People with personality disorder who offend tend to be neglected by health services in most countries. In the UK, there has been renewed interest in the field since government initiatives in the end of the 1990s. Government proposals themselves are controversial, but there is growing recognition that it is unsafe, both for the general public and fo

Chris Newrith MB ChB, MSc, MRCPsych, Consultant Psychiatrist in Psychotherapy, Birmingham Personality Disorder Service, Birmingham, UK

Clive Meux MB BS, MRCPsych, Consultant Forensic Psychiatrist, Oxford Clinic Medium Secure Unit, Littlemore, UK

Pamela J Taylor MB BS, MRCP, FRCPsych, FMedSci, Professor of Forensic Psychiatry, Wales College of Medicine, Cardiff, UK

Part 1 Theoretical Framework Describing personality and its abnormal deviations Presenting characteristics of PD Assessment of individuals with PD Diagnostic arguments Cost to society of untreated disorder (including cost to patient) Part 2 Origins and Grounds for Intervention and Prevention Early intervention and prevention and the extent of failure in this group Attachment theory Providing stability and continuity Chemically mediated impulsivity (including serotonin agonists) Other organic contributions and drug support Attention deficit disorders and stimulants Maladaptive learning and cognitive behavioural work Psychosis and personality disorder Chronic post traumatic stress disorder Dynamic approaches including the narcissism debate Theory of mind Authority and peer group The therapeutic community The advantages of an eclectic and often multimodal approach. Part 3 The clinical setting The advantages and disadvantages of a secure hospital setting and/or compulsory detention Woodstock Ward: The model for one defined patient group A service for women A service for patients with co-morbidity for alcohol illegal drug addictions A service for sex offenders Learning disability Translation of described models to other level of security Part 4 Separation and Facilitating Departure Consultation, liaison and transfer to other services Separation from the treatment centre Liaison and planning matters The law and ind