Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 8, pp 1285–1291 | Cite as

Borderline personality disorder and Axis I psychiatric and substance use disorders among women experiencing homelessness in three US cities

  • Leslie B. Whitbeck
  • Brian E. Armenta
  • Melissa L. Welch-Lazoritz
Original Paper



In this study, we report prevalence rates of borderline personality disorder (BPD) and Axis I psychiatric and substance use disorders among randomly selected women who were experiencing episodes of homelessness in three US cities.


The sample consists of 156 women, 79 from Omaha, NE, 39 from Pittsburgh, PA, and 38 from Portland, OR. It included 140 women from shelters and 16 women from meal locations. Latent class analysis was used to evaluate BPD symptoms.


A large majority of the women (84.6 %) met criteria for at least one lifetime psychiatric disorder, about three-fourths (73.1 %) met criteria for a psychiatric disorder in the past year, and 39.7 % met past month criteria for a psychiatric disorder. Approximately three-fourths of the sample (73.7 %) met lifetime criteria for at least two disorders, about half (53.9 %) met criteria for at least three lifetime disorders, and approximately one-third (39.1 %) met criteria for four or more disorders. Latent class analyses indicated that 16.7 % of the women could be categorized as low self-harm BPD and 19.9 % high self-harm BPD.


In shelters and in treatment settings, these women will present with complex histories of multiple serious psychiatric disorders. They are highly likely to manifest symptoms of BPD, post-traumatic stress disorder, and substance abuse disorders in addition to other psychiatric symptoms which will add to clinical complications.


Homeless women Psychiatric disorders Substance use disorders 



This research was supported by Grant Number HD058989, National Institute of Child Health and Human Development.


  1. 1.
    Fazel S, Khosla V, Doll H, Geddes J (2008) The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med 5(12):e225. doi: 10.1371/journal.pmed.0050225 PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    North CS, Smith EM (1993) A comparison of homeless men and women: different populations, different needs. Community Ment Health J 29(5):423–431. doi: 10.1007/BF00754410 PubMedCrossRefGoogle Scholar
  3. 3.
    Zima BT, Wells KB, Benjamin B, Duan N (1996) Mental health problems among homeless mothers: relationship to service use and child mental health problems. Arch Gen Psychiatry 53(4):332–338. doi: 10.1001/archpsyc.1996.01830040068011 PubMedCrossRefGoogle Scholar
  4. 4.
    Bassuk EL, Buckner JC, Perloff JN, Bassuk SS (1998) Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. Am J Psychiatry 155:1561–1564PubMedCrossRefGoogle Scholar
  5. 5.
    North CS, Eyrich KM, Pollio DE, Spitznagel EL (2004) Are the rates of psychiatric disorders in the homeless population changing? Am J Public Health 94:103–108. doi: 10.2105/AJPH.94.1.103 PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Whitbeck LB (2009) Mental health and emerging adulthood among homeless young people. Taylor & Francis Group, New YorkGoogle Scholar
  7. 7.
    US Department of Housing and Urban Development (HUD) (1995) Stewart B. McKinney Homeless Programs. Accessed 19 Oct 2012
  8. 8.
    National Alliance to End Homelessness (2010) Economy bytes: doubled up in the United States. Accessed 19 Oct 2012
  9. 9.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602. doi: 10.1001/archpsyc.62.6.593 PubMedCrossRefGoogle Scholar
  10. 10.
    Kessler RC, Chiu WT, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627. doi: 10.1001/archpsyc.62.6.617 PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Zanarini MC, Frankenburg FR, Sickel AE, Yong L (1996) The Diagnostic interview for DSM-IV personality disorders (DIPD-IV). McLean Hospital, BelmontGoogle Scholar
  12. 12.
    Zanarini MC (2005) The subsyndromal phenomenology of borderline personality disorder. In: Zanarini MC (ed) Borderline personality disorder. Taylor & Francis Group, Boca Raton, pp 19–40Google Scholar
  13. 13.
    Armenta BE, Whitbeck LB, Zanarini MC (2015) Patterns of borderline personality symptoms among homeless women: a latent profile analysis using IRT scores (submitted)Google Scholar
  14. 14.
    Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177. doi: 10.1037//1082-989X.7.2.147 PubMedCrossRefGoogle Scholar
  15. 15.
    Little RJA, Rubin DB (2002) Statistical analysis with missing data. Wiley, New YorkCrossRefGoogle Scholar
  16. 16.
    Enders CK (2010) Applied missing data analysis. Guilford Press, New YorkGoogle Scholar
  17. 17.
    Kessler et al (2006) The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 163:716–723. doi: 10.1176/appi.ajp.163.4.716 PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    van der Heijden GJMG, Donders ART, Stijnen T, Moons KGM (2006) Imputation of missing values is superior to complete case analysis and the missing-indicator method in multivariate diagnostic research: a clinical example. J Clin Epidemiol 59:1102–1109. doi: 10.1016/j.jclinepi.2006.01.015 PubMedCrossRefGoogle Scholar
  19. 19.
    National Comorbidity Survey Replication (2007) Lifetime prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Accessed 22 Oct 2012
  20. 20.
    National Comorbidity Survey Replication (2007) 12-month prevalence of DSM-IV/WMH-CIDI disorders by sex and cohort. Accessed 22 Oct 2012
  21. 21.
    Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007) DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry 62(6):553–564PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Goodman LA, Saxe L, Harvey M (1991) Homelessness as psychological trauma: broadening perspectives. Am Psychol 46(11):1219–1225. doi: 10.1037/0003-066X.46.11.1219 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Leslie B. Whitbeck
    • 1
  • Brian E. Armenta
    • 2
  • Melissa L. Welch-Lazoritz
    • 3
  1. 1.Department of Sociology, 201 Benton HallUniversity of Nebraska LincolnLincolnUSA
  2. 2.Department of Psychology, 208 Benton HallUniversity of Nebraska LincolnLincolnUSA
  3. 3.Department of Sociology, 210 Benton HallUniversity of Nebraska LincolnLincolnUSA

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