Therapeutic Management of Personality Disorders in Offenders: Current Evidence in Forensic Psychiatry

Because of their high prevalence and association with violent behavior, personality disorders represent a major therapeutic challenge in forensic psychiatry [1]. Once considered largely resistant to treatment, these disorders have attracted increasing attention with the development of structured psychotherapeutic interventions. This narrative review synthesizes the available evidence on the main therapeutic approaches used in forensic settings, including Dialectical Behavior Therapy (DBT), Schema Therapy (ST), Therapeutic Communities (TCs), and specialized interventions for high-risk individuals. Current evidence demonstrates significant clinical benefits, particularly reductions in aggressive behaviors and improvements in emotional regulation and interpersonal functioning, especially with forensic adaptations of Schema Therapy and Dialectical Behavior Therapy. Psychopathy, long regarded as refractory to treatment, has also been re-evaluated, with intensive treatment programs showing encouraging preliminary results in emotional, interpersonal, and behavioral functioning. However, the overall level of evidence remains moderate because of the limited number of randomized controlled trials, small sample sizes, and considerable methodological heterogeneity, particularly regarding the long-term effects of treatment on criminal recidivism. The development of individualized, evidence-based treatment programs supported by large-scale controlled trials should therefore be considered a priority in forensic psychiatry.