Anna Motz, Consultant Clinical and Forensic Psychologist led our penultimate Health Matters at Science Oxford on the 28 May discussing her work in forensic services in her talk ‘treating violence, personality disorder and crime’.
Personality disorder is a complex psychiatric diagnosis with many subcategories. Evidenced by patterns of destructive behaviour, such as unstable relationships and difficulty in managing impulsive behaviour, it is often associated with early trauma and disruptions in care. Many patients find it difficult to establish a stable sense of identity and to trust others, which can make treatment difficult.
Anna began the evening by highlighting the differences in treatment for male and female offenders with personality disorder. As more men are diagnosed with antisocial personality disorder (ASPD) and more women with borderline personality disorder, clear differences often exist in the behaviours they present. Where men often focus their violence externally towards strangers, females are more likely to direct their violence towards themselves, their partners and frequently towards their own children.
Anna talked about the Offender Personality Disorder Strategy which supports initiatives like the Reflections Group. This 18 month programme teaches male offenders with ASPD mentalisation behaviour techniques helping them gain insight into their own minds and develop empathy. By addressing male violence they work to reduce recidivism rates whilst ensuring that the mental health needs of offenders are met. Early evidence with small groups has demonstrated a reduction in violence from those participating in this programme.
Anna discussed some of the myths of female violence including that women are victims who are only violent under the coercion of men, that they are fundamentally passive but are ruled by their hormones and that only “mad” women are violent. Anna said these misconceptions create a false ideal and can make it hard for people to recognise maternal abuse as often female violence takes place in secret and is hidden, or disguised, within the home.
She went on to describe how violence in women is often a response to helplessness and is seen by the offender as a solution to underlying psychological difficulties. This was highlighted in the extremely tragic clinical study of a mother who murdered her child, and demonstrated the links between homicide and suicide; as the mother’s insight increased during her recovery so did her suicidal feelings as she was confronted by the reality of her actions.
As Anna says working with women who have killed their own children means entering the arena of the unthinkable, something not many of us could stomach I am sure. However, professionals like Anna are determined to provide help to those most at need, those often shunned by the rest of society because of the horrific nature of their crimes. Through psychotherapy and groups like Reflections violent offenders are helped to understand their personality disorders and come to terms with, and ultimately change, their cycles of behaviour helping them to have healthier, happier relationships. Though at times a very sad subject, this was a truly intriguing insight into a very complex area of mental health.