The testosterone–cortisol ratio: A hormonal marker for proneness to social aggression

Social aggression is an escalating hazard for individuals and society. It is most frequently observed as impulsive–reactive aggression in antisocial personality disorder (APD), but in psychopathic aggressive personalities instrumental social aggression is more prominent. However, the psychobiological mechanisms underlying human social aggression are still poorly understood. Here we propose a psychobiological mechanism that may explain human social aggression wherein the steroid hormones cortisol and testosterone play a critical role. High levels of testosterone and low levels of cortisol have been associated with social aggression in several species but it seems that in those individuals wherein these hormonal markers combine social aggression is most violent. In this review we discuss fundamental and clinical research which underscores the potential of the testosterone–cortisol ratio as a possible marker for criminal aggressive tendencies.     

Preliminary Study of Testosterone and Empathy in Determining Recidivism and Antisocial Behavior

Recidivism, repeated criminal behavior after conviction and correction of prior offenses, is a costly problem across the nation. However, the contribution of empathy in determining the risk of recidivism has received limited attention, although lack of empathy has been related to antisocial personality disorder in various studies. Studies linked testosterone to aggression, antisocial behavior, and criminality, and evidence support hormonal connections between empathy and aggression. Adult male prison inmates convicted of violent or nonviolent offenses were included in a cross‐sectional study of empathy, antisocial behavior, salivary testosterone, and recidivism. Subjects underwent criminal history, Empathy Quotient, Levenson Self‐Report Psychopathy Scale, Beck Depression Inventory, Spielberger State‐Trait Anxiety Inventory, and salivary testosterone assays. Bivariate analyses indicated multiple correlations between variables. Multivariate modeling analyses found a significant relationship between self‐reported conviction number and psychopathy scale score (p = 0.013). These preliminary results suggest avenues of investigation of factors contributing to recidivism risk.     

Trait Anger,Physical Aggression,and Violent Offending in Antisocial and Borderline Personality Disorders

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are common conditions in forensic settings that present high rates of violence. Personality traits related to the five‐factor model personality domains of neuroticism and agreeableness have shown a relationship with physical aggression in nonclinical and general psychiatric samples. The aim of the present investigation was to examine the association of these personality traits with violence and aggression in ASPD and BPD. Results revealed that trait anger/hostility predicted self‐reported physical aggression in 47 ASPD and BPD subjects (β = 0.5, p = 0.03) and number of violent convictions in a subsample of the ASPD participants (β = 0.2, p = 0.009). These preliminary results suggest that high anger and hostility are associated with physical aggression in BPD and ASPD. Application of validated, self‐report personality measures could provide useful and easily accessible information to supplement clinical risk assessment of violence in these conditions.     

Differentiation between drug use and environmental contamination when testing for drugs in hair

Personality disorders are associated with criminality and antisocial and borderline personalities as strong predictors of violence. Nevertheless antisocial patients show more instrumental violence, while borderline patients more emotional violence. We surveilled medical records of a personality disorder facility, searching data of aggression and crimes against property among 11 patients with antisocial personality disorder and 19 borderline personality disorder. We found that there are differences regarding engagement in violence and lawbreaking according to the personality disorder: antisocial patients statistically engage more in crimes against property than the borderline patients, and more in this kind of crime than in aggression, whilst borderline patients show a tendency to engage more in episodes of aggression and physical violence than antisocial patients, and less in crimes against property. We conclude that the distinct personality leads to a distinct pattern of crimes and violence: antisocial patients are cold and get more involved in crimes requiring more detailed planning, whilst borderline patients are impulsive and engage in explosive episodes of physical violence. Further studies on the association among personality disorder, behavior pattern and violence type may be useful for both treatment and criminal profiling.     

Aggression control therapy for violent forensic psychiatric patients: method and clinical practice

Aggression control therapy is based on Goldstein, Gibbs, and Glick's aggression replacement training and was developed for violent forensic psychiatric in- and outpatients (adolescents and adults) with a (oppositional-defiant) conduct disorder or an antisocial personality disorder. First, the conditions for promoting "treatment integrity" are examined. Then, target groups, framework, and procedure are described in detail, followed by the most important clinical findings during the period 2002 to 2006. Finally, new programme developments are mentioned, with aggression control therapy as a starting point.     

Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine

There are few effective treatments of antisocial personality disorder (APD). Preliminary work suggests that the atypical antipsychotic quetiapine can decrease irritability, impulsivity, and aggressiveness. Data were collected from 4 patients with APD who were referred to a maximum-security inpatient psychiatric facility for pretrial evaluation and were treated with quetiapine. Quetiapine was effective in these patients as was indicated by a decrease in symptoms such as impulsivity, hostility, aggressiveness, irritability, and rage reactions. Typical dosage was 600 to 800 mg per day. Patients attributed their willingness to comply with quetiapine treatment to both the effectiveness of the drug and its favorable adverse-event profile. Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Quetiapine has demonstrated efficacy in aggression, impulsivity, and irritability and has proved to be an effective medication in these patients with APD. In addition, its favorable adverse-event profile makes patients willing to comply.     

Psychological profile of sex offenders using weapons in their crimes

Abstract

A sample of 1533 sex offenders was examined for clinical characteristics associated with weapon use in their crimes. A total of 24.9% used weapons, most often knives (50.1%), with 13.6% using multiple weapons. Weapon-users were a very disturbed group, who showed a significantly higher prevalence than non-users of psychoses, suicide attempts, alcoholism, drug addiction and abuse, personality disorders, psychopathy, attention deficit hyperactivity disorder, cognitive impairment and violent criminal histories. The weapon-users recidivated more often than non-users and appeared in court on 8.7 separate occasions compared to 2.9 for non-users in an average follow-up of 21.5 years. The best predictors of weapon use were total violent offence convictions, sadism diagnoses and adult versus child victims. The importance of examining weapon use in assessing sex offenders is discussed.     

Prospective associations among borderline personality disorder symptoms, interpersonal problems, and aggressive behaviors

This study examined the prospective relationships among borderline personality disorder (BPD) symptoms, interpersonal problems, and types of aggressive behaviors (i.e., experiencing psychological and physical victimization and perpetrating psychological and physical aggression) in a psychiatric sample (N = 139) over the course of 2 years. We controlled for other PD symptoms and demographic variables. BPD symptoms at baseline were associated with interpersonal sensitivity, interpersonal ambivalence, interpersonal aggression, need for social approval, and lack of sociability 6 months later. In turn, interpersonal sensitivity predicted not experiencing physical aggression, interpersonal aggression predicted experiencing physical aggression and perpetrating both psychological and physical aggression, need for social approval predicted experiencing both psychological and physical aggression, and lack of sociability predicted perpetrating physical aggression 2 years later. Results demonstrated that interpersonal problems mediated the relationship between BPD and later violent behaviors. Our findings suggest the importance of distinguishing between these groups of aggressive behaviors in terms of etiological pathways, maintenance processes, and treatment interventions.     

Prevalence of probable attention-deficit/hyperactivity disorder in inmates and its relationship with recidivism

The aim of the current study was to determine the prevalence of probable attention-deficit/hyperactivity disorder (ADHD) in prisoners and to assess the relationship between ADHD and recidivism. We studied 356 inmates, who were evaluated using the Wender Utah Rating Scale and Adult ADHD Self-Report Scale. Type of crime and other crime-related data were compared between inmates with and without ADHD. The group with probable ADHD had a higher average number of convictions compared to the group without ADHD. The probable ADHD group also demonstrated higher incidence of extortion crime, drug trade, disciplinary action at school, and military service than the group without ADHD. Linear regression analysis revealed that the presence of probable ADHD was effective on the number of convictions. The findings of our study support that the presence of probable ADHD carries a potential risk of being prone to certain crimes and demonstrate a correlation between the presence of probable ADHD and early involvement in crime and the number of convictions.     

Implications for the prevention of aggressive behavior within psychiatric hospitals drawn from interpersonal communication theory

Although interpersonal style is a defining feature of personality and personality disorder and is commonly identified as an important influence on aggressive behavior, treatment completion, and the development of an effective therapeutic alliance, it is rarely considered in practice guidelines for preventing, engaging, and managing patients at risk of aggression. In this article, the authors consider three potential applications of interpersonal theory to the care and management of patients at risk of aggression during hospitalization: (a) preventing aggression through theoretically grounded limit setting and de-escalation techniques, (b) developing and using interventions to alter problematic interpersonal styles, and (c) understanding therapeutic ruptures and difficulties establishing a therapeutic alliance. Interpersonal theory is proposed to offer a unifying framework that may assist development of intervention and management strategies that can help to reduce the occurrence of aggression in institutional settings.     

The prevalence of mental disorders in prisoners in the city of Salvador, Bahia, Brazil

The number of individuals affected by serious psychiatric disorders in Brazilian prisons is unknown. This cross-sectional study was conducted in prison complexes within the city of Salvador, Bahia, Brazil. The sample consisted of 497 prisoners, and the outcome measure was the Brazilian Portuguese version of the Mini International Neuropsychiatric Interview. The prevalence rates found in the closed and semi-open prison systems, respectively, were as follows: depression 17.6% and 18.8%; bipolar mood disorder 5.2% and 10.1%; anxiety disorders 6.9% and 14.4%; borderline personality disorder 19.7% and 34.8%; antisocial personality disorder 26.9% and 24.2%; alcohol addiction 26.6% and 35.3%; drug addiction 27.9% and 32.4%; psychosis 1.4% and 12.6%; attention deficit/hyperactivity disorder (ADHD) in childhood 10.3% and 22.2%; and ADHD in adulthood 4.1% and 5.3%. This study revealed higher rates of substance-related disorders and lower rates of psychotic and mood disorders compared to other prevalence studies carried out in prison populations.     

The Prevalence of Mental Health Problems in Men Arrested for Domestic Violence

The problem of male perpetrated intimate partner violence (IPV) is widespread. In an effort to identify risk factors for perpetrating IPV, researchers have examined mental health problems among perpetrators. However, the majority of research in this area has examined personality psychopathology and/or limited their investigation to posttraumatic stress disorder (PTSD) or depression. Thus, the present study examined self-reported Axis I psychopathology among men arrested for domestic violence (N?=?308). Results replicated past research showing high rates of PTSD and depression. In addition, the prevalence of generalized anxiety disorder (GAD), panic disorder, social phobia, and alcohol and drug disorders were very high. All types of mental health problems were positively associated with aggression perpetration. Males meeting probable diagnostic classification reported significantly more frequent aggression than males not meeting diagnostic classification, even after controlling for social desirability. Directions for future research and implications of these findings are discussed.     

Big Five Personality Traits and Physical Aggression between Siblings in South Korea: an Actor-Partner Interdependence Analysis

The present study examined actor and partner effects of the Big Five personality traits, assessed by the NEO Five-Factor Inventory, on physical aggression within sibling dyadic interactions. Data were collected from 86 target adolescents receiving counseling services, their mothers, and closest-age siblings in South Korea. Mothers rated their children’s personalities. Target adolescents and siblings reported their own personality, as well as their sibling’s and their own perpetration of physical aggression against one another. Substantial self-other (i.e., mother and sibling) agreement was found for personality traits. Both actor and partner effects were found for the negative associations between extraversion, openness to experience, and conscientiousness and physical aggression among siblings. The current findings increase our understanding of personality traits implicated in physical aggression in general, and specifically aggression among siblings.     

Coercion,competence, and consent in offenders with personality disorder

Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale – Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.     

Associations of Personality Traits and Childhood Insult Experience with Perceived Husbands’ Psychological Aggression among Iranian Women

Psychological aggression against wives is a social problem in all societies. To analyze possible predictive factors of psychological aggression against wives, this study examined 398 women selected through multi-stage stratified sampling techniques. Research participants responded to the Conflict Tactics Scale, questions about childhood insult experience, and the Five-Factor Personality Inventory (NEO-FFI). Results showed that 86 % of respondents experienced psychological aggression from their husbands during the last year. Results also revealed that 46.7 % and 43.3 % of respondents were targets of insults during childhood by their mothers and fathers, respectively. Childhood insult experience and neuroticism, extraversion, agreeableness and conscientiousness personality traits predicted psychological aggression by husbands against their wives. Multinomial logistic regression revealed that neuroticism was a significant predictor of minor and severe psychological aggression against wives. The results highlighted the importance of childhood insult experience and personality traits in explaining the severity of psychological aggression against wives in Tehran, Iran.     

Construct validity,reliability and predictive validity of the dynamic risk assessment and management system (DRAMS) in offenders with intellectual disability

Background. There have been a number of developments in the assessment of dynamic risk in the criminological literature. The dynamic risk assessment and management system (DRAMS) has been developed to facilitate the measurement of dynamic factors of risk for offenders with intellectual disability. Method. The study was designed to assess the construct validity, reliability and predictive utility of the DRAMS in 23 male forensic patients in a high secure setting. Predictions were made against independently collected incident data. Concurrent validity was assessed against the Ward Anger Rating Scale (WARS). Results. A reformulation of the individual section variables according to convergent and discriminant correlational analysis revealed Cronbach's alpha levels of >.8 for all sections apart from mood (alpha .750) and items retained to facilitate clinical information (alpha ?.017). Two hundred pairs of WARS and DRAMS assessments revealed orderly sectional correlations. The sections of mood, antisocial behaviour, and intolerance/agreeableness predicted incidents with a medium effect size as did total DRAMS score. There were highly significant differences between assessments taken 1 or 2 days prior to an incident and control assessments conducted at least 7 days from an incident. Conclusions. The reformulated DRAMS has good construct and concurrent validity. It appears to be a reliable assessment tool and informs on risk levels relating to stable and acute proximal factors. It appears as an important addition to the utility of risk assessments for this population.     

Understanding motives for aggression in forensic psychiatric patients: a preliminary study

The primary aim of this study was to explore motivations underpinning aggression among men detained within conditions of high security. Thirty men residing at a high secure psychiatric hospital completed self-report measures, including the Aggression Motivation Questionnaire, Revised EXPAGG and Barratt Impulsiveness Scale-IIr. The Historical items of the Historical, Clinical and Risk-Management (HCR-20) and the Psychopathy Checklist-Screening Version were rated. A subsample of participants agreed to complete a functional assessment on an aggressive incident that had occurred during their placement (n = 9). Increased psychopathy and impulsivity, and the presence of historical risk items were predicted to associate with higher levels of both aggression motivation and beliefs supportive of aggression. Young age at first violent incident and personality disorder related positively to aggression motivation. Thematic analysis conducted on the functional assessments identified social recognition, emotion regulation, communication and protection as functions underpinning aggression. Results are discussed with regards to their implication for violence treatment and assessment, with a focus on motivation recommended.