Examining the economic costs of crime associated with psychopathic personality disorder: A reply to Verona and Joyner (2022).

In our article, "How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder" (Gatner et al., 2023, pp. 391-400), we estimated that psychopathic personality disorder (PPD) was associated with substantial crime costs, using a top-down approach of national costs in the United States and Canada. Verona and Joyner (2023) raised several concerns about our findings. Although we think some of their points help to map directions for future research, we disagree with others they raised related to the conceptualization of PPD, the problem of undetected crimes, and their concerns with putative national comparisons. We strongly welcome debate about the societal impacts of PPD in the hope that it spurs increased attention and innovation regarding the treatment and management of PPD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the HCR-20V3 violence risk assessment measure with mentally disordered offenders and civil psychiatric patients in China.

The current prospective risk assessment study evaluated the application of the Chinese translation of the Historical-Clinical-Risk Management-20 Version 3 (HCR-20V3 ) in a sample of 152 offenders with mental disorders and civil psychiatric patients. The ratings of the presence and relevance of risk factors were compared, as well as summary risk ratings (SRRs), both across offenders and civil psychiatric patients, and across male and female sub-samples. Interrater reliability was consistently "excellent" for the presence and relevance of risk factors and for SRRs. Concurrent validity analyses indicated that HCR-20V3 was strongly correlated with Violence Risk Scale (from r = 0.53 to 0.71). The results of predictive validity analyses provided strong support for the bivariate associations between the main indices of HCR-20V3 and violence within 6 weeks, 7-24 weeks, and 6 months; SRRs added incrementally to both relevance and presence ratings across three follow-up lengths.

The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities.

Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.

How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder.

Cost of illness research has established that mental disorders lead to significant social burden and massive financial costs. A significant gap exists for the economic burden of many personality disorders, including psychopathic personality disorder (PPD). In the current study, we used a top-down prevalence-based cost of illness approach to estimate bounded crime cost estimates of PPD in the United States and Canada. Three key model parameters (PPD prevalence, relative offending rate of individuals with PPD, and national costs of crime for each country) were informed by existing literature. Sensitivity analyses and Monte Carlo simulations were conducted to provide bounded and central tendency estimates of crime costs, respectively. The estimated PPD-related costs of crime ranged from $245.50 billion to $1,591.57 billion (simulated means = $512.83 to $964.23 billion) in the United States and $12.14 billion to $53.00 billion (simulated means = $25.33 to $32.10 billion) in Canada. These results suggest that PPD may be associated with a substantial economic burden as a result of crime in North America. Recommendations are discussed regarding the burden-treatment discrepancy for PPD, as the development of future effective treatment for the disorder may decrease its costly burden on health and justice systems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Concurrent, Convergent, and Discriminant Validity of the DSM-5 Section III Psychopathy Specifier.

Section III of the fifth iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes an alternative model of personality disorder diagnosis that conceptualizes antisocial personality disorder as an interpersonal, rather than behavioral, construct. However, the diagnostic specifier for psychopathy has been met with recent controversy due to its conceptual and empirical overlap with triarchic boldness, which has been debated as a necessary and sufficient domain of psychopathy. This study examined the concurrent, convergent, and discriminant validity of the specifier using canonical correlation analysis in samples of undergraduate students (N = 224) and community adults with prior criminal involvement (N = 306). Findings highlight the specifier as a multidimensional construct with divergent associations across its three facets. There was limited validity evidence for two of the three facets, raising concerns regarding the clinical utility of the psychopathy specifier.

Predictive validity of the SAVRY, YLS/CMI, and PCL:YV is poor for intimate partner violence perpetration among adolescent offenders.

OBJECTIVE: Despite advances in developing structured risk assessment instruments, there is currently no instrument to assess and manage the risk of intimate partner violence perpetration among adolescents. Given the empirical link between many forms of antisocial behavior, we tested whether structured tools commonly used by professionals to evaluate adolescents' risk of engaging in general violence and offending could be used to identify adolescents at risk for perpetrating intimate partner violence. HYPOTHESES: Because researchers have not yet examined whether risk assessment tools for general violence and offending predict intimate partner violence perpetration, we did not have a priori hypotheses regarding the predictive validity of these tools for this purpose. METHOD: Research assistants rated 156 adjudicated youth on the Structured Assessment of Violence Risk in Youth (SAVRY), Youth Level of Service/Case Management Inventory (YLS/CMI), and Psychopathy Checklist: Youth Version (PCL:YV) and recorded charges for intimate partner violence perpetration, any violent reoffending, and any reoffending over a 2-year follow-up period. RESULTS: Receiver operating characteristic analysis indicated that total scores and summary risk ratings on the SAVRY and YLS/CMI and total scores on the PCL:YV were significantly predictive of any violent reoffending and any reoffending, with moderate to large effect sizes, but were nonsignificantly associated with intimate partner violence perpetration. Further, penalized logistic regression analysis indicated that the SAVRY, YLS/CMI, and PCL:YV did not significantly add incremental validity to age, gender, race/ethnicity, and prior intimate partner violence perpetration and victimization for predicting future intimate partner violence perpetration. CONCLUSIONS: These findings suggest that the SAVRY, YLS/CMI, and PCL:YV could have limitations for assessing and managing intimate partner violence perpetration among adolescents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing the Utility of the Comprehensive Assessment of Psychopathic Personality-Lexical Rating Scale (CAPP-LRS): Instrument Adaptation and Simplification.

The Comprehensive Assessment of Psychopathic Personality-Lexical Rating Scale (CAPP-LRS) is a self-report instrument designed to index psychopathy according to the CAPP psychopathy framework. Developed with the expressed goal of advancing the state of knowledge regarding the specific features of psychopathy, the CAPP model and associated instruments have garnered increasing attention and support in the field. Despite the conceptual strength of the CAPP model, the advanced lexical structure of its primary research tool (the CAPP-LRS) has led researchers to question the utility of the instrument for use with some populations of interest (e.g., forensic/correctional and adolescent/young adult samples). The aim of the present work was to address this issue by creating a lexically simplified, though functionally equivalent, version of the CAPP-LRS to increase accessibility to critically relevant populations. A set of two studies (N = 602) describes the adaptation protocol and the initial validation of the modified instrument.

"Examining the incremental and interactive effects of boldness with meanness and disinhibition within the triarchic model of psychopathy": Correction.

Reports an error in "Examining the incremental and interactive effects of boldness with meanness and disinhibition within the triarchic model of psychopathy" by Dylan T. Gatner, Kevin S. Douglas and Stephen D. Hart (Personality Disorders: Theory, Research, and Treatment, 2016[Jul], Vol 7[3], 259-268). In the original article, there were several errors in the reporting of data from the Social Emotional Questionnaire. In the "Outcome Measures" section of the Method, under the "Social and emotional functioning" heading, the Sociability subscale was incorrectly identified as the Social Conformity scale. The sentence referencing the data should have read, "However, the Antisocial Behavior (α = .39, MIC = .14) and Sociability (α = -.09, MIC = .02) subscales had poor internal consistency; the Sociability subscale was removed from our analyses." In the last paragraph of the "Research Question 2: Incremental Value of Boldness" section in the Results, the data for the Sociability scale have been replaced with the data for the Social Conformity scale. Additionally, the data reported for the Sociability scale in Tables 2 and 3 have been replaced with the data reported for the Social Conformity scale. (The following abstract of the original article appeared in record 2016-13473-001). The triarchic model of psychopathy (Patrick, Fowles, & Krueger, 2009) comprises 3 phenotypic domains: Meanness, Disinhibition, and Boldness. Ongoing controversy surrounds the relevance of Boldness in the conceptualization and assessment of psychopathy. In the current study, undergraduate students (N = 439) completed the Triarchic Psychopathy Measure (Patrick, 2010) to examine the association between Boldness and a host of theoretically relevant external criteria. Boldness was generally unrelated to either prosocial or harmful criteria. Boldness rarely provided incremental value above or interacted with Meanness and Disinhibition with respect to external criteria. Curvilinear effects of Boldness rarely emerged. The findings suggest that Boldness might not be a central construct in the definition of psychopathic personality disorder. Implications for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) psychopathic specifier are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Content Validation of the Comprehensive Assessment of Psychopathic Personality-Basic Version (CAPP-Basic) Using Prototypical Analysis.

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a lexically based conceptual model of psychopathy. Despite widespread use in research settings, the Lexical Rating Scale for the CAPP (CAPP-LRS) requires an advanced reading level for completion. The present study is the first to evaluate the content validity of the CAPP-Basic, a lexically simplified version of the CAPP-LRS designed for use with individuals possessing lower verbal skills. Symptoms were rated by mental health professionals (N = 121). Findings were largely in line with results of previous studies, indicating good content validity of the CAPP-Basic at the domain and symptom level.

The Safe pilot study: A prospective naturalistic study with repeated measures design to test the psychosis - violence link in and after discharge from forensic facilities.

The research evidence is very strong for high recidivism rates of violence after discharge from forensic facilities. Big data research has found that a substantial proportion of the forensic population with relapse into violence has a psychosis diagnosis and a criminal record. However, more research on the association between psychotic symptoms and violence may inform and enhance risk assessment, prevention, and treatment. We conducted a prospective naturalistic study with a repeated measures design in a sample of 22 psychotic patients during follow-up after discharge from forensic mental health facilities. We had three aims: to test the predictive validity of three psychotic symptom scales for violence, to analyze main and interaction effects between psychotic symptoms and previous criminal conviction, and to explore the feasibility and potential benefit of the repeated measures design for prospective follow-up research. Interpreted within the limitation of the small sample size, the results were promising for all scales, particularly for adjusted effects without interaction. Two scales remained significant when their interaction with criminal conviction was adjusted. This indicates that risk judgment of psychotic patients with criminal conviction can be improved by adding measurement of fluctuations in psychotic symptoms. The repeated measures design was instrumental in this research.

Construct Validity of the Comprehensive Assessment of Psychopathic Personality (CAPP): Examining the Internal Structure and Generalizability of CAPP Self-Ratings Across Gender and Ethnicity.

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a recently developed conceptual model of psychopathy designed to index the disorder across 33 personality traits. Although recent research has evidenced support for the CAPP model with respect to the convergent, criterion, and predictive validity of CAPP instruments, little work has examined the optimal internal structure and generalizability of the model and associated measures. The present study sought to elaborate on the construct validity and psychometric properties of the CAPP Lexical Self Rating Scale and determine the utility of the instrument across men and women, and individuals of Caucasian and East Asian descent. Within a large sample of self-identified offenders (N = 1,414), we found strong support for a three-factor model comprising domains reflecting interpersonal dominance, behavioral disinhibition, and deficient emotional attachment. Analyses examining the generalizability of the model provide further insight into its applicability for diverse populations.

The Role of Life Satisfaction in Predicting Youth Violence and Offending: A Prospective Examination.

Life satisfaction in adolescence has been shown to protect against numerous negative outcomes (e.g., substance use, sexual risk-taking), but limited work has directly explored the relationship between life satisfaction and youth violence and offending. As such, we conducted a prospective assessment to explore this relationship among community (n = 334) and at-risk youth (n = 99). Findings suggest life satisfaction is significantly associated with decreased offending and violence within both samples and adds incremental value above established risk factors in predicting violent and total offending among community youth. Furthermore, moderation analyses indicate that the protective value of life satisfaction is greater for youth with high callous-unemotional traits. Mediation analyses suggest that youth who are unsatisfied with their lives may seek out substance use, in turn elevating risk of offending. Together, these findings indicate that efforts to improve overall life satisfaction may help prevent adolescent offending. However, future research is needed.

Ten-Year Trends in Physical Dating Violence Victimization Among Adolescent Boys and Girls in British Columbia, Canada.

Physical dating violence (PDV) victimization among adolescents is a serious global problem. Although knowledge of trends in PDV victimization can help guide programming and health policies, little research has examined whether the prevalence of PDV victimization has increased, decreased, or remained stable over time among non-U.S.-based samples of youth. In addition, few studies have directly tested whether disparities in PDV victimization between boys and girls have narrowed, widened, or remained unchanged in recent years. To address these gaps, we used school-based data from the British Columbia Adolescent Health Survey (BC AHS) of 2003, 2008, and 2013 (n boys = 18,441 and n girls = 17,459) to examine 10-year trends in PDV victimization. We also tested whether trends differed across self-reported sex. Data from the 2003 to 2013 BC AHS revealed that recent PDV victimization rates had significantly decreased among youth overall (5.9%-5.0%) and boys (8.0%-5.8%), but not girls (5.3%-4.2%). Although boys had steeper declines than girls in PDV victimization rates, year-by-sex interactions indicate that the sex gap in PDV victimization had not significantly narrowed. Moreover, rates of PDV victimization over the 10-year period indicated significantly higher rates of PDV victimization among boys compared with girls. Despite positive declines in recent rates of PDV victimization among youth, important differences in rates of PDV victimization between boys and girls remain. These findings underscore the need for greater attention to sex differences in research and programming and health policies to reduce PDV victimization and the sex disparities therein.

Do Community Structural Characteristics Moderate the Association Between Mental Health and the Frequency and Severity of Violent-Behavioral Outcomes in Community Respondents?

In this prospective study, we examined the association between three types of mental health symptom clusters (i.e., psychotic, internalizing, and externalizing) and the frequency and severity of violent-behavioral outcomes, and whether community disadvantage, residential instability, and criminogenic facility density moderated these associations. Study data were derived from 258 community-dwelling adults nested in 60 postal forward sortation areas (FSAs) in a large metropolitan area in Western Canada who were assessed twice over a 6-month period. In addition, census and administrative data were obtained on the same areas. Controlling for sociodemographic characteristics (i.e., age, gender, ethnicity, relationship status, and employment status), lifetime history of violent-behavioral outcomes, and community structural characteristics, internalizing and externalizing mental health symptoms were significantly positively associated with the frequency and severity of subsequent violence perpetration and with the severity of subsequent violent victimization. Several significant interactions were observed: internalizing symptoms increased the risk of frequent and severe violence perpetration in FSAs with high but not low disadvantage, and externalizing symptoms increased the risk of frequent violent victimization in FSAs with a high but not low criminogenic facility density. Only the interactive association of internalizing symptoms and community disadvantage with the severity of violence perpetration, however, remained significant after Bonferroni correction was applied. These findings provide tentative support that associations between mental health and violent-behavioral outcomes can vary with community context. The implication of these findings for assessing and managing violent-behavioral outcomes in the community is discussed.

Suicidal ideation across race in a justice-involved sample: An item response theory approach.

OBJECTIVES: Compared to community samples, rates of suicide are much higher in forensic and correctional settings, yet limited research has focused on the development and improvement of suicide assessment methods used in such contexts. Moreover, despite evidence that suicide assessment varies across Caucasians and African Americans, to our knowledge this important issue has received little attention within higher risk correctional samples. We used Item Response Theory and Differential Item Functioning analyses to address this gap within the literature. METHOD: Specifically, we examined the psychometric properties of the Suicidal Ideation scale of the Personality Assessment Inventory (Morey, 2007) in a large sample of justice-involved individuals. RESULTS: Caucasians report greater suicidal ideation compared to African American participants on average. However, after controlling for mean differences, Caucasians and African Americans differentially endorsed symptoms of suicidal ideation. If the level of suicidal ideation is held constant across racial categories, Caucasians underreported suicidal ideation relative to African Americans. CONCLUSION: Results suggest a nuanced picture of suicidal ideation across racial categories that can be informed by Item Response Theory approaches to scale construction and refinement.

Assessing Protective Factors for Adolescent Offending: A Conceptually Informed Examination of the SAVRY and YLS/CMI.

Although the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) are among the most widely used adolescent risk assessment tools, they conceptualize and measure strengths differently. As such, in this study, we compared the predictive validity of SAVRY Protective Total and YLS/CMI Strength Total, and tested conceptual models of how these measures operate (i.e., risk vs. protective effects, direct vs. buffering effects, causal models). Research assistants conducted 624 risk assessments with 156 youth on probation. They rated protective factors at baseline, and again at 3-, 6-, 9-, and 12-month follow-up periods. The SAVRY Protective Total and YLS/CMI Strength Total inversely predicted any charges in the subsequent 2 years (area under the curve scores = 0.61 and 0.60, respectively, p < .05). Furthermore, when adolescents' protective total scores increased, their self-reported violence decreased, thus providing evidence that these factors might play a causally relevant role in reducing violence. However, protective factors did not provide incremental validity over risk factors. In addition, because these measures are brief and use a dichotomous rating system, they primarily captured deficits in protective factors (i.e., low scores). This suggests a need for more comprehensive measures.

Violence after discharge from forensic units in the safe pilot study: a prospective study with matched pair design.

OBJECTIVE: This paper reports on a prospective naturalistic study of violent recidivism after discharge from forensic mental health. Main aims were to find predictors of violence and to test the feasibility of a matched pair design for this purpose. METHODS: Patients from the Safe pilot project (n=18) and a group of controls (n=18) were matched on 10 variables, such as diagnosis, seriousness of violence, setting after discharge, and risk management plans. All the Safe pilot patients had been through repeated measurement of dynamic risk factors of violence the year before discharge to develop efficient risk management plans for use after discharge. We wanted to test whether violent recidivism during follow-up would be lower and less serious in the Safe pilot group. RESULTS: We found no significant between-group difference concerning number of patients with violent recidivism. However, the Safe pilot patients had significantly lower rates of violence and fewer severe violent episodes. In the control group, there was a significant association between a high number of risk management plans and high rates of violence. There was a statistical trend for the opposite association in the Safe pilot group. CONCLUSION: We discuss this in terms of a possible gap between the development and implementation of plans.

Examining the triarchic psychopathy measure and comprehensive assessment of psychopathic personality in self-identified offender populations.

Despite the clear clinical and forensic importance of psychopathy, definitions of psychopathy and the optimal measurement of the disorder are issues of continued controversy. The present research provides an empirical examination of two self-report instruments indexing recent conceptualizations of psychopathy: the Comprehensive Assessment of Psychopathic Personality-Self-Rating Scale (CAPP-SR) and Triarchic Psychopathy Measure (TriPM). This study provides the first examination of the convergence between the two tools, and the first investigation into the criterion-related validity of the CAPP-SR within a self-identified offender population. Our findings suggest strong support for the criterion-related validity of the CAPP-SR and the convergent validity of the CAPP-SR and the TriPM Meanness and Disinhibition domains. TriPM Boldness exhibited a clearly bifurcated pattern of association with all outcome criteria as compared with all domains in the CAPP model, and the Meanness and Disinhibition domains of the TriPM. Further, TriPM Boldness did not add incrementally or interact with Meanness or Disinhibition to predict the majority of outcomes. Findings are discussed with respect to the relevance of TriPM Boldness in the conceptualization of psychopathy, and the possible contributions of the CAPP-SR to the field of psychopathy research and assessment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An evaluation of the predictive validity of the SAVRY and YLS/CMI in justice-involved youth with fetal alcohol spectrum disorder.

Despite the high prevalence of fetal alcohol spectrum disorder (FASD) in youth criminal justice settings, there is currently no research supporting the use of violence risk assessment tools in this population. This study examined the predictive validity of the Structured Assessment of Violence Risk in Youth (SAVRY) and the Youth Level of Service/Case Management Inventory (YLS/CMI) in justice-involved youth with FASD. Participants were 100 justice-involved youth (ages 12-23; 81% male), including 50 diagnosed with FASD and 50 without FASD or prenatal alcohol exposure. The SAVRY and YLS/CMI were prospectively coded based on interview and file review, with recidivism (both any and violent specifically) coded 1-year post-baseline assessment. Results provide preliminary support for the validity of the SAVRY and YLS/CMI in predicting recidivism in justice-involved youth with FASD. Higher ratings across SAVRY and YLS/CMI domains were found in youth with FASD, underscoring a critical need for assessments and interventions to buffer recidivism risk and address clinical needs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Concurrent validity of the personality assessment screener in a large sample of offenders.

Mental health problems are disproportionately prevalent in forensic and correctional settings, and there have been numerous attempts to develop screening tools to evaluate individuals in such contexts. This study investigates the clinical utility of the Personality Assessment Screener (PAS; Morey, 1997), a brief self-report measure of risk for emotional and behavioral dysfunction, in a large mixed-gender offender sample (N = 1,658). The PAS is a 22-item measure derived from the Personality Assessment Inventory (PAI; Morey, 1991, 2007), a more comprehensive self-report instrument widely used to assess for psychological disturbances among forensic and correctional populations. We examined the ability of the PAS to concurrently predict clinically significant elevations on the PAI and several other indicators of symptomatology and dysfunction. Collectively, results suggest that PAS total and element (subscale) scores show considerable promise in screening inmates for serious problems with emotional and behavioral functioning, though interpretive ranges used to categorize PAS scores in clinical and community settings may require revision for criminal justice populations. We discuss the applied value of the PAS for detecting specific areas of dysfunction relevant to risk management (e.g., aggression, suicidality) and for concentrating resources on offenders with the most immediate and severe need for psychological services. (PsycINFO Database Record