Litigious History and Borderline Personality Symptomatology

Litigious History and Borderline Personality Symptomatology

To the Editor: Patients with borderline personality disorder are frequently overrepresented in civil, criminal, and child custody cases in a defensive posture because of their self-regulation and interpersonal difficulties.1 However, victimization in adulthood has been described as a “basic theme” in borderline personality disorder,2(p46) and we wondered about the inclination of such patients to initiate legal proceedings (ie, to be litigious).

Method. Participants were men and women, aged 18 years or older, being seen at an internal medicine outpatient clinic by resident providers for non-emergent medical care. The recruiter excluded individuals with compromising symptoms of a severity that would preclude the candidate’s ability to successfully complete a survey (n = 62).

Of the 480 individuals approached, 369 agreed to participate (participation rate of 76.9%). Of these, 336 completed the relevant study measures; 228 (67.9%) were women, 106 (31.5%) were men, and 2 (0.6%) did not indicate sex. Participants ranged in age from 18 to 90 years (mean = 50.09, SD = 15.71). Most were white/Caucasian (86.2%), followed by African American (9.3%). All but 7.6% had at least graduated from high school, whereas 29.9% had earned a 4-year college degree or higher.

During clinic hours, one of the authors (J.S.L.) positioned in the clinic lobby, approached consecutive incoming patients, and informally assessed exclusion criteria. With candidates, the recruiter reviewed the project and then invited each to complete a 6-page survey that consisted of (1) a demographic query, (2) an author-developed litigation history (litigious queries as well as the need for legal defense), and (3) 2 self-report measures for borderline personality disorder symptomatology—the borderline personality scale of the Personality Diagnostic Questionnaire-43 and the Self-Harm Inventory.4

This project was reviewed and exempted by the institutional review boards of the community hospital and university. Survey completion was assumed to function as implied consent (explicitly clarified on the cover page of the booklet). Data were collected in October 2011.

Results. Ninety-one respondents (27.1%) exceeded the clinical cutoff score on at least 1 of the 2 measures of borderline personality disorder symptomatology (42 of whom exceeded the cutoff score on both measures). Both subgroups were compared to those respondents who did not exceed the clinical cutoff score on either measure of borderline personality disorder (see Table 1).

Contrary to our hypothesis, patients with borderline personality disorder symptomatology were no more likely to initiate a lawsuit than those without borderline personality disorder symptomatology. However, the former subsample was more likely to contact a lawyer to defend themselves—a finding supported by the current literature.

This study has a number of potential limitations (eg, self-report nature of the litigation data; use of self-report measures for borderline personality disorder, which may be overinclusive; risk of data bias due to the low socioeconomic status of participants, who may not be able to afford a lawyer except to defend themselves). However, to our knowledge, this is the first study to examine litigiousness in borderline personality disorder. In this study, we found no differences in litigiousness between patients with versus without borderline personality disorder symptomatology.

References

1. Reid WH. Borderline personality disorder and related traits in forensic psychiatry. J Psychiatr Pract. 2009;15(3):216-220. PubMed doi:10.1097/01.pra.0000351882.75754.0c

2. Kroll J. The Challenge of the Borderline Patient: Competency in Diagnosis and Treatment. New York, NY: WW Norton & Co; 1988.

3. Hyler S. Personality Diagnostic Questionniare-4. New York, NY: New York State Psychiatric Institute; 1994.

4. Sansone RA, Wiederman MW, Sansone LA. The Self-Harm Inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psychol. 1998;54(7):973-983. PubMed doi:10.1002/(SICI)1097-4679(199811)54:7<973::AID-JCLP11>3.0.CO;2-H

Randy A. Sansone, MD

[email protected]

Justin S. Leung, BA

Michael W. Wiederman, PhD

Author affiliations: Departments of Psychiatry and Internal Medicine (Dr Sansone), Wright State University School of Medicine (Mr Leung), Dayton, Ohio; Department of Psychiatry Education, Kettering Medical Center (Dr Sansone), Kettering, Ohio; and Department of Human Relations, Columbia College, Columbia, South Carolina (Dr Wiederman).

Potential conflicts of interest: None reported.

Funding/support: None reported.

Published online: December 27, 2012.

Prim Care Companion CNS Disord 2012;14(6):doi:10.4088/PCC.11l01325

© Copyright 2012 Physicians Postgraduate Press, Inc.