Co-morbidity of personality disorder and clinical syndrome in high-risk incarcerated offenders
| Pages | 207-216 |
| Date | 14 August 2017 |
| DOI | https://doi.org/10.1108/JFP-05-2016-0026 |
| Published date | 14 August 2017 |
| Author | Alice Bennett,Darren Johnson |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Co-morbidity of personality disorder
and clinical syndrome in high-risk
incarcerated offenders
Alice Bennett and Darren Johnson
Abstract
Purpose –In light of the clinical importance of understanding co-morbidity within offender populations, the
purpose of this paper is to examine the prevalence and comorbidities of clinical disorder (Axis I)
and personality disorder (Axis II) within a sample of high risk, male offenders located in a high secure,
prison-based personality disorder treatment service.
Design/methodology/approach –The study utilised clinical assessment data for both Axis I diagnoses
(StructuredClinical Interview for DSM-IV) and Axis II diagnoses(International PersonalityDisorder Examination)
of 115 personalitydisordered offenderswho met the criteria for the treatmentservice between 2004 and 2015.
Findings –Co-morbidity between Axis I and Axis II diagnoses was high, with 81 per cent of the sample
having co-morbid personality disorder and clinical disorder diagnosis. The most prevalent Axis I disorder
was substance misuse, and Axis II was antisocial, borderline, and paranoid personality disorder. Following χ
2
analysis, Cluster A personality disorder demonstrated co-morbidity with both mood disorder and
schizophrenia/other psychotic disorder. Paranoid, schizoid, narcissistic, and avoidant personality disorder
demonstrated a level of co-morbidity with Axis I disorders. There was no association found between the
clinical disorders of substance use and anxiety with any personality disorder within this sample.
Practical implications –In part these results suggest that certain Axis II disorders may increase the risk of
lifetime Axis I disorders.
Originality/value –The findings of no co-morbidity between the clinical disorders of substance use and
anxiety with any personality disorder within sample are inconsistent to previous findings.
Keywords Personality disorder, Co-morbidity, Offenders, Axis I, Axis II, Clinical disorder, High risk
Paper type Research paper
Introduction
Recognition and understanding of co-morbidity is fundamental in the assessment of offenders
(Blackburn, 2000); the presence of one disorder can affect the “treatment, course and
phenomenology of another”(Tyrer et al., 1997). The co-morbidity between Axis I and Axis II
diagnoses within a forensic population has previously been examined in high secure hospitals
(Coid, 2003; Blackburn et al., 2003), inpatient samples (Oldham et al., 1995), prisoner samples
(Coid et al., 2009), and community-based samples (Links and Eynan, 2013).
The most prevalent findings in studies examining associations between Axis I and Axis II
disorders is that a diagnosis of depression is significantly (and positively) associated with
borderline personality disorder. This finding has been observed within varying forensic
samples (Blackburn et al., 2003; Coid, 2003; Coid et al., 2009; Links and Eynan, 2013;
Oldham et al., 1995; Skodol et al., 2011). For example, 35 per cent of a general prison population
in England and Wales had diagnoses of borderline personality disorder and depression
(Coid et al., 2009). Within high secure hospitals in England, this figure has been as high as
61 per cent (Coid, 2003). A consistent association has also been observed between mood
disorders and varying Axis II disorders (Oldham et al., 1995, Blackburn et al., 2003; Coid, 2003).
Received 31 May 2016
Revised 22 November 2016
Accepted 23 November 2016
The authors would like to
acknowledge the contribution of all
past and present members of the
Mental Health and Psychology
teams who have collected the data
used in this study from the
Westgate Personality Disorder
Treatment Service opening
to date.
Alice Bennett is a Chartered
and Registered Psychologist at
HMP Frankland, Durham, UK.
Darren Johnson is a Chartered
and Registered Forensic
Psychologist/Senior Lecturer in
Forensic Psychology at the
School of Social Sciences,
Business and Law, Teesside
University, Middlesbrough, UK.
DOI 10.1108/JFP-05-2016-0026 VOL. 19 NO. 3 2017, pp. 207-216, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 20 7
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