Personality disorder and offending: A critical appraisal
Howard, Richard C.
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Personality disorders (PDs) are heavily over-represented among criminal populations, with about two-thirds of male prison inmates showing a diagnosable PD. Moreover, a clear link has been established between PD and violent offending. This chapter critically examines this link and raises several issues that have obscured its nature. First, PDs are highly comorbid, both with each other and with other mental disorders. PD comorbidity is particularly high in criminal populations and indicates a high degree of PD severity in offenders, particularly in those who offend violently. Second, given the heterogeneous nature of violence, particularly with regard to its motivation, an adequate typology of violence is required that does justice to its motivational heterogeneity. A recently proposed typology will be outlined that parses violence into appetitive and aversive types, and - within each type - into impulsive and premeditated subtypes. The appetitive subtypes have as their primary motives a desire to achieve a state of excitement and exhilaration (appetitive/impulsive subtype) and material self-gratification (appetitive/premeditated subtype). The aversive subtypes have as their primary motives a desire for self-protection (aversive/impulsive subtype) and for revenge (aversive/premeditated subtype). Third, a causal relationship between PD and violent offending presupposes a logical relationship between the two, which in turn raises the question of what might be the psychological mechanisms that mediate the relationship. It is proposed that severe PD is underpinned by personality traits related to emotional impulsiveness, psychopathy, and delusional ideation. By late adolescence and early adulthood, these factors contribute to the occurrence of violent offending in concert with contextual factors such as the availability of substances of abuse and interpersonal stress. This view is consistent with the abandonment of personality disorder categories in the forthcoming eleventh edition of the International Classification of Diseases (ICD-11) in favour of a dimensional classification of PD according to its severity, defined in terms of the degree of harm to self and others.