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The role of psychopathy in the assessment of dangerousness
Pergamon
International Journal of Law and Psychiatry, Vol. 18, No. 2, pp. 231-238, 1995 Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0160-2527/95 $9.50 + .00 0160-2527(95)00008-9
The Role of Psychopathy in the Assessment of Dangerousness Ralph C. Serin* and Nancy L. Amos**
The purpose of this paper is to review data from a prospective outcome study utilizing a specific diagnosis, that of criminal psychopathy, to consider its utility in assessing dangerousness. An individual's propensity to commit dangerous acts relates to a complex interaction between dispositional and situational factors (Blackburn, 1993). This study proposes that some personality variables are sufficiently correlated with violent behaviour that prediction can be enhanced, even if the situational variables cannot be anticipated and base rates are modest. The Psychopathy Checklist-Revised (Hare, 1991) has emerged to be the standard for the assessment of criminal psychopathy in North America. This does not mean that such measures as the MMPI (Psychopathic Deviate and Hypomania subscales), the SHAPS (Blackburn, 1989), and Antisocial Personality Disorder (DSM-III-R) are unhelpful, but the PCL-R appears to be a more specific measure. Further, there is extensive information regarding the reliability and validity of the PCL-R now available (cf. Hart, Hare, & Harpur, in press). The PCL-R has also been included in the DSM-IV field trials for the development of new diagnostic criteria for antisocial personality disorder (Hare, Hart, & Harpur, 1991). The potential contribution of this research should not only be the issue of prediction, although psychopathy does prove to be a good predictor of violent recidivism (Harris, Rice, & Cormier, 1992; Harris, Rice, & Quinsey, 1993a; Serin, in press). Rather, it addresses how personological variables might be incorporated into standardized practice for the assessment of risk and its man*Psychologist, Joyceville Institution, Correctional Service of Canada. **Graduate student, University of Western Ontario. Correspondence should be addressed to the first author, Joyceville Institution, Box 880, Kingston, Ontario, Canada, K7L 4X9. This research was funded by a grant from the Regional Headquarters (Ontario), Correctional Service of Canada. The comments are the authors' and do not necessarily reflect the views of the Correctional Service of Canada. This paper was presented at the 19th International Congress on Law and Psychiatry in Lisbon. We would like to thank Marie Kuriychuk and two anonymous reviewers for their comments on an earlier version of this paper. 231
232
R.C. SERIN and N. L, AMOS
agement for an individual client. Incorporating psychopathy into a model may be important etiologically, and may inform treatment from a more theoretical perspective. Method
The subjects were 300 male offenders incarcerated in a federal Canadian prison. The average age was 30.5 years. Marital status was 470-/0 single, 38070 married or living common-law at time of incarceration, and 14070 separated, divorced, or widowed. In terms of ethnicity, 88070 were Caucasian, 4070 Aboriginal, 7070 Black, and 1070 other. The average number of prior convictions was 13.7 (range 0-145). Of these subjects, 620-/0 had convictions for violent offenses when robbery is included in the definition of violent. Diagnosis of psychopathy were completed using file reviews and semistructured interviews. Groups were defined as nonpsychopaths (PCL-R < 17), psychopaths (PCL-R > 29), and a mixed group comprised the balance. Raters demonstrated high inter-rate reliability with criterion scores before data collection. The subjects were collated from several studies (Serin, 1992). Outcome was defined from a review of both Correctional Service of Canada records regarding re-incarceration and Royal Canadian Mounted Police records regarding arrests and convictions. Although these databases are considered accurate, official records are viewed to be a conservative estimate. Recidivism reflects a reconviction for a new offense while on release, and was coded as general, violent, and violent with robbery excluded. This last category was developed as a more stringent definition of violent recidivism. The maximum follow-up period was 7.8 years, with the average being 5.5 years. Results
Figure 1 presents the relation between psychopathy and violent recidivism. PCL-R scores are linearly related to violent recidivism, with higher scores associated with higher violent recidivism rates. The relation between groups (nonpsychopaths (NP), psychopaths (P), and mixed (M)) and recidivism is presented in Figure 2. The linear relation holds, but with much lower base rates for violent recidivism than general recidivism. Psychopaths fail between 2 times (general recidivism) and 5 times (violent recidivism) the rate of nonpsychopaths. Plotting a survival curve (Figure 3) shows the trend of recidivism over time, although there is the problem of a small sample size at times exceeding 70 months. Psychopaths fail significantly sooner than nonpsychopaths (t (50) = 2.02, p < .05). After 12 months, of those who failed, the rates were 320-/0 for NP, 57°70 for M, and 62070 for P. By 36 months, 82070 of NP, 90070 of M, and 100% of P who would fail had done so. Using the PCL-R in a multiple regression procedure yielded significant correlations with all o u t c o m e s - g e n e r a l recidivism R = .27, p < .001; violent recidivism (robbery included) R = .28, p < .001; violent recidivism (robbery excluded) R = .22, p < .005. Although these regression analyses are statistically significant, the PCL-R accounts for less than 10070 of the total variance.
PSYCHOPATHY AND DANGEROUSNESS
233
Psychopathy and Violent Recidivism % Failure 40
/
35
30
25
20
15
10
_/ 0-10
11-20
21-30
31-40
PCL-R Score P C L - R - Peychopathy C h e c k l i s t - R e v i s e d FIGURE 1. Psychopathy and Violent Recidivism.
A more important manner of reviewing these findings is to determine how well the PCL-R predicts outcome. For instance, does the PCL-R greatly exceed chance, and, as a single measure, how well does it classify successes and failures? For violent recidivism and a PCL-R cutoff of 30 or greater, the phi coefficient for the Relative Improvement Over Chance (Loeber & Dishion, 1983) was .18 (p < .01). This translates to 80% of offenders being correctly classified. A final consideration is how the PCL-R might be incorporated to reduce decision errors. The sample has a base rate of violent recidivism of 17%, but the rate of violent re-offending by nonpsychopaths (n = 74) is only 5%, compared to 25% for psychopaths (n -- 40). Using two cutoffs will assist the clinician to better identify good risks for release (PCL-R scores < 17) and poorer risks (PCL-R scores > 29).
234
R.C. SERIN and N. L. AMOS
Psychopathy and Recidivism % Fail 80
70
60
50
40
30
20
10
General
Violent (robbery)
Violent
Group l
Nonpsychopaths
~
n - 74
Mixed n - 185
Psychopaths n-40
FIGURE 2. Recidivism by Group.
Discussion
The current findings indicate that the PCL-R is a valid predictor of violent recidivism in an incarcerated sample. With a sample of 300 offenders and an average follow-up of 5.5 years, the present prospective study represents an important confirmation that specific predictors for low base rate events are possible to identify. Also, psychopathy was rated using a standard measure (PCL-R) and incorporated both interview and case history information. Serin and Barbaree (1993) have suggested that the PCL-R might be profitably used to select relatively good and poorer risks for release. The current data support this strategy and imply that the PCL-R might be best used in this manner, and not simply as a gate for high scorers. These data are consistent with Harris et al. (1993a) strategy to include the PCL-R as a central factor in an actuarial risk scale for the prediction of violent recidivism. As evidence for the predictive validity of the PCL-R for forensic populations continues to mount, mental health professionals will face increasing pressure
PSYCHOPATHYANDDANGEROUSNESS
235
Recidivism Survival Curve 100
% Succeed
90 ~
70 - ~
60
30
l ......
l _ .....
I
20 10 0
0
~
I
I
I
I
I
I
I
I
10
20
30
40
50
60
70
80
90
100
Time in M o n t h s Nonpsychopaths
I
Mixeds
~< Psychopaths
FIGURE 3. Survival Curve for Recidivism by Group.
to incorporate this diagnosis into their clinical practice. Notwithstanding issues of training and theoretical orientation, it is unclear how psychopathy might be judiciously considered by clinicians and decision makers. For instance, not all high-risk offenders are psychopaths; but most, if not all, psychopaths are high-risk offenders. Also, not all high-risk offenders are serving indeterminate sentences, and will therefore be eventually released to the community. It would appear that general guidelines might be instructive for clinicians. First, psychopathy appears to be a useful method to anchor a case regarding risk level (Harris et al., 1993a; Serin & Barbaree, 1993). Second, additional clinical information should be conservatively considered in the revision of level of risk for a particular case (Harris et al., 1993a; Serin & Barbaree, 1993). Third, this process should yield case-specific information helpful in the management of risk in the community and identification of treatment targets (Quinsey & Walker, 1992). Currently there is likely considerable variability among practitioners in the manner in which assessments are completed. Although forensic training programs are evolving, many clinicians in correctional settings lack such specialized training. Figure 4 presents a heuristic model ~ intended to guide clinicians towards some standard of practice. Conceptually, base rate information, demographic factors (Monahan, 1981), and psychopathy yield an initial estimate ~This model is intended to be a guide only; however, scoring information is available upon request.
236
R.C. SERINand N. L. AMOS DECISION TREE FOR THE ASSESSMENT OF DANGEROUSNESS DEMOGRAPHIC i VARIABLES
DISPOSITIONAL FACTORS
DECISION STAGE 1
I.,,F u,,o
VIOLENCE
'
GROUP BASERATE(ESTIMATE)
I
i
'
SINHI TORS~ A N " ANTECEDENTS I
DECISION STAGE 2 ~ L
INDIVIDUALBASEI RATE (ESTIMATE)I
I
VARIABLEq
RISK MANAGEMENT I
DECISION STAGE 3
L
I
l REV'SEDEST'MATE / OF VIOLENCEPOTENTIALI
FIGURE 4. Decision Tree for the Assessment of Dangerousness.
of risk for a group of offenders (Stage 1). Clinical information relating to use of violence, self-regulation deficits, and persistence in antisocial behaviour (Moffit, 1993) are then considered so that a conservative revision for an individual case might be made where applicable (cf. Harris et al., 1993a). Lastly, Stage 3 addresses risk management issues to place the assessment into a context for decision makes. For instance, how amenable is the patient towards treatment or compliance regarding medication? Where appropriate, has abstinence been addressed? Have access to weapons and victims been considered? Are adequate supervision and supports in place? Other models or aide memories exist (Marra, Konzelman, & Giles, 1987; Meloy, 1987; Webster, 1987), yet they fail to emphasize sufficiently the predictive validity of the PCL-R, and typically relate to nonincarcerated populations. Although the utility of this approach is an empirical question, at a minimum, it facilitates clinicians to consider how they arrive at their assessment and why. This should be helpful, and would appear to be an important prerequisite for meeting a standard of practice (Beck, 1990; Dix, 1987; Shapiro, 1990; Simon, 1990). Notwithstanding the promise psychopathy holds for the assessment of dan-
PSYCHOPATHY AND DANGEROUSNESS
237
gerousness in forensic populations, it would be limiting if the construct were not applied to treatment issues specifically and typology research on violent offenders more generally. The PCL-R is insufficient to measure treatment gain, but may inform clinicians in the development of treatment targets for persistently violent individuals (Serin & Kuriychuk, in press). Interestingly, psychopaths' deficits in passive avoidance tasks (Newman & Wallace, 1993) imply that nonpsychopaths successfully inhibit certain responses, but psychopaths might be more successful at modulating their responses by developing competing strategies to interfere with their dominant responses. To date, these laboratory findings have not been incorporated into clinical programs. As the relevance of the two factors of the PCL-R become more clear in terms of etiology (Harris, Rice, & Quinsey, 1993b), treatment specific to psychopathy may prove more promising than suggested by the current literature (Rice, Harris, & Cormier, 1992; Ogloff, Wong, & Greenwood, 1990). At this point it is unclear what circumstances could arise whereby psychopaths are not considered high risks to re-offend. Accordingly, stringent supervision upon release would appear to be mandatory for this group. References Beck, J. C. (1990). The basic issues. In J. C. Beck (Ed.), Confidentiality versus the duty to protect: Foreseeable harm in the practice o f psychiatry. Washington: American Psychiatric Press. Blackburn, R. (1989). Psychopathy and personality disorder in relation to violence. In K. Howells & C. Hollin (Eds.), Clinical approaches to violence. New York: Wiley & Sons. Blackburn, R. (1993). The psychology o f criminal conduct. Chichester, England: Wiley & Sons. Dix, G. E. (1987). Legal and ethical issues in the treatment and handling of violent behavior. In L. H. Roth (Ed.), Clinical treatment o f the violent person. New York: Guilford Press. Hare, R. D. (1991). Manual f o r the Revised Psychopathy Checklist. Toronto: Multi-Health Systems. Hare, R. D., Hart, S. D., & Harpur, T. J. (1991). Psychopathy and DSM-IV criteria for antisocial personality disorder. Journal o f Abnormal Psychology, 100, 391-398. Harris, G. T., Rice, M. E., & Cormier, C. A. (1992). Psychopathy and violent recidivism. Law and Human Behavior, 15, 625-637. Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993a). Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument. Criminal Justice and Behavior, 20, 315-335. Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993b). Psychopathy as a taxon: Evidence that psychopaths are a discrete class. Journal o f Consulting and Clinical Psychology, 62, 387-397. Hart, S. D., Hare, R. D., & Harpur, T. J. (in press). The Psychopathy Checklist-Revised (PCL-R): An overview for researchers and clinicians. In J. Rosen & P. McReynolds (Eds.), Advances in psychological assessment, Vol. 8. New York: Plenum. Loeber, R., & Dishion, T. J. (1983). Early predictors of male delinquency: A review. Psychological Bulletin, 94, 68-99. Marra, H. A., Konzelman, G. E., & Giles, P.G. (1987). A clinical strategy to the assessment of dangerousness. International Journal o f Offender Therapy and Comparative Criminology, 31,291-299. Meloy, J. R. (1987). The prediction of violence in outpatient psychotherapy. American Journal o f Psychotherapy, 41, 38-45. Moffit, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701. Monahan, J. (1981). Predicting violent behavior: A n assessment o f clinical techniques. Beverly Hills: Sage. Newman, J. P., & Wallace, J. F. (1993). Psychopathy. In K. S. Dobson and P. C. Kendall (Eds.), Psychopathology and cognition. Orlando, FL: Academic Press. Ogloff, J. R. P., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a therapeutic community. Behavioral Sciences and the Law, 8, 81-90. Quinsey, V. L., & Walker, W. D. (1992). Dealing with dangerousness: Community risk management strate-
238
R.C. SERIN and N. L. AMOS
gies with violent offenders. In R. DeV. Peters (Ed.), Aggression and Violence Throughout the Life Span (pp. 244-262). Newbury Park, CA: Sage. Rice, M. E., Harris, G. T., & Cormier, C. (1992). Evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16, 399-412. Serin, R. C. (in press). Violent recidivism in criminal psychopaths. Law and Human Behavior. Serin, R. C. (1992). Clinical application of the Psychopathy Checklist- Revised (PCL-R). Journal o f Clinical Psychology, 48, 637-642. Serin, R. C., & Barbaree, H. E. (1993). Decision issues in risk assessment. Forum on Corrections Research, 5, 22-25. Serin, R. C., & Kuriychuk, M. (in press). Social and cognitive processing deficits in violent offenders: Implications for treatment. International Journal of L a w and Psychiatry, 17, 431-441. Shapiro, D. L. (1990). Standard of care in the prediction of violent behaviour. Psychotherapy in Private Practice, 8, 43-53. Simon, R. I. (1990). The duty to protect in private practice. In J. C. Beck (Ed.), Confidentiality versus the duty to protect: Foreseeable harm in the practice o f psychiatry. Washington: American Psychiatric Press. Webster, C. D. (1987). Dangerous Behaviour Clinical Guide (DBCG). Toronto: Clarke Institute of Psychiatry.
International Journal of Law and Psychiatry, Vol. 18, No. 2, pp. 231-238, 1995 Copyright © 1995 Elsevier Science Ltd Printed in the USA. All rights reserved 0160-2527/95 $9.50 + .00 0160-2527(95)00008-9
The Role of Psychopathy in the Assessment of Dangerousness Ralph C. Serin* and Nancy L. Amos**
The purpose of this paper is to review data from a prospective outcome study utilizing a specific diagnosis, that of criminal psychopathy, to consider its utility in assessing dangerousness. An individual's propensity to commit dangerous acts relates to a complex interaction between dispositional and situational factors (Blackburn, 1993). This study proposes that some personality variables are sufficiently correlated with violent behaviour that prediction can be enhanced, even if the situational variables cannot be anticipated and base rates are modest. The Psychopathy Checklist-Revised (Hare, 1991) has emerged to be the standard for the assessment of criminal psychopathy in North America. This does not mean that such measures as the MMPI (Psychopathic Deviate and Hypomania subscales), the SHAPS (Blackburn, 1989), and Antisocial Personality Disorder (DSM-III-R) are unhelpful, but the PCL-R appears to be a more specific measure. Further, there is extensive information regarding the reliability and validity of the PCL-R now available (cf. Hart, Hare, & Harpur, in press). The PCL-R has also been included in the DSM-IV field trials for the development of new diagnostic criteria for antisocial personality disorder (Hare, Hart, & Harpur, 1991). The potential contribution of this research should not only be the issue of prediction, although psychopathy does prove to be a good predictor of violent recidivism (Harris, Rice, & Cormier, 1992; Harris, Rice, & Quinsey, 1993a; Serin, in press). Rather, it addresses how personological variables might be incorporated into standardized practice for the assessment of risk and its man*Psychologist, Joyceville Institution, Correctional Service of Canada. **Graduate student, University of Western Ontario. Correspondence should be addressed to the first author, Joyceville Institution, Box 880, Kingston, Ontario, Canada, K7L 4X9. This research was funded by a grant from the Regional Headquarters (Ontario), Correctional Service of Canada. The comments are the authors' and do not necessarily reflect the views of the Correctional Service of Canada. This paper was presented at the 19th International Congress on Law and Psychiatry in Lisbon. We would like to thank Marie Kuriychuk and two anonymous reviewers for their comments on an earlier version of this paper. 231
232
R.C. SERIN and N. L, AMOS
agement for an individual client. Incorporating psychopathy into a model may be important etiologically, and may inform treatment from a more theoretical perspective. Method
The subjects were 300 male offenders incarcerated in a federal Canadian prison. The average age was 30.5 years. Marital status was 470-/0 single, 38070 married or living common-law at time of incarceration, and 14070 separated, divorced, or widowed. In terms of ethnicity, 88070 were Caucasian, 4070 Aboriginal, 7070 Black, and 1070 other. The average number of prior convictions was 13.7 (range 0-145). Of these subjects, 620-/0 had convictions for violent offenses when robbery is included in the definition of violent. Diagnosis of psychopathy were completed using file reviews and semistructured interviews. Groups were defined as nonpsychopaths (PCL-R < 17), psychopaths (PCL-R > 29), and a mixed group comprised the balance. Raters demonstrated high inter-rate reliability with criterion scores before data collection. The subjects were collated from several studies (Serin, 1992). Outcome was defined from a review of both Correctional Service of Canada records regarding re-incarceration and Royal Canadian Mounted Police records regarding arrests and convictions. Although these databases are considered accurate, official records are viewed to be a conservative estimate. Recidivism reflects a reconviction for a new offense while on release, and was coded as general, violent, and violent with robbery excluded. This last category was developed as a more stringent definition of violent recidivism. The maximum follow-up period was 7.8 years, with the average being 5.5 years. Results
Figure 1 presents the relation between psychopathy and violent recidivism. PCL-R scores are linearly related to violent recidivism, with higher scores associated with higher violent recidivism rates. The relation between groups (nonpsychopaths (NP), psychopaths (P), and mixed (M)) and recidivism is presented in Figure 2. The linear relation holds, but with much lower base rates for violent recidivism than general recidivism. Psychopaths fail between 2 times (general recidivism) and 5 times (violent recidivism) the rate of nonpsychopaths. Plotting a survival curve (Figure 3) shows the trend of recidivism over time, although there is the problem of a small sample size at times exceeding 70 months. Psychopaths fail significantly sooner than nonpsychopaths (t (50) = 2.02, p < .05). After 12 months, of those who failed, the rates were 320-/0 for NP, 57°70 for M, and 62070 for P. By 36 months, 82070 of NP, 90070 of M, and 100% of P who would fail had done so. Using the PCL-R in a multiple regression procedure yielded significant correlations with all o u t c o m e s - g e n e r a l recidivism R = .27, p < .001; violent recidivism (robbery included) R = .28, p < .001; violent recidivism (robbery excluded) R = .22, p < .005. Although these regression analyses are statistically significant, the PCL-R accounts for less than 10070 of the total variance.
PSYCHOPATHY AND DANGEROUSNESS
233
Psychopathy and Violent Recidivism % Failure 40
/
35
30
25
20
15
10
_/ 0-10
11-20
21-30
31-40
PCL-R Score P C L - R - Peychopathy C h e c k l i s t - R e v i s e d FIGURE 1. Psychopathy and Violent Recidivism.
A more important manner of reviewing these findings is to determine how well the PCL-R predicts outcome. For instance, does the PCL-R greatly exceed chance, and, as a single measure, how well does it classify successes and failures? For violent recidivism and a PCL-R cutoff of 30 or greater, the phi coefficient for the Relative Improvement Over Chance (Loeber & Dishion, 1983) was .18 (p < .01). This translates to 80% of offenders being correctly classified. A final consideration is how the PCL-R might be incorporated to reduce decision errors. The sample has a base rate of violent recidivism of 17%, but the rate of violent re-offending by nonpsychopaths (n = 74) is only 5%, compared to 25% for psychopaths (n -- 40). Using two cutoffs will assist the clinician to better identify good risks for release (PCL-R scores < 17) and poorer risks (PCL-R scores > 29).
234
R.C. SERIN and N. L. AMOS
Psychopathy and Recidivism % Fail 80
70
60
50
40
30
20
10
General
Violent (robbery)
Violent
Group l
Nonpsychopaths
~
n - 74
Mixed n - 185
Psychopaths n-40
FIGURE 2. Recidivism by Group.
Discussion
The current findings indicate that the PCL-R is a valid predictor of violent recidivism in an incarcerated sample. With a sample of 300 offenders and an average follow-up of 5.5 years, the present prospective study represents an important confirmation that specific predictors for low base rate events are possible to identify. Also, psychopathy was rated using a standard measure (PCL-R) and incorporated both interview and case history information. Serin and Barbaree (1993) have suggested that the PCL-R might be profitably used to select relatively good and poorer risks for release. The current data support this strategy and imply that the PCL-R might be best used in this manner, and not simply as a gate for high scorers. These data are consistent with Harris et al. (1993a) strategy to include the PCL-R as a central factor in an actuarial risk scale for the prediction of violent recidivism. As evidence for the predictive validity of the PCL-R for forensic populations continues to mount, mental health professionals will face increasing pressure
PSYCHOPATHYANDDANGEROUSNESS
235
Recidivism Survival Curve 100
% Succeed
90 ~
70 - ~
60
30
l ......
l _ .....
I
20 10 0
0
~
I
I
I
I
I
I
I
I
10
20
30
40
50
60
70
80
90
100
Time in M o n t h s Nonpsychopaths
I
Mixeds
~< Psychopaths
FIGURE 3. Survival Curve for Recidivism by Group.
to incorporate this diagnosis into their clinical practice. Notwithstanding issues of training and theoretical orientation, it is unclear how psychopathy might be judiciously considered by clinicians and decision makers. For instance, not all high-risk offenders are psychopaths; but most, if not all, psychopaths are high-risk offenders. Also, not all high-risk offenders are serving indeterminate sentences, and will therefore be eventually released to the community. It would appear that general guidelines might be instructive for clinicians. First, psychopathy appears to be a useful method to anchor a case regarding risk level (Harris et al., 1993a; Serin & Barbaree, 1993). Second, additional clinical information should be conservatively considered in the revision of level of risk for a particular case (Harris et al., 1993a; Serin & Barbaree, 1993). Third, this process should yield case-specific information helpful in the management of risk in the community and identification of treatment targets (Quinsey & Walker, 1992). Currently there is likely considerable variability among practitioners in the manner in which assessments are completed. Although forensic training programs are evolving, many clinicians in correctional settings lack such specialized training. Figure 4 presents a heuristic model ~ intended to guide clinicians towards some standard of practice. Conceptually, base rate information, demographic factors (Monahan, 1981), and psychopathy yield an initial estimate ~This model is intended to be a guide only; however, scoring information is available upon request.
236
R.C. SERINand N. L. AMOS DECISION TREE FOR THE ASSESSMENT OF DANGEROUSNESS DEMOGRAPHIC i VARIABLES
DISPOSITIONAL FACTORS
DECISION STAGE 1
I.,,F u,,o
VIOLENCE
'
GROUP BASERATE(ESTIMATE)
I
i
'
SINHI TORS~ A N " ANTECEDENTS I
DECISION STAGE 2 ~ L
INDIVIDUALBASEI RATE (ESTIMATE)I
I
VARIABLEq
RISK MANAGEMENT I
DECISION STAGE 3
L
I
l REV'SEDEST'MATE / OF VIOLENCEPOTENTIALI
FIGURE 4. Decision Tree for the Assessment of Dangerousness.
of risk for a group of offenders (Stage 1). Clinical information relating to use of violence, self-regulation deficits, and persistence in antisocial behaviour (Moffit, 1993) are then considered so that a conservative revision for an individual case might be made where applicable (cf. Harris et al., 1993a). Lastly, Stage 3 addresses risk management issues to place the assessment into a context for decision makes. For instance, how amenable is the patient towards treatment or compliance regarding medication? Where appropriate, has abstinence been addressed? Have access to weapons and victims been considered? Are adequate supervision and supports in place? Other models or aide memories exist (Marra, Konzelman, & Giles, 1987; Meloy, 1987; Webster, 1987), yet they fail to emphasize sufficiently the predictive validity of the PCL-R, and typically relate to nonincarcerated populations. Although the utility of this approach is an empirical question, at a minimum, it facilitates clinicians to consider how they arrive at their assessment and why. This should be helpful, and would appear to be an important prerequisite for meeting a standard of practice (Beck, 1990; Dix, 1987; Shapiro, 1990; Simon, 1990). Notwithstanding the promise psychopathy holds for the assessment of dan-
PSYCHOPATHY AND DANGEROUSNESS
237
gerousness in forensic populations, it would be limiting if the construct were not applied to treatment issues specifically and typology research on violent offenders more generally. The PCL-R is insufficient to measure treatment gain, but may inform clinicians in the development of treatment targets for persistently violent individuals (Serin & Kuriychuk, in press). Interestingly, psychopaths' deficits in passive avoidance tasks (Newman & Wallace, 1993) imply that nonpsychopaths successfully inhibit certain responses, but psychopaths might be more successful at modulating their responses by developing competing strategies to interfere with their dominant responses. To date, these laboratory findings have not been incorporated into clinical programs. As the relevance of the two factors of the PCL-R become more clear in terms of etiology (Harris, Rice, & Quinsey, 1993b), treatment specific to psychopathy may prove more promising than suggested by the current literature (Rice, Harris, & Cormier, 1992; Ogloff, Wong, & Greenwood, 1990). At this point it is unclear what circumstances could arise whereby psychopaths are not considered high risks to re-offend. Accordingly, stringent supervision upon release would appear to be mandatory for this group. References Beck, J. C. (1990). The basic issues. In J. C. Beck (Ed.), Confidentiality versus the duty to protect: Foreseeable harm in the practice o f psychiatry. Washington: American Psychiatric Press. Blackburn, R. (1989). Psychopathy and personality disorder in relation to violence. In K. Howells & C. Hollin (Eds.), Clinical approaches to violence. New York: Wiley & Sons. Blackburn, R. (1993). The psychology o f criminal conduct. Chichester, England: Wiley & Sons. Dix, G. E. (1987). Legal and ethical issues in the treatment and handling of violent behavior. In L. H. Roth (Ed.), Clinical treatment o f the violent person. New York: Guilford Press. Hare, R. D. (1991). Manual f o r the Revised Psychopathy Checklist. Toronto: Multi-Health Systems. Hare, R. D., Hart, S. D., & Harpur, T. J. (1991). Psychopathy and DSM-IV criteria for antisocial personality disorder. Journal o f Abnormal Psychology, 100, 391-398. Harris, G. T., Rice, M. E., & Cormier, C. A. (1992). Psychopathy and violent recidivism. Law and Human Behavior, 15, 625-637. Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993a). Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument. Criminal Justice and Behavior, 20, 315-335. Harris, G. T., Rice, M. E., & Quinsey, V. L. (1993b). Psychopathy as a taxon: Evidence that psychopaths are a discrete class. Journal o f Consulting and Clinical Psychology, 62, 387-397. Hart, S. D., Hare, R. D., & Harpur, T. J. (in press). The Psychopathy Checklist-Revised (PCL-R): An overview for researchers and clinicians. In J. Rosen & P. McReynolds (Eds.), Advances in psychological assessment, Vol. 8. New York: Plenum. Loeber, R., & Dishion, T. J. (1983). Early predictors of male delinquency: A review. Psychological Bulletin, 94, 68-99. Marra, H. A., Konzelman, G. E., & Giles, P.G. (1987). A clinical strategy to the assessment of dangerousness. International Journal o f Offender Therapy and Comparative Criminology, 31,291-299. Meloy, J. R. (1987). The prediction of violence in outpatient psychotherapy. American Journal o f Psychotherapy, 41, 38-45. Moffit, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701. Monahan, J. (1981). Predicting violent behavior: A n assessment o f clinical techniques. Beverly Hills: Sage. Newman, J. P., & Wallace, J. F. (1993). Psychopathy. In K. S. Dobson and P. C. Kendall (Eds.), Psychopathology and cognition. Orlando, FL: Academic Press. Ogloff, J. R. P., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a therapeutic community. Behavioral Sciences and the Law, 8, 81-90. Quinsey, V. L., & Walker, W. D. (1992). Dealing with dangerousness: Community risk management strate-
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gies with violent offenders. In R. DeV. Peters (Ed.), Aggression and Violence Throughout the Life Span (pp. 244-262). Newbury Park, CA: Sage. Rice, M. E., Harris, G. T., & Cormier, C. (1992). Evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16, 399-412. Serin, R. C. (in press). Violent recidivism in criminal psychopaths. Law and Human Behavior. Serin, R. C. (1992). Clinical application of the Psychopathy Checklist- Revised (PCL-R). Journal o f Clinical Psychology, 48, 637-642. Serin, R. C., & Barbaree, H. E. (1993). Decision issues in risk assessment. Forum on Corrections Research, 5, 22-25. Serin, R. C., & Kuriychuk, M. (in press). Social and cognitive processing deficits in violent offenders: Implications for treatment. International Journal of L a w and Psychiatry, 17, 431-441. Shapiro, D. L. (1990). Standard of care in the prediction of violent behaviour. Psychotherapy in Private Practice, 8, 43-53. Simon, R. I. (1990). The duty to protect in private practice. In J. C. Beck (Ed.), Confidentiality versus the duty to protect: Foreseeable harm in the practice o f psychiatry. Washington: American Psychiatric Press. Webster, C. D. (1987). Dangerous Behaviour Clinical Guide (DBCG). Toronto: Clarke Institute of Psychiatry.