07/11/23 (W7 - Lecture)

Personality Disorders and Crime

Personality disorders are enduring patterns of behaviour that cause distress and affect
cognition, emotions, interpersonal functioning, and impulse control. To diagnose a
personality disorder, problematic, persistent, and pervasive traits must be present.
Diagnostic tools such as psychometric questionnaires and semi-structured interviews are
used. Cluster B personality disorders, which include antisocial, borderline, histrionic, and
narcissistic personality disorders, have been associated with criminal behaviour.

Aims of the session

This session will introduce you to:
 Personality
 Personality disorders and crime
 Cluster B
 Multiple personality disorders and Dissociative Identity disorders.
 Dangerous personality disorders
 Criticism

What are the four areas of functioning that a personality disorder can affect?
The four areas of functioning that can be affected by a personality disorder are:
1. Cognition: Personality disorders can impact a person's thinking patterns, perception, and
interpretation of events. They may have distorted beliefs, difficulty in problem-solving,
and impaired judgment.
2. Emotion: Personality disorders can lead to intense and unstable emotions. Individuals
may experience frequent mood swings, anger outbursts, and difficulty regulating their
emotions.
3. Interpersonal Relationships: Personality disorders can significantly affect a person's
ability to form and maintain healthy relationships. They may have difficulties with trust
and intimacy and exhibit manipulative or impulsive behaviours in their interactions with
others.
4. Behaviour: Personality disorders can manifest in maladaptive behaviours that are
persistent and inflexible. These behaviours may include impulsivity, aggression, self-harm,
substance abuse, or engaging in risky activities.

How can the Minnesota Multiphasic Personality Inventory overdiagnose

personality disorders?
The Minnesota Multiphasic Personality Inventory (MMPI) can overdiagnose personality
disorders. The MMPI is a psychometric questionnaire that is quick and easy to administer,
but it may not be as reliable as a semi-structured interview. The MMPI can produce false
positives, meaning that it may diagnose a personality disorder when one is not present.
Therefore, it is essential to use multiple sources of information when diagnosing personality
disorders.

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Can personality disorders be treated or managed? If so, how?

Personality disorders can be treated or managed. Treatment options may include
psychotherapy, medication, or a combination of both. Psychotherapy can help individuals
with personality disorders to develop coping skills, improve their relationships, and manage
their symptoms. Medications may be used to treat specific symptoms, such as anxiety or
depression. However, the effectiveness of treatment may depend on the personality
disorder and the individual's willingness to engage in treatment.

What do Personality Elusive & Personality Disorder consist of?

Personality Elusive is a psychological construct that refers to behavioural patterns linked
together meaningfully, which are relatively stable over time but not fixed. It is an integration
of biological, psychological, and environmental factors. However, the concept of Personality
Elusive is contested and needs to be more well-defined.

Personality Disorders are characterised by enduring patterns of inflexible and pervasive

behaviour in multiple areas of functioning. The components or characteristics of a
personality disorder, as outlined in the DSM (Diagnostic and Statistical Manual of Mental
Disorders), include:
Cognition (thoughts): Distorted ways of interpreting and perceiving events.
Affectivity (emotions): Range, intensity, lability, and appropriateness of emotions.
Interpersonal functioning: Difficulties in relating to others and maintaining healthy
relationships.
Impulse control: Problems with controlling impulses and engaging in impulsive behaviours.

These components or characteristics of a personality disorder cause significant distress to

the individual. Personality disorders are organised into three clusters: Cluster A (odd or
eccentric behaviour), Cluster B (dramatic, emotional, or erratic behaviour), and Cluster C
(anxious or fearful behaviour).

Why do some people have a personality disorder?

The causes of personality disorders are not fully understood. However, research suggests
that a combination of genetic, environmental, and social factors may contribute to the
development of personality disorders. For example, individuals who have a family history of
personality disorders may be more likely to develop one themselves. Additionally, childhood
experiences, such as abuse or neglect, may increase the risk of developing a personality
disorder. Other factors, such as cultural and societal influences, may also play a role.

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What is Narcissistic Personality Disorder? How can you diagnose NPD? What are
the prevalence and gender statistics? Why do people get NPD?
Narcissistic Personality Disorder (NPD) is a psychological disorder characterised by an
exaggerated sense of self-importance and a constant need for attention and admiration.
Individuals with NPD often have low self-esteem despite their grandiose self-image. They
lack empathy and have difficulty understanding or relating to the feelings and needs of
others. Criticism or challenges to their ego can trigger anger and hostility. NPD is more
prevalent in males and can be linked to parenting styles that lack empathy and genuine
affection. It is classified as one of the personality disorders in Cluster B, which includes
antisocial, borderline, histrionic, and narcissistic personality disorders.

The diagnostic criteria for Narcissistic Personality Disorder (NPD) include exaggerated
feelings of self-importance, a craving for attention, and a lack of empathy. Individuals with
NPD often have a grandiose sense of self-worth, exhibit manipulative and conning behaviour,
and have a shallow affect. They may also have a parasitic lifestyle, lack realistic long-term
goals, and show a lack of remorse or guilt for their actions.

The prevalence of NPD in the general population is less than 1%. It is more common in
males, with up to 75% of individuals with NPD being male. However, narcissistic traits can
also be prevalent in adolescents. It is important to note that these statistics are based on the
information provided and may vary in different studies or populations.

Possible factors that contribute to the development of Narcissistic Personality Disorder

include:
 Exaggerated feelings of self-importance but low self-esteem
 Craving attention and feeling better than others
 Lack of empathy and mood swings when criticised.
 Parenting factors include failure in modelling empathy, rejecting or abandoning
behaviour, treating the child as an extension of themselves, and not showing genuine
affection.
 Anger and hostility towards any perceived or real challenge to their ego

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What is 'Borderline Personality Disorder', and why do people get it? How can you
diagnose BPD? What are the prevalence and gender statistics?
Borderline Personality Disorder (BPD) is a mental disorder characterised by instability in
mood, behaviour, and functioning, as well as impulsivity. Individuals with BPD often
experience intense fear of abandonment and emotional dependency. BPD has been linked to
stalking (unusual and extreme attachment dynamics or aggressive behaviour). Some possible
causes or factors that contribute to the development of BPD include:
1. Biological Factors: Low serotonin levels, a neurotransmitter that regulates mood, have
been linked to BPD. Additionally, a family history of mood disorders may increase the risk
of developing BPD.
2. Environmental Factors: A history of abuse, neglect, or trauma during childhood can
significantly impact brain development and increase the likelihood of developing BPD.
Studies have shown that individuals with BPD often have a history of early-life trauma.
3. Attachment Dynamics: Unusual and intense attachment dynamics, such as fear of
abandonment or difficulty in maintaining stable relationships, have been associated with
BPD. These attachment patterns can contribute to the emotional instability and fear of
abandonment experienced by individuals with BPD.
4. Neurological Factors: Brain imaging studies using MRI have shown that individuals with
BPD may have smaller hippocampal volume and amygdala, brain regions involved in
emotional regulation and processing. These neurological differences may contribute to
the emotional dysregulation observed in BPD.

It is important to note that BPD is a complex disorder, and the exact causes and factors
contributing to its development are still being researched. A combination of genetic,
environmental, and neurological factors likely plays a role in the development of BPD. To
diagnose BPD, the following criteria from the DSM (Diagnostic and Statistical Manual of
Mental Disorders) are typically used:
 A pattern of unstable and intense interpersonal relationships.
 Marked impulsivity in at least two areas that are potentially self-damaging.
 Identity disturbance, such as unstable self-image or sense of self.
 Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour.
 Emotional instability due to marked reactivity of mood.
 Chronic feelings of emptiness.
 Inappropriate, intense anger or difficulty controlling anger.
 Transient, stress-related paranoid ideation or severe dissociative symptoms.

The prevalence of BPD in the general population is estimated to be around 1-3%. It is more
common in females, with approximately 75% of diagnosed individuals being women. The
completed suicide rate among individuals with BPD is estimated to be between 6-10%.

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What is 'Histrionic Personality Disorder', and why do people get it? How can you
diagnose HPD? What are the prevalence and gender statistics?
Histrionic personality disorder is a condition characterised by an overwhelming desire to be
noticed and dramatic behavior. It is diagnosed in approximately 2-3% of the general
population and is more commonly diagnosed in females, although it may be equally present
in both genders due to sex role stereotypes. Individuals with histrionic personality disorder
are less likely to commit crimes but can be easily influenced by their desire to be noticed.

Possible factors that contribute to the development of histrionic personality disorder include
biological factors such as low levels of serotonin and a family history of mood disorders.
Environmental factors such as a history of abuse, neglect, and trauma can also play a role in
the development of this disorder. Studies using MRI have shown that individuals with
histrionic personality disorder and a history of early-life trauma may have smaller
hippocampal volume and amygdala.

What is 'anti-social personality disorder', and why do people get it? How can you
diagnose ASPD? What are the prevalence and gender statistics?
Anti-social Personality Disorder (ASPD) is a clinical and legal label used to describe
individuals who consistently demonstrate atypical behaviours. According to the DSM-V,
ASPD is diagnosed when an individual exhibits three or more of the following behaviours by
the age of 15: failure to conform to social norms, deceitfulness, impulsivity, irritability and
aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse.
ASPD is often associated with psychopathic features.

It is important to note that ASPD is more prevalent in males than females, with a higher
prevalence observed in the prison population. Individuals with ASPD are more likely to
engage in criminal behaviour, and the disorder is associated with a higher risk of recidivism.

The prevalence of Antisocial Personality Disorder (ASPD) in the general population is

approximately 3% for males and less than 1% for females. The prevalence of personality
disorders in prisoners in England and Wales is high. According to different sources, 63% of
male remand prisoners and 49% of male sentenced prisoners in England and Wales
manifested antisocial personality disorder (APD). Additionally, 31% of female sentenced
prisoners also had APD. APD is predictive of high rates of recidivism. It is worth noting that
APD can exist with other personality disorders.

How do anti-social personality disorder and psychopathy relate? What is

psychopathy?
Anti-social Personality Disorder (ASPD) is mistakenly used as an umbrella term applicable to
psychopathy and sociopathy. Psychopathy is a personality disorder that is characterised by a
lack of empathy, remorse, and guilt, as well as shallow emotions, manipulativeness, and
impulsivity. While ASPD and psychopathy share some similar traits, such as a disregard for
the rights of others and a tendency to engage in criminal behaviour, they are not the same
thing. Psychopathy is a more severe form of ASPD, and individuals with psychopathy may
exhibit more extreme and harmful behaviours than those with ASPD alone.

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Definition of psychopathy is a personality disorder characterised by a lack of empathy,

remorse, and conscience, as well as manipulative and antisocial behaviour. Psychopaths
often appear charming and emotionally stable, but they have a shallow effect and a
disregard for the rights and feelings of others. Psychopathy is considered a distinct clinical
construct and is assessed using tools such as the Psychopathy Checklist (PCL-R). It is
important to note that there is still some disagreement and debate over the standard
definition of psychopathy. The 20 items included in the Psychopathy Checklist (PCL-R) are:
1. Glibness and Superficial Charm
2. Grandiose sense of self-worth
3. Need for stimulation and Proneness to boredom.
4. Pathological Lying
5. Conning and Manipulative
6. Lack of remorse or guilt
7. Shallow affect
8. Callous and lack of empathy.
9. Parasitic lifestyle
10. Poor behavioural control
11. Promiscuous sexual behavior
12. Early behavior problems
13. Lack of realistic long-term goals
14. Impulsivity
15. Irresponsibility
16. Failure to accept responsibility for own actions.
17. Many short-term marital relationships
18. Juvenile delinquency
19. Revocation of conditional release
20. Criminal versatility

The four-facet structure of psychopathy, as proposed by Hare in 2003, includes the following
facets:
Interpersonal: This facet focuses on manipulation, deceitfulness, and superficial charm traits
in interpersonal relationships.
Affective: This facet involves traits related to a lack of empathy, shallow emotions, and a lack
of remorse or guilt.
Lifestyle: This facet encompasses traits related to impulsivity, irresponsibility, and a parasitic
lifestyle.
Antisocial elements: This facet includes traits related to criminal behaviour, early behaviour
problems, and a lack of long-term goals.

These four facets provide a comprehensive framework for understanding the different
dimensions of psychopathy.

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What is Dissociative Identity Disorder, and why do people get it? How can you
diagnose DID? What are the prevalence and gender statistics?
Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder
(MPD), is a mental disorder characterised by the presence of two or more distinct
personality states or identities within an individual. These identities may have their unique
behaviours, memories, and perceptions. DID is believed to develop because of childhood
trauma, particularly severe and repetitive abuse, which leads to the fragmentation of the
individual's identity as a coping mechanism. DID typically begins before the age of five
because of severe trauma, leading to the dissociation of self from mental and physical pain.
The continuum of dissociation ranges from daydreaming to DID. Additionally, there is the
possibility of offenders pretending to have DID and the need for evidence of the disorder
before the offence. The role of high suggestibility, fantasy proneness, and sociocultural
influences in mediating DID suggests that some individuals may feign the disorder.

The diagnosis of DID involves the observation of various symptoms, including disruptions in
identity, recurrent gaps in memory, and alterations in affect, behaviour, consciousness,
perception, and cognition. These symptoms must cause significant distress or impairment in
the individual's life and cannot be attributed to cultural or religious practices, drugs, or other
medical conditions.

The prevalence of DID is estimated to be around 1.5% based on a small sample US

community study. It is more commonly diagnosed in females, with up to 75% of individuals
with DID being women. However, it is essential to note that narcissistic traits, which are
prevalent in adolescents, can sometimes be mistaken for DID.

In summary, Dissociative Identity Disorder is a mental disorder characterised by the

presence of multiple distinct personality states within an individual. It is believed to develop
as a response to childhood trauma, and its diagnosis involves the observation of specific
symptoms. The prevalence of DID is relatively low, and it is more commonly diagnosed in
females.

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What is Dangerous & Severe Personality Disorder, and why do people get it? How
can you diagnose DSPD? What are the prevalence and gender statistics?
Dangerous & Severe Personality Disorder (DSPD) is a controversial disorder that was
invented in 1999 by politicians and civil servants. It is characterised by individuals who are
more likely to commit an offence within five years, leading to severe physical or
psychological harm. The diagnostic criteria for DSPD, as outlined by the Home
Office/Department of Health, include having a significant personality disorder and
presenting a risk that is linked to the personality disorder.

Personality disorders, particularly those in Cluster B, which include antisocial personality

disorder, borderline personality disorder, histrionic personality disorder, and narcissistic
personality disorder, have been linked to crime. Individuals with these personality disorders
may be more prone to developing DSPD.

Specialist services are provided to cater to individuals with Dangerous and Severe
Personality Disorder (DSPD) in high-security hospitals, including Broadmoor, Rampton,
Frankland, and Whitemoor prisons (Hollin, 2013). However, several conceptual and practical
issues are associated with identifying individuals who meet the criteria for DSPD (Tryer et al.,
2010). Furthermore, evaluating the effectiveness of DSPD programs has proven to be
challenging and inconclusive.

Treatment & Critique

In terms of treatment, there are:
Treatment resistance in non-specialized care: The context suggests that better outcomes
are observed in specialised settings compared to non-specialized care for individuals with
treatment resistance.
Trauma-related treatment: The context implies that trauma-related treatment approaches
may be relevant for addressing specific conditions or symptoms.
Art-based treatment: The context mentions using art-based interventions as a potential
treatment option, although it does not provide further details.
Pharmacology: The context does not provide specific information about pharmacological
treatment options but suggests that they may be relevant in some instances.

In terms of critiques:
 Psychopathology/ PD
- Are they objectively defined via scientific criteria vs social construction?
 Contested definitions/categories
- Implications for understanding: inability to determine objectively/scientifically which are
correct/accurate.
 DSM
- Issue with subjectivity
- Clinical significance- what does this mean?
- Categories- clear demarcation problematic
o Context- social, cultural, and interpersonal milieu
o Impact on how people might be judged.