Although the DSM-IV Axis II Personality Disorders ( SCID-II) screening questionnaire includes 10 personality disorder categories, only ASPD and BPD have consistently been included in the National Household Surveys. In this chapter we report an investigation of the associations of ASPD and BPD with violence in a large representative sample of the population of Great Britain. 135 It might be expected that criteria for BPD, which include unstable and intense interpersonal relationships, affective instability because of a marked reactivity of mood, and inappropriate, intense anger or difficulty controlling anger, might be associated with violent behaviour despite previous studies failing to find this association. 135 BPD is defined as a pervasive pattern of instability of interpersonal relationships, self-image and affects and marked impulsivity, beginning by early adulthood and present in a variety of contexts. Conduct disorder involves a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated. For the diagnosis to be given, the individual must be at least 18 years of age and have had a history of some symptoms of conduct disorder before the age of 15 years. The essential feature of ASPD is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. It is unsurprising that ASPD is found to be associated with violence because certain criteria for diagnosing ASPD actually include violent behaviour. 129, 130 Previous studies of offending behaviour among individuals with ASPD have consistently shown an association with crimes involving financial gain, including burglary and theft, robbery and firearm offences, 131 and violent offences. ASPD was thought to demonstrate extensive overlap with the criminological construct of the career criminal. Conduct disorder and adult antisocial symptoms using continuous scores demonstrated the highest and most frequent associations with criminal behaviour including violence. 126, 127 Nevertheless, Roberts and Coid 128 did not find an association between violent offending and BPD in a representative sample of UK prisoners. These are typically characterised by poor emotional regulation and impulse control leading to behaviour that in turn results in hospitalisation. An elevated risk for violence might be evident only in prisoners and in hospitalised patients with severe conditions. One possibility considered by previous researchers is that clinical and forensic studies that have a high prevalence of BPD are likely to have sampled a more severe form of this condition than is studied in community samples. 30 However, it is probable that a single cluster B disorder, ASPD, had primarily accounted for the raised risk. These findings were generally confirmed in a survey of adults in households in Great Britain, with those with cluster B disorders (including ASPD, BPD and narcissistic personality disorder) being 10 times as likely to be violent as those without. However, it was of significant interest that these researchers did not find any associations between violence and BPD. These findings remained significant after controlling for Axis I disorders and demography. Overall, paranoid, narcissistic, passive–aggressive personality disorder symptoms correlated significantly with violence. In particular, items from personality disorders included in cluster A and cluster B disorders corresponded to violence in the community. 30, 126, 127 Personality disorder symptoms were found to be even stronger predictors of violence than overall diagnosis. 125 Longitudinal studies have provided strong evidence of personality disorders representing a significant risk for future violence. In the past, this has led to reluctance to accept patients with this diagnosis. Most mental health professionals believe that there is a strong relationship between personality disorders and violence.
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