The impact of structured risk assessments followed by management recommendations on aggression in patients with personality disorder

This study tested the proposition that structured risk assessments followed immediately by the risk assessment results and recommendations for management can reduce the frequency of aggression in high-risk personality-disordered patients. The study included three phases during which aggressive behaviour was recorded: (a) baseline, (b) daily risk assessment using the Dynamic Appraisal of Situational Aggression (DASA) and HCR-20 Clinical Scale, and (c) daily DASA risk assessment followed by risk assessment results and risk management recommendations. Following the third phase a staff survey was conducted to measure the clinical utility of the DASA and the risk management recommendations. Results revealed no significant difference in the frequency of aggression between the three phases. The staff survey revealed varied reactions to the DASA and to the utility of the risk assessment results and management recommendations. Possible reasons for the limited impact of the DASA and opportunities for future research are discussed.