Interpersonal factors as predictors of disciplinary infractions in incarcerated personality disordered offenders

Interpersonal Problem Profiles of Personality and Psychopathology Constructs in Chinese Undergraduates and Offenders

The interpersonal problem circumplex is extensively used in the field as an assessment framework for understanding the interpersonal implications of a range of personality and psychopathology constructs. The vast majority of this large literature has been conducted in Western convenience and clinical samples. We computed interpersonal problem structural summary parameters for a range of personality and psychopathology variables in two Chinese offender samples (N = 424 and N = 555) and one undergraduate sample (N = 511) to test how well findings from Western samples generalize to Chinese undergraduates and offenders. The results showed that findings in Western samples generalized reasonably well to Chinese young adult and forensic contexts, although the interpersonal profiles of external variables were less specific in Chinese samples. Compared with undergraduates, interpersonal distress has stronger associations with the mental health of offenders. This study further elaborates the interpersonal correlates of individual differences in personality and psychopathology across cultures and assessment contexts, and it also extends the literature examining interpersonal problems in forensic settings.

A Person-Centered Approach to Prison Behavior Based on Officers' Observations: Relations to Risk, Prison Misconduct, and Recidivism

Incorporating measures of prison behavior into risk assessment and management procedures may assist in treatment planning, risk monitoring, and decision-making. A behavior rating scale was used to assess prison officers' observations on externalizing, internalizing, and adaptive behavior in a sample of 277 sexual and violent offenders in correctional treatment in Berlin, Germany. The present study employed latent profile analysis to identify inmate subtypes with similar behavioral patterns. Results indicated a solution with five latent profiles that showed similarities with previous inmate typologies. The subtypes were termed "Aggressive-Psychopathic," "Asocial," "Situational," "Inconspicuous, and "Inadequate-Dependent." Analyses attested to the construct and predictive validity of the subtypes and involved the examination of differences on criminological characteristics, risk assessment instruments, various types of prison misconduct, and postrelease recidivism. This person-centered study illustrates the importance of attending to broader patterns of inmate behavior. The structured assessment of behavioral observations by prison officers can be a valuable and easy-to-implement approach to benefit from this largely neglected resource.

Predicting Offenders' Institutional Misconduct and Recidivism: The Utility of Behavioral Ratings by Prison Officers

Measures of current behavior are rarely incorporated into risk assessment. Therefore, the current study used a behavior rating scale to assess prison officers' observations of inmates prison behavior and examined the contribution of these ratings for risk assessment. Prison officers rated 272 sexual and violent offenders in three different correctional treatment facilities in Berlin, Germany. Factor analysis revealed three psychologically meaningful factors measuring externalizing, internalizing and adaptive prison behavior. The construct validity of the three factors was established through correlational analyses with standardized risk assessment instruments. Externalizing and internalizing behaviors were significant predictors of violent recidivism after release. In addition, externalizing was a significant predictor of institutional misconduct, whereas adaptive and internalizing behavior predicted whether an inmate was granted privileges (e.g., minimum-security confinement). Logistic regression analyses indicated that externalizing behavior ratings added incrementally to the Level of Service Inventory-Revised for the prediction of institutional misconduct and violent recidivism. The results indicate that prison officers observe important prison behaviors and that behavioral ratings can improve risk assessment.

Patient characteristics associated with aggression in mental health units

Aggression in mental health units is a significant and pervasive problem. However, the characteristics of patients associated with increased aggression propensity remain unclear and there are few attempts to expand understanding of these characteristics by drawing upon contemporary aggression theory. This study assessed the influence of interpersonal (hostile-dominance) and personality (psychopathy), General Aggression Model-specified (aggressive script rehearsal, attitudes towards violence, and trait anger), and clinical (psychiatric symptoms) factors on aggression during psychiatric hospitalization in 200 inpatients (132 men and 68 women; 19-64 years, M=38.32 years, S.D.=11.13 years). Patient characteristics were assessed on admission using structured interviews and self-report psychological tests. Patients' files were reviewed and nurses were interviewed after patients were discharged to establish whether patients were aggressive during their hospital stay. Results of univariate analyses showed that higher levels of interpersonal hostile-dominance, psychopathy and aggressive script rehearsal, positive attitudes towards violence, trait anger, and disorganized and excited type psychiatric symptoms all predicted aggression. In the final multivariable logistic regression model, only hostile-dominance remained as a significant predictor of aggressive behavior. This important personality characteristic should be considered in violence risk assessments and aggression prevention strategies.

An examination of the stability of interpersonal hostile-dominance and its relationship with psychiatric symptomatology and post-discharge aggression

The relevance of interpersonal hostile-dominance (HD) to post-discharge aggression in mental health patients is unclear. This study assessed whether (1) HD is stable over time; (2) the relationship between HD and positive, negative, disorganized, and excited symptoms is consistent over time; and (3) HD is related to aggression post-discharge. Two hundred psychiatric inpatients were recruited on admission to hospital; 41 were available for follow-up at 6 months post-discharge, including 29 men and 12 women, with an age range of 19-63 (M = 39.63 years, SD = 12.69 years). Psychiatric symptomatology and interpersonal style were assessed at recruitment and follow-up; aggression in the community post-discharge was measured at follow-up. Results showed that (1) HD was stable over time despite an overall reduction in psychiatric symptoms, (2) HD was positively correlated with symptom severity at both time points, and (3) higher HD, excited symptoms, and positive symptoms measured in the community, and more severe positive symptoms measured in hospital, were associated with aggressive behavior post-discharge. These results suggest that HD is a risk factor for more severe psychopathology. Furthermore, HD, positive symptoms, and excited symptoms measured in the community act as risk factors for aggressive behavior post-discharge. As such, treatment planning and risk assessment should consider HD. Aggr. Behav. 42:324-332, 2016. © 2015 Wiley Periodicals, Inc.

Observer Ratings of Interpersonal Behavior as Predictors of Aggression and Self-Harm in a High-Security Sample of Male Forensic Inpatients

Incidents of aggression and self-harm in forensic mental health inpatient settings present a significant challenge to practitioners in terms of safely managing and reducing the harm they cause. Research has been conducted to explore the possible predictors of these incidents and has identified a range of environmental, situational, and individual risk factors. However, despite the often interpersonal nature of the majority of aggressive incidents, few studies have investigated forensic inpatient interpersonal styles as predictors of aggression and even fewer have explored the potential interpersonal function of self-harming behaviors. The current study investigated the predictive validity of the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE) for incidents of verbal and physical aggression, and self-harm recorded from 204 high-secure forensic inpatients. Means comparisons, correlations, and receiver operating characteristics (ROC) were conducted on recorded incident data at 12, 24, and 48 months following baseline assessment using the CIRCLE. Dominant and coercive interpersonal styles were significant predictors of aggression, and a coercive interpersonal style was a significant predictor of self-harm, over the recorded time periods. When categorizing the inpatients on the basis of short- and long-term admissions, these findings were only replicated for inpatients with shorter lengths of stay. The findings support previous research which has demonstrated the benefits of assessing interpersonal style for the purposes of risk planning and management of forensic inpatients. The predictive value may be time-limited in terms of stage of admission.

Characteristics of interpersonal hostile-dominance in psychiatric inpatients

OBJECTIVE

This study assessed the extent to which psychiatric symptoms and aggression-related personality as well as cognitive and affective variables predicted interpersonal hostile-dominance (HD) in psychiatric inpatients.

METHOD

Two hundred patients admitted to hospital for psychiatric treatment were recruited, including 132 men and 68 women, with an age range of 19-64 years (M = 38.32 years, SD = 11.13 years). Each participant was assessed within five days of admission using the Impact Message Inventory-Circumplex (IMI-C), the Psychopathy Checklist: Screening Version (PCL:SV), the State-Trait Anger Expression Inventory-2 (STAXI-2), the Schedule of Imagined Violence (SIV), the Measures of Criminal Attitudes and Associates (MCAA), and the Positive and Negative Syndrome Scale (PANSS). Hierarchical multiple regression was used to assess the ability of psychiatric symptoms to predict HD, after controlling for the influence of psychopathy (Factor 1 [F1] and Factor 2 [F2]), trait anger, aggressive script rehearsal, and normative beliefs supporting aggression.

RESULTS

Psychopathy (F1 and F2), the tendency to rehearse aggressive scripts, and psychiatric symptomatology (PANSS Positive, Negative, Disorganized, and Excited) all predicted HD, with the final model explaining 71.30% of the variance in HD. Trait anger, positive attitudes toward violence, and PANSS Emotional Distress did not predict HD.

CONCLUSIONS

HD reflects a characteristic tendency toward interpersonal, affective, and behavioral problems marked by hostility and dominance, combined with a tendency toward frequent aggressive script rehearsal and more severe psychiatric symptomatology.

The Index Offence Representation Scales; a predictive clinical tool in the management of dangerous, violent patients with personality disorder?

BACKGROUND

Forensic mental health professionals attach considerable importance to their patient's description of his or her index offence. Despite this, there is no systematic approach to examining and formulating the patient's offence narrative.

AIM

To use the index offence narratives and capacity to mentalize of violent offender-patients with personality disorder to develop a tool to predict their progress and to evaluate that tool.

METHOD

In a prospective, cohort study, the index offence narratives of 66 violent high security hospital patients with personality disorder were obtained from a semi-structured interview and used to generate the Index Offence Representational Scales (IORS). The predictive validity of these scales was investigated across a range of outcome variables, controlling for the association between initial and final value of the dependent variable.

RESULTS

The degree to which patients held internal representations of interpersonal violence and malevolence, as measured by the IORS, predicted subsequent violent behaviour. In contrast to their actual aggressive behaviour, these patients rated themselves as having fewer symptoms on the Symptom Checklist-90-R (SCL-90-R) and fewer problems in interpersonal relationships on the Inventory of Interpersonal Problems. A more empathic victim representation on the IORS predicted better engagement with treatment.

CONCLUSIONS

The IORS show promise for helping clinicians formulate the early institutional pathway of seriously violent people with personality disorder, particularly with respect to their overt aggression and prosocial engagement. Replication studies are, however, indicated.

Implications for the prevention of aggressive behavior within psychiatric hospitals drawn from interpersonal communication theory

Although interpersonal style is a defining feature of personality and personality disorder and is commonly identified as an important influence on aggressive behavior, treatment completion, and the development of an effective therapeutic alliance, it is rarely considered in practice guidelines for preventing, engaging, and managing patients at risk of aggression. In this article, the authors consider three potential applications of interpersonal theory to the care and management of patients at risk of aggression during hospitalization: (a) preventing aggression through theoretically grounded limit setting and de-escalation techniques, (b) developing and using interventions to alter problematic interpersonal styles, and (c) understanding therapeutic ruptures and difficulties establishing a therapeutic alliance. Interpersonal theory is proposed to offer a unifying framework that may assist development of intervention and management strategies that can help to reduce the occurrence of aggression in institutional settings.

A multi-site randomized controlled trial of a cognitive skills programme for male mentally disordered offenders: social-cognitive outcomes

BACKGROUND

Cognitive skills programmes have been associated with improvements on psychometric measures and reductions in antisocial behaviour in mentally disordered offenders (MDOs). However, to date there have been no randomized controlled trials (RCTs) of such programmes with this population. In the first RCT of a cognitive skills programme with MDOs we aimed to determine if participation in the Reasoning and Rehabilitation (R&R) programme was associated with improvements in social-cognitive skills and thinking styles.

METHOD

A total of 84 men with a primary diagnosis of psychotic disorder and a history of violence were recruited from medium-secure forensic units and allocated to receive R&R (n=44) or treatment as usual (TAU; n=40). At baseline and post-treatment interviews, participants completed questionnaires to assess social problem-solving, criminal attitudes, anger experience, blame externalizing and perspective-taking. Researchers were not blind to group status.

RESULTS

The R&R group demonstrated significant improvements on measures of social problem-solving relative to the TAU group, some of which were maintained at 12 months post-treatment. Only half of those allocated to receive R&R completed the full programme. In post-hoc analyses programme completers showed improvements in social problem-solving at the end of treatment and changes in criminal attitudes at 12 months post-treatment.

CONCLUSIONS

Among male MDOs, R&R participation was associated with improvements in social-cognitive skills, some of which were maintained for up to 12 months post-treatment. Our finding that programme completers do better may reflect pre-treatment patient characteristics. This study establishes that multi-site RCTs can be conducted in medium-secure forensic units.

Voluntary consent in correctional settings: do offenders feel coerced to participate in research?

A major ethical concern in research with criminal offenders is the potential for abuse due to coercive influences that may adversely affect offenders' capacity to give voluntary consent to participate in research conducted in correctional settings. Despite this concern, to date there have been almost no systematic scientific investigations of the extent to which offenders themselves perceive that coercion occurs in these settings or that it is likely to influence their decisions about research participation. In a sample of over 600 ethnically diverse men and women recruited from various prisons and community corrections facilities in Texas and Florida, we used a vignette-based survey concerning a hypothetical research project to measure and compare offenders' global perceptions of coercive processes, as well as the differential salience and perceived coercive influence of specific factors (e.g., coercion by other inmates, inducements from staff). Somewhat surprisingly, across multiple outcome measures our participants on average reported relatively little in the way of significant coercive influences on their capacity to make voluntary decisions concerning research participation. Implications and directions for future research on coercive influences in offender research are discussed.

Staff and patient's perceptions of each other's interpersonal style: relationship with severity of personality disorder

Extreme and varied reactions are often encountered when working with patients with personality disorders. Similarly, patients with personality disorder may also hold polarised opinions of the staff involved in their treatment. This study explored the relationship between severity of personality disorder and interpersonal style in patients admitted for treatment to a secure psychiatric unit. Up to four nurses rated each patient's interpersonal style using the Impact Message Inventory, a self-report transactional inventory. Patients then rated the interpersonal style of these same staff. Contrary to expectations, severity of personality disorder was not associated with patients' interpersonal style or to variance in nurses' assessments of patients' interpersonal style. However, patients with more severe personality disorder tended to show greater variability in their assessment of nurses' interpersonal style, specifically their appraisal of staff members' interpersonal dominance. Implications for the assessment of offenders admitted for treatment of their personality disorder are discussed.

Evaluating the validity of anger regulation problems, interpersonal style, and disturbed mental state for predicting inpatient violence

Research has been conducted to try to identify risk factors to help predict which patients will be violent during psychiatric hospitalization. Despite the relatively large amount of research conducted, it is difficult to draw any firm conclusions, as the studies vary considerably in study design, methods used, and choice of outcome measures. Studies also tend to focus on risk prediction, even though risk management is the primary aim of clinical practice in mental health services and few studies have focused on a theoretical basis for understanding violence. This study assessed the predictive validity of brief assessment scales in a sample of 94 forensic inpatients who had been inpatient for a median of 521 days, to test the hypotheses that anger regulation problems, interpersonal style, and disturbed mental state would be linked to increased violence risk in a forensic hospital during a hospital stay. The outcome variables for this study were physical violence against another and/or clear threats of physical violence. The results of this study provide support for the hypotheses, and this remained the case after controlling for age, gender, length of stay, and presence of major mental disorder. The findings should not only assist clinicians with assessment and management of risk but also support the reconceptualizing of risk prediction research to reflect the task of clinical risk management.