Psychological intervention with Personality Disorder and violence

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Psychological intervention with Personality
Disorderand violence

• Dr Julian Walker
• Forensic Clinical Psychologist
• Fromeside

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Definition

• Violence
• use of physical force against another person
  (or thing) sometimes with aggression/intent to
  hurtwhere the victim is motivated to avoid
  it.
• (Hollin and Howells, 1989)

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The scale of the problemin Avon Somerset (1½m)
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Research
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Violence ResearchWhat Why

• Theories include
• Impulsivity
• Frustration intolerance
• High anxiety / stress
• Modelling (parents/peers)
• Genes
• Disorder
• Anger

• Static Risk Factors
• Gender
• Age
• Offending history
• Substance misuse
• Etc..

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Personality and Violence (Nestor, 2002)

• Poor impulse control
• Poor affect regulation (esp. anger)
• Narcissism
• Paranoia
• For reasons of conceptual obscurity, circular
  reasoning..the concept of a violence-prone
  personality is rejected in favour of several more
  specific processes
• (Walters, 2000)

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Violence Research When?

• Dont know much about when
• Predictions for individuals based on group
  behaviour (over-predict)
• i.e. under what more specific circumstances do
  individuals behave violently and what can help
  them stop?

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Why do offenders offend?(Andrews and Bonta, 1994)

• Employment
• Education
• Partner and family
• Criminal social networks
• Substance abuse
• Poor community functioning
• Personal and emotional factors
• Anti-social attitudes

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What Works? (Lipsey, 1995) improvement over
control group
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Personality Disorder Treatment
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Schizophrenia vs Antisocial PersonalityDisorder

• Diagnose
• Compliance
• Symptom management
• Reduction of harm to self
• Evidence based treatments likely to work

• Formulate
• Socialisation
• Stress/distress management
• Reduction of harm to others
• Little evidence, few treatments, dont know what
  works

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Psychological Treatment for PD (Duggan, in press)

• good quality evidence from properly conducted
  studies of psychological interventions in
  personality disorder that might aid the
  practitioner is sparse
• Preponderance of DBT for BPD
• Majority of studies in community
• Little on ASPD despite prevalence

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What can be done?

• Specialist assessment diagnosis and formulation
• Treat Axis 1
• Support agencies involved with objective and
  expert advice/supervision
• Awareness and working with criminogenic factors
• Specialist treatment..

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Cost effectiveness

• Treatment choice based on cost benefit analysis
• Treatments - broad application/delivery (groups)
• Outcome focus reduction in subjective distress,
  crime, bed occupancy
• Focus on criminogenic factors
• Focus on motivation (triage first)
• Individualised approach (each person a single
  case study with data collection)
• Staff resource (supervision, training, burnout)

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Treatments that may work(with evidence for cost
effectiveness?)

• Antisocial Personality Disorder
• Enhanced Thinking Skills
• Reasoning and Rehabillitation
• Borderline Personality Disorder
• Mentalisation Based Treatment
• Dialectical Behaviour Therapy
• Psychotherapy?
• Anything done sensibly and consistently

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