Violence PD Final November 2007

Psychological intervention with ‘Personality Disorder’and violence : 

Dr Julian Walker, Fromeside, 2007 1 Psychological intervention with ‘Personality Disorder’and violence Dr Julian Walker Forensic Clinical Psychologist Fromeside

Definition : 

Dr Julian Walker, Fromeside, 2007 2 Definition Violence: ‘use of physical force against another person (or thing) sometimes with aggression/intent to hurt’…where the ‘victim’ is motivated to avoid it…. (Hollin and Howells, 1989)

The scale of the problemin Avon & Somerset (1½m) : 

Dr Julian Walker, Fromeside, 2007 3 The scale of the problemin Avon & Somerset (1½m)

Research : 

Dr Julian Walker, Fromeside, 2007 4 Research

Violence Research:What & Why : 

Dr Julian Walker, Fromeside, 2007 5 Violence Research:What & Why Theories include : Impulsivity Frustration intolerance High anxiety / stress Modelling (parents/peers) Genes Disorder Anger Static Risk Factors : Gender Age Offending history Substance misuse Etc…..

Personality and Violence (Nestor, 2002) : 

Dr Julian Walker, Fromeside, 2007 6 Personality and Violence (Nestor, 2002) Poor impulse control Poor affect regulation (esp. anger) Narcissism Paranoia ‘For reasons of conceptual obscurity, circular reasoning…..the concept of a violence-prone personality is rejected in favour of several more specific processes’ (Walters, 2000)

Violence Research – When? : 

Dr Julian Walker, Fromeside, 2007 7 Violence Research – When? Don’t know much about when… Predictions for individuals based on group behaviour (over-predict) i.e. under what more specific circumstances do individuals behave violently and what can help them stop?

Why do offenders offend?(Andrews and Bonta, 1994) : 

Dr Julian Walker, Fromeside, 2007 8 Why do offenders offend?(Andrews and Bonta, 1994) Employment Education Partner and family Criminal social networks Substance abuse Poor community functioning Personal and emotional factors Anti-social attitudes

What Works? (Lipsey, 1995) % improvement over control group : 

Dr Julian Walker, Fromeside, 2007 9 What Works? (Lipsey, 1995) % improvement over control group

‘Personality Disorder’ Treatment : 

Dr Julian Walker, Fromeside, 2007 10 ‘Personality Disorder’ Treatment

Schizophrenia vs Antisocial PersonalityDisorder : 

Dr Julian Walker, Fromeside, 2007 11 Schizophrenia vs Antisocial PersonalityDisorder Diagnose Compliance Symptom management Reduction of harm to self Evidence based treatments – likely to work Formulate Socialisation Stress/distress management Reduction of harm to others Little evidence, few treatments, don’t know what works

Psychological Treatment for PD (Duggan, in press) : 

Dr Julian Walker, Fromeside, 2007 12 Psychological Treatment for PD (Duggan, in press) ‘good quality evidence from properly conducted studies of psychological interventions in personality disorder that might aid the practitioner is sparse’ Preponderance of DBT for BPD Majority of studies in community Little on ASPD despite prevalence

What can be done? : 

Dr Julian Walker, Fromeside, 2007 13 What can be done? Specialist assessment: diagnosis and formulation Treat Axis 1 Support agencies involved with objective and expert advice/supervision Awareness and working with criminogenic factors Specialist treatment…..

Cost effectiveness : 

Dr Julian Walker, Fromeside, 2007 14 Cost effectiveness Treatment choice based on cost benefit analysis Treatments - broad application/delivery (groups) Outcome focus – reduction in subjective distress, crime, bed occupancy Focus on criminogenic factors Focus on motivation (triage first) Individualised approach (each person a single case study with data collection) Staff resource (supervision, training, burnout)

Treatments that may work(with evidence for cost effectiveness?) : 

Dr Julian Walker, Fromeside, 2007 15 Treatments that may work(with evidence for cost effectiveness?) ‘Antisocial Personality Disorder’ Enhanced Thinking Skills Reasoning and Rehabillitation ‘Borderline Personality Disorder’ Mentalisation Based Treatment Dialectical Behaviour Therapy Psychotherapy? Anything done sensibly and consistently

Slide 16: 

Dr Julian Walker, Fromeside, 2007 16