Violent criminal offenders with personality disorders (PD's) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs.

We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise-specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms.

Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*time: t(1387) = −2.85, p = 0.005).

These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community.

患有人格障碍（PD）的暴力犯罪分子可能会造成巨大伤害，但通常被认为是无法治愈的。本研究旨在进行一项随机临床试验，以测试长期心理治疗对帕金森病罪犯康复的有效性。

我们在荷兰八家高度戒备的法医医院将图式疗法（ST）（一种针对 PD 的循证心理疗法）与常规治疗（TAU）进行了比较。这两种情况的患者都接受了多种治疗方式，唯一不同的是他们接受的个体化、特定于研究的治疗。 103 名患有反社会、自恋、边缘或偏执 PD 或 B 类 PD（未另有说明）的男性罪犯被分配接受 3 年的 ST 或 TAU，每 6 个月进行一次评估。主要结局是康复（包括逐渐重新融入社区）和帕金森病症状。

两种情况下的患者的结果均显示出中度至大幅改善。 ST 在​​主要结局（康复（即获得监督和无人监督休假）和 PD 症状）以及 9 个次要结局中的 6 个方面均优于 TAU，与 TAU 相比有小到中度的优势。 ST 患者在康复过程中进展更快（监督休假，治疗*时间： F (5308) = 9.40， p < 0.001；无人监督休假，治疗*时间： F (5472) = 3.45， p = 0.004），并且表现出更快的改善PD 量表（治疗*时间： t (1387) = −2.85， p = 0.005）。

这些发现与对患有帕金森病的暴力犯罪者可治疗性的悲观观点相矛盾，并支持长期心理治疗对于使这些患者康复、促进他们重新进入社区的有效性。