Prevalence of Borderline Personality Disorder among Syrian Private University Students, A Cross-Sectional Study
- 1. Department of Internal Medicine, Damascus University, Syria
- 2. Graduate Student, Faculty of Medicine, Syrian Private University, Syria
Abstract
Background: Borderline personality disorder (BPD) is characterized by changes in self- image and interpersonal relationships that are characterized by sudden shifts between idealization (overly positive views of self and others), and devaluation (overly negative views of self and others). People with borderline personality disorder typically suffers from anxiety, irritability, and affective disorder as well as impulsive behaviors related to spending (Profusion), sexual activity, drugs abuse, or polyphagia. Borderline personality disorder affects approximately 0.7–2.7% of adults.
Purpose: The aim of this study is to assess the prevalence of borderline personality disorder (BPD) among undergraduate students at the Syrian Private University (SPU), Damascus, Syria, where we seek to diagnose the presence of the disorder in addition to studying the impact of many factors whether those related to childhood or adulthood, from environmental, material, emotional, family and even academic conditions, and studying the manifestations that are common in this group of students
Methods: After obtaining approval from the Deanship of the Faculty of Medicine and the Ethics Committee at the Syrian Private University SPU, We designed an electronic questionnaire and distributed it randomly among students with informed consent from the participating student in a mandatory option to participate in the questionnaire. The questionnaire did not include any personal information referring to the participating student, but rather demographic data and variables related to our study. We designed the questionnaire and distributed it among students in the period between 5/1/2024 - 10/1/2024 and obtained 250 participating students, we excluded 30 students for not completing the questionnaire optimally and selected 220 students.
Results: We found a statistically significant association between the incidence of the Borderline Personality Disorder (BPD).
KEYWORDS
- Borderline Personal Disorder; Temperament; Family problems; Emotional problems; Financial problems; Symptoms; Mansion
CITATION
Yousef H, Kharfan B, Mhanna FA, Latifeh Y (2024) Prevalence of Borderline Personality Disorder among Syrian Private University Students, A Cross-Sectional Study. Ann Psychiatry Ment Health 12(3): 1197.
INTRODUCTION
Personality disorders are often recognized in adolescence and persist throughout most of adult life, whereas it is uncommon for personality disorders to be diagnosed in patients younger than 18 years of age due to the ongoing physiological changes that accompany puberty and growth. However, if the disorder is clear and meet the diagnostic criteria and is not limited to puberty, then the diagnosis of borderline personality disorder BPD in children and adults is appropriate [1].
Historically, borderline personality disorder was viewed as the borderline between psychosis and which was previously called “neurosis”, was previously called “pseudo-schizophrenia” because its symptoms combine both. It was also called “borderline” because its diagnosis and treatment are limited. This personality is twice as common in women as in men, and is more common in families of depressed and addicted people.
According to the World Health Organization, it is an emotionally unstable personality because it is unstable in terms of mood, emotions, or social relationships [1]. It is characterized by noticeable instability in performance, emotion, mood, and personal relationships, and sometimes in reality. About 20-50% of patients with borderline personality disorder suffer from psychotic and mood symptoms, meaning that most patients with borderline personality disorder suffer from a mood swing, short- term puerperal episodes, sudden outbursts of anger, addiction, and polyphagia, sudden severance of personal relationships, multiple emotional and sexual relationships (in western countries), and constant blaming of others for not understanding their suffering and depression, and repeated attempts at self- harm, body mutilation, and even suicide.
Symptoms of borderline personality disorder usually appear in late adolescence, but some cases have been diagnosed in children and initial diagnosis is rarely made in patients over the age of forty, although The incidence of this disorder tends to decrease after the age of forty, because personality disorders often decrease with age and because some people with the disorder commit suicide and thus are no longer part of the population. Studies of borderline personality disorder have revealed that the diagnosis was more common in females than in males, with the female to male ratio 4:1, and there is no evidence suggest a relationship between race and diagnosis of borderline personality disorder or borderline disorders in childhood.
METHODS
After obtaining approval from the Deanship of the Faculty of Medicine and the Ethics Committee at the Syrian Private University (SPU), we designed an electronic questionnaire and distributed it among students randomly with informed consent from the participating student in a mandatory option to participate in the questionnaire. The questionnaire did not include any personal information referring to the participating student, but rather demographic data and variables related to our study. We designed the questionnaire and distributed it among students in the period between 5/1/2024 -10/1/2024 and obtained 250 participating students. We excluded 30 students for not completing the questionnaire optimally and selected 220 students.
We insert the results on Microsoft Excel 2019 and conducted the necessary statistical analysis using the SPSS using the Chi- Square measure to study the associations between qualitative variables. The statistical significance level of 0.05 was relied upon to estimate the differences and relationships, so that if the P-Value is greater than 0.05, there are no fundamental differences and the differences are not statistically significant, while values less than 0.05 indicate that the differences are statistically significant and values less than 0.01 indicate a high level of statistical significance. The diagnosis of borderline personality disorder is based on criteria DSM-5, Mclean Screening Instrument for BPD, Borderline Symptom List (BSL-23).
RESULTS
Percentage of Affected People
Of the 220 male and female students who participated in the study, we found that 54.54% of the Student have diagnosed with borderline personality disorder, where a diagnosis was made when at least 5 of the automated manifestations were confirmed in the questionnaire (Table 1).
Table 1: Percentage of Students |
||
Number of sample students |
Number of affected students in the sample |
Percentage of affected students |
220 |
120 |
54.45% |
Age groups
The largest proportion of participants in the sample were 25 years old (36.36%), The remaining percentages were distributed similarly in the age groups 24, 23, 22, 21, 20,19 years. No student at the age of 18 years participated, and the average age in the sample was 23.05 years.
As for affected students, the minimum age was 21 years, and the average age was 23.5 years, and the largest percentage of cases was distributed at the age of 24 years 33.33%. By conducting the statistical correlation equation and comparing the result with the tabulated values at a significance level of 0.05 and a degree of freedom of 7, we found that there is a statistically significant correlation between the incidence of the disorder and age (Table 2).
Table 2: Age Groups of The Sample. |
||||
Percentage (For affected students) |
Number of affected |
Percentage |
Number of students |
The Age |
0% |
0 |
0% |
0 |
18 years |
0% |
0 |
4.54% |
10 |
19 years |
0% |
0 |
9.09% |
20 |
20 years |
8.33% |
10 |
9.09% |
20 |
21 years |
16.66% |
20 |
13.63% |
30 |
22 years |
16.66% |
20 |
9.09% |
20 |
23 years |
33.33% |
40 |
9.09% |
20 |
24 years |
25.0% |
30 |
36.36% |
80 |
25 years |
100% |
120 |
100% |
220 |
Total |
23.5?1.2 |
Average age of affected students |
23.05?1.9 |
Average age of sample |
|
0.025 |
P-Value |
55.71 |
Chi-Square |
|
P = 0.025 < 0.05. There is a statistically significant relationship between age and the incidence of borderline personality disorder. |
Significance |
Gender
As for the study sample, the percentage of male participants was greater than the percentage of females (54.54% and 45.45%, respectively), while the distribution of the disorder was greater among females than males at a rate of 2:1 (66.66% and 33.33%,respectively), and we found at the significance level of 0.05 and the degree of freedom 1, a statistically significant association between the incidence of Borderline Personality Disorder and gender, with a predominance of the incidence among females compared tomales 1:2 (Table 3).
Table 3: Gender. |
||||
Percentage (For affected students) |
Number of affected students |
Percentage |
Number of students |
Sex |
33.33% |
30 |
54.54% |
120 |
Male |
66.66% |
60 |
45.45% |
100 |
Female |
100.00 |
120 |
100.00% |
220 |
Total |
0.01 |
P-Value |
27.63 |
Chi-Square |
|
P = 0.01 < 0.05. There is a statistically significant relationship between gender and the incidence of borderline personality disorder. |
Significance |
University Status
The largest percentage of students participating in the study are Syrians residing in the country (75.45%), followed by Syrians not residing in the country (22.72%) and a small number of Arab and foreign students (0.915%) For each of them.
As for borderline personality disorder, the highest percentage was among Syrian residents (83.33% Of the cases) at a rate of 66% among the total number of resident Syrian students, while 15.05% Of the affected students, the majority were among non- resident Syrians (54% of all non-resident Syrian students), followed by scholarship students and Arabs, who occupied the lowest percentage (0.81%) Of the total affected cases (50% of both groups).
By studying the correlation coefficients at the significance level of 0.05 and the degree of freedom of 3, it was found that there is a statistically significant correlation between the university admission status and the presence of borderline personality disorder among students (Table 4).
Table 4: University Status. |
||||
Percentage (For affected students) |
Number of affected |
percentage |
Number of students |
The Situation |
83.33% |
100 |
75.45% |
166 |
Resident Syrian |
15.05% |
18 |
22.72% |
50 |
Non-Resident Syrian |
0.81% |
1 |
0.915% |
2 |
Arabs and Foreigners |
0.81% |
1 |
0.915% |
2 |
Scholarships |
100% |
120 |
100% |
220 |
The Total |
0.05 |
P-Value |
24.191 |
Chi-Square |
|
P = 0.05 = 0.05 --> There is a statistically significant relationship between having the disorder and the students’ status in terms of the quality of university admission. |
Significance |
Financial Status
The majority of the study participants were students with very good to excellent financial status (42.27% - 40.45%, respectively), and 11.36% of the participants were financially good, while a small percentage of the participants were financially poor and required work to cover their study and living expenses 5.9%.
As for the presence of borderline personality disorder, it was 47.5% of affected participants were in an excellent financial situation (64% of the total), 30.83% were in very good financial condition (39% of the total) and 14.16% were in good financial condition (68% of the total) and 7.5% were in poor financial status (69% of the total).
By studying the correlation coefficients at the significance level of 0.05 and a degree of freedom of 3, we found a relationship between financial status and borderline personality disorder, but it was not statistically significant (Table 5).
Table 5: Financial Status. |
||||
Percentage (For affected students) |
Number of affected students |
Percentage |
Number of Students |
Financial Status |
47.5% |
57 |
40.45% |
89 |
Excellent |
30.83% |
37 |
42.27% |
93 |
Very good |
14.16% |
17 |
11.36% |
25 |
Good |
7.5% |
9 |
5.9% |
13 |
Weak |
100% |
120 |
100% |
220 |
Total |
Very good |
Average financial status of the affected students |
Very good |
Average financial status |
|
0.975 |
P-Value |
13,988 |
Chi-Square |
|
P = 0.975 > 0.05. There is a relationship between financial status and borderline personality disorder, but it is not statistically significant. |
Significance |
Housing
Most of the students participating in the study live with their family (81.81%), and 10.45% live in dormitory with their colleagues, and the smaller percentage of participating students do not share housing with anyone and live alone (7.72%).
Most of the affected were those living with their families 79.36% (55% of the total), while a smaller percentage were living in dormitory with their colleagues 11.66% (60% of the total) and a small percentage were living alone 5% (35% of the total).
By studying the correlation coefficients at the significance level of 0.05 and the degree of freedom of 2, we find a relationship between the residential environment and the incidence of borderline personality disorder, but the results here are not statistically significant (Table 6).
Table 6. Housing. |
||||
Percentage (affected students) |
Number of affected students |
Percentage |
Number of students |
|
79.36% |
100 |
81.81% |
180 |
With family |
11.66% |
14 |
10.45% |
23 |
Dormitory |
5.00% |
6 |
7.72% |
17 |
Alone |
100.00% |
120 |
100.00% |
220 |
Total |
With family |
For the affected |
Live with family |
Sample mean |
|
0.025 |
P-Value |
55.71 |
Chi-Square |
|
P = 0.995 > 0.05?There is a relationship between the student's residential environment and the incidence of borderline personality disorder, but it is not statistically significant. |
Significance |
Having Family Problems
The majority of students participating in the study did not have family problems 50.0%, and there were problems with 40.9% of the participants. 65.83% of affected students had family problems and 34.16% their relationship with their family was good, and can be said in another way that 87% of the students who had family problems had borderline personality disorder while 37% of the students who did not have problems with their families had borderline personality disorder.
By studying the correlation coefficients at the significance level of 0.05 and the degree of freedom of 2, we find a statistically significant relationship between the presence of family problems and the incidence of borderline personality disorder (Table 7).
Table 7: Presence of Family Problems. |
||||
Percentage (For affected students) |
Number of affected students |
Percentage |
Number of students |
|
65.83% |
79 |
40.9% |
90 |
Yes |
34.16% |
41 |
50.0% |
110 |
No |
0.0% |
0 |
9.1% |
20 |
Maybe |
100% |
120 |
100% |
220 |
Total |
There is |
Average for affected students |
nothing |
Average |
|
0.02 |
P-Value |
67.37 |
Chi-Square |
|
P = 0.02 < 0.05. There is a statistically significant relationship between the presence of family problems and the incidence of borderline personality disorder. |
Significance |
Having a History of Separation from the Partner
Problems that led to early separation were found in 61.81% of the students participating in the study, however, the diagnosis were found in 50.7% of these students only, the percentage of affected students who suffering from early separation problems was about 57.5%.
By studying the correlation coefficients, we found a relationship between the presence of early separation problems with the partner and borderline personality disorder, but the results in our sample were not statistically significant (Table 8).
Table 8. History of Separation From Partner. |
||||
Percentage (For affected students) |
Number of affected students |
Percentage |
Number of students |
|
57.5% |
69 |
61.81% |
136 |
Yes |
42.5% |
51 |
38.18% |
84 |
No |
100% |
120 |
100% |
220 |
Total |
There are problems |
Average for affected students |
There are problems |
Sample average |
|
0.975 |
P-Value |
2.07 |
Chi-Square |
|
P = 0.975 > 0.05. There is a relationship between a history of separation from a partner and the occurrence of borderline personality disorder, but it is not statistically significant. |
Significance |
Emotional Status
The majority of students participating in the study were single (70.9%), and 21.36% of the students were in a relationship and 4.54% of them reached the engagement stage and 3.2% of students were in a marriage relationship.
For affected students, 92.5% were single in the current situation while 5.83% were in a relationship and a small percentage were engaged or married (0.835% and 0.835%, respectively).
By studying the correlation coefficients at the significance level of 0.05 and the degree of freedom of 3, we found a statistically significant relationship between the emotional state of students and the current emotional state (Table 9).
Table 9: Emotional Status. |
||||
Percentage (For affected students) |
Number of affected students |
Percentage |
Number of students |
|
92.5% |
111 |
70.9% |
156 |
Single |
5.83% |
7 |
21.36% |
47 |
In a relationships |
0.835% |
1 |
4.54% |
10 |
Engaged |
0.835% |
1 |
3.2% |
7 |
Married |
100% |
120 |
100% |
220 |
Total |
Single students |
Average affected |
Single students |
Sample mean |
|
0.005 |
P-Value |
58.96 |
Chi-Square |
|
P = 0.005 < 0.05. There is a statistically significant relationship between emotional state and borderline personality disorder. |
Significance |
Quality of Life
We found that the majority of students participating in the study rated their quality of life as 70% and Most of the patients found that their quality of life was between 40-80% while the non-affected students selected values between 70 – 100% (Figure 1).
Figure 1: Quality of Life.
Spread of demonstrations among students
We find that the majority of participating students did not suffer from any of these manifestations, and the most common of these manifestations were: I suffered from shame, afraid of losing control, mood swings, and loneliness. (Figure 2).
Figure 2: Spread of demonstrations among students
DISCUSSION
Through our study, we found a significant incidence of borderline personality disorder among students of the Syrian Private University, at a rate of 54.54%, and the diagnosis was made according to the criteria mentioned above.
As for the distribution of BPD by age: the largest percentage of those AFFECTED STUDENTS were 24-25 years old (33.33%, 25%, respectively), with an average age of infection of 23.5 years. By studying the statistical correlation equations, we found a statistically significant association between age and suffering from borderline personality disorder.
Compared to a study conducted by the researcher and physician Eric A. Fertuck We found a significant difference in the results between the two studies, as the average age of those affected in the Viatuck study was 32.1 years. This difference in the results is due to the difference in the institution and the nature of the samples. In our study, we investigated the presence of the disorder among undergraduate students, while in the Viatuck study, samples of patients diagnosed and admitted to the hospital were included. It is worth noting that although the onset of this disorder is associated with puberty, it is rarely diagnosed and a psychiatrist is consulted for it at this stage because the vast majority of cases recover spontaneously within a few years, and the remaining percentage that remains under the influence of the disorder consults the doctor and is admitted to the hospital. The majority of this group of people are between the ages of 30 and 40 years.
Regarding the distribution of BPD by gender, the greater proportion of affected people were females compared to males at a rate of 1:2 (66.66%, 33.33%, respectively), and we found a statistically significant association between infection and gender.
Compared to the study of Viatok, we found agreement between our results and the results of his study, as Viatok found a tendency for occurrence in females compared to males, but at a higher ratio (1:5), while in our study it was 1:2. According to what Viatok mentioned in another section of his study, he noticed during follow-up over twenty years that the rates of spontaneous recovery were more prevalent among males, and this may explain the increase in the ratio in the study of Viatok with the advanced ages included in his study.
As for the university situation, the largest percentage of those affected was among the Syrian resident students (83.33% of the cases), while 15.05% of the affected were among the non- resident Syrian students, and the lowest percentage was among the Arab and foreign students and scholarship students (0.81% for each). We found a statistically significant association between the distribution of borderline personality disorder and the type of university admission for the student, perhaps due to the association of the type of university admission with the student’s living environment in terms of material and family relations. We will not find anything that corresponds to this aspect of the study in the medical literature to compare the results.
Regarding the financial status, the majority of the students participating in the study were students with excellent financial status (64%), while the disorder was seen in a smaller percentage of students with very good financial status (30.83%), and the symptoms appeared less among students with good to poor financial status. There was a correlation, but not statistically significant, between the financial status and the incidence of borderline personality disorder.
Regarding housing, most of the affected students were living with their families (79.36%), while a smaller percentage of affected students were living with their university dorm mates (11.66%), and a small percentage were living alone (5%). We found a relation, but it was not statistically significant, between the housing environment and the incidence of borderline personality disorder.
As for the presence of problems in the family, there were family problems in the largest percentage of those affected students (65.83%), while there was no significant occurence of the disorder in terms of the severity of symptoms among students who enjoy good family relationships. We found that there is a statistically significant association between the infection and the presence of family problems in the student.
In comparison with other studies regarding the above- mentioned family-related risk factors, it was found that Cohen et al found that low socioeconomic background predicted BPD symptoms and that this effect remained stable over time [2]. Crawford and colleagues reached the same conclusion [3].This was confirmed by three studies by Stiep et al., which showed that poverty requiring public assistance may predispose to the onset of BPD symptoms during adolescence [4,5].
Another aspect to consider is the relation between parents and children in childhood, as it was conducted Steel et al in 2019 reviewed a fairly recent systematic review of medical literature on the impact of parenting on the development of personality disorders. They analyzed eight systematic reviews and five of these reviews found that cold relationships of low warmth, rejection, strict control, and negative affectivity emanating from the mother were a psychosocial risk factor for the development of borderline personality disorder [6-8].
As for the presence of emotional problems and a history of early separation from the partner, we found that in the largest percentage of those affected (57.5%), but the results were not statistically significant and could be relied upon based on our sample. The majority of students with borderline personality disorder were single (92.5%), while a small percentage were in stable emotional relationships (5.83%). There were emotional relationships that led to marriage among students with borderline personality disorder (0.835%). These results are statistically significant and could be relied upon because there is a relationship between the emotional state and the current emotional state.
Although Wingenfeld et al., found no significant differences in emotional reaction time between individuals with BPD and controls, except that the BPD group was generally slower [9]. They also suggested that there is a negative bias in emotion recognition, meaning that individuals with BPD appear to be biased toward identifying negative emotions in others [10,11]. This may have a significant impact on the affected person’s relationships, especially romantic relationships with a partner, and lead to early separation [12].
As for the quality of life, the majority of the students participating in the study rated their quality of life at 70%, and most of the affected students determined their quality of life as ranging between 40-80%, while the non-affected people chose values ranging between 70-100%, on the basis that 0% is a very poor quality of life in various aspects and shows the student’s dissatisfaction with his life and situation, while 50% is the average case and 100% is the excellent case that reflects the student’s complete satisfaction with his life.
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