Personality, personality disorder and violence
Chapter 1: personality, personality disorder and violence; an introducton
introducton
Violence is defned as a range of behaviours intended to harm a living being who is
motivated to avoid harma This excludes harmful acts that are accidental (road trafc
accidents), consensual (sadomasochism), and ultimately benefcial (medical procedures)a
There is also a distinction to be made between violence and aggression: violence is the
forceful infiction of physical harm, whereas aggression is behaviour that is less physically
harmful (insults, threats, ignoring), although ofen very psychologically damaginga Many
mental health and criminal justice practitioners opt to use the term violence to refer to both
aggression and physical violencea Unlike people whose violence is connected with mental
illness or developmental disabilities, for whom there is largely agreement on the
appropriateness of treatment, the issue of whether or not to treat those with personality
disorders or personality problems and an ofending history is more controversial
Personality disorders and violence
Personality disorders are described in the two major diagnostic classifcation systems: The
Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), and the International
Classifcation of Diseases 0 (ICD-0 )a They defne personality disorders as:
- DSM-IV: An enduring patern of inner experience and behaviour that deviates
markedly from the expectatons of the individual’s culture, is pervasive and infexible,
has an onset in adolescence or early adulthood, is stable over tme, and leads to
distress or impairment.
- ICD-0 : Deeply ingrained and enduring behaviour paterns, manifestng themselves
as infexible responses to a broad range of personal and social situatons. They
represent either extreme or signifcant deviatons from the way the average
individual in a given culture perceives, thinks, feels, and partcularly relates to others.
Such behaviour paterns tend to be stable and to encompass multple domains of
behaviour and psychological functoning. They are frequently, but not always,
associated with various degrees of subjectve distress and problems in social
functoning and performance.
DSM-IV groups the personality disorders in three
clusters:
- Cluster A: odd or eccentric: paranoid,
schizoid, and schizotypala
- Cluster B: dramatic or famboyant: antisocial,
borderline, histrionic, and narcissistic
- Cluster C: anxious or fearful: avoidant,
dependent and obsessive-compulsive
Psychopathy lacks specifc status as a personality
disorder in both DSM-IV and ICD0 , although
aspects of it are captured in antisocial and dissocial
personality disordersa It is being considered for
inclusion in the forthcoming DSM-Va
0
,The prevalence of personality disorders (in the general population of the UK) was identifed
as 4a4%, with men more likely to have a personality disorder than women (5a4% vsa 3a4%)a
Most people who sufer from a personality disorder are unlikely to be violent (about half has
likely not been violent in the past 5 years)a However, it is thought that people with cluster B
personality disorders were 0 times more likely to have had a criminal conviction and 8
times more likely to have spent time in prisona
General criteria for personality disorder
- Moderate or greater impairment in personality (self / interpersonal) functioninga
- One or more pathological personality traitsa
- The impairments in personality functioning and the individual’s personality trait
expression are relatively infexible and pervasive across a broad range of personal
and social situationsa
- The impairments in personality functioning and the individual’s personality trait
expression are relatively stable across time, with onsets that can be traced back to at
least adolescence or early adulthooda
- The impairments in personality functioning and the individual’s personality trait
expression are not beter explained by any other mental disordera
- The impairments in personality functioning and the individual’s personality trait
expression are not solely atributable to the physiological efects of a substance or
another medical condition (like severe head trauma)a
- The impairments in personality functioning and the individual’s personality trait
expression are not beter understood as normal for an individual’s developmental
stage or sociocultural environmenta
DSM-IV ICD-0
Cluster A
Paranoid: distrust, suspiciousnessa Paranoid: sensitivity, suspiciousness
Schizoid: socially and emotionally detacheda Schizoid: emotionally cold and detached
Schizotypal: social and interpersonal -
defcits, cognitive or perceptual distortionsa
Cluster B Dissocial: callous disregard of others,
Antisocial: violation of the rights of othersa irresponsibility, irritabilitya
Borderline: instability of relationships, self- Emotionally unstable: a) borderline: unclear
image and mooda self-image, intense, unstable relationships,
Histrionic: excessive emotionality and b) impulsive: inability to control anger,
atention seekinga quarrelsome, unpredictablea
Narcissistic: grandiose, lack of empathy, Histrionic: dramatic, egocentric,
need for admirationa manipulative seekinga
-
Cluster C
Avoidant: socially inhibited, feelings of Anxious: tense, self-conscious,
inadequacy, hypersensitivitya hypersensitivea
Dependent: clinging, submissivea Dependent: subordinates personal needs,
Obsessive-compulsive: perfectionist, needs constant reassurancea
infexiblea Anankastic: indecisive, pedantic, rigida
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, Compared with mentally ill ofenders, personality disordered ofenders are more likely to
reofend afer discharge (about 4 % will reofend)a The odds of commitng a serious ofence
were seven times higher for personality disordered ofenders compared with the mentally ill
ofendersa It is suggested that there are four fundamental personality dimensions that are
particular risk factors for violence; impulse control, afect regulation, narcissism, and
paranoid cognitive personality stylea These traits distinguish those who act violently from the
majority who do nota It is important to mention that the people with personality disorders
are not representative of all people with personality problems or personality disorders; they
are not all violenta The relationship between the type of personality disorder and violence is
apparently strongest for antisocial personality disorder (which is not a surprise since
aggressive behaviour is one of the defning criteria of the disorder: circularity of reasoning)a
In order to avoid this problem with psychopathy, Cooke and Michie found a superordinate
construct of psychopathy, with three constituent factors: 0) arrogant and deceitul
interpersonal style, 2) defcient afective experience, and 3) impulsive and irresponsible
behavioural stylea
One further question that arises is how you can tell if a violent person has a personality
disorder or nota Violence is so against our societal standards that some people would argue
that serious violence must refect an underlying personality disordera One important
consideration is the degree of choice a person exercises in the use of violence; for some
ofenders, violence is their chosen means of operating in the world and there is no moral
confict, loss of control or distressa A second consideration related to the criteria for
diagnosisa Whether certain characteristic amount to a personality disorder depends upon
the criteria set forth in the classifcation systems and the cut-ofs applied for diagnosisa
Punishment, treatment, or both?
In general, the aim of punishment is to signal to society what is acceptable and what it not,
and to prevent and reduce crimea If this logic works, we would expect that punishment
would reduce crime; however, overall it does nota Reconviction rates for prisoners in the two
years afer release are around 6 %a Cognitive-behavioural treatments turn out to be more
efective, reducing reofending to about 3 % in adults and 6 % in young ofendersa This
means that there is a utilitarian case for treating ofenders with personality problems or
personality disorders: treatment works beter than punishmenta
Personality problems and personality disorders as mitiaton
In mitigating antisocial behaviour and violence, a psychological explanation needs to identify
specifc defciencies that impair that persona The defciency may afect their capacity to make
rational decisions, impair their control over his or her behaviour or impair their degree of
awareness of the harm caused by their actsa A disorder may excuse or mitigate antisocial and
violent behaviour because the individual is not fully aware of the legal and moral imperative
to refrain from the behaviour or because that person does not fully understand the harmful
consequences of that acta In any ‘normal’ society, people who are seriously mentally
impaired are unlikely to be punished for violent actsa In relation to people with antisocial
personality disorder, there is an assumption that they know the consequences but
nonetheless are unable to exercise control over their behavioura In relation to psychopathy,
the case has been made that their lack of emotional capacities reduces their responsibility
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