Psychopathology in borderline intellectual functioning: a narrative review
| Published date | 02 January 2018 |
| Date | 02 January 2018 |
| DOI | https://doi.org/10.1108/AMHID-07-2017-0031 |
| Pages | 22-33 |
| Author | Carlos Peña-Salazar,Francesc Arrufat,Josep Manel Santos,Ramón Novell,Juan Valdés-Stauber |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Psychopathology in borderline intellectual
functioning: a narrative review
Carlos Peña-Salazar, Francesc Arrufat, Josep Manel Santos, Ramón Novell and
Juan Valdés-Stauber
Abstract
Purpose –Studies on psychiatric comorbidity in individuals with borderline intellectual functioning (BIF) are
scarce, particularly with respect to certaindiseases frequently observedin clinical practice. The purposeof this
paper is to discuss therelevance of epidemiological research to psychiatric comorbidity in people withBIF.
Design/methodology/approach –Systematic searches of MEDLINE, EMBASE and Cochrane databases.
Inclusion criteria: publications about BIF appearing between 1995 and 2017; epidemiological findings about
comorbid mental disorders in individuals with BIF; and studies comparing BIF, mild intellectual disability (ID)
and normal intellectual functioning. The discussion covers 24 of the 224 studies initially considered.
Findings –The most frequent psychiatric comorbidity reported was personality, post-traumatic as well as
psychotic disorders, followed by psychosis, attention deficit and hyperactivity disorder, bipolar and sleep
disorders. Individuals with BIF exhibit psychiatric comorbidity more frequently than individuals with normal
intellectual functioning. Some psychiatric comorbidities were similarly prevalent in patients with BIF and those
with mild or moderate ID; however, the prevalence was always higher in people with severe ID. Environmental
factors, especially psychosocial adversity, seem to play an important mediating role. Pharmacotherapy is the
most common treatment approach, including behavioural disorders.
Originality/value –This review of literature on mental disorders in people with BIF demonstrates the
epidemiological relevance of psychiatric comorbidity, especially personality and post-traumatic disorders.
Mental health professionals, general practitioners and other workers in outpatient settings have to be aware
about the vulnerability and even fragility of people with BIF.
Keywords Review, Intellectual disabilities, Psychopathology, Epidemiology,
Borderline intellectual functioning, Psychopharmacology
Paper type Literature review
Introduction
The American Association on Intellectual and Developmental Disability considers borderline
intellectual functioning (BIF) and intellectual disability (ID), also called general learning disability, to
be problemsof function rather than pathologiesand this is why some authors havesuggested that
these conditions should be excluded from classifications of mental disorders (Schalock and
Luckasson, 2004). On the other hand, the World Psychiatric Association’s Section for the
Psychiatryof Intellectual Disabilityconsiders ID and BIF to be generalised developmentaldisorders.
The revised fourth and the fifth editions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV-TR and DSM-V) (American Psychiatric Association, 2000, 2014) which
includes BIF in a section entitled “Others problems that can be the object of clinical care”, gives
only a brief definition - having an intellectual quotient ranging from 71 to 84 - and offers no
additional discussion or criteria for the further classification of BIF. Studies on the prevalence of
BIF are scarce and the reported rates have been diverse, ranging from 12.3 per cent in the
general British population (Hassiotis et al., 2008) to 3 per cent in the Spanish population
(Salvador-Carulla et al., 2011). Reported rates in specific subpopulations - such as prison
populations - have been more variable, ranging from 5.7 to 32.1 per cent (Murphy et al., 1995;
Herrington, 2009; Hayes et al., 2007; Puerta et al., 2003).
Received 14 July 2017
Revised 6 October 2017
21 October 2017
Accepted 24 October 2017
Conflict of interest: the author
and co-authors of the present
study have no conflict o f interest
to declare.
The present study has been
drawn from a PhD in Health,
Well-being, and Quality of Life
from the University of Vic –Central
University of Catalonia (Spain).
The authors affiliations can be
found at the end of this article.
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VOL. 12 NO. 1 2018, pp.22-33, © Emerald Publishing Limited, ISSN 2044-1282 DOI 10.1108/AMHID-07-2017-0031
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