Assessment and Management of Dangerous and Severe Personality Disorders
Assessment and Management of Dangerous and Severe Personality Disorders
Purpose of Review: To review recent literature on the assessment and management of individuals with severe personality disorders who present as a risk to others.
Recent Findings: The literature shows an expansion of services for individuals with personality disorders, including offenders. This appears to be partly due to increased concerns about public safety and relevant changes in legal frameworks. In England and Wales, services for individuals with 'dangerous and severe personality disorders' have been established. The evidence for the effectiveness of interventions for personality disorders remains limited and the extent to which they lead to a reduction in offending and improvements in long-term outcomes remains uncertain. Group-based interventions using cognitive-behavioural approaches have the best evidence base. Preliminary evidence suggests that pharmacological interventions using mood stabilizers and atypical antipsychotics may be effective for some symptoms of personality disorders. A number of authors have emphasized the importance of readiness for treatment and the use of motivational strategies to reduce drop-out.
Summary: Evidence for the effectiveness of any interventions for dangerous and severe personality disorders is limited. This poses particular ethical challenges for forensic psychiatrists who are increasingly expected to become involved in the management of individuals who pose a risk to others.
The British government introduced the term 'dangerous and severe personality disorder' (DSPD) in the context of proposals to reform the Mental Health Act 1983. The introduction of this 'political diagnosis' was driven by high profile cases involving serious crimes by personality disordered individuals from whom the public, in the government's view, was inadequately protected. The concept has received much criticism and initial proposals were adapted as a result. However, the term DSPD has survived and entered mainstream psychiatric jargon in the UK. This review describes the assessment and management of these patients in the context of UK DSPD units as well as more broadly of those with severe personality disorders who present a serious risk to others in other settings. There have been a number of legal changes regarding dangerous offenders and an expansion of service provision for personality disordered patients in recent years. However, concerns have been raised regarding the ethical implications of the detention of personality disordered patients for public protection in light of the dearth of robust evidence of effective interventions for this patient group.
Abstract and Introduction
Abstract
Purpose of Review: To review recent literature on the assessment and management of individuals with severe personality disorders who present as a risk to others.
Recent Findings: The literature shows an expansion of services for individuals with personality disorders, including offenders. This appears to be partly due to increased concerns about public safety and relevant changes in legal frameworks. In England and Wales, services for individuals with 'dangerous and severe personality disorders' have been established. The evidence for the effectiveness of interventions for personality disorders remains limited and the extent to which they lead to a reduction in offending and improvements in long-term outcomes remains uncertain. Group-based interventions using cognitive-behavioural approaches have the best evidence base. Preliminary evidence suggests that pharmacological interventions using mood stabilizers and atypical antipsychotics may be effective for some symptoms of personality disorders. A number of authors have emphasized the importance of readiness for treatment and the use of motivational strategies to reduce drop-out.
Summary: Evidence for the effectiveness of any interventions for dangerous and severe personality disorders is limited. This poses particular ethical challenges for forensic psychiatrists who are increasingly expected to become involved in the management of individuals who pose a risk to others.
Introduction
The British government introduced the term 'dangerous and severe personality disorder' (DSPD) in the context of proposals to reform the Mental Health Act 1983. The introduction of this 'political diagnosis' was driven by high profile cases involving serious crimes by personality disordered individuals from whom the public, in the government's view, was inadequately protected. The concept has received much criticism and initial proposals were adapted as a result. However, the term DSPD has survived and entered mainstream psychiatric jargon in the UK. This review describes the assessment and management of these patients in the context of UK DSPD units as well as more broadly of those with severe personality disorders who present a serious risk to others in other settings. There have been a number of legal changes regarding dangerous offenders and an expansion of service provision for personality disordered patients in recent years. However, concerns have been raised regarding the ethical implications of the detention of personality disordered patients for public protection in light of the dearth of robust evidence of effective interventions for this patient group.
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