Mental disorder in violent women in secure settings: Potential relevance to risk for future violence |
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| Authors: | Caroline Logan Ronald Blackburn |
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| Affiliation: | 1. Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Universitätsmedizin Berlin, Germany;2. Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, UK;3. Institute of Forensic Psychiatry, Charité Universitätsmedizin Berlin, Germany;4. Escuela de Medicina sede Puerto Montt, Universidad San Sebastián, Chile;1. Centro de Atenção Integral em Saúde Mental — Santa Casa Medical School, São Paulo, Brazil;2. Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, Kings College London;3. Female Medium Secure Forensic Service, South London and Maudsley Trust, River House, Bethlem Royal Hospital, Beckenham, Kent, BR33BX, United Kingdom;4. Institute of Psychiatry, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil;1. St Andrew''s Academic Department, Billing Road, Northampton, NN1 5DG, United Kingdom;2. Institute of Psychiatry, King''s College London, 16 De Crespigny Park, London, SE5 8AF;3. School of Health, University of Northampton, Park Campus, Boughton Green Road, Northampton, NN2 7AL, United Kingdom;1. Glasgow Caledonian University, Scotland & University of Bergen, Norway;2. Greater Manchester West Mental Health NHS Foundation Trust & University of Manchester, England;1. Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden;2. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden;3. Swedish Prison and Probation Services R&D Unit, 601 80 Norrköping, Sweden;4. Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden |
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| Abstract: | The relevance to women of common violence risk factors identified in men has in many instances yet to be established. Consequently, there is a reluctance to accept without question the application to women of practices relating to violence risk assessment and management developed from research into men. This study examines mental disorder in women who are violent in order comment on its relevance to the practice of violence risk assessment and management. A sample of 95 violent women in high secure prison and forensic psychiatric care were assessed. Structured assessments of Axis I and II mental disorders and psychopathy were undertaken on all women and conviction histories were recorded. Very high levels of psychiatric morbidity were noted and patterns in comorbidity were detected. Among Axis I conditions, psychotic disorders and disorders of mood co-occurred at a very high rate. Among the Axis II conditions, dimensional ratings of borderline personality disorder (PD) correlated with dimensional ratings of avoidant, dependent and paranoid PDs while ratings of antisocial PD correlated with those of narcissistic, histrionic and obsessive–compulsive PDs. Women who had been incarcerated for a major violent offence were four times more likely to have a diagnosis of borderline PD than women whose index offence was one of minor violence. A number of the findings reported are in contrast to those reported in similar studies of men. Findings suggest that practitioners are right to question the application to women of knowledge derived from research into men. The practice of violence risk assessment and management with women should emphasise the development of individual risk formulations and responding to psychiatric comorbidity should be the rule rather than the exception with this population. |
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