Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory.

To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study.

A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments.

Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist–Revised (especially on Factor 1) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished ‘completers' from ‘non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%).

Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.

Previous studies of borderline personality disorder report neuropsychological impairments in several domains, including memory. No studies have compared memory functioning in high-risk prisoners with borderline personality disorder with similar prisoners with other personality disorders.

To explore mnemonic impairments in prisoners undergoing personality assessment as part of the dangerous and severe personality disorder initiative or detained in a medium secure facility.

We investigated memory function in 18 prisoners with borderline personality disorder and 18 prisoners with other personality disorders.

Prisoners with borderline personality disorder exhibited a pattern of multi-modal impairments in the immediate and delayed recall of verbal and visual information, with some association with affective instability. These deficits were not associated with the severity of personality disturbance.

These data suggest that memory deficits have some specificity in relation to the constituent traits of borderline personality disorder and indicate that neuropsychological assessment may be a source of useful adjunctive information for distinguishing between the cognitive and psychological difficulties of individual prisoners.

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

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

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

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.

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.

A callous and unemotional disposition is an indicator of early-onset antisocial behaviour.

To investigate the extent to which genetic influences contribute to the overlap between callous–unemotional traits and conduct problems in a large population sample of 7-year-old twins.

Teachers provided ratings of callous-unemotional traits and conduct problems for 3434 twin pairs from the Twins Early Development Study. Model-fitting analyses were performed across the continuum of scores and at the extremes.

The phenotypic relationship was primarily genetically mediated, both across the continuum and at the extremes and was substantial.

At 7 years of age, genetic influences on callous–unemotional traits overlap substantially with genetic influences on conduct problems. This combination should guide selection criteria in future molecular genetic studies.

The assessment of personality disorder is currently inaccurate, largely unreliable, frequently wrong and in need of improvement.

To describe the errors inherent in the current systems and to indicate recent ways of improving personality assessment.

Historical review, description of recent developments, including temporal stability, and of studies using document-derived assessment.

Studies of interrater agreement and accuracy of diagnosis in complex patients with independently established personality status using document-derived assessment (PAS–DOC) with a four personality cluster classification, showed very good agreement between raters for the flamboyant cluster B group of personalities, generally good agreement for the anxious/dependent cluster C group and inhibited (obsessional) cluster D group, but only fair agreement for the withdrawn cluster A group. Overall diagnostic accuracy was 71%.

Personality function or diathesis, a fluctuating state, is a better description than personality disorder. The best form of assessment is one that uses longitudinal repeated measures using a four-dimensional system.

Actuarial risk assessment instruments (ARAIs) estimate the probability that individuals will engage in future violence.

To evaluate the ‘margins of error’ at the group and individual level for risk estimates made using ARAIs.

An established statistical method was used to construct 95% CI for group and individual risk estimates made using two popular ARAIs.

The 95% CI were large for risk estimates at the group level; at the individual level, they were so high as to render risk estimates virtually meaningless.

The ARAIs cannot be used to estimate an individual's risk for future violence with any reasonable degree of certainty and should be used with great caution or not at all. In theory, reasonably precise group estimates could be made using ARAIs if developers used very large construction samples and if the tests included few score categories with extreme risk estimates.

A risk-reduction treatment programme complemented by a focused assessment, both guided by the risk–need–responsivity principles, is suggested as the preferred treatment for violence-prone individuals with personality disorder.

Violence Reduction Programme (VRP) and Violence Risk Scale (VRS) were used to illustrate the design and implementation of such an approach. Participants from a similarly designed Aggressive Behaviour Control Programme were used to illustrate the principles discussed and to test programme efficacy.

The VRS was used to assess risk/need and treatment readiness, and DSM–III/IV psychiatric diagnoses of 203 federal offenders.

Participants had a high probability of violent recidivism and many violence-linked criminogenic needs, similar to offenders with high PCL–R scores. Most had antisocial personality disorder and substance use disorders; in terms of treatment-readiness, most were in the contemplation stage of change. Outcome evaluation results support the objectives of the VRP.

Integrating risk–need–responsivity principles in assessment and treatment can provide useful guidelines for intervention with violence-prone forensic clients with personality disorder.

Economic evaluation of the Dangerous and Severe Personality Disorder Programme is essential to ensure value for money. The collection of individual-level service use information is crucial to any such evaluation, but the best way to collect these data in secure facilities is unclear.

To develop a method for the collection of individual-level service use information for prisoners/patients in secure facilities.

Services provided within secure facilities were identified through examination of facility and policy literature, and discussions with managerial and clinical staff. Appropriate methods of measuring the quantities of services used were then explored and a new research tool capable of capturing all relevant services was developed and pilot tested.

The Secure Facilities Service Use Schedule (SF–SUS) records service use information from records and is capable of capturing data on the use of all individual-level services provided within a secure facility plus external services commonly accessed by occupants.

The SF–SUS is able to collect meaningful individual-level service use information for the economic evaluation of services provided within secure facilities.