Borderline personality in serious delinquents.

Seventy-one seriously delinquent adolescents (40 male, 31 female) were evaluated by two of the authors (an interviewer and an observer) using the Social Adaptation and Interpersonal Relations sections of the DIB (Diagnostic Interview for Borderlines) in combination with the SADS (Schedule for Affective Disorders and Schizophrenia). DIB scores and DSM-III diagnoses were assigned to each subject by the consensus of the two evaluators. Twenty-six subjects received a primary DSM-III diagnosis of borderline personality disorder. Nineteen (73%) of these subjects were also identified as borderline by the DIB. The DIB was generally successful in differentiating the DSMIll borderlines from subjects with other DSM-III diagnoses on DIB total, subscale and statement scores. Subjects with a DSM-III diagnosis of major affective disorder were frequently inappropriately categorized as borderline by the DIB, however, reasons for the difficulty of the DIB in distinguishing delinquent adolescents with borderline personalities from those with major affective disorder are discussed, comparisons with adult studies using the DIB are made and directions for future research are indicated. T HERE has been a great deal of interest in borderline phenomena in adolescence.12*‘3~‘7 To date, studies have focused primarily on the identification of psychodynamic factors important in the genesis of these conditions and their treatment with psychotherapy.r4*r8,r9 Because of the limitations of this investigatory approach, basic questions about borderline phenomena in adolescence remain unanswered. These questions include: (1) Can adolescent borderlines be reliably diagnosed using methods and diagnostic criteria developed for establishing the diagnosis in adults?; and (2) What relationships exist between the borderline diagnosis in adolescence and major affective disorders, schizophrenia and other character disorders? Previous studies of delinquent adolescents have concluded that borderline conditions make a significant contribution to the psychopathology seen in this group.‘5,24 Offer, Marohn and 0strowr5 in their study of psychiatrically hospitalized delinquents described four personality types which defined their sample. Two of these personality types were borderline, the empty borderline and the depressed borderline. In another study also designed to define personality types, Taylor-Gibbs24 found borderline personality to be a frequent type in her sample of delinquent girls. Other current studies of delinquent populations2~‘~r0~” have found that both major affective disorder and schizophrenia or “schizophrenic spectrum” symptoms occur with high frequency in these adolescents. These studies suggest that in addition to borderline conditions, delinquent adolescents exhibit a wide range of psychopathology. Studies of borderline phenomena in adults have been more systematic than those in adolescents.3*6J6 The Diagnostic Interview for Borderlines (DIB)9 is currently in From the Children’s Psychiatric Hospital, University of Michigan Hospitals, Ann Arbor, Michigan. Address reprint requests to Michael McManus, MD, Children’s Psychiatric Hospital, University of Michigan Hospitals. 1275 N. Hospital Drive, Box 52, Ann Arbor, MI 48109. @I984 by Grune & Stratton, Inc. OOIO-440X/84/2504-07~01.00/0 446 Comprehensive Psychiatry, Vol. 25, No. 4, (July/August) 1984 BORDERLINE PERSONALITY IN DELINQUENTS 447 wide use for the diagnosis of borderline conditions in adults. A semistructured interview, the DIB directs questions at five areas (social adaptation, impulsivity, affect, psychosis and interpersonal relations) in which borderline symptoms are likely to be found. In the studies of Gunderson”h and in replication studies by Soloff’“,” the DIB has been shown to adequately differentiate borderline subjects from those with schizophrenia, major affective disorders and “neurotic” depression. In a study of the intersection of DIB and DSM-III definitions of the borderline diagnosis, Kroll et a1.8 found that 80% of the subjects identified by the DSM-III as borderline were also identified as borderline by the DIB. Together these studies indicate that while further research is needed before the borderline diagnosis is fully validated, the DIB has proven to be a useful and reliable research instrument. The current study, which is part of a larger study of psychopathology in seriously delinquent adolescents, was designed to generate pilot data regarding the diagnosis of borderline conditions in adolescents. Structured interview techniques are utilized and the relationship between DIB defined and DMS-III defined borderline conditions is examined. MATERIALS AND METHODS Subjects in this study were delinquent adolescents housed in the training school system m the State of Michigan. Males were chosen from two programs designed for the serious offender. The total population of these programs at the time of the study was 120. Female subjects were chosen from the State’s only residential facility for delinquent girls, with a total population of 60. Subjects were selected based on a set of criteria designed to identify the most serious and recidivistic juvenile offenders. These criteria included: (1) commission of violent felonies (murder, rape, armed robbery, felonious assault. arson or kidnapping), (2) commission of multiple (three or more) non-violent felonies, (3) multiple placements in the training school system, and (4) assaultive in-program behavior which required that the victim receive medical attention. Subjects were considered appropriate for evaluation if they met at least two of these criteria. Felonies were recorded only if the subject had been adjudicated for the offense. No subject was included who had been in-program less than one month. All subjects were seen by two of the authors (an interviewer and an observer) in a structured interview format. The interview consisted of two parts. the first being the Social Adaptation and Interpersonal Relations sections of the Diagnostic Interview for Borderlines (DIB),’ the second being the Schedule for Affective Disorders and Schizophrenia (SADS).?L The use of the Social Adaptation and Interpersonal Relations section of the DIB allowed the interviewer to obtain specific information about the subject’s school performance and relationships with others. The SADS permitted the interviewer to inquire about specific psychiatric symptomatology, both current and past. Following the completion of the interview. DSM-III diagnoses were assigned based on the consensus of the two examiners. In all cases. one diagnosis was designated as a primary diagnosis, indicating that based on the clinical judgment of the authors, this diagnosis was the major contributor to the pattern of psychiatric symptomatology seen at the time of the evaluation. The remaining three sections of the DIB (impulse. affect, psychosis) which had not been completed during the interview were then scored. based on information generated durmg the interview. DIB scoring generated a DIB total score, 5 scaled section scores from the social adaptation. etc. sections and 29 statement scores.