Personality disorders and violence: What is the link?

Richard Howard

Personality disorders and violence: What is the link?

Richard Howard

Institute of Mental Health, UK

: Int J Ment Health Psychiatry

Abstract

While the link between personality disorders (PDs) and violence is well established, several issues obscure its nature. First, PDs are highly comorbid, both with each other and with other mental disorders. Second, given the heterogeneous nature of violence, particularly with regard to its motivation, an adequate typology of violence is required that does justice to its motivational heterogeneity. A recently proposed typology will be outlined that parses violence into appetitive and aversive types, and-within each type-into impulsive and premeditated subtypes. The appetitive subtypes have, as their primary motives, a desire to achieve a state of excitement and exhilaration and material self-gratification. The aversive subtypes have as their primary motives a desire for selfprotection and for revenge. Third, a causal relationship between PD and violent offending presupposes a logical relationship between the two, which in turn raises the question of what might be the psychological mechanisms that mediate the relationship. It is proposed that severe PD is underpinned by personality traits related to emotional impulsiveness, psychopathy and delusional ideation. By late adolescence and early adulthood, these factors contribute to the occurrence of violent offending in concert with contextual factors such as the availability of substances of abuse and interpersonal stress. This view is consistent with the abandonment of personality disorder categories in the forthcoming eleventh edition of the International Classification of Diseases (ICD-11) in favor of a dimensional classification of PD according to its severity, defined in terms of the degree of harm to self and others.