Psychiatry

Helping female inmates cope with borderline personality disorder

Female detainees who suffer from borderline personality disorder often have disturbing crises that affect their fellow inmates. Their self-destructive and suicidal behaviour can require emergency intervention from frontline workers, which sometimes does little more than exacerbate their distress.

To address the needs of these women, the Institut Philippe-Pinel opened a treatment and evaluation unit last May. This 15-bed clinic, under federal jurisdiction, receives Quebec detainees as well as prisoners referred from other regions in Canada. “We have three major mandates. Firstly, we evaluate detainees, upon request by the prison. We also treat women in crisis,” states Dr. Renée Fugère, in charge of the clinic and Associate Professor in the Université de Montréal’s Department of Psychiatry. Lastly, the clinic offers a program for women suffering from borderline personality disorder that employs dialectic behavioural therapy based on the model developed by Marsha Linehan.

Inmates receiving care at the Institut Philippe-Pinel clinic have come of their own volition. Some suffer from an anti-social personality disorder, but most have been diagnosed with borderline personality disorder, or BPD. “Women with borderline personality disorder have very little internal structure and difficulty controlling their emotions,” explains Dr. Fugère. “They are often extreme in their relationships or behaviour. They fear abandonment and cling to people with whom they have a personal relationship. They constantly push the limits with their friends and partners. Since they have a poor self-image, emotional outbursts often lead to self-destructive or suicidal behaviour. They can also be violent towards others.”

Other symptoms of the disorder include occasional disconnects with reality, particularly in stressful situations, and gender identity problems. While BPD patients are clear on their sexual preference, they may question their identity as a man or a woman.

While psychiatrists view borderline personality disorder as an adult phenomenon, it is possible to detect certain temperaments in children that could develop into BPD, such as according to Dr. Fugère, behavioural problems and extreme anger. “They are often cruel toward their peers, adults or animals. They put themselves into dangerous situations, for example, drive dangerously, abuse drugs or have unprotected sex with several sexual partners.”

The scientific community is divided over the cause of BPD. “Some specialists believe that the disorder is caused by psychosocial factors while others consider it a genetic condition,” states Dr. Fugère. More recent theories argue that it is a combination of the two, a biopsychosocial disease that is caused by both genetic predisposition and environment.