Psychosomatics 44:442, October 2003
© 2003 The Academy of Psychosomatic Medicine
Disability and Borderline Personality Symptoms
Randy A. Sansone, M.D.,
Judith Hruschka, M.D.,
Archana Vasudevan, M.D., Miamisburg, Ohio, and
Stephanie N. Miller, Muncie, Ind.
TO THE EDITOR: The relationship between disability and borderline personality symptoms has undergone limited study. However, cluster B personality disorders have been associated with an earlier age of work disability,1 and borderline personality has been associated with failure to return to work.2 Among studies examining general personality pathology, the relationship between personality disorders and disability has been equivocal.
Using a sampling method of convenience, we recruited men and women, age 18 and older, who were seen for nonemergent services at a medical outpatient clinic. Exclusion criteria were cognitive or medical impairment that would preclude participation. Of the 68 individuals approached, 53 agreed to participate (response rate=78%), although only 45 individuals provided complete data sets.
Each participant completed a research booklet that explored demographic information, disability history, and borderline personality symptoms with two self-report questionnaires: the borderline personality scale of the Personality Diagnostic Questionnaire—4,3 a 9-item, true/false version of the DSM-IV criteria for borderline personality, and the Self-Harm Inventory,4 a 22-item, yes/no measure that diagnoses borderline personality with an accuracy rate of 84%. The institutional review boards of the community hospital and university approved this project; all participants provided written informed consent.
The study group consisted of 35 women (78%) and 10 men, ages 20 to 82 years (mean=44.98, SD=12.66); five participants did not report their ages. Approximately 42% were married, 31% single, 24% separated or divorced, and 2% widowed. Approximately 87% were Caucasian, 11% African American, and 2% Native American. Seven patients (16%) had completed at least a college degree.
A comparison of the groups with and without a history of disability with regard to the demographic variables revealed that the two groups did not differ significantly. Using a chi-square analysis, we found that a significantly larger proportion of the disabled group (56%) met criteria for borderline personality symptoms on the Personality Diagnostic Questionnaire—4 than the nondisabled group (19%) ( 2=6.67, df=1, p=0.01). Similarly, more of the disabled group (39%) met the criteria for borderline personality symptoms on the Self-Harm Inventory than the nondisabled group (19%), although this difference was not statistically significant (2=2.29, df=1, p=0.13). Examining the number of measures for which participants met the criteria for borderline personality symptoms (0–2), we found that the disabled patients were most likely to meet the criteria for one measure (28% versus 50% versus 22%, respectively), while the nondisabled patients were most likely not to meet the criteria for either of the measures (74% versus 15% versus 11%) (2=9.65, df=2, p=0.008).
In conclusion, we found a relationship between disability and borderline personality symptoms (72% of the disabled versus 26% of the nondisabled participants met the criteria on at least one of the two measures). Disability may be linked with these individuals' unconscious tendency to reestablish their life roles as victims. Limitations of this study include the small group size, use of self-report measures, and the lack of differentiation between psychiatric and medical disability.
REFERENCES
- Ekselius L, Eriksson M, von Knorring L, Linder J: Personality disorders and major depression in patients with somatoform pain disorders and medical illnesses in relation to age at onset of work disability. Eur J Psychiatry 1996; 10:35–43
- Burton K, Polatin PB, Gatchel RJ: Psychosocial factors and the rehabilitation of patients with chronic work-related upper extremity disorders. J Occup Rehabil 1997; 7:139–153
- Hyler SE: Personality Diagnostic Questionnaire—4 (PDQ-4). New York, New York State Psychiatric Institute, 1994
- Sansone RA, Wiederman MW, Sansone LA: The Self-Harm Inventory (SHI): development of a scale of identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol 1998; 54:973–983[CrossRef][Medline]
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