Severe personality disorder emerging in childhood: a proposal for a new developmental disorder

Debate: Young people with personality disorder should be recognised and appropriately managed

The characteristic features of personality disorder that are found in older people are also present in young people. These features are currently not diagnosed as personality problems by most UK practitioners, through a mixture of fear and prejudice, which is used to justify this avoidant diagnostic behaviour. A simple solution is offered. State that personality function is 'disordered' in those who cross the threshold for diagnosis but emphasise that it is often ephemeral and can be managed.

The prevalence of severe personality disorder in perpetrators of homicide

BACKGROUND

Current UK evidence on the prevalence of personality disorder in homicide is lacking. The aims were to estimate the prevalence of personality disorder in homicide perpetrators from court reports and carry out a dimensional assessment in keeping with the new ICD-11 classification of the prevalence of severe personality disorder. Associations between severe personality disorder and sociodemographic, historical and offence-related characteristics were then explored.

METHODS

Six hundred court reports from a national case series of homicide perpetrators in England and Wales were analysed using a document-derived version of the Personality Assessment Schedule (PAS-DOC), providing categorical and dimensional personality assessments. The prevalence of personality disorder and severe personality disorder was estimated. Factors associated with the diagnosis of severe personality disorder were examined.

RESULTS

The prevalence of personality disorder using the PAS-DOC was 56.3% (95% confidence interval 52.3%, 60.3%), compared with 16% as diagnosed in reports. Severe personality disorder was present in 62% (n = 338) of all those with a personality disorder and was significantly associated with homicides of strangers and previous violence.

CONCLUSIONS

Severe personality disorder is highly prevalent among perpetrators of homicide, and the finding that it is more prevalent when strangers are the victims stresses both the need for early identification of those at risk of developing severe personality disorder and the development of appropriate early preventive interventions. There is also a need for the development of effective treatment and interventions for those with established severe personality disorder and better identification of this level of disorder by psychiatrists. The forthcoming ICD-11 classification should help in this endeavour. © 2021 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

Minimal emotional dysfunctions (MED) in personality disorders

The concept of minimal emotional dysfunctions (MED) refers to traditional psychopathology in order to describe, classify, and understand personality disorders. Emotional dysfunctions encompass disorders of affect predominance, production, expression, experience, modulation, and regulation. MED can explain the dimensional nature of personality disorders, their multidimensionality and problems with categorical classifications. It can stimulate research on the etiology of personality disorders in reference to modern developmental brain research and trauma psychology. It can guide new developments in pharmacotherapy and psychotherapy. It is suggested to focus on MED in future developments of the description and classification of personality disorders.

Developmental trajectories associated with juvenile sexually abusive behaviour and emerging severe personality disorder in childhood: 3-year study

Background

Little is known about the developmental trajectories of juveniles presenting with sexually abusive behaviour or emerging severe personality disorder traits.

Aims

To investigate whether ‘age at onset’ of sexually abusive behaviour and whether emerging severe personality disorder traits are associated with specific developmental profiles.

Method

A retrospective file review of 280 juveniles presenting with sexually abusive behaviour was conducted and follow-up Offenders Index data were analysed.

Results

Juveniles with early onset (<11 years) of sexually abusive behaviour had higher levels of psychosocial adversity and early childhood antisocial behaviour compared with those with late onset. Emerging severe personality disorder traits were associated with higher levels of psychosocial adversity, antisocial behaviour, convictions and predatory sexually abusive behaviour.

Conclusions

Preliminary evidence supports the existence of distinct developmental trajectories within this population and points to a key role for traits of emerging severe personality disorder.

How do nurses experience working with adolescents with a diagnosis of 'personality disorder' or 'emerging personality disorder'?

Nurses experience adults with a diagnosis of 'personality disorder' ('PD') as challenging, but nothing is known of their experiences working with young people with a diagnosis of 'PD' or 'emerging PD'. This study aimed to explore the experiences of nurses with this group. Six nurses were interviewed individually and the transcripts analysed employing interpretative phenomenological analysis. Two themes were identified: emotional impact, and conflict and need for support. Participants described powerful emotional responses and heavy time demands as particular challenges. They also reflected on tensions that arose in the wider team and service context. The importance of reflective space, training and the need for specialist approaches, such as therapeutic input, was emphasized by all participants. The study's findings suggest that while there are some similarities to adult services, there are also issues specific to nursing adolescents with 'PD', which merit further attention, including the implications of the lack of diagnostic clarity for treatment approaches and the difficult interpersonal dynamics of the condition. Recommendations for practice include additional training in relation to the theoretical understanding of diagnosis itself and in working therapeutically with young people with the diagnosis, employing approaches that have been found to be useful in adult services.

Sexually Abusive Behaviour by Children and Adolescents

Recently professionals have recognised that children as well as adults may act in sexually aggressive ways towards others. This is complemented by an expanding empirical evidence base. A comprehensive appraisal of the literature is beyond the scope of this review. However, the estimated size of the problem, it's aetiology (Lee et al., 2002), outcomes and successful intervention programmes (Borduin & Schaeffer, 2002) will be discussed. The evidence base and clinical experience with this group strongly supports the need for coherent government policies in relation to sexually abusive behaviour by children and adolescents.