Personality disorders

Abstract Personality disorders are highly prevalent and highly problematic in jails in prisons. Personality disorders, by definition, are associated with significant functional impairment of the affected individual and may negatively impact those around them. That impairment results from the way these individuals think and feel about themselves and others. Patients with personality disorder are often challenging to manage in the community. The difficulties associated with their care are accentuated in the confines and highly structured environments presented by jails and prisons. Inmates with personality disorders often require a disproportionate level of attention from correctional staff and their behavior can contribute to a dangerous environment inside a facility. Additionally, when compared to offenders with other psychiatric disorders or non-mentally disordered offenders, offenders with personality disorders have higher rates of violence, criminality, and recidivism. There are 4 personality disorders that are of particular clinical relevance to the correctional psychiatry setting: borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, and paranoid personality disorder. Research also reflects that these disorders have the highest correctional prevalence rates among the personality disorders. For each of these four disorders, this chapter presents in turn a description and some management concerns and challenges, data on correctional prevalence, appropriate psychotherapy, and potential psychopharmacologic interventions.