The prevalence of severe personality disorder in perpetrators of homicide.

Nicola Swinson,Jenny Shaw,Roger Webb

doi:10.1002/pmh.1503

Abstract

Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide perpetrators from court reports and carry out a dimensional assessment in keeping with the new ICD-11 classification of the prevalence of severe personality disorder. Associations between severe personality disorder and sociodemographic, historical and offence-related characteristics were then explored. Six hundred court reports from a national case series of homicide perpetrators in England and Wales were analysed using a document-derived version of the Personality Assessment Schedule (PAS-DOC), providing categorical and dimensional personality assessments. The prevalence of personality disorder and severe personality disorder was estimated. Factors associated with the diagnosis of severe personality disorder were examined. The prevalence of personality disorder using the PAS-DOC was 56.3% (95% confidence interval 52.3%, 60.3%), compared with 16% as diagnosed in reports. Severe personality disorder was present in 62% (n=338) of all those with a personality disorder and was significantly associated with homicides of strangers and previous violence. Severe personality disorder is highly prevalent among perpetrators of homicide, and the finding that it is more prevalent when strangers are the victims stresses both the need for early identification of those at risk of developing severe personality disorder and the development of appropriate early preventive interventions. There is also a need for the development of effective treatment and interventions for those with established severe personality disorder and better identification of this level of disorder by psychiatrists. The forthcoming ICD-11 classification should help in this endeavour. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

Highlights

ABS TRACTBack gr o u n d – C urre nt U K e vi de nce o n t he pre v ale nce of pers o n alit y dis or der i n h o mici de is l ac ki ng
T he pre v ale nce of pers o n alit y dis or der a n d se vere pers o n alit y dis or der w as esti m ate d
R es ults – T he pre v ale nce of pers o n alit y dis or der usi ng t he P A S- D O C w as 5 6. 3 % ( 9 5 % c o n fi de nce i nter v al 5 2. 3 %, 6 0. 3 %), c o m p are d wit h 1 6 % as di ag n ose d i n re p orts

Summary

Introduction

I ntr o d u cti o n P ers o n alit y dis or d er ( P D) w as d es cri b e d as a l a b el f or ‘t h e p ati e nts ps y c hi atrists disli k e’ i n 1 9 8 8.1 O v er a q u art er of a c e nt ur y l at er, it is q u esti o n a bl ehowf ar t his p ej or ati v e p er c e pti o n h as changed, wit hsugg esti o ns t h at it t e n ds t o b e sti g m atizi n g r at h er t h a n cli ni c all y us ef ul.2 Oft e n, p ati e nts wit h p ers o n all y dis or d er ar eseen as n ot b ei n g tr ul y ill or as u n d es er vi n g of c ar e a n d tr e at m e nt whencomp ar e d wit h i n di vi d u als wit h s e v er e m e nt al ill n ess.

Results

Conclusion