Psychiatry Research 250 (2017) 200203

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Prevalence of borderline personality disorder and its risk factors in female MARK
prison inmates in China
Xiao-Min Zhua,b, Jian-Song Zhoua, Chen Chena, Wang-Lian Penga, Wen Lia, Gabor S. Ungvaric,d,

Chee H. Nge, Xiao-Ping Wanga, , Yu-Tao Xiangf,
a
Mental Health Institute of the Second Xiangya Hospital & Hunan Province Technology Institute of Psychiatry & Key Laboratory of Psychiatry and Mental
Health of Hunan Province, Central South University, Changsha, China
b
Suzhou Psychiatric Hospital, The Aliated Guangji Hospital of Soochow University, Suzhou, China
c
University of Notre Dame Australia / Marian Centre, Perth, Australia
d
School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
e
Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
f
Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China

A R T I C L E I N F O A BS T RAC T

Keywords: High prevalence of borderline personality disorder (BPD) has been found in Western prisons but no such data
Borderline personality disorder exists in China. The objective of this study was to determine the lifetime prevalence of BPD in Chinese female
Female inmates prison inmates and its associated risk factors. This cross-sectional study was conducted in Hunan Provincial
Risk factors 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.

1. Introduction
Female delinquency has grown in recent years in the world
including China contributing to an increase in the number of
female prison inmates (Chesney-Lind and Pasko, 2013). A sys-
tematic review comprising ve studies found that the pooled
prevalence of borderline personality disorder (BPD) in inmates
(25%; range: 2229%) (Fazel and Danesh, 2002) is signicantly
higher than in community samples (2.75.9%) (Grant et al., 2008;
Trull et al., 2010). BPD is a complex psychiatric disorder char-
acterized by pervasive pattern of instability in interpersonal
relationship, self-image and emotion regulation with obvious im-
pulse control problem (American Psychiatric Association, 2013).
Individuals with BPD usually have serious episodic emotion out-
bursts and destructive behavior in adolescence and early adulthood
(Paris, 2008; Solo et al., 2016), which would often lead to
interpersonal conicts and illegal behavior (Sansone et al., 2012;
Koenig et al., 2016; Kredlow et al., 2017). As a result, individuals
with BPD are at higher risk to face imprisonment.
Many studies on prevalence of BPD have been conducted in the
community (Zanarini et al., 2011; Quirk et al., 2016), clinical settings
(Kealy et al., 2016; Kjaer et al., 2016) and prisons (Wetterborg et al.,
2015) in Western countries. However, there have been very few studies
on the prevalence of BPD in China (Wang et al., 2007). One possible
reason is that there is the lack of a separate category for BPD in the
Chinese Classication of Mental Disorders (CCMD-3) (Chen, 2002).
Given the high prevalence of BPD in inmates in Western countries
and the absence of such studies in China, we set out to conduct the rst
study on the lifetime prevalence of BPD in Chinese female inmates and
the associated risk factors.

Correspondence to: Mental Health Institute, The Second Xiangya Hospital, Central South University; Changsha, Hunan, China.

Correspondence to: Faculty of Health Sciences, University of Macau, Avenida da Universidade, 3/F, Building E12, Taipa, Macau SAR, China.
E-mail addresses: xiaop6@126.com (X.-P. Wang), xyutly@gmail.com (Y.-T. Xiang).

http://dx.doi.org/10.1016/j.psychres.2017.01.065
Received 21 October 2016; Received in revised form 22 January 2017; Accepted 22 January 2017
Available online 23 January 2017
0165-1781/ 2017 Elsevier B.V. All rights reserved.
X.-M. Zhu et al.
2. Methods
2.1. Subjects and study site
This was a cross-sectional study conducted in Hunan provincial
Female Prison between December 1, 2012 and November 30, 2013.
This prevalence study of BPD in female prison inmates was initiated by
the Center-South University Mental Health Research Institution,
China. Eligible participants included all inmates in this female prison
if they were of Chinese ethnicity, uent in Chinese language, and were
able to communicate adequately and comprehend the purpose and
contents of the study. Participation in the study was voluntary and all
study participants provided written informed consent. The study
protocol was approved by the Bureau of Prisons in Hunan Province,
the Hunan Female Prison and the Clinical Research Ethics Committee
of the Center South University.
2.2. Assessment instruments
Data on the socio-demographic and clinical characteristics were
collected using a standard form designed for this study during the two
hour interview conducted by nine trained psychiatry research assis-
tants. Records of major medical conditions in the various categories
(ear/nose/throat, pulmonary, cardiovascular, gastrointestinal, muscu-
loskeletal, neurological, endocrine, blood-lymphatic, dermatological
and immune system diseases) were self-reported and conrmed with
family members, if they were available.
The diagnosis of BPD according to DSM-IV (APA, 1994) was
established by administering the validated Chinese version of the
Structural Clinical Interview for DSM-IV (SCID) (Maei et al., 1997;
Dai et al., 2006). The diagnostic assessment of lifetime comorbid
psychiatric disorders including substance dependence, psychotic dis-
orders, major depression, bipolar disorder, anxiety disorder and
posttraumatic stress disorder (PTSD) was conducted using the vali-
dated Chinese version of the MINI, Version 5.0, to establish DSM-IV
diagnoses (Sheehan et al., 1998; Si et al., 2009).
2.3. Data collection
An advertisement about this study was distributed by the prison
ocers to all inmates. Those who agreed to participate in this study
were screened for eligibility following a detailed explanation about the
purpose, and consent for the study was obtained. The survey of their
socio-demographic and clinical characteristics was completed on a
voluntary basis in a quiet room at the prison before they participated in
the interview for the MINI and SCID. Information on female inmates
current oense and criminal history was collected by a review of the
police records. Index oences were divided into non-violent (e.g.
drug tracking, theft, fraud, prostitution, blackmail or forgery) and
violent crimes (e.g. homicide, assault, robbery, arson, kidnapping and
abduction) for the analyses. Information about family members, such
as drug use and history of psychiatric disorders, were also collected in
the interview and later conrmed with the families, if they were
available.
Prior to the commencement of the study, all interviewers were
trained using a standard training package and attended an inter-rater
reliability exercise. The interviewers' MINI and SCID diagnoses were
compared with the best estimate clinical diagnoses. The kappa values
for the nine interviewers ranged from 0.86 to 0.95, suggesting that the
diagnostic agreement was acceptable.
2.4. Statistical analyses
Data analyses were used by the Statistical Product and Service
Solutions (SPSS) 21.0. The comparison between the BPD and non-BPD
groups with respect to social-demographic and clinical characteristics
201
Psychiatry Research 250 (2017) 200203
were conducted by univariate analysis (two independent samples test
and chi-square test), as appropriate. Multiple logistic regression
analysis with the enter method was used to examine the independent
associations between BPD and demographic and clinical characteris-
tics. BPD was entered as dependent variable, while demographic and
clinical characteristics that signicantly diered in the above univariate
analyses were entered as independent variables. The signicance level
was set at 0.05 (two-tailed).
3. Result
Of the eligible 2916 female inmates, 2709 fullled the study criteria
and completed the study, giving a participation rate 92.9%. The lifetime
prevalence of BPD was 10.6% (288/2709; 95% condence interval [CI]:
9.511.9). In both the BPD and Non-borderline personality disorder
(NBPD) groups the most frequent crime was drug tracking (52.4%
and 35.2%, respectively) followed by homicide (11.8% and 16.7%,
respectively). Table 1 shows the basic socio-demographic and clinical
characteristics of the whole study sample and the comparison between
BPD and NBPD groups. Compared to those without BPD, female
inmates with BPD were younger, had higher education level, and were
more likely to be unmarried, unemployed, and having drug use,
criminal history and more comorbid psychiatric disorders established
by the MINI. In addition, family members of those with BPD were
more likely to have drug use and history of psychiatric disorders. There
were no signicant dierences between two groups with regard to
personal monthly income, nancial perception and current criminal
types.
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, accounting for 20.5% of the variance of BPD (p < 0.001)
(Table 2).
4. Discussion
This is the rst study to determine the lifetime prevalence and
correlates of BPD in female prison inmates in China with systemic
diagnostic instruments. The prevalence of BPD in this study is 10.6%,
which is higher than the gures in the community (1.43.02%)
(Lenzenweger et al., 2007; Trull et al., 2010) in the USA and in clinical
samples (5.8%) in China (Wang et al., 2007), but lower than the results
among female prison samples in developed country, such as in Australia
(26%) (Tye and Mullen, 2006) and in the USA (54.5%) (Black et al.,
2007). There are several possible reasons for such discrepancy across
studies. First, cultural and ethnic factors may contribute to the
dierences in prevalence of BPD. For example, a national survey in
the USA found that native Americans (5.0%) and Blacks (3.5%) had 3 or
4 fold higher prevalence of BPD than Asians (1.2%) (Tomko et al., 2014).
Second, dierent types of prison, such as closed (20%) and semi-open
ones (35%), usually have dierent prevalence of BPD (Black et al., 2007).
Third, dierent diagnostic instruments for BPD were used thus leading
to variable estimation of the rates of BPD.
Similar to previous ndings in other countries (Grant et al., 2008;
Paris, 2009; Tomko et al., 2014), BPD is independently associated with
a number of demographic and clinical characteristics, such as younger
age, unmarried marital status, more frequent unemployment and drug
use. Age was found to be negatively related with BPD in this study. It is
plausible that younger adults are likely to have more impulsivity, a core
clinical features of BDP, than older adults (Galvan et al., 2007; Leshem
and Glicksohn, 2007), which can lead to criminal behavior. Drug use is
often viewed as an accompanying feature of impulsivity in BPD. Earlier
studies found that persons with impulsive tendencies often have higher
risk of drug use (Perry and Carroll, 2008; De Wit, 2009). Unstable
X.-M. Zhu et al. Psychiatry Research 250 (2017) 200203

Table 1
Socio-demographic and clinical data of the study sample.

The whole sample NBPD BPD Statistics

(n=2709) (n=2421) (n=288)

N % N % N % X2 df p

Married 1170 43.2 1096 45.3 74 25.7 40.2 1 < 0.001

Educational Level 13.4 2 0.001
Illiteracy/primary school 1000 36.9 922 38.1 78 27.1
Junior middle school 1049 38.7 922 38.1 127 44.1
Senior middle school and above 660 24.4 577 21.3 83 28.8
Unemployeda 1166 43.0 995 41.1 171 59.4 35.0 1 < 0.001
Financial perception 1.1 2 0.58
poor 1565 57.8 1404 58.0 161 55.9
normal 964 35.6 854 35.3 110 38.2
well 180 6.6 163 6.7 17 5.9
Personal monthly income (yuan) 3.8 1 0.051
1000 1501 55.4 1357 56.1 144 50.0
> 1000 1208 44.6 1064 43.9 144 50.0
Drug use in family members 207 7.6 165 6.8 42 14.6 22.0 1 < 0.001
Family history of psychiatric disorders 163 6.0 131 5.4 32 11.1 14.7 1 < 0.001
Criminal historyb 184 6.8 153 6.3 31 10.8 8.0 1 0.005
Current oense 1.2 1 0.27
Non-violent 1861 68.7 1655 68.4 206 71.5
Violent 848 31.3 766 31.6 82 28.5
Major medical conditions 1408 52.0 1288 53.2 120 41.7 13.7 1 < 0.001
Personal drug use 701 25.9 526 21.7 157 60.8 204.4 1 < 0.001
Lifetime comorbid psychiatric disorders assessed with the MINI 1795 66.3 1539 63.6 256 88.9 73.8 1 < 0.001

Mean SD Mean SD Mean SD T df p

Age (years) 39.8 10.3 40.4 10.3 34.6 8.9 7.6 2707 < 0.001

1USD=6 yuan; BPD=borderline personality disorder; MINI=Chinese version of International Neuropsychiatric Interview; NBPD=Non-borderline personality disorder.
a
Being unemployed prior to their incarceration.
b
Past crimes prior to their incarceration.

inter-personal relationship in BPD is common (Gunderson, 2007), We found that family members of BPD groups had higher rates of
which could explain the high rates of unmarried status in this study. drug use and psychiatric disorders than in the NBPD group. A possible
Unexpectedly, we found a positive association between higher educa- explanation is that family members of individuals with BPD have great
tion and BPD. Considering the average educational level is much lower familial aggregation of impulse spectrum disorders and BPD itself
in this sample than in China nationwide (illiteracy rate: 36.9% vs. (White et al., 2003), which increases the risk of drug use. In this study,
7.3%) (National Bureau of statistics of China, 2013), this nding needs psychiatric disorders in family members of BPD groups were not
to be replicated in future studies. The unemployment rate is 10 times established by diagnostic instruments; therefore we cannot conrm
higher in the current sample compared to the general population in such observation. One study found that family members of BPD
Hunan province, China (43% vs 4.2%) (National Bureau of statistics of individuals had increased prevalence of major depression, anxiety
China, 2014), which may be related to impaired social functions in BPD disorder and suicide (Bandelow et al., 2005), but in another study
(Rendu et al., 2002; Skodol et al., 2002). there was no association between prevalence of schizophrenia and
major depression and family history of BDP (White et al., 2003).
Table 2 As expected, we found that female inmates with BPD had more
Demographic and clinical correlates independently associated with BPD by multiple lifetime comorbid psychiatric disorders established by the MINI. The
logistic regression analysis with the NBPD group as the reference. prevalence (88.9%) in this study is slightly higher than the gure
(82.7%) in community-dwelling BPD sample that only focused on
P value Odds ratio 95% C.I.
mood disorders (Tomko et al., 2014), but lower than that (100.0%) in
Unmarried 0.01 1.4 1.12.0 prisoners sample in the USA (Black et al., 2007). Of the comorbid
Being unemployeda 0.37 1.1 0.81.5 psychiatric disorders in the BPD group, substance dependence was the
Educational level most common (57.6%), which is similar to a previous study (57.4%)
Illiteracy/primary school 1.0
(Trull et al., 2000). The second most common comorbidity was major
Junior middle school 0.88 0.9 0.71.3
Senior middle school and above 0.03 1.4 1.02.1 depression (46.2%), which is much lower than the rate in Swedish male
Drug use in family members 0.02 1.6 1.12.4 oenders (82%) (Wetterborg et al., 2015). The frequency of comorbid
Family history of psychiatric disorders 0.001 2.1 1.33.4 psychotic disorder was only 5.9% in this study since inmates with
Criminal historyb 0.87 1.1 0.71.6
psychotic disorders were rarely admitted to this prison. Furthermore,
Major medical conditions < 0.001 0.5 0.40.7
Personal drug use < 0.001 3.2 2.34.3
comorbid psychiatric disorders may be associated with worse cognitive
Lifetime comorbid psychiatric < 0.001 2.2 1.53.4 impairment and outcomes in BPD (Unoka and Richman, 2016). In a
disorders by MINI UK survey the life expectancy at birth in those with personality
Age < 0.001 0.95 0.940.97 disorder was shorter than in the general population (by 18.7 years
shorter in men and 17.7 years shorter in women (Fok et al., 2012). This
Total model: p < 0.001, R square: 0.205, MINI=Chinese version of International
Neuropsychiatric Interview.
may be related to female inmates with BPD having higher rate of major
a
Being unemployed prior to their incarceration. medical conditions. Unexpectedly, there was a negative relationship
b
Past crimes prior to their incarceration. between major medical conditions and BPD in this study, for which we

202
X.-M. Zhu et al.
have no explanation. This nding needs to be replicated in future
studies.
The results of this study should be interpreted with caution due to
several methodological limitations. First, only inmates in Hunan
provincial Female Prison were included, therefore the ndings could
not be generalized to male inmates and to other parts of China. Second,
due to the cross-sectional design of the study, the causality between
BPD and other variables could not be identied. Third, some variables,
such as major medical conditions and psychiatric disorders in family
members, were self-reported, therefore recall bias could not be
excluded. Finally, further information related to BPD, such as severity
of compulsivity, were not collected.
In conclusion, this prevalence study found that BPD is common in
Chinese female prison inmates. Considering the adverse social con-
sequences of BPD, and its impact on physical and mental health,
serious attempts should be made to screen BPD (Chanen et al., 2008a,
2008b) and improve access to early treatment in women prisons.
Particular attention should be paid to possible risk factors especially
comorbid psychiatric disorders.
Conict of Interest
The authors declare no conict of interest related to the topic of this
study.
Acknowledgment
This study was partly funded by the National Natural Science
Foundation of China (Number: 81571316; 81371500). The authors
thank all participants and prison ocers in Hunan Female Prison for
their contribution to this study.
References
American Psychiatric Association, 2013. Diagnostic and statistical manual of mental
disorders: DSM-5 Arlington, VA.
APA, 1994. Diagnostic and Statistical Manual of Mental Disorders 4th ed. American
Psychiatric Association, Washington.
Bandelow, B., Krause, J., Wedekind, D., Broocks, A., Hajak, G., Rther, E., 2005. Early
traumatic life events, parental attitudes, family history, and birth risk factors in
patients with borderline personality disorder and healthy controls. Psychiatry Res.
134, 169179.
Black, D.W., Gunter, T., Allen, J., Blum, N., Arndt, S., Wenman, G., Sieleni, B., 2007.
Borderline personality disorder in male and female oenders newly committed to
prison. Compr. Psychiatry 48, 400405.
Chanen, A.M., Jovev, M., Djaja, D., McDougall, E., Yuen, H.P., Rawlings, D., Jackson,
H.J., 2008a. Screening for borderline personality disorder in outpatient youth. J.
Pers. Disord. 22, 353364.
Chanen, A.M., Jovev, M., McCutcheon, L.K., Jackson, H.J., McGorry, P.D., 2008b.
Borderline personality disorder in young people and the prospects for prevention
and early intervention. Curr. Psychiatry Rev. 4, 4857.
Chen, Y.-F., 2002. Chinese classication of mental disorders (CCMD-3): towards
integration in international classication. Psychopathology 35, 171175.
Chesney-Lind, M., Pasko, L., 2013. The female oender: girls, women, and crime. Sage.
Dai, Y.F., Xiao, Z.P., Wang, Z., 2006. The reliablity and validity of a Chinese version of
structured clinical interview for DSM-IV personality disorder. Shanghai Arch.
Psychiatry 18, 14.
De Wit, H., 2009. Impulsivity as a determinant and consequence of drug use: a review of
underlying processes. Addict. Biol. 14, 2231.
Fazel, S., Danesh, J., 2002. Serious mental disorder in 23 000 prisoners: a systematic
review of 62 surveys. lancet 359, 545550.
Fok, M.L., Hayes, R.D., Chang, C.K., Stewart, R., Callard, F.J., Moran, P., 2012. Life
expectancy at birth and all-cause mortality among people with personality disorder.
J. Psychosom. Res 73, 104107.
Galvan, A., Hare, T., Voss, H., Glover, G., Casey, B., 2007. Risktaking and the adolescent
brain: who is at risk? Dev. Sci. 10, F8F14.
Grant, B.F., Chou, S.P., Goldstein, R.B., Huang, B., Stinson, F.S., Saha, T.D., Smith, S.M.,
Dawson, D.A., Pulay, A.J., Pickering, R.P., 2008. Prevalence, correlates, disability,
and comorbidity of DSM-IV borderline personality disorder: results from the wave 2
national epidemiologic survey on alcohol and related conditions. J. Clin. Psychiatry
69, 533.
Gunderson, J.G., 2007. Disturbed relationships as a phenotype for borderline personality
disorder. Am. J. Psychiatry.
203
Psychiatry Research 250 (2017) 200203
Kealy, D., Sierra-Hernandez, C.A., Ogrodniczuk, J.S., 2016. Childhood emotional support
and borderline personality features in a sample of Canadian psychiatric outpatients.
Int J. Soc. Psychiatry.
Kjaer, J.N., Biskin, R., Vestergaard, C., Gustafsson, L.N., Munk-Jorgensen, P., 2016. The
clinical trajectory of patients with borderline personality disorder. Pers. Ment.
Health.
Koenig, J., Rinnewitz, L., Parzer, P., Resch, F., Thayer, J.F., Kaess, M., 2016. Resting
cardiac function in adolescent non-suicidal self-injury: the impact of borderline
personality disorder symptoms and psychosocial functioning. Psychiatry Res. 248,
117120.
Kredlow, M.A., Szuhany, K.L., Lo, S., Xie, H., Gottlieb, J.D., Rosenberg, S.D., Mueser,
K.T., 2017. Cognitive behavioral therapy for posttraumatic stress disorder in
individuals with severe mental illness and borderline personality disorder. Psychiatry
Res. 249, 8693.
Lenzenweger, M.F., Lane, M.C., Loranger, A.W., Kessler, R.C., 2007. DSM-IV personality
disorders in the National Comorbidity Survey Replication. Biol. Psychiatry 62,
553564.
Leshem, R., Glicksohn, J., 2007. The construct of impulsivity revisited. Personal. Individ.
Dier. 43, 681691.
Maei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah, D., Namia, C.,
Novella, L., Petrachi, M., 1997. Interrater reliability and internal consistency of the
structured clinical interview for DSM-IV axis II personality disorders (SCID-II),
version 2.0. J. Personal. Disord. 11, 279284.
National Bureau of statistics of China, 2013. China Statistical Yearbook. China Statistical
Press, Beijing.
National Bureau of statistics of China, 2014. China Statistical Yearbook. China Statistical
Press, Beijing.
Paris, J., 2008. Personality disorders over time: precursors, course, and outcome.
American Psychiatric Pub..
Paris, J., 2009. The treatment of borderline personality disorder: implications of research
on diagnosis, etiology, and outcome. Annu. Rev. Clin. Psychol. 5, 277290.
Perry, J.L., Carroll, M.E., 2008. The role of impulsive behavior in drug abuse.
Psychopharmacology 200, 126.
Quirk, S.E., Berk, M., Pasco, J.A., Brennan-Olsen, S.L., Chanen, A.M., Koivumaa-
Honkanen, H., Burke, L.M., Jackson, H.J., Hulbert, C., C, A.O., Moran, P., Stuart,
A.L., Williams, L.J., 2016. The prevalence, age distribution and comorbidity of
personality disorders in Australian women. Aust. N. Z. J. Psychiatry.
Rendu, A., Moran, P., Patel, A., Knapp, M., Mann, A., 2002. Economic impact of
personality disorders in UK primary care attenders. Br. J. Psychiatry 181, 6266.
Sansone, R.A., Lam, C., Wiederman, M.W., 2012. The relationship between illegal
behaviors and borderline personality symptoms among internal medicine
outpatients. Compr. Psychiatry 53, 176180.
Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E.,
Hergueta, T., Baker, R., Dunbar, G.C., 1998. The Mini-International
neuropsychiatric Interview (M.I.N.I.): the development and validation of a
structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin.
Psychiatry 59 (Suppl 20), 2233, (quiz 34-57).
Si, T.M., Shu, L., Dang, W.M., Su, Y.A., Chen, J.X., Dong, W.T., Kong, Q.M., Zhang, W.H.,
2009. Evaluation of the reliability and validity of Chinese version of the Mini
International neuropsychiatric Interview in patients with mental disorders (in
Chinese). Chin. Ment. Health J. 23, 493503.
Skodol, A.E., Gunderson, J.G., McGlashan, T.H., Dyck, I.R., Stout, R.L., Bender, D.S.,
Grilo, C.M., Shea, M.T., Zanarini, M.C., Morey, L.C., 2002. Functional impairment in
patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality
disorder. Am. J. Psychiatry.
Solo, P.H., Abraham, K., Burgess, A., Ramaseshan, K., Chowdury, A., Diwadkar, V.A.,
2016. Impulsivity and aggression mediate regional brain responses in Borderline
Personality Disorder: an fMRI study. Psychiatry Res. 260, 7685.
Tomko, R.L., Trull, T.J., Wood, P.K., Sher, K.J., 2014. Characteristics of borderline
personality disorder in a community sample: comorbidity, treatment utilization, and
general functioning. J. Personal. Disord. 28, 734.
Trull, T.J., Sher, K.J., Minks-Brown, C., Durbin, J., Burr, R., 2000. Borderline personality
disorder and substance use disorders: a review and integration. Clin Psychol. Rev.
20, 235253.
Trull, T.J., Jahng, S., Tomko, R.L., Wood, P.K., Sher, K.J., 2010. Revised NESARC
personality disorder diagnoses: gender, prevalence, and comorbidity with substance
dependence disorders. J. Personal. Disord. 24, 412.
Tye, C.S., Mullen, P.E., 2006. Mental disorders in female prisoners. Aust. N.Z. J.
Psychiatry 40, 266271.
Unoka, Z., Richman, M.J., 2016. Neuropsychological decits in BPD patients and the
moderator eects of co-occurring mental disorders: a meta-analysis. Clin. Psychol.
Rev. 44, 112.
Wang, L.L., Zhang, T., H., Xiao, Z.P., 2007. A survey of the comorbidity of borderline
personality disorder amony psychiatric at Shanghai mental health center. Shanghai
Arch. Psychiatry 19, 136139.
Wetterborg, D., Langstrom, N., Andersson, G., Enebrink, P., 2015. Borderline personality
disorder: prevalence and psychiatric comorbidity among male oenders on
probation in Sweden. Compr. Psychiatry 62, 6370.
White, C.N., Gunderson, J.G., Zanarini, M.C., Hudson, J.I., 2003. Family studies of
borderline personality disorder: a review. Harv. Rev. Psychiatry 11, 819.
Zanarini, M.C., Horwood, J., Wolke, D., Waylen, A., Fitzmaurice, G., Grant, B.F., 2011.
Prevalence of DSM-IV borderline personality disorder in two community samples:
6330 English 11 year-olds and 34,653 American adults. J. Pers. Disord. 25,
607619.