The validity of two diagnostic systems for personality disorder in people with intellectual disabilities: a short report
| Date | 11 September 2017 |
| Pages | 104-110 |
| DOI | https://doi.org/10.1108/JIDOB-04-2015-0004 |
| Published date | 11 September 2017 |
| Author | William R. Lindsay,Anne van Logten,Robert Didden,Lesley Steptoe,John L. Taylor,Todd E. Hogue |
| Subject Matter | Health & social care,Learning & intellectual disabilities,Offending behaviour,Sociology,Sociology of crime & law,Deviant behaviour,Education,Special education/gifted education,Emotional/behavioural disorders |
The validity of two diagnostic systems for
personality disorder in people with
intellectual disabilities: a short report
William R. Lindsay, Anne van Logten, Robert Didden, Lesley Steptoe, John L. Taylor and
Todd E. Hogue
Abstract
Purpose –Over the last ten years, there has been greater interest in the diagnosis of personality disorder
(PD) in people with intellectual and developmental disabilities (IDD). One important characteristic of a
diagnostic system is that it should have validity as a contribution to utility. PD has been found to have
a predictive relationship with violence and the purpose of this paper is to review two methods for the
diagnosis of PD in offenders with IDD in order to evaluate the utility of the diagnoses.
Design/methodology/approach –In total, 212 offenders with ID were recruited from three
settings –maximum-security, medium/low security and community services. Diagnoses of PD in the case
files were compared with a structured system of diagnosis based on DSM-IV traits.
Findings –There were significant differences between the two systems with a significantly higher frequency
of PD diagnosis in the community forensic setting in the structured assessment system. There was no
relationship between the case files diagnosis of PD and future violence but there was a significant predictive
relationship between the structured diagnosis of PD and future violence with an AUC ¼0.62.
Research limitations/implications –As with all such studies, the research is limited by the quality of the
case files available to the researchers.
Practical implications –Only the structured assessment of PD had utility for the prediction of violence.
Reasons for the differences between the systems are discussed and suggestions made on how a diagnosis
of PD can be structured for the busy clinician.
Social implications –The accurate diagnosis of PD has important implications since the PD is a crucial
addition to any violence risk evaluation.
Originality/value –This study is the first of its kind to review the way in which clinicians assess PD.
Keywords Intellectual disability, Learning disability, Offenders, Personality disorder, Clinical assessment,
Structured assessment
Paper type Research paper
Diagnosis is one of the cornerstones of clinical practice. A diagnosis should be as concise as
possible and a technical summary that conveys information about the cause, nature and
symptoms of the disorder. It should provide a “roadmap”that gives an indication of any follow-up
tests required, treatment or management that might be indicated, future manifestations and
prognosis of the disorder. For many disorders, these are ideals that are only achieved
occasionally and for psychiatric disorders, they are rarely seen completely. However, for many
conditions they are reasonable goals. For example, a diagnosis of intellectual disability provides
summary information, or at least broad predictions about intellectual capacity, adaptive
behaviour, likely parameters across the lifespan and likely responses to educational and
occupational opportunities. Therefore, a diagnosis carries information about how the disorder
may have developed in the past, current manifestations and prediction of future implications.
The diagnosis of personality disorder (PD) in people with intellectual and developmental
disabilities (IDD) has been particularly problematic because of lack of reliability and validity.
Studies have found huge differences in prevalence in what were similar populations.
Received 3 April 2015
Revised 24 June 2016
Accepted 13 October 2016
Since the time of writing, William R.
Lindsay has regrettably died.
William R. Lindsay was the
Clinical Director at the
Department of Psychology,
University of Abertay,
Dundee, UK.
Anne van Logten is based at
the Department of Psychology,
Radboud University, Nijmegen,
The Netherlands.
Robert Didden is a Professor at
the Department of Psychology,
Radboud University, Nijmegen,
The Netherlands.
Lesley Steptoe is based at NHS
Tayside, Dundee, UK.
John L. Taylor is a Professor of
Clinical Psychology and
Clinical Psychologist at the
Department of Psychological
Services, Northumbria
University –Coach Lane
Campus, Newcastle upon
Tyne, UK.
Todd E. Hogue is a Professor of
Forensic Psychology at the
Lincoln University, Lincoln, UK.
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JOURNAL OF INTELLECTUAL DISABILITIES AND OFFENDING BEHAVIOUR
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VOL. 8 NO. 3 2017, pp.104-110, © Emerald Publishing Limited, ISSN 2050-8824 DOI 10.1108/JIDOB-04-2015-0004
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