Chapter 12: Borderline Personality Disorder Among Justice Involved Populations

What is Borderline Personality Disorder?

• a cluster B personality disorder

• involves

  • emotional dysregulation

  • impulsiveness

  • anger

  • intense fear of abandonment

  • higely unstable relationships

  • feelings of emptiness/loneliness

  • self-harm/ideation

Prevalence of Borderline Personality Disorder — General Population

• 2.7% prevalence (2014)

Prevalence of Borderline Personality Disorder — Criminal Justice System Involved Populations

• substantially higher rates within the criminal justice system than in the general population

  • around 15-29% prevalence — using interviews

  • up to 50% using symptom inventories

Mechanisms leading to arrest

• several studies have examined engagement in illegal behaviours

  • interpersonal violence (IPV)

  • half of participants in other studies met 4 or more BPD criteria

  • people with BPD are mostly likely to display reactive relational aggression (vs. organized)

  • violent behaviours prompted by dysregulated anger and impulsivity may explain the high prevalence of people with BPD in the criminal justice system

Substance use and Borderline Personality Disorder

• 13-28% of people in the CJS with BPD have co-occurring substance use disorders (most commonly alcohol)

• comorbidity is thought to be most driven by aggressiveness, impulsivity, and strong mood fluctuations

Borderline Personality Disorder and Antisocial Personality Disorder

• ASPD prevalence in people with BPD in the CJS ranges from 32-92%

• co-occurrence offers unique problems

  • antisocial traits are more predictive of future legal issues if BPD traits are also present

  • more likely to express anger outwardly — less control

  • more likely to reoffend

ASPD

• lack of empathy (callousness)

  • dysfunctional paralymbic system (responsible for converting emotion into learning and behaviour)

• neglecting or violating rights of others (before the age of 15)

• non-compliance

• recklessness

• impulsivity

• aggressiveness

• lack of remorse

Gender Differences in Borderline Personality Disorder

• less gender difference within the CJS population than the general population

• may be more prevalent in women despite similar symptomology between men and women

• intense anger in women = BPD? but intense anger in men = substance use disorder

• physical abuse in men → ASPD but sexual/emotional trauma in women → BPD

Treatment of Borderline Personality Disorder in the Criminal Justice System

• BPD leads to special difficulties in the CJS

  • increased risk of violent interactions with peers and staff, as well as NSSI and suicide

• dialectical behavioural therapu (DBT) in the CJS involves group skills sessions, individual therapy and as needed skills coaching

• DBT is normally the most effective treatment for BPD, but of course the CJS is not the ideal setting (for anything)

• prison staff are not psychologists — not equiped to provide this kind of support

More Treatment Options for Borderline Personality Disorder

• studies found that both DBT and CJS modified versions are effective in reducing stress, recidivism, aggression, borderline symptoms and substance use in inmates

• mentalization-based treatment (MBT)

  • cognition, attachment and neurobiology

  • teaches capacity to understand behaviour/beliefs of others

  • reported to be effective in treating BPD in small samples, more research is needed