.91-0.97), and participants with lower educational levels (OR = 1.69; 95% CI: 1.01-2.82). The disorder triad was significantly associated with previous incarcerations (OR 2.60; 95% CI: 1.55-4.34) and histories of psychiatric hospitalizations (OR 2.82; 95% CI: 1.27-6.28). DISCUSSION The complex triad of disorders from different diagnostic groups is common in prison populations, especially among young men. Successful treatment interventions may have the potential to break a cycle of repeat institutionalization in prisons and psychiatric institutions.
Collapse
Affiliation(s)
- Adrian P Mundt
- Faculty of Medicine, Universidad Diego Portales, Santiago, Chile.,Department of Psychiatry, Faculty of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gergő Baranyi
- Centre for Research on Environment, Society and Health, School of GeoSciences, The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
12
|
Sebastian A, Retz W, Tüscher O, Turner D. Violent offending in borderline personality disorder and attention deficit/hyperactivity disorder. Neuropharmacology 2019; 156:107565. [DOI: 10.1016/j.neuropharm.2019.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 12/20/2022]
|
13
|
Poreh AM, Levin JB. The Cleveland Adaptive Psychopathology Inventory: preliminary validity and reliability of a multi-scale personality and psychopathology questionnaire. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1633724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Amir M. Poreh
- Department of Psychology, Cleveland State University, Cleveland, OH, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, OH, USA
| | - Jennifer B. Levin
- Department of Psychiatry, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, OH, USA
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
14
|
Bertsch K, Krauch M, Roelofs K, Cackowski S, Herpertz SC, Volman I. Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder. Neuropharmacology 2018; 156:107463. [PMID: 30553826 DOI: 10.1016/j.neuropharm.2018.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022]
Abstract
Difficulty in anger control and anger-related aggressive outbursts against others are frequently reported by patients with borderline personality disorder (BPD). Although male sex is a known predictor for aggression, hardly any study has addressed the neural correlates of deficient anger control in male patients with BPD. Building on previous reports in female BPD, we investigated the involvement of lateral antero- and dorsal prefrontal cortex in the control of fast emotional actions and its relation to self-reported tendencies to act out anger. 15 medication-free male patients with BPD and 25 age- and intelligence-matched healthy men took part in a social Approach-Avoidance task in the MR-scanner. This task allows the measurement of neural correlates underlying the control of fast behavioral tendencies to approach happy and avoid angry faces. Hypothesis-driven region-of-interest and exploratory whole brain analyses were used to test for activations of antero- and dorsolateral prefrontal regions and their relation with the amygdala during emotional action control as well as their association with self-reported anger out in male patients with BPD and healthy volunteers. Male patients with BPD showed reduced anterolateral prefrontal activations during emotional action control compared to healthy volunteers. Furthermore, anger out was negatively related to antero- and dorsolateral prefrontal activations, while it was positively related to amygdala activity in male patients with BPD. The current results suggest the involvement of antero- and dorsolateral prefrontal regions in controlling and overriding fast emotional actions. Deficits in lateral prefrontal emotion control seem to be a common neural mechanism underlying anger-related aggression. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.
Collapse
Affiliation(s)
- Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
| | - Marlene Krauch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Karin Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Inge Volman
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
15
|
van den Brink C, Harte JM, Denzel AD. Men and women with borderline personality disorder resident in Dutch special psychiatric units in prisons: A descriptive and comparative study. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:324-334. [PMID: 29971844 DOI: 10.1002/cbm.2084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 01/05/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The overall prevalence of borderline personality disorder is well known, but characteristics of offender patients with the condition are less clear, especially among men. AIM Describe characteristics of men and women with borderline personality disorder in special psychiatric units in Dutch prisons on three domains: prevalence of child abuse, comorbidity of borderline personality disorder with other disorders, and clinical symptoms. METHODS One hundred and sixty-seven people were assigned to this study based on a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnoses retrieved from records. Other DSM-5 diagnoses were also recorded. Two scales, the Dutch Historisch, Klinisch, Toekomst-Revisie and the international Brief Psychiatric Rating Scale-Expanded (BPRS-E) were used to record child abuse and clinical symptoms, respectively. RESULTS Prevalence rates of child abuse were high, but the men and women did not differ in this respect. The male offender patients were more likely than the women to have a comorbid substance use disorder, whereas the women were more likely to have a comorbid anxiety disorder. Intellectual disability was the most common comorbid Axis II disorder. The women were more likely than the men to have committed a fatal/nearly fatal index offence and showed higher rates of distress or behavioural disturbance on all five BPRS-E factors. CONCLUSIONS This study provides evidence of the importance of in-depth knowledge of presentations with borderline personality disorder specific to setting. Although we were unable to make direct comparisons with other samples, our figures suggest clinically relevant differences among offender patients from the more widely reported general samples. We also shed light on a sometimes underexposed group of men with borderline personality disorder and their clinical needs. More population-specific intervention and follow-up studies are now indicated.
Collapse
Affiliation(s)
| | - Joke M Harte
- Vrije Universiteit Amsterdam - Criminal Law and Criminology, Amsterdam, Netherlands
| | - A Dorina Denzel
- Vrije Universiteit Amsterdam - Criminal Law and Criminology, Amsterdam, Netherlands
- Judicial Complex Zaanstad, Westzaan, Netherlands
| |
Collapse
|
16
|
Guy N, Newton-Howes G, Ford H, Williman J, Foulds J. The prevalence of comorbid alcohol use disorder in the presence of personality disorder: Systematic review and explanatory modelling. Personal Ment Health 2018; 12:216-228. [PMID: 29611335 DOI: 10.1002/pmh.1415] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 12/11/2022]
Abstract
Comorbid personality disorder (PD) worsens outcome in mental state disorders; however, the proportion of people with PD who have an alcohol use disorder (AUD) is poorly described. A systematic review of the literature for studies reporting on AUD in those with PD was completed. Lifetime prevalence figures were meta-analysed using multilevel models, accounting for type of PD and population examined. Sixteen unique studies contributed data to the analysis. PD type accounted for most of the heterogeneity in lifetime AUD prevalence. People with antisocial PD had the highest lifetime AUD prevalence, at 76.7%, followed by those with borderline PD at 52.2%, while those with other forms of PD, or undifferentiated PD, had a prevalence of 38.9%. Lifetime AUD prevalence was not significantly higher in clinical compared with population samples. The majority of people with PD experience an AUD at some time in the life course. This has clinical screening and management implications. Copyright © 2018 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Nikki Guy
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Hannah Ford
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan Williman
- Department of Biostatistics and Computational Biology, University of Otago, Christchurch, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
17
|
Borderline personality disorder and substance use disorders: an updated review. Borderline Personal Disord Emot Dysregul 2018; 5:15. [PMID: 30250740 PMCID: PMC6145127 DOI: 10.1186/s40479-018-0093-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/03/2018] [Indexed: 12/23/2022] Open
Abstract
For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).
Collapse
|
18
|
Bayes A, Parker G. Borderline personality disorder in men: A literature review and illustrative case vignettes. Psychiatry Res 2017; 257:197-202. [PMID: 28768209 DOI: 10.1016/j.psychres.2017.07.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/26/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022]
Abstract
The aim is to review the salient literature on borderline personality disorder (BPD) in men and link those findings with case vignettes. We provide a literature review and then report case examples of those who met DSM and clinical BPD criteria, and consider the extent to which the small male sub-set corresponded developmentally and phenomenologically with prototypic BPD in women. The review considered phenomenological, epidemiological, biological and developmental BPD factors, finding BPD men evidence elevated substance abuse, and 'externalising' patterns of behavior, antisocial personality traits, violent self-harm and interpersonal aggression, whereas women display more 'internalising' strategies. The five male vignettes enriched the literature review providing support for gender differences reported in our review. The literature and case vignette findings should assist clinicians in recognising that BPD in men may not be as rare as generally viewed, and which may reflect BPD being commonly viewed as weighted to women and being misdiagnosed as an antisocial personality disorder (ASPD) in men.
Collapse
Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales, NSW 2050, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW 2050, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
| |
Collapse
|
19
|
Lindberg N, Miettunen J, Heiskala A, Kaltiala-Heino R. Mortality of young offenders: a national register-based follow-up study of 15- to 19-year-old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010. Child Adolesc Psychiatry Ment Health 2017; 11:37. [PMID: 28794798 PMCID: PMC5547467 DOI: 10.1186/s13034-017-0174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls. METHODS We collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (n = 606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (n = 2424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9 years (interquartile range 15.3-29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural. RESULTS By the end of the follow-up period, 22.1% (n = 134) of the delinquents and 3.4% (n = 82) of their controls had died (OR 8.11, 95% CI 6.05-10.86, p < 0.001). Among boys, 22.0% (n = 121) of the delinquents and 3.7% (n = 81) of the controls had died (OR 7.38, 95% CI 5.46-9.95, p < 0.001). Male delinquents' risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (n = 13) of the delinquents and 0.5% (n = 1) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63-532.00, p < 0.001). The violent delinquents' risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups. CONCLUSIONS Even though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.
Collapse
Affiliation(s)
- Nina Lindberg
- 0000 0000 9950 5666grid.15485.3dForensic Psychiatry, Helsinki University and Helsinki University Hospital, PO Box 590, 00029 HUS Helsinki, Finland
| | - Jouko Miettunen
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland ,0000 0004 4685 4917grid.412326.0Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anni Heiskala
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Riittakerttu Kaltiala-Heino
- 0000 0001 2314 6254grid.5509.9School of Medicine, Tampere University, Tampere, Finland ,0000 0004 0628 2985grid.412330.7Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland ,0000 0004 0628 2766grid.417253.6Vanha Vaasa Hospital, Vaasa, Finland
| |
Collapse
|
20
|
Lindberg N, Miettunen J, Heiskala A, Kaltiala-Heino R. Serious delinquency and later schizophrenia: A nationwide register-based follow-up study of Finnish pretrial 15- to 19-year-old offenders sent for a forensic psychiatric examination. Eur Psychiatry 2017. [PMID: 28645056 DOI: 10.1016/j.eurpsy.2017.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010. METHODS The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care. RESULTS Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, P<0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5years. CONCLUSIONS The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia.
Collapse
Affiliation(s)
- N Lindberg
- Helsinki University and Helsinki University Hospital, Forensic Psychiatry, Psykiatriakeskus, PO Box 590, 00029 HUS, Helsinki, Finland.
| | - J Miettunen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, PO Box 5000, 90014 Oulu, Finland
| | - A Heiskala
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014 Oulu, Finland
| | - R Kaltiala-Heino
- School of Medicine, Tampere University, 33014 Tampere, Finland; Department of Adolescent Psychiatry, Tampere University Hospital, 33380 Pitkäniemi, Finland; Vanha Vaasa Hospital, Vierinkiventie 1, 65380 Vaasa, Finland
| |
Collapse
|
21
|
Prevalence of borderline personality disorder and its risk factors in female prison inmates in China. Psychiatry Res 2017; 250:200-203. [PMID: 28167433 DOI: 10.1016/j.psychres.2017.01.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/22/2017] [Accepted: 01/22/2017] [Indexed: 11/24/2022]
Abstract
High prevalence of borderline personality disorder (BPD) has been found in Western prisons but no such data exists in China. The objective of this study was to determine the lifetime prevalence of BPD in Chinese female prison inmates and its associated risk factors. This cross-sectional study was conducted in Hunan Provincial Female Prison. Data on consenting inmates' socio-demographic and clinical characteristics were collected and the diagnosis of lifetime BPD was established using the Structural Clinical Interview for DSM-IV. The prevalence of BPD was 10.6% in the cohort of 2709 participating inmates. Multiple logistic regression analysis revealed that younger age, unmarried marital status, higher education level, fewer major medical conditions, more frequent personal and family members' drug use, more frequent comorbid psychiatric disorders and family history of psychiatric disorders were positively and independently associated with BPD. BPD is common in Chinese female prison inmates. Considering its adverse social consequences and impact on physical and mental well-being, serious attempts should be made to diagnose BPD early and improve access to treatment in women prisons.
Collapse
|
22
|
Robitaille MP, Checknita D, Vitaro F, Tremblay RE, Paris J, Hodgins S. A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder. Borderline Personal Disord Emot Dysregul 2017; 4:25. [PMID: 29225887 PMCID: PMC5719590 DOI: 10.1186/s40479-017-0076-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/22/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Some evidence suggests that the prevalence of Borderline Personality Disorder (BPD) is elevated among male criminal offenders. It is not presently known whether offending, and violent offending, are limited to those presenting comorbid Antisocial Personality Disorder (ASPD) who have a childhood history of conduct problems and whether offending is linked to psychopathic traits. METHODS A community sample of 311 males followed from age 6 to 33 years, one third of whom had a criminal charge between ages 18 and 24, completed diagnostic interviews and the Psychopathy Checklist-Revised interview. Information on childhood included parent-reported family characteristics and teacher-rated of hurtful and uncaring behaviours, conduct problems, hyperactivity and inattention, and anxiety at age 6, 10, and 12 years. Health files were obtained as were records of criminal convictions from age 12 to 33. RESULTS At age 33, 4% of the men presented BPD and not ASPD, 16% ASPD and not BPD, 8% BPD + ASPD, and 72% neither disorder (ND). Comorbid disorders were common: BPD were distinguished by high levels of anxiety disorders, BPD and BPD + ASPD by depression disorders, and BPD, BPD + ASPD, and ASPD by substance dependence. Official files indicated use of health services by all participants. One-third of participants with BPD and BPD + ASPD acquired a diagnosis of a personality disorder. More than one-third of participants with BPD + ASPD obtained scores indicative of the syndrome of psychopathy. Convictions for violent crimes varied across groups: In adolescence, BPD none, BPD + ASPD 16%, ASPD 16%, and ND 3.6%; from age 18 to 33, BPD 18%, ASPD 19%, BPD + ASPD 52%, and ND 4.4%. Offenders with BPD + ASPD were convicted, on average, for four times more violent crimes than offenders with ASPD and seven times more than ND offenders. In childhood, men with BPD + ASPD and with ASPD had obtained similarly elevated ratings for disruptive behaviours as compared to ND. CONCLUSION BPD comorbid with ASPD was associated with violent criminal offending in adolescence and most strongly in adulthood, elevated levels of psychopathic traits, and childhood disruptive behaviour. BPD showed similar characteristics but to a much less degree.
Collapse
Affiliation(s)
- Marie-Pier Robitaille
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montréal, Québec H1N 3M5 Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada.,Departement de psychiatrie, Université de Montréal, Montreal, Canada
| | - Dave Checknita
- Center for Clinical Research, Uppsala University, Västmanland County Council, Uppsala, Sweden
| | - Frank Vitaro
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montréal, Québec H1N 3M5 Canada.,École de psychoéducation, Université de Montréal, Montréal, Canada
| | - Richard E Tremblay
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montréal, Québec H1N 3M5 Canada.,Département de pédiatrie, Université de Montréal, Montréal, Canada.,School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Joel Paris
- Department of Psychiatry, McGill University, Montréal, Canada.,Institute of Community and Family Psychiatry, McGill University, Montréal, Canada
| | - Sheilagh Hodgins
- Research Unit on Children's Psychosocial Maladjustment, Université de Montréal, Montréal, Québec H1N 3M5 Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Canada.,Departement de psychiatrie, Université de Montréal, Montreal, Canada
| |
Collapse
|
23
|
Korsgaard HO, Torgersen S, Wentzel-Larsen T, Ulberg R. Personality disorders and Axis I comorbidity in adolescent outpatients with ADHD. BMC Psychiatry 2016; 16:175. [PMID: 27245754 PMCID: PMC4888410 DOI: 10.1186/s12888-016-0871-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/16/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a lifelong condition which carries great cost to society and has an extensive comorbidity. It has been assumed that ADHD is 2 to 5 times more frequent in boys than in girls. Several studies have suggested developmental trajectories that link ADHD and certain personality disorders. The present study investigated the prevalence of ADHD, common Axis I disorders, and their gender differences in a sample of adolescent outpatients. We also wanted to investigate the relationship between ADHD and personality disorders (PDs), as well as how this relationship was influenced by adjustment for Axis I disorders, age and gender. METHODS We used a sample consisting of 153 adolescents, aged 14 to 17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. ADHD, conduct disorder (CD) and other Axis I conditions were assessed using the Mini International Neuropsychiatric Interview (MINI). PDs were assessed using the Structured Interview for DSM-IV Personality (SIDP-IV). RESULTS 13.7 % of the adolescents met diagnostic criteria for ADHD, with no significant gender difference. 21.6 % had at least one PD, 17.6 % had CD, and 4.6 % had both ADHD and a PD. There was a significantly elevated number of PD symptoms in adolescents with an ADHD diagnosis (p = 0.001), and this relationship was not significantly weakened when adjusted for age, gender and other Axis I disorders (p = 0.026). Antisocial (χ (2) = 21.18, p = 0.002) and borderline (χ (2) = 6.15, p = 0.042) PDs were significantly more frequent in girls than in boys with ADHD. CONCLUSIONS We found no significant gender difference in the prevalence of ADHD in a sample of adolescents referred to a general mental health outpatient clinic. Adolescent girls with ADHD had more PDs than boys, with antisocial and borderline PDs significantly different. The present study suggests that ADHD in girls in a general outpatient population may be more prevalent than previously assumed. It especially highlights the importance of assessing antisocial and borderline personality pathology in adolescent girls presenting with ADHD symptoms.
Collapse
Affiliation(s)
- Hans Ole Korsgaard
- Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, P.O. Box 4970, Nydalen, N-0440, Oslo, Norway.
| | - Svenn Torgersen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Department of Psychology, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway ,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Randi Ulberg
- Vestfold Hospital Trust, Tønsberg, Norway ,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|