Explaining the Link Between Personality Disorder and Violence
The mechanism of the link between personality disorder and offending is addressed in an article by Logan and Johnstone.[18••] They provide a conceptual framework for understanding the link between personality disorder and risk of violence in individuals when doing structured professional judgement risk assessment. They argue that when assessing risk of violence in personality disorder there is a need to go beyond just listing risk factors such as having a personality disorder and instead produce detailed, comprehensive, individual explanations of risk potential and risk management needs. They outline the principles and stages of risk formulation. They then consider the four higher order dimensions into which DSM-V will organize personality pathologies (dissocial, emotional deregulation, social avoidance and compulsive dimensions) and how these dimensions might relate to violence if doing a risk formulation, drawing on the literature to back up their hypotheses. They suggest that people who are on the emotional dysregulation dimension experience extreme and fluctuating moods, dejection and disillusionment, impulsive anger and irritability and fear of abandonment and rejection. Where these features co-exist with dissocial characteristics violence can occur when triggered by perceived injury or abandonment by another person. The motivation for injuring others may be more motivated by a desire to prevent loss and express intolerable emotions rather than the desire for retribution and to restore self esteem that is seen in dissocial individuals. They suggest that dissocial individuals may be violent when they perceive themselves to have been injured by another person. This triggers feelings of shame, guilt, humiliation or envy, which are highly threatening to their fragile self esteem. They hypothesize that violence may arise in the socially inhibited dimension when an individual is confronted with unexpected, unwanted or overwhelming evidence of their inadequacy. Violence may arise in the compulsive dimensions when control over their environment or those within it is threatened by the actions of others.
Gilbert and Daffern[19••] wrote a conceptual article integrating contemporary psychological aggression theory and the extant personality disorder–violence literature. They proposed that the general aggression model (GAM) should be drawn on to elaborate on the link between personality disorder and violence. The article points out that there is increasing acknowledgement that violent behaviours result from a complex interaction of the individual and contextual factors. They explain the GAM, which contends that aggressive acts rarely occur without the convergences of multiple precipitating situational factors and predisposing personal characteristics. The GAM postulates that people who hold entrenched and accessible aggression-related cognitions and who are susceptible to experiencing the internal states that activate these cognitions are more prone to act aggressively. The GAM specifies several key constructs that are important in influencing aggression: maladaptive cognitions (these influence how the environment is perceived and interpreted), aggressive behavioural scripts (acquired through observation of others), aggression-supportive beliefs (beliefs about the appropriateness of aggressive behaviour in particular circumstances) and anger and affective arousal (which serves as a cue for retrieval of cognitive schema and aggressive scripts). The authors review the evidence for the importance of these constructs in the personality disorder–violence literature. They conclude that people with personality disorders associated with aggression have more of the constructs described in GAM. They conclude that the empirical evidence is strongest for antisocial personality disorder but a number of constructs, including violent scripts, have been rarely studied. They suggest that their conceptualization provides a focus for researchers to further elucidate the relationship between personality disorder and violence and for clinicians to more systematically assess relevant constructs to determine violence potential in people with personality disorder and to focus their violence reduction efforts.
Curr Opin Psychiatry. 2012;25(1):39-45. © 2012 Lippincott Williams & Wilkins
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