Using self-reflective tools to understand violence perpetration among patients with personality disorders

Patients with personality disorders (PD) can present with challenging violent behaviours in inpatient units. To effectively manage violence occurring in these units, it is first crucial to understand the reasons behind patients' use of violence. Although many studies have attempted to delineate these violence risk factors, there is a dearth in research that looks into the interplay of these factors, including patient perspectives of why violence occurs. This study attempted to address these limitations by using behaviour cycle logs (BCLs) (Gordon & Wong, 1999–2009), a self-reflective behavioural strategy tool, that is currently used as an approach to manage violence on a particular PD forensic unit. All available BCLs in the period from January 2014 to April 2017 belonging to 11 patients were analysed. Using thematic analysis, three themes on factors associated with violence use were derived: power struggles, raging emotions, blame game. These findings also highlighted potential treatment targets to curb future violence use. Future research is needed to see if these factors can be generalised to other PD secure units and if behavioural tools such as BCLs can be further developed to be used as progress indicators in relation to violence risk management.