The central role of borderline personality disorder in imprisoned people: a network analysis of mental disorder diagnoses

ABSTRACT

Multiple comorbid mental disorders have been reported in prison populations worldwide. This study aimed to assess the interrelatedness of comorbid mental disorders in imprisoned people. We surveyed 427 consecutively imprisoned people at intake to the prison system in the Greater Metropolitan Region of Santiago, Chile, using the Mini Neuropsychiatric Interview. In addition, we used the Structured Clinical Interview for DSM-IV (SCID-II) to assess borderline personality disorder (BPD). We conducted network analyses using R 4.3.1 (package bootnet version 1.5.3) with 11 variables representing the diagnostic entities agoraphobia, alcohol use disorder, antisocial personality disorder, BPD, illicit drug use disorder, major depression, obsessive-compulsive disorder, panic disorder, psychotic disorder, posttraumatic stress disorder (PTSD), and social anxiety disorder. BPD had a central position in a network of nine interrelated diagnoses and showed the highest levels of connectedness (strength, closeness, and betweenness) among personality, anxiety, mood, and substance use disorders. Psychotic disorders and PTSD were not connected with the other diagnoses. In sensitivity analyses stratified by sex, BPD remained in a central position and psychotic disorders were unconnected, while PTSD was connected with different nodes in each sex. BPD has a central role in the complex comorbidity of imprisoned people, which needs consideration for intervention development.

KEYWORDS:

• Borderline personality disorder
• comorbidity
• incarcerated populations
• network analyses
• prison

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

Adrian P. Mundt and Stephanie Baggio conceived of the study, Adrian P. Mundt coordinated the data collection, Stephanie Baggio conducted the network analyses, Adrian P. Mundt drafted the manuscript, both authors revised the manuscript and approved of the final version.

Availability of data and materials

The raw data are available from the corresponding author upon reasonable request.

Consent for publication

No details on individuals are reported within the manuscript.

Ethical approval and consent to participate

All study participation was voluntary and upon written informed consent. All potential participants were informed that the assessment had exclusively scientific means, and was independent of all legal procedures, benefits, or court evaluations. The study complied with the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules). The study protocol was approved by the Ethics Committee of Hospital Clínico Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Región Metropolitana, Chile (Acta de Aprobación N° 01; 25 January 2012).

Additional information

Funding

This work was supported by the Agencia Nacional de Investigación y Desarrollo [FONDECYT Regular 1240624].