Charlene Lam

The relationship between illegal behaviors and borderline personality symptoms among internal medicine outpatients

BACKGROUND In psychiatric dysfunction, illegal behaviors are frequently associated with the traditional prison personality antisocial personality disorder. However, some empirical data indicate that illegal behaviors may also be associated with borderline personality, which is the focus of the present study. METHOD Using a cross-sectional sample of consecutive internal medicine outpatients from a resident-provider clinic, we examined relationships between 27 illegal behaviors as delineated by the Federal Bureau of Investigations crime-cataloguing schema and 2 measures of borderline personality disorder (BPD), the BPD scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory. RESULTS The overall correlations between BPD and the number of the 27 illegal behaviors endorsed were r = 0.32 (P < .001, n = 375) for the Personality Diagnostic Questionnaire-4 and r = 0.47 (P < .001, n = 372) for the Self-Harm Inventory. Six specific illegal behaviors were endorsed by at least 12 participants each, and analyses indicated associations for each of these illegal behaviors with BPD (ie, aggravated and simple assault, disorderly conduct, driving under the influence, drug abuse violations, public drunkenness/intoxication). These 6 behaviors may be interrelated through alcohol/substance use. Participants who were male and younger were more likely to report having engaged in a greater number of different illegal behaviors. CONCLUSIONS There appear to be associations between illegal behaviors and BPD, particularly in relation to alcohol/substance abuse and in young men.

Borderline Personality Disorder and Reckless Driving

To the Editor: Borderline personality disorder (BPD) is characterized by pervasive impulsivity. Reckless driving, one potential form of impulsivity, is implicated in a number of diagnostic approaches to BPD, including the DSM, yet empirical studies both suggest and dispel associations between BPD and reckless driving. In the present study, we examined in a consecutive sample of primary care outpatients the relationship between BPD and selfreported driving citations.

Victims of bullying in childhood, criminal outcomes in adulthood

Abstract Objective. Being bullied in childhood is empirically associated with a number of negative psychosocial outcomes, including delinquency. However, no study to date has examined in a clinical population relationships between being bullied in childhood and accruing charges for criminal behavior in adulthood – the focus of the present study. Method. In this cross-sectional study of 377 consecutive outpatients from an internal medicine clinic, we examined relationships between three self- reported bullying variables and self-reported charges for any of 27 criminal behaviors as schematized by the Federal Bureau of Investigation. Results. In this sample, approximately 45% of participants self-reported being victims of bullying in childhood. Men, but not women, evidenced relationships between being a victim of bullying in childhood and the number of different illegal charges reported in adulthood. Conclusions. Although the methodology of this study does not allow for the determination of a causal relationship, findings suggest that being a victim of bullying in childhood may be associated with criminal behavior in adulthood, particularly among males.

Driving citations: Relationships with criminal behavior

Objective: The purpose of the present study was to examine relationships, if any, between the number of lifetime driving citations and the number of lifetime criminal charges. Methods: Using a cross-sectional, consecutive sample of internal medicine outpatients and a self-report survey methodology, we queried participants about the number of past driving citations as well as charges for any of 27 criminal behaviors as delineated by the crime cataloguing schema of the Federal Bureau of Investigation. Results: Scores on the measure of driving citations were positively correlated with scores on the measure of different forms of illegal behavior (r = .39, p < .001). Additional analyses indicated that the relationship between driving citations and illegal behaviors did not vary by sex. Conclusions: Though the receipt of driving citations is fairly common, an increasing number of driving citations demonstrates a relationship with criminal behavior. This relationship may be mediated by a number of psychological variables, including various Axis I and II disorders.

History of Attempted Suicide and Reckless Driving: A Cross-Sectional Study in Primary Care

OBJECTIVE In this study, we explored whether a past history of suicide attempts is associated with a history of reckless driving (ie, driving citations). METHOD Using a cross-sectional design in a consecutive sample of primary care outpatients from a suburban setting in Ohio, we surveyed men and women (N = 419), aged 18-65 years, who were seeking nonemergent medical care during April 2009. With yes/no response options, we queried participants about whether they (1) had ever attempted suicide and (2) had tried to hurt or kill themselves. We also asked if they had ever been cited for any of 29 driving violations. After the elimination of participants who responded illogically to the 2 items exploring suicide attempts, the working sample was reduced to 377 participants. RESULTS According to statistical analyses, compared to participants who did not acknowledge histories of suicide attempts (n = 337), participants who acknowledged histories of suicide attempts (n = 40) were no more likely to report a greater number of different types of moving violations or automobile/motorcycle accidents (ie, high-risk driving behaviors). However, participants with past suicide attempts reported a statistically significantly greater number of different types of nonmoving violations (P = .001) as well as being cited for leaving the scene of an accident (P = .05), driving while intoxicated (P = .001), and having a drivers license revoked (P = .001) than those without past attempts. CONCLUSIONS While a past history of suicide attempts does not appear to overtly predict reckless driving behavior, there appear to be other associated and specific problematic driving behaviors.

Self-Harm Behaviors in Borderline Personality: An Analysis by Gender

A number of authors have examined gender differences in patients with borderline personality disorder. Current data suggest that for some clinical features, there appear to be genuine gender differences, whereas for other clinical features, there are not apparent differences. In this study, we examined by gender 22 self-harm behaviors in 61 internal medicine outpatients with borderline personality symptomatology. We found that only 2 self-harm behaviors were statistically significantly more common in one of the sexes—head-banging and losing a job on purpose, with both being more common in men. These findings appear to mirror the existing literature—i.e., that there may be some genuine gender differences with regard to specific self-harm behaviors, but the majority of self-harm behaviors overlap between the sexes.

Prevalence of criminal behaviors in an internal-medicine-resident clinic population.

Objective: Few, if any, US studies have examined rates of criminal behaviors among patients in clinical samples. According to findings from non-US studies, mostly in psychiatric samples, rates of criminal behavior are higher than in the general population. In this study, we examined the prevalence of criminal behaviors in an internal medicine outpatient sample from a resident-provider clinic. Method: In a consecutive sample of internal medicine outpatients, 380 participants were surveyed in October of 2010 regarding 27 criminal offenses as delineated by the crime categorization schema used by the Federal Bureau of Investigation. Results: In this sample, 22.1% reported at least one criminal charge. The most commonly self- reported criminal charge was driving under the influence of alcohol or drugs (10.3%), followed by disorderly conduct (7.1%), drug abuse violations (5.8%), simple assault (5.3%), drunkenness (4.5%), and aggravated assault (3.2%). Conclusions: Like previous non-US studies among psychiatric samples, there appears to be a higher prevalence of criminal behavior among outpatients in an internal medicine training clinic than in the general population. These behaviors may be inter-related through alcohol/substance-use disorders.

History of attempted suicide and the medical review of systems

Previous studies indicate relationships between borderline personality disorder, characterized by chronic selfharm behaviour, and somatic preoccupation. 1 Therefore, we hypothesized a relationship between a history of suicide attempts and multiple somatic symptoms in the context of a medical review of systems (ROS). Participants were male and female outpatients, aged 18 or older, seen in a resident-provider internal medicine clinic. We excluded individuals with medical or other symptoms that would preclude their ability to complete a survey. Of 471 individuals approached, 417 (88.5%) agreed to participate; 367 completed all study measures – 124 male and 243 female, aged 19–97 years (M = 50.13, SD = 15.46). Most (88.0%) were White (African American, 7.9%; Other, 2.2%; Hispanic, 1.1%; Asian, 0.8%), with 6.6% reporting less than a high school diploma and 28.7% a bachelor’s degree or higher. One author positioned in the clinic lobby, approached incoming patients, assessed exclusion criteria, reviewed the project and invited each to complete an anonymous survey. The survey consisted of: (i) a demographic query; (ii) a query about a past history of suicide attempts (‘Have you ever intentionally, or on purpose, attempted suicide?’) and (iii) the presence or not of 35 general medical symptoms (i.e. one clinical version of a ROS) adapted from Sinsky; 2 items were preceded by the statement, ‘Have you experienced any of the following symptoms in the past week?’, with yes/no response options. The project was approved by two institutional review boards and completion of the survey was assumed to be implied consent (clarified on the survey cover page). Forty-nine (13.4%) participants indicated suicide attempts. The number of endorsed ROS symptoms ranged 0–32 (M = 6.87, SD = 5.95), with 89.9% endorsing at least one symptom. The mean number of such symptoms was greater for those who indicated a history of attempted suicide (M = 10.29, SD = 7.40) compared with those who denied such a history (M = 6.35, SD = 5.53), [F(1,365) = 19.50, P < 0.001]. Age was inversely related to the total number of symptoms endorsed (r = -0.12, P < 0.05), and those who indicated a history of attempted suicide were younger (M = 41.83, SD = 13.15) compared with those who denied such a history (M = 51.40, SD = 15.41), [F(1,361) = 16.63, P < 0.001]. However, history of attempted suicide remained a statistically significant predictor [F(1,360) = 15.84, P < 0.001] of the total number of symptoms endorsed even when age was entered as a covariate. In this sample of internal medicine outpatients, past suicide attempts were associated with a greater number of current physical symptoms – a finding that we believe is unique to the current literature. If valid, multiple current somatic symptoms might be an indistinct marker for past suicide attempts.

Relationship Between Rages and Criminal Behavior in an Internal Medicine Outpatient Sample

To the Editor: To our knowledge, the relationship between episodes of rage and past criminal behaviors has not been explored. Toward this end, we conducted a survey in which the participants were adults seen at an outpatient internal medicine clinic staffed predominantly by residents.

Hair‐pulling and borderline personality symptomatology among internal medicine outpatients

and common viruses were negative. Active tuberculosis was excluded after tuberculin skin test and T-spot test. According to the criteria defined by an international consensus statement of experts, the patient was diagnosed as primary antiphospholipid syndrome (APS) with PE and was treated with low molecular weight heparin followed by warfarin alone. The fever settled over one week and the patient was discharged on warfarin. The serum anticardiolipin IgG remained high positive 3 months later. APS is a prothrombotic disorder predisposing to thrombocytopaenia, recurrent pregnancy morbidity, or thrombosis. It can be divided into primary APS when it occurs alone and secondary APS when it occurs in association with other conditions. In this case, the only autoimmune antibody detected was anticardiolipin, and no evidence of infections was found. Although rare, isolated fever can be a symptom of primary APS. For this patient, persistent fever (over 39°C) unresponsive to anti-bacterial therapy was the major clinical manifestation. Anticardiolipin antibodies and D-dimer were strongly positive and an embolic disorder was therefore suspected. The patient responded well to the anticoagulant treatment, and the fever settled. We recommend that patients with an unexplainable persistent fever should be screened for primary APS and PE by testing for antiphospholipid antibodies and D-dimer.