Differentiating between pathological demand avoidance and antisocial personality disorder: a case study

DOIhttps://doi.org/10.1108/JIDOB-07-2016-0013
Publication Date13 March 2017
Date13 March 2017
Pages13-27
AuthorGrace Trundle,Leam A. Craig,Ian Stringer
SubjectHealth & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders
Differentiating between pathological
demand avoidance and antisocial
personality disorder: a case study
Grace Trundle, Leam A. Craig and Ian Stringer
Abstract
Purpose The purpose of this paper is to explore the different clinical features of pathological demand
avoidance (PDA) and antisocial personality disorder (ASPD) presented in the form of a single case study.
The study highlights the potential of misdiagnosis and conceptual confusions to practitioners in forensic
settings between the two conditions when working with offenders with personality disorders.
Design/methodology/approach A case formulation using the five Psmethod based on the personal
history of an incarcerated male is presented and the clinical similarities and differences between PDA and
ASPD are delineated. These differences and similarities are evaluated and applied to offender management
including intervention options.
Findings There are considerable similarities between ASPD and PDA making the two conditions difficult to
separate. Both diagnostic criteria identify childhood behavioural problems, aggression, destructiveness,
conduct disorder (CD), manipulation and non-compliance as indications of the disorder. For example,
the criteria for later adult ASPD are the presence of childhood antisocial behaviour and CD. However, these
behaviours may also be suggestive of the attention deficit hyperactivity disorder and non-compliance that are
part of PDA. Violent behaviours and aggression can also be perceived in a similar way. Misdiagnosis
of PDA as ASPD reduces the efficiency of treatment programmes.
Originality/value The implications of these findings could prove useful in the successful risk management
of offenders with PDA. Given the similar behavioural characteristics between PDA and ASPD, the prevalence
of PDA among offenders may be higher than observed. The aim of this studyis to raise awareness of potential
conceptual complications and clinical confusions between the two conditions with a view to aid offender
management through case formulation. A large scale study into offenders with PDA would draw attention to
the prevalence of the condition as well as its association with offending behaviour.
Keywords Case study, Offending behaviour, Autism spectrum disorder, Antisocial personality disorder,
Clinical comparison, Pathological demand avoidance
Paper type Research paper
Introduction
In June 2016, there were 85,130 incarcerated males and females in prisons in England and Wales
(Ministry of Justice, 2016), 60-70 per cent of which estimated to have at least one personality
disorder (PD) (Singleton et al., 1998) with similar numbers being reported under community
supervision (Pluck et al., 2012). Amongst this group, antisocial personality disorder (ASPD) is the
most frequently reported personality disorder (Moffitt, 2004; Motz et al., 2015). ASPD is
characterised by unconcern of others feelings, attitude of irresponsibility and disregard for social
norms and rules and a low threshold for aggression and violence (WHO, 2005) and has been shown
to be associated with an increased likelihood of reoffending (Quinsey et al., 2006). Offenders with
personality disorder (OPD), and in particular those with ASPD, have become the focus of offender
management and probation services. In 2011, in an effort to work more effectively with OPDs, the
Ministry of Justice and the Department of Health (DH) in England and Wales jointly commissioned an
initiative that aims to provide a pathway of psychologically informed services for a highly complex and
challenging offender groups who are likely to haveaseverepersonalitydisorder(SPD)andwhopose
Received 29 July 2016
Revised 27 November 2016
Accepted 27 November 2016
Grace Trundle is an Assistant
Forensic Psychologist at
Forensic Psychology Practice
Ltd, Sutton Coldfield, UK and the
School of Psychology, Aston
University, Birmingham, UK.
Leam A. Craig is a Clinical
Forensic Psychologist at
Forensic Psychology Practice
Ltd, Sutton Coldfield, UK; the
Centre for Forensic and
Criminological Psychology,
University of Birmingham,
Birmingham, UK and the
School of Social Sciences,
Birmingham City University,
Birmingham, UK.
Ian Stringer is a Clinical
Forensic Psychologist at
Forensic Psychology Practice
Ltd, Sutton Coldfield, UK and
the Centre for Forensic and
Criminological Psychology,
University of Birmingham,
Birmingham, UK.
DOI 10.1108/JIDOB-07-2016-0013 VOL. 8 NO.1 2017, pp. 13-27, © Emerald PublishingLimited, ISSN 2050-8824
j
JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
j
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