Dr Howard has held academic positions in Ireland, New Zealand, Singapore and England, latterly at the University of Nottingham and at Rampton Hospital, where he worked as part of a team of researchers on a UK Government sponsored initiative to assess and treat those offenders with “dangerous and severe personality disorder”. He has authored or co-authored almost 100 scientific papers and book chapters, many of them concerned with personality disorders in offenders, which remains a topic of long-standing and enduring interest. His particular interest is in violent offending as this relates to personality disorder.
Personality disorders are typified by relatively enduring, inflexible, and pervasive disturbances in how individuals experience and interpret themselves, others, and the world around them. These are reflected in maladaptive patterns of cognition, emotion, and behaviour, usually evident in childhood and adolescence, which result in significant problems in psychosocial functioning, particularly in interpersonal relationships. Their prevalence in the general population (4 -13 per cent) exceeds that for other major mental disorders, such as schizophrenia (0.87%), bipolar disorder (0.24%), and major depressive disorder (0.35%). There is a particularly high prevalence of personality disorders in criminal justice settings.
While it is well established that personality disorders are linked to violence, the nature of the link is obscured by several issues. First, PDs are highly comorbid, both with each other and with other mental disorders. 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 and material self-gratification. The aversive subtypes have as their primary motives a desire for self-protection and for revenge. 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.
Audience take away?
- A better understanding of personality disorders, their prevalence and their significance in forensic and mental health contexts.
- A clearer understanding of the motivational heterogeneity of violence, and of..
- How different types of violence are likely linked to particular constellations of personality pathology.
- Given the high prevalence of, and comorbidity associated with, personality disorders, it is important that nurses operating in mental health contexts have a clear understanding of personality disorder and the risks that individuals with PD present.
- Existing typologies of violence (e.g. the reactive/impulsive vs. instrumental dichotomization) does not do justice to the heterogeneity of violence found in mentally disordered offenders. The proposed (2x2) typology offers a new perspective that should benefit research on violence by allowing a more nuanced analysis. In particular, it should permit a clearer understanding of how particular constellations of personality pathology are related to particular types of violence.