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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.

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.

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.

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

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.

ABSTRACT Providing nursing care for patients with personality disorders is seen by many nursing staff as a highly undesirable job. This paper reviews the available literature and attempts to explore why the task of providing nursing care to these clients is so unpopular. Five core areas of difficulty are identified in the literature and each of these will be elaborated upon within the paper: i) these patients are perceived as less reinforcing and more demanding than mentally ill patients, ii) nurse training is inadequate preparation for this type of work, iii) the role of nursing personality‐disordered patients is high in conflict, iv) this type of nursing is traumatising and v) this type of nursing requires specific skills and qualities.The paper will then outline the implications that these challenges have for a nursing service that provides care for personality‐disordered patients. These include the impact upon i) the retention of staff, ii) the recruitment of staff, iii) the patients and iii) an organisation. The paper will also suggest some potential solutions to these challenges.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

This report highlights the current understanding of personality disorders with specific emphasis on service provision in the context of recent policies and guidelines issued by the Department of Health. It gives an overview of the wide range of perspectives of various stakeholders. It explores the key aspects of collaboration and the implications of a collaborative approach to delivering services for people with personality disorders. It also makes recommendations for implementation and identifies the organisations involved in the process of collaboration.

The purpose of this paper is to provide an overview of the rationale for appropriate treatment for offenders with personality disorder and intellectual disability co‐morbid with intellectual disability (ID), and to describe a specific treatment model.

The paper provides a narrative review of approaches to treatment for offenders with personality disorder and draws on the available research for the treatment of personality disordered offenders without ID as well as the treatment of offenders with ID.

The relevance and validity of the construct of personality disorder in intellectual disability is reviewed. Evidence from treatment of personality disorder in mainstream populations is summarized. A treatment model, which integrates adapted cognitive behavioural programmes with a social milieu approach, is then described. It is argued that this treatment model addresses the criminogenic, psychological and social needs of those with personality disorder and intellectual disability.

Services being developed for people with both intellectual disability and personality disorder should take account of the literature on treatment of mainstream personality disorder when developing treatment models.

There are few published papers concerning treatment approaches with offenders with intellectual disability and personality disorder. This descriptive paper will be of interest to clinicians working with such populations.

Assessment of personality disorders in substance abusing patients may produce important insights. Little is known about the value of routine personality disorder assessment in a clinical context. Adults with past‐year substance dependence seeking treatment at a centralised intake unit for substance abusers in the City of Copenhagen were randomised to assessment of personality disorders and individual psychoeducation vs. attention placebo (n=75). All patients received psychoeducation for attention deficit hyperactive disorder (ADHD) and anxiety/depression when indicated. Patients were followed at three and six months post‐treatment. The psychoeducation for personality disorder did not result in improved functioning. Significant differences indicated a larger drop in substance use in the experimental group. Assessing personality disorders and providing psychoeducation is a promising treatment in a clinical context. There is a need for relevant treatment options to improve functioning and quality of life for this group of patients.

Treatment satisfaction of different mental disorders is still poorly understood, but of high clinical interest. Inpatients of a general psychiatric care hospital were asked to fill out questionnaires on satisfaction and clinical variables at admission and discharge. On the basis of an exploratory approach, differences in treatment satisfaction among diagnostic groups were examined by means of one-way analysis of variance. Potential associated clinical and socio-demographic variables were studied using multi/univariate tests. Patients with personality disorders (n=18) showed a significantly lower treatment satisfaction (ZUF-8, Zurich Satisfaction Questionnaire) and a slightly lower improvement of symptoms (CGI, Clinical Global Impression) and global functioning (GAF, Global Assessment of Functioning scale) than that of other diagnostic groups (n=95). Satisfaction in patients with personality disorders correlated much stronger with the symptom improvement and slightly with the functioning level than in patients without personality disorders. Interestingly, in patients with personality disorders psychopharmacological treatment in general (present versus not present) was independent from satisfaction. This exploratory investigation suggests that a lower satisfaction of patients with personality disorders in a general psychiatric hospital is mainly based on a reduced improvement of the symptoms and of the global functioning level.

The profile of personality disorder in forensic clinical practice has been raised by key developments over the last decade, although services remain in the large part piecemeal and disconnected. This paper aims to describe the lessons learnt from the development of one specialist service for personality disordered offenders.

The policy context in which the service was developed, the challenges of working in this area, and data relating to the clinical and risk profile of referred cases are presented.

Data demonstrate extensive comorbidity and heterogeneity amongst those referred to the service. With reference to the experience gained in the first four years of the service, it is suggested that a systematic and formalised model of “understanding” the psychology of the individual should be the core process of future developments for this group of offenders, and subsequently recommendations are made to enhance the practical utility of such formulations rate.

Conclusions are mostly based on expert opinion and upon one particular service provision, and therefore care should be exercised in generalising the results of this study to existing services. The need for further research in order to enhance knowledge and understanding of this complex group is highlighted.

The heterogeneity and comorbidity within this group of offenders emphasises the need for services to offer a range of assessment methods and interventions to meet individuals' requirements.

The experiences and recommendations in this paper are valuable to professionals working with personality disordered offenders and to the development of more extensive services for such individuals.

Positive professional attitudes towards personality‐disordered clients have been linked with extensive clinical and strategic benefits. The largest influences upon such attitudes are associated with staff training, supervision and support. This preliminary evaluation seeks to consider the effect of an introductory personality disorder awareness workshop upon trainees' attitudes towards personality disordered prisoners.

The attitude towards personality disorder questionnaire (APDQ) was administered to prison staff (predominantly prison officers) immediately before the workshop and then re‐tested, on average, two months later.

The study sample (n=26) showed significant improvements on the “security versus vulnerability” APDQ sub‐scale. The remaining four sub‐scales and overall APDQ scores showed no significant change.

The findings indicate that personality disorder awareness training should initially engage with trainees' perceptions of their personal security and vulnerability when working with this client group, rather than aiming to increase liking, enjoyment and acceptance of such offenders.

This study marks a preliminary analysis of a new personality disorder awareness training programme.