Saturday, September 26, 2015

Personality Disorders and Violence: What Is The Link?

Despite a well-documented association between personality disorders (PDs) and violence, the relationship between them is complicated by the high comorbidity of mental disorders, the heterogeneity of violence (particularly in regard to its motivation), and differing views regarding the way PDs are conceptualised and measured. In particular, it remains unclear whether there is a causal relationship between PDs and violence, and what the psychological mechanisms might be that mediate such a relationship. Here, a perspective on PD and violence is offered that views the relationship between them through the lenses of the Five Factor Model of personality and a quadripartite typology of violence. Evidence is reviewed suggesting that emotion dysregulation/impulsiveness, psychopathy, and delusional ideation conjointly contribute to the increased risk of violence shown by people with PD, and do so by contributing to a broad severity dimension of personality dysfunction. This view is consistent with the abandonment of personality disorder categories in the forthcoming eleventh edition of the International Classification of Diseases (ICD-11), where severity of personality disorder is defined in terms of the degree of harm to self and others.

Below: The quadripartite (2×2) violence typology. The intersection of impulsiveness (vs. control/premeditation) and affect (positive vs. negative) yields 4 distinct types of violence characterised by motives of excitement seeking and greed (both associated with positive affect) and revenge and self-defence (both associated with negative affect)

Below:  A schematic overview of the suggested relationship between personality disorder (PD) and violence. General psychopathology (p) is subsumed by 3 factors, Externalizing, Internalizing and Thought Disorder but, as reported in [7], p is associated most strongly with Thought Disorder (indicated by a heavy arrow in the figure). Externalizing subsumes traits associated with both psychopathy and emotional impulsiveness, both of which contribute to severe PD and increase the risk for violence, particularly appetitive violence. Thought Disorder is shown as contributing independently to the risk of violence, and particularly of aversive violence. Also shown are contextual factors such as alcohol use that operate as proximal causal risk factors for violence in concert with distal personality factors

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By:  Richard Howardcorresponding author
Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU UK

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