Violent and aggressive behavior by criminal psychopaths

Callous-unemotional traits, cognitive functioning, and externalizing problems in a propensity-matched sample from the ABCD study

BACKGROUND

Many studies show that both callous-unemotional (CU) traits (e.g., low empathy, lack of guilt) and cognitive difficulties increase risk for externalizing psychopathology across development. However, other work suggests that some aggression (e.g., relational, proactive) may rely on intact cognitive function, which could vary based on the presence of CU traits. Moreover, no prior research has adequately accounted for common risk factors shared by CU traits, cognitive difficulties, and externalizing problems, which confounds conclusions that can be drawn about their purported relationships. The current study addressed these knowledge gaps by leveraging rigorous propensity matching methods to isolate associations between CU traits and different dimensions of cognitive function and externalizing problems.

METHODS

Associations between CU traits, cognitive functioning, and externalizing outcomes were tested within dimensional (n = 11,868) and propensity-matched group-based (n = 1,224) models using data from the Adolescent Brain Cognitive Development Study®, with rigorous statistical control for shared sociodemographic risk factors. Cross-sectional outcomes were parent-reported symptoms of conduct disorder (CD), oppositional defiant disorder (ODD), and attention deficit hyperactivity disorder (ADHD). Longitudinal outcomes were child-reported overt and relational aggression.

RESULTS

CU traits were uniquely related to more parent-reported CD, ODD, ADHD symptoms, as well as more child-reported aggressive behaviors. Effects of cognitive difficulties were domain specific and were not consistent across dimensional and propensity matched models. There was minimal evidence for divergent associations between CU traits and externalizing outcomes as a function of cognition (i.e., no moderation).

CONCLUSIONS

Rigorous control for sociodemographic factors within propensity-matched models establish CU traits as a robust and unique risk factor for externalizing psychopathology, over and above difficulties with cognitive functioning.

Gun Violence and Psychopathy Among Female Offenders

Research exploring risk factors of gun violence is limited, especially research involving women as perpetrators of violence. Yet, women account for 18-21% of convicted violent crime. The present study aimed to test if psychopathy, a notable risk factor for violence, was related to past convictions of gun violence, general forms of violence, and non-violent crime. In a sample of 206 female offenders, multinomial logistic regressions assessed how interpersonal, affective, and behavioral psychopathic traits increased the likelihood of women belonging to the gun violence group, a violent crime group, and a non-violent crime group. Results showed the interpersonal and affective facets increased the likelihood of women belonging to the gun violence group compared to both the violent and non-violent crime groups. The behavioral facet increased the likelihood of women belonging to the violent crime group when compared to the gun violence and non-violent crime groups. These results suggest that gun violence has different risk factors than violent and non-violent crime. This line of inquiry indicates that existing violence prevention strategies may need to be modified to address gun violence.

Psychopathy and Economic Behavior Among Prison Inmates: An Experiment

This paper investigates whether there is a connection between psychopathy and certain manifestations of social and economic behavior, measured in a lab-in-the-field experiment with prison inmates. In order to test this main hypothesis, we let inmates play four games that have often been used to measure prosocial and antisocial behavior in previous experimental economics literature. Specifically, they play a prisoner's dilemma, a trust game, the equality equivalence test that elicits distributional preferences, and a corruption game. Psychopathy is measured by means of the Levenson Self-Report Psychopathy Scale (LSRP) questionnaire, which inmates filled out after having made their decisions in the four games. We find that higher scores in the LSRP are significantly correlated with anti-social behavior in the form of weaker reciprocity, lower cooperation, lower benevolence and more bribe-oriented decisions in the corruption game. In particular, not cooperating and bribe-maximizing decisions are associated with significantly higher LSRP primary and LSRP secondary scores. Not reciprocating is associated with higher LSRP primary and being spiteful with higher LSRP secondary scores.

The usefulness of self‐reported psychopathy‐like traits in the study of antisocial behaviour among non‐referred adolescents

The present study addresses the question of whether it is possible to use a self‐report measure of psychopathic traits on non‐referred youth samples to identify a subgroup of problematic youths who are particularly problematic and different from other problem youths. A large sample of eighth‐grade, non‐referred adolescents, and their parents were assessed. Results showed that the adolescents exhibiting a low‐socialized psychopathy‐like personality constellation had a more frequent, violent, and versatile conduct‐problem profile than other low‐socialized and well socialized adolescents. The psychopathy‐like adolescents also differed from other poorly socialized adolescents in ways that suggested that their etiological background was different from adolescents with non‐psychopathy‐like conduct problems. We conclude that self‐report measures can indeed be useful for research purposes in subtyping youths with conduct problems. Copyright © 2002 John Wiley & Sons, Ltd.

Personality and psychopathy of males with a history of early criminal behaviour

Data from three personality inventories—the Eysenck Personality Questionnaire (EPQ) including an Impulsivity scale from the IVE inventory, a short version of two Chapman scales, and the Karolinska Scales of Personality (KSP)—were studied for a group of 199 male subjects (age range 32–40 years) subdivided ( 1 ) according to the level of Psychopathy Check List (PCL) scores at adult age and (2) according to criminal activity during the age period of 11–14 years. Intelligence scores from the age of 11–14 and ratings of mental health, both from age 11–14 and from adult life, were examined in relation to the PCL and early criminal groupings, respectively. Furthermore, a dimensional description of the PCL was performed on the total sample. Subjects with high PCL scores formed a risk group for developing ‘disinhibitory psychopathology’. They manifested a personality pattern of markedly high impulsivity, monotony avoidance, and psychoticism, and low socialization in combination with high proneness to somatic anxiety. A significant quadratic trend was found for PCL group on the IVE Impulsiveness scale. The early ‘high criminal’ and early ‘low criminal’ groups had significantly lower socialization scores and higher PCL impulsivity item scores than the control group indicating ‘vulnerability’ for developing psychosocial disorders. Furthermore, the early ‘high criminal’ group displayed higher scores on the three PCL factors obtained, denoted ‘Sensation seeking and impulsivity’, ‘Callousness/lack of deep emotions’, and ‘Narcissistic appearance/manipulative’. The results are discussed in terms of usefulness of a classification according to PCL scores, as compared with early criminal activity, when focusing on risk subjects for disinhibitory tendencies.

Childhood behaviour and adult personality in male and female subjects

In a follow‐up study, teacher ratings of behaviour at 13 years of age were analysed in relation to personality factors in adults (mean age 27 years) for a group of 77 male and 84 female subjects. In the male group, ratings of Aggressiveness, Motor Restlessness, and Concentration Dificulties correlated positively with a broad psychopathy‐related factor. Furthermore, ratings of Timidity correlated positively with two anxiety factors. In the female group, ratings of Motor Restlessness correlated positively with an extraversion factor. The rated childhood behaviours and the adult personality factors were assumed to be a differential reflection of vulnerability to externalizing and internalizing psychosocial disturbances.

Morphology of the criminal brain: gray matter reductions are linked to antisocial behavior in offenders

Aggression and psychopathy are multifaceted conditions determined interpersonal and antisocial factors. Only a few studies analyze the link between these separate factors and specific brain morphology distinctively. A voxel-based morphometry (VBM) analysis was performed on 27 violent offenders and 27 controls aiming to associate sub-features of aggressive and psychopathic behavior with specific gray matter volumes. Trait aggression was assessed using two self-report tests (Aggression Questionnaire, AQ, and Reactive-Proactive-Aggression Questionnaire, RPQ) and psychopathy with the Psychopathy Checklist-Revised (PCL-R). Total and sub-scale scores of these tests were correlated to the brain morphometry of the offenders group in separate analyses. It was found that psychopathic behavior was negatively correlated with prefrontal gray matter volume and that this result was primarily driven by the antisocial behavior sub-scale of the PCL-R. Furthermore, less gray matter in right superior frontal and left inferior parietal regions with increasing antisocial behavior could be observed. One cluster comprising the right middle and superior temporal gyrus was negatively correlated with both, reactive aggression and antisocial behavior. These results outline (1) the importance of distinctively analyzing sub-features that contribute to aggressive and psychopathic behavior, given that the negative correlation of psychopathy global scores with prefrontal volume was driven by one single facet of the PCL-R scale (antisocial behavior). Moreover, these results indicate (2) fronto-temporo-parietal network deficits in antisocial, criminal offenders, with a particular strong effect in the temporal lobe.

Evolving systems of care: Individuals found not criminally responsible on account of mental disorder in custody of civil and forensic psychiatric services

Following psychiatric deinstitutionalization and changes in involuntary civil commitment laws, many individuals with severe mental disorders have been receiving mental health services through the back door, that is, the criminal justice system. Significant changes to the section of Criminal Code of Canada dealing with individuals with mental disorders have led to significant annual increases in the number of individuals declared Not criminally responsible on account of mental disorder (NCRMD), many of whom are directed to civil psychiatric settings. The goal of the present study was to describe the psychosociocriminological and risk characteristics of individuals found NCRMD remanded to civil psychiatric hospitals (CPH) compared to a forensic psychiatric hospital (FPH). This study was conducted between October 2004 and August 2006 in the sole FPH of the province of Québec and two large CPH in the Montréal metropolitan area. The final sample for the current study consisted of 96 men: 60 from the FPH and 36 from the two CPH. Results indicate that individuals in both settings have similar psychosociocriminal profiles, including PCL-R scores, but that individuals in CPH have higher scores in the Risk subscale of the HCR-20 than do their counterparts in the FPH. This difference is due to a higher score on two items: exposure to destabilizing factors and noncompliance with remediation attempts. Results are discussed in terms of the need for civil psychiatric settings to implement risk assessment and management programs into their services, and the need for further research into forensic mental health services.

Enhanced error-related brain activations for mistakes that harm others: ERP evidence from a novel social performance-monitoring paradigm

Our mistakes often have negative consequences for ourselves, but may also harm the people around us. Continuous monitoring of our performance is therefore crucial for both our own and others' well-being. Here, we investigated how modulations in responsibility for other's harm affects electrophysiological correlates of performance-monitoring, viz. the error-related negativity (ERN) and error positivity (Pe). Healthy participants (N = 27) performed a novel social performance-monitoring paradigm in two responsibility contexts. Mistakes made in the harmful context resulted in a negative consequence for a co-actor, i.e., hearing a loud aversive sound, while errors in the non-harmful context were followed by a soft non-aversive sound. Although participants themselves did not receive auditory feedback in either context, they did experience harmful mistakes as more distressing and reported higher effort to perform well in the harmful context. ERN amplitudes were enhanced for harmful compared to non-harmful mistakes. Pe amplitudes were unaffected. The present study shows that performing in a potentially harmful social context amplifies early automatic performance-monitoring processes and increases the impact of the resulting harmful mistakes. These outcomes not only further our theoretical knowledge of social performance monitoring, but also demonstrate a novel and useful paradigm to investigate aberrant responsibility attitudes in various clinical populations.

Neural processing of social exclusion in individuals with psychopathic traits: Links to anger and aggression

Psychopathy is a cluster of personality traits associated with high rates of aggression. While research on psychopathic traits largely focuses on neurobiological factors implicated in aggression, other research suggests that contextual factors, such as social exclusion, also contribute to promoting aggression. Yet, the relationships among psychopathic traits, neural processing of exclusion, and aggression remain unknown. A sample of 76 adolescents and young adults completed Cyberball, a task involving conditions of social inclusion, ambiguous exclusion, and unambiguous exclusion. During Cyberball, a slow wave (SW) event-related potential (an index of elaborative processing) and self-reported anger were measured. Additionally, acts of real-world aggression were assessed. Results indicated that as psychopathic traits increased, SW during ambiguous exclusion also increased, but SW during inclusion decreased. However, the combination of smaller SW during ambiguous exclusion and higher psychopathic traits predicted heightened anger following Cyberball and more frequent real-world aggression. This response to social exclusion among individuals with elevated psychopathic traits may represent an unreflective, reactive style that exacerbates anger and aggression in certain contexts. These data suggest that neurobiological dysfunction in elaborative processing is related to psychopathic traits, and social context comprises another important influence on the aggression of individuals with elevated psychopathic traits.

Primary and Secondary Variants of Psychopathy in a Volunteer Sample Are Associated With Different Neurocognitive Mechanisms

BACKGROUND

Recent work has indicated that there at least two distinct subtypes of psychopathy. Primary psychopathy is characterized by low anxiety and thought to result from a genetic predisposition, whereas secondary psychopathy is characterized by high anxiety and thought to develop in response to environmental adversity. Primary psychopathy is robustly associated with reduced neural activation to others' emotions and, in particular, distress. However, it has been proposed that the secondary presentation has different neurocognitive correlates.

METHODS

Primary (n = 50), secondary (n = 100), and comparison (n = 82) groups were drawn from a large volunteer sample (N = 1444) using a quartile-split approach across psychopathic trait (affective-interpersonal) and anxiety measures. Participants performed a widely utilized emotional face processing task during functional magnetic resonance imaging.

RESULTS

The primary group showed reduced amygdala and insula activity in response to fear. The secondary group did not differ from the comparison group in these regions. Instead, the secondary group showed reduced activity compared with the comparison group in other areas, including the superior temporal sulcus/inferior parietal lobe, thalamus, pallidum, and substantia nigra. Both psychopathy groups also showed reduced activity in response to fear in the anterior cingulate cortex. During anger processing, the secondary group exhibited reduced activity in the anterior cingulate cortex compared with the primary group.

CONCLUSIONS

Distinct neural correlates of fear processing characterize individuals with primary and secondary psychopathy. The reduced neural response to fear that characterizes individuals with the primary variant of psychopathic traits is not observed in individuals with the secondary presentation. The neurocognitive mechanisms underpinning secondary psychopathy warrant further systematic investigation.

Child and Adolescent Disposition Model: An Examination of the Temperament Factor Structure Within Early Childhood

Lahey and Waldman proposed a temperament theory of conduct disorder (CD). Critical is the hypothesized temperament structure in which three relatively uncorrelated temperament dimensions (i.e., negative emotionality, daring, prosociality) central to CD are theorized to emerge in early childhood. The validity of this hypothesized factor structure in early childhood is unknown. The current study seeks to fill this gap by examining Lahey and Waldman's hypothesized temperament structure utilizing a Canadian sample ( n = 283) of preschoolers. Confirmatory factor analyses (CFAs) were performed to compare the hypothesized relatively uncorrelated temperament structure with two alternative models (i.e., correlated three-factor and single-factor structure). The CFA indicated that the temperament dimensions are present in early childhood and are relatively uncorrelated consistent with previous work at later developmental stages. Of importance, the findings highlighted key gender differences observable at 3 and 4 years of age. The theoretical implications are discussed.

Information processing capacity in psychopathy: Effects of anomalous attention

Hamilton and colleagues (2015) recently proposed that an integrative deficit in psychopathy restricts simultaneous processing, thereby leaving fewer resources available for information encoding, narrowing the scope of attention, and undermining associative processing. The current study evaluated this parallel processing deficit proposal using the Simultaneous-Sequential paradigm. This investigation marks the first a priori test of the Hamilton et al.'s theoretical framework. We predicted that psychopathy would be associated with inferior performance (as indexed by lower accuracy and longer response time) on trials requiring simultaneous processing of visual information relative to trials necessitating sequential processing. Results were consistent with these predictions, supporting the proposal that psychopathy is characterized by a reduced capacity to process multicomponent perceptual information concurrently. We discuss the potential implications of impaired simultaneous processing for the conceptualization of the psychopathic deficit. (PsycINFO Database Record

Is the Revised Psychopathy Checklist Clinically Useful for Adolescents?

Recent studies have provided evidence for the reliability and validity of Hare's Psychopathy Checklist, Revised (PCL-R) for forensic samples. The present study investigated PCL-R psychometric properties among Caucasian and African-American adolescent males from forensic and school settings. The clinical utility of the PCL-R was investigated in terms of predicting future delinquency above and beyond data that are more readily available. Good reliability and validity for the PCL-R were found. PCL-R Total and Factors scores were greatest for participants with conduct disorder, followed by those with oppositional defiant disorder, with the smallest scores observed for participants with neither disorder. In a 1-year follow-up, PCL-R scores accounted for a unique proportion of the variance in juvenile criminal justice sentencing above and beyond the baseline number of delinquent acts recorded in juvenile criminal justice records and above a baseline disruptive behavior diagnosis continuum score. Compared to conduct disorder diagnosis, the PCL-R psychopath threshold score provided much better sensitivity with only slightly worse specificity for predicting delinquency during the 1-year follow-up.

Actuarial Models for Assessing Prison Violence Risk

An investigation and extension of the Risk Assessment Scale for Prison (RASP-Potosi), an actuarially derived scale for the assessment of prison violence, was undertaken through a retrospective review of the disciplinary records of the first 12 months of confinement of a cohort of inmates entering the Florida Department of Corrections in 2002 and remaining throughout 2003 (N = 14,088). A near replication of the RASP-Potosi and additional analyses based on other weighted logistic regression models were performed on an inmate subsample for whom all information categories were available (n = 13,341). Younger age and shorter sentences were associated with increased violent misconduct. Older age, drug conviction, and higher educational attainment were associated with reduced violent misconduct. Regardless of whether the original RASP-Potosi or its progeny were utilized, or the custody level of the inmate sample, the models were modestly successful in predicting prison violence, with the area under the curve (AUC) ranging from .645 to .707.

Behavioral and neural impairments of frontotemporal dementia: Potential implications for criminal responsibility and sentencing

Individuals in the early stages of the behavioral variant of frontotemporal dementia (bvFTD), a progressive neurodegenerative disorder marked by atrophy to the brain's frontal regions, exhibit severe disturbances to social and moral processing and decision-making after the onset of the disorder. These behavioral impairments, underlain by the neural deficits associated with the disorder, can often lead individuals with bvFTD to criminally offend. As such, behavioral and frontotemporal lobe abnormalities exhibited by offenders with bvFTD potentially represent several complex challenges for the legal system. This paper examines some of the ways in which the behavioral and neural impairments associated with bvFTD may influence issues surrounding the criminal responsibility, specifically legal insanity, and sentencing of offenders with bvFTD in the U.S. legal system. As there is very little literature in these areas concerning bvFTD, the existing academic dialogue on psychopathy, a disorder with similar behavioral symptoms and neural deficits, is used to frame the discussion on these issues.

Weapon carrying and psychopathic-like features in a population-based sample of Finnish adolescents

We investigated the prevalence of juvenile weapon carrying and psychosocial and personality-related risk factors for carrying different types of weapons in a nationally representative, population-based sample of Finnish adolescents. Specifically, we aimed to investigate psychopathic-like personality features as a risk factor for weapon carrying. The participants were 15-16-year-old adolescents from the Finnish self-report delinquency study (n = 4855). Four different groups were formed based on self-reported weapon carrying: no weapon carrying, carrying knife, gun or other weapon. The associations between psychosocial factors, psychopathic-like features and weapon carrying were examined with multinomial logistic regression analysis. 9% of the participants had carried a weapon in the past 12 months. Adolescents with a history of delinquency, victimization and antisocial friends were more likely to carry weapons in general; however, delinquency and victimization were most strongly related to gun carrying, while perceived peer delinquency (antisocial friends) was most strongly related to carrying a knife. Better academic performance was associated with a reduced likelihood of carrying a gun and knife, while feeling secure correlated with a reduced likelihood of gun carrying only. Psychopathic-like features were related to a higher likelihood of weapon carrying, even after adjusting for other risk factors. The findings of the study suggest that adolescents carrying a weapon have a large cluster of problems in their lives, which may vary based on the type of weapon carried. Furthermore, psychopathic-like features strongly relate to a higher risk of carrying a weapon.

Why psychopathy matters: Implications for public health and violence prevention

Psychopathy is an early-appearing risk factor for severe and chronic violence. The violence largely attributable to psychopathy constitutes a substantial portion of the societal burden to the public health and criminal justice systems, and thus necessitates significant attention from prevention experts. Yet, despite a vast base of research in psychology and criminology, the public health approach to violence has generally neglected to consider this key variable. Fundamentally, the public health approach to violence prevention is focused on achieving change at the population level to provide the most benefit to the maximum number of people. Increasing attention to the individual-level factor of psychopathy in public health could improve our ability to reduce violence at the community and societal levels. We conclude that the research literature on psychopathy points to a pressing need for a broad-based public health approach with a focus on primary prevention. Further, we consider how measuring psychopathy in public health research may benefit violence prevention, and ultimately society, in general.

Long-term patterns in interpersonal behaviour amongst psychopathic patients in secure inpatient treatment: A follow-up study

Psychopathy is a disorder that is partly defined by with maladaptive interpersonal behaviour and has significant effects on treatment outcomes. A previous study (Draycott et al., ) found that higher levels of psychopathy led to a specific interpersonal 'trajectory' amongst patients in a secure psychiatric treatment programme during the first 9 months of their admission. In that programme, more psychopathic patients became increasingly dominant over time, and less psychopathic patients became increasingly hostile. This study is a longer-term follow-up and extension of that study, extending the window of observation to 33 months of treatment. It was found that the more psychopathic patients' increased dominance returned to baseline levels by 33 months, as did the less psychopathic patients' increased hostility. This suggests that treatment for this group is not idiopathic but leaves unanswered the question as to what these divergent trajectories represent.

The startle paradigm in a forensic psychiatric setting: elucidating psychopathy

BACKGROUND

Most people who meet the diagnostic criteria for anti-social personality disorder (ASPD) do not meet the criteria for psychopathy. A differentiating feature is affective-interpersonal style. Eye blink startle reflex paradigms have been used to study affect.

AIM

The aim of this study is to explore an eye blink startle paradigm as a means of distinguishing between men with both ASPD and psychopathy, and men with ASPD alone.

METHODS

One hundred and thirty-six men were recruited as follows: 31 patients with ASPD and a Psychopathy Checklist-Revised (PCL-R) score of 26 or more, 22 patients with ASPD and a PCL-R score of 25 or less, 50 forensic hospital employees and 33 general population men, none in the latter two groups having abnormal personality traits. Each was presented with 16 pleasant, 16 unpleasant and 16 neutral pictures. Acoustic probes were presented during each category at 300, 800, 1300 and 3800 milliseconds (ms) after picture onset. Eye blink response was measured by electromyography.

RESULTS

Overall, both patient groups showed significantly smaller eye blink responses to the startle stimuli compared with the community controls. Both the latter and the ASPD group showed the expected increase in eye blink response at longer startle latencies to unpleasant pictures than pleasant pictures, but this was not present either in the group with psychopathy or in the forensic hospital employees. With increasing startle latency onset, eye blink amplitude increased significantly in both the healthy comparison groups and the ASPD group, but not in the group with psychopathy.

CONCLUSIONS

We replicated eye blink startle modulation deficiencies among men with psychopathy. We confirmed that the psychopathy and ASPD groups could be distinguished by startle stimulus onset asynchrony, but this pattern was also seen in one healthy group - the forensic hospital employees. This suggests a case for more research with more diverse comparison groups and more differentiation of personality traits before drawing definitive conclusions about distinctive startle response patterns among men with psychopathy.

Association of low-activity MAOA allelic variants with violent crime in incarcerated offenders

The main enzyme for serotonin degradation, monoamine oxidase (MAO) A, has recently emerged as a key biological factor in the predisposition to impulsive aggression. Male carriers of low-activity variants of the main functional polymorphism of the MAOA gene (MAOA-uVNTR) have been shown to exhibit a greater proclivity to engage in violent acts. Thus, we hypothesized that low-activity MAOA-uVNTR alleles may be associated with a higher risk for criminal violence among male offenders. To test this possibility, we analyzed the MAOA-uVNTR variants of violent (n = 49) and non-violent (n = 40) male Caucasian and African-American convicts in a correctional facility. All participants were also tested with the Childhood Trauma Questionnaire (CTQ), Barratt Impulsivity Scale (BIS-11) and Buss-Perry Aggression Questionnaire (BPAQ) to assess their levels of childhood trauma exposure, impulsivity and aggression, respectively. Our results revealed a robust (P < 0.0001) association between low-activity MAOA-uVNTR alleles and violent crime. This association was replicated in the group of Caucasian violent offenders (P < 0.01), but reached only a marginal trend (P = 0.08) in their African American counterparts. While violent crime charges were not associated with CTQ, BIS-11 and BPAQ scores, carriers of low-activity alleles exhibited a mild, yet significant (P < 0.05) increase in BIS-11 total and attentional-impulsiveness scores. In summary, these findings support the role of MAOA gene as a prominent genetic determinant for criminal violence. Further studies are required to confirm these results in larger samples of inmates and evaluate potential interactions between MAOA alleles and environmental vulnerability factors.

Assessment of aggression in inpatient settings

The threat of violence is a major concern for all individuals working or receiving treatment in an inpatient psychiatric setting. One major focus in forensic psychology and psychiatry over the past several decades has been the development of risk assessments to aid in the identification of those individuals most at risk of exhibiting violent behavior. So-called second- and third-generation risk assessments were developed to improve the accuracy of decision making. While these instruments were developed for use in the community, many have proven to be effective in identifying patients more likely to exhibit institutional aggression. Because the purpose of risk assessment is the reduction of violence, dynamic factors were included in third-generation risk instruments to provide opportunities for intervention and methods for measuring change. Research with these instruments indicates that both static factors (second-generation) and dynamic factors (third-generation) are important in identifying those patients most likely to engage in institutional aggression, especially when the aggression is categorized by type (impulsive/reactive, organized/predatory/instrumental, psychotic). Recent research has indicated that developing a typology of aggressive incidents may provide insight both into precipitants to assaults as well as appropriate interventions to reduce such aggression. The extant literature suggests that both static and dynamic risk factors are important, but may be differentially related to the type of aggression exhibited and the characteristics of the individuals exhibiting the aggression.

Comorbid personality disorders and violent behavior in psychotic patients

Schizophrenia without any comorbidity confers a modest, but statistically significant elevation of the risk for violence. That risk is considerably increased by comorbid antisocial personality disorder or psychopathy as well as by comorbid substance use disorders. These comorbidities are frequent. Conduct disorder and conduct disorder symptoms elevate the risk for aggressive behavior in patients with schizophrenia. Violence among adults with schizophrenia may follow at least two distinct pathways-one associated with premorbid conditions, including antisocial conduct, and another associated with the acute psychopathology of schizophrenia. Aggressive behavior in bipolar disorder occurs mainly during manic episodes, but it remains elevated in euthymic patients in comparison with controls. The risk of violent behavior is increased by comorbidity with borderline personality disorder, antisocial personality disorder, and substance use disorders. These comorbidities are frequent. Borderline personality disorder and bipolar disorder are related in their phenomenology and response to medication. These two disorders share a tendency to impulsiveness, and impulsive behavior, including impulsive aggression, is particularly expressed when they co-occur.

Aggression in Psychoses

Most individuals diagnosed with a mental illness are not violent, but some mentally ill patients commit violent acts. PubMed database was searched for articles published between 1980 and November 2013 using the combination of key words “schizophrenia” or “bipolar disorder” with “aggression” or “violence.” In comparison with the general population, there is approximately a twofold increase of risk of violence in schizophrenia without substance abuse comorbidity and ninefold with such comorbidity. The risk in bipolar disorder is at least as high as in schizophrenia. Most of the violence in bipolar disorder occurs during the manic phase. Violence among adults with schizophrenia may follow two distinct pathways: one associated with antisocial conduct and another associated with the acute psychopathology, particularly anger and delusions. Clozapine is the most effective treatment of aggressive behavior in schizophrenia. Emerging evidence suggests that olanzapine may be the second most effective treatment. Treatment nonadherence greatly increases the risk of violent behavior, and poor insight as well as hostility is associated with nonadherence. Nonpharmacological methods of treatment of aggression in schizophrenia and bipolar disorder are increasingly important. Cognitive behavioral approaches appear to be effective in cases where pharmacotherapy alone is not sufficient.

Relating sexual sadism and psychopathy to one another, non-sexual violence, and sexual crime behaviors

Sexual sadism and psychopathy have been theoretically, clinically, and empirically linked to violence. Although both constructs are linked to predatory violence, few studies have sought to explore the covariation of the two constructs, and even fewer have sought to conceptualize the similarities of violence prediction in each. The current study considered all four Psychopathy Checklist-Revised (PCL-R) facets and employed well-defined, validated measures of sadism to elucidate the relation between sadism and psychopathy, as well as to determine the role of each in the prediction of non-sexual violence and sexual crime behaviors. Study 1 assessed 314 adult, male sex offenders using archival ratings, as well as the self-report Multidimensional Inventory of Development, Sex, and Aggression (the MIDSA). Study 2 used archival ratings to assess 599 adult, male sex offenders. Exploratory and confirmatory factor analyses of crime scene descriptions yielded four sexual crime behavior factors: Violence, Physical Control, Sexual Behavior, and Paraphilic. Sadism and psychopathy covaried, but were not coextensive; sadism correlated with Total PCL-R, Facet 1, and Facet 4 scores. The constructs predicted all non-sexual violence measures, but predicted different sexual crime behavior factors. The PCL-R facets collectively predicted the Violence and Paraphilic factors, whereas sadism only predicted the Violence factor.

Reducing psychopathic violence: A review of the treatment literature

Psychopathy reflects a pathological form of personality that predisposes individuals to risk for perpetration of chronic and severe violence across their lifespan. The violence attributable to psychopathic persons constitutes a substantial portion of the societal burden to the public health and criminal justice systems and thus necessitates significant attention by prevention experts. However, there is a relatively nascent literature that has examined psychopathic persons' response to treatment, especially considering violence as an outcome. Nevertheless, there have been repeated averments about the amenability (or lack thereof) of psychopathy to treatment. In the present paper, we attempt to provide a comprehensive review of studies assessing the relation of psychopathy to violence outcomes following intervention. Our review of studies suggests there is reason to suspect that specific and tailored interventions which take into consideration psychopathic persons' unique patterns of behavioral conditioning and predispositions may have the potential to reduce violence. However, equally important, certain interventions may potentially exacerbate these persons' violent behavior. The nature of the outcomes is likely highly dependent on the specific components of the intervention itself. We conclude that future research should increase methodological rigor by striving to include treatment control groups and increasing the transparency of the implemented interventions.

Emotion processing in Psychopathy Checklist-assessed psychopathy: a review of the literature

Deficient emotional experience is recognized as one of the central features of psychopathy and an impressive body of empirical findings regarding emotion processing in psychopathy has amassed over the past several decades, resulting in two broad theoretical perspectives. The general emotional deficit perspective postulates a globally reduced capacity for emotional experience and processing across the emotional spectrum. In contrast, according to the specific emotional deficit perspective, psychopathy is associated with abnormal experience of only specific types of emotion; several distinct hypotheses have been proposed under this latter perspective. We systematically and critically review findings from peer-reviewed research of emotion processing in psychopathy in relation to the two theoretical perspectives. In general, findings suggest that, compared to controls, psychopaths exhibit behavioral, psychophysiologic, and regional brain activation anomalies when processing emotion, but their ratings of self-arousal and stimulus valence/intensity do not differ from controls. However, when behavioral findings are examined separately by emotion type, the overall pattern of findings is not clearly consistent with any of the dominant theoretical perspectives of emotion processing in psychopathy. We summarize the current state of the field, including consistencies and inconsistencies in the literature, offer alternative explanations for the findings, and outline directions for future research.

Cool and hot executive function impairments in violent offenders with antisocial personality disorder with and without psychopathy

BACKGROUND

Impairments in executive function characterize offenders with antisocial personality disorder (ASPD) and offenders with psychopathy. However, the extent to which those impairments are associated with ASPD, psychopathy, or both is unknown.

METHODS

The present study examined 17 violent offenders with ASPD and psychopathy (ASPD+P), 28 violent offenders with ASPD without psychopathy (ASPD-P), and 21 healthy non-offenders on tasks assessing cool (verbal working memory and alteration of motor responses to spatial locations) and hot (reversal learning, decision-making under risk, and stimulus-reinforcement-based decision-making) executive function.

RESULTS

In comparison to healthy non-offenders, violent offenders with ASPD+P and those with ASPD-P showed similar impairments in verbal working memory and adaptive decision-making. They failed to learn from punishment cues, to change their behaviour in the face of changing contingencies, and made poorer quality decisions despite longer periods of deliberation. Intriguingly, the two groups of offenders did not differ significantly from the non-offenders in terms of their alteration of motor responses to spatial locations and their levels of risk-taking, indicated by betting, and impulsivity, measured as delay aversion. The performance of the two groups of offenders on the measures of cool and hot executive function did not differ, indicating shared deficits.

CONCLUSIONS

These documented impairments may help to explain the persistence of antisocial behaviours despite the known risks of the negative consequences of such behaviours.

[Impaired resonance in offenders with psychopathic traits]

BACKGROUND

Resonance is the phenomenon of unconsciously mirroring the motor actions of another person. Beside autism and schizophrenia psychopathic personality traits are associated with empathy dysfunction.

METHODS

We explore empathic resonance in terms of contagion by laughing and yawning in a group of offenders with psychopathic traits. Offenders with psychopathic traits (n = 12) and matched controls (n = 10) were video-taped while watching short video sequences of yawning, laughing or neutral faces. They were rated regarding contagion. Further, we assessed a self-report on psychopathy and on empathic tendencies.

RESULTS

Compared to the control group, the offenders showed significantly less contagion and less self-reported empathic tendencies. Individuals who rated themselves as more empathic showed more contagion.

CONCLUSIONS

The observed reduced resonance in terms of contagion may illuminate the cold-heartedness, with which some psychopathic offenders treat their victims: When embodied experiencing of other's physical and emotional situation is missing, a natural inhibition of violence may be overcome. The small sample size limits the generalisability of these findings.

Neuroprediction, Violence, and the Law: Setting the Stage

In this paper, our goal is to (a) survey some of the legal contexts within which violence risk assessment already plays a prominent role, (b) explore whether developments in neuroscience could potentially be used to improve our ability to predict violence, and (c) discuss whether neuropredictive models of violence create any unique legal or moral problems above and beyond the well worn problems already associated with prediction more generally. In "Violence Risk Assessment and the Law", we briefly examine the role currently played by predictions of violence in three high stakes legal contexts: capital sentencing ("Violence Risk Assessment and Capital Sentencing"), civil commitment hearings ("Violence Risk Assessment and Civil Commitment"), and "sexual predator" statutes ("Violence Risk Assessment and Sexual Predator Statutes"). In "Clinical vs. Actuarial Violence Risk Assessment", we briefly examine the distinction between traditional clinical methods of predicting violence and more recently developed actuarial methods, exemplified by the Classification of Violence Risk (COVR) software created by John Monahan and colleagues as part of the MacArthur Study of Mental Disorder and Violence [1]. In "The Neural Correlates of Psychopathy", we explore what neuroscience currently tells us about the neural correlates of violence, using the recent neuroscientific research on psychopathy as our focus. We also discuss some recent advances in both data collection ("Cutting-Edge Data Collection: Genetically Informed Neuroimaging") and data analysis ("Cutting-Edge Data Analysis: Pattern Classification") that we believe will play an important role when it comes to future neuroscientific research on violence. In "The Potential Promise of Neuroprediction", we discuss whether neuroscience could potentially be used to improve our ability to predict future violence. Finally, in "The Potential Perils of Neuroprediction", we explore some potential evidentiary ("Evidentiary Issues"), constitutional ("Constitutional Issues"), and moral ("Moral Issues") issues that may arise in the context of the neuroprediction of violence.

Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype?

OBJECTIVES

about 50% of men with antisocial personality disorder (APD) present a comorbid anxiety disorder. Historically, it was thought that anxiety limited criminal activity and the development of APD, but recent evidence suggests that heightened responsiveness to threat may lead to persistent violent behaviour. Our study aimed to determine the prevalence of APD comorbid with anxiety disorders among offenders and the association of these comorbid disorders with violent offending.

METHOD

a random sample of 495 male penitentiary inmates completed an interview using the Diagnostic Interview Schedule. After excluding men with psychotic disorders, 279 with APD were retained. All authorized access to their criminal records.

RESULTS

two-thirds of the prisoners with APD presented a lifetime anxiety disorder. Among them, one-half had the onset of their anxiety disorder before they were aged 16 years. Among the offenders with APD, those with, compared with those without, anxiety disorders presented significantly more symptoms of APD, were more likely to have begun their criminal careers before they were aged 15 years, to have diagnoses of alcohol and (or) drug abuse and (or) dependence, and to have experienced suicidal ideas and attempts. While there were no differences in the mean number of convictions for violent offences between APD prisoners with and without anxiety disorders, more of those with anxiety disorders had been convicted of serious crimes involving interpersonal violence.

CONCLUSIONS

among men with APD, a substantial subgroup present life-long anxiety disorders. This pattern of comorbidity may reflect a distinct mechanism underlying violent behaviour and signalling the need for specific treatments.

Homicide, psychopathy, and aging--a nationwide register-based case-comparison study of homicide offenders aged 60 years or older

With populations aging there have been some concerns on elderly offending. We compared elderly homicide offenders with a younger comparison group with special emphasis on psychopathy. We analyzed nationwide register-based material on all homicide offenders aged 60 or older who were in a forensic psychiatric examination in Finland 1995-2004 and their gender-matched comparison group of younger homicide offenders. The offenders 60 years or older were diagnosed less often than the younger ones with drug dependence and personality disorders and more often with dementia and physical illnesses. The mean Psychopathy Checklist--Revised total scores as well as factor and facet scores were lower in the 60 or older age group. The group 60 years or older had significantly lower scores on eight individual items of social deviance. The interpersonal/affective factor 1 scores did not differ. Understanding the possible underlying phenomena of violent behavior may provide help for developing services for the elderly.

Psychopathy and instrumental violence: facet level relationships

The relationship between psychopathy and violence is well established. However, the extent to which psychopathy is related to different types of violent behavior warrants further study. We examined the relationship between instrumental violence, psychopathy, and psychopathic traits among 248 European American and African American adult male county jail inmates. We assessed instrumentality based on subjective motivations for respondent-identified acts of violence. Psychopathy was assessed using the PCL-R based on interview and file review. We controlled for potentially important covariates, namely IQ and prior violence. Results were in part consistent with findings from studies with adolescents, in that we identified a positive relationship between instrumentality of violence and manipulative interpersonal style. Results differed from youth studies with regard to relationships between instrumentality and other facets of psychopathy. The implications of our study are discussed with regard to treatment and the developmental stability of the relationship between psychopathic traits and instrumental violence.

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.

Hypothetical versus real-life moral reasoning among psychopathic and delinquent youth

Differences in moral reasoning concerning hypothetical versus real-life conflicts were examined with a sample of 44 youths (aged 15–18 years) who were classified as psychopathic, delinquent, or normal. All subjects were individually interviewed and assessed on (a) Hare's Psychopathy Checklist, (b) two of Kohlberg's hypothetical moral dilemmas, and (c) a subject-generated real-life moral dilemma. The results revealed that the normal youths attained a higher level of moral reasoning than either the delinquents or psychopaths. All groups scored lower on the real-life than the hypothetical dilemmas, indicating that hypothetical dilemmas may best elicit a person's level of moral reasoning competence, whereas real-life dilemmas may entail factors that lower the level of reasoning used in a situation of moral conflict. These two dilemma types also were found to elicit differing moral orientations. Finally, psychopaths were found to orient more to egoistic concerns than did delinquents when discussing real-life dilemmas.

Antisocial process screening device: validation on a Russian sample of juvenile delinquents with the emphasis on the role of personality and parental rearing

The objectives of the present study were 1) to validate the Antisocial Process Screening Device (APSD) in a sample of Russian juvenile delinquents; 2) to examine subgroups of delinquents with higher versus lower levels of childhood problem behaviors with respect to the APSD subscales, personality traits, and parental rearing; and 3) to attempt to replicate the previous finding that the APSD subscale measuring callous/unemotional traits can differentiate subgroups of delinquents with different precursors for problem behaviors (predominantly biological versus predominantly social). A group of 250 Russian juvenile inmates (mean age=16.4) was examined by means of the APSD completed by the staff at the correctional institution. The inmates completed several self-reports assessing their current and childhood behavior problems, personality traits and experienced parental rearing practices. A factor structure of the APSD was obtained that is similar, albeit not identical, to that from the original studies by Frick and colleagues [Frick, P.J., O'Brien, B.S., Wootton, J.M., McBurnett, K., (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103, 700-707]; [Frick, P.J., Barry, C.T., Bodin, S.D., (1999). Applying the concept of psychopathy to children: Implications for the Assessment of antisocial youth. In Gacono, C.B. (Ed), The clinical and forensic assessment of psychopathy: A practitioners guide. Hillsdale, NJ: Erlbaum]; [Frick, P.J., Lilienfeld, S.O., Ellis, M., Loney, B., Silverthorn, P., (1999). The association between anxiety and psychopathy dimensions in children. Journal of Abnormal Child Psychology, 27, 383-392]; callous unemotional traits in the present sample were expressed in manipulative behavior. Results further disclosed higher levels of antisocial and aggressive activities, higher levels of personality attributes such as narcissism and novelty seeking, as well as lower cooperativeness, and negatively perceived parental rearing in a subgroup with higher (versus lower) number of childhood symptoms of conduct disorder and oppositional disorder. The juvenile delinquents with higher levels as compared to lower levels of callous unemotional traits also perceived their parents as using more negative rearing strategies. The findings are discussed in terms of interactional processes between personality of the juvenile delinquents and parental rearing in the development of antisocial behavior.

Predicting violent infractions in a Swiss state penitentiary: a replication study of the PCL-R in a population of sex and violent offenders

BACKGROUND

Research conducted with forensic psychiatric patients found moderate correlations between violence in institutions and psychopathy. It is unclear though, whether the PCL-R is an accurate instrument for predicting aggressive behavior in prisons. Results seem to indicate that the instrument is better suited for predicting verbal rather than physical aggression of prison inmates.

METHODS

PCL-R scores were assessed for a sample of 113 imprisoned sex and violent offenders in Switzerland. Logistic regression analyses were used to estimate physical and verbal aggression as a function of the PCL-R sum score. Additionally, stratified analyses were conducted for Factor 1 and 2. Infractions were analyzed as to their motives and consequences.

RESULTS

The mean score of the PCL-R was 12 points. Neither the relationship between physical aggression and the sum score of the PCL-R, nor the relationship between physical aggression and either of the two factors of the PCL-R were significant. Both the sum score and Factor 1 predicted the occurrence of verbal aggression (AUC=0.70 and 0.69), while Factor 2 did not.

CONCLUSION

Possible explanations are discussed for the weak relationship between PCL-R scores and physically aggressive behavior during imprisonment. Some authors have discussed whether the low base rate of violent infractions can be considered an explanation for the non-significant relation between PCL-R-score and violence. The base rate in this study, however, with 27%, was not low. It is proposed that the distinction between reactive and instrumental motives of institutional violence must be considered when examining the usefulness of the PCL-R in predicting in-prison physical aggressive behavior.

Brain anatomy of persistent violent offenders: more rather than less

Most violent crimes in Western societies are committed by a small group of men who display antisocial behavior from an early age that remains stable across the life-span. It is not known if these men display abnormal brain structure. We compared regional brain volumes of 26 persistently violent offenders with antisocial personality disorder and substance dependence and 25 healthy men using magnetic resonance imaging volumetry and voxel-based morphometry (VBM). The violent offenders, as compared with the healthy men, had markedly larger white matter volumes, bilaterally, in the occipital and parietal lobes, and in the left cerebellum, and larger grey matter volume in right cerebellum (effect sizes up to 1.24, P<0.001). Among the offenders, volumes of these areas were not associated with psychopathy scores, substance abuse, psychotropic medication, or global IQ scores. By contrast, VBM analyses of grey matter revealed focal, symmetrical, bilateral areas of atrophy in the postcentral gyri, frontopolar cortex, and orbitofrontal cortex among the offenders as compared with the healthy men (z-scores as high as 5.06). Offenders with psychopathy showed the smallest volumes in these areas. The larger volumes in posterior brain areas may reflect atypical neurodevelopmental processes that underlie early-onset persistent antisocial and aggressive behavior.

Examining the role of static and dynamic risk factors in the prediction of inpatient violence: variable- and person-focused analyses

Although the construct of psychopathy is related to community violence and recidivism in various populations, empirical evidence suggests that its association with institutional aggression is weak at best. The current study examined, via both variable-level and group-level analyses, the relationship between standard violence risk instruments, which included a measure of psychopathy, and institutional violence. Additionally, the incremental validity of dynamic risk factors also was examined. The results suggest that PCL-R was only weakly related to institutional aggression and only then when the behavioral (Factor 2) aspects of the construct were examined. The clinical and risk management scales on the HCR-20, impulsivity, anger, and psychiatric symptoms all were useful in identifying patients at risk for exhibiting institutional aggression. These data suggest that factors other than psychopathy, including dynamic risk factors, may be most useful in identifying forensic patients at higher risk for exhibiting aggression.