Personality, Personality Disorder and Violence: An Evidence Based Approach / Edition 1

by Mary McMurran, Richard Howard

Overview

Presents the evidence-base for links between personality traits, psychological functioning, personality disorder and violence - with a focus on assessment and treatment approaches that will help clinicians to assess risk in this client group.

• An evidence-based examination of those personality traits and types of psychological functioning that may contribute to personality disorder and violence- and the links that can be made between the two
• Each chapter tackles an area of personality or psychological functioning and includes a developmental perspective, discussion of how to gauge risk, and an outline of effective treatments
• Traits covered include impulsivity, aggressiveness, narcissism and the ‘Big Five’ - neuroticism, extraversion, openness, agreeableness and conscientiousness
• New for the prestigious Wiley Series in Forensic Clinical Psychology, a market leader with more than 20,000 books in print

Product Details

ISBN-13:	9780470059494
Publisher:	Wiley
Publication date:	04/20/2009
Series:	Wiley Series in Forensic Clinical Psychology , #41
Pages:	352
Product dimensions:	6.60(w) x 9.60(h) x 0.80(d)

About the Author

Mary McMurran is Professor of Personality Disorder Research at the University of Nottingham. She is series editor for the Wiley Series in Forensic Clinical Psychology and her previous books include Motivating Offenders to Change, commended by the BMA. She is co-editor of Criminal Behaviour and Mental Health and associate editor of both The Journal of Forensic Psychiatry and Psychology and Legal and Criminological Psychology. She received the Senior Award for Significant Lifetime Contribution from the British Psychological Society in 2005.

Richard Howard is Senior Research Fellow at The Peaks Academic and Research Unit at Rampton Hospital in the UK, and Reader in Personality Disorder Research at the University of Nottingham.

Read an Excerpt

Personality, Personality Disorder and Violence

An Evidence Based Approach

---

John Wiley & Sons
Copyright © 2009

John Wiley & Sons, Ltd
All right reserved.


ISBN: 978-0-470-05948-7

---

Chapter One PERSONALITY, PERSONALITY DISORDER AND VIOLENCE: AN INTRODUCTION

Mary McMurran University of Nottingham, UK

INTRODUCTION

Few would argue that interpersonal violence, in its many forms, is a major social problem, causing considerable harm to individuals, families and communities. Indeed, the World Health Organisation (WHO) (2002) has recognised violence as a significant public health issue. The WHO report acknowledges that there are multiple factors that need to be taken into account in explaining violence, including individual, relationship, social, cultural and environmental factors. These are represented in an ecological model (see Figure 1.1). While all levels are clearly important, the focus in this book is on individual-level explanations.

Beginning with the basics, it is useful to define violence. Violence is defined as a range of behaviours intended to harm a living being who is motivated to avoid harm (Baron and Richardson, 1994). This definition is useful in that it excludes harmful acts that are accidental (e.g. a road traffic accident), consensual (e.g. sadomasochism) and ultimately beneficial (e.g. medical procedures). A distinction may be made between violence and aggression: violence is the forceful infliction of physical harm, whereas aggression is behaviour that is less physically harmful (e.g. insults, threats, ignoring), although it is often severely psychologically damaging. Because aggression can be as damaging to the victim as actual physical violence, and sometimes even more so, many mental health and criminal justice practitioners opt to use the term violence to refer to both aggression and physical violence. This avoids appearing to collude with the belief that aggression is not serious or harmful.

There is wide variation between individuals in their proneness to violence, and the agenda in this book is to investigate individual variation in relation to personality and personality disorder. The psychological study of personality relates to the understanding of how individual differences (i.e. personality traits) and personality processes (i.e. cognitive, emotional and motivational processes) relate to behaviour (Brody and Ehrlichman, 1998). The study of personality disorder relates to a range of clinically important problems with thoughts, feelings and behaviour whose regularities are defined in specific personality pathologies (Livesley, 2001). The term 'personality disorder' references diagnostic categories (see the next section for an elaboration); however, there are mostly no categorical cut-offs for problems in personality traits and personality processes. Hence, in referencing problems in the personality domain, the term 'personality problems' is used here. In this book, both fields of study are represented so that we may best advance our understanding of individual variation in violence.

One of the major reasons for studying personality, personality disorder and violence is to advance psychological and psychiatric treatments. Both criminal justice and mental health professionals play a role in treating and managing people who are violent. Broadly speaking, differing organisational agendas mean that criminal justice personnel see society as the primary client and aim to control crime, whereas mental health professionals view the patient as the client and aim to improve functioning and reduce distress. These days, however, most interventions offered by either group of professionals are designed both to promote individual well-being and reduce risk (Ward, 2002; Ward and Brown, 2004). Nonetheless, the latter aim is still viewed as highly contentious by some mental health professionals (Grounds, 2008).

The contributors to this book, all of whom are internationally renowned researchers and practitioners, will expand on issues related to personality, personality disorder and violence. In this chapter, the aim is to set the scene by addressing some fundamental questions about detention, punishment and treatment of people with personality problems or personality disorders who are violent. 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 offending history is more controversial. The case for punishment, treatment or a combination of the two requires exploration. If treatment is to be offered, then what should be the treatment goals? Where should treatment be offered: in criminal justice or mental health service locations? However, before embarking on these topics, the scale and nature of the problem needs to be put into perspective.

PERSONALITY DISORDERS AND VIOLENCE

Personality disorders are described in the two major diagnostic classification systems: the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV; American Psychiatric Association, 1994, 2000) and the International Classification of Diseases 10 (ICD-10; World Health Organisation, 1992). DSM-IV defines personality disorder as

An enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (p. 629).

ICD-10 defines personality disorder as

... deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems in social functioning and performance (p. 200).

The personality disorders are listed in Table 1.1, along with their key features. DSM-IV groups the personality disorders in three clusters: Cluster A - odd or eccentric (paranoid, schizoid and schizotypal); Cluster B - dramatic or flamboyant (antisocial, borderline, histrionic and narcissistic); and Cluster C - anxious or fearful (avoidant, dependent and obsessive-compulsive). Psychopathy, a personality disorder that is covered extensively in later chapters, lacks specific status as a personality disorder in DSM-IV and ICD10, although aspects of it are captured in antisocial and dissocial personality disorders. Extensive research on features of psychopathy over recent years has led to it being considered for inclusion in the forthcoming DSM-V.

In a recent study of a representative sample of the UK general population, using a structured clinical interview, the prevalence of personality disorder was identified as 4.4%, with men more likely to have a personality disorder (5.4%) than women (3.4%) (Coid et al., 2006b). Thus, an estimated three and a quarter million people in the United Kingdom have a personality disorder. Most of these are unlikely to be violent. Indeed, in Coid et al.'s study, even among those people diagnosable as having an antisocial personality disorder, about half had not been violent in the previous 5 years (Coid et al., 2006a). Nonetheless, Coid et al. (2006a) noted that people with Cluster B disorders, compared to those without, were 10 times more likely to have had a criminal conviction and almost 8 times more likely to have spent time in prison. This elevation of criminal risk was not evident for those with Cluster A and C disorders. Compared with mentally ill offenders, personality disordered offenders are more likely to reoffend after discharge from hospital. In their 12-year follow-up of a cohort of 204 patients discharged from UK high security hospitals in 1984, Jamieson and Taylor (2004) found that 38% were reconvicted, 26% of them for a serious offence. The odds of committing a serious offence were seven times higher for personality disordered offenders compared with the mentally ill offenders. However, although personality disordered offenders were more likely to be reconvicted of a serious offence, note that three-quarters of them were not reconvicted of a serious offence and 62% were not reconvicted at all.

In this book, the focus is specifically on those personality dimensions and disorders that are associated with violence. Nestor (2002) suggested that four fundamental personality dimensions operate as clinical risk factors for violence: (1) impulse control, (2) affect regulation, (3) narcissism and (4) paranoid cognitive personality style. These traits, he says, distinguish those who act violently from the majority who do not. Through the identification of the specific personality dimensions that are associated with high risk for violence, we may contribute to the elimination of the stigmatising generalisation that all personality disordered people are violent. It is important to remind ourselves that not all people with personality problems or personality disorders are violent. Those we see in forensic psychiatric hospitals and prisons are there because they present a risk and are not representative of all people with personality problems or personality disorders.

The relationship between the type of personality disorder and violence is apparently strongest for antisocial personality disorder (Hiscoke et al., 2003), which is unsurprising since aggressive behaviour is one of the defining criteria of the disorder. There is a clear circularity of reasoning here: if violence is part of the definition of antisocial personality disorder, then the incidence of violence among people diagnosed as having antisocial personality disorder is going to be higher than for those with diagnoses that do not feature violence. Skeem and Cooke (in press) have commented upon this problem of conflating measures and constructs in relation to psychopathy, as measured by Hare's (1991, 2003) Psychopathy Checklist - Revised (PCL-R). Psychopathy is measured by the PCL-R in terms of traits (grandiosity, selfishness and callousness) and behaviours (antisocial, irresponsible and parasitic lifestyle). The PCL-R has been shown to be a good predictor of future violence in convicted offenders (Hare et al., 2000; Hemphill, Hare and Wong, 1998). However, the PCL-R includes items relating to criminality, leading to an unhelpful mix of the behaviours that we are trying to explain (crime, violence) and the explanatory variables (traits). More recent analyses by Cooke and Michie (2001) indicated that seven items relating to criminality and disapproved behaviours could be removed to leave a purer personality model of psychopathy. They found a superordinate construct of psychopathy, with three constituent factors: (1) arrogant and deceitful interpersonal style; (2) deficient affective experience; and (3) impulsive and irresponsible behavioural style. These features may well be the core of psychopathy and the variables that explain crime and violence. Or, as Skeem and Cooke point out, these factors may have no explanatory value at all! Given that research into psychopathy has used a measure that conflates traits and criminal behaviour, it is possible that the observed relationship between psychopathy and violence is the result of the inclusion of the behaviour under study within the measure itself.

What is the likely relationship between personality, personality disorder and violence? Some basic personality characteristics are associated with an increase in the risk of violence whereas others are associated with a decrease in the risk of violence. Studies of the development of antisocial behaviour, for example, find that impulsiveness in children is associated with later antisocial behaviour and aggression, while inhibition is associated with a lower likelihood of later antisocial behaviour and aggression (Farrington, 2005). It is easy to imagine how impulsiveness (acting without thinking) can lead to antisocial behaviour and aggression and how inhibition (fearfulness and shyness) may protect against antisocial behaviour and aggression. However, characteristics such as these are neither necessary nor sufficient to explain the behaviour of interest. Over the person's lifespan, there are continuous reciprocal interactions between the individual and social and environmental variables that account for the development of the complex personality of the adult. That is, biological, psychological, social and contextual variables, singly and through their interaction, all contribute their share to the explanation of a person's propensity for violence. It is unlikely that any one factor alone will contribute sufficiently to warrant designation as the sole causal agent of violence. Of particular interest in this book are the mechanisms whereby basic personality characteristics promote the development of and increase the risk of aggression and violence. These mechanisms include emotional experiences and emotion regulation, perception of and responses to social cues and beliefs about the self and the world. These mechanisms are, at least in theory, open to the possibility of change, with the potential to reduce the likelihood of violent behaviour.

One further question that arises is how can one tell if a violent person has a personality disorder or not? Serious violence contravenes not only the law but also society's moral and ethical codes to such a degree that some people would say that serious violence must reflect an underlying personality disorder. One consideration is the degree of choice a person exercises in the use of violence. For some offenders, violence is their chosen means of operating in the world and there is no moral conflict, loss of control or distress. Such people would not normally be described as personality disordered, although our growing knowledge about psychopathy may herald changes to this perspective, with major implications for the legal process (Fine and Kennett, 2004). A second consideration relates to the criteria for diagnosis. As for any other behaviour, serious violence can be explained by reference to an individual's traits, social history, current thoughts and feelings and the context the person is in. Whether these characteristics amount to a personality disorder depends upon the criteria set forth in the classification systems and the cut-offs applied for diagnosis. A person may have problems to some degree but that degree may be insufficient to meet the level for a diagnosis. This situation of having personality problems but not meeting the cut-off for diagnosis is one disadvantage of a categorical model of personality disorders, and it is likely that the next version of the Diagnostic and Statistical Manual of Mental Disorders, DSM-V, will move towards a dimensional model (Widiger and Simonsen, 2005).

PUNISHMENT OR TREATMENT OR BOTH?

Broadly speaking, the aims of punishment are to signal to society what is acceptable and what is not, and to prevent and reduce crime. By applying sanctions for socially proscribed behaviours, members of society in generalwill be deterred from crime, and the individual offender will be deterred from committing crime again. Additionally, where the crime has been grave, an offender can be incapacitated through long-term detention or even, in some countries, death. Hollin (2002) noted that, if this logic works, we would expect punishment to reduce crime. The truth is that, overall, it does not. Reconviction rates for prisoners in the 2-year period after release run at around 55% to 60% (Cunliffe and Shepherd, 2007). Furthermore, meta-analyses of what is effective in reducing crime by individuals indicate that punitive measures, such as the 'short sharp shock', fines, surveillance and drug monitoring, are not effective in reducing crime, whereas cognitive-behavioural treatments are effective, reducing reoffending by 30% to 40% in adults and as much as 60% in young offenders (McGuire, 2001, 2002). So, as for other types of offenders, there is a utilitarian case for treating offenders with personality problems or personality disorders: treatment works better than punishment.

(Continues...)

---

Excerpted from Personality, Personality Disorder and Violence Copyright © 2009 by John Wiley & Sons, Ltd. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---

Table of Contents

About the Editors vii

List of Contributors ix

Series Editors' Preface xiii

Preface xvii

INTRODUCTION 1

1 Personality, Personality Disorder and Violence: An Introduction 3
Mary McMurran, University of Nottingham, UK

2 The 'Functional Link' Between Personality Disorder and Violence: A Critical Appraisal 19
Conor Duggan and Richard Howard, University of Nottingham, UK

PART I TRAITS 39

3 A Systematic Review of the Relationship Between Childhood Impulsiveness and Later Violence 41
Darrick Jolliffe, University of Leicester, UK and David P Farrington, University of Cambridge, UK

4 The 'Big Five': Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness as an Organisational Scheme for Thinking About Aggression and Violence 63
Vincent Egan, School of Psychology, University of Leicester, UK

5 Narcissism 85
Caroline Logan, Ashworth Hospital, UK

6 Subtypes of Psychopath 113
Ronald Blackburn, University of Liverpool, UK

7 Antisocial Personality Disorder 133
Stephane A De Brito and Sheilagh Hodgins, Institute of Psychiatry, King's College, London, UK

PART II AFFECT 155

8 The Neurobiology of Affective Dyscontrol: Implications for Understanding 'Dangerous and Severe Personality Disorder' 157
Rick Howard, University of Nottingham, UK

9 The Processing of Emotional Expression Information in Individuals with Psychopathy 175
R. James R. Blair, National Institute of Mental Health, USA

10 Angry Affect, Aggression and Personality Disorder 191
Kevin Howells, University of Nottingham, UK

11 Attachment Difficulties 213
Anthony R. Beech and Ian J. Mitchell, University of Birmingham, UK

12 Empathy and Offending Behavior 229
William L. Marshall, Liam E. Marshall and Geris A. Serran, Rockwood Psychological Services, Canada

PART III COGNITION 245

13 Psychopathic Violence: A Cognitive-Attention Perspective 247
Jennifer E. Vitale, Hampden-Sydney College, USA and Joseph P. Newman, University of Wisconsin-Madison, USA

14 Social Problem Solving, Personality Disorder and Violence 265
Mary McMurran, University of Nottingham, UK

15 Criminal Thinking 281
Glenn D. Walters, Federal Correctional Institution-Schuylkill, USA

CONCLUSION 297

16 Personality, Personality Disorder and Violence: Implications For Future Research and Practice 299
Mary McMurran and Richard Howard, University of Nottingham, UK

Index 313