Violent Forensic Psychiatric Patients: Individual Differences and Consequences for Treatment

Abstract

The literature on differences between aggressive individuals exhibiting reactive and proactive aggression raises the issue whether different treatment programs should be developed for violent forensic psychiatric patients with a conduct disorder or an antisocial personality disorder. In order to study this issue, aggressive behavior of 133 inpatients and of 176 outpatients was analyzed in detail for four subgroups, composed on the basis of the two factors of the Psychopathy Checklist-Revised. Contrary to expectations, there were no differences found in scores on self-report questionnaires for disposition to anger, hostility and aggressive behavior between the four subgroups. Minor differences were found, however, between these four subgroups in the relationship to aspects of aggressive behavior on the one hand, and neuroticism, social anxiety and social skills on the other hand. To some extent, this explorative study appears to confirm recommendations to distinguish between individuals who exhibit reactively aggressive behavior, and those who primarily display proactively aggressive behavior. In line with our clinical experiences and with our findings, it seems advisable to focus especially on anger management and social skills in the reactively aggressive group and on moral reasoning and prosocial thinking styles in the proactively aggressive group.