Aggression, psychopathy and brain imaging — Review and future recommendations

Violent behavior appears to result from a complex web of interacting genetic as well as environmental factors. Psychopathy is a strong predictor for relapse in violent acts. The current review shed light on rapidly expanding knowledge in brain imaging related to violent behavior and psychopathy. A literature search was performed in PubMed, Cochrane and PsycInfo combining the key words: mentally disordered offender/aggression/violence/ crime/forensic psychiatry/brain imaging neuroimaging/fMRI/MRI/PET/SPECT/lack of empathy/psychopathy and antisocial personality disorder. The reviewed material, which consisted of 48 articles, indicates a rather strong consensus on the connection between dysfunctional parts of the frontal and temporal lobes and violent antisocial behavior and psychopathy. In future studies, it would be useful to focus on the limbic system and to investigate which parts of the frontal lobes and cerebral networks that are of interest in the psychopathic personality. Moreover, the reviewed material highlights some of the methodological difficulties in this area of research such as selection bias in the recruitment of patients, inadequate matching of control subjects, and sometimes incongruous results. In the future we hope that brain imaging can be used to map biological deviations in different offenders in order to try to learn more about the different mechanisms behind violent behaviors.     

Psychopathy, intelligence and conviction history

The current study examined the relationship between psychopathy, intelligence and two variables describing the conviction history (length of conviction and number of prior convictions). It was hypothesized that psychopathy factors (interpersonal and antisocial factors assuming a 2-factor model or interpersonal, affective, lifestyle and antisocial factors assuming a 4-factor model) would be related in different ways to IQ scores, length of conviction and number of prior convictions. Psychopathy and IQ were assessed using the PCL:SV and the CFT 20-R respectively. Results indicated no association between interpersonal psychopathy features (Factor 1, two-factor model), IQ and the number of prior convictions but a positive association between Factor 1 and the length of conviction. Antisocial features (Factor 2, two-factor model) were negatively related to IQ and the length of conviction and positively related to the number of prior convictions. Results were further differentiated for the four-factor model of psychopathy. The relationship between IQ and psychopathy features was further assessed by statistically isolating the effects of the two factors of psychopathy. It was found that individuals scoring high on interpersonal features of psychopathy are more intelligent than those scoring high on antisocial features, but less intelligent than those scoring low on both psychopathy features. The results underpin the importance of allocating psychopathic individuals to subgroups on the basis of personality characteristics and criminological features. These subgroups may identify different types of offenders and may be highly valuable for defining treatment needs and risk of future violence.     

Implicit attitudes toward violence and their relation to psychopathy,aggression, and socially adaptive behaviors in forensic psychiatric inpatients

In order to investigate the relation between implicit attitudes toward violence and different aspects of violent and social behavior in Dutch forensic psychiatric inpatients, an implicit association test was related to measures of psychopathy, aggression, and socially adaptive behaviors. Results indicated that all patients had negative implicit attitudes toward violence. Although implicit attitudes toward violence were unrelated to several self-report measures of aggression, there was a significant positive relation between these attitudes and the antisocial facet of psychopathy. Furthermore, it was found that implicit attitudes toward violence were significantly negatively associated with coping behaviors and the level of moral awareness, indicating that patients with more negative implicit attitudes toward violence more often reported these behaviors, which can be assumed to inhibit aggression. As the present study was only correlational in nature, our findings need to be further explored in prospective research.     

Assessing psychopathy in young people: the validity of the Psychopathic Checklist: Youth Version for a sample of Spanish offenders

In this study, we assessed the validity of the Psychopathic Checklist: Youth Version (PCL:YV) in a Spanish sample of juvenile court-involved youths. Although recent Anglo-Saxon literature on the topic supports the usefulness of psychopathic traits in adolescent offenders for predicting recidivism and future violence, little is still known about their predictive ability for other cultures. The results of this study suggest that the PCL:YV possesses adequate concurrent criterion-related validity (by using self-reported version of Antisocial Process Screening Device) and retrospective validity (particularly as regards the antisocial, but also the affective–interpersonal domain). Specifically, retrospective validity was confirmed by positive correlations with history of truancy at school, poor parenting, parental delinquency, self-reported antisocial behaviour and illicit behaviour patterns including violent offences recorded in official files; however, careful analysis revealed that the Lifestyle and Antisocial factors are the main dimensions related to past offences, whether violent or otherwise. In conclusion, the PCL:YV is a convenient instrument for assessing psychopathy, and, hence, the risk of criminality, in youths.     

Treatment-Related Changes in Behavioral Outcomes of Psychopathy Facets in Adolescent Offenders

This study examines the association between the facets of psychopathy embedded in the Psychopathy Checklist: Youth Version (PCL:YV; Forth et al., Psychopathy Checklist: Youth Version, 2003), and changes in institutional behavior and post-treatment violent and general offending in a sample of juvenile delinquent males treated in the Mendota Juvenile Treatment Center (MJTC), an intensive treatment program. Affective, Interpersonal, Behavioral and Antisocial facet scale scores were calculated from items of the Psychopathy Checklist: Youth Version (PCL:YV; Forth et al., 2003). Data on daily institutional behavior were collected from treatment records. In order to analyze re-offense patterns, the number and type of new criminal charges were collected over a mean follow-up of 54 months (range = 24–79 months), after the youth was released from custody. The Interpersonal facet of the PCL:YV was significantly related to admission behavior problems, while other facet scores were not. Youth with elevated Interpersonal facet scores showed the greatest improvement in institutional behavior during treatment. Treatment was also associated with a significant decrease in general and violent offending for each facet. The Interpersonal facet of the PCL:YV was found to play a key role in institutional and community violence in this study. Treatment appeared to disrupt the link between institutional and community violence and psychopathy features in this population.     

The relation of ADHD and violent aggression: What can we learn from epidemiological and genetic studies?

Disruptive behavior includes psychopathological and behavioral constructs like aggression, impulsivity, violence, antisociality and psychopathy and is often closely related with diagnostic categories like conduct disorder (CD), attention deficit disorder (ADHD) and antisocial personality disorder (ASP). There is now clear evidence that neurobiological and environmental factors contribute to these phenotypes. A mounting body of evidence also suggests interactive effects of genetic and environmental risks.In this selective review we give an overview over epidemiological aspects of the relation between ADHD and antisocial behavior, including violent aggression and psychopathy. Moreover, we summarize recent findings from molecular genetic studies and particularly discuss pleiotropic effects of a functional polymorphism of the serotonin transporter promoter gene (5HTTLPR) and childhood adversity on ADHD and violent behavior. The reported gene–environment interactions are not only informative for understanding the neurobiological underpinnings of disruptive behavior, but also throw some light on the relation between ADHD and violent behavior from a genetic perspective. The impact of genetic research on forensic psychiatry and future directions of neurobiological research are discussed.     

Psychopathy, traumatic exposure, and lifetime posttraumatic stress

This study examined two theoretical models on the interaction between psychopathy, traumatic exposure, and lifetime posttraumatic stress in a sample of 81 male detainees. In Model 1, the interpersonal and affective features of psychopathy were assumed to protect against posttraumatic stress. In Model 2, the lifestyle and antisocial traits of psychopathy were assumed to lead to a lifestyle that increases the risk of traumatic exposure and subsequent posttraumatic stress. The authors found significant negative bivariate associations between Psychopathy Checklist-Revised (PCL-R) total, Interpersonal and Affective facet scores, and posttraumatic stress. Model 1 was confirmed, as they found the interaction between the Affective facet and traumatic exposure had a significant negative effect on posttraumatic stress. Model 2 was rejected. The authors' findings confirm that the interpersonal and affective features of psychopathy are associated with an emotional deficit and that the affective features of psychopathy are crucial for understanding the relationship between psychopathy and anxiety.     

Roles of Psychopathic Personality,Mental Health,and Recidivism in Criminal Behavior: Survey of Brunei Inmates

The survey investigated the contributions of sociodemographics, psychopathic personality, mental health, and recidivism to criminal behavior in a random sample of 64 Brunei convicts representing both genders. Participants committed five major types of crime related to stealing, drugs, sex, violence, and deception. Hierarchical multiple regression analysis revealed gender, age, the inmates’ marital status and marital status of the inmates’ parents as significant demographic predictors of criminality. Multinomial logistic regression analysis identified the demographic, psychopathic, and mental health variables that were related to committing the specific crimes. Significant psychopathic predictors were interpersonal and affective (stealing-related offenses), interpersonal and affective (drug crimes), interpersonal (sex offenders), and interpersonal (violent/ aggressive felonies). The best mental health predictors included: depression and psychoticism (stealing-related offenses); depression, hostility, and psychoticism (drug crimes); psychoticism (sex offenses); and depression, paranoid ideation, and psychoticism (violence/aggression). Binary logistic regression analysis showed male gender and inmates with married parents as the main predictors of recidivism (while other variables with high odds for re-offending included age-group 30–35, inmates with primary education, affective, lifestyle, antisocial, interpersonal sensitivity, depression, paranoid ideation, and psychoticism). Future research which incorporates interviews with probes and appropriate interventions to address crimes were recommended.     

Youth Psychopathy and Criminal Recidivism: A Meta-Analysis of the Psychopathy Checklist Measures

Although narrative reviews have suggested that "youth psychopathy" is a strong predictor of future crime and violence, to date no quantitative summaries of this literature have been conducted. We meta-analyzed recidivism data for the Psychopathy Checklist measures across 21 non-overlapping samples of male and female juvenile offenders. After removing outliers, psychopathy was significantly associated with general and violent recidivism (r (w)'s of .24 and .25, respectively), but negligibly related to sexual recidivism in the few studies examining this low base rate outcome. Even after eliminating outliers, however, considerable heterogeneity was noted among the effects, with some of this variability being explained by the gender and ethnic composition of the samples. Effect sizes for the small number of female samples available for analysis were mostly small and nonsignificant, and psychopathy was a weaker predictor of violent recidivism among more ethnically heterogeneous samples. In relation to predicting both general and violent recidivism, psychopathy performed comparably to an instrument designed specifically to assess risk, the Youth Level of Service/Case Management Inventory (Hoge & Andrews, 2002).     

Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample

Background: Evidence suggests the relationship between personality disorder (PD) and violence in offenders might be clarified by considering sub-groups of PD offenders defined by patterns of PD comorbidity. Aim: to identify patterns of PD comorbidity associated with severe violence, defined by its severity, quantity and age of onset (Violence Index: VI) in a forensic sample of 100 PD offenders. Methods: Correlations were first computed between VI and a range of personality and criminological variables; next, patients with antisocial/borderline comorbidity were compared with other PD patients; finally, regression analysis was conducted to identify unique predictors of VI. Results: The antisocial deviance factor of psychopathy and antisocial/borderline comorbidity were each significantly and independently associated with severe violence. Patients showing both a high psychopathy score and antisocial/borderline comorbidity had a significantly greater VI than those without these characteristics. Conclusion: PD patients with high psychopathy co-occurring with borderline and antisocial PDs show a criminal profile characterised by a high degree of serious violence.     

Psychopathy and intelligence in high-risk violent women

There has been a longstanding debate and mixed evidence on the link between psychopathy and intelligence. Most of the existing research comes from male prisoners, with the literature on female psychopathy and intelligence remaining sparse. Thus, the current study explored the correlational association between psychopathy and intelligence in a sample of high-risk violent female offenders. This is the first study of its kind from the Offender Personality Disorder (OPD) pathway for women in the United Kingdom (UK). The sample includes high-risk violent women presenting with severe personality disorder. In the present study, we conducted a correlational examination between total scores, and the 2-factor and 4-facet structure of the Psychopathy Checklist-Revised (PCL-R) with intelligence using the Wechsler Adult Intelligence Scale (WAIS). No significant associations were found between total PCL-R scores, or factor 2, and intelligence. Positive associations were found between verbal comprehension and factor 1 and the interpersonal facet. Thus, the results suggest high-risk violent female offenders with interpersonal psychopathic traits demonstrate higher levels of verbal comprehension skills. This finding may help explain why psychopathic female offenders, who can be characterized by deceitful and egocentric behaviours, may be able to successfully charm and con others for their own personal gain.     

A study of the psychosexual characteristics of sex killers: can we identify them before it is too late?

Thirty-three sex killers were compared to 80 sexual aggressives, 23 sadists, and 611 general sex offenders on sexual history and preferences, substance abuse crime, violence, mental illness, personality, neurological and endocrine abnormalities. Compared to other groups, sex killers started their criminal careers earlier, more often had been to reform school, were members of criminal gangs, set fires, and were cruel to animals. They tended so show more sadism, fetishism, and voyeurism. They more often collected pornography, but they did not use it in their offenses. They more often abused drugs and some suffered from drug induced psychoses. Their most common diagnosis was antisocial personality disorder, but only 15.2% met criteria for psychopathy. Sex killers showed most signs of neuropsychological impairment, grades failure, and learning disabilities. Results suggest that greater emphasis be placed on studying adolescent sex offenders and conduct disordered children which may help identify potential sex killers.     

Deceptive behaviour and instrumental violence among psychopathic and non-psychopathic violent forensic psychiatric patients

Deceptive behaviour and instrumental violence are well-known psychopathic features and as such play important roles in the assessment of psychopathy. This study examined first, the nature of the violence committed by offenders that have been admitted to forensic psychiatric care and whether scores on the Psychopathy Checklist: Screening Version (PCL:SV), Part 1, were associated with the instrumentality of violence. Second, we examined the proneness of offenders to re-frame the instrumentality in their past violent crimes, and whether this was associated with scores on the PCL:SV. The results show that the PCL:SV, Part 1 (interpersonal/affective features), was positively related to the officially coded instrumentality of the violent crimes. As expected, this association disappeared when the instrumentality was self-reported. However, the majority of the patients tended to exaggerate the reactivity of their violent crimes when it was self-reported, indicating that most offenders, independently of level of psychopathy, used deception when questioned about the characteristics of their past violent crimes. The reasons for, and implications of, the use of deception are discussed.     

Is PCL-R psychopathy associated with either type or severity of personality disorder?

The extent to which assessment of personality disorders (PDs), and trans-diagnostic measures of PD severity, can capture the variance in psychopathy measured by the Psychopathy Checklist-Revised (PCL-R) was examined in 100 forensic patients with a history of violent offending. Correlational and linear regression analyses were carried out to establish whether (i) combinations of PDs would predict PCL-R scores for each of its two factors, interpersonal–affective (F1) and antisocial deviance (F2); (ii) ‘acting out’, a putative measure of externalising maladjustment that transcends PD categories, would predict PCL-R scores. Results showed that narcissistic and avoidant PDs contributed significantly to the prediction of F1, but only antisocial PD contributed to the prediction of F2. ‘Acting out’ predicted both F1 and F2, suggesting that core features of PCL-R psychopathy are embedded within and across different PD diagnoses. Results are discussed in relation to different sub-types of psychopathy described in the literature.     

Clarifying the characteristics of youth who have engaged in appetitive violence

Appetitive violence is a form of proactive violence; its purpose is to generate or maintain a positive emotional state and, possibly, to strengthen social bonds. Portrayals of an increasing frequency of youth acts of appetitive violence have contributed to a perception that aggressive delinquents are callous and predatory. However, the characteristics of these youth and the nature of their violent behaviour have not been elucidated. This study compared demographic and psychological characteristics of 143 young violent offenders according to whether or not they had a history of appetitive violence. It was hypothesised that youth with a history of appetitive violence would score higher on a measure of psychopathy and that their violence would be perpetrated within the context of a group assault. Results revealed that acts of appetitive violence were perpetrated exclusively by males and were more likely to occur when co-offenders were present. Psychopathy did not differentiate the youth. These results suggest that appetitive violence perpetrated by young offenders is the product of social factors rather than individual psychopathology.     

Projective risk variables in early adolescence and subsequent disinhibitory psychopathology

The objective was to examine early adolescent projective risk indicators for the development of antisocial behaviour as related to adult personality traits, psychopathy, and violent behaviour over the life span. Assessment data included Rorschach (Rr) ratings (at age 11-14 years), personality inventories (EPQ-I and KSP scales), and a shortened Psychopathy Check List (PCL) (administered at age 32-40 years), obtained from a group of 199 male subjects; and smoking habits (at age 36-44 years) obtained from 125 of those subjects. Results, controlled for intelligence, indicated that the high and very high risk groups, as determined by level of total Rr risk scores, were (1) significantly higher on self-rated IVE Impulsiveness, the anxiety-related KSP Muscular Tension, and nonconformity traits, as compared to the low Rr risk group--the very high risk group also scoring significantly higher on the EPQ Psychoticism scale, related to aggressiveness and cruelty; (2) higher on clinically rated PCL total sum and factor scores; and (3) they were overrepresented among Ss with subsequent violent offence, and Ss with heavy smoking habits. The results are discussed in terms of the possible usefulness of psychodynamic oriented cognitive-emotional indicators in the search for underlying mechanisms in the development of disinhibitory psychopathology.     

Fear,Social Interactions,and Violence Mitigation

The fear of crime is generally considered as a social ill that undermines dimensions of individual well-being. Prior research generally specifies the fear of crime as an outcome variable in order to understand its complex etiology. More recently, however, researchers have suggested fear has a deterrence function whereby it reduces individuals’ involvement in violent encounters. This notion could hold important clues to understand the social sources of violence. We examine whether the fear of crime inhibits involvement in violent encounters, both as offender or victim, and if adjustments in routine activities explain these effects. The results suggest fear of crime reduces violence involvement, in part, by constraining routine activities. We conclude that the fear of crime appears to be a mechanism of violence mitigation that, paradoxically, bolsters physical well-being. The results are discussed with regard to their implications for criminological theory and research on interpersonal violence.     

Behavior on the ward of personality-disordered inpatients and chronically psychotic inpatients during a three-year stay in a Dutch forensic psychiatric hospital

To gain insight into the behavior of a group of personality-disordered patients and a group of chronically psychotic patients during their stay in a Dutch forensic psychiatric hospital, data on these patients were collected biannually for seven years. Three aspects of the patients’ behavior were examined: the prediction of institutional behavior shortly after admission, changes in the patients’ behavior on the ward during their stay in hospital, and the prediction of these changes. In the personality-disordered patients, observed irritation/anger and aggressive behavior on the ward turned out to be positively related to psychopathy, the PCL-R lifestyle and antisocial facets, and the neuroticism domain. A positive relationship was also found between aggressive behavior on the ward and trait anger. In the chronically psychotic patients, a positive relationship was found between irritation/anger and the PCL-R interpersonal and lifestyle facet. During a stay of three years, the aggressive behavior of both patient subgroups, which was already low at the start, did not decrease further, but their prosocial behavior increased. In the personality-disordered patients, relatively high scores on the antisocial facet of the PCL-R indicated an increase in prosocial behavior, whereas in the chronically psychotic patients no relationship was found between any PCL-R facet and behavior change. Effect studies on treatment programs for forensic psychiatric inpatients have to contend with the problem of a low base rate of institutional aggression. Therefore, we advise that such studies focus not only on a decrease in negative behaviors but also on an increase in positive behaviors.     

Diagnostic profiles of civilly committed sexual offenders in Illinois and other reporting jurisdictions: what we know so far

The records of 377 men civilly committed under Illinois' Sexually Violent Persons Act were compared with similar published samples from seven other states. Civilly committed sexual offenders in Illinois were more likely to be diagnosed with any personality disorder and more likely to exceed the cutoff score for psychopathy than similar offenders in other states. The authors then present a national composite of demographic, victim, and diagnostic information on men referred or pursued for civil commitment in eight states to better understand how these individuals differ from sex offender populations in correctional settings. Results suggest that there may be less victim specificity in sexually violent person (SVP) populations, as although nearly 50% of SVPs are diagnosed with pedophilia, 80% had committed at least one sexual offense against a child or adolescent victim. Across all samples, 72.7% of SVPs were diagnosed with a personality disorder, with antisocial personality disorder the most prevalent.     

Psychopathy,intelligence, and impulsivity in German violent offenders

Previous studies have reported numerous correlations between psychopathy and various personality traits, behavioural tendencies or clinical characteristics. The present study examined in greater depth the relationships between the components of psychopathy as measured by the Psychopathy Checklist—Revised (PCL-R) and intelligence as well as impulsivity. A total of ninety male violent offenders were recruited from a prison and a forensic–psychiatric hospital in Germany. All of the subjects were assessed using the PCL-R, the Barratt Impulsiveness Scale (BIS-11), and a short version of the German Wechsler Adult Intelligence Scale (WIP). As expected, a canonical correlation analysis showed a negative association between spatial intelligence and the Factor 2 subtotal on the PCL-R (reckless lifestyle/antisociality). In addition, our results agreed with the assumption of an association between impulsivity and the subtotal for PCL-R Factor 2. The positive relationship between verbal intelligence and the subtotal for Factor 1 of the PCL-R (insincere, manipulative conduct/affective deficits) vanished after controlling for educational level. The results indicate that there is a relationship between the spatial components of intelligence and the concept of psychopathy as described by Hare. This result supports the spatial impairment aetiological model of antisocial behaviour.