Global prevalence of borderline personality disorder and self-reported symptoms of adults in prison: A systematic review and meta-analysis

The prevalence of borderline personality disorder (BPD) in the general population is estimated to be 1.8 % whereas the rates of BPD among people in prison have been reported between 9 and 30 %. To date, there are no published systematic reviews into the rates of BPD among adults in prison. Understanding the prevalence of BPD in this setting can help to inform prison-staff education, funding and intervention options, and adequate care for an already at-risk population. We aimed to explore the global prevalence of BPD diagnoses and self-reported symptomology among adults in prisons via systematic review and meta-analysis. We also aimed to explore gender differences between women and men in prison. Following the PRISMA guidelines, we conducted a systematic review and meta-analysis of papers where a BPD diagnosis or self-reported symptoms were reported within a prison population of male or female adult offenders (18+ years). Our search yielded 33 studies comprising diagnostic interviews, and 15 studies which included self-reported symptom measures. The results indicated that for women and men in prison, the prevalence of BPD was (27.4 % and 18.8 %, respectively) when assessed via diagnostic interview. Results were similar for both women and men in studies that used a self-report measure to assess a BPD diagnosis (29.1 % and 16.4 %). Findings suggest that the prevalence of BPD in prisons should be considered when making decisions about mental health and criminogenic interventions. Self-report measures could be a resource-efficient method for screening prisoners for personality pathology in prison settings. Contemporary, well-structured, large-scale studies are required to better understand the prevalence of personality disorder in prisons.