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The 'functional link' between personality disorder and violence: A critical appraisal
Duggan, Conor Howard, Richard C.
Duggan, Conor
Howard, Richard C.
Abstract
The development in the last decade of a program in England and Wales to provide services for those who were deemed to be dangerous because of their severe personality disorder (DSPD) marked a major departure from much of previous thinking in a contentious area of medico-legal practice. Of special interest for this chapter is that this proposal extended the previously ill-defined criteria such as the legal designation 'psychopathic disorder' and 'treatability' with more precise scientific terms to justify involuntary detention into the service. For within this extended system, in order to be subject to compulsory treatment in a DSPD unit, an individual needed to satisfy, not just these aforementioned conditions, but also criteria from the following triad: (a) have a severe personality disorder (SPD), (b) being more likely than not to behave violently within the next 5 years and (c) there being a 'functional link' between (a) and (b). The third criterion (i.e. the 'functional link') was left undefined and this might well be the proposal's Achilles' heel as regards a legal challenge. Use of the term 'functional link' is ambiguous, since it could mean either a functional relationship between personality disorder (PD) and dangerousness, that is, mere covariation between the two, or a causal connection between them. More importantly, this question of a 'functional link' goes beyond the DSPD proposal, extending indeed to the heart of much of what preoccupies forensic mental health practitioners in their quest to 'link' mental disorder to an increased risk of violence. Although the meaning of a 'functional link' in the DSPD documentation was not made explicit, we believe that it is reasonable to interpret this as implying a 'causal connection' between the severity of the PD and the resultant increased risk of violent behavior. Put simply, it is the 'severity of the PD' that 'causes' the individual 'to behave violently'. In this chapter, therefore, we will examine the conditions that are deemed necessary to establish a causal claim in behavioral sciences in general and apply these to the DSPD proposal in particular. We will then consider some of the limitations of current approaches to causal modeling in PD and violence and argue that these need to be expanded to models of greater complexity in order to develop a more satisfactory understanding of this relationship. In doing so, we will rely heavily on Stephen Haynes' Models of Causality in Psychopathology to provide us with a sensible approach to several contentious issues. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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2009
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Book chapter
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Duggan, C. & Howard, R. C. (2009). The 'functional link' between personality disorder and violence: A critical appraisal. In: McMurran, M. & Howard, R. (eds.) Personality, personality disorder and violence: An evidence based approach. Chichester: Wiley, pp. 19-37.
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Available in the Library: https://nottshc.koha-ptfs.co.uk/cgi-bin/koha/opac-detail.pl?biblionumber=109401