Personality, PD and Violence
Chapter 1: An Introduction
The World Health Organization (WHO) has recognized that interpersonal violence is a social
problem, causing harm to individuals, their families and communities. It also costs a lot.
Violence is explained by individual, relationship, social, cultural and environmental factors.
Violence= range of behaviors intended to harm a living being who is motivated to avoid harm.
No accidental, consensual or ultimately beneficial acts.
Violence vs. aggression:
- Violence= forceful infliction of physical harm
- Aggression= less physically harmful, although often severely psychologically
damaging (threats, ignoring, excluding). Often more damaging than violence.
Violence= aggression + physical violence.
Big difference between individuals in their proneness to violence.
Study of personality: understanding of how individual differences and personality processes
relate to behavior.
Study of personality disorder: range of clinically important problems with thoughts, feelings
and behavior whose regularities are defined in specific personality pathologies.
Personality disorders references diagnostic categories, but with traits it’s often not that black
and white. Therefore, problems in personality domain, are called personality problems.
Aims criminal justice and mental health professionals: reduce risk for society – improve
functioning and reduce distress.
Personality Disorders and Violence
Definition PDs in DSM4:
Enduring pattern of inner experience and behavior that deviated markedly from the
expectations of the individual’s culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time and leads to distress or impairment.
Definition PDs in ICD-10 is pretty similar.
Cluster A Cluster B Cluster C
Paranoid – distrust and Antisocial – violation of the Avoidant – socially inhibited
suspiciousness rights of others + hypersensitivity
Schizoid – socially and Borderline – instability of Dependent – clinging +
emotionally detached relationships, self-image, mood submissive
Schizotypal – social and (Psychopathy not really Obsessive-compulsive –
interpersonal deficits; included but fits here) perfectionist + inflexible
cognitive or perceptual
distortions
Histrionic – excessive
emotionality + attention seeking
Narcissistic – grandiose
Study UK about prevalence general population:
- 4.4% in general, 5.4% men, 3.4% women have a PD
Most of them aren’t even violent. Even 50% of those with ASPD aren’t violent.
People with Cluster B disorders, compared with those without, were 10x more likely to have
had a criminal conviction + 8x more likely to have spent time in prison.
Reoffend after discharge hospital: PD > mentally ill offenders.
- However: most of them DIDN’T reconvict.
Serious offense: PD > mentally ill offenders.
Here, focus on personality dimensions (less categorical). 4 fundamental personality
dimensions operate as clinical risk factors for violence:
1. Impulse control
2. Affect regulation
3. Narcissism (traits, not PD)
4. Paranoid cognitive personality style
, Personality, PD and Violence
They distinguish those who act violently from those who don’t. Not everyone with a PD is
violent. Offenders with a PD aren’t representative of all people with a PD.
ASPD is the strongest associated with violence of all PDs. Unsurprising since violence is a
characteristic/ criteria. There is a circularity of reasoning:
- If violence is a part of the definition, then the incidence of violence among people
diagnosed with ASPD > diagnosed without violence
Psychopathy has the same issue. The tool used for those people, PCL-R, has multiple items
included about violence. So, maybe the reason psychopathy and violence have an observed
relationship, is because of the inclusion of the behavior under study.
Cooke and Michie found a superordinate construct of psychopathy:
- Arrogant and deceitful interpersonal style
- Deficient affective experience
- Impulsive and irresponsible behavioral style
This doesn’t include violence and criminality. It leaves a more pure model. It’s the core.
These variables might explain crime and violence.
Basic personality traits are involved in violence. So, everyone has them, but not in the same
degree. Examples antisocial behavior:
- Impulsiveness children – greater risk for antisocial behavior later and aggression
- Inhibition children – lower likelihood for antisocial behavior and aggression later
However, characteristics like these are neither necessary nor sufficient to explain the
behavior of interest. Many other processes or factors are involved over the life-span.
Mechanisms are involved and they can be changed with the right treatment to reduce the risk
of violent behavior.
How to see whether someone who committed a crime, also has a PD:
- The degree of choice a person exercises in the use of violence
- Criteria for diagnosis
o Individual’s traits, social history, current thoughts and feelings
o Check off criteria to see whether he has a PD. Pretty categorical and black
and white. Someone may have some problems, but not strong enough to
meet the criteria. A disadvantage of a categorical model.
Punishment or treatment or both?
Aims of punishment: signal to society of what is (not) acceptable and to prevent crime.
However, overall, it doesn’t reduce or prevent crime. Most offenders reconvict.
So, punitive measures don’t help. Treatment works better:
- CBT is effective and reduces reoffending.
Personality problems and personality disorder as mitigation
To modify antisocial behavior and violence, a psychological explanation needs to identify
specific deficiencies that impair the agency of the person. This deficiency may affect the
person in various ways (control, capacity to make rational decisions etc.)
People with PDs are usually viewed as normal people, as being responsible with no excuse.
This is because when you see them, you won’t perceive them as being different. They do the
same things and live the same, but they have more issues. A dimensional approach here
would be better. They would be at the end of the continuum of normal experiences.
People with dementia or intellectual disorder are pretty unlikely to be punished. They don’t
understand what they did. People with ASPD do know the consequences, but they can’t
control themselves.
If someone is responsible proportionate punishment. This punishment should change
behavior but ONLY if the individual can understand punishment in relation to the deed.
Otherwise, punishment has social function but may not reduce future risk.
For offenders with PDs, treatment often happens in forensic hospitals or in prison. So,
punishment + treatment. An understanding is crucial for the right treatment.
Not all patients are treatable.
, Personality, PD and Violence
Identifying treatment targets
Example: an offender with intermittent explosive disorder, or BPD, may say he wants
treatment because he has strong emotions (that usually drive violence) and he can’t control
this.
However, an offender with psychopathy whose violence is driven by possible gains probably
doesn’t want treatment or says he wants to just to avoid punishment. Here, treatment won’t
help. The patient will reject having it, and the therapist will reject the patient.
In both cases, the violence is explained by emotional or cognitive deficits. Ex.: absence fear.
Treatment target= reduce violence. But first you need to know how someone became violent.
From birth, he or she probably had a high risk, but also experiences throughout the life-span:
life-course developmental model. This model can identify many facets useful in treatment.
Antisocial Personality Disorder
Impulsiveness + low intelligence – deficits in executive functions of the brain impairment in
abilities for planning, goal-directed behavior such as attention and behavioral inhibition.
This is a risk for ASPD. Other factors involved:
- Harsh and inconsistent parental management
Child seldom rewarded, often punished
- Conflict and antisocial behavior in families (modeling)
- Deviant peers
There might be a genetic and neurobiological mechanisms underpinning the differential
effects of maltreatment.
Helpful for treating ASPD: improve problem solving, beliefs and attitudes supporting violence.
Not a lot of research done (2 sources). Most strongly connected to violence from PDs.
Psychopathy
Emotional dysfunction is at the heart of this. Traits are probably heritable.
There are neurobiological risks and social and environmental influences.
- (Absence) prosocial role models
No real suggestion for treatment. 21 studies, but all methodologically poor.
Treatments for Offenders with PD
Ideally: take into account nature and degree of dysfunctioning treatment, punishment, both
Reality: depends on available treatments and services.
Maybe there are special treatments necessary, and the resources aren’t available for that.
Only 2 treatment trials specifically for ASPD, focusing on reducing drug use, comparing
combinations of contingency management and CBT.
CBT and psychodynamic therapy appear to be helpful though for PDs, in general.
- Limited good quality research + mostly based on BPD
- Also, offenders with PDs aren’t representative of everyone with PDs.
Offenders Without Personality Problems or PDs
65% male offenders had a PD, with 47% having ASPD.
42% female offenders had a PD, with 21% having ASPD.
Very different from the general population. Good treatment is often based on RNR principles.
There are useful treatments that work for prison populations addressing thinking skills,
values, emotion management, self-regulation and substance use. They work for these
groups, and these groups also include a lot of people with a PD. So maybe, effective
treatments, incidentally, have already been developed. Or maybe, we only need some
additional treatment components. If these people can be treated in criminal justice settings,
why not treat them there instead of the mental health services, which is way more expensive.
, Personality, PD and Violence
Lecture
DSM4 was a categorical model, with a multi-axial system, separating PDs and clinical
disorders.
- Categorical: there is a list with criteria/ characteristics and if, at the end of the
interview, you have a number of them, you have the disorder.
- Dimensional: doesn’t include this strict distinction. It defines PDs as extreme variants
of general personality traits. So, everyone has these traits, but just the extent of it
differs. There is a quantitative difference between normal and dysfunction.
DSM5 is more dimensional and had more recommendations for the future.
Elements of personality functioning they look at:
Self:
1. Identity: experience of oneself as unique, with clear boundaries between self and
others; stability of self-esteem and accuracy of self-appraisal, capacity for and ability
to regulate, a range of emotional experiences.
2. Self-direction: pursuit of coherent and meaningful short-term and life goals; utilization
of constructive and prosocial internal standards of behavior; ability to self-reflect
productively.
Interpersonal:
- Empathy: comprehension and appreciation of others’ experiences and motivations;
tolerance of differing perspectives; understanding the effects of one’s own behavior
on others
- Intimacy: depth and duration of connection with others; desire and capacity for
closeness; mutuality of regard reflected in interpersonal behavior.
There need to be impairments in either one of those.
If that’s the case, we go to the level of dysfunctional traits, with 5 domains.
Negative Detachment Antagonism Disinhibition Psychoticism
affectivity
Emotional Withdrawal Manipulativeness Irresponsibility Unusual beliefs
lability or experiences
Anxiousness Intimacy Deceitfulness Impulsivity Eccentricity
avoidance
Separation Anhedonia Grandiosity Distractibility Cognitive or
insecurity perceptual
dysregulation
Submissiveness Depressivity Attention seeking Risk taking
Hostility Restricted Callousness Rigid
affectivity perfectionism
(lack of)
Perseveration Suspiciousness
(Don’t know this by heart, the traits). It’s about extent, not presence/ absence.