Psychopathy, Borderline Personality Disorder, and Substance Use in Incarcerated Females

AuthorKent A. Kiehl,J. Michael Maurer,Bethany G. Edwards,Carla L. Harenski
Published date01 December 2021
Date01 December 2021
Subject MatterArticles
CRIMINAL JUSTICE AND BEHAVIOR, 2021, Vol. 48, No. 12, December 2021, 1732 –1748.
Article reuse guidelines:
© 2021 International Association for Correctional and Forensic Psychology
The Mind Research Network (MRN), Albuquerque, NM, USA
University of New Mexico, Albuquerque, NM, USA
The Mind Research Network (MRN), Albuquerque, NM, USA
The Mind Research Network (MRN), Albuquerque, NM, USA
The Mind Research Network (MRN), Albuquerque, NM, USA
University of New Mexico, Albuquerque, NM, USA
Psychopathy and borderline personality disorder (BPD) are commonly associated with an increased propensity toward sub-
stance use. However, few studies have accounted for shared variance between psychopathy and BPD when examining rela-
tionships with unique forms of substance use, particularly in justice-involved females. This study investigated psychopathic
and BPD traits in relation to alcohol and drug use in a sample of 274 incarcerated adult females. Results revealed that psy-
chopathic and BPD traits were differentially related to alcohol and drug use. Specifically, unique variance in BPD traits was
related to alcohol use, whereas unique variance in lifestyle-antisocial psychopathic traits was related to drug use. Findings
support unique relationships between psychopathic and BPD traits and problematic and prolonged alcohol and drug use in
incarcerated adult females. Results may inform methods of tailoring specific substance use treatments for use in females with
distinct personality profiles.
Keywords: psychopathy; personality; alcohol; substance use; incarcerated females
Substance use is estimated to cost the United States $740 billion dollars annually
(National Drug Intelligence Center, 2011; National Institute on Drug Abuse, 2017). It
places significant burden on the criminal justice system, with roughly 85% of incarcerated
persons having histories of substance use and/or being imprisoned for a substance-related
reason (The National Center on Addiction and Substance Abuse at Columbia University,
AUTHORS’ NOTE: We would like to thank the New Mexico Corrections Department for their support in
making this research possible. Data collection for this project was funded in part by the National Institutes of
Health across R01MH085010, R01DA026964, and R01DA020870 (PI: Kent A. Kiehl). Correspondence con-
cerning this article should be addressed to Kent A. Kiehl, The Mind Research Network, 1101 Yale Blvd NE,
Albuquerque, NM 87106; e-mail: The National Institute of Health has provided stipend sup-
port for Bethany G. Edwards (F31DA047048). The content in this manuscript is the responsibility of the
authors and does not necessarily represent the official views of the National Institutes of Health.
1033336CJBXXX10.1177/00938548211033336Criminal Justice and BehaviorEdwards et al. / Short Title
2010). Drug policy changes have led to drastic increases in substance-related offending.
Despite consequences across gender, these changes have disproportionately affected
females, causing some to describe the “War on Drugs” as the “War on Women” (Chesney-
Lind & Pasko, 2004; Javdani et al., 2011b). In fact, in 2017, the most serious offense for
28% of incarcerated females was substance-related, while the same was true for only 15%
of incarcerated males (Carson, 2020). Accordingly, research on risk factors for substance
use in females holds notable implications for the criminal justice system.
Substance use is commonly implicated in female pathways to offending (Bloom et al.,
2004; Broidy et al., 2018). The feminist pathways literature has shown that relative to males,
females likely have distinct paths to offending and recidivism (Chesney-Lind & Pasko,
2013). This work sheds light on interacting psychosocial factors (e.g., trauma, mental ill-
ness, substance use, relational dysfunction) that are particularly relevant to female involve-
ment in the system (Chesney-Lind & Pasko, 2013). Specifically, the pathways perspective
posits that early trauma indirectly relates to offending via status offenses, psychopathology,
and substance use (Benedini & Fagan, 2020; Bozzay et al., 2020). Accordingly, substance
use likely plays a more integral role in understanding offending in females than males, as
females may engage in substance use to cope with trauma and psychopathology (Chesney-
Lind & Pasko, 2013; Moe, 2006). Substance use reflects direct and indirect routes into the
system. As for the latter, females report being under the influence of substance(s) during
offenses and/or engaging in crime (e.g., prostitution) to support their use (Carson, 2015;
Young & Boyd, 2000). Substance use also contributes to high recidivism rates, also referred
to as a revolving prison door, in females (Scott et al., 2014).
Researchers have expanded their view of female pathways to offending to include other
individual-level features, including pathological personality traits, as risk factors (Javdani
et al., 2011a). In particular, studies have implicated psychopathy and Cluster B personality
disorders, most notably borderline personality disorder (BPD), as pertinent to substance use
and antisocial outcomes in females (Edwards, Carre, et al., 2019). Aligning with female
pathways literature, early trauma has been linked to behavioral and emotional dysregulation
in females, and elevated dysregulation has been associated with personality pathology,
including psychopathy and BPD, substance use, and antisocial outcomes in females
(Chapman, 2019; Edwards, Carre, et al., 2019; Hicks et al., 2010; Hien et al., 2005).
Interpersonal contexts are also key to understanding antisociality in females, and females
are more likely than males to express psychopathic and BPD traits in interpersonal contexts
(e.g., sex work, partner/child aggression; Javdani et al., 2011a; Lazarus et al., 2014). Given
the relevance of substance use to female offending, studies testing individual-level risk fac-
tors for substance use is deserving of further empirical attention.
Psychopathy and BPD have traditionally been conceptualized as distinct. However, evi-
dence of their comorbidity, along with emerging dimensional models of personality, has
shifted focus from unique symptoms in each to shared traits between them (e.g., disinhibi-
tion; Edwards et al., 2017; Miller et al., 2010). Dimensional personality models have been
proposed as more informative than traditional diagnostic categories in understanding behav-
ioral outcomes (e.g., substance use) and advancing clinical decision-making (Kotov et al.,
2018; Lowe & Widiger, 2009). In line with this, shared trait vulnerabilities between psy-
chopathy and BPD (e.g., disinhibition) may help to explain relationships with substance use
(Jones et al., 2013; Krueger et al., 2007). However, studies often continue to conceptualize

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