Personality Traits as Predictors of Inpatient Aggression in a High-Security Forensic Psychiatric Setting: Prospective Evaluation of the PCL-R and IPDE Dimension Ratings

Abstract

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist-Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings.

Schema modes in criminal and violent behaviour of forensic cluster B PD patients: A retrospective and prospective study

“…Personality disorders (PDs) are highly prevalent in institutional settings with prevalence rates typically ranging from 50 to 90% (Blackburn, Logan, Donnelly, & Renwick, 2003;Leue, Borchard, & Hoyer, 2004;Timmerman & Emmelkamp, 2001). Although there is a well-established link between PD traits and violence in general (e.g., Cooke, 2010;Fountoulakis, Leucht, & Kaprinis, 2008;Nestor, 2002), PD offenders are associated with an even increased risk for institutional violence and re-offending compared with other offenders (e.g., offenders with psychotic disorders; Coid, Hickey, & Yang, 2007;Hiscoke, L angstr€ om, Ottosson, & Grann, 2003;Jamieson & Taylor, 2004;Langton, Hogue, Daffern, Mannion, & Howells, 2011;Leistico, Salekin, DeCoster, & Rogers, 2008).…”

The dangerous and severe personality disorder experiment – Review of empirical research

“…Three studies focused on aspects of the assessment process, investigating temporal reliability (Tyrer et al, ) and predictive utility of the main assessment tools (Langton et al, ) and the impact and perception of the assessment process (Tyrer et al, ).…”

“…They found only fair agreement on the HCR‐20 and PCL‐R; agreement on PD category ranged from poor to good with the lowest inter‐rater reliability in narcissistic PD and the highest in anti‐social PD. Langton et al () found that personality assessments did not predict institutional violence very well. Over a 12‐month period, only the dimensional score of histrionic PD and Factor 1, but not Factor 2, PCL‐R scores predicted the occurrence of at least one act of interpersonal violence; repeated acts were predicted by histrionic, anti‐social and borderline PD.…”

The Index Offence Representation Scales; a predictive clinical tool in the management of dangerous, violent patients with personality disorder?

“…Psychopathy‐based measures have yielded associations with only small–moderate effect sizes, which vary across studies (Doyle et al, ). Studies conducted as part of the ‘Dangerous and Severe Personality Disorder’ programme in the UK used actuarial and risk assessment tools and personality measures to predict institutional aggression (Langton et al, , ). Many offenders with personality disorder who need treatment do not, however, fit the DSPD criteria.…”