Personality, affect and coping style in severe personality disorder

The concepts of internalization and externalization have been proposed as personality tendencies or traits related to the constructs of neuroticism and extraversion. They have been associated to the bifactorial structure of affect and also to the coping style. This paper examines the interaction of personality, affect and coping in a sample of people diagnosed with personality disorder (n= 358). Negative affect (NA) in internalizers is higher than in externalizers (g= 0.62), and so is the severity of symptoms (GSI: g= 0.60). Mediation analyses show that personality type produces an indirect effect on GSI, with NA and coping style as partial mediators. 88.1 % of the sample has an unfavourable coping style (U-CS). The frequency of U-CS among internalizers is bigger than among externalizers (93% vs 83%; 2= 7.23, p= .007). However, the subgroup of internalizers with a favourable coping style (F-CS) shows no difference with externalizers with the same F-CS, either in NA (p= .428) or in GSI (p= .082). Regardless of personality structure, promoting adaptive strategies of coping can alleviate the psycopathology of severe patients.

New Labour, New Realism?

This chapter will explore four developments within the CJS system that occurred, from the 1990s onwards, under Conservative and New Labour administrations - Imprisonment for Public Protection (IPP), Joint Enterprise and the whole life tariff. The chapter begins with a discussion of the influence of Left Realism on New Labour and how New Public Management led to significant changes across the CJS.It begins with a discussion the reform of the Mental Health Act (MHA) and the notion of Dangerous Severe Personality Disorder (DSPD). Left Realism emerged within criminology a decade before the election of New Labour. However, it is possible to see its impact on some key notions of New Labour policy. Left realist were ultimately critical of the way that the New Labour approached questions of community and crime.

A more promising architecture? Commissioners’ perspectives on the reconfiguration of personality disorder services under the Offender Personality Disorder (OPD) pathway

Purpose The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty’s Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway. Design/methodology/approach A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted. Findings Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness. Research limitations/implications The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway. Practical implications While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation. Originality/value There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway.

Personality disorders

This chapter covers personality disorders, using the framework of defining a ‘normal’ personality to classify different disorders. Psychopathy and severe personality disorder are defined, including assessment, diagnosis, and aetiology of these disorders. The relationship between personality disorders and other mental health conditions are discussed, and assessment is also described. Management is described, from general aspects to specific pharmacological treatments and psychotherapy.

Making an impact: Have we got it right yet?

This concluding chapter adopts a formulation-based approach to reflect on the tough question of whether the Offender Personality Disorder (OPD) pathway has achieved a real impact in terms of the national strategy’s high-level outcomes. First, the explicit and implicit premises of the former Dangerous and Severe Personality Disorder (DSPD) developments are considered, contrasting them with those underpinning the OPD pathway strategy. It is suggested that while DSPD was predicated on an illness model, the OPD strategy more accurately reflects a public health model, with the associated benefits and disadvantages. Second, the evidence for impact to date is summarized. Third, the high-level strategy outcomes are reworked in line with our theoretical model to achieve a more coherent articulation of the hypothesized mechanism of change within the pathway.

Time for a new zeitgeist in perinatal mental health

Perinatal depression, and to a lesser extent anxiety, has been the focus of interest for perinatal psychiatrists for several decades. Policy and substantial funding has supported this. We argue that it is now time to change this focus and to invest greater funding to support clinical and research effort in ‘high-risk’ caregivers and their infants. We define high-risk caregivers as those who are likely to have attachment and relationship difficulties with their infant as a result of their own developmental experiences, personality difficulties and/or trauma-related mental disorders, often complicated by substance abuse, depression and anxiety. We propose that early intervention with such caregivers, focussing on both maternal mental health and on the needs of the infant for responsive and sensitive interaction and emotional care, would contribute to prevention of infant developmental disorders, with real gains to be made in breaking the transgenerational cycle of development of severe personality disorder.