• Sensational interests and sensation seeking in mentally disordered offenders

      Egan, Vincent; Charlesworth, Philip (2001)
      Examined the differences in sensational interests and sensation-seeking (SS) between patients detained under the Mental Health Act (1983) classifications of psychopathic disorder (PD) and mental illness (MI), the degree to which sensational interests related to sensation-seeking, and the relationship between these factors and self-reported personality disorders. The Sensational Interests Questionnaire (SIQ), Zuckerman's Sensation-Seeking Scale (SSS), the Standard Progressive Matrices (SPM) and the MCMI-II were given to 42 psychiatric patients (32 MI, 10 PD). There were no significant differences between the MI and PD groups for scores on the SIQ or the SSS. The SIQ was not related to scores on the SPM. As predicted, the SIQ's subscales of militarism and the violent-occult were significantly and positively associated with sensation-seeking, especially the SSS subscales of Disinhibition and Thrill and Adventure Seeking. Sensation-seeking mediated the relationship between sensational interests and measures of personality disorder. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • The treatment of deliberate self-harm in borderline personality disorder using dialectical behaviour therapy: A pilot study in a high security hospital

      Low, Gail; Jones, David; Duggan, Conor (2001)
      Deliberate self-harm (DSH) presents a significant health problem, especially as treatments have not been particularly successful in reducing repetition. Dialectical behaviour therapy (DBT; Linehan, 1993) is one approach that has reported some success in reducing self-harm rates in borderline personality disorder patients, who self-harm frequently, though it remains largely untested outside its original setting. The present study aimed to assess the effectiveness of DBT in self-harming women in an institutional setting in the United Kingdom where self-harm is common. Female patients at Rampton Hospital who were displaying self-harming behaviour and met criteria for borderline personality disorder (N = 10) participated in the full one-year treatment package of DBT. Patients were assessed on self-harm rates and on a number of psychological variables, pre-, during- and post-therapy, including a 6-month follow-up. There was a significant reduction in DSH during therapy, which was maintained at 6-month follow-up. This was paralleled by a reduction in dissociative experiences and an increase in survival and coping beliefs, alongside improvements in depression, suicide ideation, and impulsiveness. The findings are preliminary but the results suggest that DBT might provide an effective treatment for severe self-harm in institutional settings, and also highlight some of the psychological mechanisms that might mediate these improvements in self-harming behaviour.
    • Are perceptions of parenting and interpersonal functioning related in those with personality disorder? Evidence from patients detained in a high secure setting

      Duggan, Conor; Collins, Mick; Larkin, Emmet P. (2001)
      We explored the widely-held assumption that dysfunctional interpersonal behaviour, a key characteristic of personality disorder, is associated with adverse experiences in childhood in a sample of patients detained in high secure care. We obtained Parental Bonding Inventory (PBI) and Chart of Interpersonal Relations in Closed Living Environment (CIRCLE) data from 79 patients detained at a high secure hospital. This comprised 48 with the legal classification (1983 Mental Health Act) of Psychopathic Disorder (PD) and 31 with the legal classification of Mental Illness (MI). On the PBI, the PD group had significantly lower care scores and increased protection scores compared with the MI group; the latter reported care and protection scores similar to those from published norms. The CIRCLE scores also demonstrated significantly different interpersonal functioning between the PD and MI groups, with each group typically plotted in opposing halves of the interpersonal circle (IPC). Although the PDs showed abnormalities in both the PBI and CIRCLE in the expected direction, there were no clear associations between aspects of abnormal parenting and adult dysfunctional interpersonal behaviour within this group. This finding did not confirm our hypothesis and we discuss possible explanations. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • The relationship between social problem-solving and personality in mentally disordered offenders

      Egan, Vincent (2001)
      Poor social problem-solving skills may account for some criminal behaviours in mentally disordered offenders, and social problem-solving may be mediated by personality traits. We examined the relationship between personality and social problem-solving in 52 mentally disordered offenders, (38 mentally ill and 14 personality disordered) detained in a regional secure unit. Since t-tests indicated no differences between the mentally ill and personality disordered groups, they were pooled into a single sample. Correlations indicated that high neuroticism (N) was related to poor social problem-solving, and high scores on the other five-factor traits were related to good social problem-solving. High N, which is a core feature of personality disorders as well as being a common feature of offenders, may signal emotional reactivity which militates against effective social problem-solving. N is, however, negatively correlated with extraversion (E), conscientiousness (C), and agreeableness (A), therefore partial correlations were conducted controlling for N. Once N is discounted, the main trait associated with problem-solving is openness (O), which is positively related to problem-solving, perhaps due to the relationship of O to intelligence and creativity. A positive correlation between E and a more positive problem orientation remains, perhaps because optimism is a defining feature of high E. © 2001 Elsevier Science Ltd.
    • Treatment benefits of psychoanalytically oriented partial hospitalisation were maintained over 18 months in borderline personality disorder: Commentary

      Evans, Chris (2001)
      QUESTION: In patients with borderline personality disorder, are the short term benefits of psychoanalytically oriented partial hospitalisation maintained over an 18 month follow up period?DesignRandomised {allocation concealed*}**, unblinded*, controlled trial with 36 months total follow up.SettingHalliwick Psychotherapy Unit, London, UK.Patients44 patients with borderline personality disorder diagnosed using DSM-III-R and the Diagnostic Interview for Borderline Patients. Exclusion criteria were schizophrenia, bipolar disorder, substance misuse, mental impairment, or evidence of organic brain disorder. 3 patients in the control group refused continued participation.Intervention22 patients were allocated to psychoanalytically oriented partial hospitalisation and 22 to standard psychiatric care. Treatment was for a maximum of 18 months. A follow up programme was offered to those assigned to partial hospitalisation which consisted of analytic therapy twice a week over 18 months. The control group continued to receive general psychiatric treatment.Main outcome measuresFrequency of suicide attempts and acts of self harm, number and duration of inpatient admissions, service utilisation, and self reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment.Main resultsAnalysis was by intention to treat. At 36 months follow up, fewer patients assigned partial hospitalisation reported engaging in self mutilation and fewer had made serious suicidal gestures (table). Over the 18 month extended follow up period, patients in the partial hospitalisation group had fewer inpatient treatment days (1.7 v 15.8 mean d in the control group), outpatient psychiatric visits (0.7 v 4.3 mean visits), partial hospitalisation days (0 v 13.9 mean d), and days in community centre attendance (0.9 v 17.3 mean d) (p < 0.002 for all comparisons). Patients in the partial hospitalisation group improved more than the control patients on all self report measures (p < 0.001).ConclusionIn patients with borderline personality disorder, benefits of psychoanalytically oriented partial hospitalisation were maintained 18 months after treatment completion.*See glossary.**Information provided by the author.
    • Service innovations: Development of a psychoeducational programme for patients with personality disorder

      D'Silva, Karen; Duggan, Conor (2002)
      Aims and method: This study describes a survey of in-patients with personality disorder admitted to a specialist personality disorder unit, in terms of their knowledge and understanding of their diagnosis, and the subsequent development of a psychoeducational programme. Results: Overall, patients had a poor knowledge and understanding of their diagnosis. Most had not had their diagnosis explained to them, and if they had, they had not retained the information. Consequently a structured psychoeducational programme was developed, incorporating diagnostic information obtained at the pre-admission assessment. Clinical implications: Diagnostic information for those with personality disorder, even when it is available, is not transmitted to patients. Imparting this information through a psychoeducational programme is one way in which the therapeutic relationship between patient and clinician can be strengthened.
    • Proposals for managing dangerous people with severe personality disorder: New legislation and new follies in a historical context

      Cordess, Christopher (2002)
      Current proposals in England and Wales to ' capture' an ill-defined group of anti-social and violent people within the widest possible definition of mental disorder, and thereby to detain them under proposed new mental health legislation, is criticized and critiqued on intellectual, ethical and pragmatic grounds. The view is taken that psychiatrists must utterly reject these proposals which, if adopted, would make them primarily agents of social control. Psychiatrists and other mental health professionals must fight to retain the essentials of ethical and effective treatment earned trust and primary responsibility to the individual patient which these proposals seek to undermine and pervert.
    • The properties of self-report research measures: Beyond psychometrics

      Evans, Chris (2002)
      Self-report measures pertinent for personality disorder are widely used and many are available. Their relative merits are usually assessed on nomothetic psychometrics and acceptability to users is neglected. We report reactions of lay, patient and professional groups to the Personality Diagnostic Questionnaire (PDQ-IV); Millon Clinical Multiaxial Inventory (MCMI-III); the Borderline Syndrome Index (BSI); Rosenberg's Self-Esteem Scale (RSE) and the Social Functioning Questionnaire (SFQ). These were sent to 148 professionals, ex-patients and lay people for comment. Thirty-six per cent were returned. Pattern-coding by three raters revealed problematic themes across all measures, including inappropriate length, vague items and language, cultural assumptions and slang, state-bias and response-set. Measures can be depressing and upsetting for some participants (both patients and non-patients), hence administration of measures should be sensitive. Treatment may make people more self-aware, which may compromise validity for outcome research. This evaluation raises issues and concerns, which are missed in traditional psychometric evaluation.
    • The voice of detainees in a high security setting on services for people with personality disorder

      Ryan, Sue (2002)
      BACKGROUND: British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area.
    • 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)
    • 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)
    • Therapeutic community treatment of personality disorder: Service use and mortality over 3 years' follow-up

      Davies, Steffan (2003)
      Background: A number of studies have demonstrated reductions in the utilisation of psychiatric services, especially acute in-patient admissions, following therapeutic community treatment of personality disorder. These studies have, however, been of limited duration (1 year) and follow-up has not always been complete. Aims: To identify hospital admissions before and after therapeutic community treatment of personality disorder. Method: A naturalistic clinical cohort of patients admitted between January 1993 and December 1995 was followed up for 3 years. All subjects were traced to their current consultant psychiatrist, general practitioner or death. Results: All patients were traced at 3-year follow-up. The significant reduction in in-patient admissions seen in the first year was maintained over 3 years. Those with the poorest outcomes, suicide, accidental death or prolonged admission were all in the quartile with the shortest admissions (under 42 days) to the therapeutic community. Conclusions: Previously reported reductions in psychiatric admissions following therapeutic community treatment of personality disorder are maintained over 3 years.
    • An overview: DSPD programme concepts and progress

      Hogue, Todd E. (2003)
      The article focuses on the progress made toward developing services for individuals identified with Dangerous and Severe Personality disorder (DSPD). The article defines the DSPD programme, the structure of the programme and progress made in key areas of work, research and development, assessment and treatment. The background to the programme lies in the limited availability of specialist services for this group. Current mental health legislation can only be used to detain this group if they are considered 'treatable', yet professionals often disagree whether this is possible and this has often resulted in people with these characteristics being excluded from services. Despite the risk that they pose and the problems they face, too often they are not given access to interventions that might protect the public and help them achieve safe and successful re-integration into the community. The Government's proposals for the DSPD Programme are intended both to ensure that the public is protected from some of the most dangerous people in society and provide high quality services to improve their health outcomes and reduce risk. The DSPD Programme has now moved on from the initial work to launch the programme, to its main and longer-term implementation phase. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Practice-based outcomes of dialectical behaviour therapy (DBT) targeting anger and violence, with male forensic patients: A pragmatic and non-contemporaneous comparison

      Evershed, Sue; Tennant, Allison; Boomer, Debbie (2003)
      OBJECTIVE: To examine the effectiveness of an eighteen-month treatment based on dialectical behaviour therapy (DBT) targeting anger and violence, on a group of male forensic patients.
    • Personality traits, personality disorders and sensational interests in mentally disordered offenders

      Elliot, Debbie; Patel, Darshana; Charlesworth, Philip (2003)
      Purpose. Sensational interests (e.g. an interest in the occult or the methods of violence) in mentally disordered offenders are claimed to signify greater risk of psychopathology, but evidence to support this view is slight. Methods. The relationships between self-reported DSM-IV personality disorder (PD), general personality traits and sensational interests were examined in 155 of 167 consecutively referred offenders to a forensic psychology service. The subscales of the PD and personality trait measures were reduced to the four basic PD/trait dimensions (asocial, antisocial, anxious and anankastic) using confirmatory factor analysis. Results. Those high on the 'antisocial' factor (which was primarily defined by low Agreeableness, low Conscientiousness, and substantial elements of Paranoid, Antisocial and Borderline PD) were more interested in 'violent-occult' and militaristic topics. Conclusions. The aspects of the antisocial factor primarily associated with an interest in sensational and potentially violent topics cover a wide range of putative disorders. However, the factors reflecting asocial, anxious or anankastic disorders do not show a reliable association with measures of sensational interests. These results suggest that the personality dimensions reflecting an interest in 'sensational' topics in mentally disordered offenders are relatively specific.
    • Substance use by the mentally disordered committing serious offences - A high-security hospital study

      D'Silva, Karen; Ferriter, Michael (2003)
      In recent years there has been increasing interest in the link between mental disorder, violent behaviour/offending and substance misuse. However, because of the low prevalence of serious offending, most studies to date have concentrated on relatively minor offending. The aims of our study were twofold. We wanted to investigate the frequency and pattern of substance use by mentally disordered offenders committing serious offences, both at the time of the offence and in the year prior to detention. We also wanted to determine whether the prevalence of substance use had increased over rime. Data on patients admitted to the Special Hospitals from 1972 to 1998 were collected from the Special Hospital Case Register. Overall, 18.6% of patients had taken substances at the time of the offence and 38.3% admitted to regular substance use in the 12 months prior to detention. However, from the early 1970s to the late 1990s the percentage of patients using substances at the time of the offence and admitting to regular substance use in the 12 months prior to detention, had risen almost threefold. The rising prevalence of substance use in this population highlights, yet again, the necessity for drug and alcohol treatment programs in secure settings.
    • Theories of general personality and mental disorder

      Duggan, Conor; Milton, John; McCarthy, Lucy (2003)
      Background: A major shortcoming of current research into personality is its failure to explore the relationship between theories of general personality and mental disorder. Aims: To provide preliminary data to address this deficit. Method: In the first of two studies, we examined the relationship between the Neuroticism, Extraversion and Other - Five-Factor Inventory (NEO-FFI) and DSM personality disorders in a consecutive series of mentally disordered offenders. In the second, we sought to separate the personality dimension neuroticism from symptoms of depressive disorder in a sample of subjects with current depression. Results: Factors from the NEO-FFI were associated with different personality disorders in a predictable manner (first study). It was possible to identify a component of neuroticism (i.e. 'worry') that could be separated from depressive symptoms (second study). Conclusions: Theories of general personality theory can enlighten and refine descriptions of abnormal mental states by informing both their aetiology and their prognosis.
    • 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)
    • Impulsivity and self-damaging behaviour in severe personality disorder: The impact of democratic therapeutic community treatment

      Evans, Chris (2004)
      Impulsivity is a defining characteristic of borderline and antisocial personality disorders (PD) and may contribute to the difficulty of providing successful treatment for this client group. Comparisons were made within and between groups of patients admitted (n = 75) and not admitted ('treatment-as-usual': n = 60) to a residential democratic therapeutic community (DTC) for treatment of personality disorder Assessment of a range of impulsive feelings and behaviours was made at referral and one-year follow-up. Significant reductions were found in the treated group for both total impulsive feelings and total actions. Highly significant differences were also found between change scores for the admitted and treatment-as-usual groups for both impulses and behaviours. Our results indicate that impulsive feelings and behaviours in personality disorder are amenable to TC treatment. © The Authors.