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
Childhood abuse is a risk factor for the development of externalizing characteristics and disorders, including antisocial personality disorder and psychopathy. However, the precise relationships between particular types of childhood maltreatment and subsequent antisocial and psychopathic traits remain unclear.
Using a large sample of incarcerated adult male criminal offenders (n = 183), the current study confirmed that:
- severity of overall childhood maltreatment was linked to severity of both psychopathy and antisocial personality disorder in adulthood.
- Moreover, this relationship was particularly strong for physical abuse and the antisocial facet of psychopathy.
- Sexual abuse history was uniquely related to juvenile conduct disorder severity, rather than adult psychopathy or antisocial behaviors.
- Additionally, there was a significantly stronger relationship between childhood maltreatment and juvenile conduct disorder than between childhood maltreatment and ASPD or psychopathy.
These findings bolster and clarify the link between childhood maltreatment and antisocial behavior later in life.
Below: Behavioral outcomes for groups with low, middle, and high scores at baseline on proactive aggression and callous-unemotional traits. Note: Each row shows associations between one behavioral outcome and baseline severity groups (low, middle, high) of proactive aggression and callous-nemotional traits. Panels on the left show behavioral outcomes with participants stratified by proactive aggression group. Panels on the right show callous-unemotional traits groups. The table within each chart shows the contrasts between the 3 severity groups (the differences in least-squares means and the 95% CI for that difference) at baseline and at the end of the stimulant monotherapy protocol. APSD C-U = Antisocial Process Screening Device Callous-Unemotional scale; CBCL = Child Behavior Checklist; ConnGI-P = Conners Global Index (Parent Version); R-MOAS = Retrospective-Modified Overt Aggression Scale; VAQ = Vitiello Aggression Scale.
82 children (51%) experienced remission of aggressive behavior. Neither CU traits nor proactive aggression predicted remission (CU traits: odds ratio=0.94, 95% CI=0.80–1.11; proactive aggression, odds ratio=1.05, 95% CI=0.86–1.29). Children whose overall aggression remitted showed decreases in CU traits (effect size=−0.379, 95% CI=−0.60 to −0.16) and proactive aggression (effect size=−0.463, 95% CI=−0.69 to −0.23).
Findings suggest that pretreatment CU traits and proactive aggression do not forecast worse outcomes for aggressive children with ADHD receiving optimized stimulant pharmacotherapy. With such treatment, CU traits and proactive aggression may decline alongside other behavioral improvements.
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Most discussions of the social and interpersonal styles in individuals with strong psychopathic traits focus on their dangerousness or their affective and interpersonal deficiencies. This study has a different focus, and starts from the idea that such focus on the threat emanating from individuals with a psychopathic style might blind us from the logic inherent to their way of relating with the world. By means of a qualitative analysis (thematic analysis) of narratives from a Lacanian talking therapy, this study examines how 15 youngsters with strong psychopathic traits make sense of interpersonal events and relations. The main recurring theme across these narratives was that others in general are fundamentally distrustful antagonists that they have to protect themselves from. Especially the father figure, with whom identification seems to take place, is seen as a violent actor. Consequently, these youngsters develop multiple strategies of dealing with the threat they experience in relation to (significant) others. These relationship patterns also emerged within the therapeutic relationship, resulting in frequent testing of the therapist's trustworthiness. The results of this study, discussed in terms of Lacanian theory, might help therapists to develop treatment approaches that better fit with the interpersonal orientation of individuals with strong psychopathic traits.
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