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.     

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.     

Characteristics that predict firesetting in male and female mentally disordered offenders

Few studies have adequately explored the characteristics of male and female mentally disordered firesetters and compared these to those of non-firesetting mentally disordered offenders. Furthermore, there is a paucity of research examining the characteristics which can predict repeat firesetting within this population. The current study aimed to examine similarities and differences in the characteristics of (1) male and female mentally disordered firesetters, (2) male and female mentally disordered firesetters compared to non-firesetting offenders, and (3) one-time and repeat firesetters. Furthermore, the ability of these characteristics to predict offence status (i.e. firesetter or non-firesetter) and repeat firesetting was explored. Information was collected from patient hospital records for 77 (43 firesetters, 34 non-firesetters) mentally disordered offenders; including sociodemographic, family and personal background, psychiatric, and offence history factors. The findings suggest that mentally disordered firesetters are similar to their non-firesetting counterparts on key characteristics; however, firesetters are more likely to have an expressed interest in fire/explosives and a diagnosis of a schizophrenic disorder and female firesetters are more likely to have a higher number of firesetting incidents than males. Furthermore, findings suggest that fire interest is the largest predictor of repeat firesetting. Clinical implications in terms of treatment and risk assessment 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.     

How do professionals experience working with offenders diagnosed with personality disorder within a prison environment?

To explore the different experiences of a Multidisciplinary Team working with offenders diagnosed with personality disorder (PD) and produce a substantive model of the Offender PD Pathway strategy from a staff perspective. Fourteen participants were recruited from ‘Unit A’ located within a high security prison. Semi-structured interviews were conducted with participants and the data collected were analysed using constructivist grounded theory. A model was constructed depicting the experiences of those working with offenders with PD. Main themes identified were: prison environment; synergy of the workforce; understanding of the client; individual perceptions; support; and personal change. Although there was enough similarity within the participants’ responses to consider them to be a homogenous population, there were some noticeable differences in trends of responses evident between the two sub-groups of health service-based clinical staff and prison staff as expressed in the model. There is interplay between factors which influence an individual’s experience of working with offenders with PD. How a member of staff experiences working with offenders with PD depends on more than just the nature of the client and the challenges they pose. These factors external to the client group appear to have a significant impact on the professional and their emotional experiences of their work.     

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.     

The implementation of case formulation by probation officers: service user and carer views

Background: The recent UK Government strategy on high-risk offenders with personality disorders (PD) proposes improved identification of this group, assessment of their treatment needs through case formulation (CF) and the subsequent provision of treatment pathways. Little is known about service user and carer views on this strategy. Aims/Hypotheses: This study sought to identify the views of personality-disordered (PD) offenders and carers on the proposed role of Probation staff in CF. Methods: Three focus groups were carried out, two with service users and one with carers, with a total of 10 participants overall. Results: Five themes emerged: ‘power’, ‘conflicting roles’, ‘trust’, ‘building a relationship through consistency of care’ and ‘hope and possibility’. Conclusions/Practical implications: Offenders and carers were sceptical regarding the proposed role of Offender Manager (OMs) in CF and this could pose a potential barrier to the successful implementation of the strategy.     

Are they different? A comparison of risk in Dangerous and Severe Personality Disordered and Personality Disordered hospitalized populations

Abstract

There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high risk of future recidivism. In the UK, the Dangerous and Severe Personality Disorder (DSPD) programme was initiated to deal with just this group. It is unclear, yet, whether those admitted to these services are different from those admitted to conventional personality disorder (PD) services. In the present study, 60 patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including (1) an index of predicted future violence, (2) previous offending behaviour and (3) ‘pre-treatment’ levels of institutional risk-related behaviour. Results indicated that DSPD patients do pose a greater clinical and management risk, have a higher number of ‘pre-treatment’ risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients. The implications and limitations of these results are discussed.     

精神障碍吸毒者刑事责任能力研究

随着毒品在我国的蔓延,吸毒的人数渐渐增多,精神障碍的吸毒者犯罪也开始引起相关部门的注意,对这一特殊犯罪人群能否比照精神病人来处理意见不统一。笔者介绍了其他诸国的相关法律规定,结合本国国情和相类似的法律规定,阐明了对精神障碍的吸毒者犯罪一般作完全刑事责任能力评定为最优的观点。     

A comparative analysis of media reports of U.S. parricide cases with officially reported national crime data and the psychiatric and psychological literature

This article is a content analysis of 150 unique cases of children killing parents in the United States as reported in the electronic news media. The accuracy of online coverage of U.S. parricide incidents is assessed using two types of resources: officially reported national statistics on known parricidal incidents and the psychological and psychiatric literature on matricide and patricide. Comparisons of news accounts of media-reported U.S. parricide cases with Supplementary Homicide Report data indicate that electronic media coverage of parricide cases focused on the more sensational and unusual parricides. Analyses of these media accounts by offender age found 13 significant differences between juvenile and adult offenders. Ten of these 13 differences related to motive and Heide's parricide offender types (severely abused, severely mentally ill, and dangerously antisocial) and were consistent with the mental health-related literature in this area. The limitations and directions for future research are discussed at length.     

Prevalence of Criminal Thinking among State Prison Inmates with Serious Mental Illness

To examine the prevalence of criminal thinking in mentally disordered offenders, incarcerated male (n = 265) and female (n = 149) offenders completed measures of psychiatric functioning and criminal thinking. Results indicated 92% of the participants were diagnosed with a serious mental illness, and mentally disordered offenders produced criminal thinking scores on the Psychological Inventory of Criminal Thinking Styles (PICTS) and Criminal Sentiments Scale-Modified (CSS-M) similar to that of non-mentally ill offenders. Collectively, results indicated the clinical presentation of mentally disordered offenders is similar to that of psychiatric patients and criminals. Implications are discussed with specific focus on the need for mental health professionals to treat co-occurring issues of mental illness and criminality in correctional mental health treatment programs.     

STABILITY AND CHANGE IN ANTISOCIAL BEHAVIOR: THE TRANSITION FROM ADOLESCENCE TO EARLY ADULTHOOD*

This longitudinal research, based on two samples of respondents who were differentially involved in delinquency as teenagers, identifies latent trait and life‐course correlates of the persistence of antisocial behavior into young adulthood. The data show that prior delinquency is a stable predictor among respondents in both our household and institutional samples. However, although social bonding has a substantial impact on continued criminality among the household respondents, its influence is minimal among those who were previously institutionalized. The data suggest that the bonding levels and antisocial behavior of serious offenders are more resistant to change than are those of more typical and less serious offenders.     

从经典判例之行为人处置看强制监护治疗

中国司法精神病学研究人员对野兽条例、妄想标准、不可抗拒冲动检验、M＇Naghten规则等关于精神病人刑事责任能力评定标准的典型案例耳熟能详,但对这些案例中的行为人处置却不甚熟悉。介绍这些行为人的最终处置,并结合国内外监护治疗研究现状,对肇祸精神病人的强制监护治疗制度进行探讨。     

Dangerous mentally disordered criminals: unresolvable societal fear?

The average person fears dangerous criminals, especially those suffering from mental illness. Existing mental health and criminal justice systems provide social control for some of these dangerous individuals, but may be inadequate to deal with those mentally disordered offenders who were not found not guilty by reason of insanity (NGI). In California, innovative laws have attempted to address this problem. However, putative lack of efficacious treatment of mentally ill criminals, insufficient economic support, and individual liberty concerns loom as limiting factors in solving the criminal and psychiatric recidivism problem posed by non-NGI dangerous mentally disordered offenders.     

An examination of the role of neuropsychological deficits in mentally disordered sex offenders

Abstract

The present study examines the neuropsychological model of sexual offending proposed by Flor-Henry (1987) in relation to a group of mentally disordered sex offenders and a control group of mentally disordered non-sex offenders. The model predicts that the sex offender group would show specific left fronto-temporal dysfunction as compared with the control group. The results, while in the predicted direction, failed to reach statistical significance. Implications and limitations of the study are discussed.     

Delays in attentional processing when viewing sexual imagery: The development and comparison of two measures

Purpose. Critically important to effectively treating and managing sexual offending is the identification or validation of an offender's deviant sexual interests as the nature of their sexual interests is what demarcates repetitive sexual offenders from non‐offenders and lower risk offenders. As an alternative or verification to self‐report or phallometric measures, focus has turned to attention‐based measures. These measures assess sexual content‐induced delay (SCID), a specific form of attentional bias associated with preferred sexual content (images or text). Viewing time (VT) and choice reaction time (CRT) were developed and utilized to assess sexual interest via SCID ( Geer & Bellard, 1996 ) and examine the measures’ clinical utility via estimates of sensitivity and specificity. Method. Participants were 44 youth non‐sexual offenders, 60 university students, and 22 adult sexual offenders. Differences between groups were examined on various sub‐scores and receiver operator characteristic curves provided information on clinical utility. Results. The VT and CRT measures produced subtest scores with high reliability in all three samples. There were significant differences in VT between the adult sexual offenders and the youth non‐sexual offenders, but not between the youth non‐sexual offenders and the university students. Some of the VT subtests demonstrated good clinical utility in their ability to differentiate adult heterosexual sexual offenders from non‐sexual offenders (e.g., area under the curve (AUC) = 0.87 female mature images, 0.88 male child images). Interestingly, the VT and CRT measures provided significantly different results. Conclusion. The results of this study provide further evidence that measures of SCID are accurate and are useful as indications of sexual interest. Differences between measures suggest, however, that further work is required.     

Legal narratives as significant news sources about mental illness and violent crime

Media coverage about people affected by mental illness is an area of research that is extensively examined. Many scholars argue that the media depicts people with mental illness as inherently violent and dangerous within sensational narratives. These depictions are criticized for reinforcing the social stigma and disadvantages many of the mentally ill face. The media does, however, require news sources and, in the context of crime and mental illness, the courts are a significant source. Through qualitative content analysis of Australian newspaper articles, this research examines an under-researched and incompletely theorized area. In doing so, it demonstrates that media depictions of some mentally ill offenders reflect and heavily draw upon legal narratives and what is argued in court about these offenders in the context of criminal responsibility and legal insanity.     

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.     

Personality typologies of male juvenile offenders using a cluster analysis of the Millon Adolescent Clinical Inventory introduction

The Millon Adolescent Clinical Inventory (MACI) is a unique adolescent instrument that attempts to delineate between personality and acute symptoms. This study sought to explore typologies based on the Personality Pattern scales of the MACI in a sample of detained male juvenile offenders (N = 103). A Ward's method cluster analysis yielded a four-cluster solution, and each cluster was provided a clinically relevant label: (a) disruptive, antisocials; (b) agreeable, antisocials; (c) anxious, prosocials; and (d) reactive, depressives. The largest group consisted of the reactive depressives (n = 41). This suggests the importance of considering the role of internalizing problems as a conduit to delinquency in addition to antisocial personality. No interaction between cluster membership and offense history or race was found.     

Female impulsive aggression: A sleep research perspective

The rate of violent crimes among girls and women appears to be increasing. One in every five female prisoners has been reported to have antisocial personality disorder. However, it has been quite unclear whether the impulsive, aggressive behaviour among women is affected by the same biological mechanisms as among men. Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Most psychiatric disorders are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep (SWS), the physiologically significant, refreshing part of sleep. Among men with antisocial behaviour with severe aggression, on the contrary, increased SWS has been reported, reflecting either specific brain pathology or a delay in the normal development of human sleep patterns. In our preliminary study among medication-free, detoxified female homicidal offenders with antisocial personality disorder, the same profound abnormality in sleep architecture was found. From the perspective of sleep research, the biological correlates of severe impulsive aggression seem to share similar features in both sexes.