BJPsych Advances (2018), vol. 24, 83–92 doi: 10.1192/bja.2017.23 Psychodynamic approaches to ARTICLE violence† Jessica Yakeley violent crime are themselves at increased risk of Jessica Yakeley is a consultant SUMMARY psychiatrist in forensic psychother- developing physical and mental ill health. The assessment and management of violent apy, Director of the Portman Clinic, behaviour in mentally disordered patients are no Personality disorder, most commonly antisocial per- and Director of Medical Education at longer the sole domain of forensic psychiatrists, sonality disorder (ASPD), is overrepresented in the Tavistock and Portman National offending populations (Alwin 2006), particularly Health Service Foundation Trust, but are increasingly part of the day-to-day work London. She is also Editor of of all psychiatrists and mental health professionals. among individuals with convictions for violent Psychoanalytic Psychotherapy and a Violence risk assessment has become a huge offences (McMurran 2009). ASPD is associated Fellow of the British Psychoanalytical industry, and although the importance of dynamic, with high levels of comorbid psychiatric illness, sub- Society. as well as actuarial, risk factors is now recognised, stance misuse, poor physical health and early death Correspondence Dr Jessica Yakeley, Portman Clinic, 8 Fitzjohns a more systematic approach exploring the psycho- from suicide or reckless behaviour (Martin 1985; dynamics in the aetiology, assessment and treat- Avenue, London NW3 5NA, UK. Black 1996; Odgers 2007; Piquero 2011). Violent Email:
[email protected] ment of violent behaviour is often lacking. In this acts may lead to post-traumatic stress disorder in article I revisit some of the key psychodynamic perpetrators as well as victims (Minne 2008).