Are they different? A comparison of risk in Dangerous and Severe Personality Disordered and Personality Disordered hospitalized populations

Abstract

There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high risk of future recidivism. In the UK, the Dangerous and Severe Personality Disorder (DSPD) programme was initiated to deal with just this group. It is unclear, yet, whether those admitted to these services are different from those admitted to conventional personality disorder (PD) services. In the present study, 60 patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence, (2) previous offending behaviour and (3) ‘pre-treatment’ levels of institutional risk-related behaviour. Results indicated that DSPD patients do pose a greater clinical and management risk, have a higher number of ‘pre-treatment’ risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. The implications and limitations of these results are discussed.

Keywords:

• severe personality disorder
• risk assessment
• HCR-20
• violence risk
• violence