Severe Personality Disorder (severe + personality_disorder)

Distribution by Scientific Domains


Selected Abstracts


Dangerous and Severe Personality Disorder

JOURNAL OF ADVANCED NURSING, Issue 3 2003
William Whitfield Director
No abstract is available for this article. [source]


Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004
Eileen Vizard
Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright 2004 Whurr Publishers Ltd. [source]


Temporal reliability of psychological assessments for patients in a special hospital with severe personality disorder: a preliminary note

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2005
Professor P. Tyrer
Background The new programme for assessing those with dangerous and severe personality disorder relies heavily on psychological assessments of personality disorder and risk. Methods The temporal reliability of assessments of psychopathy (PCL-R), risk (HCR-20) and personality was assessed using the International Personality Disorder Examination (IPDE) in 15 randomly selected male prisoners in a high secure hospital carried out at intervals varying between a mean of nine and 19 months after initial assessments by a variety of assessors. Results Using the intra-class correlation coefficient the agreement varied between0.57 (HCR-20), 0.58 (PCL-R) and 0.38-0.70 for IPDE personality disorders, with the best agreement for antisocial personality disorder (0.70). Comment These levels of agreement are consistent with other recent work on temporal reliability of personality instruments but are a little too low for confidence in these measures alone in the assessment process. Copyright 2005 Whurr Publishers Ltd. [source]


Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004
Eileen Vizard
Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright 2004 Whurr Publishers Ltd. [source]


Quality of life for patients with a personality disorder , comparison of patients in two settings: an English special hospital and a Dutch TBS clinic

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2001
Dr Mark Swinton Consultant Forensic Psychiatrist
Introduction There are differing approaches to the management of people with a severe personality disorder in the UK and The Netherlands. Few comparative studies exist. This study describes the use of an adapted version of the Lancashire Quality of life profile as a patient based-outcome measure. Method A cross-sectional sample of 37 patients was interviewed at each site. Result Patients in the Dutch service reported a significantly higher quality of life which could not be explained by better objective circumstances. Discussion The data collected do not explain why the Dutch patients reported a higher quality of life. It is suggested that this finding was related to more extensive therapeutic activity and greater therapeutic optimism in the Dutch service. There is a need for critical scrutiny of the appropriateness of quality of life measures in offender patients before they are accepted for use as an outcome measure. Copyright 2001 Whurr Publishers Ltd. [source]


Eating disturbance and severe personality disorder: outcome of specialist treatment for severe personality disorder

EUROPEAN EATING DISORDERS REVIEW, Issue 2 2006
Fiona Warren
Abstract Objective To assess the outcome for patients receiving specialist democratic therapeutic community treatment for personality disorder (PD) when they also have eating disturbance. Method Prospective, naturalistic study. Personality psychopathology and disturbed eating attitudes of 135 male and female referrals to tertiary treatment for PD were assessed at referral. Seventy-five referrals were admitted for treatment and 60 were not. Participants were reassessed at 1-year follow-up. Results There was a significant effect of treatment on dieting but not other aspects of eating disturbance. However, patients with eating disturbance were not more likely than those without to terminate treatment early or to have poorer outcome in terms of their personality pathology. Severity of baseline personality pathology did not predict treatment response. Conclusion Clients with comorbidity should be considered for treatment of the personality disorder prior to treatment for the eating disorder. Copyright 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source]


Dangerous and severe personality disorder: an ethical concept?

NURSING PHILOSOPHY, Issue 2 2005
Sally Glen phd ma rn
Abstract Most clinicians and mental health practitioners are reluctant to work with people with dangerous and severe personality disorders because they believe there is nothing that mental health services can offer. Dangerous and severe personality disorder also signals a diagnosis which is problematic morally. Moral philosophy has not found an adequate way of dealing with personality disorders. This paper explores the question: What makes a person morally responsible for his actions and what is a legitimate mitigating factor? How do psychiatric nurses working with this client group understand the awful things some clients do? What concepts do they need, if they are to know how to explain and how to react? It is suggested that dangerous and severe personality disorder is best regarded as a moral category, framed in terms of goodness, badness, obligation and other ethical concepts. It seems plausible that in important ways the dangerous and severe personality disordered client does not understand morality or understands it differently. The peculiar position of the dangerous and severe personality disordered individual in our system of moral responsibility stems from his apparent inability to see the importance of the interests of others. It might be more helpful to regard personality disordered clients as we do children: partially but not fully reasonable for their actions. We might regard the dangerous and severe personality disordered client responsible for those actions which he most clearly understands, such as causing others physical pain, but not for those with which he is only superficially engaged, such as causing emotional pain. The paper concludes by suggesting that the dangerous and severe personality disordered individual does not fit easily into any conventional moral category, be it criminal, patient, animal or child, and thus an assessment of his moral accountability must take into consideration his special circumstances. [source]


Peaks and troughs,an exploration of patient perspectives of dangerous and severe personality disorder assessment (Peaks Unit, Rampton Hospital)

PERSONALITY AND MENTAL HEALTH, Issue 1 2008
Lisa Maltman
Rationale,Although accessing user-perspectives is a key National Health Service initiative, the literature reporting user's views of forensic services, particularly dangerous and severe personality disorder (DSPD) services, is in its infancy. Aim and Design,This qualitative study applied thematic analysis to 12 semi-structured interviews aimed to enhance professional understanding of how Peaks Unit treatment-ward participants retrospectively perceive their experience of being admitted and assessed at the unit. Findings,Reported themes include ,fear' associated with participants' personal safety concerns and apprehensions regarding inhumane treatment and prolonged detention. The local metaphor of the DSPD Unit as the ,dark side' exacerbated such fears. ,Shock' also emerged as a primary theme resulting from unexpected admissions, security measures and some staff responses. ,Offering hope' provided a further theme with many participants reporting a climate of therapeutic optimism within staff teams and ,refreshing' opportunities for change. Reservations were also expressed about the service potentially offering ,false hope'. Several suggestions are proposed for future assessment strategy including escalating user-involvement activity, managing expectations, promoting therapeutic optimism and helping patients to attain a realistic sense of hope in order to maximise therapeutic engagement. Copyright 2008 John Wiley & Sons, Ltd. [source]


Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2004
Eileen Vizard
Background The concept of ,severe personality disorder' is currently applied to adults with a history of serious antisocial and offending behaviour. There is, however, no similar classification that can be applied to the sub-group of children and adolescents who display persistent and serious offending from an early age. This omission from diagnostic nomenclature prevents the appropriate early identification, assessment and management of these young people. Method This paper therefore proposes a new developmental disorder: ,severe personality disorder emerging in childhood'. The existing evidence base strongly supports the presence of a developmental trajectory from childhood to adult life for the small number of children who show early signs of severe personality disorder (SPD). Based on a review of the literature and the experience of working in a specialist, forensic Child and Adolescent Mental Health Service (CAMHS), a multi-factorial model is proposed that outlines the developmental trajectory of SPD. This model includes neurobiological, psychosocial, environmental and systemic factors, within a developmental framework, and contributes to a more developmentally appropriate understanding of the genesis of severe personality disorder. Copyright 2004 Whurr Publishers Ltd. [source]


The voice of detainees in a high security setting on services for people with personality disorder

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 4 2002
Sue Ryan
Background British government Home and Health Departments have been consulting widely about service development for people with ,dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. Methods All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. Aims To establish views on services from one subgroup of people nominated by the government department as having ,DSPD'. Results Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and ,experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. Conclusions As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences. Copyright 2002 Whurr Publishers Ltd. [source]