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

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.