Genital Responses to Rape Vignettes Among Young Men: The Influence of Mood and Directed Attention.

Although it is clear that men with a history of sexual assaults against women produce higher relative genital responses to rape vignettes in the laboratory than do men without such a history, it remains unclear what aspects of the vignettes are eliciting these responses, and whether the genital responses are affected by situational factors. The antisocial tendencies hypothesis states that many men are inhibited by cues of violence, suffering, and coercion in rape vignettes, but other men, particularly antisocial and sexually aggressive men, are not so inhibited. In this study, we investigated whether the hypothesized inhibition to rape vignettes among nonoffenders could be affected by manipulation of mood and directed attention. A total of 48 young men were exposed to audio-recorded vignettes describing mutually consenting and nonviolent sexual interactions, mutually consenting and violent sexual interactions, nonconsenting and violent sexual interactions, and nonsexual and nonviolent social interactions (within-subjects). Participants were randomly assigned to a mood manipulation designed to induce a happy, neutral, or sad mood (between-subjects). All were asked to pay attention to either sex words or violent words while listening to the vignettes (within-subjects). As is typically observed, genital responses were lower (inhibited) when vignettes included cues of violence or nonconsent. Both happy and sad mood inductions reduced this inhibition, so that men induced into a happy or sad mood showed greater relative responding to cues of violence or nonconsent compared with men in a neutral mood. The attention manipulation had no significant effect. Results suggest that genital responses to rape cues can be situationally influenced, but not necessarily as predicted by the antisocial tendencies hypothesis.

Progress in violence risk assessment and communication: hypothesis versus evidence.

We draw a distinction between hypothesis and evidence with respect to the assessment and communication of the risk of violent recidivism. We suggest that some authorities in the field have proposed quite valid and reasonable hypotheses with respect to several issues. Among these are the following: that accuracy will be improved by the adjustment or moderation of numerical scores based on clinical opinions about rare risk factors or other considerations pertaining to the applicability to the case at hand; that there is something fundamentally distinct about protective factors so that they are not merely the obverse of risk factors, such that optimal accuracy cannot be achieved without consideration of such protective factors; and that assessment of dynamic factors is required for optimal accuracy and furthermore interventions aimed at such dynamic factors can be expected to cause reductions in violence risk. We suggest here that, while these are generally reasonable hypotheses, they have been inappropriately presented to practitioners as empirically supported facts, and that practitioners' assessment and communication about violence risk run beyond that supported by the available evidence as a result. We further suggest that this represents harm, especially in impeding scientific progress. Nothing here justifies stasis or simply surrendering to authoritarian custody with somatic treatment. Theoretically motivated and clearly articulated assessment and intervention should be provided for offenders, but in a manner that moves the field more firmly from hypotheses to evidence.

Evidence for risk estimate precision: implications for individual risk communication.

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

What does it mean when age is related to recidivism among sex offenders?

Age is a robust predictor of recidivism and an item on actuarial tools commonly used to predict sexual violent recidivism among sex offenders. However, little is known about whether or how much offenders' risk diminishes as a result of aging. In the first of two studies, we examined the sexual and violent recidivism of 533 sex offenders who were over age 50 on release. Age at index offense was at least as good at predicting both outcomes as was age at release, and age at index offense provided at least as much incremental validity in the prediction of violent recidivism to scores on a brief static actuarial tool. Neither age added incrementally to static score in the prediction of sexual recidivism. The second study examined how well age at first offense, age at index offense, and age at release predicted violent recidivism among 527 sex offenders aged 13 to 79 at release. Age at first offense predicted best. When age was removed from score on the Sex Offender Risk Appraisal Guide, all ages added incrementally but age at release least to SORAG score. When participants were divided into quartiles based on age at index offense, there was no evidence from any quartile that age at release predicted violent recidivism better than age at first offense. The authors concluded that age at release is a poor index of within-subject changes in risk of sexual or violent recidivism. No adjustment to a sex offender's score on a comprehensive actuarial tool that includes age at first or index offense should be made simply because the offender is older.

Bayes and base rates: what is an informative prior for actuarial violence risk assessment?

Bayes' theorem describes an axiomatic relationship among marginal and conditional proportions within a single "experiment." In many ways, it has been fruitful to greatly extend this idea to the task of drawing inferences from data much more generally. Commonly, what matters is how all prior knowledge is revised (or not) by new findings resulting in posterior (sometimes "subjective") probabilities. And, to address many important problems, it is sensible to conceive of probability in such subjective terms. However, some commentators in the domain of violence risk assessment have assumed an analogous axiomatic relationship among marginals (i.e., priors in the form of base rates) observed in one study and conditionals (i.e., posteriors in the form of revised rates) expected in a separate study or assessment context. We present examples from our own research to suggest this assumption is generally unwarranted and ultimately an unaddressed empirical matter.

Implementing Residential Integrated Treatment for Co-occurring Disorders.

Objective: Much is now known about effective treatment for co-occurring substance abuse and psychiatric difficulties and many evidence-based practice recommendations have been disseminated. Implementation of these recommended interventions in daily clinical practice has been more of a struggle. This article describes successful implementation of integrated treatment for co-occurring disorders in a small residential program. Methods: A traditional 28-day addiction service was transformed into a 3-month integrated treatment program and 155 individuals with co-occurring disorders agreed to participate in its evaluation. The transformation entailed a completely new manualized service, training in a number of clinical interventions for all program clinicians, ongoing clinical supervision, and formal measurement of clients' backgrounds, substance abuse, quality of life, mental health symptoms, self-esteem, and satisfaction with the program. We also obtained collateral informants' reports on participants' symptoms, substance use, and quality of life. Fidelity to the treatment model was continuously assessed, as were participants' knowledge and skill acquisition. In addition, impact of the implementation on the program clinicians' morale and attitudes toward evidence-based practices was assessed, as was staff turnover and per diem costs. Results: Despite very problematic clinical and sociodemographic histories, the 86 participants who completed the program showed clinically significant mental health symptom improvement, acquisition of knowledge and skill, and high self-esteem and satisfaction with the program. Program fidelity, clinician morale, commitment to the program, and attitudes toward evidence-based practice were uniformly high. These successes were achieved while maintaining the lowest per-inpatient day cost of all hospital inpatient units. Conclusions: The findings support the contention that evidence-based integrated treatment can be implemented with fidelity in regular clinical practice to the benefit of participants, staff, and the hospital. Our experience was that having a scientist-practitioner working as a staff member on the program to lead the implementation was a key element. Future reports will focus on longer-term follow-up of substance use and quality of life outcomes.

Effects of hydrogen gas inhalation on L-DOPA-induced dyskinesia.

L-3,4-dihydroxyphenylalanine (L-DOPA)-induced dyskinesia is a side effect of Parkinson's disease treatment and it is characterized by atypical involuntary movements. A link between neuroinflammation and L-DOPA-induced dyskinesia has been documented. Hydrogen gas (H2) has neuroprotective effects in Parkinson's disease models and has a major anti-inflammatory effect. Our objective is to test the hypothesis that H2 inhalation reduces L-DOPA-induced dyskinesia. 15 days after 6-hydroxydopamine lesions of dopaminergic neurons were made (microinjection into the medial forebrain bundle), chronic L-DOPA treatment (15 days) was performed. Rats were exposed to H2 (2% gas mixture, 1 h) or air (controls) before L-DOPA injection. Abnormal involuntary movements and locomotor activity were conducted. Striatal microglia and astrocyte was analyzed and striatal and plasma samples for cytokines evaluation were collected after the abnormal involuntary movements analysis. H2 inhalation attenuated L-DOPA-induced dyskinesia. The gas therapy did not impair the improvement of locomotor activity achieved by L-DOPA treatment. H2 inhalation reduced activated microglia in the lesioned striatum, which is consistent with the observed reduced pro-inflammatory cytokines levels. Display of abnormal involuntary movements was positively correlated with plasma IL-1ß and striatal TNF-α levels and negatively correlated with striatal IL-10 levels. Prophylactic H2 inhalation decreases abnormal involuntary movements in a preclinical L-DOPA-induced dyskinesia model. The H2 antidyskinetic effect was associated with decreased striatal and peripheral inflammation. This finding has a translational importance to L-DOPA-treated parkinsonian patients' well-being.

Explaining the erectile responses of rapists to rape stories: the contributions of sexual activity, non-consent, and violence with injury.

In phallometric research, rapists have a unique pattern of erectile responses to stimuli depicting sexual activities involving coercion and violence. In this study, we attempted to determine the cues that control rapists' erectile responses to rape stories in the laboratory. A total of 12 rapists and 14 non-rapists were exposed to recorded audio scenarios that systematically varied with regard to the presence or absence of three orthogonally varied elements: sexual activity and nudity, violence and injury, and expression of non-consent. As expected from prior research, an index computed by subtracting participants' greatest mean responses to stories describing mutually consenting sexual activity from their greatest mean responses to stories describing rape was much higher among rapists than non-rapists. Both groups showed larger responses when stories involved sexual activity and nudity, but neither group exhibited a preference for cues of violence and serious injury, or for cues of non-consent. The element that produced the larger group difference, however, was the presence or absence of active consent. The results indicated that a sexual interest in (or indifference to) non-consent is at least as central to accounting for the unique sexual orientation of rapists as is sexual responding to violence and injury.

Adolescents who have sexually offended: is phallometry valid?

It is unclear whether deviant sexual preferences distinguish adolescents who commit sex offenses in the same way that such deviance characterizes adult sex offenders. We compared male adolescents (mean age = 15 at the time of a referral sex offense), matched adult sex offenders, and normal men (adult nonoffenders or nonsex offenders). We hypothesized the following: phallometric responses of the adolescents would be similar to those of adult sex offenders and would differ from normals; adolescents with male child victims would exhibit greater evidence of sexual deviance than those whose only victims were female children; among adolescents who had molested children, those with a history of sexual abuse would exhibit more evidence of sexual deviance than those with no such history; and phallometric measures would predict recidivism. With some notable exceptions or qualifications, results confirmed the hypotheses. Phallometry has valid clinical and research uses with adolescent males who commit serious sex offenses.

How nonrecidivism affects predictive accuracy: evidence from a cross-validation of the Ontario Domestic Assault Risk Assessment (ODARA).

Prediction effect sizes such as ROC area are important for demonstrating a risk assessment's generalizability and utility. How a study defines recidivism might affect predictive accuracy. Nonrecidivism is problematic when predicting specialized violence (e.g., domestic violence). The present study cross-validates the ability of the Ontario Domestic Assault Risk Assessment (ODARA) to distinguish subsequent recidivists and nonrecidivists among 391 new cases with less extensive criminal records than previous cross-validation samples, base rate=27%, ROC area=.67. Excluding ambiguous nonrecidivists increases the base rate to 33%, ROC area=.74. Random samples of 50 recidivists and 50 unambiguous nonrecidivists yield ROC areas from .71 to .80. Published norms significantly underestimate official recidivism. Ambiguous nonrecidivism is prevalent and leads to underestimating base rates and predictive accuracy.

Actuarial assessment of violence risk in hospital-based partner assault clinics.

Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

Does using nonnumerical terms to describe risk aid violence risk communication? Clinician agreement and decision making.

Actuarial risk assessments yield valid numerical information about violence risk, but research suggests that forensic clinicians prefer to communicate risk using nonnumerical information (i.e., verbal terms such as high risk). In an experimental questionnaire study, 60 forensic clinicians disagreed on the interpretation of nonnumerical terms, and their nonnumerical risk estimates for one group of violent offenders were influenced by comparison with another group. Adding nonnumerical terms to numerical probability statements had no effect on hypothetical forensic decisions. These findings suggest that nonnumerical descriptive terms do not aid effective communication of violence risk and that contextual information might artificially affect estimated risk.

Response inhibition in psychopathy: the frontal N2 and P3.

Psychopathy has been associated with atypical function of the anterior cingulate cortex (ACC) and adjacent brain regions and with abnormalities in performance monitoring, which is thought to rely on these structures. The ACC and adjacent regions are also involved in the generation of two characteristic components of the event-related potential: the frontal N2 and P3. Both components are enhanced when a response is withheld (NoGo trial) within a series of positive-responses (Go trials) and are considered an index of response inhibition. We recorded event-related potentials while violent offenders who varied on the dimension of psychopathy and non-offender controls performed a Go/NoGo task. The offenders made more errors of commission on NoGo trials but this effect was unrelated to level of psychopathy within the group and, inconsistent with a previous report, they produced the enhanced frontal N2 and P3 effect in response to NoGo relative to Go conditions. We conclude that the neural processes involved in response inhibition are not abnormal in psychopaths when both stimuli and context are affectively neutral and suggest that a more nuanced perspective regarding impulsivity in this population be considered.

ERN varies with degree of psychopathy in an emotion discrimination task.

It is hypothesized that anterior cingulate cortex (ACC) function may be disrupted in psychopathy. Since ACC is considered the generator of the error-related negativity (ERN), we expected the ERN to be sensitive to the degree of psychopathy among violent offenders. EEG was collected while offenders and controls responded to a standard letter flanker task and to a face flanker task that required discrimination between angry and fearful expressions. Offenders were as accurate as controls on the letter flanker task but made more errors in emotion discrimination on the face flanker task. ERNs elicited by letter flanker errors did not differ across groups but were markedly reduced in the offenders in the face flanker condition. These effects were related to the degree of psychopathy within the offender group. Source modelling of the ERN also indicated an atypical response for psychopaths when error monitoring required the discrimination of affectively based information.

Coercive and precocious sexuality as a fundamental aspect of psychopathy.

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.

Effects of a tobacco ban on long-term psychiatric patients.

A total ban on all tobacco products was implemented in a diverse psychiatric institution. A post hoc evaluation examined the effect of the ban on long-term patients by comparing their characteristics the year before the ban to the year after. Several variables measuring physical health, psychiatric symptomatology, feelings of well-being, and interpersonal conflict were coded with very high reliability from health records. For the majority of patients who were in the maximum security forensic division, the tobacco ban was associated with almost no detectable ill effects with some clear benefits. Among the remainder of the long-term patients, the ban might have been associated with a temporary increase in physical aggression towards staff members. It was concluded that successful implementation, and the avoidance of ill effects, depended entirely on the success staff members had in actually preventing patient access to tobacco.

Effects of a Snoezelen room on the behavior of three autistic clients.

The effect of a Snoezelen room on the disruptive and prosocial behavior of three male, autistic inpatients was examined. In an ABAB reversal design, specific disruptive and prosocial behaviors were recorded for each client throughout the four 28-day periods of the study. Results indicated that the three clients had different responses to the room, but no client showed a decrease in disruptive behaviors while in the Snoezelen condition compared to baseline, and one client showed a clear pattern of increased disruptive behavior during the Snoezelen periods. There was a slight tendency for clients to engage in more prosocial behaviors while in Snoezelen. These findings do not support the contention that Snoezelen rooms are effective interventions for aggressive behavior in this client population.

Actuarial risk assessment of sexual offenders: The psychometric properties of the Sex Offender Risk Appraisal Guide (SORAG).

The Sex Offender Risk Appraisal Guide (SORAG) is one of the most commonly used actuarial risk assessment instruments for sexual offenders. The aims of the present field study were to examine the predictive validity of the German version of the SORAG and its individual items for different offender subgroups and recidivism criteria in sexual offenders released from the Austrian Prison System (N = 1,104; average follow-up period M = 6.48 years) within a prospective-longitudinal research design. For the prediction of violent recidivism the German version of the SORAG yielded an effect size of AUC = .74 (p < .001, 95% CI = .70-.78). The predictive accuracy for general and violent recidivism was slightly higher than for general sexual and sexual hands-on recidivism. The effect sizes were found to be higher for the child molester sample than for rapists. However, the differences were significant only for general recidivism (z = 2.48, p = .001). Further analyses exhibited the SORAG to have incremental predictive validity beyond the VRAG and the PCL-R, and to remain the only significant predictor for violent recidivism once all 3 instruments were forced into a combined regression model. Twelve out of the 14 SORAG items were found to have a significant positive relationship with violent recidivism. The comparison of the relative and absolute risk indices between the Austrian and the Canadian samples showed that the normative data distribution yielded more (absolute risk indices) or less (relative risk indices) meaningful differences between the 2 countries. (PsycINFO Database Record

Predicting wife assault: a critical review and implications for policy and practice.

In this review, the authors examine the research evidence for the prediction of wife assault recidivism, lethal wife assault, and wife assault onset. They also review and present original data on the effect of treatment attendance on wife assault risk. Violence does not always become a stable habit, and variables associated with wife assault onset do not necessarily predict recidivism. General antisociality, psychopathy, substance abuse, and a history of assault and psychological abuse in the relationship are the most promising predictors of recidivism. Formal risk assessments, and victims' predictions, have demonstrated value in predicting recidivism. The authors review existing assessments for wife assault onset and recidivism and explain the relative merits of actuarial tools and structured clinical assessments. Because of statistical and practical limitations to predicting lethal assault, they recommend using an actuarial assessment of wife assault risk, plus attention to the strongest correlates of lethal assault when lethality is a concern.

Weight Gain and Its Correlates Among Forensic Inpatients.

OBJECTIVE: We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population. METHODS: We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization. RESULTS: On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker. CONCLUSIONS: Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.