Prediction of treatment outcomes for personality disordered offenders
| DOI | https://doi.org/10.1108/JFP-05-2013-0037 |
| Date | 04 November 2014 |
| Pages | 281-294 |
| Published date | 04 November 2014 |
| Author | Sarah-Jane Archibald,Colin Campbell,Derval Ambrose |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice |
Prediction of treatment outcomes for
personality disordered offenders
Sarah-Jane Archibald, Colin Campbell and Derval Ambrose
Sarah-Jane Archibald, based
at Department of Forensic and
Neurodevelopmental
Sciences, Institute of
Psychiatry, Kings College
London, London, UK.
Dr Colin Campbell, based at
Forensic Intensive
Psychological Treatment
Service, South London and
Maudsley NHS Trust, London,
UK and Department of
Forensic and
Neurodevelopmental
Sciences, Institute of
Psychiatry, Kings College
London, London, UK.
Derval Ambrose, based at
Forensic Intensive
Psychological Treatment
Service, South London and
Maudsley NHS Trust,
London, UK.
Abstract
Purpose – Evidence has shown associations between personality disorder (PD) and poor treatment
outcomes. The purpose of this paper is to: first, establish which risk assessment method (i.e. structured
professional judgement or actuarial) is most reliable for predicting treatment outcomes for individuals with
PD. Second, determine whether individuals identified as high risk are more likely to have poorer treatment
outcomes. Third, determine if engagement in treatment helps to reduce risk assessment scores.
Design/methodology/approach – In total, 50 patients were recruited from a medium secure forensic
PD service. Their risk was assessed using one structured professional judgement instrument (the HCR-20)
and one actuarial instrument (the RM2000). The study used a retrospective cohort design.
Findings – Overall, the HCR-20 was a better predictor of treatment outcome than the RM2000.
Personality-disordered offenders with high HCR-20 scores are at an increased risk of adverse treatment
outcomes.
Research limitations/implications – This investigation used a small, non-randomised sample of male
patients with PD at one South East England medium secure unit. The data were over-represented by
white British males. Future research should compare PD offenders with non-PD offenders to investigate
what factors best predict poorer treatment outcomes.
Originality/value – The findings indicate that structured professional judgement approaches are more
effective predictors of risk than actuarial measures for assessing patients with PD. This study therefore
adds value to forensic services and to the risk assessment debate.
Keywords Personality disorder, Risk assessment, Offenders, HCR-20, RM2000, Treatment outcomes
Paper type Research paper
Introduction
Personality disorder (PD) has been the subject of much debate over the past decade, both in
clinical and political circles, and there have been significant changes to services in order to
attempt to address the needs of individuals diagnosed with a PD. The Diagnostic and Statistical
Manual of Mental Disorders Fourth Edition (DSM-IV; American Psychiatric Association, 2000)
defines PD as “an enduring pattern of inner experience and behaviour that deviates markedly
from the expectations of the individual’s culture, is pervasive and inflexible, has an onset
in adolescence or early adulthood, is stable over time and leads to distress or impairment”
(p. 685). The DSM-IV groups PD into three clusters: Cluster A (paranoid, schizoid and
schizotypal); Cluster B (antisocial, borderline, histrionic and narcissistic); and Cluster C
(avoidant, dependent and obsessive-compulsive).
PD can have wide ranging implications for an individual and can vary significantly in terms of the
severity of impact, ranging from mild to severe (Home Office and Department of Health, 1999).
Individuals with psychopathic traits and on the higher end of the PD continuum have been found
to have a more severe form of PD which may increase their risk of engaging in antisocial and
criminal behaviour (Coid and Ullrich, 2010).
The authors would like to thank
Dr Alexis Cullen and Mr Symon
Wandiembe for their assistance
with statistical analyses. Many
thanks are extended to Mr Philip
Norman, Ms Chloe Charteris, Ms
Qian Zhang, Ms Belinda Coulston
and Dr Matt Bruce for their support
throughout the study.
DOI 10.1108/JFP-05-2013-0037 VOL. 16 NO. 4 2014, pp. 281-294, CEmerald Group Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAGE 281
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