Therapeutic Communities in Forensic — MRCPsych Paper B MCQ

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ModerateForensic PsychiatryTherapeutic Communities in ForensicMRCPsych Paper B

Within the traditional categorical classification of personality disorder, which diagnosis has the longest-established association with therapeutic-community treatment in UK forensic services, exemplified by HMP Grendon?

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Correct answer: A — Antisocial personality disorder

Antisocial personality disorder is the best answer. UK forensic therapeutic communities have a particularly long historical association with offenders displaying antisocial or formerly termed psychopathic personality pathology. HMP Grendon, opened in 1962, is the key UK example and was established to provide therapeutic-community treatment for prisoners with antisocial personality disorders. Contemporary prison therapeutic communities now work more broadly with complex personality pathology and offending behaviour, so the association is historical rather than an exclusive current indication. Schizoid, avoidant, dependent and obsessive-compulsive personality disorders may occur in people receiving therapeutic-community treatment, but none has the same established forensic tradition. The previous NICE reference concerned current management of antisocial personality disorder and did not directly substantiate the historical comparison being tested.

Reference: Independent Monitoring Board at HMP Grendon. Annual Report 2020, section 2.1: Description of the establishment. https://cdn.websitebuilder.service.justice.gov.uk/uploads/sites/13/2022/10/Grendon-AR-2020-for-circulation.pdf