Psychopathy and violent recidivism among young criminal offenders.

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

Psychopathy and the predictive validity of the PCL-R: an international perspective.

Its controversial past notwithstanding, psychopathy has emerged as one of the most important clinical constructs in the criminal justice and mental health systems. One reason for the surge in theoretical and applied interest in the disorder is the development and widespread adoption of reliable and valid methods for its measurement. The Hare PCL-R provides researchers and clinicians with a common metric for the assessment of psychopathy, and has led to a surge in replicable and meaningful findings relevant to the issue of risk for recidivism and violence, among other things. Most of the research thus far has been based on North American samples of offenders and forensic psychiatric patients. We summarize this research and compare it with findings from several other countries, including England and Sweden. We conclude that the ability of the PCL-R to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability, and that the PCL-R and its derivatives play a major role in the understanding and prediction of crime and violence.

A preliminary typology of young sex offenders.

Data concerning all young (15-20 years, n = 56) sex offenders (YSOs) subjected to forensic psychiatric investigation in Sweden during 1988-1995 were used in an attempt to construct and validate an introductory YSO typology based solely on offence characteristics. A 5-cluster solution received optimal support from cluster analysis of 15 offence-related variables. A few historical and clinical characteristics varied across clusters. Survival analyses revealed that the clusters differed with respect to sexual but not to violent or general reconviction rates.

Psychopathy (PCL-R) as a predictor of violent recidivism among criminal offenders with schizophrenia.

Hare's Psychopathy Checklist--Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score > or = 26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.

The medico-legal status of young sex offenders: forensic psychiatric evaluations in Sweden 1988-1995.

Young sex offenders (YSOs) attract significant public and professional concern. YSOs might be perceived as more psychologically deviant or dangerous than other offenders. This study focused on how often YSOs subjected to forensic psychiatric investigation (FPI) were declared medico-legally insane as compared to young non-sex offenders and adult sex offenders. Logistic regression models were applied to data from all major FPIs performed in Sweden between 1988 and 1995 (N=4354) to explore factors affecting the likelihood of receiving a medico-legal insanity declaration. When we adjusted for the statistical effects of age, sex offender status, and psychopathology, YSOs (n=47) were three to four times more likely to be declared insane in the medico-legal sense. The results indicate that YSOs in Sweden constitute a medico-legally distinct subgroup of forensic psychiatric examinees.

Psychopathy (PCL-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden.

Psychopathy as conceptualized with Hare's Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66-.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57-.70) and .71 (95% CI: .65-.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.

Suicide among personality-disordered offenders: a follow-up study of 1943 male criminal offenders.

Suicide mortality among all male criminal offenders in Sweden who had been subjected to a major forensic psychiatric examination 1988-1991 (n = 1943) was studied, with special reference to offenders with personality disorders. The cohort was followed until the end of 1995. Altogether 135 individuals (6.9%) died during the follow-up period; the mode of death was suicide in 50 individuals (2.6%). The unadjusted suicide mortality ranged from 2.8% among those with personality disorders to 6.1% among those with drug-related psychosis. The standardised mortality ratio (SMR) among personality-disordered offenders was 1212, i.e. around 12 times that of the general population. Survival analyses by means of Cox regression models were performed to identify background factors associated with completed suicide. No specific principal diagnosis showed significantly increased risk for completed suicide. However, concomitant depression and drug abuse were significantly linked to suicide. Violent crime showed no association. Among personality-disordered offenders suicide methods did not differ from those of suicide victims in the general population. There was no association between violent index criminality or between life-time violent criminality and choice of a violent suicide method.

Reliability of file-based retrospective ratings of psychopathy with the PCL-R.

A rapidly emerging consensus recognizes Hare's Psychopathy Checklist-Revised (PCL-R; Hare, 1991) as the most valid and useful instrument to assess psychopathy (Fulero, 1995; Stone, 1995). We compared independent clinical PCL-R ratings of 40 forensic adult male criminal offenders to retrospective file-only ratings. File-based PCL-R ratings, in comparison to the clinical ratings, yielded categorical psychopathy diagnoses with a sensitivity of .57 and a specificity of .96. The intraclass correlation (ICC) of the total scores as estimated by ICC(2,1) was .88, and was markedly better on Factor 2, ICC(2,1) = .89, than on Factor 1, ICC(2,1) = .69. The findings support the belief that for research purposes, file-only PCL-R ratings based on Swedish forensic psychiatric investigation records can be made with good alternate-form reliability.

Validation of the self-report questionnaire DIP-Q in diagnosing DSM-IV personality disorders: a comparison of three psychiatric samples.

The DSM-IV section of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP-Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP-Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis I disorders, gender or age. The strongest association between DIP-Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self-reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help-seeking exaggeration of problems. These are aspects to consider when using the DIP-Q, which overall appears to discriminate well between different samples.

DSM-IV and ICD-10 personality disorders: a comparison of a self-report questionnaire (DIP-Q) with a structured interview.

OBJECTIVE: Diagnosing personality disorders according to structured expert interviews is time-consuming and costly. For epidemiological studies, self-report instruments have several advantages. The DSM-IV and ICD-10 personality questionnaire (DIP-Q) is a selfreport questionnaire constructed to identify personality disorder according to DSM-IV and ICD-10. METHOD: The DIP-Q is validated vs a structured expert interview in a clinical sample of 138 individuals. In addition, prevalence rates yielded by DIP-Q among 136 healthy volunteers are assessed and compared to expected prevalence. RESULTS: For DSM-IV the agreement for any personality disorder as measured by Cohen's Kappa was 0.61 and 0.56 for ICD-10. Overall sensitivity for any personality disorder was for DSM-IV 0.84 and for ICD-10 0.85. However, specificity was lower: 0.77 and 0.70, respectively. When dimensional scores between self-report and interview for each personality disorder were compared, the intraclass correlation for the DSMIV entities was 0.37-0.87 and for the ICD-10 entities 0.33-0.73. Among healthy volunteers the base rate of personality disorders was found to be 14%. CONCLUSION: DIP-Q can be used as a screening instrument for personality disorders according to DSM-IV and ICD-10. Self-report questionnaires such as DIP-Q will probably play an increasingly important role in future epidemiological studies.