Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Forensic Psychiatry Research Unit, London, UK.
Int J Law Psychiatry. 2010 Mar-Apr;33(2):84-8. doi: 10.1016/j.ijlp.2009.12.008. Epub 2010 Jan 3.
Introduction of the construct "Dangerous and Severe Personality Disorder" (DSPD) by the UK Home Office and Department of Health has provoked strong debate and opposition. Its aims and that of proposed subsequent legislation was to enhance public protection by identifying and detaining a minority of persons with severe personality disorder who pose a high risk of serious sexual/violent offending. The most serious criticism was the ethical implication of allowing indefinite detention of people without criminal convictions. More recently, policy emphasis has shifted towards treatment. 1396 male prisoners serving sentences of 2+years for sexual/violent offenses were prospectively interviewed (personality disorders, psychopathy, and risk) at a mean follow-up of 2 years. The prevalence of DSPD was 15%. Significantly more re-offended. Five DSPD offenders would need treatment to prevent one violent act. Based on an estimate of attributable risk, successful treatment of DSPD could reduce violent re-convictions among DSPD offenders by 71% and violent/sexual re-offenses in the prison population by 27%. DSPD criteria correctly identify high risk prisoners but primarily through risk-related demographic features. DSPD does not accurately identify serious sexual/violent re-offenders. The DSPD programme may reduce major violent re-offending if treatment interventions prove effective.
英国内政部和卫生部引入的“危险和严重人格障碍”（DSPD）这一概念引起了强烈的争论和反对。其目的和随后提议的立法旨在通过识别和拘留少数有严重人格障碍、极有可能严重性犯罪或暴力犯罪的人，加强公众保护。最严厉的批评是允许对没有犯罪记录的人无限期拘留的伦理含义。最近，政策重点已经转向治疗。1396 名男性囚犯因性犯罪/暴力犯罪被判处 2 年以上有期徒刑，在平均 2 年的随访中进行了前瞻性访谈（人格障碍、精神病态和风险）。DSPD 的患病率为 15%。再犯罪率显著更高。需要治疗 5 名 DSPD 罪犯才能预防 1 起暴力行为。根据归因风险估计，DSPD 的成功治疗可以将 DSPD 罪犯的暴力再定罪减少 71%，将监狱人口中的暴力/性犯罪减少 27%。DSPD 标准可以正确识别高风险囚犯，但主要是通过与风险相关的人口统计学特征。DSPD 并不能准确识别严重的性犯罪/暴力再犯者。如果治疗干预措施有效，DSPD 计划可能会减少重大暴力再犯罪。
