Mental Disorders, Personality Traits, and Grievance-Fueled Targeted Violence: The Evidence Base and Implications for Research and Practice.

This article aims to move away from intuitive appeals that link mental disorder with violence such as terrorism, mass murder, and other targeted violence. The article synthesizes the existing evidence base regarding the relationship between mental disorders and personality traits and (a) attitudinal affinities with violent causes, and (b) a number of violent behaviors (including mass murder and terrorism). The evidence base is mixed and the research focus changed across time: from simple and unempirical assertions of causation to an almost complete rejection of their presence to a finer grained and disaggregated understanding. Empirical research examining mental disorder in crime and violence highlights that the commission of such events is a complex synthesis of psychopathology, personal circumstance, and environment. The article concludes with several suggestions regarding future research and practice.

Outcome and Efficacy of Interventions by a Public Figure Threat Assessment and Management Unit: A Mirrored Study of Concerning Behaviors and Police Contacts Before and After Intervention.

Specialized units for the assessment and management of concerning behaviors towards public figures have been set up in various jurisdictions. Their efficacy has been demonstrated descriptively and in terms of reduction in concern rates. This study of 100 consecutive cases from the Fixated Threat Assessment Centre (FTAC) in the UK uses a novel measure of outcome in the form of reduction in behaviors of concern and in police call-outs/stops, using data culled from police and health service records. It adopts a mirrored design, comparing individuals over 12-month and 2-year periods before and after FTAC intervention. It demonstrates significant reductions in both numbers of individuals involved in, and number of actual incidents of, concerning communication and problematic approach, as well as police call-outs/stops. Most results are consistent across subgroups with regard to gender, previous convictions, concern level, compulsory hospitalization and grievance-driven behavior. Such threat assessment units reduce risky behavior and save police time and, possibly, costs. Copyright © 2016 John Wiley & Sons, Ltd.

Threats to public figures and association with approach, as a proxy for violence: The importance of grievance.

The adoption of the term grievance-fuelled violence reflects the fact that similarities exist between those committing violent acts in the context of grievance in different settings, so potentially allowing the application of insights gained in the study of one group to be applied to others. Given the low base rate of violence against public figures, studies in the field of violence against those in the public eye have tended to use, as a proxy for violence, attempts by the individuals concerned to achieve unwarranted and unwanted proximity to the subject of their attention, given that approach is a necessary prerequisite for most forms of attack. In such studies, one factor that has frequently been considered is whether the making of threats is associated with a subsequent approach. The results have been varied, with no correlation found in some, a negative correlation in others, and a positive correlation in at least one. Such studies have been retrospective, using case files prepared for other purposes, and samples of cases have been selected according to their victims' sector of employment - for instance, politicians, celebrities, judiciary, and the corporate world. This study of a sample of 126 threat assessment cases, using a prospective methodology, looks at the associations between the making of threats and subsequent approach from a different angle - that of a standardised and validated classification of underlying motivation. It finds that particular types and forms of threat are significantly associated with subsequent approach in cases that are fuelled by grievance, but not in those with the motivation of seeking a relationship. Furthermore, when a sample with a mixture of motivational categories was examined in the manner of previous studies, such associations with threat were not apparent. These results refine the existing understanding of the significance of threats in public-facing cases. Future research projects in this area might usefully incorporate the consideration of underlying motivation, in particular grievance.

Stalkers and harassers of British royalty: an exploration of proxy behaviours for violence.

Study of risk factors for violence to prominent people is difficult because of low base rates. This study of harassers of the royal family examined factors suggested in the literature as proxies for violence--breaching security barriers, achieving proximity, approach with a weapon, and approach with homicidal ideation. A stratified sample of different types of approach behaviour was randomly extracted from 2,332 Royalty Protection Police files, which had been divided into behavioural types. The final sample size was 275. Significant differences in illness symptomatology and motivation were found for each proxy group. Querulants were significantly over-represented in three of the four groups. There was generally little overlap between the proxy groups. There is no evidence of the proxy items examined being part of a "pathway to violence". Different motivations may be associated with different patterns of risk. Risk assessment must incorporate knowledge of the interactions between motivation, mental state, and behaviour.

Suicidal behavior in individuals accused or convicted of child sex abuse or indecent image offenses: Systematic review of prevalence and risk factors.

OBJECTIVE: An emerging body of research indicates that child sex abuse (CSA) offenders are at high risk of suicide when their offenses come to light and that those accused of accessing indecent images of children (IIOC) are at particular risk. METHODS: We conducted a systematic review and narrative synthesis on suicide rates and risk factors in this population of offenders. A keyword search of bibliographic databases (PsycINFO, Ovid, MEDLINE, Embase, PILOTS, SCIE, the Cochrane Central Register of Controlled Trials [CENTRAL] and CINAHL) was conducted. RESULTS: Eighteen articles were included in the review, with eleven studies meeting criteria for quality assessment. The risk of suicide in perpetrators of CSA and IIOC might be over 100 times that of the general population, although estimates vary widely between studies. Several complex, interlinking factors were identified as associated with risk, including shame, unique demographic characteristics of the offenders, absence of prior criminal contact, and the impact of a criminal investigation. CONCLUSIONS: The review identified factors that may have practical, clinical, and operational implications in the prevention of suicide in CSA and IIOC perpetrators. Exploring the impact of the investigation itself on suicide risk, including potential operational strategies and clinical input to reduce risk, should be a priority.

Understanding Risk of Suicide among perpetrators who view child sexual abuse material (CSAM).

Attempts to address the threat of harm posed by perpetrators of child sexual abuse (CSA) have rightly increased in recent years, with well-known efforts such as operation NOTARISE resulting in 750 arrests; however, the cost of such operations is also high. Operation NOTARISE resulted in 24 suicides; the estimated economic and social cost of which has been estimated to be £34.8 million.[1] Perpetrators who view child sexual abuse materials (CSAM) are not only at higher risk of suicide than the general population, individuals diagnosed with a mental health disorder, and perpetrators of other violent and sexual crimes,[2-5] but they also appear to be at higher risk of suicide than perpetrators of CSA who engage directly in sexual acts with a child .[6-8] An in-depth understanding of the experiences of CSAM offenders is missing in the literature, but is required to understand how to mitigate the risk of suicide amongst this high risk group. This qualitative study investigates the experiences of CSAM perpetrators from the perspectives of law enforcement officers (n = 16), CSAM perpetrators themselves (n = 5), and help-line operators who have provided support to CSAM perpetrators through the Lucy Faithfull Foundation "Stop it now!" helpline (n = 6). Analysis was conducted separately for each dataset and in accordance with guidelines set out by Braun and Clark .[9] The focus of this paper is the six over-arching themes that were common across all datasets: (i) offender demographics; (ii) psychological impact of arrest; (iii) coping with the investigation; (iv) cognitive distortion; (v) shame and stigma; and (vi) professional support. Findings are discussed in the context of the challenges faced by law enforcement and healthcare professions when providing support to this high risk group, and eight key recommendations are made to reduce the risk of suicide.

Predictors of varying levels of risks posed by fixated individuals to British public figures.

Concerning approaches and communications to the Royal Family and other British public figures are relatively numerous. This paper examines over 2000 such cases logged over a three-year period in the United Kingdom. Using police and health data, the paper conducts a series of bivariate and multivariate analyses to demonstrate the predictors of what types of risk are posed by an individual case (e.g., communicate only, approach, security breach). The results showed that (a) the rates of serious mental disorders are higher among this sample than the general population base rate, (b) approachers were significantly more likely than communicators to suffer from serious mental disorders, (c) approachers were significantly more likely than communicators to have a history of substance use and abuse problems, (d) approachers were significantly more likely than communicators to have a history of violent behavior against property and persons, and (e) the motivations of approachers and communicators significantly differ. The paper concludes with a consideration of the implications for threat assessment and management.

Attacks on the British Royal family: the role of psychotic illness.

The role of psychotic disorders in attacks on British Royalty is examined. In the 23 attacks, there was evidence of psychotic illness at the time in 11 (48%) cases, with evidence of mental disorder in 4 additional ones. These data almost certainly underestimate the contribution of major mental disorder, as psychiatric evaluations were not available on several attackers. Psychotic states do not, however, preclude a rational element to the attackers' grievances. The objective of most attackers was to commit an outrageous act to bring attention to grievances. Nine attackers had stalked their victims. Greater attention to psychiatric disorder among those who harass royalty or other public figures would allow early intervention. Ensuring that the obviously mentally ill stalkers of prominent persons are referred to psychiatric services would meet the needs of most of them for treatment and care, while reducing the chances that a tiny minority will progress to attack.

A research review of public figure threats, approaches, attacks, and assassinations in the United States.

The authors review extant research on threats, approaches, attacks, and assassinations of public figures in the United States. Despite the limited number of studies, data exist concerning: 1) threatening letters and approaches to celebrities; 2) attacks and assassinations of public figures, usually the President of the United States; 3) threats and approaches to legislative members of state and federal governments; and 4) threats, approaches, and attacks against federal judicial officials. Similarities and differences across the various studies are discussed. Consistent findings across the studies indicate that direct threats toward the target are unusual and are often correlated negatively with an approach or attack; a significant proportion of subjects are mentally ill and have criminal histories; many subjects evidenced a downward spiral in their lives in the months or year before their approach or attack; and if an attack occurred, it was predatory (instrumental, premeditated) rather than affective (emotional, reactive), and the weapon of choice was a firearm, usually a handgun. Operational guidance and further research recommendations are made.

Stalking and serious violence.

Studies of violence in stalking have treated interpersonal violence as a homogeneous phenomenon. This study was conducted to ascertain whether the associations of serious violence in stalking are the same as those of general violence in stalking. Of 85 stalkers referred to a forensic service, those who had committed acts of serious violence (homicide and serious assaults) were compared with those who had not on preselected clinical, demographic, and criminological variables. Associations of serious violence were found to differ from those reported for general violence. In particular, serious violence was significantly associated with an absence of criminal convictions and the presence of employment. There was no association with substance abuse, previous convictions for violence, or personality disorder. Different degrees of violence have different associations. This has implications for the development of violence prediction instruments and for violence prevention in stalking.

Factors associated with escalation and problematic approaches toward public figures.

Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research.

Abnormal attentions toward the British Royal Family: factors associated with approach and escalation.

Abnormal approach and escalation from communication to physical intrusion are central concerns in managing risk to prominent people. This study was a retrospective analysis of police files of those who have shown abnormal attentions toward the British Royal Family. Approach (n = 222), compared with communication only (n = 53), was significantly associated with specific factors, most notably serious mental illness and grandiosity. In a sample of those who engaged in abnormal communication (n = 132), those who approached (n = 79) were significantly more likely to evidence mental illness and grandiosity, to use multiple communications, to employ multiple means of communication, and to be driven by motivations that concerned a personal entitlement to the prominent individual. Logistic regression produced a model comprising grandiosity, multiple communications, and multiple means of communication, for which receiver operating characteristic (ROC) analysis gave an area under the curve (AUC) of 0.82. The implications of these findings are discussed in relation to those for other target groups.