The Internet is a scary place: How does evidence source and examinee race or ethnicity influence determinations of threat?

Violent rhetoric online is becoming increasingly relevant to the practice of forensic mental health assessment as examinee's virtual lives may transform into real-world acts of violence. With the rise of a diverse subculture of violent online communities, the aim of the present study was to inform how concerns with online sources of collateral data and racial/ethnic biases may influence determinations of violence potential. Using an experimental design, jury-eligible participants (N = 278) and forensic mental health experts (N = 78) were presented with mock Twitter (now referred to as X) posts that varied by data source (i.e., how information was accessed) and the examinee's race/ethnicity. Results showed no differences in participants' ratings of data credibility, how much weight they would place on the posts in a threat assessment, or how likely the examinee was to act violently against his intended target. Implications regarding the interpretation of social media evidence, relevant limitations, and future research are discussed.

Psychopathy in Correctional Settings: Considerations for Developing and Implementing a Treatment Program

Psychopathy is associated with higher levels of violence as well as general and violent recidivism after release from prison. A disorder with a long and rich clinical and research history, psychopathy has gained an undeserved reputation as a syndrome that is unresponsive to treatment. This article presents information that undermines long-standing problematic assumptions regarding the treatability of individuals with psychopathic traits and posits that implementing treatment programs in correctional settings is critical to decrease recidivism and violence. We discuss several treatment programs that have evidenced some success in the treatment of individuals with psychopathy and have the potential to be widely implemented in correctional settings, as well as general tenets of successful treatment programs and specific targets.

MMPI-2-RF Differences Between Violent Offending and Institutional Violence Among Incarcerated Women

The examination of violence perpetrated by female offenders remains an understudied topic, as research typically focuses on male offender samples. As such, it remains unclear what personality characteristics may be associated with the perpetration of violence among female offenders. This study sought to examine the relationship between personality characteristics, as assessed by the MMPI-2-RF, and engagement in violence, within a sample of 228 incarcerated women. Results indicated that women serving time for a violent offense obtained higher mean scores on MMPI-2-RF scales related to underreporting, atypical thoughts/experiences, and paranoia. Women who obtained disciplinary reports for violence within the institution obtained higher mean scores on MMPI-2-RF scales related to behavior/externalizing dysfunction, overactivation, and aggression. Taken together, violence was most strongly associated with the MMPI-2-RF scales related to paranoia and atypical thoughts/experiences (e.g., THD, PSYC-r). This study provides new data on the viability of the MMPI-2-RF to provide critical insights into violent and aggression behavior in female inmates, an understudied population and demonstrate the instrument's efficacy in assessing characteristics associated with violent behavior.

Jail-Based Competency Restoration: What's Out There and What's Missing

Forensic systems have seen an increase in the number of defendants in need of competency restoration services. Traditionally, competency restoration services have occurred at state psychiatric hospitals. Unfortunately, the waitlists for hospital competency restoration are extensive and result in many defendants waiting in jail for more than 4 months for an inpatient bed. These waitlists have led to lawsuits forcing states to provide adequate treatment and evaluation services to mentally ill adults languishing in jails. To reduce waitlists for competency restoration and to combat the extensive delays in restoration, some states have implemented jail-based restoration to reduce hospital waitlists, restoration time, and costs to complete restoration. This review article discusses pros and cons of jail-based services and provides a framework for future services and research.

Conditional release and cannabis use: Concerns and challenges for community reintegration

This article, which serves as a perspective review, delves into the complexities of cannabis use among individuals preparing for or already on conditional release (CR). These complexities include an association between cannabis use and mental illness and dealing with the fact that the use of illicit substances, such as cannabis, is against CR rules, leading to potential revocation. A focus of this article is the deleterious effects cannabis and synthetic derivatives of cannabis can have for individuals on CR. The article concludes with six-specific recommendations for managing cannabis use in this population with a focus on careful and detailed risk assessments that considers the relationship between substance use and dangerousness, the role of protective factors, the need for a detailed conditional release plan, inpatient and community-based interventions aimed at increasing individual autonomy, and education on the dangers of cannabis use for both the treatment team and the insanity acquittee.

Strategies for Assessing and Preventing Inpatient Violence in Forensic Hospitals: A Call for Specificity

Abstract. Violence within inpatient forensic hospitals is a significant and enduring problem that leads to harm to staff and patients and causes significant expenditures. This paper provides comprehensive recommendations for developing and implementing violence reduction strategies within forensic settings that are predicated on appropriate evaluation for violence risk. This paper posits that proper strategies must take into account subtypes of violence and classifying risk with systematic and continuous evaluations. Treatment interventions should be geared to patients most at-risk for violence. By recognizing the dynamic nature of violence, hospital administrators can work closely with institution staff to provide support for improving the environment of forensic hospitals. By employing empirically based treatment interventions on both acute and long-term units, forensic hospitals can provide a safer environment.

Predicting violence risk and recidivism in female parolees: A state-wide sample

Historically, research on violence risk assessments has primarily focused on male psychiatric patients and/or inmates, with minimal attention given to female patients and/or inmates-two populations likely to differ with regard to violence risk conceptualization. To date, there is no known measure of violence risk specifically tailored to predicting risk for this population that is accurate, brief, and cost-effective. As such, the current study exclusively focused on the predictive ability of the Iowa Violence and Victimization Instrument (IVVI) for female parolees over a 30-month follow-up period. Results indicated not only was the IVVI comparable across genders, its predictive power was comparable to more established measures (i.e., Violence Risk Appraisal Guide-Revised, HCR-20 V3). Results also found the IVVI may have greater usefulness with prediction of violent and felony property offenses, but limited usefulness for predicting misdemeanor property and drug offenses. Taken together, findings gathered from the current study suggest while women are reoffending at lower rates than men, yet there are fewer gender differences in risk factors for engaging in violence than expected.

Reconsidering risk assessment with insanity acquittees

States continue to rely on conditional release (CR) as an effective and cost-effective way to manage individuals found not guilty by reason of insanity (NGRI). Research has demonstrated that insanity acquittees returning to the community have low recidivism rates and moderately low revocation rates. This study followed 238 individuals found NGRI in Oregon who were evaluated with the Historical, Clinical, Risk-20 (HCR-20; Webster, Douglas, Eaves, & Hart, 1997) and placed in the community on CR. The majority of individuals on CR (n = 157, 66%) maintained their release throughout the entire follow-up period (between 4 and 9 years), but 81 (33.6%) had their release revoked during the follow up. In considering the efficacy of violence risk assessment in predicting CR outcome with NGRI acquittees, the HCR-20 was mostly unrelated to CR outcome. Only two items from the HCR-20, both from the Risk Management scale (exposure to destabilizers and stress) predicted revocation, but not imminence to CR revocation. This paper reconsiders how risk assessments are utilized with insanity acquittees and provides a roadmap for improving risk assessments with this unique population by relying on risk assessment results to plan effective interventions to reduce the likelihood of revocation and violence. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

An update and expansion on the role of the Violence Risk Appraisal Guide and Historical Clinical Risk Management-20 in United States case law

An individual's risk for future violent behavior may be considered in various legal contexts, including civil commitment, criminal sentencing, or suitability for parole. Among the assessment tools forensic evaluators use to assess violence risk are the Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, ) and the Historical Clinical Risk Managment-20 (HCR-20)/Historical Clinical Risk Management-20, Version 3 (HCR-20^V3 ) (Webster, Douglas, Eaves, & Hart, and Douglas, Hart, Webster, & Belfrage, , respectively). Previous surveys and case law research suggest that these measures are widely used and perceived to be useful in aiding forensic clinicians. This study provides an update to Vitacco, Erickson, Kurus, and Apple () and examines the use of the HCR-20 and VRAG in United States case law. A LexisNexis review revealed 134 cases decided between 1 January 2010 and 21 December 2016 that included the HCR-20, VRAG, or both. Results revealed that these measures are typically introduced by the prosecution to inform opinions regarding general violence risk. In addition, consistent with previous research, these data suggest the introduction of the HCR-20 and VRAG is rarely challenged and, when challenged, these challenges are rarely successful. However, data suggest that courts and parole boards may focus on specific risk factors (e.g., lack of insight) at the expense of other, more objective factors. Finally, we offer suggestions for clinicians who have transitioned to the newest version of the HCR-20.

Callous-unemotional traits and early life stress predict treatment effects on stress and sex hormone functioning in incarcerated male adolescents

The stress response system is highly plastic, and hormone rhythms may "adaptively calibrate" in response to treatment. This investigation assessed whether stress and sex hormone diurnal rhythms changed over the course of behavioral treatment, and whether callous-unemotional (CU) traits and history of early adversity affected treatment results on diurnal hormone functioning in a sample of 28 incarcerated adolescent males. It was hypothesized that the treatment would have beneficial effects, such that healthier diurnal rhythms would emerge post-treatment. Diurnal cortisol, testosterone, and dehydroepiandrosterone (DHEA) were sampled two weeks after admission to the correctional/treatment facility, and again approximately four months later. Positive treatment effects were detected for the whole sample, such that testosterone dampened across treatment. CU traits predicted a non-optimal hormone response to treatment, potentially indicating biological preparedness to respond to acts of social dominance and aggression. The interaction between CU traits and adversity predicted a promising and sensitized response to treatment including increased cortisol and a steeper testosterone drop across treatment. Results suggest that stress and sex hormones are highly receptive to treatment during this window of development.

Using Technology to Improve the Objectivity of Criminal Responsibility Evaluations

Criminal responsibility (or insanity) evaluations require forensic clinicians to reconstruct a defendant's decision-making abilities, behavioral control, and emotional state at the time of the criminal act. Forensic evaluators are ultimately tasked to evaluate whether an individual had the capacity to understand right from wrong, and in some jurisdictions, determine whether the defendant lacked substantial capacity to conform his behavior to the requirements of the law as a result of a threshold condition (e.g., mental illness). Insanity evaluations are inherently complex, because they require the clinician to determine someone's mental state at some point in the past (weeks, months, or even years). Recent research on insanity evaluations underscores significant problems with the reliability and validity of these evaluations. However, technological advances including social media (e.g., Facebook and Twitter), mandating that law enforcement videotape interrogations, and the use of body and dashboard cameras can aid clinicians in improving the precision and quality of insanity evaluations. This article discusses practical guidelines and ethics-related concerns regarding the use of technology to improve the objectivity of criminal responsibility evaluations.

Predicting violence and recidivism in a large sample of males on probation or parole

This study evaluated the utility of items and scales from the Iowa Violence and Victimization Instrument in a sample of 1961 males from the state of Iowa who were on probation or released from prison to parole supervision. This is the first study to examine the potential of the Iowa Violence and Victimization Instrument to predict criminal offenses. The males were followed for 30months immediately following their admission to probation or parole. AUC analyses indicated fair to good predictive power for the Iowa Violence and Victimization Instrument for charges of violence and victimization, but chance predictive power for drug offenses. Notably, both scales of the instrument performed equally well at the 30-month follow-up. Items on the Iowa Violence and Victimization Instrument not only predicted violence, but are straightforward to score. Violence management strategies are discussed as they relate to the current findings, including the potential to expand the measure to other jurisdictions and populations.

Improving the Detection of Feigned Knowledge Deficits in Defendants Adjudicated Incompetent to Stand Trial

Malingering is relatively common in criminal forensic evaluations as base rates of malingering have ranged from 20% to 30%. Given that the most prevalent criminal forensic evaluation is the assessment of competency to stand trial, the assessment of feigning during competency evaluations is necessary for accurate findings. Most of the response style literature focuses on feigning mental health symptoms, but in competency evaluations, individuals may attempt to feign legal knowledge deficits in order to be found incompetent to stand trial. The current investigation includes two studies: 195 students instructed to simulate feigned mental illness or incompetence to stand trial and one using a sample of 130 state psychiatric hospital residents who had been adjudicated incompetent to stand trial. The purpose of the study was to evaluate the Inventory of Legal Knowledge’s (ILK; Musick & Otto, 2010) ability to detect individuals who are feigning legal knowledge deficits. Classification utility statistics, including sensitivity, specificity, positive predictive power, and negative predictive power are provided for each cut-score on the ILK beginning with a cut-score of 24 (which is the lower end of the range of chance) are provided. The current cut-score of 47 provided in the professional manual of the ILK was shown to create a large number of false positives and suggests that modifications to this cut-score are required.

Psychosis and Substance Use: Implications for Conditional Release Readiness Evaluations

In Foucha v. Louisiana (1992), the United States Supreme Court ruled that individuals adjudicated not guilty by reason of insanity (NGRI) could not remain in a forensic hospital if they were no longer mentally ill and dangerous. Since this decision, a variety of important questions have arisen related to the insanity defense and what should happen to insanity acquittees post-adjudication. This article provides an analysis of clinical issues confronting forensic examiners when psychosis as a result of substance abuse is the underlying condition supporting an insanity defense. To accomplish this analysis, this article provides the reader with a review of literature showing the complex relationship between psychosis and substance abuse. Second, this article investigates how substance-induced psychosis may impact both insanity opinions and subsequent conditional release decisions. Third, the article aims to provide research-driven information to assist clinicians in conducting conditional release evaluations. Finally, this paper provides a model for evaluating dangerousness in the context of conditional release evaluations. Given the substantial comorbidity between substance abuse and psychosis, it is critical for researchers and clinicians to consider potential effects of substance abuse when evaluating insanity acquittees for conditional release, especially as substance use relates to future dangerousness. Copyright © 2016 John Wiley & Sons, Ltd.

Projecting Risk: The Importance of the HCR-20 Risk Management Scale in Predicting Outcomes with Forensic Patients

The present study evaluates data from 116 forensic inpatients who underwent violent risk assessments, which included the Historical, Clinical, Risk-20 (HCR-20), from 2006 to 2013 as part of an opportunity to be conditionally discharged from state forensic facilities. Of the 116 inpatients, 58 were never released, 39 were released and returned to a hospital, and 19 were released and never returned. Results from analyses of variance and multinomial logistic regression found the risk management (R) scale of the HCR-20 successfully predicted group membership in that higher scores were associated with a greater likelihood of not being released from a forensic facility or returning to a forensic facility after release. The results of this study indicate that clinicians should consider community-based risk variables when evaluating forensic patients for potential return to the community. This research demonstrates that clinicians failing to fully consider dynamic risk factors associated with community integration jeopardize the quality and thoroughness of their violence risk assessment with regards to readiness for release. Copyright © 2016 John Wiley & Sons, Ltd.

Eliciting Responsivity: Exploring Programming Interests of Federal Inmates as a Function of Security Classification

Research supports the effectiveness of the Risk-Needs-Responsivity model for reducing criminal recidivism. Yet programming interests of inmates--one facet of responsivity--remain an understudied phenomenon. In the present study, we explored the programming interests of 753 federal inmates housed across three levels of security. Results suggest that inmates, as a group, prefer specific programs over others, and that some of their interests may differ by security level. We discuss possible implications of these findings.

Competency to Proceed to Trial Evaluations and Rational Understanding

In Dusky v. United States, the United States Supreme Court established "rational understanding" as a necessary component of a defendant's competency to stand trial. Yet, rational understanding has engendered misunderstanding, stemming from inconsistent court rulings and lack of systematic attention given to definitions of rationality. The purpose of this article is to assist with the conceptualization of rational understanding as it relates to competency to proceed to trial. This will be accomplished through a review of legal decisions and scholarly papers that provide various definitions of rationality. We discuss the suitability of standardized instruments of competency and how they may assist in providing a valid metric for evaluating rational abilities. We also provide discussion of how case law, in conjunction with psycholegal research, can be used to gain nuanced insight into operationalizations of rational understanding. By gaining a thorough understanding of rationality in competency to proceed to trial evaluations, clinicians may improve on the quality and foundation of their evaluations.

Coupling of the HPA and HPG axes in the context of early life adversity in incarcerated male adolescents

The effects of early life adversity can be observed across the lifespan, and the hypothalamic-pituitary-adrenal (HPA) and hypothalamic-pituitary-gonadal (HPG) axes could be mechanistic intermediaries underlying this phenomenon. The current study examined 50 adolescent males aged 12-18 in a maximum-security correctional and treatment setting. Saliva samples were collected five times a day for 2 days and assayed for cortisol, testosterone, and DHEA. Youth completed semi-structured life stress interviews and self-reports of child maltreatment to index adversity. When youth had higher testosterone levels, they had higher cortisol and DHEA levels, indicating positive "coupling" of the HPA-HPG axes. In addition, children experiencing greater life adversity had tighter coupling of the HPA-HPG axes. Additional analyses hint that coupling may be driven largely by HPG axis functioning. Results indicate that positive coupling of the HPA-HPG axis is observed within incarcerated adolescents, especially for those with the greatest life stress.

Predicting voluntary and involuntary readmissions to forensic hospitals by insanity acquittees in Maryland

The current study investigated factors associated with voluntary and involuntary readmissions to forensic hospitals 356 insanity acquittees on conditional release in the state of Maryland from 2007, 2008, and 2009 and monitored their community progress for a 3-year follow-up period. The results indicated that voluntarily readmitted insanity acquittees had fewer reported arrests on conditional release and fewer reported instances of non-compliance with treatment compared with insanity acquittees who were returned involuntarily to hospital. As expected, arrests and treatment non-compliance predicted involuntary readmission. A third group of insanity acquittees who were not readmitted on conditional release presented with numerous differences compared with voluntarily and involuntarily readmitted acquittees. These included a longer duration in the community prior to any psychiatric readmission and fewer community psychiatric admissions than both the voluntary and involuntary groups. Data from this study provide useful information on where community monitoring resources for insanity acquittees may best be allocated.

Decision-making in post-acquittal hospital release: how do forensic evaluators make their decisions?

A large number of individuals are acquitted of criminal charges after being found "not guilty by reason of insanity." Most of these individuals are hospitalized and later seek hospital discharge under a court-ordered provision called conditional release ("CR"). Courts rely on opinions from forensic evaluators to determine acquittees' readiness for CR. However, how evaluators make these decisions are unknown. Eighty-nine CR readiness evaluators from nine states were surveyed to understand which factors evaluators prioritize and to understand evaluators' assessment methodologies and their beliefs about the CR process itself. Little uniformity was found among evaluators on any aspect of the decision-making process. Evaluators utilized a wide variety of methodologies when making their decisions on readiness for CR. Moreover, evaluators' conceptualizations of the CR process itself varied widely. The results highlight the difficulty and confusion evaluators face when conducting CR readiness evaluations, and demonstrate the need for enhanced training, statutory guidance, and standardized evaluation protocols for these evaluations.

Evaluating conditional release in not guilty by reason of insanity acquittees: a prospective follow-up study in Virginia

Detailed research on treatment and risk management approaches with not guilty by reason of insanity acquittees (NGRI) during their conditional release is needed as states increasingly use community-based services for these individuals. Grounded in case law, and supported by follow-up studies demonstrating low recidivism rates, states have been encouraged in their efforts to conditionally release NGRI acquittees. The authors evaluated a state-wide sample of 127 NGRI acquittees released into the community after spending a mean of 61.63 months (SD = 76.54) in the hospital. One hundred individuals were committed to the hospital for lengthier treatment (M hospital time = 77.23 months, SD = 79.84), but 27 individuals were released to the community after a relatively short hospital stay (M hospital time = 5.60 months, SD = 3.01). Regarding release, 96 individuals (75.6%) maintained their conditional release. After evaluating a host of demographic and standardized risk data, the following variables predicted revocation on conditional release: previous failure on conditional release, nonadherence with hospital treatment, dangerousness to others, and previous violent charges. A multivariate survival analysis determined criminal behavior and previous failure on conditional release predicted time to revocation. The results of this study demonstrate the importance of considering standardized risk variables in the community-based management of forensic patients. In addition, the data are supportive of continued attempts at moving insanity acquittees from the hospital to the community via conditional release.

Beyond physiological hypoarousal: the role of life stress and callous-unemotional traits in incarcerated adolescent males

The development of antisocial behavior in youth has been examined with neurobiological theories that suggest that adolescents who are less responsive to their environments are less likely to develop empathy in the absence of extant physiological arousal. However, little attention is paid to these individuals' social context. Individuals with adverse early experiences can also exhibit attenuated physiological arousal. The current investigation examines whether psychopathic symptoms or life stress exposure is associated with cortisol and its diurnal rhythm within 50 incarcerated adolescent boys (14-18years old). Ten saliva cortisol samples were collected 1-2weeks after admission to a maximum-security juvenile facility. Hierarchical Linear Modeling distinguished waking cortisol levels, the awakening response (CAR) and the diurnal rhythm. Multiple interviews and self-report measures of CU traits and stressor exposure were collected. Boys with higher levels of CU traits or greater life stress exposure had flat diurnal rhythms and a steeper awakening response in analyses with lifetime stress exposure specifically. Nonetheless, boys who were elevated on both CU traits and prior stress exposure had steeper diurnal rhythms. These results extend neurobiological theories of cortisol and illustrate that boys with the combination of severe stress with CU traits have a unique physiological profile.

Comment: Holding Psychopaths Morally and Criminally Culpable

Theoretical arguments that psychopathy eliminates individual responsibility for illegal behavior and can therefore serve as a basis for an insanity defense are largely premised on emotional characteristics of psychopathy that impede the individual’s capacity to appreciate right from wrong. We offer arguments and countervailing evidence indicating psychopaths do have the capacity to appreciate right from wrong and therefore should not be absolved of criminal responsibility.

Psychopathy's influence on the coupling between hypothalamic-pituitary-adrenal and -gonadal axes among incarcerated adolescents

Conduct disorder (CD) is a heterogeneous diagnosis, leading researchers to initiate studies focused on neurobiological mechanisms underlying this disorder. One specifier of CD currently considered for inclusion in the DSM-V is callous-unemotional (CU) traits, a key component of psychopathy. CU traits are thought to have neuroendocrine underpinnings, yet little is known about hypothalamic-pituitary-adrenal (HPA) and -gonadal (HPG) hormones in the context of psychopathic traits. The current study sought to identify daily coupling patterns between HPA and HPG hormones in order to clarify distinct neurobiological underpinning associated with psychopathic/CU traits. Fifty incarcerated adolescent males who met criteria for CD were recruited and provided 10 saliva samples across 2 days. Participants completed the Psychopathy Checklist Youth Version (PCL:YV) and Inventory of Callous Unemotional Traits (ICU) on a third day. Diurnal cortisol, testosterone, and DHEA functioning was modeled via hierarchical linear modeling. Psychopathy subscales from the measures administered were used as predictors of daily coupling patterns between these hormones. Results indicated all three hormones were tightly coupled. Further, higher PCL-YV interpersonal scores related to greater coupling between all three hormones, whereas higher ICU callousness scores related to greater uncoupling of testosterone with cortisol and DHEA. The current study is novel in its emphasis on testing the coupling of HPA and HPG hormones among incarcerated adolescent males. Results suggest that affective and interpersonal psychopathic traits are marked by unique HPA- and HPG coupling.

Dangerousness and mental health treatment: civil commitment in the USA

Civil commitment standards in the USA have undergone dramatic changes over the past 50 years. The relevant statutes have largely focused on treatment, but how this treatment has been administered and the placement of individuals undergoing commitment have been dynamic. There have also been changes in commitment as it relates to sexual offenders and individuals deemed not competent to proceed to trial. As legislatures strive to find a balance between mandated treatment and civil liberties, changing standards of commitment provide opportunities for scholarship and research.

Dangerousness and mental health treatment: civil commitment in the USA

Civil commitment standards in the USA have undergone dramatic changes over the past 50 years. The relevant statutes have largely focused on treatment, but how this treatment has been administered and the placement of individuals undergoing commitment have been dynamic. There have also been changes in commitment as it relates to sexual offenders and individuals deemed not competent to proceed to trial. As legislatures strive to find a balance between mandated treatment and civil liberties, changing standards of commitment provide opportunities for scholarship and research.

Evaluating the relation between psychopathy and affective empathy: two preliminary studies

It is widely believed that impairment in an ability to experience affective empathy for others is a central feature of psychopathy. The authors tested this assumption by covertly manipulating and measuring state experiences of emotional contagion and empathic concern in college undergraduates and male forensic inpatients. Surprisingly, they found little evidence of a negative association between psychopathy and affective empathy in either sample. In those instances in which associations were found, they tended to indicate that higher psychopathy was associated with increased affective empathy. Follow-up analyses also revealed that psychopathy was positively associated with pervasive experiences of sadness, anger, and fear, and negatively associated with pervasive experiences of happiness among nonforensic individuals. This research raises questions about existing conceptualizations of interpersonal affect in psychopathy and offers suggestions for advancing future understanding of the role-played by emotional processes in psychopathy.

Understanding psychopathy through an evaluation of interpersonal behavior: testing the factor structure of the interpersonal measure of psychopathy in a large sample of jail detainees

Interpersonal characteristics are core features of the psychopathy construct which have a unique pattern of correlations with a variety of external correlates. To improve the assessment of interpersonal traits, the current study evaluated the internal structure of the Interpersonal Measure of Psychopathy (IM-P) through exploratory and confirmatory factor analyses (CFA) in a large sample of jail inmates. A 17-item, 3-factor (Dominance, Grandiosity, and Boundary Violations) structure evidenced good fit in European American inmates. A second CFA demonstrated good fit for this structure in a sample of African American inmates. Moreover, a multigroup CFA indicated structural invariance between European and African American inmates. External validity was tested and demonstrated through positive correlations between IM-P factor scores and Psychopathy Checklist--Revised total and facet scores (R. D. Hare, 2003) and antisocial personality disorder symptoms and diagnoses. Modest correlations between Grandiosity scores and scores on the Shipley Institute of Living Scale--Revised (R. A. Zachary, 1994) were also observed. Finally, a step-down hierarchical regression was conducted to test for racial bias of the IM-P factor scores in relation to external correlates. Little evidence was found for slope bias, but there was evidence of intercept bias for some analyses. Implications and advantages of assessing psychopathy through a comprehensive evaluation of interpersonal traits are discussed.

Paraphilias with co-morbid psychopathy: the clinical and legal significance to sex offender assessments

This article briefly discusses the historical development of the constructs of paraphilia and psychopathy. An overview of recent developments in the assessment of these constructs for legal purposes is also provided. The historical, clinical, legal, and ethical obligations of clinicians who work with persons suffering from paraphilias and co-morbid psychopathy is then reviewed. An emphasis of the current article is integrating recent developments in the construct of psychopathy into a discussion of sex offender risk assessment and treatment. The co-morbidity of psychopathy and paraphilias as factors in predicting risk of recidivism is reviewed. The need for practitioners to remain cognizant of language requirements in both legal and clinical contexts is addressed. Finally, this article reviews the legal history of sex offender legislation and its evolution into current United States Supreme Court jurisprudence.

Assessment of malingering with repeat forensic evaluations: patient variability and possible misclassification on the SIRS and other feigning measures

Patients with Axis I disorders often fluctuate markedly in their clinical presentations in forensic and other professional settings. Although such fluctuations could suggest ineffectual efforts at malingering, more likely explanations include confusion or poor insight into psychopathology, imprecision in the assessment methods, or actual changes in symptomatology. An important concern is whether such fluctuations, common in repeat forensic evaluations, might lead to false-positive results-specifically, the misclassifications of patients as malingerers. We used the Structured Interview of Reported Symptoms (SIRS) to examine the effects of repeat administration of the interview on 52 likely genuine forensic inpatients. As expected, test-retest correlations for individual SIRS scales were highly variable. Despite this variability, the magnitude of differences remained small. The SIRS produced no errors in the classification of likely genuine forensic inpatients at the first or the repeat administrations. Implications of variable clinical presentations for other feigning measures are considered.

Assessing risk in adolescent sexual offenders: recommendations for clinical practice

Accurately predicting the likelihood that an adolescent with a sex offense history will reoffend is a precarious task that carries with it the potential for extreme consequences for the adolescent offender (e.g., lifelong public registration). Recently implemented laws regarding adolescent sex offenders are dramatically upstream of current knowledge. Several of these laws were ostensibly based on the misassumption that clinicians could accurately identify adolescents at the greatest risk for sexual recidivism. However, predicting which adolescents are at greatest risk to sexually recidivate is severely constrained by limited knowledge about which predictors are most accurately linked to sexual recidivism and uncertainty over how to best make use of instruments designed to predict recidivism. This paper reviews research on risk assessment and provides a set of recommendations for conducting risk assessments with adolescent sex offenders.

An Investigation of the ECST-R in Male Pretrial Patients

Forensic clinicians have the option of employing well-validated structured interviews when conducting competency to stand trial (CST) evaluations to ensure adequate coverage of the three prongs delineated in Dusky v. United States. This study evaluates the effects of feigning on the Evaluation of Competency to Stand Trial—Revised (ECST-R) in a sample of 100 male defendants undergoing CST evaluations. The ECST-R competency scales are reliable, with good alpha coefficients and interrater reliabilities, and differentiate patients found competent from those found not competent. The current study suggests that feigning may bridge both psychopathology and cognitive abilities and that clinicians should consider each when conducting CST evaluations. These results are discussed in the context of conducting comprehensive evaluations integrating response style assessments in CST evaluations.

Predicting short-term institutional aggression in forensic patients: a multi-trait method for understanding subtypes of aggression

Accurately predicting inpatient aggression is an important endeavor. The current study investigated inpatient aggression over a six-month time period in a sample of 152 male forensic patients. We assessed constructs of psychopathy, anger, and active symptoms of mental illness and tested their ability to predict reactive and instrumental aggression. Across all levels of analyses, anger and active symptoms of mental illness predicted reactive aggression. Traits of psychopathy, which demonstrated no relationship to reactive aggression, were a robust predictor of instrumental aggression. This study (a) reestablishes psychopathy as a clinically useful construct in predicting inpatient instrumental aggression, (b) provides some validation for the reactive/instrumental aggression paradigm in forensic inpatients, and (c) makes recommendations for integrating risk assessment results into treatment interventions.

Neurobiology of empathy and callousness: implications for the development of antisocial behavior

Information on the neurobiology of empathy and callousness provides clinicians with an opportunity to develop sophisticated understanding of mechanisms underpinning antisocial behavior and its counterpart, moral decision-making. This article provides an integrated in-depth review of hormones (e.g. peripheral steroid hormones such as cortisol) and brain structures (e.g. insula, anterior cingulate cortex, and amygdala) implicated in empathy, callousness, and psychopathic-like behavior. The overarching goal of this article is to relate these hormones and brain structures to moral decision-making. This review will begin in the brain, but will then integrate information about biological functioning in the body, specifically stress-reactivity. Our aim is to integrate understanding of neural processes with hormones such as cortisol, both of which have demonstrated relationships to empathy, psychopathy, and antisocial behavior. The review proposes that neurobiological impairments in individuals who display little empathy are not necessarily due to a reduced ability to understand the emotions of others. Instead, evidence suggests that individuals who show little arousal to the distress of others likewise show decreased physiological arousal to their own distress; one manifestation of reduced stress reactivity may be a dysfunction in empathy, which supports psychopathic-like constructs (e.g. callousness). This integration will assist in the development of objective methodologies that can inform and monitor treatment interventions focused on decreasing antisocial behavior.

Detection Strategies for Malingering With the Miller Forensic Assessment of Symptoms Test

Two of the most widely used measures for the assessment of malingering in forensic populations are the Miller Forensic Assessment of Symptoms Test (M-FAST) and the Structured Interview of Reported Symptoms (SIRS). The underlying dimensions of the SIRS have been well established in the literature, but the structure of the M-FAST remains relatively untested. Understanding of its dimensions is critical for construct validity and guiding its proper use. Confirmatory factor analysis was used to provide evidence of a single parsimonious malingering factor to account for the covariation of the M-FAST items in a sample of 244 forensic patients. In addition, the model was cross-validated with an independent sample of 210 forensic patients. Finally, the M-FAST factor was modeled in conjunction with two factors of the SIRS. Results provide further validation of the underlying detection strategy found in the M-FAST.

Psychopathy and behavioral correlates of victim injury in serious juvenile offenders

The study examines delinquent behavior and psychopathy and assesses their relationship to victim injury in a population of 168 incarcerated juvenile delinquent males with lengthy histories of criminal and violent behavior. A series of multiple regressions found that 17% of the variance associated with level of victim injury was accounted for by a model that included the three-factor model of the Psychopathy Checklist: Youth Version [Forth, Kosson, and Hare, 2003], criminal versatility, and age of onset of criminal offending. Notably, anger and DSM-IV symptoms of conduct disorder were not related to level of victim injury. The results of this study support an escalation hypothesis where individuals with earlier onset to criminal behavior and greater criminal versatility escalate to more severe violence. The current results demonstrate the importance of integrating established theories of juvenile delinquency when explaining severe violence in youth.

Impulsivity, anger, and psychopathy: the moderating effect of ethnicity

The present research tested the four-factor Psychopathy Checklist: Screening Version (PCL:SV) latent variable model for structural invariance across ethnicity in a large sample of civil psychiatric patients. In addition, it also examined how Barratt (1994) impulsivity and Novaco (1994) anger latent variables were related to the psychopathy dimensions within and across ethnicity. The data were analyzed with Mplus (Muthen & Muthen, 2001), and results indicated that the four-factor model was invariant across Caucasian and African American males in terms of both item factor loadings and thresholds. However, differential relations between the external correlates and the psychopathy dimensions were found across groups, suggesting that the association between impulsivity and psychopathy may be moderated by ethnicity.