Violent Female Offenders Compared With Violent Male Offenders on Psychological Determinants of Aggressive Behavior.

Psychological determinants of aggressive behavior (personality traits and problem behaviors) in 59 Dutch female offenders (outpatients and detainees) were compared with those in 170 male offenders (outpatients and detainees) who were all convicted of a violent crime. The violent female offenders scored significantly higher on neuroticism and trait anger, and significantly lower on hostility than the male offenders; however, effect sizes were small. A subgroup of female forensic psychiatric outpatients did not differ from a subgroup of male outpatients on all measures, whereas a subgroup of female detainees scored significantly higher on anger and aggression, but lower on hostility and psychopathy than did a subgroup of male detainees. These first results might indicate that violent female offenders do not differ much from violent male offenders regarding personality traits and problem behaviors. The differences between both groups of violent offenders were largely borne by the subgroup of violent female detainees compared with the subgroup of violent male detainees.

Are Child Abusers Sexually Attracted to Submissiveness? Assessment of Sex-Related Cognition With the Implicit Association Test.

Child sexual abuse is associated with social anxiety, low self-esteem, and intimacy deficits. This, in combination with the core belief of a dangerous world, might suggest that child abusers are sexually attracted to submissiveness. The Implicit Association Test (IAT) was used to examine this hypothesis. Results indicated that child abusers have a stronger sexual preference for submissiveness than rapists, although there were no differences between child abusers and non-sexual offenders. Multinomial logistic regression analysis revealed that submissive-sexy associations have incremental value over child-sex associations in differentiating child abusers from other offenders. The predictive value of both implicit associations was explored by correlating IAT scores with measures for recidivism risk, aggression, and interpersonal anxiety. Child abusers with stronger child-sex associations reported higher levels of interpersonal anxiety and hostility. More research on implicit cognition in sex offenders is required for a better understanding of what these and similar implicit measures are exactly measuring and what role implicit cognition may play in sexual offending.

The four-factor model of the Psychopathy Checklist--Revised: validation in a Dutch forensic inpatient sample.

In The Netherlands, the Ministry of Security and Justice requires the assessment of the Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Hare, 2003) in all forensic psychiatric inpatients. To examine the four-factor structure of the Psychopathy Checklist-Revised, confirmatory factor analysis (CFA) was conducted using a Dutch sample of forensic psychiatric inpatients (N=411) and the results indicated acceptable fit. Also, using multiple group CFA, the four-factor model provided an acceptable fit in both patients with a personality disorder and patients with a psychotic disorder, and there was reasonably good evidence of measurement invariance between these two subgroups. Furthermore, correlations with external measures of aggression and personality traits provided additional support for the validity of the four-factor model in patients with a personality disorder. In patients with a psychotic disorder fewer significant correlations with external measures were found. Taken together, the results support the use of the four-factor structure in Dutch offenders who are detained under hospital order.

Aggression Replacement Training for Violent Young Men in a Forensic Psychiatric Outpatient Clinic.

The effects of Aggression Replacement Training (ART) were explored in a group of Dutch violent young men aged 16 to 21 years, who were obliged by the court to follow a treatment program in a forensic psychiatric outpatient clinic. To evaluate the training, patients completed a set of self-report questionnaires at three moments in time: at intake/before a waiting period, after the waiting period/before the training, and after the training. During the waiting period, the patients did not change on most measures, although they displayed a significant increase in anger. The patients who completed the therapy scored significantly lower on psychopathy than the patients who dropped out. The training produced significant decreases in physical aggression and social anxiety and showed trends toward a decline in self-reported hostility, general aggression, and anger. After the training, the patients scored comparably with a reference group on measures of hostility and aggressive behavior. Altogether, these results provide tentative support for the efficacy of the ART for violent young men referred to forensic psychiatric outpatient settings.

The Novaco Anger Scale-Provocation Inventory (1994 version) in Dutch forensic psychiatric patients.

We examined the psychometric properties of the Novaco Anger Scale-Provocation Inventory (NAS-PI, 1994 version) in Dutch violent forensic psychiatric patients and secondary vocational students. A confirmatory factor analysis of the subscale structure of the NAS was carried out, reliability was investigated, and relations were calculated between NAS-PI scores and other measures of personality traits and problem behaviors. The 3-subscale structure of the original NAS could not be confirmed. However, the internal consistency of the NAS and the PI was excellent, and the test-retest reliability of the NAS was good. The validity of the NAS and the PI was supported by a meaningful pattern of correlations with alternative measures of anger and personality traits. Forensic psychiatric outpatients displayed higher NAS scores than secondary vocational students, but inpatients scored even lower than this nonclinical control group. Our preliminary conclusion is that the NAS-PI is a valuable instrument for the assessment of anger in Dutch violent forensic psychiatric patients.

Psychometric properties of the aggression questionnaire in Dutch violent forensic psychiatric patients and secondary vocational students.

The psychometric properties of a Dutch version of Buss and Perry's Aggression Questionnaire (AQ) were examined in a sample of violent forensic psychiatric inpatients and outpatients and a sample of secondary vocational students. The internal consistency, interitem correlations, and item-scale correlations of the subscales Physical Aggression, Anger, and Hostility were good but turned out to be unsatisfactory for the subscale Verbal Aggression. The four-factor structure of the AQ could not be confirmed, but the four-factor structure of a 12-item version (short form) of the AQ, the AQ-SF, produced an acceptable fit. The test-retest reliability of the AQ and AQ-SF total scores was good, although the test-retest reliability of the AQ-SF subscale Physical Aggression was not satisfactory. The validity of both the AQ and AQ-SF could be demonstrated by meaningful correlations with alternative measures of aggression and personality, but inpatients were not found to display higher scores on the AQ or AQ-SF than the students.

An evaluation of behavioural and personality differences between native and non-native male adolescents in the Netherlands ordered into treatment in a forensic psychiatric outpatient clinic, and their non-violent peers.

BACKGROUND: In a previous study of the dynamic criminogenic needs of violent outpatients we did not differentiate between native and non-native adolescents, but differences between personality traits and problem behaviours may require adaptations to any treatment programme. AIM: To compare, in the Netherlands, native and non-native adolescents with and without a violence history on personality traits and problem behaviours. METHODS: Forty-eight native and 71 non-native violent male adolescents were recruited from consecutive referrals to a forensic outpatient clinic after a violent offence and compared with randomly selected male youths in secondary vocational schools, but without a violent history, 82 of whom were from Dutch and 79 from non-Dutch descent. Each took part in an individual interview to complete a range of personality and behavioural rating scales. RESULTS: Native and non-native adolescent outpatients did not differ from each other on any measure. Overall, the outpatients scored higher than the students on hostility but not aggressive behaviour, but there were differences within the student group according to descent, with the native students having higher agreeableness scores and lower hostility and aggressive behaviour scores than the students of non-Dutch descent. CONCLUSION: Our study suggested that any differences in behavioural or personality traits seen in the general adolescent population according to descent are not reflected in a violent offender group of similar age. It therefore seems unlikely to be necessary to run different treatment programmes for native and non-native adolescent offenders.

Domestically and generally violent forensic psychiatric outpatients: personality traits and behavior.

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.

Aggression control therapy for violent forensic psychiatric patients: method and clinical practice.

Aggression control therapy is based on Goldstein, Gibbs, and Glick's aggression replacement training and was developed for violent forensic psychiatric in- and outpatients (adolescents and adults) with a (oppositional-defiant) conduct disorder or an antisocial personality disorder. First, the conditions for promoting "treatment integrity" are examined. Then, target groups, framework, and procedure are described in detail, followed by the most important clinical findings during the period 2002 to 2006. Finally, new programme developments are mentioned, with aggression control therapy as a starting point.

Development of the Observation Scale for Aggressive Behavior (OSAB) for Dutch forensic psychiatric inpatients with an antisocial personality disorder.

The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are "placed at the disposal of the government". The scale should have the sensitivity to measure changes in the possible determinants of aggressive behavior, such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills. In developing the OSAB 40 items were selected from a pool of 82 and distributed among the following a priori scales: Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent (to aggressive behavior), Sanction (for aggressive behavior) and Social behavior. The internal consistency of these subscales was good, the inter-rater reliability was moderate to good, and the test-retest reliability over a two to three week period was moderate to good. The correlation between the subscales Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent, Sanction was substantial and significant, but the anticipated negative correlation between these subscales and the Social behavior subscale could not be shown. Relationships between the corresponding subscales of the OSAB and the FIOS, used to calculate concurrent validity, yielded relatively high correlations. The validity of the various OSAB subscales could be further supported by significant correlations with the PCL-R and by significant but weak correlations with corresponding subscales of the self-report questionnaires. The Observation Scale for Aggressive Behavior (OSAB) seems to measure aggressive behavior in Dutch forensic psychiatric inpatients with an antisocial personality disorder reliably and validly. Contrary to expectations, a negative relationship was not found between aggressive and social behavior in either the OSAB or FIOS, which were used for calculating concurrent validity.

An adapted version of the Rosenzweig Picture-Frustration Study (PFS-AV) for the measurement of hostility in violent forensic psychiatric patients.

BACKGROUND: The original Rosenzweig Picture-Frustration Study (PFS), designed to measure reactive aggressive behaviour in adults, contains 24 pictures of ambiguous situations in which someone is making a remark that can be interpreted as provocative. AIM: An adapted version of Rosenzweig's PFS (PFS-AV) was developed to assess the hostile thoughts elicited by interpersonal frustrating situations in forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. METHODS: Patients were asked to give their responses in a few words on paper, which were then evaluated for hostility using a seven-point Likert scale. The patients also completed questionnaires on personality and on aggressive and socially competent behaviour. RESULTS: Twelve of the 24 pictures that had a good internal consistency, inter-rater reliability, and test-retest reliability were selected. In support of the instrument's concurrent validity, scores on the PFS-AV were positively correlated with those on the aggressive behaviour questionnaires but less strongly than the correlations between the aggressive behaviour questionnaires mutually. The validity of the PFS-AV was demonstrated by the positive correlation between PFS-AV hostility and neuroticism, and by the negative correlation with extraversion, openness, agreeableness and conscientiousness. A relatively low but positive correlation was found with social anxiety and a negative correlation was found with social skills in situations where approaching behaviour may be exhibited. CONCLUSION: The adapted version of the PFS-AV appears reliably and validly to measure hostility in violent forensic psychiatric patients.

Evaluation of a cognitive-behavioral program for chronically psychotic forensic inpatients.

The present study evaluated the progress of four groups of chronically psychotic patients in treatment at De Kijvelanden Forensic Psychiatric Hospital. The psychotic patients were offered a cognitive-behavioral program, including psycho education, grief processing, stress management, functional training, coping with psychotic symptoms (Liberman module) and social skills training. Nine patients dropped out of the program. Sixteen patients who completed it scored significantly better than a control group of 16 psychotic patients, who had not yet participated in the program, on the "social skills" and "negative coping behavior" subscales of one of two observation scales used. On the other observation instrument (REHAB), however, no significant improvement in the general level of functioning was found in the group of treated patients, as compared to the control group. Apart from these two observation scales, the PANSS (structured interview for positive, negative and general psychopathological symptoms) and the SIG (self-report questionnaire for social anxiety and social responses) were used to evaluate treatment progress. Significant improvements were not found on these scales, except for a slight positive effect on the PANSS negative symptoms scale. These results illustrate the difficulties and limitations of treating chronically psychotic offenders, who often also suffer from cluster B personality disorders.