Personality disorder and violence: making the link through risk formulation

The extant research demonstrates that the combination of personality disorder and violence implies severe dysfunction, poor responsivity to treatment, more serious and persistent violence, and higher recidivism rates. Thus, it comes as no surprise that personality disorder is included in many of the available guidelines for assessing and managing violence. Unsurprisingly, the combination of personality pathology and violence frequently presents the greatest challenge to services, even those in whom violence risk assessment and management practice is established and routine. Conceptual and methodological limitations pervade the literature and a full explanation of the nature of the association between personality pathology and violence is still awaited. Furthermore, current approaches to risk assessment fail to provide a systematic framework for assessors to use to make sense of the heterogeneous presentations typically found in individuals with personality disorder and violence. In this paper, formulation is proposed as the critical process linking risk assessment and risk management. It is argued that assessors must move beyond a simple listing of risk factors and should instead produce detailed, comprehensive, individualized explanations of risk potential and risk management needs. Personality disorder is used in this paper to illustrate the important contribution of formulation to the risk assessment process, and in doing so, the link between personality pathology and violence is explored.