Psychopathy (PCL-R) in a forensic psychiatric sample of homicide offenders: some reliability issues

Several studies have shown that psychopathy is overrepresented among homicide offenders. There is a consensus that Hare's Psychopathy Checklist-Revised PCL-R is currently the most valid and useful tool for rating psychopathy (e.g., [Fulero, S. M. (1995). Review of the Hare Psychopathy Checklist-Revised. In J. C. Conoley & J. C. Impara (Eds.), Twelfth Mental Measurements Yearbook (pp. 453-454). Lincoln, NE: Buros Institute]). Usually, when making a rating of psychopathy, both an interview and an examination of the subject's files are used. However, it has been discussed what is really required to be able to rate psychopathy in a reliable manner. The aim of the present study was to retrospectively rate the degree of psychopathy in 35 homicide offenders being subjected to forensic psychiatric assessment. These ratings of psychopathy were carried out using forensic psychiatric files and courts'; verdicts only. Another aim was to examine the reliability of PCL-R in this specific Swedish sample of homicide offenders. There was a good agreement between the two raters with respect to the categorical diagnosis of psychopathy (Cohen's kappa=.81, p<.001), which indicates that retrospective ratings of psychopathy are well suited for research purposes. The prevalence of psychopathy among the homicide offenders was 31.4% (using a cut-off score of 30), which means that the construct of psychopathy may contribute to the understanding of the phenomenon of homicide. In the planning of treatment for homicide offenders, a consideration of possible psychopathy is necessary. As criminal psychopaths are known to relapse into violent criminality, it is very important that they are given efficient treatment, placement and management.     

Violent recidivism in criminal psychopaths

The predictive validity of the Psychopathy Checklist-Revised (PCL-R) was compared with 3 actuarial risk scales in a sample of 81 offenders followed for a maximum of 67 months (average of 30 months). The recommittal or general recidivism rate for the entire sample was 57% (40% for nonpsychopaths, 51.2% for a mixed group, and 85% for psychopaths). The violent reoffense rate was 10% for the sample (nonpsychopaths 0%, mixed 7.3%, psychopaths 25%). All instruments were significantly correlated with general recidivism; however, the PCL-R was the best predictor of violent recidivism. Compared to the actuarial scales, the PCL-R had a higher predictive efficiency (Relative Improvement Over Chance (RIOC)) and yielded fewer decision errors. Most importantly, Factor 1 was a better predictor of violent recidivism than Factor 2, suggesting that the trait construct of psychopathy makes a unique contribution to the prediction of violent recidivism.     

Psychopathy (PCL-R) as a Predictor of Violent Recidivism Among Criminal Offenders with Schizophrenia

Hare's Psychopathy Checklist-Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score 26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.     

The PCL-R and violent recidivism in a prospective follow-up of a nationwide sample of female offenders

Psychopathy has been linked to violent reoffending in men, but the findings in women have been contradictory. The aim of this study was to examine the predictive validity of the Psychopathy Checklist-Revised (PCL-R) for violent recidivism in a nationwide sample of female violent offenders. The offenders (n = 48) had been assessed by the PCL-R and were followed after their release from prison or a psychiatric hospital. The average follow-up period was 8 years. Of the offenders, 16 (33%) had been reconvicted of a violent crime. Current findings of the performance indicators did not support the use of the PCL-R as a predictive instrument assessing risk of violent recidivism in females. The findings indicate that impulsivity plays a crucial role in female violent recidivism and that the PCL-R should be used with caution in risk assessment with female populations.     

A study of stranger rapists from the English high security hospitals

Abstract

Heterogeneity hinders our understanding of sexual violence; but does this problem extend to stranger rape and, if so, would the construction of homogeneous subtypes advance our understanding of this crime and aid criminal investigations and clinical practice? To answer these questions, 41 stranger rapists from the English high security hospitals were examined using version 3 of the Massachusetts Treatment Centre rapist typology (MTC:R3) and multidimensional scaling (MDS). The MTC:R3 suggested that sexual desire and opportunism were the primary motivations for these men, but that proportionately more psychopaths were violent and sadistic. In accordance with previous research, the men experienced problematic childhoods and displayed high rates of criminality and psychiatric morbidity in adulthood. However, MDS found that rapist histories and offence behaviours generally divide into sexual and violent themes. These results have important implications for theory, criminal investigations and clinical practice.     

Understanding the risk factors for violence and criminality in women: the concurrent validity of the PCL-R and HCR-20

This study explores the performance of 132 female maximum-security inmates on the Psychopathy Checklist-Revised (PCL-R) and the HCR-20 (Historical, Clinical, and Risk Management Scheme) to examine the concordance between these two risk assessment instruments, and to assess their potential usefulness in determining level of risk for violent behavior and other forms of criminality. The two instruments demonstrated consistent and highly significant correlations across total scores, factor scores, and subscale scores. When the two instruments were entered into a multiple regression analysis to predict violent and non-violent crime, the HCR-20 did not add to the variance explained by the PCL-R. These results confirm earlier research that suggests that there is little or no difference between these two risk assessment instruments in their relationship to community or institutional violence. Further, Receiver Operating Characteristics (ROC) analyses show that both instruments demonstrated an inverse ability to predict convictions for murder, a close to chance ability to predict violent crime, but a shared ability to predict property and minor crime. Broadly, these results suggest that psychopathic women are involved in chronic patterns of non-violent criminality, while women charged and convicted of murder generally do not have elevated scores on the PCL-R or HCR-20. The relevance of these findings to rehabilitation and treatment is discussed.     

Crime profiles and conditional release performance of psychopathic and non‐psychopathic sexual offenders

Purpose. This study investigated the influence of psychopathy and sex offender subtype on criminal history, probability of being granted conditional release, and performance while on conditional release in a diverse group of violent offenders. We predicted that psychopathic sexual offenders would be associated with relatively prolific violent and sexual offending, a high probability of successful conditional release applications despite their past behaviour (resulting from ‘putting on a good show’ in a parole hearing), and poor performance in the community. Methods. Information was gathered via a correctional file review of 310 Canadian male federal offenders. Offenders were categorized into groups based on their sexual offence history (non‐sex offender, rapist, child molester, or mixed rapist/molester) and Psychopathy Checklist – Revised (PCL‐R; Hare, 2003) ratings. Their offences (sexual, violent, or non‐violent) and their complete conditional release histories were coded. Results. Psychopathy was associated with more violent and non‐violent, but not sexual, offences. A significant interaction between psychopathy and offender subtype revealed that psychopathy was associated with a greater number of sex offences within child molesters. High‐psychopathy offenders (both sexual and non‐sexual offenders) were about 2.5 times more likely to be granted conditional release than non‐psychopathic offenders. Conclusions. Psychopathy is associated with more prolific sexual offending among child molesters and – despite their extensive criminal histories and high recidivism rate – a great proficiency in persuading parole boards to release them into the community. Specialized education and training in dealing with psychopathic offenders is urgently needed.     

Investigation of the Criminal and Conditional Release Profiles of Canadian Federal Offenders as a Function of Psychopathy and Age

Using the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) diagnostic cutoff score of 30, the complete criminal career and community release profiles of 317 Canadian federal offenders (224 low scorers and 93 scoring within the psychopathic range) were investigated. Adult crimes were coded according to age at commission as well as either violent, nonviolent, or nonsexually violent. Changes in performance following release into the community also were examined. Results indicated that offenders scoring within the psychopathic range consistently committed more violent and nonviolent crimes than their counterparts for about three decades, spanning their late adolescence to their late 40s. Numbers of nonviolent criminal offenses committed by high PCL-R scorers declined considerably after age 30 relative to violent offenses, which declined and then rebounded in the late 30s before a major reduction was evidenced. Throughout adulthood, high PCL-R scorers failed during community release significantly faster than did low scorers. Importantly, from a risk management perspective, the release performance of low PCL-R scorers improved with age, whereas the opposite was seen for high scorers. Further, offenders scoring high on the PCL-R did not show a lower charge to conviction ratio with age, suggesting that they may not have been getting better at manipulating the legal system.     

Psychopathy and Culpability: How Responsible Is the Psychopath for Criminal Wrongdoing?

Recent research into the psychological and neurobiological underpinnings of psychopathy has raised the question of whether, or to what degree, psychopaths should be considered morally and criminally responsible for their actions. In this article, we review the current empirical literature on psychopathy, focusing particularly on deficits in moral reasoning, and consider several potential conclusions that could be drawn based on this evidence. Our analysis of the empirical evidence on psychopathy suggests that while psychopaths do not meet the criteria for full criminal responsibility, they nonetheless retain some criminal responsibility. We conclude, by introducing the notion of rights as correlative, that even if psychopaths were to be fully nonresponsible, imposing some form of civil commitment would still be warranted.     

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.     

Community violence to prison assault: A test of the behavioral continuity hypothesis

This large-scale study (N = 23,277) investigated the relationship between criminal history in the community and serious or assaultive prison misconduct, while controlling for the effects of inmate characteristics, general criminality, and custody level. Community violence variables included the rate of prior violent crime arrests and the types of prior violent crime, as well as a range of specific violent crimes of conviction. Behavioral continuity from community to prison was neither simple nor intuitively discernible, depending on the type, recency, and pattern of community criminality. Application of logistic regression models revealed that the omnibus measure of the rate of prior violent arrests was not related to either serious or assaultive prison misconduct. Prior arrests for assault and current convictions for robbery and/or assault, but not prior or current homicides, were associated with an increased risk for prison violence. Current conviction for a sexual assault had the strongest inverse relationship to prison violence, while prior arrests for sexual assault showed no relationship to prison violence. A more "nuanced" approach in assigning risk ratings based on prior criminal history and seriousness of offense is recommended. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

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.     

Effects of psychopathy and violence risk testimony on mock juror perceptions of dangerousness in a capital murder trial

The recent introduction of the Psychopathy Checklist-Revised (PCL-R) into the sentencing phase of capital murder trials has heightened concerns about the potentially prejudicial impact of such information on jurors, who might give disproportionate weight to this diagnosis when determining whether a defendant is a “continuing threat to society”. To investigate this issue, 238 undergraduates read a case summary based on US v. Barnette ( ), in which prosecution testimony was presented regarding the presence of a mental disorder (psychopathy, psychosis, or no disorder). Compared to the “no disorder” condition, participants rated psychopathic defendants as more likely to be violent in the future, even though testimony related to level of risk (high or low) was held constant. The difference in perceived dangerousness across the psychopathy and no disorder groups was particularly pronounced when the experts described the defendant as being at low risk. A similar pattern of effects was noted for the psychosis condition, suggesting that the impact of mental disorder testimony on perceptions of dangerousness may not necessarily be specific to the PCL-R.     

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.     

Psychopathy, treatment change, and recidivism in high-risk, high-need sexual offenders

The present study investigated 154 consecutive admissions to the Regional Treatment Center (Ontario) Sex Offender Treatment Program with reference to psychopathy and outcome. Ratings of treatment behavior, as well as clinical judgments as to whether risk was reduced, were coded based on treatment reports. With reference to Psychopathy Checklist-revised (PCL-R) scores, survival analyses indicated that high scorers recidivated at significantly higher rates than low scorers. However, offenders who received high PCL-R scores and lower scores on measures of treatment behavior recidivated at the same rate as low scorers on the PCL-R. Furthermore, among high PCL-R offenders, those rated as lower risk at post treatment in fact reoffended at a lower rate than those whose risk was rated as unchanged, although this difference failed to reach significance. Findings are discussed in light of the clinical and research literature.     

Exploring gender issues in the development from conduct disorder in adolescence to criminal behaviour in adulthood

Using results from a large Norwegian follow-up study of former adolescent psychiatric in-patients we have traced the progression from mental disorders requiring hospitalisation in adolescence to registered criminal behaviour in adulthood, particularly highlighting gender differences. A nationwide representative sample of 1095 adolescent psychiatric inpatients (46% females) was followed up 15–33 years after admission to the National Centre for Child and Adolescent Psychiatry in Oslo, Norway. In adolescence 45% fulfilled the DSM-IV criteria for a disruptive behaviour disorder. At follow-up, 63% of the males and 39% of the females had a criminal record. Among females, psychoactive substance use disorder in adolescence seemed to be a sine qua non for later registered criminality, with intravenous drug use a potent risk factor for life-course-persistent criminality. The same strong association between drug use and criminality was not found in males. Factor analysis demonstrated that while the DSM-IV Conduct Disorder criteria structure was similar across genders, the prevalence of the various forms of expression was different in males and females. The differences between individuals with violent and non-violent crimes were more substantial in males than in females. There were marked gender differences in the criminal profiles observed, with the females' criminal career developing in a less serious manner than in males: females had later criminal debut, a lower number of acts on record, less diverse criminal behaviour, and an escalation in the severity of offences over time was less frequently encountered. However, secular trend analyses indicated that gender differences had diminished over the last several decades, with females “catching up” with their male counterparts. Overall, the results demonstrated important qualitative and quantitative gender differences in the criminal behaviour of former adolescent psychiatric in-patients. The results may be of use in prevention.     

Sexual fantasies and sensation seeking among psychopathic sexual offenders

Abstract

This study investigated the relationship between psychopathy, sensation seeking behavior and sexual fantasies in a sample of 199 participants from a maximum security forensic hospital. Psychopathy, measured by the Psychopathy Checklist – Revised (PCL-R), and several sensation seeking and sexual fantasy measures were utilized. Results indicated that, in agreement with previous research, sexually deviant psychopaths are more likely to offend against adults than children. Likewise, psychopaths showed some tendency to score significantly higher on sexual sensation seeking measures than nonpsychopathic sexual offenders. Furthermore, a relationship between psychopathy and overall sexual fantasies existed but there were not specific patterns among psychopaths and nonpsychopaths with regard to specific categories of sexual fantasies.     

Bullying behaviour and criminality: a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland

The recent school shootings in Europe and the USA have raised the question of whether victims of bullying run an increased risk of committing violent crimes later in life, but scientific research in this area is scarce. The aim of this work was to investigate whether bullying behaviour is associated with later criminal offences committed in adolescence and young adulthood. We studied a sample of 508 Finnish adolescents (age 12-17 years) admitted to psychiatric inpatient care between April 2001 and March 2006. Data on crimes committed and the age of onset of criminal activity were extracted from the official criminal records of the national Legal Register Centre in October 2008. The Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL) was used to define bullying status, and to obtain DSM-IV-based psychiatric diagnoses for the adolescents. Violent crimes were statistically significantly associated with bullying behaviour, but not non-violent crimes. Furthermore, being a bully was predictive of an early onset of severe violent offences. When controlled for the psychiatric diagnoses of the adolescents, we observed decreased likelihood of criminality among victims. Thus bullying others may increase the risk of violent offences, while being a victim is not a risk factor for criminality.     

Object relations in criminal psychopaths

Although many empirical studies have documented the range and severity of problems caused by psychopaths, considerably less attention has focused on understanding its origins. Efforts to treat this potentially dangerous population have been equally frustrating, as psychotherapeutic approaches have almost always proven ineffectual. Because of the limited understanding of the psychological and interpersonal dynamics underlying psychopathy, the authors sought to assess the extent to which object relations theory could inform our understanding of psychopathy. In addition to eliciting background information, 74 men sentenced to probation following a criminal conviction were assessed using the Psychopathy Checklist: Screening Version, a clinician-rated measure of psychopathy, and were administered the BORI, a self-report measure of object relations. Results showed significant correlations between object relations dimensions, psychopathy scores, and childhood environment data. Furthermore, object relations scores added to the prediction of psychopathy even after demographic and behavioral variables were considered, suggesting that object relations deficits comprise a significant component of psychopathy. Results suggest that psychopaths harbor profound underlying psychosocial damage including intense anxiety, anger, bitterness, and resentment. Implications for interventions and future research are discussed.     

Psychopathy and Violent Crime: A Prospective Study of the Influence of Socioeconomic Status and Ethnicity

The relationship between psychopathy and violence is well-established. However, few studies have examined the extent to which this relationship is influenced by sociodemographic predictors of violent criminality. In this prospective study we examine the power of psychopathy to predict criminal violence across ethnicity and levels of socioeconomic status in 199 European American and African American U.S. county jail inmates. A Psychopathy x SES x Ethnicity interaction was identified such that among European Americans psychopathy predicted recidivism at lower levels of SES but was unrelated to recidivism at higher levels of SES. The predictive power of psychopathy was relatively stable across SES among African Americans. The implications of our results for psychopathy and violence prediction are discussed.