Skip to main content

Dangerous and severe personality disorder

  • Conor Duggan (a1)

The Dangerous and Severe Personality Disorder (DSPD) initiative was introduced a decade ago against overwhelming opposition from psychiatrists and others concerned with the implications of extending the public protection agenda through the use of a questionable medical ‘diagnosis'. As this initiative is now being scaled down, it offers an opportunity to consider the positive and negative aspects of the initiative together with its longer-term legacy.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Dangerous and severe personality disorder
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Dangerous and severe personality disorder
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Dangerous and severe personality disorder
      Available formats
Hide All
1 Popper, KR. Conjectures and Refutations. The Growth of Scientific Knowledge. Routledge, 1963.
2 Maden, T. (2007) Dangerous and severe personality disorder: antecedents and origins. Br J Psychiatry 2007; 190 (suppl 49): s811.
3 Rutherford, M. Blurring the Boundaries: The Convergence of Mental Health, Criminal Justice Policy, Legislation, Systems and Practice. Sainsbury Centre for Mental Health, 2010.
4 Haddock, AW, Snowden, PR, Dolan, M, Parker, J, Rees, H. Managing dangerous people with severe personality disorder: a survey of forensic psychiatrists' opinions. Psychiatr Bull 2001; 25: 293–6.
5 Eastman, N. Public health psychiatry of crime prevention? Government's proposals emphasise doctors' role as public protectors. BMJ 1999; 318: 549–51.
6 Chiswick, D. Preventive detention exhumed – and enhanced. Psychiatr Bull 1999; 23: 703–4.
7 Peay, J. Mentally disordered offenders, mental health, and crime. In The Oxford Handbook of Criminology (eds Maguire, M, Morgan, R, Reiner, R): 496527. Oxford University Press, 2007.
8 Blackburn, R. Criminal behaviour, personality disorder and mental illness: the origins of confusion. Crim Behav Ment Health 1992; 2: 6677.
9 Moffitt, TE. Adolescent-limited and life-course persistent antisocial behaviour: a developmental taxonomy. Psychol Rev 1993; 100: 674701.
10 Labour Party. Ambitions for Britain. Labour's Manifesto 2001: 32. Labour Party, 2001.
11 Hare, RD. The Hare Psychopathy Checklist – Revised (PCL–R) (2nd edn). Multi-Health Systems, 2003.
12 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
13 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA, 1994.
14 National Institute for Mental Health in England. Personality Disorder: No Longer a Diagnosis of Exclusion. Policy Implementation Guidance for the Development of Services for People with Personality Disorder. Department of Health, 2003 (
15 Department of Health, Ministry of Justice, Borderline UK. Working Effectively with Personality Disorder. The New KUF Framework. Institute of Mental Health Nottingham, 2007 (
16 National Collaborating Centre for Mental Health. Borderline Personality Disorder: Treatment and Management. Clinical Guideline 78. National Institute for Health and Clinical Excellence, 2009.
17 National Collaborating Centre for Mental Health. Antisocial Personality Disorder: Treatment, Management and Prevention. Clinical Guideline 77. National Institute for Health and Clinical Excellence, 2009.
18 Home Office. Managing Dangerous People with Severe Personality Disorder: Proposals for Policy Development. TSO (The Stationery Office), 1999.
19 Tyrer, P, Johnson, T. Establishing the severity of personality disorder. Am J Psychiatry 1996; 153: 1593–7.
20 Cooke, DJ, Michie, C. Limitations of diagnostic precision and predictive utility in the individual case: a challenge for forensic practice. Law Hum Behav 2009; 32: 2845.
21 Yang, M, Wong, SC, Coid, J. The efficacy of violence prediction: a meta-analytic comparison of nine risk assessment tools. Psychol Bull 2010; 136: 740–67.
22 Duggan, C, Howard, R. The ‘functional link’ between personality disorder and violence: a critical appraisal. In Personality, Personality Disorder and Violence (eds McMurran, M, Howard, R): 1938. Wiley, 2009.
23 Tyrer, P, Cooper, S, Rutter, D, Seivewright, H, Duggan, C, Maden, T, et al. The assessment of dangerous and severe personality disorder: lessons from a randomised controlled trial linked to qualitative analysis. J Forens Psychiatry Psychol 2009; 20: 132–46.
24 Draycott, S, Kirkpatrick, T, Askari, JF. An idiographic examination of patients' progress in the treatment of dangerous and severe personality disorder: a reliable change index approach. J Forens Psychiatry Psychol 2010; in press.
25 Barrett, B, Byford, S, Seivewright, H, Cooper, S, Duggan, C, Tyrer, P. The assessment of dangerous and severe personality disorder: service use, cost, and consequences. J Forens Psychiatry Psychol 2009; 20: 120–31.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Dangerous and severe personality disorder

  • Conor Duggan (a1)
Submit a response


Goodbye to All That?

Raymond F Travers, Consultant Forensic Psychiatrist
08 June 2011

Duggan challenges his colleagues1. Did we form a Faustian pact with the government in embracing the DSPD programme? It was definitely a Tragicall Hiftory.

The ethnographic record of human life documents a mix of insight and irrationality. Given our capacity for competence, systematic, persistent, and expensive incompetence is puzzlingly maladaptive. Evolutionary psychology emphasises change as the explanation of human irrationality. Richard Dawkins’ views emphasize conflict more than change as the source of our collective idiocy2.

The DSPD programme should be seen in the context of its times. Nurtured by the selfish amoralism of Thatcher and Reagan in the ‘80s, political life was smugly stagnant when the programme was introduced in the late ’90s; the first of two lost decades, during which fantasies of prosperity and limitless personal advancement displaced all talk of political liberation, social justice or collective action3.

Though change was afoot, as Thatcher’s children, clinicians had no experience of genuine political movements. There were many single shared interest issues at play; new buildings and resources, new jobs, new careers and new challenges. But efforts to convert such interests into collective goals; the care and treatment of the personality disordered individual, the role of mental health services in either safeguarding public safety or contributing to the common good, were undermined by the fragmented individualism of our concerns. We responded to the broad gamut of competing objectives as individual consumers lacking the imagination tocombine these into a coherent whole.

Christopher Ricks reminds us that as a critic Duggan ‘must resist allthe time the temptation to write as if the discussable things were the most important ones.’4 The absence of trust is clearly inimical to a well-run society. In the late ‘90s the practice of psychiatry was under threat as exemplified by the media response to the Michael Stone tragedy. A corrosion of trust was evident in the state’s hardening attitude to its forensic practitioners in the run in to the introduction of the DSPD programme. Tension, conflict and even fear fuelled relationships.

Was it an error for certain clinicians to support the DSPD programme?The idea of error has always contained a sense of motion: of wandering, seeking, going astray5. Duggan wonders about what has been learnt. Perhaps, above all, that nothing is necessary or inevitable. History is not foreordained. We shall have to ask the perennial questions about personality disorder, forensic psychiatric practice and risk management again, but be open to different answers.

We need to rediscover how to talk clinically about risk management: how to imagine very different arrangements for the practice of forensic psychiatry, free from the cant of ‘public protection’ and beyond our secure unit comfort zones. We must distinguish better than some of our predecessors between desirable ends and unacceptable means. At the very least, we should accommodate Keynes’s warning on this matter: “[i]t is notsufficient that the state of affairs which we seek to promote should be better than the state of affairs which preceded it; it must be sufficiently better to make up for the evils of the transition.”3

1 Duggan C. Dangerous and severe personality disorder. Br J Psychiatry 2011; 198: 431-433

2 Sterelny K. The Perverse Primate. In Richard Dawkins: How a Scientist Changed The Way We Think (eds A Grafen and M Ridley): 213-223. Oxford University Press, 2006

3 Judt T. Ill Fares The Land: A Treatise On Our Present Discontents: Penguin Books, 2011

4 Ricks C. Poems and critics: an anthology of poetry and criticism from Shakespeare to Hardy (ed CB Ricks): Collins, 1966

5 Schulz K. Being Wrong: Adventures in the Margin of Error: 41. Portobello Books, 2010
... More

Conflict of interest: None Declared

Write a reply


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *