Given substantial national crime costs and that psychopathic personality disorder (PPD) is a robust predictor of recidivism, a research gap exists concerning the cost of crime attributable to adults with PPD. The current study employed a bottom-up cost of illness approach to estimate the association between PPD and crime costs among Canadian men incarcerated in the federal correctional system (n = 188). Participants were rated using the Psychopathy Checklist–Revised (PCL-R) and the Historical-Clinical-Risk Management–20 (HCR-20, version 2). Group mean crime costs were highest for participants who scored highly on the PCL-R and were rated high risk on the HCR-20, and higher scores on both measures were associated with prospective costs accrued from violent and nonviolent recidivism. The findings highlight the need to improve the treatment and management of high-risk individuals with prominent psychopathic features, as it has the potential for significant financial savings for criminal justice systems.
AchesonS. K.OlmiD. J. (2005). Test review of Hare Psychopathy Checklist–Revised: 2nd edition. In SpiesR. A.PlakeB. S. (Eds.), The sixteenth mental measurements yearbook. http://marketplace.unl.edu/buros/
BarrettB.ByfordS.SeivewrightH.CooperS.TyrerP. (2005). Service costs for severe personality disorder at a special hospital. Criminal Behavior and Mental Health, 15(3), 184–190. https://doi.org/10.1002/cbm.7
8.
Baskin-SommersA. R.BaskinD. R.SommersI. B.NewmanJ. P. (2013). The intersectionality of sex, race, and psychopathology in predicting violent crimes. Criminal Justice and Behavior, 40(10), 1068–1091. https://doi.org/10.1177/0093854813485412
9.
BatemanA.FonagyP. (2003). Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. American Journal of Psychiatry, 160(1), 169–171. https://doi.org/10.1176/appi.ajp.160.1.169
10.
BerkoutO. V.GrossA. M.KellumK. K. (2013). Behaving badly: A perspective on mechanisms of dysfunction in psychopathy. Aggression and Violent Behavior, 18(6), 620–629. https://doi.org/10.1016/j.avb.2013.07.013
11.
BloomB. S.BrunoD. J.MamanD. Y.JayadevappaR. (2012). Usefulness of US cost-of-illness studies in healthcare decision making. PharmacoEconomics, 19(2), 207–213. https://doi.org/10.2165/00019053-200119020-00007
CampbellD. T.StanleyJ. C. (1966). Experimental and quasi-experimental designs for research. Houghton Mifflin Company.
14.
CampbellM. A.FrenchS.GendreauP. (2009). The prediction of violence in adult offenders: A meta-analytic comparison of instruments and methods of assessment. Criminal Justice and Behavior, 36(6), 567–590. https://doi.org/10.1177/0093854809333610
15.
ChakhssiF.BernsteinD.RuiterC. (2014). Early maladaptive schemas in relation to facets of psychopathy and institutional violence in offenders with personality disorders. Legal and Criminological Psychology, 19(2), 356–372. https://doi.org/10.1111/lcrp.12002
16.
ChapkoM. K.LiuC. F.PerkinsM.LiY. F.FortneyJ. C.MaciejewskiM. L. (2009). Equivalence of two healthcare costing methods: Bottom-up and top-down. Health Economics, 18(10), 1188–1201. https://doi.org/10.1002/hec.1422
17.
ChevalierC. S. (2017). The association between structured professional judgment measure total scores and summary risk ratings: Implications for predictive validity [Unpublished doctoral dissertation]. Sam Houston State University.
18.
ChongH. Y.TeohS. L.WuB.-C.KotirumS.ChiouC.-F.ChaiyakunaprukN. (2016). Global economic burden of schizophrenia: A systematic review. Neuropsychiatric Disease and Treatment, 12, 357–373. https://doi.org/10.2147/NDT.S96649
19.
CicchettiD. V.SparrowS. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127–137.
20.
CookeD. J.HartS. D.LoganC.MichieC. (2012). Explicating the construct of psychopathy: Development and validation of a conceptual model, the comprehensive assessment of psychopathic personality (CAPP). International Journal of Forensic Mental Health, 11(4), 242–252. https://doi.org/10.1080/14999013.2012.746759
21.
CookeD. J.LoganC. (2015). Capturing clinical complexity: Towards a personality-oriented measure of psychopathy. Journal of Criminal Justice, 43(4), 262–273. https://doi.org/10.1016/j.jcrimjus.2015.04.004
DavidsonK. M.TyrerP.TataP.CookeD.GumleyA.FordI.WalkerA.BezlyakV.SeivewrightH.RobertsonH.CrawfordM. J. (2009). Cognitive behavior therapy for violent men with antisocial personality disorder in the community: An exploratory randomized controlled trial. Psychological Medicine, 39(4), 569–577. https://doi.org/10.1017/S0033291708004066
24.
DaviesS. T.HelmusL. M.QuinseyV. L. (2020). Improving risk communication: Developing risk ratios for the VRAG-R. Journal of Interpersonal Violence, 37(1–2), 835–862. https://doi.org/10.1177/0886260520914555
25.
DeLisiM.ReidyD. E.HeirigsM. H.TostlebeJ. T.VaughnM. G. (2018). Psychopathic costs: A monetization study of the fiscal toll of psychopathy features among institutionalized delinquents. Journal of Criminal Psychology, 8(2), 112–124. https://doi.org/10.1108/JCP-07-2017-0031
26.
DeMatteoD.HartS. D.HeilbrunK.BoccacciniM. T.CunninghamM. D.DouglasK. S.DvoskinJ. A.EdensJ. F.GuyL. S.MurrieD. C.OttoR. K.PackerI. K.ReidyT. J. (2020). Statement of concerned experts on the use of the Hare Psychopathy Checklist-Revised in capital sentencing to assess risk for institutional violence. Psychology, Public Policy, and Law, 26(2), 133–144. https://doi.org/10.1037/law0000223
27.
DouglasK. S.BelfrageH. (2014). Interrater reliability and concurrent validity of the HCR-20 Version 3. International Journal of Forensic Mental Health, 13(2), 130–139. https://doi.org/10.1080/14999013.2014.908429
28.
DouglasK. S.HartS. D.WebsterC. D.BelfrageH. (2013). HCR-20V3: Assessing risk for violence—User guide. Mental Health, Law, and Policy Institute, Simon Fraser University.
29.
DouglasK. S.NikolovaN. L.KelleyS. E.EdensJ. F. (2015). Psychopathy. In CutlerB. L.ZapfP. A. (Eds.), APA handbook of forensic psychology, Vol. 1: Individual and situational influences in criminal and civil contexts (pp. 257–323). American Psychological Association. https://doi.org/10.1037/14461-009
30.
DouglasK. S.OgloffJ. (2003). Violence by psychiatric patients: The impact of archival measurement source on violence base rates and risk assessment accuracy. The Canadian Journal of Psychiatry, 48(11), 734–740. https://doi.org/10.1177/070674370304801105
31.
DouglasK. S.ShafferC. S. (2021). The science of and practice with the HCR-20 V3 (Historical-Clinical-Risk Management-20, Version 3). In DouglasK. S.OttoR. K. (Eds.), Handbook of violence risk assessment (2nd ed., pp. 322–358). Routledge/Taylor & Francis Group.
32.
DouglasK. S.YeomansM.BoerD. (2005). Comparative validity analysis of multiple measures of violence risk in a sample of criminal offenders. Criminal Justice and Behavior, 32(5), 479–510. https://doi.org/10.1177/0093854805278411
EllingsonJ. M.LittlefieldA. K.VergésA.SherK. J. (2018). Psychopathy and substance use disorders. In PatrickC. J. (Ed.), Handbook of psychopathy (2nd ed., pp. 635–661). Guilford Press.
35.
GaliettaM.RosenfeldB. (2012). Adapting Dialectical Behavior Therapy (DBT) for the treatment of psychopathy. International Journal of Forensic Mental Health, 11(4), 325–335. https://doi.org/10.1080/14999013.2012.746762
36.
GatnerD. T.DouglasK. S.HartS. D.KroppP. R. (2022). Structured professional judgment (SPJ) violence risk case formulation and psychopathic personality disorder. International Journal of Forensic Mental Health, 21(1), 20–36. https://doi.org/10.1080/14999013.2021.189537
37.
GoereeR.FarahatiF.BurkeN.BlackhouseG.O’ReillyD.PyneJ.TarrideJ. E. (2005). The economic burden of schizophrenia in Canada in 2004. Current Medical Research and Opinion, 21(12), 2017–2028. https://doi.org/10.1185/030079905X75087
Grogan-KaylorA.OtisM. D. (2003). The effect of childhood maltreatment on adult criminality: A Tobit regression analysis. Child Maltreatment, 8(2), 129–137. https://doi.org/10.1177/1077559502250810
40.
GustavssonA.SvenssonM.JacobiF.AllgulanderC.AlonsoJ.BeghiE.DodelR.EkmanM.FaravelliC.FratiglioniL.GannonB.JonesD. H.JennumP.JordanovaA.JönssonL.KarampampaK.KnappM.KobeltG.KurthT.. . . OlesenJ. (2011). Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology, 21(10), 718–779. https://doi.org/10.1016/j.euroneuro.2011.08.008
41.
GuyL. S.DouglasK. S.HendryM. C. (2010). The role of psychopathic personality disorder in violence risk assessments using the HCR-20. Journal of Personality Disorders, 24(5), 551–580. https://doi.org/10.1521/pedi.2010.24.5.551
42.
HallJ.CaleoS.StevensonJ.MearesR. (1999). Economic analysis of psychotherapy for borderline personality disorder patients. Centre for Health Economics Research, University of Sydney.
43.
HareR. D. (1991). The Hare Psychopathy Checklist–Revised manual. Multi-Health Systems.
HareR. D. (2003). The Hare Psychopathy Checklist–Revised: Technical manual (2nd ed.). Multi-Health Systems.
46.
HarrisG. T.RiceM. E.CormierC. A. (2013). Research and clinical scoring of the Psychopathy Checklist can show good agreement. Criminal Justice and Behavior, 40(11), 1349–1362. https://doi.org/10.1177/0093854813492959
47.
HartS. D. (1998). The role of psychopathy in assessing risk for violence: Conceptual and methodological issues. Legal and Criminological Psychology, 3(1), 121–137. https://doi.org/10.1111/j.2044-8333.1998.tb00354.x
48.
HartS. D.CoxD. N.HareR. D. (1995). The Hare Psychopathy Checklist: Screening Version (PCL: SV). Multi-Health Systems.
49.
HemphillJ. F.HareR. D. (2004). Some misconceptions about the Hare PCL-R and risk assessment. Criminal Justice and Behavior, 31(2), 203–243. https://doi.org/10.1177/0093854803261326
50.
HopwoodC. J.KotovR.KruegerR. F.WatsonD.WidigerT. A.AlthoffR. R.AnsellE. B.BachB.BagbyR. M.BlaisM. A.BornovalovaM. A.ChmielewskiM.CiceroD. C.ConwayC.De ClercqB.De FruytF.DochertyA. R.EatonN. R.EdensJ. F.. . . ZimmermannJ. (2018). The time has come for dimensional personality disorder diagnosis. Personality and Mental Health, 12(1), 82–86. https://doi.org/10.1002/pmh.1408
51.
HörzS.ZanariniM. C.FrankenburgF. R.ReichD. B.FitzmauriceG. (2010). Ten-year use of mental health services by patients with borderline personality disorder and with other axis II disorders. Psychiatric Services, 61(6), 612–616.
52.
HowardR. C.KhalifaN.DugganC. (2014). Antisocial personality disorder comorbid with borderline pathology and psychopathy is associated with severe violence in a forensic sample. Journal of Forensic Psychiatry & Psychology, 25(6), 658–672. https://doi.org/10.1080/14789949.2014.943797
53.
JerschkeS.MeixnerK.RichterH.BohusM. (1998). Zur Behandlungsgeschichte und Versorgungssituation von Patientinnen mit Borderline-Persönlichkeitsstörung in der Bundesrepublik Deutschland [Health care utilisation of patients with borderline personality in Germany]. Fortschritte der Neurologie·Psychiatrie, 66(12), 545–552.
54.
KiehlK. A.HoffmanM. B. (2011). The criminal psychopath: History, neuroscience, treatment, and economics. Jurimetrics, 51(4), 355–397.
55.
KiehlK. A.Sinnott-ArmstrongW. P. (2013). Introduction. In KiehlK. A.Sinnott-ArmstrongW. P. (Eds.), Handbook on psychopathy and law (pp. 1–2). Oxford University Press.
KoeglC. J.DayD. M. (2019). The monetary costs of crime for a sample of offenders in Ontario. Canadian Journal of Criminology and Criminal Justice, 61(3), 21–44. https://doi.org/10.3138/cjccj.2018-0017
58.
LeisticoA. R.SalekinR. T.DeCosterJ.RogersR. (2008). A large-scale meta-analysis relating the Hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32(1), 28–45. https://doi.org/10.1007/s10979-007-9096-6
59.
LinehanM. M. (1993). Cognitive–behavioral treatment of borderline personality disorder. Guilford Press.
60.
LipseyM. W. (2009). The primary factors that characterize effective interventions with juvenile offenders: A meta-analytic overview. Victims & Offenders, 4(2), 124–147. https://doi.org/10.1080/15564880802612573
61.
MathieuC.BabiakP. (2016). Corporate psychopathy and abusive supervision: Their influence on employees’ job satisfaction and turnover intentions. Personality and Individual Differences, 91, 102–106. https://doi.org/10.1016/j.paid.2015.12.002
62.
McCollisterK. E.FrenchM. T.FangH. (2010). The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug and Alcohol Dependence, 108(1), 98–109. http://doi.org/10.1016/j.drugalcdep.2009.12.002
63.
MillerJ. D.DirA.GentileB.WilsonL.PryorL. R.CampbellW. K. (2010). Searching for a vulnerable dark triad: Comparing factor 2 psychopathy, vulnerable narcissism, and borderline personality disorder. Journal of Personality, 78(5), 1529–1564. https://doi.org/10.1111/j.1467-6494.2010.00660.x
64.
MillsL.MurphyJ.LeeL.ClarkeC. (2018). Dialectical Behavioral Therapy for forensic service users: A systematic literature review and meta-analysis of the literature. Journal of Psychiatric Intensive Care, 15(1), 45–49. https://doi.org/10.20299/jpi.2018.010
65.
MooneyR.IrelandJ. L.LewisM. (2019). Understanding interpersonal relationships and psychopathy. The Journal of Forensic Psychiatry & Psychology, 30(4), 658–685. https://doi.org/10.1080/14789949.2019.1615102
66.
Mullins-SweattS. N. (2013). Conceptual and empirical support for the clinical utility of five-factor model personality disorder diagnosis. In WidigerT. A.CostaP. J. (Eds.), Personality disorders and the five-factor model of personality (pp. 311–324). American Psychological Association. https://doi.org/10.1037/13939-000
67.
MulveyE.ShawE.LidzC. (1994). Editorial: Why use multiple sources in research on patient violence in the community?Criminal Behavior and Mental Health, 4(4), 253–258. https://doi.org/10.1002/cbm.1994.4.4.253
68.
National Institute for Health & Clinical Excellence. (2010). Antisocial personality disorder: Treatment, management, prevention (National Clinical Practice Guideline Number 77). The British Psychological Society.
69.
O’SheaL. E.MitchellA. E.PicchioniM. M.DickensG. L. (2013). Moderators of the predictive efficacy of the Historical, Clinical and Risk Management-20 for aggression in psychiatric facilities: Systematic review and meta-analysis. Aggression and Violent Behavior, 18(2), 255–270. https://doi.org/10.1016/j.avb.2012.11.016
70.
OstermannM.MatejkowskiJ. (2014). Estimating the impact of mental illness on costs of crimes: A matched samples comparison. Criminal Justice and Behavior, 41(1), 20–40. https://doi.org/10.1177/0093854813496239
71.
PalmerS.DavidsonK.TyrerP.GumleyA.TataP.NorrieJ.MurrayH.SeivewrightH. (2006). The cost-effectiveness of cognitive behavior therapy for borderline personality disorder: Results from the BOSCOT trial. Journal of Personality Disorders, 20(5), 466–481. https://doi.org/10.1521/pedi.2006.20.5.466
72.
PapaliaN.SpivakB.DaffernM.OgloffJ. R. P. (2019). A meta-analytic review of the efficacy of psychological treatments for violent offenders in correctional and forensic mental health settings. Clinical Psychology: Science and Practice, 26(2), Article e12282. https://doi.org/10.1111/cpsp.12282
73.
PauliM.EssemyrK.SörmanK.HownerK.GustavssonP.LiljebergJ. (2018). Gendered expressions of psychopathy: Correctional staffs’ perceptions of the CAPP and CABP models. International Journal of Forensic Mental Health, 17(2), 97–110. https://doi.org/10.1080/14999013.2018.1431337
74.
ReidyD. E.KearnsM. C.DeGueS.LilienfeldS. O.MassettiG.KiehlK. A. (2015). Why psychopathy matters: Implications for public health and violence prevention. Aggression and Violent Behavior, 24, 214–225. https://doi.org/10.1016/j.avb.2015.05.018
Salvador-CarullaL.BendeckM.FerrerM.AndiónÓ.AragonèsE.CasasM. (2014). Cost of borderline personality disorder in Catalonia (Spain). European Psychiatry, 29(8), 490–497. https://doi.org/10.1016/j.eurpsy.2014.07.001
SellbomM.DonnellyK. M.RockR. C.PhillipsT. R.Ben-PorathY. S. (2017). Examining gender as moderating the association between psychopathy and substance abuse. Psychology, Crime & Law, 23(4), 376–390. https://doi.org/10.1080/1068316X.2016.1258466
79.
SewallL. A.OlverM. E. (2019). Psychopathy and treatment outcome: Results from a sexual violence reduction program. Personality Disorders: Theory, Research, and Treatment, 10(1), 59–69. https://doi.org/10.1037/per0000297
SiegelS.CastellanN. J. (1988). Nonparametric statistics for the behavioral sciences (2nd ed.). McGraw Hill.
82.
SinghJ. P.GrannM.FazelS. (2011). A comparative study of violence risk assessment tools: A systematic review and metaregression analysis of 68 studies involving 25,980 participants. Clinical Psychology Review, 31(3), 499–513. https://doi.org/10.1016/j.cpr.2010.11.009
83.
SoetemanD. I.RoijenL. H. V.VerheulR.BusschbachJ. J. (2008). The economic burden of personality disorders in mental health care. Journal of Clinical Psychiatry, 69(2), 259–265. https://doi.org/10.4088/jcp.v69n0212
StoreyJ. E.HartS. D.CookeD. J.MichieC. (2016). Psychometric properties of the Hare Psychopathy Checklist-Revised (PCL-R) in a representative sample of Canadian federal offenders. Law and Human Behavior, 40(2), 136–146. https://doi.org/10.1037/lhb0000174
TobinJ. (1958). Estimation of relationships for limited dependent variables. Econometrica, 26(1), 24–36.
88.
TomlinsonM. F. (2018). A theoretical and empirical review of dialectical behavior therapy within forensic psychiatric and correctional settings worldwide. International Journal of Forensic Mental Health, 17(1), 72–95. https://doi.org/10.1080/14999013.2017.1416003
89.
VeronaE.SpragueJ.JavdaniS. (2012). Gender and factor-level interactions in psychopathy: Implications for self-directed violence risk and borderline personality disorder symptoms. Personality Disorders: Theory, Research, and Treatment, 3(3), 247–262. https://doi.org/10.1037/a0025945
90.
WebsterC. D.DouglasK.EavesD.HartS. (1997). HCR-20: Assessing risk for violence (Version 2). Simon Fraser University.
91.
WhitefordH. A.DegenhardtL.RehmJ.BaxterA. J.FerrariA. J.ErskineH. E.CharlsonF. J.NormanR. E.FlaxmanA. D.JohnsN.BursteinR.MurrayC. J.VosT. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. The Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6
WidigerT. A.LivesleyW. J.ClarkL. A. (2009). An integrative dimensional classification of personality disorder. Psychological Assessment, 21(3), 243–255. https://doi.org/10.1037/a0016606
94.
YangM.WongS. C. P.CoidJ. (2010). The efficacy of violence prediction: A meta-analytic comparison of nine risk assessment tools. Psychological Bulletin, 136(5), 740–767. https://doi.org/10.1037/a0020473
95.
ZhangT. (2011). Costs of crime in Canada, 2008. Department of Justice Canada.
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