What is the link between personality disorder and dangerousness? A critique of ‘dangerous and severe personality disorder’

This paper reviews the medico‐legal background to the development of the pilot programme for treatment and assessment of dangerous individuals with severe personality disorder. It raises the question: is personality disorder related to dangerousness, and (if so) what mediates the relationship? It then reviews recent findings suggesting that patients deemed to be dangerous and severely personality disordered are characterised by a combination of antisocial and borderline traits, and as such are a source of distress both to themselves and to others. It remains for future research to determine how this particular constellation of personality disorders is functionally linked to dangerousness, and whether the link is mediated by neuropsychological impairment resulting from early‐onset alcohol abuse, as recently proposed by Howard (2006). It is recommended that the current criteria for ‘dangerous and severe personality disorder’ be dispensed with.