Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patients

Background There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. Aims Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 – the interpersonal affective dimension – was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. Methods Sixty‐five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. Results The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. Conclusions The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy. Copyright © 2010 John Wiley & Sons, Ltd.     

Psychopathy checklist score predicts negative events during the sentences of prisoners with Hare psychopathy: a prospective study at a German prison.

OBJECTIVE: This study examined the predictive validity of the German translation of the Psychopathy Checklist-Screening Version (PCL-SV) for negative events during the course of the prison sentence of German prisoners. METHOD: Using the PCL-SV, we investigated 145 offenders in a German prison at the start of their sentences. We then compared the extreme groups identified by the PCL-SV--the high and low scorers--using a prospective design with respect to negative events and factors during the course of the sentences. This involved the standardized collection of data on both objective records of disciplinary incidents and subjective impressions from prison staff on the basis of operationalized criteria. RESULTS: The high scorers were involved in significantly more disciplinary incidents and were also rated significantly less favourably by prison staff than the low scorers. CONCLUSION: Until now, the PCL has only been shown to predict recidivism following release from prison. The results of our study show that the PCL also has predictive validity for problems during the course of the sentence. It is therefore recommended that the PCL be used routinely at the start of the prison sentence to estimate the likelihood of subsequent difficulties.     

Psychopathy and violent recidivism among young criminal offenders

OBJECTIVE: To investigate the predictive validity of psychopathic personality traits (assessed with the revised psychopathy checklist, PCL-R; Hare, 1991) for violent criminal recidivism among young offenders. METHOD: The relationship between PCL-R psychopathy and violent re-offending was studied in 98 young (M=18.40, range 15-20 years) violent and sex offenders subjected to forensic psychiatric evaluation in Sweden during 1988-95. Subjects were followed during detainment and for 24 months in the community to first reconviction for a violent offence. RESULTS: We found a modest but significant association between PCL-R scores and violent recidivism, almost exclusively accounted for by behavioural criteria. Among 13 possible confounders tested, conduct disorder before age 15 and a young age at first conviction eliminated the relationship between psychopathy and violent recidivism in pair-wise logistic regression models. CONCLUSION: PCL-R psychopathy may be a less valid predictor for violent criminal recidivism among severe youthful offenders than among adult offenders.     

Predictions of violent and total infractions among institutionalized male juvenile offenders

Forensic practitioners in settings with institutionalized adolescent offenders are frequently responsible for the accurate classification of problematic and potentially violent youths. Methods of assessment often include traditional tests, such as the MMPI and MMPI-A, and interview-based determinations of psychopathy. In a study of residential male adolescent offenders, the MMPI-A and the Screening Version of the Psychopathy Checklist (PCL:SV) were used to predict total, violent, self-injurious, and nonviolent infractions in a treatment-oriented facility for delinquents. In predicting the overall number of infractions, the MMPI-A was superior to the PCL:SV. Psychopaths manifested a significantly higher rate of violent infractions than nonpsychopaths. Finally, ethnic differences raise serious concerns about the generalizability of the PCL:SV; differences were found in the relationship between psychopathy and infractions based on ethnicity.     

Temperament and character and psychopathy in male conduct disordered offenders

Adult male offenders with high psychopathy scores are characterized by high Novelty Seeking, low Harm Avoidance and low Cooperativeness; temperament and character traits that may moderate treatment outcomes. This is the first study to investigate if a similar profile is present in juveniles. One hundred and twenty two incarcerated juvenile male offenders who met the criteria for conduct disorder in the absence of current psychiatric disorder (e.g. psychosis, depression, anxiety) were rated on the Temperament and Character Inventory (TCI) and the Psychopathy Checklist: Youth Version (PCL: YV). PCL: YV total score was positively correlated with Novelty Seeking but negatively correlated with Cooperativeness and Harm Avoidance. Examination of the PCL: YV facets indicated a significant negative correlation between Harm Avoidance and PCL: YV Interpersonal and PCL: YV Antisocial; and Reward Dependence and Cooperativeness and PCL: YV Lifestyle/Behavioral. Relationships were primarily with lifestyle/behavioral and antisocial facets of psychopathy. The TCI profile resembles that seen in adult offenders and has implications for treatment as low cooperativeness and reward dependency are likely to be key responsivity factors that need to be addressed in treatment planning.     

Psychopathy and institutional outcome in patients with schizophrenia in forensic settings in the UK

This study examined the institutional outcomes (12 weeks post-admission) of 134 male patients with DSM-IV schizophrenia assessed using the Psychopathy Checklist: Screening Version (PCL: SV) in a medium secure unit in the UK. High psychopathy scorers (HP) were more likely to be violent, non-compliant with programmes, engage in substance misuse violations, have criminal attitudes/peers and have low levels of insight into risk and violence. Psychopathy was also a modest predictor of institutional outcome in these domains.     

Kategoriale und dimensionale Erfassung von "psychopathy" bei deutschen Straftätern

The personality construct "psychopathy" is of utmost importance in legal prognosis. In the last 20 years, a multitude of empirical research proved the predictive validity of this concept concerning the degree of dangerousness represented by an offender. In the present study, a representative, nonselected sample of 416 offenders was examined using the Screening Version of the Psychopathy Checklist (PCL:SV). The data were analysed both categorically and dimensionally according to the three-factor model proposed by Cooke and Michie. In comparison to North American Studies the prevalence of high scorers was significantly lower, implicating intercultural differences. Analyses of the effects of gender yielded higher scores on each of the three factors in male offenders. Concerning different age cohorts, it turned out that the arrogant and deceitful interpersonal style and deficient affective experience remained stable, whereas the impulsive and irresponsible behavioral style decreased with increasing age. Therefore, our results point out intercultural differences already shown in the prevalence of "psychopathy" and confirm the effects of gender and age concerning this construct.     

An Exploration of Responsivity among Violent Offenders: Predicting Access to Treatment,Treatment Engagement and Programme Completion

This retrospective archival study examines whether pre-treatment responsivity characteristics influence access to, engagement in, and completion of a violent offender treatment programme. The participants are 115 violent offenders referred for a group-based multi-module treatment programme in medium- and high-security correctional facilities in Victoria, Australia. The case files for each participant were reviewed and information regarding responsivity factors and responses to treatment were gathered. Responsivity characteristics include psychopathy (Psychopathy Checklist: Screening Version; PCL:SV), denial and minimisation (Denial and Minimisation Checklist – Third Edition; DMCL-III), and measures of motivation to engage in treatment and guilt and shame associated with violent offending. Engagement was scored using the Response to Treatment Scale. Offenders with higher PCL:SV Factor 2 scores were less likely to be offered a place in the programme and offenders with greater external pressure or motivation to participate in treatment were more likely to commence treatment. Psychopathy and pre-treatment denial and minimisation of offending are related to poorer engagement in treatment; feelings of guilt and shame, along with motivation to participate in treatment, are positively associated with engagement. Predictors of treatment completion include external motivators promoting participation in treatment, within-treatment behaviours (e.g. inappropriate or disruptive behaviour), and psychopathy.     

Erfassung von Persönlichkeitsdimensionen der Psychopathy nach Hare bei der strafrechtlichen Begutachtung von Jugendlichen

In accordance with Robert Hare's concept, the term psychopathy was operationalized in 1985 when the revised form of the psychopathy checklist (PCL-R) was published. Since then, the PCL-R has been used internationally. For several years in North America and now even in England and the Netherlands, personality traits of psychopathy have also been studied in children and juveniles. Based on the PCL-R, a checklist for adolescents (PCL-YV) was developed that takes the special conditions of adolescents into account. The goal of this paper was to test the applicability of the PCL-YV retrospectively in a sample of forensic psychiatric evaluations of delinquent juveniles that were assigned to the Clinic for Child and Adolescent Psychiatry at the University of Cologne, Germany. Based on results collected with the PCL-YV, data on groups of low- and medium-scoring juveniles were classified which partially differed significantly in relation to sociodemographic and anamnestic data. Furthermore, factor analyses showed a three-factor model solution. Associations with legal issues such as the question of criminal responsibility could not be found. In summary, the results indicate the applicability of the PCL-YV for adolescents but show the difficulties of retrospective design without conducting PCL interviews.     

Casenote assessment of psychopathy in a high security hospital

INTRODUCTION: There is now a large amount of data demonstrating the internal reliability and construct validity of the Hare Psychopathy Checklist (PCL/PCL-R) when used in the assessment of psychopathy in male forensic populations. It has well-established psychometric properties when scored following a review of collateral information and a subsequent interview. However, its internal reliability and factor structure, when casenote information alone has been used, have not been examined outside North America. METHOD: A sample of 89 patients from a British high security hospital, with the legal classification of psychopathic disorder, was scored retrospectively on the PCL-R from their medical files only. The psychometric properties of the PCL-R were analysed. Results The PCL-R ratings showed a high level of internal reliability. The factor structure was very similar to that found in Hare's North American sample of forensic psychiatric patients. DISCUSSION: The findings support the application of the PCL-R, when scored using existing file data alone, to a British high security hospital population.     

The Psychopathy Checklist and non-violent offender groups

Cleckley’s concept of psychopathy includes characteristics such as superficial charm, unreliability, and affective poverty. In this study, the Psychopathy Checklist (PCL) and personality questionnaires (MMPI, CPI, EPQ, and SSS) were used to assess 92 non-violent male offenders. The variable-based approach was applied in order to study the structure of the PCL and the relationships between the PCL, the PCL factors and the personality questionnaire scores. The results indicated that the personality scale scores failed to correlate positively with the PCL score, with the exception of the MMPI hypomania score. Two PCL factors emerged: factor 1 related to the core personality characteristics of the Cleckley psychopath, and factor 2 referred to a chronically unstable and antisocial lifestyle. In the person-oriented approach, three offender groups were distinguished based on the cluster analysis of the PCL items; cluster 1 subjects scored high on factor 1 items describing the personality characteristics of Cleckley’s psychopathy. They were psychopaths with a high level of fraud-like offences. Severely antisocial offenders, starting their criminal behaviour early and having an active criminal lifestyle, comprised cluster 2. Cluster 3 was a group of non-psychopathic but antisocial and experience-seeking offenders. The overall results advocated the importance of the PCL as a method of assessing the Cleckley psychopaths and the usefulness of personoriented analysis in differentiating them from others.     

Clinical and economic outcomes from the UK pilot psychiatric services for personality-disordered offenders

Personality-disordered offenders are difficult individuals to manage, and knowledge about effective treatment is sparse. In the UK, novel forensic psychiatric services were recently established for the treatment of offenders with personality disorder. In this paper we report the clinical and economic findings from a 2-year follow-up of a cohort of service users recruited from these services. Baseline information on developmental, clinical and offending histories was obtained from case records. Case records were checked at 6 and 24 months for new episodes of self-harm, violence, alcohol and substance use, and offending behaviour. Ratings of social functioning and therapeutic alliance were obtained from service users at baseline, 6 and 24 months. Fifty-six percent of service users were still engaged with the services at 24-month follow-up. Service users involved in the greatest number of behavioural incidents had greater impairment in baseline social functioning and lower IQ scores. There was no significant change in either therapeutic alliance or social functioning at 6 or 24 months. The economic analysis showed that although the services were predominantly run by the Health Service, there were considerable economic burdens shared by other service providers. Treatment costs at six-month follow-up were also significantly higher. Implications are discussed.     

A Rorschach investigation of attachment and anxiety in antisocial personality disorder

We investigated the constructs of anxiety and attachment in a group of 42 offenders who met the DSM-III-R criteria for antisocial personality disorder. Each antisocial subject's level of psychopathy was assessed with the Hare Psychopathy Checklist (PCL). Three Rorschach variables related to attachment, anxiety, and coping were compared between subjects scoring greater than or equal to 30 (N = 21) on the PCL and subjects scoring less than 30 (N = 21). Comparison Rorschach variables are also presented from a sample of 60 antisocial personality-disordered offenders. Moderate psychopaths (PCL score, less than 30) produced texture and diffuse shading responses at a significantly greater frequency than severe, or primary, psychopaths (PCL score, greater than or equal to 30). There was no significant difference in the two groups' propensity for producing vista responses. Although there were no significant differences between the coping index scores, the trend suggests less conflictual functioning in the severe psychopaths. A virtual absence of texture responses in the severe psychopaths, and a significantly greater frequency of diffuse shading responses in the moderate psychopaths, add construct validity to the lack of attachment in psychopaths and the role of anxiety in differentiating secondary from primary psychopathy. We view the presence of vista responses in this population as a measure of a failed grandiose self-structure, and note that it often occurs in the records of moderate psychopaths who also present achromatic color responses.     

CSF studies in violent offenders. I. 5-HIAA as a negative and HVA as a positive predictor of psychopathy

Summary. Low serotonin activity in man has been related to impulsive, self-destructive violence but not to instrumental aggression aimed at dominance. A relationship has also been suggested between aggression and high catecholaminergic activity. Several studies have reported signs of aberrant dopaminergic function in attention deficit hyperactivity disorder, autism, and schizophrenia. In 22 violent offenders undergoing pretrial forensic psychiatric investigation, interpersonal and behavioral features of psychopathy, measured by the Psychopathy Checklist Revised (PCL-R), were significantly predicted by low cerebrospinal fluid (CSF) concentrations of 5-HIAA and high CSF concentrations of HVA in multivariate regression models. CSF concentrations of MHPG did not contribute to the model. This seems to link the outward-directed aggression of psychopathy to serotonergic hypofunctioning and high dopamine turnover, which might account for disinhibition of destructive impulses. Received October 25, 2000; accepted February 21, 2001     

Extraction of Potential Difficult-to-Manage Psychiatric Cases among Criminal Offenders: 5-Year Data from the Tokyo District Public Prosecutors Office

Abstract: In order to examine the characteristics of potential difficult-to-manage psychiatric cases, seven potential subgroups were extracted from the criminal offenders who were sent to the division of psychiatric diagnosis, Tokyo District Public Prosecutors Office for Pre-Prosecution Psychiatric Justice (PPPJ). The following criteria were used to select the potential subgroups: offenders who had experienced compulsory discharge from a mental hospital, those who had experienced Involuntary Admission to the mental hospital by the Prefectural Governor at least twice, those who had experienced admission to mental hospitals on more than 5 occasions, those who had been put on PPPJ previously for other criminal matters at least 3 times, those who had previously attempted suicide, and those who had committed homicide or arson. From the results of this study, it could be concluded that at least two types of "difficult-to-manage" psychiatric cases exist in the criminal offenders.     

Suicide attempts and impulse control disorder are related to low cerebrospinal fluid 5-HIAA in mentally disordered violent offenders

OBJECTIVE: The aim of this study was to investigate the relationship between low cerebrospinal fluid 5-hydroxyindoleacetic acid (CSF 5-HIAA) and aggressive acts in mentally disordered violent offenders. METHOD: CSF concentrations of 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid and 4-hydroxy-3-methoxyphenyl glycol were measured in 35 drug-free men convicted of homicide and currently undergoing forensic psychiatric investigation in a high security hospital. RESULTS: The mean metabolite concentrations in the homicide offenders did not differ from those of age- and body-height matched male control subjects. One-third of the murderers had made one or several suicide attempts, and their mean concentration of spinal fluid 5-HIAA was significantly lower than that of the remaining murderers. Subjects with impulse control disorder also had lower mean CSF 5-HIAA. A consistent pattern of higher CSF 5-HIAA in subjects with more self-reported anxiety traits was observed. CONCLUSION: The association between serotonin and suicidal behaviour holds for yet another subject group. Determining CSF 5-HIAA might be worth while in the routine assessment of psychiatrically ill homicide offenders.     

Older criminals: a descriptive study of psychiatrically examined offenders in Sweden

OBJECTIVE: We retrospectively examined psychiatric diagnoses of older offenders referred by court for psychiatric assessment in Sweden, and compared them with younger offenders. METHOD: In Sweden, structured court-ordered forensic psychiatric evaluations are undertaken by a forensic psychiatric team. Data on age, sex, citizenship, psychiatric diagnoses, offences, and legal insanity declarations were obtained for the years 1988-2000 (n = 7297). RESULTS: There were 210 forensic psychiatric evaluations in those aged 60 and over. 7% had a diagnosis of dementia, 32% psychotic illness, 8% depressive or anxiety disorder, 15% substance abuse or dependence, and 20% personality disorder. Older offenders were significantly less likely to be diagnosed with schizophrenia or a personality disorder, and more likely to have dementia or an affective psychosis compared to younger ones. Logistic regression analyses suggested that of the studied factors, the ones most typical of older offenders were a diagnosis of dementia and being charged with a sexual offence. CONCLUSION: There appear to be important differences in psychiatric morbidity between older offenders and younger ones who come into contact with forensic psychiatric services. This research may assist in the planning of forensic and therapeutic services for the increasing number of older adults passing through the criminal justice system.     

The childhood-onset neuropsychiatric background to adulthood psychopathic traits and personality disorders

Childhood conduct disorder (CD) and adult psychopathic traits according to the Psychopathy Checklist Revised (PCL-R) were the closest psychiatric covariates to repeated violent crimes and aggression among offenders under forensic psychiatric investigation in Sweden. As psychopathy is not included in the present psychiatric diagnostic systems, we compared total and factor PCL-R scores to Axis I disorders, including childhood-onset neuropsychiatric disorders, and to Axis II personality disorders, to establish the convergence of psychopathic traits with other psychiatric diagnoses, and to identify possible unique features. Psychopathic traits were positively correlated with bipolar mood disorder and negatively with unipolar depression. The total PCL-R scores as well as the Factor 2 (unemotionality) and Factor 3 (behavioral dyscontrol) scores were significantly correlated with attention-deficit/hyperactivity disorder, Asperger's syndrome/high-functioning autistic traits, CD, substance abuse, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster B personality disorders. The interpersonal Factor 1 showed none of these correlations and may capture features that are specific to psychopathy, distinguishing core psychopathy from other diagnostic definitions.     

Long-term validity of biological markers of psychopathy and criminal recidivism: follow-up 6-8 years after forensic psychiatric investigation

This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.     

Distinct neural activation patterns underlie economic decisions in high and low psychopathy scorers

Psychopathic traits affect social functioning and the ability to make adaptive decisions in social interactions. This study investigated how psychopathy affects the neural mechanisms that are recruited to make decisions in the ultimatum game. Thirty-five adult participants recruited from the community underwent functional magnetic resonance imaging scanning while they performed the ultimatum game under high and low cognitive load. Across load conditions, high psychopathy scorers rejected unfair offers in the same proportion as low scorers, but perceived them as less unfair. Among low scorers, the perceived fairness of offers predicted acceptance rates, whereas in high scorers no association was found. Imaging results revealed that responses in each group were associated with distinct patterns of brain activation, indicating divergent decision mechanisms. Acceptance of unfair offers was associated with dorsolateral prefrontal cortex activity in low scorers and ventromedial prefrontal cortex activity in high scorers. Overall, our findings point to distinct motivations for rejecting unfair offers in individuals who vary in psychopathic traits, with rejections in high psychopathy scorers being probably induced by frustration. Implications of these results for models of ventromedial prefrontal cortex dysfunction in psychopathy are discussed.