Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres Distinct pathological profiles of inmates showcasing cluster B personality traits, mental disorders and substance use regarding violent behaviors Laura Dellazizzo a,b , Jules R. Dugré a,b,c , Marieke Berwald a,b , Marie-Christine Stafford e , Gilles Côté d,e , Stéphane Potvin a,b , Alexandre Dumais a,b,e, ⁎ a Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada b Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Canada c School of Criminology, Faculty of Arts and Science, Université de Montréal, Montreal, Canada d Department of Psychology, Université du Québec, Trois-Rivières, Canada e Centre de recherche de l'Institut Philippe-Pinel de Montréal, Montreal, Canada ARTICLE INFO Keywords: Violence Suicide Cluster B personality traits Substance use disorders Severe mental illnesses Clustering ABSTRACT High rates of violence are found amid offenders with severe mental illnesses (SMI), substance use disorders (SUDs) and Cluster B personality disorders. Elevated rates of comorbidity lead to inconsistencies when it comes to this relationship. Furthermore, overlapping Cluster B personality traits have been associated with violence. Using multiple correspondence analysis and cluster analysis, this study was designed to differentiate profiles of 728 male inmates from penitentiary and psychiatric settings marked by personality traits, SMI and SUDs fol- lowing different violent patterns. Six significantly differing clusters emerged. Cluster 1, “Sensation seekers”, presented recklessness with SUDs and low prevalence's of SMI and auto-aggression. Two clusters committed more sexual offenses. While Cluster 2, “Opportunistic-sexual offenders”, had more antisocial lifestyles and SUDs, Cluster 6, “Emotional-sexual offenders”, displayed more emotional disturbances with SMI and violence. Clusters 3 and 4, representing “Life-course-persistent offenders”, shared early signs of persistent antisocial conduct and severe violence. Cluster 3, “Early-onset violent delinquents”, emerged as more severely antisocial with SUDs. Cluster 4, “Early-onset unstable-mentally ill delinquents”, were more emotionally driven, with SMI and auto-aggression. Cluster 5, “Late-start offenders”, was less severely violent, and emotionally driven with antisocial behavior be- ginning later. This study suggests the presence of specific psychopathological organizations in violent inmates. 1. Introduction Violence is a complex and multifactorial issue that has serious health and social consequences (World Health Organization, 2014). Importantly, people with severe mental illnesses (SMI) are at an in- creased risk of violence and criminality compared to the general po- pulation (Hodgins et al., 1996; Arseneault et al., 2000; Fazel et al., 2014) and even higher rates have been seen in diagnoses such as sub- stance abuse disorders (SUDs) and Cluster B personality disorders (PDs) (Boles and Miotto, 2003; Yu et al., 2012). Such behaviors have many negative consequences including hospitalization and incarceration. Likewise, there is an increased prevalence of these disorders in forensic psychiatry and prisons settings (Prins, 2014). Although prior literature has clearly shown an association between SMI, Cluster B PDs and SUDs and violence, research is still plagued by the elevated rates of co- morbidity, which translates to great heterogeneity. Thus, distinct sub- groups of offenders may exist. Criminal offenders often have dual or triple diagnoses, whereas they are often accompanied by distinct co- morbid PDs, SMI and/or SUDs (Hartwell, 2004), accentuating their involvement in aggression substantially (Hodgins et al., 1999; Swanson et al., 2002; Chang et al., 2015). More common amid offenders is the co-occurrence of Antisocial PDs (ASPD) and Borderline PDs (BPD). Freestone et al. (2013) found that this co-occurrence represents a combination of traits that is linked with adverse outcomes (i.e., a high risk for frequent and severe violence) and with comorbid drug/alcohol dependence. Overlapping personality traits may explain this co- morbidity such as impulsivity reflected in risk taking behaviors as well as affective instability, aggressiveness and novelty seeking that char- acterize both substance abusers and PDs (Gerra et al., 2000, 2001; Liraud and Verdoux, 2000; Bornovalova et al., 2005). Various constellation of Cluster B personality traits may likely aid to explain the proclivity towards violent acts. Offenders with psychiatric illnesses may be at a higher risk of violence due to abnormal personality traits that are common risk factors for violence (Skeem et al., 2004). In https://doi.org/10.1016/j.psychres.2017.12.006 Received 25 May 2017; Received in revised form 4 December 2017; Accepted 4 December 2017 ⁎ Corresponding author at: Centre de recherche de l′Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Canada H1N 3V2. E-mail address: alexandre.dumais@umontreal.ca (A. Dumais). Psychiatry Research 260 (2018) 371–378 Available online 06 December 2017 0165-1781/ © 2017 Elsevier B.V. All rights reserved. T