Patients with psychopathy need intensive care and supervision. There is however reluctance to treat them because of (supposedly) limted chances of success and risk of therapy-interfering behavior. This study focused on inpatient disruptive behavior in mentally disordered offenders during medium security treatment. Patients (N = 224) were assessed using the Psychopathy Checklist-Revised total, factor and facet scores and divided into three groups depending on the presence of low, medium, and high psychopathy traits. Associations between psychopathy and criminogenic risk and need factors were analyzed. Additionally, the association between psychopathy and therapy-interfering behavior (non-compliance, drop-out, institutional misconduct) was investigated with correlational and logistic regression analyses. The results showed that psychopathy was associated with greater risk, needs, and therapy-interfering behavior. PCL-R Factor 2 predicted institutional misconduct, whereas PCL-R Factor 1 predicted drop-out from treatment. The study highlights the importance of responsive treatment climates in retaining this difficult-to-treat group in treatment.
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References
1.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of mental disorders (4th ed., text revision). Washington, DC: Author.
2.
AndrewsD. A.BontaJ. (2010). Rehabilitating criminal justice policy and practice. Psychology, Public Policy, and Law, 16(1), 39–55. doi: 10.1037/a0018362
3.
BoS.ForthA.KongerslevM.HaahrU. H.PedersenL.SimonsenE. (2013). Subtypes of aggression in patients with schizophrenia: The role of personality disorders. Criminal Behaviour and Mental Health, 23(2), 124–137. doi: 10.1002/cbm.1858
4.
BogaertsS.PolakM.SpreenM.ZwetsA. (2012). High and low aggressive narcissism and anti-social lifestyle in relationship to impulsivity, hostility, and empathy in a group of forensic patients in the Netherlands. Journal of Forensic Psychology Practice, 12(2), 147–162. doi: 10.1080/15228932.2012.650144
5.
BontaA.BlaisJ.WilsonH. (2014). A theoretically informed meta-analysis of the risk for general and violent recidivism for mentally disordered offenders. Aggression and Violent Behavior, 19, 278–287. doi: 10.1016/j.avb.2014.04.014
6.
Buffington-VollumJ.EdensJ. F.JohnsonD. W.JohnsonJ. K. (2002). Psychopathy as a predictor of institutional misbehavior among sex offenders: A prospective replication. Criminal Justice and Behavior, 29(5), 497–511. doi: 10.1177/009385402236730
7.
BultenE.DecoeneS. (2015). Management van psychopathie in een klinische context. In CantonW.ClaesL.GijsL.JeandarmeI.Klein-HaneveldE.van BeekD. (Eds.), Handboek Psychopathie en de Antisociale-Persoonlijkheidsstoornis (pp. 359–375). Utrecht, The Netherlands: De Tijdstroom.
8.
ChakhssiF.de RuiterC.BernsteinD. (2010). Change during forensic treatment in psychopathic versus nonpsychopathic offenders. The Journal of Forensic Psychiatry & Psychology, 21(5), 660–682. doi: 10.1080/14789949.2010.483283
9.
CohenJ. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
10.
CookeD. J.MichieC. (1999). Psychopathy across cultures: North America and Scotland compared. Journal of Abnormal Psychology, 108(1), 58–68. doi: 10.1037/0021-843X.108.1.58
11.
CullenA. E.JewellA.TullyJ.CoghlanS.DeanK.FahyT. (2015). A prospective cohort study of absconsion incidents in forensic psychiatric settings: Can we identify those at high-risk? PLoS One, 10(9), e0138819. doi: 10.1371/journal.pone.0138819
12.
D'SilvaK.DugganC.McCarthyL. (2004). Does treatment really make psychopaths worse? A review of the evidence. Journal of Personality Disorders, 18(2), 163–177.
13.
DeMatteoD.EdensJ. F.GallowayM.CoxJ.SmithS. T.KollerJ. P.BersoffB. (2014). Investigating the role of the Psychopathy Checklist-Revised in United States case law. Psychology, Public Policy, and Law, 20(1), 96–107. doi: 10.1037/a0035452
14.
DolanM.DaviesG. (2006). Psychopathy and institutional outcome in patients with schizophrenia in forensic settings in the UK. Schizophrenia Research, 81(2–3), 277–281. doi: 10.1016/j.schres.2005.07.002
15.
DolanM.MillingtonJ. (2002). The influence of personality traits such as psychopathy on detained patients using the NHS complaints procedure in forensic settings. Personality and Individual Differences, 33(6), 955–965.
16.
EdensJ. F.MarcusD. K.LilienfeldS. O.PoythressN. G.(2006). Psychopathic, not psychopath: Taxometric evidence for the dimensional structure of psychopathy. Journal of Abnormal Psychology, 115(1), 131–144. doi: 10.1037/0021-843X.115.1.131
17.
Every-PalmerS.BrinkJ.ChernT. P.ChoiW. K.Hern-YeeJ. G.GreenB.MellsopG. (2014). Review of psychiatric services to mentally disordered offenders around the Pacific Rim. Asia-Pacific Psychiatry, 6(1), 1–17. doi: 10.1111/appy.12109
18.
FelthousA. R. (2015). The appropriateness of treating psychopathic disorders. CNS Spectrums, 20(3), 182–189. doi: 10.1017/s1092852915000243
19.
FullamR.DolanM. (2006). The criminal and personality profile of patients with schizophrenia and comorbid psychopathic traits. Personality and Individual Differences, 40(8), 1591–1602.
20.
GaconoC. B.MeloyJ. R.SpethE.RoskeA. (1997). Above the law: Escapes from a maximum security forensic hospital and psychopathy. The Journal of the American Academy of Psychiatry and the Law, 25(4), 547–550.
21.
GowR. L.ChooM.DarjeeR.GouldS.SteeleJ. (2010). A demographic study of the Orchard Clinic: Scotland's first medium secure unit. The Journal of Forensic Psychiatry & Psychology, 21(1), 139–155. doi: 10.1080/14789940903188956
22.
GuyL. S.EdensJ. F.AnthonyC.DouglasK. S. (2005). Does psychopathy predict institutional misconduct among adults? A meta-analytic investigation. Journal of Consulting and Clinical Psychology, 73(6), 1056–1064. doi: 10.1037/0022-006X.73.6.1056
23.
HansonR. K.BussiereM. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66(2), 348–362.
24.
HareR. D. (2003). The Hare Psychopathy Checklist Revised. Toronto, Canada: Multi-Health Systems.
25.
HareR. D.ClarkD.GrannM.ThorntonD. (2000). Psychopathy and the predictive validity of the PCL-R: An international perspective. Behavioral Sciences & the Law, 18(5), 623–645.
26.
HartS. D.HareR. D. (1989). Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population. Psychological Assessment, 1(3), 211–218.
27.
HeilbrunK.HartS. D.HareR. D.GustafsonD.NunezC.WhiteA. J. (1998). Inpatient and postdischarge aggression in mentally disordered offenders: The role of psychopathy. Journal of Interpersonal Violence, 13(4), 514–527. doi: 10.1177/088626098013004007
28.
HildebrandM.de RuiterC. (2012). Psychopathic traits and change on indicators of dynamic risk factors during inpatient forensic psychiatric treatment. International Journal of Law and Psychiatry, 35(4), 276–288. doi: 10.1016/j.ijlp.2012.04.001
29.
HildebrandM.De RuiterC.NijmanH. (2004). PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital. Journal of Interpersonal Violence, 19(1), 13–29. doi: 10.1177/0886260503259047
30.
HillC. D.RogersR.BickfordM. E. (1996). Predicting aggressive and socially disruptive behavior in a maximum security forensic psychiatric hospital. Journal of Forensic Sciences, 41(1), 56–59.
31.
HobsonJ.ShineJ.RobertsR. (2000). How do psychopaths behave in a prison therapeutic community? Psychology, Crime & Law, 6(2), 139–154. doi: 10.1080/10683160008410838
32.
Jeandarme, I., Edens, J. F., Habets, P., Bruckers, L., Oei, T. I., & Bogaerts, S. (2017). PCL-R field validity in prison and hospital settings. Law and Human Behavior,41(1), 29–43. doi: 10.1037/lhb0000222
33.
Jeandarme, I., Pouls, C., De Laender, J., Oei, T. I., Bogaerts, S. (2016). Field validity of the HCR-20 in forensic medium security units in Flanders. Psychology, Crime & Law. doi: 10.1080/1068316X.2016.1258467
34.
LevensonJ. S. (2004). Reliability of sexually violent predator civil commitment criteria in Florida. Law and Human Behavior, 28(4), 357–368.
35.
MarcusD. K.LilienfeldS. O.EdensJ. F.PoythressN. G. (2006). Is antisocial personality disorder continuous or categorical? A taxometric analysis. Psychological Medicine, 36(11), 1571–1581. doi: 10.1017/S0033291706008245
36.
McMurranM.TheodosiE. (2007). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime & Law, 13(4), 333–343. doi: 10.1080/10683160601060374
37.
MillerC. S.KimonisE. R.OttoR. K.KlineS. M.WassermanA. L. (2012). Reliability of risk assessment measures used in sexually violent predator proceedings. Psychological Assessment, 24(4), 944–953. doi: 10.1037/a0028411
38.
MoensI.PauwelynL. (2012). Geen opsluiting, maar sleutels tot re-integratie. Voorstellen voor een gecoördineerd zorgtraject voor geïnterneerden. Brussels, Belgium: Zorgnet Vlaanderen.
39.
MorrisseyC.MooneyP.HogueT. E.LindsayW. R.TaylorJ. L. (2007). Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: Treatment progress. Journal of Intellectual and Developmental Disability, 32(2), 125–133. doi: 10.1080/13668250701383116
40.
NealT.MillerS. L.ShealyR. C. (2015). A field study of a comprehensive violence risk assessment battery. Criminal Justice and Behavior, 42(9), 952–968. doi: 10.1177/0093854815572252
41.
NewhillC.VaughnM.DeLisiM. (2010). Psychopathy scores reveal heterogeneity among patients with borderline personality disorder. The Journal of Forensic Psychiatry & Psychology, 21(2), 202–220. doi: 10.1080/14789940903281157
42.
OgloffJ. R. P.WongS.GreenwoodA. (1990). Treating criminal psychopaths in a therapeutic community program. Behavioral Sciences & the Law, 8(2), 181–190. doi: 10.1002/bsl.2370080210
43.
OlverM. E.LewisK.WongS. C. (2013). Risk reduction treatment of high-risk psychopathic offenders: The relationship of psychopathy and treatment change to violent recidivism. Personality Disorders, 4(2), 160–167. doi: 10.1037/a0029769
44.
OlverM. E.StockdaleK. C.WormithJ. S. (2011). A meta-analysis of predictors of offender treatment attrition and its relationship to recidivism. Journal of Consulting and Clinical Psychology, 79(1), 6–21. doi: 10.1037/a0022200
45.
OlverM. E.WongS. (2011). Predictors of sex offender treatment dropout: Psychopathy, sex offender risk, and responsivity implications. Psychology, Crime & Law, 17(5), 457–471. doi: 10.1080/10683160903318876
46.
PolaschekD. L.RossE. C. (2010). Do early therapeutic alliance, motivation, and stages of change predict therapy change for high-risk, psychopathic violent prisoners?Criminal Behaviour and Mental Health, 20(2), 100–111. doi: 10.1002/cbm.759
47.
ReidyD. E.KearnsM. C.DeGueS. (2013). Reducing psychopathic violence: A review of the treatment literature. Aggression and Violent Behavior, 18(5), 527–538. doi: 10.1016/j.avb.2013.07.008
48.
ReissD.GrubinD.MeuxC. (1999). Institutional performance of male ‘psychopaths’ in a high-security hospital. The Journal of Forensic Psychiatry, 10(2), 290–299. doi: 10.1080/09585189908403682
49.
RiceM. E.HarrisG. T.CormierC. A. (1992). An evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16(4), 399–412.
50.
RichardsH.CaseyJ.LucenteS. (2003). Psychopathy and treatment response in incarcerated female substance abusers. Criminal Justice and Behavior, 30(2), 251–276.
51.
SalekinR. T.WorleyC.GrimesR. D. (2010). Treatment of psychopathy: A review and brief introduction to the mental model approach for psychopathy. Behavioral Sciences & the Law, 28(2), 235–266. doi: 10.1002/bsl.928
52.
SalizeH. J.DressingH. (2007). Admission of mentally disordered offenders to specialized forensic care in fifteen European Union member states. Social Psychiatry and Psychiatric Epidemiology, 42(4), 336–342. doi: 10.1007/s00127-007-0159-2
53.
SchuringaE.SpreenM.BogaertsS. (2014). Inter-rater and test-retest reliability, internal consistency, and factorial structure of the Instrument for Forensic Treatment Evaluation. Journal of Forensic Psychology Practice, 14(2), 127–144. doi: 10.1080/15228932.2014.897536
54.
SimourdD.HogeR. (2000). Criminal psychopathy. A risk-and-need erspective. Criminal Justice and Behavior, 27(2), 256–272.
55.
SkeemJ. L.ManchakS.PetersonJ. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110–126. doi: 10.1007/s10979-010-9223-7
56.
TengströmA.HodginsS.GrannM.LangströmN.KullgrenG. (2004). Schizophrenia and criminal offending. The role of psychopathy and substance use disorders. Criminal Justice and Behavior, 31(4), 367–391.
57.
VertommenH.VerheulR.de RuiterC.HildebrandM. (2002). Handleiding bij de herziene versie van Hare's Psychopathie Checklist. Lisse: Swets Test Publishers.
58.
Vitacco, M. J., Van Rybroek, G. J., Rogstad, J. E., Yahr, L. E., Tomony, J. D., & Saewert, E. (2009). Predicting short-term institutional aggression in forensic patients: A multi-trait method for understanding subtypes of aggression. Law and Human Behavior,33(4), 308–319. doi: 10.1007/s10979-008-9155-7
59.
WaltersG. D. (2003). Predicting institutional adjustment and recidivism with the Psychopathy Checklist factor scores: A meta-analysis. Law and Human Behavior, 27(5), 541–558.
60.
WaltersG. D.HeilbrunK. (2010). Violence risk assessment and facet 4 of the Psychopathy Checklist: Predicting institutional and community aggression in two forensic samples. Assessment, 17(2), 259–268. doi: 10.1177/1073191109356685
61.
WebsterC. D.DouglasK. S.EavesD.HartS. D. (1997). HCR-20: Assessing risk for violence (Version 2). Burnaby, Canada: Simon Fraser University.
62.
WongS. C.GordonA.GuD. (2007). Assessment and treatment of violence-prone forensic clients: Âaan integrated approach. British Journal of Psychiatry, 49(Suppl), s66–74. doi: 10.1192/bjp.190.5.s66
63.
WongS. C.GordonA.GuD.LewisK.OlverM. (2012). The effectiveness of violence reduction treatment for psychopathic offenders: Empirical evidence and a treatment model. International Journal of Forensic Mental Health, 11(4), 336–349. doi: 10.1080/14999013.2012.746760
64.
WongS. C.OlverM. E. (2015). Risk reduction treatment of psychopathy and applications to mentally disordered offenders. CNS Spectrums, 20(3), 303–310. doi: 10.1017/s1092852915000322
