The assessment and meaning of the legal classification of offenders in a Special Hospital using observer ratings of interpersonal style

Abstract

Disturbed interpersonal functioning is believed to be a cornerstone of personality disorder. We sought to determine differences in interpersonal functioning between patients detained under the Mental Health Act classifications of psychopathic disorder and mental illness. An observer-rated scale of interpersonal behaviour (CIRCLE) was administered to a mixed gender, Rampton Hospital sample of 92 patients classified as having psychopathic disorder and 92 matched patients classed as suffering from mental illness. Three-quarters of the initial sample (136 patients) were successfully assessed. Satisfactory inter-rater reliability was achieved (intra-class correlation coefficients between 0.72 and 0.55), although some potential for rater bias was identified. We found statistically significant differences between the two groups for four of the eight octants of the interpersonal circle and the two groups were typically represented in opposing halves of the interpersonal circle. The significant differences in interpersonal functioning between the two groups suggest that the current legal categorization has some validity. Our results are generally in accordance with findings from previous work in another English Special Hospital and may be generalizable to other similar settings. The CIRCLE may provide a simple tool to assist in the assessment and management of the personality disordered in secure hospitals.