Dangerous Personality Research Articles

The baby, the bathwater and the bath itself: a response to Tyrer et al.'s review of the successes and failures of dangerous and severe personality disorder

A recent paper by Tyrer et al. in this journal has reviewed the dangerous and severe personality disorder (DSPD) initiative in the assessment and management of severe personality disorder associated with high risk. This previous paper summarized the authors' perceptions of the successes and failures of the DSPD pilot. In the present paper we identify some inaccuracies in the previous review and provide a critique of the conclusions reached.

The slide to pragmatism: A values-based understanding of ‘dangerous’ personality disorders

This paper reports on a qualitative study of UK mental health practitioners’ experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values – within individuals, between occupational groups, and between individuals in occupational groups – which led to widespread uncertainty and caution about whether and how those with ‘dangerous’ personality disorders could be treated. These disputes were resolved by a ‘slide to pragmatism’, whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available.

Význam doléčovacího programu pro resocializaci osob s drogovou závislostí

Význam doléčovacího programu pro resocializaci osob s drogovou závislostí

Treatments for dangerous severe personality disorder (DSPD)

Four units established in England for individuals with dangerous severe personality disorder differ significantly in their treatment regimes. Their distribution and relationship to risk are unknown. In this study, a modified Delphi process identified the treatments and allocated them to 11 mutually exclusive categories. Attendance at treatments was obtained from records, and these were compared to annual assessments of risk. Of 150 proposed treatments, 50 were allocated to the 11 categories. Only two treatment categories were provided in all units. Specified psychological treatment programmes occupied an average of less than 2 h a week, and 10% of patients had no treatment in each year. Reduction in risk was significantly associated with total hours of treatment received. A rigorous rationalisation of the treatments is needed to permit a robust evaluation of their effectiveness. Further research is needed to determine whether reductions in risk reflect reoffending rates.

There Ain’t No End for the ‘Wicked’: Implications of and Recommendations for § 4248 of the Adam Walsh Act after United States v. Comstock

The civil commitment of “sexually dangerous persons” is not a new concept. States first began doing so in the mid-20th century, based then on “sexual psychopathy.” Since that time, concepts of “sexually dangerous predators” have evolved and the laws have evolved with them. It was not until 2006, however, that Congress created federal laws to mirror those of the States. The Adam Walsh Act, named after the son of television host John Walsh, was created to “protect children” and “make communities safer.” The Supreme Court in United States v. Comstock held the Act constitutional under the Necessary and Proper Clause. While Congress had good intentions behind the Act, Comstock’s ruling created a veritable “blank check” for Congress and paved the way for exorbitant costs to the States, in a time when fiscal pressures make simply implementing the law nearly impossible. This Note explores the rationale behind Comstock and the Adam Walsh Act, highlights the damaging implications behind the decision and the good intentions of Congress, and makes recommendations for the future of both the case and the Act itself.

Dangerous Severe Personality Disordered (DSPD) Patients: Characteristics and Comparison with Other High-Risk Offenders

England and Wales introduced the administrative category of Dangerous Severe Personality Disorder (DSPD) and established special units in prisons and high-secure psychiatric hospitals for their treatment. To examine their characteristics, we approached 202 patients admitted to DSPD units; 174 consented to participate in research. All were male, and the median age was 38 years. Most were white and born in the UK. Most patients (75%) met full DSPD criteria as suffering from severe personality disorder that caused them to be dangerous. With respect to personality disorder, most had elevated psychopathic traits and 40% met criteria for psychopathy on the Psychopathy Checklist-Revised (Hare, 2003). With respect to dangerousness, 25% of patients had a history of homicide; 28%, sexual offenses; and 41%, other violent offenses. Median time spent in prison was more than 12 years. According to standardized measures of violence risk, those admitted to DSPD units resembled other groups of high risk offenders described in the international literature. There were some significant differences between those admitted to prison- versus hospital-based units. The findings confirmed that DSPD units contain dangerous offenders with no evidence of preemptive incarceration.

PREVENTIVE DETENTION, CHARACTER EVIDENCE, AND THE NEW CRIMINAL LAW

A new criminal law has emerged in the last quarter century. The dominant goal of the new criminal law is preventive detention-incarceration to incapacitate dangerous persons. The emergence of the new criminal law has remade both sentencing law and definitions of crimes themselves. The new criminal law has also begun to remake the law of evidence. As incapacitation has become an accepted goal of criminal punishment, the rationale of the character rule has become less compelling, and the rule itself has begun to wane in criminal practice. These changes have been subtle, but they have also been both radical and fairly rapid. There is no indication that the law will reverse course. Indeed, the law's response to the threat of terrorism has only accelerated the move toward the new criminal law. In coming years, the Supreme Court will be forced to address a variety of difficult constitutional questions that the new criminal law presents. Ironically, the safest solution may be to embrace preventive detention as an accepted function of the criminal law. Doing so would alter the Supreme Court doctrines which distinguish the civil from the criminal-doctrines that limit the reach of the Bill of Rights. The procedural protections guaranteed by the Bill of Rights should be extended to more citizens faced with incarceration regardless of whether the purpose of incarceration is incapacitation rather than punishment or deterrence. As the new criminal law remakes the American justice system, the Court must recognize that preventive detention is now a core function of the criminal law. That recognition will have the counterintuitive effect of expanding the constitutional protections given to citizens facing imprisonment.

The therapeutic challenge

Abstract Ten years ago the Dangerous and Severe Personality Disorder Programme (DSPD) was launched. There were initial human rights concerns about forcibly detaining and treating offenders before they had committed offences. Many of the key issues have been well described elsewhere (Seddon, 2008).

Law & Psychiatry: Gun Laws and Mental Illness: How Sensible Are the Current Restrictions?

This column describes federal and state laws to restrict access to firearms among people with mental illness. The contribution to public safety of these laws is likely to be small because only 3%-5% of violent acts are attributable to serious mental illness, and most do not involve guns. The categories of persons with mental illnesses targeted by the laws may not be at higher risk of violence than other subgroups in this population. The laws may deter people from seeking treatment for fear of losing the right to possess firearms and may reinforce stereotypes of persons with mental illnesses as dangerous.

My mistake could have put a person in danger

My mistake could have put a person in danger

Application of a Firearm Seizure Law Aimed at Dangerous Persons: Outcomes From the First Two Years

Application of a Firearm Seizure Law Aimed at Dangerous Persons: Outcomes From the First Two Years

A descriptive evaluation of patients and prisoners assessed for dangerous and severe personality disorder

The Dangerous and Severe Personality Disorder (DSPD) programme was introduced to assess, manage and treat severely personality disordered individuals who present a high risk of serious offending. We describe the clinical and risk characteristics of the first 241 patients admitted to the high-security DSPD service for assessment. Eighty-four percent of patients were regarded as meeting the DSPD criteria. Clinically, the DSPD patients demonstrated high levels of psychopathy, with 78% scoring 25 or more on the Psychopathy Checklist. The most commonly diagnosed personality disorders were antisocial, borderline and paranoid. The risk assessments indicated the DSPD patients exhibited a broad range of risk factors for future offending, suggesting that these patients had extensive treatment needs. The DSPD service had been relatively successful in retaining patients, with 82% of those admitted to treatment remaining within the high-security DSPD service. The clinical mix of the patients may have implications for treatment outcome, and future challenges for the service are highlighted.

Difficulties in the pathway from high to medium secure services for personality-disordered patients

Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n = 68) and a Dangerous and Severe Personality Disorder service (n = 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group.

Lasting recognition of threatening people by wild American crows

While many domestic and laboratory animals recognize familiar humans, such ability in wild animals is only anecdotally known. Here we demonstrate experimentally that a cognitively advanced, social bird, the American crow, Corvus brachyrhynchos, quickly and accurately learns to recognize the face of a dangerous person and continues to do so for at least 2.7 years. We exposed wild crows to a novel ‘dangerous face’ by wearing a unique face mask as we trapped, banded and released 7–15 birds at five sites near Seattle, WA, U.S.A. After trapping, crows consistently used harsh vocalizations to scold and mob people of different sizes, ages, genders and walking gaits who wore the dangerous mask, even when they were in crowds. In contrast, prior to trapping, few crows scolded people who wore the dangerous mask. Furthermore, after trapping, few crows scolded trappers who wore no mask or who wore a mask that had not been worn during trapping. In a fully crossed, balanced experiment in which each site had a unique trapping (dangerous) mask and five neutral masks, crows scolded and mobbed a mask more when it was the dangerous mask at that site than when it was a neutral mask at another site. When simultaneously presented with a person in the dangerous mask and a person in the neutral mask, crows typically ignored the neutral mask and followed and scolded the person wearing the dangerous mask. Risky, aggressive scolding by crows was sensitive to variable costs across study sites; aggression was less where people persecuted crows most. We suggest that conditioned and observational learning of specific threats may allow local bird behaviours to include aversions to individual people.

The clinical and risk characteristics of patients admitted to a secure hospital‐based Dangerous and Severe Personality Disorder unit

This paper describes the clinical and risk characteristics of patients admitted over the first four years of operation of the Dangerous and Severe Personality Disordered (DSPD) NHS pilot at the Peaks Unit, Rampton Secure Hospital. There were 124 referrals, mainly from Category A and B prisons, resulting in 68 DSPD admissions. Clinically, 29% scored 30 or more on the Psychopathy Checklist. The most common personality disorders were antisocial, borderline, paranoid and narcissistic. There is a high risk of violent/sexual recidivism as measured by the Static‐99, Violence Risk Scale, and the Historical, Clinical and Risk Management Scale.

Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS, Static-99, and Risk Matrix 2000

Entry to the Dangerous and Severe Personality Disorder (DSPD) service in England and Wales is heavily determined by risk status, and therefore requires valid procedures for monitoring changes in risk over time in order to make risk management decisions and determine patients’ suitability for transfer to lower security settings. Yet little is known about the validity of current risk assessment tools with the new DSPD population. This study reports a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 consecutive admissions to the DSPD unit at a high secure forensic psychiatric hospital. Thirty eight per cent of the sample exhibited interpersonal physical aggression (IPA) on one or more instances over an average 1.5 year period following admission, and a similar percentage caused damage to property (DTP) on one or more occasions over the same period. All tools predicted DTP. HCR-20 Total and scale scores predicted IPA with structured final risk judgements also predicting repetitive (2 + incidents of) IPA. HCR-20 Risk Management scores were significantly associated with imminence of IPA. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients.

'Flesh and Blood': Autobiographical 'Material' between Fiction and Non-fiction

I want to avoid generalities as far as possible. (1) In some of the most quoted lines from his essays, Baldwin owns up to the difficulty for the 'Negro writer' to tap the source of his creative energy: One writes out of one thing only-one's own experience. Everything depends on how relentlessly one forces from this experience the last drop, sweet or bitter, it can possibly give ... The difficulty then for me, of being a Negro writer was the fact that I was, in effect, prohibited from examining my own experience too closely by the tremendous demands and the very real dangers of my social situation. (NNSo, p8, italics mine) The 'Negro writer' is estranged from his experience as an individual by his social condition that acts as a barrier between individual experience and creative talent. (2) The urgency of survival, the ever-present risks of an untimely death, and the necessities of life are linked to the condition of being black. What makes him write is precisely what this 'condition' prevents him from accessing. This obstacle echoes the geographical distance that Baldwin placed between himself and America when he felt he had to write. It spells the necessity of exile, an exile that merely doubles up the exile of his condition. (3) His first novel Go Tell it on the Mountain took ten years to complete and was finished abroad. Baldwin claimed that his leaving for France was not a deliberate choice, but rather his way of separating himself from America: 'I left America much more than I went to live in France. I simply left. I got out of where I was because I was becoming a dangerous person to myself '.' (4) A year later, in answer to Henry Louis Gates's questions, that predicament is even clearer: 'The only thing standing between my writing had to be me: it was I, it was me-I had to see that. Because the French left me alone, I was freed of crutches, the crutches of race' (CJB, p264). The biblical metaphor of the cripple spells the paradox of having to reach a place where 'race' is both the obstacle to writing and what needs to be probed in writing. The recurrence of the danger that one is to oneself as a black American, rooted in death by suicide or as a result of police brutality or of street violence, lies at the core of the advent of writing. (5) Much later, commenting on his leaving the church, Baldwin wrote that the leap demanded: 'commit[ing himself] to the clear impossibility of writing, and attempting to save [his] family at that' (DFW, p503, italics mine). The experience of his adolescent friend Eugene Worth who threw himself from the George Washington Bridge, a recurrent memory transposed into his texts, haunts his writing, mixed with his remorse at not having declared his love for him. (6) For the black writer writes under the threat of death, the menace that he may lose his life. (7) Conversely, writing can be a way out of suicide, as when Baldwin returned to writing at the end of his stay in Corsica after attempting to drown himself. His thoughts are conveyed in a long confessional journal entry entitled 'The Last Days' (JBB, p131). That Baldwin's essays are grounded in autobiography is a common-place of Baldwin's criticism. Indeed, the essays and the various speech genres that his writing inhabits-notes, letters, addresses, speeches-almost all develop around an autobiographical core. (8) Yet the modality of the articulation of personal memories with a didactic stance needs to be addressed. Another obvious instance of autobiographical anchoring in Baldwin's work is the slightly veiled transposition of real-life characters into the fictional characters of his plays and novels and the use of real-life incidents in the fiction. Thus 'autobiography' is present in both the author's non-fiction and fiction to such an extent that one can wonder about the necessity of its anchoring, the modality of its combination with the rest of the text and the effects of its presence throughout the output. …

Factors influencing decisions on seclusion and restraint

Seclusion with or without restraint is a measure for managing aggressive or agitated clients and promoting site security, particularly in an emergency psychiatric setting. The decision to control a potentially dangerous person's behaviour by removal or seclusion seems ethically justifiable in such a setting. However, although the decisions on these restrictive measures are based on rational needs, they are also influenced by the healthcare team's perceptions of the client and by the characteristics of the team and the environment. The purpose of this paper is to set out and categorize the factors in play in aggression- and agitation-management situations as perceived by the healthcare teams, particularly the nurses. The first part of the paper deals briefly with the settings in which control measures are applied in a province in eastern Canada and the effect of such measures on patients and healthcare teams. The second part identifies the factors involved in the management of agitation and aggression behaviour. The final part discusses the current spin-offs from this knowledge as well as promising paths for further research on the factors involved. The ultimate objective is to reduce recourse to coercive measures and enhance professional practices.

Sex-Offender Commitment Law Ruled Unconstitutional

Sex-Offender Commitment Law Ruled Unconstitutional

Self-Harm and Aggression in Dangerous and Severely Personality Disordered Patients of a High-Security Hospital

This study examined the frequency, prevalence and co-occurrence of aggression and self-harm in patients admitted for assessment and treatment to a high-security dangerous severe personality disorder (DSPD) hospital. Results showed that most patients admitted to this unit were aggressive and many patients self-harmed during the period of study. Few patients were neither aggressive nor self-harming. Patients who self-harmed and behaved aggressively were typically aggressive before their first episode of self-harm, and the likelihood of self-harm seemed to increase during the later stages of their hospital stay. Possible explanations for these findings are offered.