Abstract
Drawing on recent advances in the violence risk assessment literature, this study tested the predictive validity of two structured measures designed to support risk related decision making, the HCR-20 and the Dynamic Appraisal of Situational Aggression (DASA), for the prediction of imminent aggression and self-harm in personality disordered patients of a high secure psychiatric hospital. For four months nursing staff completed daily assessments of patients using the DASA and the Clinical scale items from the HCR-20. On the following day they documented whether patients had behaved aggressively and/or self-harmed. Results revealed modest predictive validity, significantly better than chance, for both the prediction of imminent self-harm and aggression for both measures. Furthermore, these results suggest that personality disordered patients in a negative psychological state characterized by irritability, impulsivity and disagreeableness are at an increased risk of aggression and self-harm during involuntary psychiatric inpatient treatment and that this state is sensitive to structured risk assessment.
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