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Two studies on the prevalence and validity of personality disorder in three forensic intellectual disability samples
- Authors:
- LINDSAY William R., et al
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 17(3), September 2006, pp.485-505.
- Publisher:
- Taylor and Francis
There is an extensive research literature on the association between personality disorder, antisocial personality disorder, and risk of future violent and sexual offences. Several studies have found an elevated prevalence of personality disorder diagnoses amongst those individuals with severe mental illness and criminal populations. While there has been some work on the prevalence of personality disorder among intellectual disability populations, it has been criticised as being unreliable and inconsistent. The present authors have taken account of these criticisms and recommendations in this comparison of 164 offenders with intellectual disability across three settings – community, medium/low secure, and high secure. In Study 1, DSM-IV diagnoses were made on the basis of four information sources: file review, interview with clinician, observations by care staff, and the Structured Assessment of Personality Interview. Across the samples, total prevalence of PD was 39.3%. The most common diagnosis was antisocial personality disorder. There was a higher rate of diagnosis in the high security setting, with no significant differences between the other two settings. There was no diagnosis of dependent PD, indicating that assessors were not overly influenced by the developmental disability itself. In Study 2 it was found that increase in severity of PD (as indicated by PCL-R scores and/or the number of PD diagnoses) showed a strong lawful relationship with instruments predicting future violence (VRAG, RM 2000/V) and a weaker relationship with instruments predicting future sexual offences (Static-99, RM 2000/S). The results indicate the utility of PD classification in this client group and that a number of individuals with PD classification are being managed successfully in community settings. These findings have considerable implications for staffing, both in terms of which individuals can be treated by these services and staff training.
The dynamic risk assessment and management system: an assessment of immediate risk of violence for individuals with offending and challenging behaviour
- Authors:
- LINDSAY William R., et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 17(4), December 2004, pp.267-274.
- Publisher:
- Wiley
Research on dynamic risk assessment has developed over the last 10 years and a number of variables have emerged as being possible predictors of future sexual and violent offences. These variables include hostile attitude/anger and compliance with routine. In 2002, Thornton developed a framework for dynamic risk assessment which also includes distorted and dysfunctional attitudes, socio-affective functioning, self-management and, for sex offenders, sexual interests. In 2000, Hanson & Harris provided empirical support for the predictive power of a number of dynamic factors which they split into stable and acute variables. In their research they found poor social supports, antisocial lifestyle, and poor self-management strategies to be important in addition to co-operation with supervision and hostile attitude. The present report describes the development of the Dynamic Risk Assessment and Management System (DRAMS) an assessment for dynamic/proximal risk factors in people with intellectual disabilities. In a field trial, the DRAMS was administered by staff unfamiliar with the formal requirements of the assessment. They were familiar with other ward-based assessments. Ten subjects were assessed for reliability purposes (total of 45 assessments) and five subjects were assessed consistently over a 3-month period. Eighteen aggressive incidents were recorded in these five subjects and the relationship between DRAMS assessments and the incidents was calculated. Assessments were recorded on the day of the incident, the day before the incident and on a control day, which was at least 7 days before or after an incident. Four items achieved high reliability mood, psychotic symptoms, self-regulation, compliance with routine in addition to total score. Two items achieved intermediate reliability antisocial behaviour and problems with thinking/attitudes, and three items were not applicable to this client group in that none of the participants was ever rated on them substance abuse, renewal of emotional relationships and victim access. One item had poor reliability therapeutic alliance. There were significant differences between the DRAMS assessment on the control day and assessments both on the day prior to the incident and the day of the incident for three of the six subscales and total score. Initial results would suggest that the DRAMS is a reliable instrument apart from the therapeutic alliance category. Initial signs suggest that it may be predictive of aggressive incidents in residential settings. Several developments to other settings and the client groups are discussed.