Friday, March 4, 2011

More on Borderlines and Crime

In January I posted on Borderline Personality Disorder, Crime and Responsibility.  More recently, I came across an interesting literature review on the topic of BPD and its association with crime and incarceration.  “Borderline Personality and Criminality,” by Randy and Lori Sansone, was published in Psychiatry in 2009.

In this paper, the authors review multiple studies that have looked into the rates of Borderline Personality Disorder among the incarcerated and the criminal.  They acknowledge that it is not a comprehensive review and they did find a wide discrepancy in findings probably related to differences in methodology as well as peculiarities of different sample populations drawn on from penitentiaries.


Their overall conclusions:
According to the findings of the majority of studies in this area, compared to rates expected in the community, BPD is over-represented in prison populations.  This finding may be particularly evident among female prisoners.  Rates vary, depending on the methodology, but generally appear to be in the range of 25-50 percent.
This is a considerable difference from the rate in the general population that has been measured at between two and six percent. 

They continue:
Factors that may be associated with the presence of BPD among criminals include being female, having a history of childhood sexual abuse, committing an impulsive and violent crime (e.g., murder), having antisocial personality disorder traits, and perpetrating domestic violence.  given this association, clinicians in both mental health and primary care settings need to be aware of the possibilities of such histories in their patients with BPD.
Gender:
It is well known that BPD has a higher rate among women than men.  This holds true in prison populations as well.  Rates among incarcerated men range around 5-6%, very similar, but maybe slightly higher than men in general.  Now where it gets interesting is with women.  Studies varied significantly in their findings.  On the low end, one study found 11.5% of incarcerated women to have BPD but another study found as many as 42.9%!  This last study was conducted in Germany using structured interviews.  Overall, not only do imprisoned  women have a higher rate of BPD than men, but also significantly higher than women in general.

It has often been speculated that the overall gender imbalance is due to biases in the formulation of the disorder criteria or biases in the act of diagnosing.  The authors mention this question in passing but do not offer any speculations.  (In my own, non-scientific, observations from the world of practice, I believe that because we expect to see BPD in women it leads to over-diagnosing among women where any kind of Axis II behavioral problems tend to result in a BPD label while, in contrast, BPD traits in men often go unnoted or misinterpreted as anti-social features.)

Childhood sexual abuse:
As with the general population, incarcerated people with BPD had a higher rate of childhood sexual abuse.  Not surprisingly, history of childhood sexual abuse was even higher for incarcerated women who were both sex offenders themselves and met the criteria for BPD.

Violent offenses:
Overall, data supports an association between BPD with higher rates of violence (toward others) when comparing prisoners with and without BPD.  One study found that women prisoners who had committed crimes related to major violence were four times more likely to meet criteria for BPD than women who had committed minimally violent crimes.  Another study of men in British prisons for murder found 49% of their subjects had BPD traits.

Some studies looked at violence in association to subtypes of BPD.  One study found serial murderers to be associated with a strongly manipulative subtype of BPD.  Another study relates rage-based murder with an “over-control” subtype of BPD.  The authors conclude that “the majority of current data and impressions indicate an association between BPD and the impulsive, rage-fueled murder."

Antisocial personality:
Both BPD and Antisocial Personality Disorder are associated with higher rates of violence.  Antisocial individuals tend to engage in more property crimes and are more calculating and planned.  Borderline individuals tend toward episodes of aggression and violence.

Where BPD and APD co-occur, there are significantly higher rates of anger, impulsivity and aggression resulting in a higher score of psychopathy.  (Personally, I've often felt there is a significant overlap between these two categories but the authors do not give any additional insight on the topic.)

Domestic Violence:
Multiple studies have found a very solid association between BPD and both male and female batterers.  Many batterers have a history of experiencing trauma themselves, and this, in turn, is also associated with development of BPD.  One study found that 27% of women arrested for domestic violence met the criteria for BPD.

Overall it seems there is a very clear link between BPD and both violence and criminality in general.  The strength of that link varies quite a bit from study to study, however.  The authors offer no causal speculations.  Make of it what you will.

Reference:  Sansone, Randy; Sansone, Lori (2009).  “Borderline Personality and Criminality.”  Psychiatry; 6(10):16-20.

2 comments:

  1. It should also be noted that a large percentage of female alcoholics may well be borderline and/or have childhood sexual abuse in their backgrounds. Given that alcohol is involved in greater than 50% of most violent crimes, this may be relevant (don't have the links, anecdotal).

    However, to be fair, one should add that the vast majority of patients with Borderline Personality Disorder are NOT criminals, and make themselves far more miserable than others. Are likelier to be victims than victimizers. People tend to love or hate them, but it is one of the most stigmatized and vilified diagnoses.

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  2. I believe all your points are good ones. These kind of correlational stats tell us nothing of the dynamics that are behind the links. Ultimately, if we want to be successful in understanding BPD and helping both individuals with BPD _and_ reducing the impact on society (mental health hospitalizations, prison expenses, etc.) we'll all need to get over our love-hate reactions to BPD.

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