Cognitive-affective drivers of fixation in threat assessment.

Pathological fixation - preoccupation with a person or a cause that is accompanied by deterioration in social and occupational functioning - has been found to precede most cases of targeted violence. It is clinically observed and theorized to have three different cognitive-affective drivers: delusion, obsession, or extreme overvalued belief. Each driver is explained, and case examples are provided in the context of threat assessment. Extreme overvalued belief as a new concept is discussed in detail, both its historical provenance and its demarcation from delusions and obsessions. Threat management for each separate cognitive-affective driver is briefly summarized, based upon current clinical findings and research. Emphasis is placed upon understanding both the categorical and dimensional nature (intensity) of these cognitive-affective drivers, and suggested guidelines are offered for the assessment of such in a clinical examination by a forensic psychiatrist or psychologist.

A Preliminary Report of Psychiatric Diagnoses in a Scottish County Sample of Persons of National Security Concern.

Increasing anecdotal, empirical, and research evidence indicates mental disorder history is one of the several factors associated with increased risk of involvement in lone-actor terrorist activities. Currently, few studies have been conducted on the mental disorder histories of individuals assessed as at risk of involvement in terrorist activities (Meloy, J Threat Assess Manag 2019;6:93). This pilot study describes demographic, psychiatric, and criminal characteristics of a sample of Scottish individuals identified by the Prevent element of the U.K. national counterterrorism strategy, and outcome data after follow-up at 2 years. Twenty-three individuals were referred to Prevent as posing a national security risk from a county in Scotland. Their records were studied for psychiatric and criminal histories. Nine (39%) had previous psychiatric contact, all were "lone actors", and none were embedded with organized terrorist groups. The most common diagnoses were substance use disorder, personality disorder, depression, and psychotic disorder. The sample displayed factors associated with increased risk of violence including previous offending, early behavioral difficulties, school problems, substance misuse, cluster B personality disordered traits. After 2 years, 44% of the mentally disordered group had re-offended. The offense types were generally similar to those prior to the individual being involved with the Prevent counter terrorism program. Only one of the mentally disordered group committed a further national security offense. In this sample, mental disorder history is overrepresented in individuals who come to the attention of the U.K. Prevent counter terrorism strategy. Further empirical studies with additional power are required to develop the empirical evidence base in this under-researched area.

Extreme Overvalued Beliefs.

An extreme overvalued belief is shared by others in a person's cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. Over time, the belief grows more dominant, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. Study participants (n = 109 forensic psychiatrists) were asked to select among three definitions (i.e., obsession, delusion, and extreme overvalued belief) as the motive for the criminal behavior seen in 12 randomized fictional vignettes. Strong interrater agreement (kappa = 0.91 [95% CI 0.83-0.98]) was seen for vignettes representing extreme overvalued belief. Vignettes representing delusion and obsession also had strong reliability (kappa = 0.99 for delusion and 0.98 for obsession). This preliminary report suggests that forensic psychiatrists, given proper definitions, possess a substantial ability to identify delusion, obsession, and extreme overvalued belief. The rich historical foundation of extreme overvalued belief and this small survey study highlight the benefit of inclusion of "extreme overvalued belief" in future glossaries of the Diagnostic and Statistical Manual.

Visualizing the relationship among indicators for lone actor terrorist attacks: Multidimensional scaling and the TRAP-18.

This validation study analyses data from a sample of North American terrorist attackers (n = 33) and non-attackers (n = 23) through the lens of the Terrorist Radicalization Assessment Protocol (TRAP-18; Meloy, 2017) utilizing a multivariate statistical approach - multidimensional scaling - to visualize potential clustering (co-occurrence) of risk factors. Rarely done in terrorism research, the results plotted in two-dimensional space show the clustering and co-occurrence of most of the eight proximal warning behaviors among the attackers, but not among the non-attackers, and less of a clustering and association of distal characteristics, but their presence in both attackers and non-attackers. These findings provide further empirical support for the rational-theoretical model of the TRAP-18, a structured professional judgment instrument for threat assessment of lone actor terrorists. It advances the quantitative analysis of operationally relevant and behaviorally observable indicators for use by law enforcement and counterterrorism professionals and their consultants. Findings are discussed in relation to other research on pre-offense behaviors of lone actor terrorists, and recommendations are made for both operational use and further research.

Extreme Overvalued Belief and the Legacy of Carl Wernicke.

Individuals with extreme overvalued beliefs often carry out abhorrent and inexplicable acts of violence. They hold odd and bizarre beliefs that are shared by others in their culture or subculture. This creates a dilemma for the forensic psychiatrist because the definition of delusion may not be adequate. We discuss the evolution of the term "overvalued idea" first described in a forensic context by neuropsychiatrist Carl Wernicke in 1892. The overvalued idea is invoked in British scholarship as a definition for beliefs seen in anorexia nervosa, morbid jealousy, paranoid litigious states, and other disorders. This is sometimes referred to as delusional disorder by psychiatrists in the United States. The concept of an extreme overvalued belief has recently been validated and is separate from an obsession or delusion. It plays an important role in identifying fixation as a warning sign in threat assessment. We use this definition in three well-known cases (i.e., Anders Breivik, John Hinckley, Jr., and Ted Kaczynski) to emphasize how form and content of beliefs are critical to understanding the mens rea in violent criminal acts. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, would be enhanced by the addition of extreme overvalued belief as a definition to differentiate it from idiosyncratic, fixed, false beliefs seen in delusion.

Spiteful and contemptuous: A new look at the emotional experiences related to psychopathy.

Psychopathy has long been conceptualized in terms of an absence of emotion. Yet, recent studies have suggested that the experience of other-directed negative emotions may be more intimately linked to psychopathy than previously acknowledged, although there is limited knowledge concerning the experience of such emotions. The present study examined the disposition to experience two other-directed emotions, spitefulness and contempt, that are conceptually linked with psychopathy but currently are limited in empirical support. Across 2 studies with 3 nonclinical samples (Ns = 1,237, 239, 521), we found evidence that psychopathic traits-as assessed via the Self-Report Psychopathy Scale (SRP; Paulhus, Neumann, & Hare, 2016; Study 1 and Study 2) and the Triarchic Psychopathy Measure (TriPM; Patrick, 2010; Study 2)-were positively associated with spitefulness (Study 1) and contempt (Study 2). These associations were consistent across psychopathy instruments (SRP and TriPM) and dimensions (i.e., the SRP Interpersonal, Affective, Lifestyle, and Antisocial facets, and the TriPM Meanness and Disinhibition dimensions), were stronger for the interpersonal and affective traits of psychopathy, and held when accounting for several theoretically relevant covariates. The only exception concerned the TriPM Boldness scale, which had less consistent associations with contempt. The present findings further our understanding of the emotional experiences related to psychopathy, highlighting the relevance of focusing on other-directed negative emotions, especially those that are interpersonal in nature and share an antagonistic component. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Operational Development and Empirical Testing of the Terrorist Radicalization Assessment Protocol (TRAP-18).

The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for threat assessment of the individual terrorist. It is a rationally derived theoretical model comprising eight proximal warning behaviors and 10 distal characteristics. Empirical research on the TRAP-18 is reviewed, including both nomothetic and idiographic studies of individual terrorists in both the United States and Europe. Mean interrater reliability is 0.895 (Cohen's kappa), ranging from 0.69 to 1.0. Evidence of criterion validity has been demonstrated, including usefulness of the instrument across various extremist ideologies (jihadism, ethnic nationalism, and single-issue), and its ability to discriminate between thwarted and successful attackers. The instrument appears to advance the domain recommendations of Monahan (2012, 2016) for the risk assessment of the individual terrorist. The TRAP-18 is further discussed as a threat assessment instrument for mental health clinicians. The limitations of the current research provide direction for further studies to assess its reliability and construct, discriminant, and predictive validity.

Lone-actor Terrorism and Impulsivity.

In some recent cases of lone-actor terrorism, there is evidence the subject acted impulsively, often in response to a triggering event which contained a loss and humiliation. Evidence suggests the subjects acted precipitously, despite planning and preparation carried out in the preceding weeks or months, and their attacks failed to include the often considerable preparation that had been done. The pathway became a runway. The authors recommend the traditional assessment of impulsivity in persons of concern for lone acts of terrorism, as well as other proximal warning behaviors for targeted violence. Both indirect and direct assessment guidelines are proposed, with an emphasis upon self-report, psychological testing, collateral data gathering, and historical records.

The Clinical Threat Assessment of the Lone-Actor Terrorist.

The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for the assessment of individuals who present a concern for lone-actor terrorism. It consists of eight proximal warning behaviors and 10 distal characteristics. Previous research has demonstrated its interrater reliability and some concurrent and postdictive validity. In this article, TRAP-18 is retrospectively applied to the case of US Army psychiatrist and jihadist Malik Nidal Hasan, who committed a mass murder at Fort Hood, Texas in 2009. The strengths and limitations of TRAP-18 as a structured professional judgment instrument for mental health clinicians are discussed, and clinical risk management suggestions are made.

Public Figure Attacks in the United States, 1995-2015.

An archival descriptive study of public figure attackers in the United States between 1995 and 2015 was undertaken. Fifty-six incidents were identified, primarily through exhaustive internet searches, composed of 58 attackers and 58 victims. A code book was developed which focused upon victims, offenders, pre-attack behaviors including direct threats, attack characteristics, post-offense and other outcomes, motivations and psychological abstracts. The average interrater agreement for coding of bivariate variables was 0.835 (intraclass correlation coefficient). The three most likely victim categories were politicians, judges, and athletes. Attackers were males, many with a psychiatric disorder, most were grandiose, and most had both a violent and nonviolent criminal history. The known motivations for the attacks were often angry and personal, the most common being dissatisfaction with a judicial or other governmental process (23%). In only one case was the primary motivation to achieve notoriety. Lethality risk during an attack was 55%. Collateral injury or death occurred in 29% of the incidents. Only 5% communicated a direct threat to the target beforehand. The term "publicly intimate figure" is introduced to describe the sociocultural blurring of public and private lives among the targets, and its possible role in some attackers' perceptions and motivations. Copyright © 2016 John Wiley & Sons, Ltd.

The Concept of Identification in Threat Assessment.

Identification is one of eight warning behaviors--superordinate patterns of accelerating risk--that are theorized to correlate with targeted violence, and have some empirical validation. It is characterized by one or more of five characteristics: pseudo-commando behavior, evidence of a warrior mentality, a close association with weapons or other military or law enforcement paraphernalia, wanting to imitate and often surmount previous attackers or assassins, or believing oneself to be an agent to advance a particular cause or belief system. The authors briefly explore the history of the psychology of identification, its current usage, and its application to threat assessment. Four cases are used to illustrate identification as both a process and a product, and a likely motive for targeted violence in some subjects. Its operational relevance for threat assessment is suggested.

Workplace assessment of targeted violence risk: the development and reliability of the WAVR-21.

This study describes the development of the WAVR-21, a structured professional judgment guide for the assessment of workplace targeted violence, and presents initial interrater reliability results. The 21-item instrument codes both static and dynamic risk factors and change, if any, over time. Five critical items or red flag indicators assess violent motives, ideation, intent, weapons skill, and pre-attack planning. Additional items assess the contribution of mental disorder, negative personality factors, situational factors, and a protective factor. Eleven raters each rated 12 randomly assigned cases from actual files of workplace threat scenarios. Summary interrater reliability correlation coefficients (ICCs) for overall presence of risk factors, risk of violence, and seriousness of the violent act were in the fair to good range, similar to other structured professional judgment instruments. A subgroup of psychologists who were coders produced an ICC of 0.76 for overall presence of risk factors. Some of the individual items had poor reliability for both clinical and statistical reasons. The WAVR-21 appears to improve the structuring and organizing of empirically based risk-relevant data and may enhance communication and decision making.

Commentary: Stalking by patients--psychiatrists' tales of anger, lust and ignorance.

Stalking is a thriving social and criminal concern and a risk inherent in our personal and professional lives. Health care professionals, particularly psychiatrists and other mental health practitioners, are vulnerable to being stalked by their patients and, far from providing helpful insights that discourage the behavior, their training can be a hindrance. Neither a psychiatrist's gender nor seniority confers protection from the protracted vengeance or infatuation of a patient-turned-stalker, any more than does working through the transference and soldiering on. The ensuing social, psychological, and vocational damage can, however, be minimized through early recognition, informed advice, and the support, not censure, of our colleagues.

The value of crime scene and site visitation by forensic psychologists and psychiatrists.

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after-the-fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision-making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations.

The concept of leakage in threat assessment.

Leakage in the context of threat assessment is the communication to a third party of an intent to do harm to a target. Third parties are usually other people, but the means of communication vary, and include letters, diaries, journals, blogs, videos on the internet, emails, voice mails, and other social media forms of transmission. Leakage is a type of warning behavior that typically infers a preoccupation with the target, and may signal the research, planning, and implementation of an attack. Nomothetic data suggest that leakage occurs in a majority of cases of attacks on and assassinations of public figures, adult mass murders, adolescent mass murders, and school or campus shootings: very low-frequency, but catastrophic acts of intended and targeted violence. Idiographic or case data illustrate the various permutations of leakage. We discuss the operational importance of the concept, place it in the context of other warning behaviors, emphasize the need for further research, and outline risk management strategies for the mitigation of such acts of violence in both law enforcement and clinical mental health settings.

Attacks on German public figures, 1968-2004: warning behaviors, potentially lethal and non-lethal acts, psychiatric status, and motivations.

Fourteen non-terrorist attackers of public figures in Germany between 1968 and 2004 were intensively studied, with a particular focus on warning behaviors, attack behaviors, and the relationship between psychiatric diagnosis, symptoms, and motivations for the assault. A large proportion of the attackers were severely mentally ill, and most likely to be in the potentially lethal rather than the non-lethal group. A new typology of seven warning behaviors was applied to the data, and all were present, most frequently fixation and pathway warning behavior, and least frequently a direct threat. Psychiatric diagnosis could be closely linked to motivation when analyzed at the level of symptom and content of thought, often delusional. Most of the attacks were directed at political figures, and the majority occurred after 1995.

Suicide by cop among female subjects in officer-involved shooting cases.

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study.

A female mass murder.

A case study of a 44-year-old woman who committed a mass murder is presented. Following a chronic course of psychotic deterioration, and a likely diagnosis of paranoid schizophrenia that remained untreated, she returned to her workplace after 3 years from her termination and killed seven people and herself. Her history is reconstructed through investigation of primary and secondary source materials. Although there are very few female mass murderers in recorded criminal history, this case is quite similar to the known research on mass murderers in general. Such individuals often have a psychotic disorder evident in violent and paranoid delusions, show a deteriorating life course before the mass murder, intentionally plan and prepare for their assault, and methodically kill as many individuals as possible before taking their own lives. They typically do not directly threaten the target beforehand, but do leak their intent to third parties--however, in this case, leakage and other obvious warning behaviors did not occur. Such acts are impossible to predict but depend on threat management and target security for risk mitigation.

Predictors of recidivism by stalkers: a nine-year follow-up of police contacts.

In a subsample of a multisite stalking study (Mohandie, Meloy, McGowan, & Williams, 2006) comprising 78 offenders from one site, 77% committed new offenses within an average follow-up of 106 months (8.8 years). Over half (56%) were charged for new stalking related offenses and 33% for violent recidivism. Violent reoffending, including sexual offenses, was predicted by risk factors consistent with existing literature: younger age at first conviction, prior release failures, and criminal history. Stalking recidivism was predicted by pre-index offending scores, using the Cormier-Lang, and prior diagnosis of a mental illness. In addition, stalkers with previously diagnosed mental illness had significantly more police contacts as complainants than those without; their recidivism was also more likely to be non-violent.