Personality disorders in offenders with intellectual disability: a comparison of clinical, forensic and outcome variables and implications for service provision.
Offenders with ID do just as well in regular ID units whether or not they carry a personality-disorder label.
01Research in Context
What this study did
Munce et al. (2010) looked at offenders with intellectual disability (ID).
They compared two groups: those with a personality disorder label and those without.
Both groups lived in the same secure ID units and received the same care.
What they found
The two groups ended up the same.
Violence history, extra mental-health needs, and final treatment results did not differ.
Adding a separate personality-disorder unit did not help.
How this fits with other research
van den Hazel et al. (2009) asked staff what they expected. Staff thought the personality-disorder group would need longer, harsher, less hopeful care. Munce et al. (2010) show those fears were wrong.
Taylor (2002), Cudré-Mauroux (2010), and Matson et al. (2009) all say the same thing: pills do little for aggression in ID. Munce et al. (2010) agree—no extra drug wing is needed.
Levin et al. (2014) later mapped seven personality profiles that do predict aggression risk. Munce et al. (2010) did not split their group this finely, so the profiles may still help you plan care even if a whole new unit does not.
Why it matters
If you run a secure service for offenders with ID, keep using the unit you have. Do not spend money on a separate personality-disorder wing. Spend it on good functional assessment and behavioral plans that work for everyone.
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02At a glance
03Original abstract
AIM: To establish any differences between patients with and without a diagnosis of personality disorders, being treated in a secure inpatient service for offenders with intellectual disability (ID) in the UK. METHOD: A cohort study involving a selected population of people with ID and offending behaviours. Results The study included a total of 138 patients, treated over a 6 year period - 77 with a dissocial or emotionally unstable personality disorder and 61 without. Women were more likely to be in the personality disorder group. Both groups had high prevalence of abuse with no significant differences. Depressive disorders and substance abuse were more common in the personality disorder group, while epilepsy and autistic spectrum disorders were more common in the non-personality disorder group. Rather than differences, what was more striking was the rate and range of these comorbidities across both groups. Although past histories of violence and institutional aggression were no different, compulsory detention under criminal sections and restriction orders were more common in the personality disorder group. There were no differences in treatment outcomes. CONCLUSIONS: Although about half of patients detained in secure units for offenders with ID have a personality disorder, there were more similarities than differences between this group and the rest. While good treatment outcomes supported the case for specialised secure treatment units for people with ID, the case for establishing a more specialised ID-personality disorder unit was less convincing. There is also a need to explore whether there are alternative diagnostic models that can delineate better the group with personality difficulties in this population.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01248.x