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Treatment of antisocial personality disorder

Published online by Cambridge University Press:  02 January 2018

Martin P. Lock
Martin P. Lock*
Affiliation:
Email: dr.martinlock@tiscali.co.uk
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Abstract

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Type
Correspondence
Information
The British Journal of Psychiatry , Volume 193 , Issue 5 , November 2008 , pp. 426
Copyright
Copyright © Royal College of Psychiatrists, 2008 

Although Professor Maden's article was only 100 words long, Reference Maden1 it contained some profound and, I think, unfair and unsubstantiated, statements. Where is the evidence that patients with severe antisocial personality disorders who do not want to be treated, like many of those detained in the dangerous and severe personality disorder (DSPD) unit at Broadmoor Hospital, where Professor Maden is the clinical director, can be effectively treated?

Professor Maden criticises lawyers and independent experts but both he and others researching in the field have not produced independently verified evidence of efficacy. Professors Coid Reference Dolan and Coid2 and Duggan, Reference Binks, Fenton, McCarthy, Lee, Adams and Duggan3,Reference Binks, Fenton, McCarthy, Lee, Adams and Duggan4 with others, have carried out meta-analyses and concluded that there was no evidence or that the evidence was very weak. Professor Duggan went as far as to suggest that this situation was ultimately unsustainable and would inevitably lead to legal challenges by those detained on the basis of their ‘treatability’.

The Canadians and Americans are concerned that psychological therapy with individuals with high scores on the Hare Psychopathy Checklist – Revised is making the situation worse and leading to increases in recidivism. Reference Seto and Barbaree5 They appear to have moved on and are investigating biological treatments such as hormone treatment for sex offenders or even addressing the putative causes with gene mapping. Reference Seto, Quinsey and Patrick6

Is it really justifiable to blame lawyers and independent experts for pointing out this lack of evidence and that the DSPD project might not only be an expensive waste of time but it could be making the situation worse?

Footnotes

Edited by Kiriakos Xenitidis and Colin Campbell

Declaration of interest

M.P.L. provides independent psychiatric reports to solicitors of patients in DSPD units. He is also a member of the Mental Health Review Tribunal and sometimes sits on DSPD units.

References

1 Maden, T. Can personality disorder be treated? 100 words. Br J Psychiatry 2008; 192: 457.Google Scholar
2 Dolan, B, Coid, J. Psychopathic and Antisocial Personality Disorders: Treatment and Research Issues. Gaskell, 1993.Google Scholar
3 Binks, CA, Fenton, M, McCarthy, L, Lee, T, Adams, CE, Duggan, C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2006; 1: CD005653.Google Scholar
4 Binks, CA, Fenton, M, McCarthy, L, Lee, T, Adams, CE, Duggan, C. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006; 1: CD005652.Google Scholar
5 Seto, MC, Barbaree, HE. Psychopathy, treatment behaviour, and sex offender recidivism. J Interpers Violence 1999; 14: 1235–48.Google Scholar
6 Seto, MC, Quinsey, VL. Toward the future: translating basic research into prevention and strategies. In Handbook of Psychopathy (ed Patrick, CJ): 589–601. Guilford Press, 2006.Google Scholar
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