• Dangerous and severe personality disorder

      Duggan, Conor (2011)
      The Dangerous and Severe Personality Disorder (DSPD) initiative was introduced a decade ago against overwhelming opposition from psychiatrists and others concerned with the implications of extending the public protection agenda through the use of a questionable medical 'diagnosis'. As this initiative is now being scaled down, it offers an opportunity to consider the positive and negative aspects of the initiative together with its longer-term legacy.
    • Dangerous and Severe Personality Disorder (DSPD). Integrating education, training, teamwork and supervision

      Davies, Jason; Tennant, Allison (2003)
      The major resource underpinning Dangerous and Severe Personality Disorder (DSPD) services is the workforce. In order to deliver appropriate interventions which promote change and ensure safe and efficient practice: high quality staff education, training, teamwork and supervision are needed. This paper outlines a model for workforce development which integrates these elements to ensure that staff are prepared for, engaged in and supported in their efforts to provide treatment intervention and management to this client group. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Defence styles in a sample of forensic patients with personality disorder

      Huband, Nick; Duggan, Conor; McCarthy, Lucy; Mason, Lauren (2014)
      Background - Ego defences, often considered central to clinical work, have received surprisingly little attention in the forensic literature. Method - In this exploratory study, 114 male inpatients completed the Defence Style Questionnaire (DSQ) following their admission to a specialist personality disorder (PD) service. Change in DSQ scores over time was examined using mixed effects models for those (n = 48) remaining in treatment for at least 18 months. Results - Defensive functioning at baseline was less mature in comparison with non-clinical norms, with two other non-forensic PD samples, and with a male paedophile sample, but was unrelated to criminal history. Axis II severity was negatively associated with overall defensive functioning (ODF). Antisocial PD was positively associated with a maladaptive defence style. Borderline PD was negatively associated with self-sacrificing defences. Avoidant PD was negatively associated with both self-sacrificing and adaptive styles. Non-completion of treatment was predicted by low ODF scores and high maladaptive defence style scores at baseline. ODF improved significantly over time in treatment and was predicted by strong antisocial and weak schizotypal PD pathologies. Conclusions - Defence style, as measured by the DSQ, appears to have the potential to inform assessment and measure change in this group of offenders. Copyright (C) 2014 John Wiley & Sons, Ltd.
    • Developing a framework for the identification of criminogenic needs in offenders with intellectual disability and personality disorder: the Treatment Need Matrix

      Taylor, Jon (2014)
      Purpose – The criminogenic needs and psychological vulnerabilities of offenders with intellectual disability (ID) has only recently received attention within the academic literature. The purpose of this paper is to provide an overview of an approach to identifying such needs in order to inform treatment planning and service delivery.
    • Developing a national institute of clinical excellence and health guideline for antisocial personality disorder

      Duggan, Conor; Kane, Eddie (2010)
      Antisocial personality disorder (ASPD) is a common disorder with a prevalence rate in the general population of around 1%, which means that it is as prevalent as other major psychiatric conditions such as schizophrenia and bipolar disorder. People with ASPD tend to present for treatment because of a comorbid disorder, such as substance misuse, depression and anxiety or because they have been legally mandated to do so. Consequently, their commitment is often lukewarm with a high rate of noncompletion. Individuals with ASPD are often treatment rejecting and rejected by those who should be treating and supporting them. Despite this bleak picture ASPD is very costly in human and financial terms to society, the individual and their family and social networks yet targeted services and support are minimal and individuals with ASPD are among the most excluded in our society. Clearly intervention was necessary to stem the loss of human and financial capital under the current system. It was for this reason that the decision was taken that the National Institute of Clinical Excellence and Health (NICE) would produce a guideline to stimulate action based on the best available evidence. The Guideline, Anti-social personality disorder: Treatment, management and prevention, was published in 2009 (NICE, 2009). It aims to make its decisions on the best available research evidence and to do so in a transparent way. Producing the Guideline presented a number of challenges to the Guideline Development Group (GDG). The GDG decided on a pragmatic, practical, threefold strategy to resolve the dilemma. As the GDG had been asked specifically to consider prevention, we examined the literature on the treatment of childhood conduct disorder (CD), for which there was a reasonable evidence base, including some high-quality RCTs, widened the search for relevant literature by reviewing studies from related populations, and examined the evidence for the treatment of the relevant co-morbid conditions in those with ASPD. The ASPD Guideline presents a practical, positive and optimistic approach to work with people with ASPD that is becoming increasingly common in the offending literature. It aims to act as an antidote to much of the negativity that many with ASPD have habitually experienced. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security

      Sarkar, Jaydip; Beeley, Chris (2011)
      There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive self-harm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity. © 2011 Copyright Taylor and Francis Group, LLC.
    • "Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security": Corrigendum

      Sarkar, Jaydip; Beeley, Chris (2012)
      Reports an error in "Developing an algorithm of hierarchical model of management of repetitive self-harm among women with severe personality disorders in medium security" by Jaydip Sarkar and Chris Beeley (Journal of Forensic Psychiatry & Psychology, 2011[Dec], Vol 22[6], 845-862). In the original article, Table 1 was reproduced incorrectly. The table is given in the erratum. (The following abstract of the original article appeared in record 2011-28873-006). There is an urgent need for development of practice-based and theoretically grounded model of care for immediate and short-term risk assessment and management by front-line staff (nurses and doctors) for women with severe personality disorders and high-risk repetitive self-harm. This is particularly necessary for forensic in-patients as available guidelines do not address the needs of and risks associated of this group. An algorithm of a hierarchical model of risk assessment and management and care for high-risk repetitive self-harmers within medium secure care is developed and tested for model effectiveness and fidelity. The model was found to be effective in reducing frequency of self-harm and assessment of staff practice revealed adequate model fidelity. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Developing and implementing a Postgraduate Certificate Course for people working in the Dangerous and Severe Personality service

      Whyte, Lawrence (2003)
      This article describes the development and implementation of a course aimed at developing leadership in the emerging Dangerous and Severe Personality Disorder Service nationally. The problematic nature of defining and conceptualising 'leadership' is discussed as well as the debate around whether leadership can be learned. These form the background for a discussion of this unique and innovative programme. The course is described in relation to its aims, unique features such as mentorship and virtual e-learning. The evaluation process is described. Despite the noble intentions of course planners and providers, the conclusion in relation to this course, is that 'the jury is still out'. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Developing models and a framework for multiprofessional clinical supervision

      Tennant, Allison; Ferguson, Esme; Jones, Lawrence F. (2004)
      The UK government proposals for services for individuals considered to be dangerous with a severe personality disorder (DSPD) are developing. The complex task of balancing safety and therapeutic change in DSPD services will rest largely upon the skills, knowledge and practice of the staff group. As a result, one challenge for DSPD services is to provide sufficient training and support to staff, in order to ensure that adequate resources are available to assist them in processing their emotional reactions to their work. As part of this, clinical supervision systems need to be developed to offer professional support and learning, enabling individual practitioners to develop knowledge and competence and assume responsibility for their own practice (DoH, 1993). Among the service developments at Rampton Hospital an innovative multi-professional supervision strategy has been introduced for all staff working in the unit. This paper describes the evolving supervision framework, including a new tool, the 'Supervision Matrix', and implementation guidelines, and describes how this supervision framework will be evaluated. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Development and validation of a treatment progress scale for personality disordered offenders

      Baliousis, Michael; Huband, Nick; Duggan, Conor; McCarthy, Lucy; Vollm, Birgit A. (2015)
      Background: There is a need for a measure to evaluate change in treatment for offenders with a personality disorder, and the Progress Rating Scale (PRS) was developed to meet this need taking account of multiprofessional input.; Method: The PRS comprises six process and five non-process items developed via thematic analysis of routine CPA patient treatment reports at a forensic Personality Disorder Service. Rating for items was fully standardized and operationalized with revisions aiming to maximize inter-rater agreement reflecting good face and content validity. Psychometric properties were examined using PRS ratings for 147 patients at three different time points in conjunction with relevant psychometrics.; Results: Following refinement, the instrument demonstrated good content validity. Intra-class correlations suggested moderate to substantial inter-rater agreement (intraclass correlations: 0.63-0.92). Item analyses indicated good internal consistency for process items (Cronbach's alpha: 0.82-0.88). Correlations with relevant psychometrics revealed meaningful relationships between PRS scores, defence styles and social problem solving. PRS score trajectories were in line with previously known treatment outcomes supporting predictive validity.; Conclusion: The PRS shows promise as process measure in clinical settings but requires further testing on other samples to confirm initial findings and demonstrate its utility.; Copyright © 2015 John Wiley & Sons, Ltd.
    • Development of a self-report measure of social functioning for forensic inpatients

      Willmot, Phil; McMurran, Mary (2015)
      Despite increasing interest in the measurement of social functioning in people with personality disorder, there are currently no social functioning measures specifically for forensic or other inpatients with a diagnosis of personality disorder. This paper describes the development and validation of the Hospital Social Functioning Questionnaire (HSFQ), a self-report measure of social functioning for forensic inpatients. A sample of fifty four male inpatients in a forensic personality disorder treatment unit completed the HSFQ and a range of measures indicative of social functioning, namely self-report measures of psychological wellbeing and symptoms, recorded incidents of self-harm and aggression. Clinicians' ratings of global functioning, and clinically assessed personality disorder severity were also collected. The HSFQ showed good internal consistency and test-retest reliability, good concurrent validity with self-report measures of personality pathology, other symptoms and psychological wellbeing, but only a moderate correlation with clinician-rated global functioning and with frequency of self-harm and aggressive behavior. These results suggest that the HSFQ is a more focused measure of social functioning than the Global Assessment of Functioning (GAF), which conflates social functioning with self harm and aggressive behavior. The HSFQ is a potentially useful assessment of social functioning in secure and other inpatient settings. Copyright © 2015 Elsevier Ltd. All rights reserved.
    • Diagnosis and classification of personality disorder: Difficulties, their resolution and implications for practice

      Sarkar, Jaydip; Duggan, Conor (2010)
      There are many difficulties associated with the diagnostic guidelines for personality disorder in the current international classificatory systems such as ICD-10 and DSM-IV. These lead not only to significant overlap with DSM Axis I disorders, result ing in high rates of diagnoses of comorbidities and multiple personality disorders, but also to lack of adequate capture of core personality pathology. The current classifications are also unhelpful in treatment selection, presumably the prime reason for assess ing individuals in the first place. In this article we highlight various deficits and inadequacies related to the nosology of the current systems and suggest some strategies for dealing with these. We offer an integrated model of assessing and diagnosing personality disorders. We attempt to demonstrate how using a more integrated approach minimises or even eliminates some of the key problems high lighted in the current systems.
    • Difficulties in the pathway from high to medium secure services for personality-disordered patients

      Tetley, Amanda C.; Evershed, Sue; Krishnan, Gopi (2010)
      Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n = 68) and a Dangerous and Severe Personality Disorder service (n = 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group. © 2010 Taylor & Francis.
    • Do mood stabilizers help in borderline personality disorder?

      Vollm, Birgit A. (2017)
      BackgroundDespite the relatively weak evidence base, individuals with borderline personality disorder are often treated with pharmacological interventions. Amongst the drugs, which have shown most promise, are mood stabilizers, which were one of the two drug classes with the most beneficial effects in a previous cochrane review though the robustness of findings was described as low (Stoffers et al., 2010). Here we present data on the latest evidence for mood stabilizers based on an updated cochrane review currently underway.
    • Does personality change and, if so, what changes?

      Duggan, Conor (2004)
      BACKGROUND: Although the question of whether or not personality changes is fundamental to much of what clinicians do, we do not appear to be very curious about the question itself.
    • Does social problem solving mediate the relationship between personality traits and personality disorders? An exploratory study with a sample of male prisoners

      McMurran, Mary (2010)
      Background: Social problem solving therapy is one helpful approach to treating people with personality disorders (PD). Consequently, it is worthwhile to develop a greater understanding of the role of social problem solving in PD. One hypothesis is that social problem solving mediates the relationship between personality dimensions and personality disorder. This premise was explored in a sample of male prisoners, a population known to have a high prevalence of PD. Method: Sixty-eight men completed the International Personality Disorder Examination (IPDE), NEO-Five Factor Inventory (NEO-FFI) and the Social Problem-Solving Inventory-Revised: Short Version (SPSI-R:S). The data were explored for direct and indirect mediational effects of social problem solving variables in the personality dimension-PD relationship, using methods appropriate for small samples and multiple mediators. Results: A number of relationships between personality dimensions, social problem solving, and personality disorder traits were identified, but only for paranoid, schizotypal, borderline, narcissistic, and avoidant PDs. Discussion: These findings support the hypothesis that social problem solving mediates between personality dimensions and some PDs. Further research is necessary to verify these relationships. However, these findings begin to clarify the mechanisms by which personality dimensions relate to PDs. This knowledge has potential to contribute to the development of more effective interventions for people with particular personality dimensions and specific personality disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Does treatment really make psychopaths worse? A review of the evidence

      D'Silva, Karen; Duggan, Conor; McCarthy, Lucy (2004)
      We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
    • DSM-5 and ICD-11 on personality disorder: A lawyer's perspective

      Bartlett, Peter (2011)
      Medical definitions are not merely abstract categorizations. They are used in the real world, where they have social effects, and nowhere is this more true than for diagnoses of personality disorder. This article considers the relevance of personality disorder in legal contexts and questions whether meaningful analysis of how the new diagnostic structures proposed for ICD-11 and DSM-5 will play out in real, social situations has been carried out. Without such analysis, it is not possible to know whether the new criteria will be an improvement or a step backwards. Copyright (c) 2011 John Wiley & Sons, Ltd.