Psychopathic traits and deviant sexual interests : the moderating role of gender

The present study examined associations between psychopathic traits and deviant sexual interests across gender in a large community sample (N = 429, 24% men). Correlation analyses supported the positive link between psychopathic traits and deviant sexual interests. Regression analyses indicated that the unique variance in the antisocial facet of psychopathy predicted all six deviant sexual interests. The interpersonal facet predicted voyeuristic and exhibitionistic interests, whereas the affective facet predicted pedophilic interests. Moderation analyses revealed that gender moderated most of the relations between the antisocial facet of psychopathy and deviant sexual interests, such that those positive associations were stronger among women. On the contrary, the associations between the interpersonal facet and voyeuristic interests, as well as between the lifestyle facet and sadistic interests, were stronger among men. Findings appear to suggest that deviant sexual interests represent a domain in which the manifestation of psychopathic traits may differ across gender. These findings emphasize the relevance of psychopathic traits for the understanding and risk assessment of sexual deviance, while suggesting the need for gender-sensitive considerations

Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes

Background: Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical itemlevel per patient class.Method: A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure.Results: Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge.Discussion: Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention

The moderating roles of resilience and coping strategy on well-being of victimized forensic workers

Previous research on workplace victimization has often disregarded forensic psychiatric populations and not yet been extended to the coronavirus pandemic. The present study expected the isolation of the government-issued lockdown to increase aggressive behavior in forensic patients, ultimately decreasing the general well-being of victimized forensic workers. Possible buffering protective factors (resilience and active coping) and enhancing risk factors (avoidant coping and passive coping) were investigated with the intention of optimizing the general well-being of at-risk forensic workers. The valid sample (N = 311) consisted of Dutch and Belgian forensic workers (74.6% females) with at least 9 hours of weekly patient contact, and with a mean age of 37.99 (SD = 12.20). Participants reported the number of violent incidents in the past 2 months, as well as completed a questionnaire battery including measures of well-being, resilience, and coping strategies. A significant increase of victimization during the lockdown compared to after it was lifted was found, however, the study did not find evidence to support that this negatively influenced the worker’s general well-being. Active coping was found to be a significant moderator and protective factor for the general well-being of victimized forensic workers. In contrast, resilience, avoidant and passive coping were not significant moderators in this association. The present study has valuable clinical implications that could lead to preparatory and preventative measures for forensic workers at risk of being victimized. Future research may investigate constructs such as life satisfaction and post-traumatic growth, as well as be broadened into prison populations

How to evaluate a tailor-made social work intervention?:Some practice-based solutions with single-vase designs

Purpose: With the increased attention to the principles of evidence-based practice (EBP), social workers are challenged to adapt their daily interventions accordingly when treating clients. They usually work with individual clients, all with their own specificities. Single-Case Experimental Designs (SCEDs) can be used to inform a social worker about the effectiveness of an intervention at the individual client level. In everyday social work practice, however, it is difficult to meet methodological requirements of SCEDs to find causal explanations. A concern is that repeated measurements prior to an intervention are required in most situations. This study aims to provide researchers with alternatives to repeated measurement when using the logic of SCED to apply EBP in their everyday practice. Methods: In this study, we reviewed published single-case designs between January 1 and December 31, 2019, on types of SCEDs in the social domain, and how is dealt with baseline conditions. Results: SCEDs and quasi-experimental alternatives are hardly published in situations when baseline data are not available. Four underused quasi-experimental strategies that can be employed when repeated measurement during baseline is not possible are as follows: retrospective baselines, theoretical inference, multiraters, and triangulation with qualitative data. Discussion and Conclusion: The suggestions to work with single-case designs with quasi-experimental elements are meant to enable social workers to evaluate their interventions in a way that enhances mere narrative evaluations of the experiences of an intervention.</p

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

Introduction: Children’s development into healthy well-functioning adults can be negatively affected by adversity. Adverse childhood experiences (ACEs) have been shown to lead to a variety of poor life outcomes, ranging from mental health problems (e.g., anxiety or suicidality) through problematic health behaviors to serious physical diseases and even early death. ACEs can also make people more prone to aggressive behavior, criminality, and recidivism. In this study, we investigated the association between ACEs, specifically childhood maltreatment (CM), and forensically relevant factors; aggression, criminal risk factors, and treatment trajectories, as little is known about these associations in forensic psychiatric patients.Methods: The study includes data derived from two studies in The Netherlands, of which the first study enrolled 128 patients residing in a Forensic Psychiatric Center (FPC) and the second study included 468 patients who were released unconditionally from FPCs between 2009 and 2013. We expected that more CM would be correlated with higher levels of aggression, higher clinical risk factor scores, and less decrease in clinical risk factor scores over time. To investigate this, we applied correlational analyses and linear growth curve modeling on risk assessment scores and self-report as well as staff report questionnaires on CM and aggression.Results: Consistent with our first hypothesis, patients with higher CM scores also had higher aggression and risk assessment scores. The effect sizes were small to medium (0.12 to 0.34). Unexpectedly, CM did not influence the course of these treatment trajectories, however, we found that patients with histories of CM had a significantly longer length of stay in a forensic facility than patients without CM (respectively, 10.8 years and 9.3 years on average).Discussion: This study underlines the importance of carefully examining the history of ACEs and CM in forensic psychiatric patients and considering this in forensic risk assessment and risk guided treatment. More research is needed to draw conclusions about whether and how histories of ACEs should be considered and targeted during treatment trajectories

Mapping aggressive behavior of forensic psychiatric inpatients with self-report and structured staff-monitoring

Structured assessment of aggressive behavior in forensic psychiatry is needed. This study investigated staffobserved and self-reported measures to map prevalence and characteristics of aggressive behavior in forensic inpatients and aimed to identify early signs of aggressive outbursts. In this longitudinal study, 120 forensic psychiatric inpatients with a history of aggression were included. Staff monitored aggressive behavior for 30 weeks using the Social Dysfunction and Aggression Scale (SDAS). Patients completed baseline self-report measures on aggression, anger, and impulsivity. Staff monitoring showed that most inpatients displayed moderate (86%) or severe (65%) aggressive behavior at least once, and 37.5% showed physical aggression. Inpatients with a least one physical aggression incident differed from others in self-reported anger, (reactive) aggression, nonplanning impulsivity, and sociodemographic and clinical characteristics (e.g., higher prevalence of cluster B personality disorders, and lower intelligence). Two-thirds of the physical aggression incidents were preceded by observations of increased non-physical aggression (SDAS). In forensic psychiatric inpatients with a history of aggression, more than a third of the patients demonstrated at least one occasion of physical aggression during 30 weeks of observation

Violent recidivism and adverse childhood experiences in forensic psychiatric patients with impaired intellectual functioning

Accurate risk assessment and insight into which factors are associated with recidivism are essential for forensic correctional practice. Therefore, we investigated whether the Historical, Clinical, and Future–Revised (HKT-R [Historisch Klinisch Toekomst–Revised]) risk assessment instrument could predict violent recidivism over a 2-year follow-up period in forensic psychiatric patients with intelligence quotient (IQ) < 80. We refer to these patients as intellectually disabled (ID) and patients with IQ ≥ 80 as non-ID. Additionally, the associations of the 14 clinical HKT-R factors with ID versus non-ID group membership were investigated, as well as a possible moderating role of adverse childhood experiences (ACE) in these associations. The final sample encompassed 748 forensic psychiatric patients (15.9% were patients with ID) who were unconditionally released from highly secured Dutch forensic psychiatric institutions between 2004 and 2014. The results showed that the HKT-R total score (AUC = 0.705, 95% confidence interval [CI] [0.527, 0.882]) and the clinical domain (AUC = 0.733, 95% CI [0.579, 0.886]) had a large effect size for predictive validity for 2-year violent recidivism, while the future domain (AUC = 0.653, 95% CI [0.524, 0.781]) and the historical domain (AUC = 0.585, 95% CI [0.397, 0.772]) had a medium effect size for predictive validity for 2-year violent recidivism in ID patients. It was also found that lower levels of self-reliance and social skills were associated with ID, indicating that treatment should prioritize these skills. However, ACE was not associated with ID, nor did it moderate the associations of the clinical HKT-R factors with ID. This study contributes to the understanding of both risk assessment and treatment of forensic psychiatric patients with ID

Dark ladies:Maladaptive personality domains, alexithymia, and the dark triad in women

Objective:  The Dark Triad (DT) traits (Machiavellianism, narcissism, and psychopathy) have been linked with both alexithymia and maladaptive personality domains (negative effectivity, detachment, disinhibition, antagonism, psychoticism) comprised in the alternative model of personality disorder (AMPD) of the DSM 5. However, the differential associations of DT with the AMPD personality domains need to be further examined in research with homogeneous samples, in order to improve our understanding of malevolent personality traits. Method:  We examined the associations between maladaptive personality domains, DT traits and alexithymia factors in 420 women aged between 18 and 66 years old. Results:  Despite uniform bivariate associations, distinct profiles emerged from multiple regression analyses, in line with conceptual expectations. Antagonism was the only common positive predictor of all DT traits. Negative effectivity was positively associated with narcissism, but negatively with psychopathy and Machiavellianism. Psychopathy was related to high detachment and disinhibition. Alexithymia exerted a mediating effect in the association between AMPD domains and both psychopathy (positively) and Machiavellianism (negatively). Conclusions:  Findings showed differential personality profiles associated with the DT traits in women based on maladaptive traits that characterize personality pathology, with specific emotional mechanisms that may link maladaptive personality domains and the three DT components among women

Factor structure and construct validity of the Levenson Self-Report Psychopathy scale (LSRP):A replication and extension in Dutch nonclinical participants

The Levenson Self-Report Psychopathy (LSRP) scale is widely used to assess psychopathic traits in noninstitutionalized samples. Recent studies suggest that a three-factor structure measuring Egocentricity, Callousness, and Antisocial factors outperformed the original two-factor structure of the LSRP. This study replicated and extended these findings by examining the factor structure and construct validity of a Dutch version of the LSRP in a community sample (N = 856, subsamples ranging between 140 and 572 participants). Confirmatory factor analysis results corroborated the superiority of the three-factor model of the LSRP, using 19 of the 26 LSRP items. Limitations included the need to specify correlated residuals for some indicators, although these were largely in line with prior studies. Across three subsamples, we found evidence for construct validity of the LSRP subscales. Egocentricity and Antisocial showed a pattern of differential associations with external correlates in accordance with theoretical expectations. Callousness shared some correlates with Egocentricity, others with Antisocial, and uniquely predicted low morality and high physical aggression. Few exceptions to the hypothesized associations were observed, mostly concerning Callousness. Overall, the LSRP three-factor model received further support in a Dutch sample, and is thus recommended in future research, possibly adding items to improve the performance of the Callousness factor

Longitudinal network structure and changes of clinical risk and protective factors in a nationwide sample of forensic psychiatric patients

In this study, we investigated network configurations of 14 Clinical risk and protective factors in a sample of 317 male forensic psychiatric patients across two time points: at the time of admission to the forensic psychiatric centers (T1) and at the time of unconditional release (T2). In terms of network structure, the strongest risk edge was between "hostility-violation of terms" at T1, and between "hostility-impulsivity" at T2. "Problem insight-crime responsibility" was the strongest protective edge, and "impulsivity-coping skills" was the strongest between-cluster edge, at both time points, respectively. In terms of strength centrality, "cooperation with treatment" had the highest strength centrality at both measurement occasions. This study expands the risk assessment field toward a better understanding of dynamic relationships between individual clinical risk and protective factors and points to the highly central risk and protective factors, which would be the best for future treatment targets