Rep36 Understanding Personality Disorder

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3.1.6 Personality disorder assessment in legal
settings
Hart has described a number of important
points about personality disorder assessment and
crime (Hart, 2001).
First, the problems that contribute to
personality disorders are unlikely to result in major
impairments of thought and speech or in obviously
irrational perceptions of and beliefs about the
external world. Therefore, in most jurisdictions in
Europe and North America, a diagnosis of
personality disorder is not thought to be sufficient
to make a person incompetent to stand trial or not
criminally responsible with respect to any particular
criminal act. (See also Melton 
et al
., 1997).
Second, in legal settings symptoms of
personality disorder should be assessed using
methods that integrate information obtained
from a number of different sources (e.g. family,
employment, and education sources) in addition
to information obtained directly from the client
during a clinical interview. Assessments based
only on interviews or written self-reports should
not be relied upon. 
Third, practitioners should provide information
about the context in which personality disorders
are interpreted including information about their
prevalence in relevant settings, such as prisons or
forensic psychiatric hospitals. In particular,
practitioners should not over-emphasise the
significance of antisocial behaviour in the
assessment of personality disorders in forensic
settings (Hart, 2001); the problems that lead to a
diagnosis of antisocial personality disorder are
common in those who reoffend. 
Fourth, when writing reports or giving
evidence, psychologists should explain the ways in
which he or she believes the individual’s diagnosis
of personality disorder is linked to their risk to
others and to any other legally relevant
impairment from which the person suffers. 
Fifth, in legal proceedings involving
individuals with many different types of mental
health needs, practitioners commonly make the
mistake of offering opinions about diagnosis or
assessment when they are already involved in
treating the person or offering therapy. It is
difficult to switch from the role of treatment
provider, where the practitioner works for a
person and advocates his or her well-being or
best interests, to that of neutral assessor in which
the assessor is required – and sometimes paid –
to offer an objective opinion. Ethical codes of
practice warn psychologists about the problems
that can arise from conflicts of interest and
lawyers are increasingly sensitive to the bias that
may result from such conflicts. Structured
assessments of personality disorders as well as
risk mitigate against such bias.
Finally, a most basic mistake made by
practitioners is to be unfamiliar with the law
relevant to the issue being decided. Ignorance of
the law can lead to a variety of sometimes very
costly errors. For example, if the practitioner
forms an opinion based on evidence that is
legally inadmissible (such as hearsay), their
opinion can be disregarded because it could be
unreliable or prejudicial. Practitioners are
obliged to learn the basics of the law as it relates
to their professional practice. 
presentation. Clare had always been very shy, but it seemed to the psychologist that a variety of
events had happened around the same time (i.e. the death of her mother, changes in the bank, a
new and bossy boss, the emigration to Canada of her closest friend), which were enough for her
shyness to become much more salient. Her withdrawal from her employment in the bank and
from her friends seemed to make her feel better even though she was generally unhappy with the
consequences for her life with James. 
The psychologist tested her hypotheses by carrying out a personality assessment using the
International Personality Disorder Examination, which is a semi-structured interview during which
clients are asked about all sorts of personality traits. It was very clear from this examination that
Clare met the criteria for a diagnosis of avoidant personality disorder. This was a good assessment
to do because, in the course of the interview, it was possible for Clare to start to see patterns in her
behaviour that she had not really noticed before, and she felt good about talking about this with
someone who seemed to understand that was happening. This assessment lasted two sessions. The
psychologist also asked Clare to complete the Beck Depression Inventory (BDI).
The results on the BDI indicated that Clare was not depressed although she reported
increasing anxiety about the way she was and how it was affecting her much treasured relationship
with James. The psychologist concluded that Clare’s primary presenting problem was avoidant
personality disorder and marked its onset to the period following Clare’s 25th birthday although
she had personality traits consistent with a premorbid avoidant presentation.

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