Child Abuse & Neglect 132 (2022) 105822

Contents lists available at ScienceDirect

Child Abuse & Neglect

journal homepage: www.elsevier.com/locate/chiabuneg

Antisocial and borderline personality traits and childhood trauma

in male prisoners: Mediating effects of difficulties in
emotional regulation☆,☆☆
Chenxiao Yang a, Jian Wang b, Yuan Shao b, Mingfan Liu a, Fulei Geng a, *
a
School of Psychology, Jiangxi Normal University, Nanchang, China
b
Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China

A R T I C L E I N F O A B S T R A C T

Keywords: Objective: To investigate the prevalence of probable antisocial personality disorder (ASPD) and
ASPD borderline personality disorder (BPD) among prisoners, and further examine the mediating effect
BPD of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and
Childhood trauma
BPD.
Emotional regulation
Suicidal behaviors
Methods: A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in
Mediating effect Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and
Prisoners suicidal behaviors were measured by self-administered structured questionnaires. Logistic re­
gressions were performed to investigate the associations of ASPD and BPD with suicidal behav­
iors. Path analysis was used to examine the mediating effects of difficulties in ER between
childhood trauma and symptoms of ASPD and BPD.
Result: Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD,
respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors.
Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in
prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of
difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the
dimensions of clarity, impulse, and strategies on BPD.
Conclusion: ASPD and BPD are two of the common personality disorders in prisoners. Difficulties
in ER are key to understanding the relationships between childhood trauma and personality
disorders.

1. Introduction

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are the two most common personality disorders,
which are highly associated with crime (Hill, 2003; Khouri, 1986). ASPD is characterized by illegal, aggressive, deceptive and
impulsive behavior (Skodol & Andrew, 2012); BPD is characterized by unstable emotional regulation (ER), interpersonal and self-

☆
Funding: The present study was funded by National Natural Science Foundation of China (grant numbers: 31700987). The funder had no role
in study design, data collection and analysis, decision to publish, or preparation of the manuscript.☆☆ Data availability statement: The data that
support the findings of this study are openly available in [Mendeley Data] at https://data.mendeley.com, DOI [10.17632/sp7knj8bjr.1].
* Corresponding author at: School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, Jiangxi 330022, China.
E-mail address: fl-geng@163.com (F. Geng).

https://doi.org/10.1016/j.chiabu.2022.105822
Received 6 July 2021; Received in revised form 10 December 2021; Accepted 27 July 2022
Available online 6 August 2022
0145-2134/© 2022 Elsevier Ltd. All rights reserved.
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

awareness, impulsive aggressive behavior, and chronic suicidal tendencies (Gunderson, 2008).
Epidemiological studies on ASPD and BPD in community samples are rare. One recent meta-analysis study of ten studies in Western
countries showed that about 3.1 % of individuals from the general population were diagnosed as ASPD and that about 1.9 % were
diagnosed as BPD (Volkert et al., 2018). Notably, the prevalence raised to about 47.2 % and 20.9 % respectively for ASPD and BPD in
prison (Liu & Huang, 2005), which means that the prison population is at high risk of being affected. Moreover, comorbidity of ASPD
and BPD are common among prisoners and are strongly associated with juvenile and adult delinquency (Robitaille et al., 2017). The
violent criminal offending is most pronounced in their adulthood, associated with psychopathic traits and elevated levels of disruptive
behavior in childhood. Studies have also shown that patients with ASPD and BPD have a very high suicide rate, which is consistent with
the situation in prisons. Individuals with BPD are about 3 % to 8 % likely to commit suicide, which is 10–50 times higher than that of
the general population (Ullrich & Coid, 2010), and those with ASPD attempt suicide more often, with 18.1 % of ASPD patients
attempting suicide (Widiger & Weissman, 1991). Therefore, it is of great significance to study etiological mechanisms of ASPD and
BPD, as well as correlations of suicide in the populations.
The formation of ASPD and BPD were related to many factors, biological, psychological factors and brain injuries all have
important impacts on their onset (Ball & Links, 2009; Bandelow et al., 2005; Horwitz et al., 2001; Luntz et al., 1994). Beside these, the
role that childhood trauma plays in the development of ASPD and BPD has been consistently supported by many research (Horwitz
et al., 2001). Individuals in prisons who suffered adverse childhood experiences are more likely to be diagnosed with a mental disorder,
or have suicidal or self-injurious behaviors, and to have current low mental wellbeing whilst in prison (Ford et al., 2020). A longi­
tudinal study from the United States found that when factors such as age, race, gender and family social status were controlled, abused
and neglected children were more likely to develop ASPD as adults (Horwitz et al., 2001). Also, BPD patients typically experienced
trauma events in childhood, ranging from the early death of or the divorce of their parents to repeated neglect and rejection in early
childhood, physical abuse and even sexual abuse (Bandelow et al., 2005).
Emotional regulation (ER) refers to the internal and external process of monitoring, evaluating and regulating emotional responses
in order to achieve goals (Thompson, 1994; Thompson, 2019). A great number of studies found that difficulties in ER were highly
related to personality disorders traits (Carlo et al., 2018), especially considered to be a central defining feature of BPD (Gunderson,
2008). Difficulties in ER are defined as patterns of emotional experience or expression that interfere with goal-directed activity
(Thompson, 2019), individuals with emotion dysregulation would face the problem of awareness, understanding, or modulation of
emotion, which may interfere with adaptation and contribute to a wide range of negative outcomes (Bjureberg et al., 2016). Difficulties
in ER can be said to be the primary and core symptom of individuals with or highly prone to BPD, and the emotional style of patients
with ASPD also tends to be negative. Different patterns of ER in individuals with ASPD and BPD were found compared to general
population. Studies have shown that due to the characteristics of extraversion and impulsivity (Cale, 2006), patients with ASPD will
have the characteristics of “catastrophic” and “blaming others” in their emotional regulation. Similarly, a large number of studies have
also shown that there is a connection between difficulty in ER and BPD pathology. People with a diagnosis of BPD report general
difficulties in mood regulation (Kuo & Linehan, 2009).
It is noted that though Bjureberg et al. (2016) verified five sub-dimensions of difficulties in ER: clarity (the lack of emotional
clarity), goals (the difficulties engaging in goal-directed behaviors), impulse (the difficulties in impulse control), nonacceptance (the
nonacceptance of the emotional responses), strategies (the limited access to effective emotion regulation strategies); few studies have
examined specific characteristics of emotion regulation in patients with ASPD and BPD (Daros & Williams, 2019; Gratz et al., 2006).
BPD and ASPD traits were uniquely and positively related to trait impulsivity (Fossati et al., 2007), and when compared to other mental
disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance
(Gunderson, 2008). Some studies found that individuals with BPD were limited to access to emotion regulation strategies perceived as
effective and impulse control difficulties when experiencing negative emotions (Ibraheim et al., 2017), further, BPD patients showed
more unwillingness to experience emotional distress in order to pursue goal-directed behavior and the inability to engage in goal-
directed behavior when distressed (Gratz et al., 2006).
Meanwhile, lots of research findings support the correlation between ER and childhood trauma experience (Erin et al., 2010;
Shipman et al., 2010). The experience of growing up being abused may adversely affect a child's later ability to regulate emotions
(Alink et al., 2009). In Shipman's studies (Shipman et al., 2000; Shipman et al., 2005), the children who experienced more neglect had
poor understanding to their negative emotions such as sadness and anger, fewer adaptive emotional regulation strategies and tended to
suppress their negative feeling. Childhood trauma experience was broadly associated with poor emotion regulation as well as increased
avoidance, emotional suppression, and expression of negative emotions in response to stress (Gruhn & Compas, 2020). One study
found that ER played a role in translating childhood trauma into distressing psychotic experiences in later life (Lincoln et al., 2017).
However, until now, no studies have been conducted on childhood trauma and ER of in prison populations.
In summary, difficulties in ER, as another factor in the development of ASPD and BPD, may underlie the emotional and behavioral
problems that are frequently observed in ASPD and BPD. However, there is still little research on the childhood trauma and personality
disorders mediated by difficulties in ER (Gaher et al., 2013; Kuo & Linehan, 2009; Peng et al., 2021), especially on ASPD. The goals of
our study were to understand the prevalence of ASPD and BPD, and to verify the mediating effects of difficulties in ER and the influence
of ER on suicidal behaviors among male prisoners a group that not only has a high prevalence of personality disorders, but is also prone
to childhood traumatic experiences (Cuomo et al., 2008) and difficulty regulating emotions. We hypothesized that ASPD and BPD
would be positively correlated with childhood trauma and difficulties in ER, and difficulties in ER were mediators in this process, at
least partially mediating childhood trauma and personality traits. Moreover, given the very high suicide rates in ASPD and BPD
populations, we expected that ER difficulties were associated with suicidal behaviors in ASPD and BPD.

2
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

2. Methods

2.1. Sample

The survey was conducted in a male prison with 2358 inmates located in Guangdong China. The sampling was described in detail in
our previous study (Geng et al., 2020). Only the prisoners who have (1) willingness to participate in the study, (2) normal sight and (3)
completion of at least primary school education were included. With 320 of them refused to participate, 48 had certain vision problem,
264 did not complete primary school education, and 18 prisoners under observation (5people) or seriously mentally ill patients (13
people) were excluded, 1708 prisoners were invited to take part in the study. Finally, 1491 participants completed survey ques­
tionnaires, with response rate of 87. 3 %. Among them, there were 362 for drug-related crimes (248 for trafficking drugs, 53 for illegal
possession of drugs, 22 for allowing others to take drugs, 23 for manufacturing drugs and 16 for others), 509 for violent crimes (212
people for robbing, 49 for raping, 129 for intentionally injured, 40 for provoking troubles, 36 for gathered for affray, 19 for kidnapped,
and 24 for others), 529 for economy-related crimes (170 people for theft, 108 for fraud, 46 for smuggling, 31 for embezzlement or
bribery, 42 for opening casinos, 63 for illegally counterfeiting goods or currency, 21 for organizing prostitution and 48 for others), 33
for traffic offences and 58 for other crimes. The mean age of the participants was 35.44 (SD = 9.67), ranging from 18 to 69 years.
Demographics and prison record data are presented in Table 1.
The assessment was conducted during May 7 to 15, 2019. Data were collected using self-report questionnaires in unit setting, took
about 40 min on average, with assistance of five psychological professionals and one psychiatrist. This study was approved by [edited
out for blind review]. Permission and support were also obtained from the prison. Written informed consents were obtained from all
participants.

Table 1
Sample characteristics by ASPD and BPD status.
Total Probable ASPD Probable BPD

Yes No t/χ2 Effect size Yes No t/χ2 Effect size

a a
(n = 316) (n = 1175) (n = 169) (n = 1322)

n (%) n (%) n (%) n (%) n (%)

Education 8.09*** 0.07 4.01* 0.05

Less than high school 1253 282(89.2) 971(82.6) 151(89.3) 1102
(84.1) (83.4)
High school or above 238(15.9) 34(10.8) 204(17.4) 18(10.7) 220(16.6)
Marriage 33.78*** 0.15 8.36* 0.08
Single 606(40.6) 171(54.1) 435(37.0) 79(46.7) 527(39.9)
Married 747(50.1) 114(36.1) 633(53.9) 68(40.2) 679(51.4)
Divorced /widowed 138(9.3) 31(9.8) 107(9.1) 22(13.0) 116(8.8)
Perceived health 18.35*** 0.11 44.03*** 0.17
Poor 185(12.4) 52(16.5) 133(11.3) 45(26.6) 140(10.6)
Well 842(56.5) 195(61.7) 647(55.1) 96(56.8) 746(56.4)
Good 464(31.1) 69(21.8) 395(33.6) 28(16.6) 436(33.0)
Smoking history 10.52*** 0.08 3.17 0.05
≥11 cigarettes per day 913(61.2) 225(71.2) 688(58.6) 120(71.0) 793(60.0)
1–10 cigarettes per day 360(24.1) 63(19.9) 297(25.3) 30(17.8) 330(25.0)
No 218(14.6) 28(8.9) 190(16.2) 19(11.2) 199(15.1)
Drinking history 11.20*** 0.09 9.14** 0.08
≥3 times per week 517(34.7) 147(46.5) 370(31.5) 86(50.9) 431(32.6)
1–2 times per week 547(36.7) 97(30.7) 450(38.3) 47(27.8) 500(37.8)
No 427(28.6) 72(22.8) 355(30.2) 36(21.3) 391(29.6)
Drug addiction history, yes 397(26.6) 116(36.7) 281(23.9) 20.86*** 0.12 59(34.9) 338(25.6) 6.70* 0.07
Gambling addiction history, 317(21.3) 123(38.9) 194(16.5) 74.73*** 0.22 65(38.5) 252(19.1) 33.69*** 0.15
yes
Violent crime, yes 509(34.1) 137(43.4) 372(31.7) 15.15*** 0.10 71(42.0) 438(33.1) 5.25* 0.06
First incarceration, yes 341(22.9) 216(68.4) 934(79.5) 17.50*** 0.11 119(70.4) 1031 4.87* 0.06
(78.0)
Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD)
Age, years 35.4(9.7) 32.56(8.8) 36.27(9.8) 6.50*** 0.40 33.94(9.0) 35.68(9.8) 2.20* 0.19
Sentence length, months 70.23 66.51 71.23 1.72 0.11 62.45 71.22 6.14* 0.21
(43.4) (41.6) (43.9) (41.0) (43.6)
Imprison duration, months 26.94 25.44 27.34 1.23 0.11 22.46 27.51 7.99** 0.22
(24.5) (23.8) (24.7) (21.5) (24.8)

Note, *, p < 0.05; **, p < 0.01; ***, p < 0.001; Antisocial personality disorder: ASPD; Borderline personality disorder: BPD.
a
Cohen's d for continuous variables, Cramer's V for categories variables.

3
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

2.2. Instruments

2.2.1. Participants' general information

A questionnaire was used to collect participants' general information such as gender, age, education level, marital status, gambling
history, and substance abuse histories. Smoking and alcohol using histories were assessed by “Before imprisonment, the number of
cigarettes smoked per day ?” and “Before imprisonment, the frequency of alcohol consumption per week?”. Smoking history was
categorized into: no, 1–10 cigarettes per day, ≥11 cigarettes per day; and drinking history was categorized into: no, 1–2 times per
week, ≥3 times per week. The histories of drug addiction and gambling addiction were assessed by “Before imprisonment, have you
taken illegal drugs? Yes / No.” and “Before imprisonment, were you addicted to gambling? Yes / No.”
Criminal data were collected from the jail records, including offence types, history of imprisonment, sentence length and duration
in prison. Offence type was recorded into violent (e.g., murder, manslaughter, and rape) vs. non-violent (e.g., drug offenders, theft, and
fraud).

2.2.2. ASPD and BPD traits

The subscales of ASPD and BPD in the Personality Diagnostic Questionnaire - 4 (PDQ - 4 +) were used to measure symptoms of
ASPD and BPD (Huang et al., 2007). The ASPD subscale includes 8 items, with the first 7 items measuring antisocial behavior in
adulthood, and the 8th item comprised of 15 questions to evaluate conduct disorder before the age of 15. The BPD subscale includes 9
items, with the first 8 items measuring the characteristics of borderline personality in adulthood, and the 9th item comprised of 9
questions to evaluate BPD before the age of 15. Each item in the subscales was scored as 0–1 points. As suggested by previous study
(Huang et al., 2007), the cutoffs for ASPD and BPD are 5 and 4, respectively. The Cronbach's α was 0.88 and 0.82 for ASPD and BPD
with the current sample.

2.2.3. Childhood trauma

The brief screening version of the Childhood Trauma Questionnaire (CTQ) was used to measure the individual's childhood trauma
experience before they were 16 years old. The brief screening version of CTQ had great validity and reliability (Bernstein et al., 2003),
consisted of 28 items, including 5 factors of emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect.
Items are rated on a 5-point Likert-type scale with response options ranging from “Never True” to “Very Often True”. The total score is
in the range from 25 to 125 scores. The CTQ has been validated in a sample of Chinese male offender (Wang et al., 2019). The
Cronbach's α was 0.75 with the current sample.

2.2.4. Difficulties in emotion regulation

The Brief Version of Difficulties in Emotion Regulation Scale (DERS-16) was used to evaluate the individuals' typical levels of
difficulties in emotion regulation (Bjureberg et al., 2016). The DERS-16 includes 16 items rating on a 5-point Likert-type scale, the total
score is in the range from 0 to 64. The DERS-16 is divided into 5 subscales: clarity, goals, impulse, nonacceptance, strategies. Since
there is no validity study of the Chinese version DERS-16 in prisoners, confirmatory factor analysis (CFA) was used to test the structure
validity. The result showed that all of the fit indices were acceptable (χ 2 / df = 11.25, CFI = 0.972, TLI = 0.964, RMSEA = 0.083,
WRMR = 1.659), indicating good structural validity in the current sample. The Cronbach's α of total score was 0.94 with the current
sample; and the Cronbach's α were 0.85, 0.86, 0.90, 0.88, and 0.80 for clarity, goals, impulse, nonacceptance, and strategies,
respectively.

2.2.5. Suicidal behaviors

Four items from the Self-Injurious Thoughts and Behaviors Interview (SITBI) (Nock et al., 2007) were used to assess the partici­
pants' suicidal thought, plan and attempt: (1) “Have you ever had thoughts of killing yourself in your lifetime?”; (2) “Have you ever had
thoughts of killing yourself in the last 12 months?”; (3) “Have you ever actually made a plan to kill yourself in the last 12 months?”; and
(4) “Have you ever made an actual attempt to kill yourself in the last 12 months”. Each item is responded on yes or no.

2.3. Statistical analysis

For demographic data, independent samples t-test was used to evaluate the differences of continuous variables between prisoners
with and without probable personality disorder, meanwhile the chi-square test was used to compare categorical variables. In order to
examine to what extent probable ASPD and BPD symptoms were associated with suicidal behaviors, several binary logistic regression
were performed with participants' general information as covariates. In addition, Pearson correlation analyses were used to test
whether childhood trauma and difficulties in ER were related to suicidal behaviors in participants with probable ASPD and BPD
symptoms.
Path analysis was used to test the hypothetical mediation models by Mplus 7.0. The mediating effect model used the scores of
childhood trauma as the predictor, ASPD and BPD as the outcome measures, and difficulties in ER as the mediators. The overall fit of
the model was evaluate by the χ 2 /df ratio, Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker-
Lewis Index (TLI), and Standardized Root Mean Square Residual (SRMR). TLI and CFI > 0.95, RMSEA <0.06 and SRMR <0.08 suggest
an excellent model fit (Hu & Bentler, 1999; Kline, Kline, & Kline, 2011). The total and specific indirect effects were estimated through
bootstrapping set at 5000 samples, and the values and 95 % confidence interval were presented.

4
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

3. Results

3.1. Prevalence

The prevalence of ASPD and BPD were 21.2 % (n = 316, 95 % CI = [19.2 %, 23.3 %]) and 11.3 % (n = 169, 95 % CI = [9.8 %, 13.0
%]) among the whole 1491 male prisoners, respectively. Probable ASPD and BPD were younger and had lower education. These
screened prisoners also reported more histories of substance abuse and gambling addiction, and were more likely to be single or
divorced. All these data are presented in Table 1.

3.2. Associations of APSD and BPD with suicidal behaviors

The results of logistic regressions showed that, after controlling for general information, ASPD (OR = 2.24, 95 % CI = [1.55, 3.22])
and BPD (OR = 6.83, 95 % CI = [4.54, 10.26]) were significant associated with lifetime suicide ideation. Furthermore, BPD was also
associated with last year suicide ideation (OR = 13.76, 95 % CI = [6.59, 28.73]), suicide plan (OR = 27.71, 95%CI = [9.69, 79.30]) and
suicide attempt (OR = 7.00, 95%CI = [2.51, 19.47]), see Fig. 1.

3.3. Associations of childhood trauma and difficulties in ER with suicidal behaviors in probable ASPD and BPD

The correlations of childhood trauma and difficulties in ER with suicidal behaviors among probable ASPD and BPD were sum­
marized in Table 2. Childhood trauma was positively correlated with lifetime and last year suicidal ideation in ASPD, but only
correlated with lifetime suicidal ideation in BPD. All dimensions of difficulties in ER were positively correlated with lifetime suicide
ideation, last year suicide ideation and plan for both probable ASPD and BPD, except correlations between clarity, nonacceptance and
lifetime suicide ideation, as well as correlations between clarity, goals and last year suicide plan among BPD. Last year suicide attempt
was only correlated with impulse and strategies in ASPD.

3.4. Correlations between ASPD, BPD, childhood trauma and difficulties in ER among all studied participants

ASPD had significant positive correlations with BPD, childhood trauma and all dimensions of difficulties in ER. BPD showed
significant positive correlations with childhood trauma and difficulties in ER. Meanwhile, positive correlations were also found be­
tween childhood trauma and difficulties in ER. Several demographic variables were also significantly associated with ASPD, BPD,
childhood trauma, and difficulties in ER. The Pearson correlation analysis of the included variables can be found in Table 3.

3.5. Path analysis

Taking childhood trauma as predictor, the five dimensions of difficulties in ER as mediating variables, and symptoms of ASPD and
BPD as outcome variables, an ideal mediating effect model was obtained through path analysis. Our model showed good model fit as
χ 2 = 185.935, p < 0.001(df = 43; n = 1491), CFI = 0.977, TFI = 0.954, SRMR = 0.045, RMSEA = 0.047.
The results of path analysis are shown in Fig. 2. There were significant direct effects from childhood trauma to ASPD (β = 0.15, 95 %
CI = [0.09, 0.20]) and BPD (β = 0.15, 95 % CI = [0.09, 0.20]). The direct effects from childhood trauma to the dimensions of dif­
ficulties in ER were also significant (clarity: β = 0.29, 95 % CI = [0.23, 0.34]; goals: β = 0.24, 95 % CI = [0.18, 0.30]; impulse: β = 0.26,
95 % CI = [0.20, 0.32]; strategies: β = 0.29, 95 % CI = [0.23, 0.35]; nonacceptance: β = 0.17, 95 % CI = [0.11, 0.23]). However, only

Fig. 1. Logistic regression analyses of suicide ideation and behaviors in ASPD and BPD.
Note, *, p < 0.05; *, p < 0.01; *, p < 0.001; Antisocial personality disorder: ASPD; Borderline personality disorder: BPD.

5
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

Table 2
Associations of childhood trauma and difficulties in emotion regulation with suicidal behaviors in probable ASPD and BPD.
Variables Lifetime suicidal ideation Last year suicidal ideation Last year suicide plan Last year suicide attempt

ASPD (n = 316)
ER Clarity 0.26*** 0.34*** 0.19*** 0.00
ER Goals 0.36*** 0.32*** 0.17** 0.02
ER Impulse 0.32*** 0.41*** 0.34*** 0.18**
ER Strategies 0.31*** 0.41*** 0.31*** 0.14*
ER Nonacceptance 0.29*** 0.29*** 0.24*** 0.10
Childhood trauma 0.27*** 0.16** 0.07 0.09

BPD (n = 169)
ER Clarity 0.15 0.34*** 0.13 0.07
ER Goals 0.17* 0.33*** 0.14 0.05
ER Impulse 0.16* 0.43*** 0.27*** 0.14
ER Strategies 0.18* 0.44*** 0.26*** 0.13
ER Nonacceptance 0.13 0.29*** 0.19* 0.05
Childhood trauma 0.17* 0.07 0.05 0.06

Note, *, p < 0.05; **, p < 0.01; ***, p < 0.001; Antisocial personality disorder: ASPD; Borderline personality disorder: BPD; Emotional regulation: ER.

dimensions of clarity (β = 0.13, 95%CI = [0.06, 0.20]) and strategies (β = 0.17, 95 % CI = [0.07, 0.26]) were associated with ASPD
symptoms; clarity (β = 0.12, 95 % CI = [0.05, 0.19]), impulse (β = 0.10, 95 % CI = [0.02, 0.18]) and strategies (β = 0.26, 95 % CI =
[0.17, 0.36]) were associated with BPD symptoms. Bootstrap analyses showed that dimensions of clarity (3.6 %, 95 % CI = [1.6 %, 6.0
%]) and strategies (4.9 %, 95 % CI = [2.0 %, 8.0 %]) partially mediated childhood trauma and ASPD, and dimensions of clarity (3.4 %,
95 % CI = [1.4 %, 5.8 %]), impulse (2.6 %, 95 % CI = [0.6 %, 4.9 %]), and strategies (7.7 %, 95 % CI = [4.6 %, 11.2 %]) partially
mediated childhood trauma and BPD.

4. Discussion

Our study reported the prevalence of probable ASPD and BPD and examined the mediating effects of difficulties in ER between
childhood trauma and symptoms of ASPD, BPD among male prisoners in mainland China. The findings revealed that ASPD and BPD
were common among prisoners. Difficulties in ER, partially mediated the childhood trauma, played a significant role in the devel­
opment of ASPD and BPD. Furthermore, difficulties in ER were also associated with suicidal behaviors among probable ASPD and BPD.
Compared with general population, the prevalence of ASPD and BPD among male prisoners were greatly higher which is consisted
with previous studies (Blackburn, 2000; Liu & Huang, 2005; Wetterborg et al., 2015). In one study conducted in China, about 47.2 % of
the male prisoners were diagnosed as ASPD and 20.9 % of them were diagnosed as BPD (Liu & Huang, 2005), and another study in
China also reported the prevalence at 14 % of ASPD in prison. In a Canadian prison, the prevalence of ASPD was 39 %, and BPD was
also common among people of antisocial behavior (Blackburn, 2000). It's similar with other studies that reported the prevalence at
35.5 % of ASPD (Black et al., 2010) and 19.8 % of BPD (Wetterborg et al., 2015) in prisoners. Some research on these personalities
disorders found gender has been shown to influence the prevalence of ASPD and BPD (Fazel & Danesh, 2002; Harpur & Hare, 1994),
men have a higher risk of ASPD than women and a lower risk of BPD (Skodol & Andrew, 2012). On the whole, the prevalence of ASPD
and BPD is high in prison, however, most other studies of prisoners have shown higher prevalence rates than ours, this might because
we only measured male prisoners and did not clinically diagnose ASPD and BPD, and our participants included various types of
criminals, such as economic criminals in which the prevalence of ASPD and BPD was relatively low. In addition, most of our par­
ticipants were in long-term imprisonment, therefore the symptoms of ASPD and BPD were controlled to a certain extent under prison
control.
Further, we found that ASPD and BPD were risk factors for suicidal ideation and behaviors among prisoners, and childhood trauma
and difficulties in ER were also closely related to suicidal behaviors (Yen et al., 2020). Consisted with previous research, individuals
with ASPD and BPD have strong suicidal tendencies and will attempt to suicide repeatedly, which result from childhood abuse,
physical damage and psychological fear (Yen et al., 2020). A research convinced that help on emotion regulation can help reduce the
symptoms of ASPD and BPD, and reduce the risk of suicide (McCauley et al., 2018). Thus, the prison authorities should pay attention to
mental health education of prisoners, and give guidance and teach the prisoners with ASPD and BPD appropriate ER methods. For
people with BPD, dialectical behavioral therapy (DBT) can be used to help them change their behavior and manage their emotions
(McCauley et al., 2018), DBT has a good effect on relieving individual bad emotions and can prevent the occurrence of patients' non-
suicidal self-injury (Wetterborg et al., 2020). The authorities should also carry out activities that are good for emotional support,
improve their psychological health level, reduce the incidence of psychological barriers of inmates.
Childhood trauma, in line with other studies (Alink et al., 2009), was closely related to difficulties in ER, moreover, our study
showed that childhood trauma had significant impacts on all dimensions of difficulties in ER. Previous studies had also proved that the
ability for emotion regulation is developed early in life (Alink et al., 2009), growing up with experiences of maltreatment may
adversely affect a child's later emotion regulation capacity, without receiving appropriate education on ER from their families (Erin
et al., 2010). In the aspect of family and social environment, childhood trauma and abuse will lead to the weakened connection be­
tween prefrontal cortex and amygdala and, therefore, make the individual's emotional function impaired (Tottenham & Galván, 2016).

6
 C. Yang et al.
Table 3
Corelationships among childhood trauma, difficulties in ER, ASPD, BPD and other covariates (n = 1491).

10

11

12

13

14

15

16

17
1

9
1.ASPD 1
2.BPD 0.69*** 1
3.Childhood trauma 0.30*** 0.33*** 1
4.ER Clarity 0.37*** 0.46*** 0.29*** 1
5.ER Goals 0.31*** 0.44*** 0.24*** 0.55*** 1
6.ER Impulse 0.36*** 0.47*** 0.26*** 0.53*** 0.61*** 1
7.ER Strategies 0.40*** 0.55*** 0.29*** 0.70*** 0.69*** 0.73*** 1
7

8.ER Nonacceptance 0.26*** 0.37*** 0.17*** 0.52*** 0.57*** 0.47*** 0.63*** 1

9.Age − 0.23*** − 0.11*** − 0.11*** 0.11*** − 0.01 − 0.02 − 0.01 − 0.01 1
10.Education − 0.10*** − 0.06* − 0.18*** 0.05 − 0.02 0.02 0.01 − 0.01 0.15*** 1
11.Marriage − 0.13*** − 0.04 − 0.06* 0.09*** − 0.03 − 0.04 − 0.01 − 0.02 0.52*** 0.08** 1
12.First incarceration 0.12*** 0.08** 0.09** 0.03 0.05* 0.06* 0.05* 0.07* 0.02 − 0.16*** − 0.02 1
13.Drug addiction history − 0.17*** − 0.11*** − 0.08** − 0.03 − 0.06* − 0.06* − 0.06* − 0.06* − 0.03 0.94*** − 0.01 − 0.13*** 1
14.Gambling addiction history − 0.26*** − 0.21*** − 0.07* − 0.14*** − 0.15*** − 0.18*** − 0.17*** − 0.18*** 0.03 0.05 0.01 − 0.20*** 0.16*** 1
15.Smoking history 0.17*** 0.17*** 0.08** 0.05 0.08** 0.08** 0.10*** 0.09** − 0.001 − 0.14*** 0.04 0.08** − 0.17*** − 0.14*** 1
16.Drinking history 0.16*** 0.17*** 0.10*** 0.03 0.08** 0.11*** 0.13*** 0.12*** − 0.09** − 0.03 − 0.04 − 0.02 0.06* − 0.11*** 0.28*** 1
17.Perceived health − 0.11*** − 0.19*** − 0.16*** − 0.15*** − 0.20*** − 0.18*** − 0.21*** − 0.19*** − 0.18*** 0.05 − 0.07** − 0.09** 0.08** 0.14*** − 0.10*** − 0.00 1

Note, *, p < 0.05; **, p < 0.01; ***, p < 0.001; Antisocial personality disorder: ASPD; Borderline personality disorder: BPD; Emotional regulation: ER.

Child Abuse & Neglect 132 (2022) 105822

C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

Fig. 2. Mediation model of the difficulties in ER between childhood trauma and ASPD, BPD.
Note, *, p < 0.05; *, p < 0.01; *, p < 0.001; Antisocial personality disorder: ASPD; Borderline personality disorder: BPD.

The major findings of our study suggested that in the model of difficulties in ER as a mediating variable, all the sub-dimensions of
difficulties in ER were affected by childhood trauma, but had different effects on ASPD and BPD, which is in accord with previous study
(Gratz et al., 2008). Clarity affected both ASPD and BPD, suggested that prisoners had poor abilities to clearly aware of their emotions.
Dimension of nonacceptance had no effect on both the two personality disorder, reflecting prisoners' psychological states. Individuals
who are imprisoned in jail for a long time might learn to accept their lives and negative emotions. However, strategies showed sig­
nificant effects on ASPD and BPD, which is contrast with one previous report of nonsignificant results in a community sample (Carlo
et al., 2018). Our significant findings may be due to poor education and lack of opportunity to learn emotional regulation strategies in
prisoners. Among all the dimensions, strategies and clarity respectively explain the most indirect effect of the mediation model of ASPD
and BPD, this suggests that ASPD are linked to difficulties in strategies using to regulation when experiencing negative emotions, and a
focus on the ability to recognize emotions seems a crucial aspect to better understand individual differences in BPD. The prisoners with
ASPD symptom, of noted, received no effect from the dimension of impulse, although their impulsive behavior has long been
considered a major characteristic of their personality. This is not consistent with our hypothesis, a reasonable explanation can be that
our assessment of ER is in the current status, but the impulse of prisoners who are incarcerated and managed in prison will be
controlled to a certain extent. The average length of our prison incarceration is about two years, which means that the vast majority of
our participants have been in prison for a long time.
The results of this study need to be regarded as preliminary and are restricted by several limitations. First, the measurement of
ASPD, BPD, childhood trauma and difficulties in ER were presented by using self-report questionnaires, therein the possibility of
response bias and limits of self-reporting emotion regulation cannot be ruled out. Future study should therefore introduce clinical
interviews as a valid assessment. Second, the cross-sectional design of the present study did not permit us to test causal effects. Other
latent variables may explain the observed associations. Prospective studies are needed to address these limitations. Third, the limi­
tations of this study are mainly reflected in the fact that the samples are all male, and more in-depth research is needed to investigate
whether there is a similar situation among female prisoners, which may be the reason for the difference in prevalence rate from other
studies. At the same time, we did not screen the biological parents of prisoners for personality disorders and failed to report the genetic
effects of personality disorders in this population.
In the process of summarizing the literature, we found that research in China on ASPD and BPD is very insufficient, especially the
research on the aspect of prisoners. Therefore, to develop ASPD and BPD epidemiological investigation and further analyze its in­
fluence factors, clinical treatment and other issues, will certainly become the research emphasis in the future. Studies showed that if an
individual receives inappropriate upbringing or even abuse, they are more likely to be into aggressive personalities (Finzi et al., 2000;
Lansford et al., 2002). According to our research, clinical interventions for prisoners can be carried out on childhood trauma and
emotional regulation, especially difficulties in ER not only mediate childhood trauma and personality disorder and also significantly
related to suicidal behaviors, this can help them mitigate the negative effects of childhood trauma on their behavior, mood, and

8
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

cognition. Furthermore, suicide ideation and behavior were closely related to ASPD and BPD among prisoners. Therefore, we suggest
that, in the treatment of ASPD and BPD individuals, we can start from their emotion, combined with cognitive behavior therapy and
emotional therapy to improve the emotional experience of individuals, thus improving the pathological personality of individuals, and
guide them to learn positive adaptive strategies, so as to improve their behaviors, so that may help to reduce symptoms related to ASPD
and BPD, and the rate of suicidal behaviors.

5. Conclusion

Childhood trauma contributes to ASPD, BPD and suicidal behaviors in adult prisoners. Difficulties in ER play partial mediating roles
between childhood trauma, ASPD, and BPD, furthermore the mediating effects are different in different dimensions of ER. Intervention
of multiple types of ER are needed to reduce mental health problems and built resilience among vulnerable populations.

Declaration of competing interest

No.

References

Alink, L. R. A., Cicchetti, D., Kim, J., & Rogosch, F. A. (2009). Mediating and moderating processes in the relation between maltreatment and psychopathology:
Mother-child relationship quality and emotion regulation. Journal of Abnormal Child Psychology, 37(6), 831–843.
Ball, J. S., & Links, P. S. (2009). Borderline personality disorder and childhood trauma: Evidence for a causal relationship. Current Psychiatry Reports, 11(1), 63–68.
Bandelow, B., Krause, J., Wedekind, D., Broocks, A., Hajak, G., & Rüther, E. (2005). Early traumatic life events, parental attitudes, family history, and birth risk factors
in patients with borderline personality disorder and healthy controls. Psychiatry Research, 134(2), 169–179.
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., & Zule, W. (2003). Development and validation of a brief screening version of the
childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190.
Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., & Gumpert, C. H. (2016). Development and validation of a brief version of the difficulties
in emotion regulation scale: The DERS-16. Journal of Psychopathology & Behavioral Assessment, 38(2), 284–296.
Black, D. W., Gunter, T., Loveless, P., Allen, J., & Sieleni, B. (2010). Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of
life. Annals of Clinical Psychiatry, 22(2), 113–120.
Blackburn, R. (2000). Treatment or incapacitation? Implications of research on personality disorders for the management of dangerous offenders. Legal &
Criminological Psychology, 5(1), 1–21.
Cale, E. M. (2006). A quantitative review of the relations between the "Big 3" higher order personality dimensions and antisocial behavior. Journal of Research in
Personality, 40(3), 250–284.
Carlo, G., Patrizia, V., Antonino, C., Raffaele, P., Giampaolo, S., Francesca, C., & Giancarlo, D. (2018). Emotion dysregulation, impulsivity and personality disorder
traits: A community sample study. Psychiatry Research, 266, 186–192.
Cuomo, C., Sarchiapone, M., Giannantonio, M. D., Mancini, M., & Roy, A. (2008). Aggression, impulsivity, personality traits, and childhood trauma of prisoners with
substance abuse and addiction. American Journal of Drug & Alcohol Abuse, 34(3), 339–345.
Daros, A. R., & Williams, G. E. (2019). A meta-analysis and systematic review of emotion-regulation strategies in borderline personality disorder. Harvard Review of
Psychiatry, 27(4), 217–232.
Erin, E., Burnsa, J. L. J., & Hardinga, H. G. (2010). Child maltreatment, emotion regulation, and posttraumatic stress: The impact of emotional abuse. Journal of
Aggression Maltreatment & Trauma, 19(8), 801–819.
Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23000 prisoners: A systematic review of 62 surveys. Lancet, 359(9306), 545–550.
Finzi, R., Cohen, O., Sapir, Y., & Weizman, A. (2000). Attachment styles in maltreated children: A comparative study. Child Psychiatry & Human Development, 31(2),
113–128.
Ford, K., Bellis, M. A., Hughes, K., Barton, E. R., & Newbury, A. (2020). Adverse childhood experiences: A retrospective study to understand their associations with
lifetime mental health diagnosis, self-harm or suicide attempt, and current low mental wellbeing in a male welsh prison population. Health & Justice, 8(1), 13.
Fossati, A., Barratt, E. S., Borroni, S., Villa, D., & Maffei, C. (2007). Impulsivity, aggressiveness, and DSM-IV personality disorders. Psychiatry Research, 149(1–3),
157–167.
Gaher, R. M., Hofman, N. L., Simons, J. S., & Hunsaker, R. (2013). Emotion regulation deficits as mediators between trauma exposure and borderline symptoms.
Cognitive Therapy & Research, 37(3), 466–475.
Geng, F., Wang, J., Wen, C., Shao, Y., Wu, J., & Fan, F. (2020). Prevalence and correlates of sleep problems among chinese prisoners. Social Psychiatry and Psychiatric
Epidemiology, 56(4), 671–678.
Gratz, K. L., Rosenthal, M. Z., Tull, M. T., Lejuez, C. W., & Gunderson, J. G. (2006). An experimental investigation of emotion dysregulation in borderline personality
disorder. Journal of Abnormal Psychology, 115(4), 850.
Gratz, K. L., Tull, M. T., Baruch, D. E., Bornovalova, M. A., & Lejuez, C. W. (2008). Factors associated with co-occurring borderline personality disorder among inner-
city substance users: The roles of childhood maltreatment, negative affect intensity/reactivity, and emotion dysregulation. Comprehensive Psychiatry, 49(6),
603–615.
Gruhn, M. A., & Compas, B. E. (2020). Effects of maltreatment on coping and emotion regulation in childhood and adolescence: A meta-analytic review. Child Abuse &
Neglect, 103, Article 104446.
Gunderson, J. G. (2008). Borderline personality disorder: A clinical guide. American Psychiatric Press.
Harpur, T. J., & Hare, R. D. (1994). Assessment of psychopathy as a function of age. Juornal of Abnormal Psychology, 103(4), 604–609.
Hill, J. (2003). Early identification of individuals at risk for antisocial personality disorder. British Journal of Psychiatry, 44, S11–S14.
Horwitz, A. V., Widom, C. S., Mclaughlin, J., & White, H. R. (2001). The impact of childhood abuse and neglect on adult mental health: A prospective study. Journal of
Health and Social Behavior, 42(2), 184–201.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation
Modeling, 6(1), 1–55.
Huang, X., Ling, H., Yang, B., & Dou, G. (2007). Screening of personality disorders among chinese college students by personality diagnostic Questionnaire-4+.
Journal of Personality Disorders, 21(4), 448–454.
Ibraheim, M., Kalpakci, A., & Sharp, C. (2017). The specificity of emotion dysregulation in adolescents with borderline personality disorder: Comparison with
psychiatric and healthy controls. Borderline Personality Disorder & Emotion Dysregulation, 4, 1.
Khouri, P. J. (1986). Borderline personality disorder. American Journal of Psychiatry, 154(8), 1101–1106.
Kline, R. B. (2011). Principles and practice of structural equation modeling. Guilford press.
Kuo, J. R., & Linehan, M. M. (2009). Disentangling emotion processes in borderline personality disorder: Physiological and self-reported assessment of biological
vulnerability, baseline intensity, and reactivity to emotionally evocative stimuli. Journal of Abnormal Psychology, 118(3), 531–544.

9
C. Yang et al. Child Abuse & Neglect 132 (2022) 105822

Lansford, J. E., Dodge, K. A., Pettit, G. S., Bates, J. E., Crozier, J., & Kaplow, J. (2002). A 12-year prospective study of the long-term effects of early child physical
maltreatment on psychological, behavioral, and academic problems in adolescence. Archives of Pediatrics & Adolescent Medicine, 156(8), 824.
Lincoln, T. M., Marin, N., & Jaya, E. S. (2017). Childhood trauma and psychotic experiences in a general population sample: A prospective study on the mediating role
of emotion regulation. European Psychiatry the Journal of the Association of European Psychiatrists, 42, 111.
Liu, B., & Huang, X. (2005). A preliminary research on the personality disorders of 220 male prisoners. Journal of Psychological Science, 4, 958–960.
Luntz, Barbara, K., Widom, C., & Spatz. (1994). Antisocial personality disorder in abused and neglected children grown up. American Journal of Psychiatry, 151(5),
670–674.
McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., & Linehan, M. M. (2018). Efficacy of dialectical behavior therapy for adolescents at high
risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 777–785.
Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an
adolescent sample. Psychological Assessment, 19(3), 309–317.
Peng, W., Liu, Z., Liu, Q., Chu, J., Zheng, K., Wang, J., & Yi, J. (2021). Insecure attachment and maladaptive emotion regulation mediating the relationship between
childhood trauma and borderline personality features. Depression & Anxiety, 38(1), 28–39.
Robitaille, M. P., Checknita, D., Vitaro, F., Tremblay, R. E., Paris, J., & Hodgins, S. (2017). A prospective, longitudinal, study of men with borderline personality
disorder with and without comorbid antisocial personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 4, 25.
Shipman, K., Edwards, A., Brown, A., Swisher, L., & Jennings, E. (2005). Managing emotion in a maltreating context: A pilot study examining child neglect. Child
Abuse & Neglect, 29(9), 1015–1029.
Shipman, K., Zeman, J., Penza, S., & Champion, K. (2000). Emotion management skills in sexually maltreated and nonmaltreated girls: A developmental
psychopathology perspective. Development and Psychopathology, 12(1), 47–62.
Shipman, K. L., Schneider, R., Fitzgerald, M. M., Sims, C., Swisher, L., & Edwards, A. (2010). Maternal emotion socialization in maltreating and non-maltreating
families: Implications for Children's emotion regulation. Social Development, 16(2), 268–285.
Skodol, & Andrew, E. (2012). Personality disorders in DSM-5. Annual Review of Psychology, 8(1), 317–344.
Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2–3), 25–52.
Thompson, R. A. (2019). Emotion dysregulation: A theme in search of definition. Development & Psychopathology, 31(3), 805–815.
Tottenham, N., & Galván, A. (2016). Stress and the adolescent brain: Amygdala-prefrontal cortex circuitry and ventral striatum as developmental targets. Neuroscience
& Biobehavioral Reviews, 70, 217–227.
Ullrich, S., & Coid, J. (2010). Antisocial personality disorder: Co-morbid Axis I mental disorders and health service use among a national household population.
Personality & Mental Health, 3(3), 151–164.
Volkert, J., Gablonski, T.-C., & Rabung, S. (2018). Prevalence of personality disorders in the general adult population in Western countries: Systematic review and
meta-analysis. British Journal of Psychiatry the Journal of Mental Science, 213(6), 709–715.
Wang, W., Wu, R., Tang, H., Wang, Y., Liu, K., Liu, C., & Pu, W. (2019). Childhood trauma as a mediator between emotional intelligence and recidivism in male
offenders. Child Abuse & Neglect, 93, 162–169.
Wetterborg, D., Dehlbom, P., Långström, N., Andersson, G., Fruzzetti, A. E., & Enebrink, P. (2020). Dialectical behavior therapy for men with borderline personality
disorder and antisocial behavior: A clinical trial. Journal of Personality Disorders, 34(1), 22–39.
Wetterborg, D., Långström, N., Andersson, G., & Enebrink, P. (2015). Borderline personality disorder: Prevalence and psychiatric comorbidity among male offenders
on probation in Sweden. Comprehensive Psychiatry, 62, 63–70.
Widiger, T. A., & Weissman, M. M. (1991). Epidemiology of borderline personality disorder. Hospital & Community Psychiatry, 42(10), 1015–1021.
Yen, S., Peters, J. R., Nishar, S., Grilo, C. M., Sanislow, C. A., Shea, M. T., & Skodol, A. E. (2020). Association of borderline personality disorder criteria with suicide
attempts: Findings from the collaborative longitudinal study of personality disorders over 10 years of follow-up. JAMA Psychiatry, 78(2), 187–194.

10