Personality Traits and Dynamic Variables Associated with Types of Aggression in High Security Forensic Psychiatric Inpatients

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales, underway since 2000, provides specialized care to high risk personality disordered individuals in prison and secure psychiatric facilities. Entry to the service, for a capacity nationwide total of approximately 300 individuals at four sites, is determined in part by risk (whether or not the individual is more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it hard to recover). This requires valid procedures for assessing risk to determine individuals’ suitability for entry into and transfer out of the service. Yet little is known about the validity of current risk assessment tools and personality measures with the DSPD population. One of the studies reported, the first of its kind with the DSPD population, described a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 admissions to the DSPD unit at a high security forensic psychiatric hospital. Consistent with hypotheses, all tools predicted damage to property. HCR-20 Total and scale scores predicted interpersonal physical aggression with structured final risk judgments also predicting repetitive (2+ incidents of) interpersonal physical aggression. HCR-20 Risk Management scores were significantly associated with imminence of interpersonal physical aggression. The second study described a prospective evaluation of the predictive accuracy of Psychopathy Checklist-Revised Factor and Facet scores as well as scores for Cluster B traits using the International Personality Disorder Examination with the same sample. Partial support for hypotheses was found. Only Borderline PD dimension scores predicted damage to property. Histrionic PD predicted interpersonal physical aggression, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive interpersonal physical aggression. Factor 1 and Facets 1 and 2 were also significant predictors of interpersonal physical aggression. Factor 1 and Histrionic PD scores were also significantly associated with imminence of this type of aggression. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients and the functional link (between personality disorder and violence) criterion for DSPD service entry.Ph