title: Are patients deemed 'dangerous and severely personality disordered' different from other personality disordered patients detained in forensic settings?
abstract: BACKGROUND
  In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group.
  
  
  OBJECTIVE
  The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services.
  
  
  METHODS
  Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures.
  
  
  RESULTS
  Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership.
  
  
  CONCLUSIONS
  The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality.
authors.affiliation: Institute of Mental Health, Nottinghamshire Healthcare Trust & University of Nottingham, Nottingham, UK. Richard.Howard@nottingham.ac.uk
authors.forename: Rick
authors.initials: R
authors.lastname: Howard
authors.forename: Najat
authors.initials: N
authors.lastname: Khalifa
authors.forename: Conor
authors.initials: C
authors.lastname: Duggan
authors.forename: John
authors.initials: J
authors.lastname: Lumsden
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003417:Criminal Psychology / Q000379:methods*; D003617:Dangerous Behavior; D005555:Forensic Psychiatry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000145:classification* / Q000175:diagnosis; D011330:Prisons; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology / Q000379:methods; D012720:Severity of Illness Index; D055815:Young Adult