Michael Daffern

The Function of Aggression in Personality Disordered Patients

It has been suggested that psychological interventions for personality disorders should focus on improving adaptive expression of the functional needs expressed through problematic behaviors such as aggression. The measurement of function is a necessary condition for devising a function-based treatment approach. Two studies that employ a method for assessing the functions of aggressive behavior in personality disordered patients are described by: (a) a retrospective analysis, through file review of inpatient aggressive behaviors and of the index offenses of patients admitted for treatment, and (b) an analysis of inpatient aggressive incidents where staff and patients were interviewed to elicit functions. Results showed that most aggression had the function of expressing anger, although other functions were also evident. The profile of functions observed in the inpatient studies was somewhat dissimilar to that observed in the studies of predominantly psychotic patients. Therapeutic implications of these findings are discussed.

Violence risk and gang affiliation in youth offenders: a recidivism study

Abstract Youth gangs are ubiquitous around the world and have been problematic for the social and criminal justice agencies. Despite widespread public concern, there has been relatively scarce empirical scrutiny of youth gangs internationally and little outside of America and Europe. In particular, the activities of youth gangs, the function of gang membership, the criminogenic needs of gang-affiliated youth, and the risk of criminal recidivism for gang-affiliated youth remain unclear. Against this background, this study explored the sociodemographic characteristics, risk and rate of criminal recidivism in a cohort of 165 male youth offenders in Singapore, of which 58 were gang-affiliated. Multivariate analyses revealed that gang-affiliated youth offenders were significantly more likely to have histories of substance use, weapon use and violence than nongang-affiliated youth offenders. Gang-affiliated offenders also scored higher on measures of risk for recidivism (SAVRY and YLS/CMI), and engaged in violent and other criminal behaviors more frequently during follow-up. These differences indicate a significant relationship between gang affiliation and criminal recidivism in youth offenders. Furthermore, these findings have important clinical and policy implications, indicating an increased requirement for additional and more intensive assessment and tailored interventions for gang-affiliated youth offenders.

The impact of interpersonal style on aggression and treatment non-completion in patients with personality disorder admitted to a medium secure psychiatric unit

Abstract The aim of this study was to examine the impact of interpersonal style and psychopathy on treatment non-completion and aggressive behaviour. Participants were patients with personality disorder admitted for treatment to a structured group program operating within a medium secure psychiatric hospital. Assessment of personality disorder and psychopathy occurred prior to admission. Interpersonal style was assessed on admission with the Impact Message Inventory (IMI), a self-report transactional inventory. Files were subsequently reviewed to determine whether patients were aggressive during their hospital stay and whether they were prematurely expelled from the unit and therefore did not complete treatment. Results showed that patients who completed treatment were more nurturing and help-seeking. Aggressive patients were more competitive and dominant. Psychopathy did not differentiate treatment completers from non-completers or aggressive from non-aggressive patients. Clinical implications and opportunities for further research are explored.

Resilience in Young Offenders

Youth offending is an important societal issue. A considerable amount of research has sought to examine the characteristics of young people who offend and to determine the factors within youth and their social environments that contribute to recidivism. More recently, research has begun to focus on those individual and environmental factors that help young people desist from offending. This has involved research into those individuals who cease offending after a period of criminal engagement and research into protective factors, that is, a factor whose presence is associated with increased protection from a negative outcome (i.e., offending). This article reviews these streams of research, with a particular focus on the protective factor of resilience. Implications of this research for clinicians will be discussed.

Personality Traits as Predictors of Inpatient Aggression in a High-Security Forensic Psychiatric Setting: Prospective Evaluation of the PCL-R and IPDE Dimension Ratings

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales provides specialized care to high-risk offenders with mental disorders. This study investigated the predictive utility of personality traits, assessed using the Psychopathy Checklist—Revised (PCL-R) and the International Personality Disorder Examination, with 44 consecutive admissions to the DSPD unit at a high-security forensic psychiatric hospital. Incidents of interpersonal physical aggression (IPA) were observed for 39% of the sample over an average 1.5-year period following admission. Histrionic personality disorder (PD) predicted IPA, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive (2+ incidents of) IPA. PCL-R Factor 1 and Facets 1 and 2 were also significant predictors of IPA. PCL-R Factor 1 and Histrionic PD scores were significantly associated with imminence of IPA. Results were discussed in terms of the utility of personality traits in risk assessment and treatment of specially selected high-risk forensic psychiatric patients in secure settings.

Reducing the use of seclusion in a forensic psychiatric hospital: assessing the impact on aggression, therapeutic climate and staff confidence

Against the background of an emerging international demand, this study examined the impact of a suite of interventions designed to reduce the use of seclusion in a forensic psychiatric hospital. These interventions included a review of existing seclusion practices and staff training in the management of aggression as well as the implementation of evidence-based alternatives. Evaluation occurred via pre- and post measurements of (1) therapeutic climate, (2) staff attitudes towards seclusion, (3) staff confidence to manage aggression, (4) the frequency and duration of seclusion episodes and (5) the frequency of aggression. The results revealed a significant reduction in the use and duration of seclusion episodes. Although staff appeared to use seclusion less frequently to manage a similar number of aggressive incidents there was no deterioration in staff perceptions of personal safety, nor any change in staff confidence to manage aggressive patients. There was also no change to therapeutic climate or staff attitudes towards seclusion. The clinical implications and opportunities for future research are discussed.

The impact of structured risk assessments followed by management recommendations on aggression in patients with personality disorder

This study tested the proposition that structured risk assessments followed immediately by the risk assessment results and recommendations for management can reduce the frequency of aggression in high-risk personality-disordered patients. The study included three phases during which aggressive behaviour was recorded: (a) baseline, (b) daily risk assessment using the Dynamic Appraisal of Situational Aggression (DASA) and HCR-20 Clinical Scale, and (c) daily DASA risk assessment followed by risk assessment results and risk management recommendations. Following the third phase a staff survey was conducted to measure the clinical utility of the DASA and the risk management recommendations. Results revealed no significant difference in the frequency of aggression between the three phases. The staff survey revealed varied reactions to the DASA and to the utility of the risk assessment results and management recommendations. Possible reasons for the limited impact of the DASA and opportunities for future research are discussed.

Elucidating the treatment needs of gang-affiliated youth offenders

Purpose – Gang affiliation is strongly associated with youth crime. Although gang prevention, intervention and suppression programmes have been used to reduce affiliation and manage youth gang‐related activities, the effectiveness of these approaches is questionable. Further, comprehensive programmes supporting disengagement from gangs that also address the actual criminal behaviours of gang‐affiliated youth are rare. Arguably, these are necessary if the goal of intervention is to reduce criminal behaviour and support disengagement from gangs. This paper aims to address these issues.Design/methodology/approach – This study sought to elucidate the criminogenic needs of gang‐ and nongang‐affiliated youth offenders (n=165) using two commonly used risk/need assessment instruments, the structured assessment of violence risk in youth (SAVRY) and the youth level of service/case management inventory (YLS/CMI).Findings – The results revealed that gang‐ and nongang‐affiliated youth offenders had similar criminogeni...

Prediction of institutional aggression among personality disordered forensic patients using actuarial and structured clinical risk assessment tools: prospective evaluation of the HCR-20, VRS, Static-99, and Risk Matrix 2000

Abstract Entry to the Dangerous and Severe Personality Disorder (DSPD) service in England and Wales is heavily determined by risk status, and therefore requires valid procedures for monitoring changes in risk over time in order to make risk management decisions and determine patients’ suitability for transfer to lower security settings. Yet little is known about the validity of current risk assessment tools with the new DSPD population. This study reports a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 consecutive admissions to the DSPD unit at a high secure forensic psychiatric hospital. Thirty eight per cent of the sample exhibited interpersonal physical aggression (IPA) on one or more instances over an average 1.5 year period following admission, and a similar percentage caused damage to property (DTP) on one or more occasions over the same period. All tools predicted DTP. HCR-20 Total and scale scores predicted IPA with structured final risk judgements also predicting repetitive (2 + incidents of) IPA. HCR-20 Risk Management scores were significantly associated with imminence of IPA. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients.

Are patients with a history of illicit drug use perceived to be 'drug-seeking' when they request pro re nata medication and does this impact on its administration?

Background: Providing optimal treatment is pivotal to improved health and justice outcomes for patients with dual diagnosis. Unfortunately, the available evidence suggests that these patients may be unduly prejudiced during hospitalisation due to perceptions that their requests for pro re nata (PRN) medication is ‘drug-seeking’, reflecting persistent dependence or tendencies toward abuse of licit and illicit substances. Aims: To examine psychiatric nurses responses to patients requests for PRN medication, to examine whether these requests are interpreted as ‘drug-seeking’, and to characterise patients described as such. Method: Case files and medication charts of patients diagnosed with schizophrenia admitted to a secure psychiatric service were reviewed to determine (a) their history of drug use, (b) the frequency with which they requested PRN medication, (c) how often staff administered PRN medication following request, and (d) how often patients were labelled ‘drug seeking’. Results: Patients with a h...