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 Howard

Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU UK

Personality Disorders Do Not Affect Treatment Outcomes for Chronic HCV Infection in Spanish Prisoners: The Perseo Study

Below:  Treatment discontinuation in prisoners with and without personality disorders, stratified by cause of treatment interruption. *Release and/or transfer between prisons. PD: personality disorder; NS: not significant

Results

The sample included 236 patients (mean age: 40.3 years, 92.8 % male, 79.2 % intravenous drug users, and 26.3 % HIV-coinfected). The prevalence of PD was 72.5 %. 32.2 % of patients discontinued treatment; this percentage was higher in patients with HCV genotypes 1/4 (AOR = 3.55; CI:1.76–7.18) and those without PD (AOR = 2.51; 1.23–5.11). Treatment discontinuation was mainly for penitentiary reasons (40.3 %): release or transfer between prisons.

The rate of sustained viral response (SVR) was 52.1 % by ITT and 76.9 % by observed treatment (OT). SVR was higher among patients with genotype 2 or 3, and those with low baseline HCV-RNA. We did not observe any differences between individuals with and without PD in term of SVR, HCV genotype or HIV infection.

Conclusions

Our results support the safety and clinical effectiveness of the treatment of chronic HCV infection in correctional facilities, both in prisoners with PD and those without. Our data support non-discrimination between patients with and without PD when offering treatment for HCV infection to prison inmates.

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