Exploring the relationships between personality disorder, sexual preoccupation, and adverse childhood experiences among individuals who have previously sexually offended

Hamilton, JA ORCID: https://orcid.org/0000-0001-7898-4204, 2020. Exploring the relationships between personality disorder, sexual preoccupation, and adverse childhood experiences among individuals who have previously sexually offended. PhD, Nottingham Trent University.

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Abstract

Sexual offending creates a significant public health issue (Mann, Hanson & Thornton, 2010), whereby having a better understanding of the underlying factors related to sexual offending will result in more effective prevention, assessment, and intervention (Seto, 2019). Various factors are identified as aetiological factors for sexual offending, or risk factors for recidivism, including adverse childhood experiences (ACEs), problematic personality traits, intimacy deficits, deviant sexual preferences, and sexual preoccupation (Hanson & Morton-Bourgon, 2005; Mann et al., 2010).

Personality disorders (PDs) are highly prevalent among Individuals Who Have Previously Sexually Offended (IPSO; Chen, Chen & Hung, 2016; Craissati & Blundell, 2013), with this relationship being recognised in the UK by the development of the Offender Personality Disorder (OPD) pathway in 2011. However, there are issues regarding the current screening procedure in that it predominantly screens for antisocial and borderline PDs, meaning that a proportion of IPSO with a range of other PDs may be being missed. Furthermore, the prevalence of PDs among IPSO housed in UK prison establishments has not yet been explored.

Another factor which is thought to contribute to the aetiology of sexual offending is Sexual Preoccupation (SP; Seto, 2019; Ward & Beech, 2017), which is one of the most strongly present treatment needs among IPSO in the UK (Hocken, 2014). Nonetheless, it is the only risk factor that is not currently addressed by psychological treatment programs for IPSO in the UK (Lievesley, 2019). A tentative link has been reported between PD and SP among IPSO, with sexually preoccupied IPSO presenting with a different personality profile compared to those without SP (Berman-Roberts, 2015). Given that these individuals have acted upon their sexual thoughts and engaged in illegal sexual behaviour, it is imperative to learn more about the underlying mechanisms of SP in order to inform and enhance assessment and treatment (Jardin et al., 2017), which is the main aim of this thesis.

Additionally, ACEs are an integral part of understanding sexual offending (Hanson & Morton-Bourgon, 2005; Levenson, 2014), and are also implicated in the aetiology of PD and SP (Courtois & Weiss, 2018; Zanarini, 2000), whereby PD symptomology and SP may be better understood as functional responses deployed as ways of coping with these experiences. ACEs are now considered to be a public health ‘'crisis' (Anda, Butchart, Felitti & Brown, 2010), and studies have recently explored the prevalence of ACEs among prisoners in Scotland and Wales (Carnie, Broderick, Cameron, Downie & Williams, 2017; Ford et al., 2019). Yet, the prevalence of ACEs among IPSO housed in UK prison establishments has not yet been explored, nor the relationships between PD and ACEs, and SP and ACEs among this population. Therefore, ACEs were also included for exploration within this thesis in order to fully understand the relationship between PD and SP among IPSO.

Through utilising a mixed-methods approach, this thesis offers the first in-depth exploration of the relationships between PD, SP, and ACEs among a sample of IPSO housed in two UK prison establishments. Study one (n = 203) explores the psychometric properties of two PD scales in a UK general population sample, before they were employed for use with a prison population. The second (n = 155) and third (n = 45) studies explore the prevalence of PD, SP, and ACEs among IPSO, as well as the relationships between PD and SP, PD and ACEs, and SP and ACEs. Finally, the fourth study (n = 5) explores the life trajectories and narrative identities of IPSO that experienced adverse environments during childhood and developed a preoccupation with sex and problematic personality traits.

The findings reveal that attempting to understand the underlying mechanisms of SP is a complicated process, as SP manifests differently for each individual. SP may be used as a way to regulate emotions and manage stress, and/or as a way of managing identity and self-worth. Although this thesis provides support for the impulsivity and compulsivity models of SP, as well as it being used as a coping mechanism for anxiety and depression, it also highlights the relationships between SP and emotion dysregulation, and SP and impaired identity. Furthermore, the results bolster Montaldi's (2002) claim that some presentations of SP may be better understood through the use of PDs, whereby this thesis highlights the possibility of two pathways for IPSO with SP (in relation to borderline and narcissistic PDs). Multiple kinds of SP presentation suggest the need for multiple treatment approaches, and it is important for clinicians to tailor treatment according to the individual’s motivation for SP.

In regard to the prevalence of PD among IPSO in the UK, a range of PDs (predominantly dependent, depressive, borderline, and avoidant PDs) were reported among IPSO housed in UK category C prison establishments. This has important implications for the current OPD pathway screening procedures, in that these may need amending to be more inclusive of the range of PDs present among IPSO, or specific services for IPSO with PD may need to be developed and implemented. Moreover, a large proportion of IPSO met the criteria for PD, and among these individuals, all of them experienced at least one ACE, with over half reporting four or more ACEs. Thus, this demonstrates the need for all services to adopt a trauma-informed and relational approach, whilst also highlighting how preventative measures are crucial in order to try and prevent the cyclical nature of ACEs, and to prevent individuals from coming into contact with the criminal justice system in the first place.

This thesis concludes that PD and SP symptomology may be better understood as effective survival strategies to abnormal circumstances, and it is important that clinicians address this aspect of an individual's sense-making during treatment. Furthermore, a common thread throughout all studies is regarding impairments in identity. Therefore, a useful treatment target among IPSO is in relation to incoherence in the self-narrative, as having a coherent, pro-social identity is thought to be crucial to rehabilitation and desistance (Maruna, 2001). Clinicians should work from a Good Lives Model (GLM; Ward, Mann & Gannon, 2007) perspective in order to help individuals identify appropriate values and goals, and work towards a more appropriate narrative identity (Ward & Marshall, 2007). An individual’s protective factors should also be taken into account, in which peer-support roles and religiosity may play an important part in protecting individuals from future offending. Implications and limitations of all studies are discussed extensively throughout, as are opportunities for further research.

Item Type:	Thesis
Creators:	Hamilton, J.A.
Date:	March 2020
Rights:	This work is the intellectual property of the author. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, university, degree level and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed in the owner(s) of the Intellectual Property Rights.
Divisions:	Schools > School of Social Sciences
Record created by:	Linda Sullivan
Date Added:	11 May 2020 15:08
Last Modified:	11 May 2020 15:10
URI:	https://irep.ntu.ac.uk/id/eprint/39813

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