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.

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.

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.

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.

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.

The female stalker.

A study of 143 female stalkers was conducted, part of a large North American sample of stalkers (N=1005) gathered from law enforcement, prosecutorial, and entertainment corporate security files (Mohandie, Meloy, Green McGowan, & Williams, 2006). The typical female stalker was a single, separated, or divorced woman in her mid-30s with a psychiatric diagnosis, most often a mood disorder. She was more likely to pursue a male acquaintance, stranger, or celebrity, rather than a prior sexual intimate. When compared with male stalkers, the female stalkers had significantly less frequent criminal histories, and were significantly less threatening and violent. Their pursuit behavior was less proximity based, and their communications were more benign than those of the males. The average duration of stalking was 17 months, but the modal duration was two months. Stalking recidivism was 50%, with modal time between intervention and re-contacting the victim of one day. Any prior actual relationship (sexual intimate or acquaintance) significantly increased the frequency of threats and violence with large effect sizes for the entire female sample. The most dangerous subgroup was the prior sexually intimate stalkers, of whom the majority both threatened and were physically violent. The least dangerous were the female stalkers of Hollywood celebrities. Two of the McEwan, Mullen, MacKenzie, and Ogloff (2009b) predictor variables for stalking violence among men were externally validated with moderate effect sizes for the women: threats were associated with increased risk of violence, and letter writing was associated with decreased risk of violence.

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.

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.

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.

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.

Psychopathy and stalking.

We examined the association between psychopathy, assessed using the Hare Psychopathy Checklist-Revised: Screening Version (Hart et al., Manual for the psychopathy checklist screening version (PCL:SV), 1995), and stalking in 61 men convicted of stalking-related offenses. Psychopathic symptoms were rare, but their presence-especially that of affective deficit symptoms-was associated with victimization of casual acquaintances and with several risk factors from the Guidelines for Stalking Assessment and Management (SAM) (Kropp et al., Guidelines for stalking assessment and management, 2008a), including stalking in violation of supervision orders, degree of preoccupation with victims, and targeting of victims with limited access to external resources. The findings suggest that in spite of their rarity, psychopathic traits may be important in the assessment and management of stalking risk.

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).

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.

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 RECON typology of stalking: reliability and validity based upon a large sample of North American stalkers.

A new typology of stalking, RECON (relationship and context-based), is proposed, based upon the prior relationship between the pursuer and the victim, and the context in which the stalking occurs. The static typology yields four groups: Intimate, Acquaintance, Public Figure, and Private Stranger. The typology was tested on a large (N = 1005) nonrandom sample of North American stalkers gathered from prosecutorial agencies, a large police department, an entertainment corporation security department, and the authors' files. Interrater reliability for group assignment was 0.95 (ICC). Discriminant validity (p < 0.01) was demonstrated on a variety of demographic, clinical, pursuit, threat, and violence characteristics among and between groups. Findings confirm and extend the work of other researchers, most notably the very high risk of threats and violence among prior sexually intimate stalkers, the very low risk of threats and violence among public figure (celebrity) stalkers, and the negative relationship between stalking violence and psychosis.

Characterizing aggressive behavior in a forensic population.

The concept of a dichotomous versus a continuous aggression model continues to be debated within the research literature. The Impulsive/Premeditated Aggression Scale (IPAS; M. S. Stanford, R. J. Houston, C. W. Mathias, et al., 2003) is a newly developed self-report instrument designed to classify an individual's aggressive behavior as predominantly premeditated or predominantly impulsive. The IPAS consists of 30-items that are scored on a 5-point Likert scale. This study used a nonrandom sample of convenience (N = 85) from a forensic state hospital. Principal-components analysis of the 30 items revealed 2 distinct factors (Impulsive and Premeditated Aggression), which accounted for 33% of the variance. The results of this study further validate the bimodal classification of aggression through its application to a forensic sample. The implications for general assessment, diagnosis, and treatment are discussed.