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Article
Publication date: 1 December 2006

Rick Howard

This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality

Abstract

This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality disorder. It raises the question: is personality disorder related to dangerousness, and (if so) what mediates the relationship? It then reviews recent findings suggesting that patients deemed to be dangerous and severely personality disordered are characterised by a combination of antisocial and borderline traits, and as such are a source of distress both to themselves and to others. It remains for future research to determine how this particular constellation of personality disorders is functionally linked to dangerousness, and whether the link is mediated by neuropsychological impairment resulting from early‐onset alcohol abuse, as recently proposed by Howard (2006). It is recommended that the current criteria for ‘dangerous and severe personality disorder’ be dispensed with.

Details

The British Journal of Forensic Practice, vol. 8 no. 4
Type: Research Article
ISSN: 1463-6646

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Article
Publication date: 14 December 2010

Adebowale

Personality disorders manifest themselves in a variety of ways and there is also debate about the extent to which these conditions can be treated. The author debates the…

Abstract

Personality disorders manifest themselves in a variety of ways and there is also debate about the extent to which these conditions can be treated. The author debates the definition of personality disorder and considers the stigma that this diagnosis can attach to individuals. A new approach to the treatment of people with personality disorders is proposed, using the person‐centred approach and placing the individual at the centre of services. With regards to personality disorder, this person‐centred approach is able to treat the condition as well as addressing the negative effects of how it manifests itself.

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Mental Health Review Journal, vol. 15 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 1 March 2008

Jenny Torr

This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms…

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341

Abstract

This article reviews the literature on personality disorder in offenders with learning disabilities, using Medline, PsychoInfo and CINAHL databases, and search terms ‘offending’, ‘personality disorder and intellectual disabilities’, ‘learning disabilities’ and related terms. Methods of defining offending population, personality disorder and learning disabilities vary greatly, and few studies focus specifically on personality disorder, learning disability and offending. The definition of learning disability often encompasses both borderline learning disability and low average intelligence. Personality disorder, especially anti‐social personality disorder, is prevalent in offenders with learning disabilities, but less than in the general population, and is associated with higher levels of security and poorer outcomes. The study concludes that there is a continuum of offenders with borderline and mild learning disabilities, reflected in learning disability forensic services.

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Advances in Mental Health and Learning Disabilities, vol. 2 no. 1
Type: Research Article
ISSN: 1753-0180

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Article
Publication date: 9 March 2015

Alice L. Bennett

The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R…

Abstract

Purpose

The purpose of this paper is to explore the range of personality disorder diagnoses and levels of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) associated with treatment discontinuation in a sample of adult male prisoners.

Design/methodology/approach

Data from 92 male offenders in a high secure prison personality disorder treatment unit was analysed. PCL-R and personality disorder diagnoses were predicted as being related to increased treatment dropout.

Findings

Having a diagnosis of narcissistic personality disorder was related to treatment dropout, but PCL-R total scores were not. There was a trend for a diagnosis of antisocial personality disorder being associated with remaining in treatment.

Research limitations/implications

The current study highlights that narcissistic personality disorder can be associated with treatment dropout, warranting further exploration as to why this is the case.

Practical implications

Managing responsivity issues for those presenting with a personality disorder diagnosis could be effective in maximising treatment engagement from this specific offender group.

Originality/value

Although treatment dropout has been explored previously, this is the first study to explore treatment dropout at a specialised unit designed specifically to provide treatment for this client group.

Details

Journal of Criminological Research, Policy and Practice, vol. 1 no. 1
Type: Research Article
ISSN: 2056-3841

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Article
Publication date: 16 September 2021

Gary Lamph, Jake Dorothy, Tamar Jeynes, Alison Coak, Raeesa Jassat, Alison Elliott, Mick McKeown and Tim Thornton

The label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by…

Abstract

Purpose

The label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. This study aims to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder.

Design/methodology/approach

This study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience/occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring the contested subject matter.

Findings

This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words “personality” and “disorder” are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered.

Research limitations/implications

The findings have the potential to contribute to the ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label is understood, hence, attention is required to enhance these processes in clinical practice. There is much more study required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required.

Originality/value

This study brings together a wide range of views and experiences of mental health professionals, individuals lived experiences and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced World Café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field.

Details

Mental Health Review Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 1 December 2007

Frankie Pidd and Janet Feigenbaum

Abstract This article summarises criteria that can lead to a diagnosis of personality disorder before considering the impact on personality disorder of specific…

Abstract

Abstract This article summarises criteria that can lead to a diagnosis of personality disorder before considering the impact on personality disorder of specific interventions and policy initiatives designed to ensure that services respond to need.

Details

Mental Health Review Journal, vol. 12 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 12 June 2017

Sacha Evans, Faisil Sethi, Oliver Dale, Clive Stanton, Rosemary Sedgwick, Monica Doran, Lucinda Shoolbred, Steve Goldsack and Rex Haigh

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of…

Abstract

Purpose

The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.

Design/methodology/approach

A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.

Findings

The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.

Research limitations/implications

The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.

Originality/value

This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

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Article
Publication date: 30 November 2012

Paul Withers, Natalie Boulton, James Morrison and Amanda Jones

The purpose of this paper pertains to the implementation of an occupational therapy service within a newly‐established medium secure service for 16 men with intellectual…

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Abstract

Purpose

The purpose of this paper pertains to the implementation of an occupational therapy service within a newly‐established medium secure service for 16 men with intellectual disabilities and additional diagnosis of personality disorder located in the North West of England.

Design/methodology/approach

This is a general review, providing a descriptive account of the development and implementation of an occupational therapeutic provision for men residing in a medium secure unit with a dual diagnosis of intellectual disability and personality disorder and a service user account of its efficacy.

Findings

The paper seeks to illustrate the efficacy of occupational therapy implemented by a specifically recruited and trained staff team, describing engagement in meaningful, bespoke programmes of occupation used to assist service users to address deficit areas via mutual engagement in activities, serving to facilitate the formation and development of positive and trusting relationships between service users and staff. The impact of the service is described from a service user's perspective.

Originality/value

There is very little literature relating to those with intellectual disability also diagnosed with personality disorder. There appears to be no specific study of occupational therapy amongst those with dual diagnosis of intellectual disability and personality disorder. This paper is therefore unique in its approach and provides an overview of both the process and method used to implement occupational therapy, as well as a service user perspective and an illustration of its efficacy in a medium secure setting.

Details

Journal of Learning Disabilities and Offending Behaviour, vol. 3 no. 4
Type: Research Article
ISSN: 2042-0927

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Article
Publication date: 31 December 2010

Roos Stals, Albert Dijkhuizen and Tom Joosten

GGzE, a mental health care organisation in the south Netherlands, implemented treatment for patients with severe personality disorders and substance use: clinical case…

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176

Abstract

GGzE, a mental health care organisation in the south Netherlands, implemented treatment for patients with severe personality disorders and substance use: clinical case management (CCM). CCM is a special healthcare facility for patients whose needs do not match other existing treatment designs. These patients are characterised by unproductive or disturbed relationships and multiple crises that deregulate clinical practice and impede recovery. In the CCM team, patients are treated with the theoretical concepts of relationship management, interpersonal reconstructive therapy, Livesley's stage‐wise treatment and integrated dual disorder treatment (IDDT). These theoretical models and methods used within CCM have been described extensively, though there has been no clinical study about its effect within GGzE so far. Professionals working within the CCM team report that behaviour such as acting out is reduced after about one year of treatment, with less interventions from other caretakers or police involvement. To substantiate these claims, a single group pre‐test and posttest was conducted to find out whether these patients really experience changes in physical and psychological problems, as well as changes in their personality disorder.The sample consists of patients who started treatment between 2004 and 2009 (pre measurement T=0), (n = 21). At T=0, patients completed the Symptom Checklist (SCL‐90) and Personality Characteristics Questionnaire (Vragenlijst Kenmerken Persoonlijkheid, VKP). The outcomes are compared with the results of the same questionnaires that were completed by patients in 2010 (post measurement T=1). The outcomes of the SCL‐90 show significant changes for fear, depression, hostility, distrust and interpersonal sensitivity, as well as the total score of psychoneurosis. The VKP shows significant changes for general personality disorder, schizoid personality disorder and borderline personality disorder. More research is needed to find stronger evidence of treatment effects of CCM, using a bigger sample, a control group and more outcome measurements that also include the drug use of patients.

Details

Advances in Dual Diagnosis, vol. 3 no. 4
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 14 August 2017

Alice Bennett and Darren Johnson

In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of…

Abstract

Purpose

In light of the clinical importance of understanding co-morbidity within offender populations, the purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I) and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure, prison-based personality disorder treatment service.

Design/methodology/approach

The study utilised clinical assessment data for both Axis I diagnoses (Structured Clinical Interview for DSM-IV) and Axis II diagnoses (International Personality Disorder Examination) of 115 personality disordered offenders who met the criteria for the treatment service between 2004 and 2015.

Findings

Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ2 analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the clinical disorders of substance use and anxiety with any personality disorder within this sample.

Practical implications

In part these results suggest that certain Axis II disorders may increase the risk of lifetime Axis I disorders.

Originality/value

The findings of no co-morbidity between the clinical disorders of substance use and anxiety with any personality disorder within sample are inconsistent to previous findings.

Details

Journal of Forensic Practice, vol. 19 no. 3
Type: Research Article
ISSN: 2050-8794

Keywords

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