• A cluster analytic examination and external validation of psychopathic offender subtypes in a multisite sample of Canadian federal offenders

      Wong, Stephen C. P. (2015)
      The present study is a cluster analytic examination and validation of psychopathic offender subtypes from 4 combined samples of Canadian federally incarcerated offenders, most of whom were serving sentences for violent offenses. The men were rated on the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003) on the basis of comprehensive file information and 314 cases were extracted using a PCL-R total cut score of 25. Cluster analysis of the 4 PCL-R facets converged at a 2-cluster solution: a primary subtype characterized by prominent interpersonal and affective features of psychopathy and a secondary subtype characterized by comparatively few interpersonal features and high scores on the remaining facets. Validation analyses found that the vast majority of primary psychopathic offenders (74.1%) were White or of non-Aboriginal descent in contrast to the secondary subtype (47.6%). Secondary psychopathic offenders tended to be actuarially higher risk, have greater criminogenic needs, and to make greater amounts of treatment change on criminogenic targets; however, contrary to expectations, within-treatment changes from a violence reduction program were significantly associated with reductions in violent recidivism for primary, but not secondary, variants. There were few differences in rates of recidivism between the groups overall; secondary variants had higher rates of sexual violence which was largely accounted for by individual differences in baseline static risk. Implications for risk assessment, treatment planning, and the classification and etiology of primary and secondary psychopathy are discussed.Copyright (c) 2015 APA, all rights reserved).
    • A comparison of adults with antisocial personality traits with and without childhood conduct disorder

      Perdikouri, Marianna; Huband, Nick (2007)
      Background: Antisocial personality disorder (ASPD) in DSM-IV is unique among personality disorder diagnoses in requiring the individual to satisfy a number of childhood criteria in addition to relevant traits exhibited in adulthood. We examined the validity of this childhood requirement.; Methods: Personality disordered individuals assessed using the International Personality Disorder Examination and exhibiting a sufficient number of adult antisocial traits to meet criterion A of DSM-IV were subdivided into those who exhibited antisocial traits in both adulthood and childhood and those who had such traits in adulthood only. The two groups were then compared on a number of historical, clinical, and self-report measures.; Results: Thirty individuals meeting both childhood and adult criteria (ASPD) were compared with 39 meeting adult antisocial criteria only (ASS). Few differences were found between the two groups on the measures examined, although those in the ASPD group appeared more severe and had higher anger scores on the STAXI-2 psychometric test.; Conclusions: This failure to find clinically important differences between the two groups is in agreement with previous reports and needs to be taken into account in future revisions of ASPD in DSM.;
    • A comparison of treatment completers and non-completers of an in-patient treatment programme for male personality-disordered offenders

      McMurran, Mary; Huband, Nick; Duggan, Conor (2008)
      Background. In the treatment of offenders with personality disorders, one matter that requires attention is the rate of treatment non-completion. This is important as it has cost-efficiency and negative outcome implications. Method. We compared the characteristics of those who participated in a personality disorder treatment programme divided into three groups: Group 1, treatment completers (N = 21); Group 2, those expelled for rule breaking (N = 16); and Group 3, those removed because they were not engaging in treatment (N = 19). We hypothesized that, compared with the other two groups, Group 2 would score higher on the impulsive/careless style scale, and that those in Group 3 would score higher on the avoidant style scale of the social problem-solving inventory-revised (SPSI-R). Further, we hypothesized that high anxiety would be associated with treatment non-completion in both the groups. Results. These differences were not found. However, in combining both groups of non-completers for comparison, completers were shown to score significantly higher on SPSI-R rational problem solving and significantly lower on SPSI-R impulsive/careless style. Conclusion. Findings suggest that teaching impulsive people a rational approach to social problem solving may reduce their level of non-completion.
    • A comparison of women who continue and discontinue treatment for borderline personality disorder

      McMurran, Mary (2009)
      Background: Treatment non-completion is a significant problem for personality disorder treatment services. Aims: We investigated differences between treatment continuers and treatment discontinuers of a tertiary specialist service for people with borderline personality disorder. The two groups were compared on: (1) personality disorder severity; (2) motivation for therapy; (3) mood; and (4) social problem solving. Method: Patients' personality disorders were examined using the International Personality Disorder Examination. Three self-report questionnaires were administered at the start of treatment: the Treatment Motivation Questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the Social Problem Solving Inventory-Revised. Results: Of 14 outpatients recruited to the service during 2005 to 2007, seven continued and seven discontinued treatment. Those who did not continue with therapy had more complex personality disorder profiles, were more externally motivated for treatment and were less internally motivated for treatment. All patients scored high on the HADS. Problem-solving abilities were apparently intact, but adversely affected by a negative problem orientation. Treatment discontinuers spent, on average, three times longer in hospital than continuers. Conclusion: Engaging people with complex personality disorders, low internal motivation for therapy and negative problem orientation is a challenge for services. Non-completion of treatment is associated with more days in hospital and higher service costs. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • A cost and economic evaluation of the Leeds personality disorder managed clinical network-A service and commissioning development initiative

      Kane, Eddie (2016)
      In the UK, patients with personality disorders presenting complex needs frequently experience an unhelpful pattern of acute treatment followed by community care-with associated high cost implications for services. With UK mental health resources under severe pressure, this leaves commissioners with difficult decisions to make. Yet studies on cost-effectiveness in respect of personality disorder treatment are scarce, particularly for treatments taking place outside of major teaching hospitals in the USA. This paper studies the benefits of an intensive, holistic approach and finds that the Network achieved substantial reductions in health care usage and expenditure in the short to medium term. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
    • A cross-sectional snapshot of therapeutic community client members

      Evans, Chris; Manning, Nick (2005)
      This paper describes some of the characteristic of 242 client members of 19 therapeutic communities in England and Scotland. On the first day of data collection of a research project evaluating the effectiveness of therapeutic communities in treating people with personality disorders, everyone who was a client member of these communities was invited to complete a set of questionnaires. We report here on their scores on the PDQ4+, a self-report measure of personality difficulties; and on the CORE-OM and Brief Symptom Inventory, two measures of state distress, to provide a snapshot of therapeutic community client members. © The Authors.
    • A descriptive evaluation of patients and prisoners assessed for dangerous and severe personality disorder

      Jones, Lawrence F.; Moore, Claire; Andrews, Kathryn (2010)
      The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted. © 2010 Taylor & Francis.
    • A living life, a living death: Bessie Head's writing as a survival strategy

      Atkinson, Sue (2011)
      This paper explores Bessie Head's writing as a survival strategy through which she transformed her lived experience into imaginative literature, giving meaning and purpose to a life under permanent threat from the dominant group first in South Africa and later in Botswana. This threat included the destructive effect of the many fixed labels imposed upon her including: a 'Coloured' woman, the daughter of a woman designated mad, an exile, a psychotic, a tragic black woman, and a Third World woman writer. Her endeavours to avoid and defeat such limited, static definitions produced work characterised by contradiction and paradox, through which she asserted her right to survive and determined, like Makhaya in When Rain Clouds Gather, to establish 'a living life' in place of the 'living death that a man could be born into' (Head 1989, 136). Through a combination of Head's personal letters and papers and her published work, it can be seen how her particular preoccupations and experiences including her life in exile, her beliefs about her origins, her relationship to her absent mother, her distress, her madness and her need for love and for work were transformed into writing which expresses not only the destructive circumstances of her life but also its life-affirming aspects. Her writing was also a means by which she could create identities to express the dangers she encountered from the all-pervasive power structures which influenced her life and her sense of self, as well as ways to transcend them, enabling her to say in the last years of her life 'I am no failure' (20.2.1986 KMM BHP). © 2011 Springer Science+Business Media, LLC.
    • A postal survey of the assessment procedure for personality disorder in forensic settings

      Milton, John (2000)
      Aims and method: A survey of 50 in-patient forensic health care and prison services in England, Wales and Scotland was employed to evaluate: (a) how severe personality disorder is assessed; and (b) how assessments compare with recommendations concerning standardised assessment by the Working Group on Psychopathic Disorder (Reed, 1994). Results: Seventy per cent of services responded, of whom 40% formally assessed personality disorder. Fifty-four instruments were routinely employed. Assessments of personality structure and cognitive/emotional styles were more common than structured diagnostic instruments or ratings of interpersonal functioning. Of the assessment tools, 25.7% of services provided at least one suggested by Reed (1994). Clinical implications: A nationally agreed, focused repertoire of instruments should be encouraged within secure forensic settings offering assessments to individuals with severe personality disorder.
    • A preliminary investigation of services for people with personality disorder in the East Midlands region of England

      Tetley, Amanda C.; Jinks, Mary; Howells, Kevin; Duggan, Conor; McMurran, Mary; Huband, Nick; Geelan, Steve; Milton, John; Kaul, Adarsh (2012)
      Aim This paper presents a preliminary investigation of dedicated and specialist personality disorder services in three counties within the East Midlands in England (Nottinghamshire, Lincolnshire and Derbyshire). We examined (1) the levels of dedicated National Health Service, independent and voluntary service provisions for people with personality disorder in these counties and (2) the psychological and psychosocial treatments on offer. Method Searches were conducted to identify dedicated and specialist personality disorder services, and senior clinicians within each service were asked to complete a survey about their facility. Results Our findings suggest that dedicated and specialist service capacity within this region is inadequate to meet the needs of both offenders and non-offenders with personality disorder. In addition to this, we found that there is significant disparity in the therapeutic interventions on offer across this region. Conclusion It is likely that similar observations apply throughout England. This suggests that the configuration and accessibility of services for people with people disorder requires a major review if these services are to meet their intended objectives. Copyright (C) 2011 John Wiley & Sons, Ltd.
    • A response to the commentaries by the complex case authors

      Morris, Adrian; Gibbon, Simon D.; Duggan, Conor (2007)
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    • A survey of how clinicians in forensic personality disorder services engage their service users in treatment

      Clarke, Martin; Fardouly, Peter; McMurran, Mary (2013)
      Non-completion is a significant problem in treatments for personality disorder (PD), and is associated with poorer outcomes. Clinicians routinely attend to engagement issues with people diagnosed with PD and so we accessed their views about the techniques they used to facilitate treatment engagement with service users with PD. Twenty-three clinicians from a range of disciplines were asked how they defined treatment engagement, what they thought were the causes of treatment engagement problems in people with PD, and what techniques or strategies they used to enhance engagement of people with PD. Data were analysed using inductive thematic analysis. Staff working with people with PD have broad views on the factors that are implicated in treatment engagement for their client group. Consequently, the techniques they use to engage service users are wide-ranging, addressing issues to do with services, individuals, therapies and therapists. Given the limited published data thus far, the suggestions generated may be of value to other practitioners in improving service user engagement. © 2013 Taylor & Francis.
    • A therapeutic community for personality disorder in a high secure intellectual disability service: Inception and early experiences

      Taylor, Jon; Trout, Sarah; Christopher, Janice; Bland, Alan (2012)
      Purpose: This paper seeks to explain the reasons for use of a therapeutic community for personality disorder in a high secure intellectual disability service. Design/methodology/approach: The paper describes the rationale for, and early experiences of, a therapeutic community intervention for people with mild intellectual disability and personality disorder in a high secure setting. Findings: No empirical findings are reported. Evaluation is being undertaken and will be reported in due course. Originality/value: The therapeutic community approach has not been applied in forensic intellectual disability before, and this paper therefore describes an original and, in many ways, radical intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • A training and development strategy for clinically based staff working with people diagnosed as having psychopathic disorders

      Hughes, Gareth; Tennant, Allison (1996)
      There is a growing consensus that cognitive/behavioural methods of treatment are the most effective techniques in reducing offender recidivism. Consequently, these may be the treatment of choice in working with offenders who are detained under the Mental Health Act 1983 with the classification of psychiatric disorder. An effective strategy for the training of nurses and other ward-based staff is seen as essential to the effective cognitive/behavioural treatment of patients with psychopathic disorder. This article describes the implementation of a flexible training approach. This approach is multifaceted and enables staff to be trained to different levels of proficiency.
    • A treatment goal checklist for people with personality disorder

      McMurran, Mary (2013)
      Background: Agreement between client and therapist on treatment goals has been consistently linked with improved treatment outcomes. Having clear and collaborative goals may be particularly important when working with clients diagnosed with personality disorders who are often difficult to engage and test the boundaries of therapy. This paper outlines the development of a personality disorder treatment goal checklist aimed at helping clients and therapists to identify and prioritize their goals for therapy. Method: The checklist was developed using self-reported problems of the first 90 participants randomized into the psychoeducation and problem solving (PEPS) trial. Problems were coded and categorized into problem areas. The checklist was viewed by two service users who gave suggestions for improvements. Results: The final checklist consists of 161items in 16 problem areas. Conclusions: The checklist may provide a clinically useful tool for working with this client group. © 2013 John Wiley & Sons, Ltd.
    • A treatment guideline for people with antisocial personality disorder: Overcoming attitudinal barriers and evidential limitations

      Duggan, Conor (2009)
      Mental health professionals have always been ambivalent in their response to treating and managing those with personality disorder, and this especially applies to those with antisocial personality disorder (ASPD). The decision by the National Collaborating Centre for Mental Health to develop a guideline to cover the prevention, treatment and management of the disorder is a courageous step. The guideline provides a positive and optimistic approach, as this is not only becoming increasingly prevalent in the offending literature, but would also act as an antidote to much of the negativity that many with ASPD have habitually experienced. When this guideline comes to be revised in the future, professional attitudes towards those with ASPD will not only have altered, but this will be accompanied by a more engaged response from those who suffer from the condition. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • A validation of cognitive biomarkers for the early identification of cognitive enhancing agents in schizotypy: A three-center double-blind placebo-controlled study

      Dadhiwala, Rukiya (2012)
      A number of compounds aimed at improving cognition in schizophrenia have failed to demonstrate efficacy in Phase 2 clinical trials. Translational studies using biomarkers in surrogate populations, such as schizotypy, could be used to assess the efficacy of novel compounds. In this study, we aimed to validate the sensitivity and inter-site reliability of cognitive biomarkers (working memory (N-back), spatial working memory (SWM) and verbal fluency (VF) tasks) to detect the schizotypy phenotype and its reversal by psychotropic drugs. Healthy volunteers scoring high or average on a schizotypal personality measure (122 in each group) were randomized to receive a single dose of risperidone, amisulpride, nicotine or placebo in a double-blind, between-subject design. We found evidence for a poorer performance on N-back and VF tasks in the high schizotypy group, replicating previous research. This effect was counteracted by amisulpride on N-back: it improved working memory in high schizotypy group but impaired the controls. A similar pattern was seen in SWM and VF. We interpret this finding in the light of the dopamine enhancing action of amisulpride when given in low doses. In contrast, risperidone impaired both groups and nicotine had a beneficial effect for the low baseline performers only. These effects were consistent across sites. These data demonstrates the utility of biomarkers in detecting the effect of schizotypy and its reversal by drugs that enhance dopamine and cholinergic function. Studies using similar design could help the early assessment of potential of compounds designed to improve cognition in schizophrenia. © 2011 Elsevier B.V.
    • Addiction to violence: A new model of psychopathy

      Hodge, John E. (1992)
      Our understanding of the Mental Health Act 1983 category of psychopathic disorder is not enhanced by describing it as a personality disorder. A new operational concept of psychopathic disorder would greatly assist in both diagnosis and treatment planning. This paper proposes that psychopathic disorder has its origins in post-traumatic stress disorder (PTSD) consequent on childhood sexual and physical abuse. Such abuse is common in the background histories of psychopaths. Recent research on PTSD in Vietnam veterans has suggested that it is often associated with an increase in aggression and violence. In some veterans violent behaviour can assume the characteristics of an addiction, while at the same time becoming indistinguishable from the behaviour of violent psychopaths. Conceptualising psychopaths as being addicted to violence as a consequence of a developmentally mediated PTSD leads to many new avenues of possible treatment.
    • Adult antisocial syndrome co-morbid with borderline personality disorder is associated with severe conduct disorder, substance dependence and violent antisociality

      Howard, Richard C. (2013)
      This study tested the hypothesis that syndromal adult antisocial behaviour (AABS) co-morbid with borderline personality disorder (BPD) is a syndrome that emerges from severe conduct disorder (CD) in childhood and adolescence and is strongly associated, in adulthood, with both violence and substance dependence. In a sample of 8580 community-resident adults screened for the presence of personality disorders, the following predictions arising from this hypothesis were tested: first, that those with AABS co-morbid with BPD would, in comparison with those showing AABS or BPD only, show a high level of antisocial outcomes, including violence; second, that adjusting for co-morbid alcohol dependence would attenuate group differences in many of the antisocial outcomes, and violence in particular; and third, that the AABS/BPD group would show both a high prevalence and a high severity of CD, and that adjusting for co-morbid CD would attenuate any association found between AABS/BPD co-morbidity and violence. Results confirmed these predictions, suggesting that AABS/BPD co-morbidity mediates the relationship between childhood CD and a predisposition to adult violence. The triad of AABS/BPD co-morbidity, alcohol dependence and severe CD is likely associated with the risk of criminal recidivism in offenders with personality disorder following release into the community. © 2012 John Wiley & Sons, Ltd.