PERSONALITY DISORDERS AND CRIME

As it is known, the prevalence of mental disorders in the penitentiary system is high. Among mental disorders, there are psychoses of different genesis, affective disorders, post-traumatic stress disorder, personality disorders, substance abuse, dual disorder, etc. The study within the prison system of the relationship between crime committed by an individual and mental disorders is a very interesting current problem. I think the study of personality disorders in prisons deserves special attention. The goal of this study was to examine personality disorders in prisoners placed in the psychiatric ward of the medical unit of the accused and convicted treatment facility. Of the 501 patients studied, the majority were men (448) and the minority were women (12) what is consistent with the statistics for the penitentiary system as a whole. Indicators such as age, place of permanent residence, and education were included in the survey and are presented in the corresponding tables. These tables show that the average age of the participants is young (39 years), most of them live in the regions (59.3%), and have secondary education (71.3%). According to the results of the study, 77% of the participants were diagnosed with emotionally unstable (borderline) personality disorder (F60.3), which is included in the B-cluster of personality disorders. This, on its turn, as the relevant literature shows, is consistent with the findings of other studies. However, the given studies show: B Cluster


Introduction.
According to the last review conducted by ICPR (Institute for Crime and Justice Policy Research) and World Prison Brief, there are more than 10 million prisoners worldwide in penitentiary establishments [19].
Prevalence of personality disorders in the prison population.Fazel and Danesh (2002) reviewed the prevalence of mental health disorders in prison populations.The authors conducted a systematic review of psychiatric surveys based on clinical interviews conducted with 23,000 prisoners from 12 western countries.According to the results, it was reported that 65% of male prisoners and 42% of female prisoners had the diagnosis of personality disorder.It was also reported that the percentage of B-cluster personality disorders was high among both male and female prisoners (47% of male prisoners were diagnosed with antisocial personality disorder; 25% of female prisoners were diagnosed with borderline personality disorder and 21% with antisocial personality disorder) [8].
Two important factors that contribute to individuals with personality disorders being vastly represented in prisons are antisocial behavior (including aggressive and violent behavior) and repeated offending, both of which are discussed in the systematic review by Yu, Geddes, and Fazel (2012).
The first part of the systematic review examined the association between personality disorder and antisocial behavior in comparison with the general population.The review included 14 studies conducted in 7 countries with a sample of 10,007 participants.According to the results, the risk of individuals with personality disorders to engage in antisocial behaviors is three times higher compared to the general population [17].
The second part of the systematic review investigated the risk of recidivism among offenders with personality disorders in comparison to other offenders.According to the results, offenders with personality disorders are 2-3 times more likely to re-offend compared to other offenders with mental health disorders or compared to offenders without mental health disorders [17].

Personality Disorders.
The American Psychiatric Association (2013) defines personality disorders as an enduring pattern of behavior and inner experiences that deviate from cultural expectations of the individual, which are expressed in two or more areas: cognition, affect, interpersonal functioning, and impulse control; Patterns are stable, inflexible, long-lasting, cover a wide range of personal and social situations and cause clinically significant distress or impaired functioning in social, occupational, or other important domains [1].
In the fifth edition of diagnostic and statistical manual of mental disorders personality disorders are grouped in three categories (A, B, C clusters) based on similar characteristics and symptoms [1].
Generally, personality disorders are associated with antisocial behavior.According to research, Cluster B personality disorders are more closely associated with delinquent and criminal behavior [6].Cluster B personality disorders are characterized by anger, aggression, weak impulse control, emotion regulation difficulties, interpersonal conflicts, which are risk factors that can contribute to offending [6].
Cluster A personality disorders are characterized as less violent compared to cluster B. However, due to distrustfulness, suspicion, odd style of thinking, social isolation-violent behavior can also be associated with this cluster.Alcohol and drug use are an additional contributing factor to criminal or violent behaviors [6].
Cluster C personality disorders have the least association with aggression and violence as Cluster C are characterized as over-controlling, anxious, fearful, obsessive, with need for sense of safety [6,12].
Studies have shown that Cluster B personality disorders are more associated with an increased risk of criminal offending.Therefore, the scientific literature examining prison population or association between crime and personality disorders mostly focuses on Cluster B personality disorders, while data on cluster A and C personality disorders in this context are relatively scarce.

Aim of the study.
The present study is of exploratory nature and it aims to explore the link between personality disorders and crime in the Georgian study sample.The goal of the study is to examine type of crimes committed by prisoners with personality disorders who have been serving their sentence in the special penitentiary service of the Ministry of Justice N18 medical establishment for convicts and accused (Tbilisi, Georgia).

Methods.
The study was conducted in the psychiatric department of N18 penitentiary medical establishment.In the frame of the study, the medical files of prisoners were retrieved from the archive of the facility and analyzed.Medical files of all prisoners that were diagnosed with personality disorder who were detained in N18 penitentiary medical establishment from 2005 to 2019 were included in the study.Medical files older than 2005 were not available, therefore the study period was defined as 2005-2019 to include as many subjects in the study as possible.
The medical files of all the prisoners who met the inclusion criteria were retrieved from the archive of the psychiatric department of N18 penitentiary medical establishment.To protect the confidentiality of the prisoners, medical files were coded, so that identification of the individuals would not be possible.Study relevant information was collected from medical files, coded, and analyzed.

Results. Demographic information.
In the frame of the study, 500 medical files were analyzed.488 study subjects were male, 12female.Mean age of study subjects: 39 (min.age -20, max.age-87); 0.6% of study subjects did not have a permanent place of residence, 38.1% -lived in the capital (Tbilisi), 59.3%-in the region, and 2% -were citizens of foreign countries.0.8% of subjects didn't have education, 16%had incomplete secondary education, 71.3% -had completed secondary education, 0.6% had incomplete higher education and only 11.3% of subjects had complete higher education (see Fig. 1).

Diagnosis.
The study sample comprised of various personality disorders.77% study subjects were diagnosed with emotionally unstable (borderline) personality disorder (F60.3),5.6% were diagnosed with mixed and other personality disorders (F61), 5.2% with paranoid personality disorder (F60.0), 5% with schizoid personality disorder (F60.1),3% with anxious (avoidant) personality disorder (F60.6).Other personality disorders were presented in small percentages (see Fig. The abovementioned data on diagnosed personality disorders among the study subject were grouped according to DSM clusters.Cluster A personality disorders make up 6.2% of the total study sample, Cluster C personality disorders account for 3.6% of the total study sample, and Cluster B personality disorders are represented with the highest percentage -79.2% of the total study sample (see Fig. 3).Data concerning the offenses that the study subjects committed and were convicted for was analyzed.Results show that 40.9% of study subjects were convicted for economic crime (crime against property), which includes criminal statutes such as theft, burglary, robbery, etc.
The second most frequently committed offenses by the study subjects fall under the category of crime against public security and public order (14.9%), which encompasses criminal statutes such as banditry, hooliganism, illegally purchasing, carrying, manufacturing, selling firearms explosives, or explosive devices, organizing/ managing or participating in group violence, etc.
14.4% of the crimes committed by study subjects were crimes against life -which entails killing another human being.
Fourth, most frequently, committed offenses by the study subjects are drug-related crimes -11.7%, which entails criminal statutes on illegally manufacturing, producing, purchasing, storing, transfering, selling illegal substances, narcotics, their analogs, precursors, or psychoactive substances.
6.7% of offenses committed by the study subjects were crimes against health.
Crimes against human rights and freedoms accounted for 3.5% of offenses.This category includes criminal statutes such as unlawful imprisonment of a person, coercion (illegal restriction of a person's freedom to act), threat (of killing, damaging health, or destroying property), etc.
3% of offenses committed were crimes against administrative order -which includes resistance, threats, or violence against a public order officer or other governmental officials.
Crimes against sexual freedom and sexual inviolability, which consist of sexual offenses, accounted for 1.8% of the study sample.The rest of the offenses were represented with small percentages (see Fig. 4).

Conclusions.
In the frame of the recent study medical files of 500 prisoners who were diagnosed with personality disorder were analyzed.Out of 500 study subject 97.6% were male, 2.4% -female.71.3% of study subjects had complete secondary education, 11.3% had higher education.
The study sample included personality disorders from all three clusters.Cluster B personality disorders were the most prevalent in the sample (77% of study subjects were diagnosed with borderline personality disorder -F60.3), which is in line with the findings of Coid and colleagues (2006), whose study results showed that individuals with Cluster B personality disorder traits were ten times more likely to be charged with a criminal offense and eight times more likely to serve the sentence in the penitentiary establishment, compared with individuals with cluster A and C personality disorders [4,5].
The most common offenses committed by study subjects are as follows: economic crime (crime against property) -40.9%; crime against public security and public order -14.9%, which entails criminal statutes such as hooliganism, banditry, etc; crime against life -14.4%;drug-related crimes -11.4%; crime against health -6.7%, which encompasses criminal statutes such as infliction of grave or less grave bodily injury to another person.Crimes against human rights and freedoms accounted for 3.5% of offenses, 3% of offenses were crimes against administrative order and 1.8% were crimes committed against sexual freedom and sexual inviolability.
The results of the study show that the offenses committed by the study subjects are diverse and consist of both non-violent and violent acts, which is in line with the results of a study by Sanson and colleagues (2016) that surveyed 145 individuals with borderline personality disorder using several assessment scales including the measure of criminal behavior (ABQ-Antisocial Behavior Questionnaire).The results showed that borderline personality disorder is associated with both violent and non-violent acts including crime against property, drug offenses, illegal possession of a weapon, damage to health, and others [18].
International scholars have been researching prison-populations, results of which often are used by correctional and justice systems to identify, plan and implement various programs, rehabilitative and preventive measures.Unfortunately, Georgian study samples are never represented in international systematic reviews of prison populations, due to the fact that the data is scarce.Researching mental health disorders in the Georgian prison-population and further researching personality disorders as one of the target groups is important, as the prevalence of personality disorders is high among people in contact with the criminal justice system, including prisons, jails, or probation agencies.Individuals with personality disorders have an increased risk for antisocial and criminal behavior compared to the general population and they have a higher probability of reoffending compared to other offenders with mental health disorders and also compared to offenders without mental health disorders [17]; Research of the abovementioned topics, including researching the type of crimes that are associated with the personality disorders could prove to be of use for criminal justice system for planning preventive measures in regards to this target group in Georgia.

Limitations of the study.
In the frame of the research, there was no opportunity to interview the study subjects, therefore it was not possible to gather information, explore risk factors or social aspects contributing to criminal behavior of the study subjects such as unemployment, socio-economic conditions, delinquent or antisocial behavior in early adulthood, information about the family, etc, as such information is generally not recorded in the medical files.

Fig. 2 .
Fig. 2. Percentage distribution of diagnosed personality disorders among the study subjects.

Fig. 3 .
Fig. 3. Personality disorders of the study sample grouped according to DSM Clusters.

Fig. 4 .
Fig. 4. Categories of crimes committed by the study subjects.