Beauty in the eye of the beholder? How high security hospital psychopathically-disordered patients rate their own interpersonal behaviour

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As service user involvement, particularly through ‘expert patient’ schemes, increases for service development and implementation in the UK, we investigated the concordance between how patients with personality disorder view their interpersonal functioning and the views of staff who care for them in a high security mental health setting. We compared self and observer ratings of interpersonal functioning for 55 legally-defined psychopathic disorder patients detained in a high security psychiatric hospital using the CIRCLE, an instrument designed to assess interpersonal functioning. We found that male patients underestimated their worst qualities, such as dominance (p < .0005) or coerciveness (p < .0005), and overestimated their best qualities, such as nurturance (p < .0005), a finding not intuitively surprising but which confirms aspects of previous research. This result raises the questions of how such discordance should be interpreted, whether self or observer ratings should be considered more valid, and whether such findings have a bearing on both future risk assessment and the individual's eventual movement from high secure care.