Prototypical analysis of antisocial personality disorder

The diagnostic criteria for antisocial personality disorder (APD) have gone through successive modifications with DSM-II, DSM-III, DSM-III-R, and DSM-IV. We asked 331 forensic psychiatrists to make prototypic ratings of the DSM versions, PCL-R (Hare, 1991), and the ICD-10 dyssocial personality disorder. Four distinct factors emerged that encompassed the following dimensions: (a)unstable self image, unstable relationships and irresponsibility, (b)manipulation and lack of guilt, (c)aggressive behavior, and (d)nonviolent delinquency. These dimensions are discussed in light of an earlier prototypical analysis (Rogers et al., 1992) and raise questions concerning the DSM-IV criteria.Clarke Institute of Psychiatry.     

Diagnostic validity of antisocial personality disorder

Competing models of antisocial personality disorder have important consequences for mentally disordered offenders and their management in the criminal justice system. In order to provide a fresh perspective on these enduring diagnostic problems, we conducted a prototypical analysis on 250 adult subjects' perceptions of psychopathy from a set of criteria, which included DSM-II, DSM-III, DSM-III-R, and Psychopathy Checklist (PCL) scores. Through principal components analysis we identified four factors: (a) impaired relationships and deception, (b) aggressive behavior, (c) nonviolent delinquency, and (d) frequent sexual relationships not attributable to mental illness/substance abuse. These factors appear to be more closely allied with PCL and two new proposals for DSM-IV than the current DSM-III-R model.We appreciate the efforts of David Di Giuseppe and Ireneusz Celejewski in data entry and management as well as the cooperation of the Ontario Science Centre in making this study possible.     

Self-control strength in prison inmates with antisocial personality disorder

The present study aimed to examine the difference in self-control strength between individuals with and without antisocial personality disorder (ASPD) in a Chinese male prisoner sample. Thirty-seven male inmates who met the criteria for DSM-IV ASPD and 38 who did not were asked to watch a four-minute silent videotape of an interview, and ignore the words displayed on screen during the videotape to deplete their ego strength. A handgrip task was conducted both before and after watching the videotape, with participants’ time squeezing the handgrip being the dependent variable. Result showed a significant interaction between group (ASPD/no-ASPD group) and time (baseline/post-manipulation measure). The post-manipulation result was significantly worse than the baseline result for the ASPD group, but not for the no-ASPD group. These results indicate that tasks that contribute to ego depletion lead to a deficit of self-control strength in prisoners with ASPD.     

Childhood identification and prophylaxis of antisocial personality disorder

Physiological and psychological characteristics show considerable similarity between children with attention deficit disorder with hyperactivity (ADDH) and adults with antisocial personality disorder (ASPD). Prospective studies of ADDH children, with or without conduct disorder (CD), show a high outcome of ASPD. Recently, other forms of treatment have been added to the traditional psychopharmacological agents used for ADDH. If medication and new treatment modalities are administered for a period of three years, a recent controlled study indicates that the mean number of arrests for felony offenses and the mean number of institutionalizations are reduced at a p less than 0.0001 level (1.32 versus 0.19 and 0.49 versus 0.00, respectively).     

Diagnosis of antisocial personality disorder and criminal responsibility

The present study empirically investigates whether personality disorders and psychopathic traits in criminal suspects are reasons for diminished criminal responsibility or enforced treatment in high security hospitals. Recently, the tenability of the claim that individuals with personality disorders and psychopathy can be held fully responsible for crimes has been questioned on theoretical bases. According to some interpretations, these disorders are due to cognitive, biological and developmental deficits that diminish the individual's accountability.The current article presents two studies among suspects of serious crimes under forensic evaluation in a Dutch forensic psychiatric observation clinic. The first study examined how experts weigh personality disorders in their conclusions as far as the degree of criminal responsibility and the need for enforced forensic psychiatric treatment are concerned (n = 843). The second study investigated associations between PCL-R scores and experts' responsibility and treatment advisements (n = 108).The results suggest that in Dutch forensic practice, the presence of a personality disorder decreased responsibility and led to an advice for enforced forensic treatment. Experts also take characteristics of psychopathy concerning impulsivity and (ir)responsibility into consideration when judging criminal accountability. Furthermore, they deem affective deficiencies sufficiently important to indicate suspects' threat to society or dangerousness and warrant a need for forensic treatment.     

Rethinking the DSM III-R diagnosis of antisocial personality disorder

The diagnosis of antisocial personality disorder (APD) has undergone substantive revisions in the DSM III and DSM III-R criteria. Within the context of these modifications, the authors reviewed the current research and psychometric models of APD. They found considerable variability among these models which in turn appear to be only modestly correlated with DSM standards. Recommendations are offered to reduce symptom variations subsumed within APD and to explore a reformulation of APD for achieving greater congruence with research findings.     

Static risk factors predict sexual misconduct among incarcerated female sexual offenders

Abstract

Although there has been a great deal of research conducted on sexual offenders in recent years, the vast majority of studies have focused on male perpetrators. Little is known about female sexual perpetrators, due primarily to the small number of offenders/offences and sociocultural factors. This study evaluated if there was an association between static risk factors [as delineated by the Static-99 and Rapid Risk Assessment for Sex Offender Recidivism (RRASOR)] and institutional sexual misconduct for incarcerated female sexual offenders. In addition to demographic information, total Static scores were obtained from a file review along with institutional conduct reports. The STATIC-99 and RRASOR scores from intake information significantly predicted sexual conduct reports in prison.     

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.     

The impact of collaborative case formulation with high risk offenders with personality disorder

This study investigated the impact of completing collaborative case formulations (CFs) on the professional relationship between Offender Managers (OMs) and high risk offenders with personality disorder (PD). It was hypothesised that collaborative CFs would result in significantly improved professional relationships, offender engagement and OM confidence. Seventy-seven OMs were randomised into control and formulation groups and randomly allocated a high risk offender with PD. OMs in the formulation group attended advanced formulation training and constructed collaborative CFs. No collaborative CFs were constructed by the control group. All participants subsequently completed a measure of relationship quality. OMs also completed a perceived benefits rating scale evaluating perceived offender engagement and OM confidence. OMs in the formulation group reported significantly higher overall relationship quality, a stronger working alliance and greater confidence. Offenders in the formulation group reported significantly higher degrees of trust in their OMs. Results indicate that completing CFs collaboratively with high risk offenders with PD may have a small, beneficial impact on the quality of OM/Offender relationships and increase OM confidence.     

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.     

An investigation into maladaptive personality functioning in Internet sex offenders

Abstract

Psychopathology and maladaptive personality functioning are purported to play a significant role in the aetiology of sexual offending (e.g. Ahlmeyer et al., 2003; Murray, 2000). The present study examined whether this applied to those individuals who commit sexual offences against children via the Internet. The sample consisted of 30 Internet sex offenders, all completing mandatory 3-year community rehabilitation orders. Participants were administered the Personality Assessment Inventory (PAI) and two questionnaires pertaining to demographic characteristics and personal history. Results indicated that Internet sex offenders differed significantly from the normal population on a number of PAI scales, most strikingly: Warmth, Dominance, and Depression. This suggests that Internet offenders may experience deficits in interpersonal functioning and affective difficulties. Significant correlations were also found between hours per week spent accessing indecent images of children and PAI scales assessing Schizophrenia, Borderline Features, Depression, and Warmth. These findings are considered in relation to current empirical research and implications for therapeutic practice and future research are discussed.     

Review on female sexual offenders: findings about profile and personality

Introduction

Although in the past sexual abuse was perceived as an issue connected only with males the contemporary literature is placing increasing emphasis on the role of female sexual perpetrators. There is still disagreement about the definition of sexual abuse, the frequency that it occurs and the characteristics of the women that are sexual abusers.

Methods

Thorough research of the main databases (MEDLINE and PsycInfo), for case reviews and studies along with restriction on European and North American literature, is due to perceived culture differences. Further investigation for relevant studies through web search engines such as Google, locates agencies and organizations that are interested and connected to sexual abuse issues.

Results

Distinction between sexual offense and sexual abuse has as a result difference in the characteristics of female sexual perpetrators. They are mainly young (age up to 36 years old), friends or relatives of the victim, using more persuasion and psychological coercion and legally charged in a lesser extent compared with male abusers. However the psychological consequences for the victim can be more severe.

Conclusion

A unanimous view of what is female sexual abuse is difficult to reach. Often it is under reported, unrecognized or considered ethically more acceptable than male abuse. It is also connected with an increased self-report of history of sexual abuse of the perpetrators. A typology of female sexual abusers should be developed. Treatments focusing on different psychological interventions along with prevention and public awareness can be a powerful tool in reduction of sexual abuse perpetrated by females.     

A controlled,problem-solving,group-based intervention with vulnerable incarcerated young offenders

Recent research has indicated that vulnerable incarcerated young offenders--such as those at risk of suicidal behaviour, those on formal protection due to their inability to assimilate into mainstream, and those who are bullied but remain in normal circulation--display impoverished problem-solving abilities. Furthermore, deficits in their problem-solving skills are significantly correlated with levels of anxiety, depression, and hopelessness. This study evaluated the effectiveness of a time-limited, group-based problem-solving training intervention compared with a no-treatment control for vulnerable, incarcerated young offenders. A total of 46 young offenders were equally allocated to intervention or control groups. Intervention participants experienced significant reductions in their levels of anxiety, depression, and hopelessness and improvement in their self-assessed social problem-solving abilities. Gains in aspects of self-assessed problem-solving ability and mental health for the intervention group continued to be evident at 3-month follow-up. Methodological concerns in this study and directions for future research are discussed.     

An evaluation of intimate partner violence intervention with incarcerated offenders

The following study is an evaluation of the Moderate Intensity Family Violence Prevention Program (MIFVPP). The sample consisted of 298 male federal offenders who participated in the MIFVPP while incarcerated or on release within the community. Participants were assessed pre-, mid-, and postprogram using an assessment battery consisting of self-report questionnaires and facilitator-rated evaluation scales. Results of the study found uniform and significant (p < .001) improvement for pre and post program change in the self-report questionnaires and in the facilitator ratings. A positive improvement in motivation, whether assessed by the participant or facilitator, was associated with improvement in program outcomes and significant within, between, and interaction effects were found when participant program performance over time was compared among grouped postprogram ratings of motivation. The implication for the efficacy of addressing offender motivation to change in intimate partner violence (IPV) interventions is discussed.     

Case study of three generations of incarcerated sexual offenders

In an attempt to better understand sexual offenders, this study with the aid of a genogram utilizing a grounded theory approach examined the experiences of three generations of incarcerated sexual offenders. The offenders in this study described experiences characterizing a continuum of failure to control their own criminal offences and perpetuity of their chronic conduct despite its serious consequences including imprisonment. One implication of those findings is that some incarcerated chronic sexual offenders possess a predisposition towards a sexual addiction and accordingly, a biological inheritance and environmental factors contribute to their conduct. Therefore, it is recommended for correctional systems including supervisory care that mandatory treatment within a medical model of confinement as opposed to a punitive model be established in order to curve recidivism and victimization levels. A longitudinal study should be conducted consisting of family members who are violent sexual offenders.     

Dangerous and severe personality disorder: An investigation of the construct

Introduction of the construct “Dangerous and Severe Personality Disorder” (DSPD) by the UK Home Office and Department of Health has provoked strong debate and opposition. Its aims and that of proposed subsequent legislation was to enhance public protection by identifying and detaining a minority of persons with severe personality disorder who pose a high risk of serious sexual/violent offending. The most serious criticism was the ethical implication of allowing indefinite detention of people without criminal convictions. More recently, policy emphasis has shifted towards treatment. 1396 male prisoners serving sentences of 2+ years for sexual/violent offenses were prospectively interviewed (personality disorders, psychopathy, and risk) at a mean follow-up of 2 years. The prevalence of DSPD was 15%. Significantly more re-offended. Five DSPD offenders would need treatment to prevent one violent act. Based on an estimate of attributable risk, successful treatment of DSPD could reduce violent re-convictions among DSPD offenders by 71% and violent/sexual re-offenses in the prison population by 27%. DSPD criteria correctly identify high risk prisoners but primarily through risk-related demographic features. DSPD does not accurately identify serious sexual/violent re-offenders. The DSPD programme may reduce major violent re-offending if treatment interventions prove effective.     

Cluster analysis of a forensic population with antisocial personality disorder regarding PCL-R scores: differentiation of two patterns of criminal profiles

Fifty six cases of a forensic population were submitted to a cluster analysis to observe the aglomerative behavior in relation to the total scores of the items comprising the PCL-R Psychopathy Checklist Revised [R.D. Hare, Manual for the Hare Psychopathy Checklist-Revised, Multi-Health System, Toronto, 1991]. The analysis indicated two independent types of antisocial personality disorders, not identified in the PCL-R in its standardized form, one of them being strongly associated with criminal conduct and the other with psychopathic personality. Such clusters were stable when the analysis was replicated with other hierarchical algorithms, and also, they were independently extracted via the k-means method without having previously fixed the value for k. One of the clusters concentrated the PCL-R highest scores, indicating that it is the prototypical psychopathic character determinant.     

Development of the Observation Scale for Aggressive Behavior (OSAB) for Dutch forensic psychiatric inpatients with an antisocial personality disorder

The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are "placed at the disposal of the government". The scale should have the sensitivity to measure changes in the possible determinants of aggressive behavior, such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills. In developing the OSAB 40 items were selected from a pool of 82 and distributed among the following a priori scales: Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent (to aggressive behavior), Sanction (for aggressive behavior) and Social behavior. The internal consistency of these subscales was good, the inter-rater reliability was moderate to good, and the test-retest reliability over a two to three week period was moderate to good. The correlation between the subscales Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent, Sanction was substantial and significant, but the anticipated negative correlation between these subscales and the Social behavior subscale could not be shown. Relationships between the corresponding subscales of the OSAB and the FIOS, used to calculate concurrent validity, yielded relatively high correlations. The validity of the various OSAB subscales could be further supported by significant correlations with the PCL-R and by significant but weak correlations with corresponding subscales of the self-report questionnaires. The Observation Scale for Aggressive Behavior (OSAB) seems to measure aggressive behavior in Dutch forensic psychiatric inpatients with an antisocial personality disorder reliably and validly. Contrary to expectations, a negative relationship was not found between aggressive and social behavior in either the OSAB or FIOS, which were used for calculating concurrent validity.