(COMPLETE VERSION)

SS 4718
Forensic Criminology
(Semester B 2019/20)

Week 02: Psychopathology and Criminal Behavior

Heng Choon (Oliver) CHAN, Ph.D.

Department of Social and Behavioural Sciences
City University of Hong Kong

Tardiff (2007)

 Antisocial Personality Disorder (APD)

 The violence toward others & other aspects of antisocial behavior – are
not accompanied by – remorse or guilt

 Violence – is accompanied by little display of emotion – & seems cold-

blooded

 Issues of self-esteem and/or revenge – frequently underlie the violence

 The patient with APD – can resemble the narcissistic person – but the
antisocial patient – is more likely to be impulsive

 In APD – violence can be – premeditated or impulsive

 Borderline Personality Disorder (BPD)

 In addition to exhibiting frequent displays of anger – & recurrent

physical violence toward others – the patient manifest other behavioral
problems between the violent episodes

 There is a wide range of impulsive behaviors – e.g.,

 (a) Suicidal or self-mutilating behaviors

 (b) Excessive spending

 (c) Indiscreet sexual behavior

 (d) Drug abuse

 (e) Shoplifting

 (f) Reckless Driving

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  There is also a marked & persistent identity problem – manifested by
uncertainty about self-image, sexual orientation, career goals &
other values

 There are manipulative attempts – to obtain caring & attention from

others

 Violence – is characteristically in response to – feelings of

abandonment or rejection – by someone from whom the patient wants
love, caring or merely attention

 Violence – is accompanied by intense emotional displays & affective

instability

 Narcissistic Personality Disorder (NPD)

 The patient with narcissistic personality – feels he/she has the right to
control others – & to be the focus of their attention & admiration

 The patient

 Is exploitative in relations with others – & has little or no remorse

in doing so

 Does not experience chaotic disruption of interpersonal

relationships (unlike BPD) & may exhibits little flagrant criminal
activity (unlike APD)

 Violence – results from the patient’s frustration & anger – that the other
person has not given him/her – what the patient thinks he/she deserves

 Paranoid Personality Disorder (PPD)

 The patient with PPD – is suspicious believes that people – whether

they are in government or other organizations or are members of a
certain race or class – conspire against him/her

 A history of episodic violence – is not common – however – a history of

threats of violence against others – is common

 Most patients with PPD – will not be physically violent – but when
violence does occur – it is often lethal & may be targeted toward
multiple persons

 Intermittent Explosive Disorder (IED)

 A key characteristic of IED – is episodic, recurrent & discrete outbursts

of aggression & violence – that are grossly out of proportion – to any
precipitating psychosocial stressor

 These episodes of violence – stem from the failure to resist aggressive

urges
  The patient – feels remorse – & expresses it profusely following the
violent episode

 The patient with IED – usually appears “normal” – between the violent
episodes – in terms of employment, interpersonal relationships & other
aspects of life

 These episodes of violence – are not accounted for – by other mental

disorders – however – the use of alcohol – may play a part in the
outbursts of violence

 Schizophrenia

 Schizophrenia – can produce violence – in a number of ways:

 (a) Psychosis

 In violent schizophrenic patients with psychosis – there

can be delusional thinking – particularly in terms of
persecution

 Patients – may believe that people are trying to harm

them

 Patients with paranoid delusions in schizophrenia – may

react to these persecutory delusions – by retaliating
against the presumed source of this persecution

 Patients with other types of schizophrenia – may attempt

to kill others – because of some form of psychotic
identification with the victim

 Hallucinations associated with schizophrenia –

particularly command hallucinations – have been known
to result in violent behavior & homicide

 Hallucinations – in which people are cursing or insulting

the patient – may result in retaliation against the
supposed source of the insults

 (b) Unpredictable changes in affect

 May be associated with anger, aggression & violent

behavior

 Some schizophrenic patients are violent – because of

generalized disorganization of thought & a lack of impulse
control – accompanied by purposeless, excited
psychomotor activity

 (c) Akathisia secondary to antipsychotic medication

  Is a movement disorder – characterized by a feeling of
inner restlessness – & a compelling need to be in
constant motion & actions – e.g., rocking while standing
or sitting, lifting the feet as if marching on the spot &
crossing & uncrossing the legs while sitting.

 With the agitation & restlessness from akathisia –

patients with schizophrenia – may inadvertently come into
physical contact with other patients – which may lead to
fights

 (d) Brain damage secondary to heavy drug or alcohol use, head

trauma, or any other of the numerous neurological or systemic
diseases

 (e) Other psychiatric disorders – e.g., mental retardation or

personality pathology

 Delusional Disorder (DD)

 Persons with DD – may appear normal in terms of behavior &

appearance – when their delusions are not being discussed

 The persistent delusion held by patients with DD – may be of the

persecutory type – involving feelings of being conspired against,
cheated, spied on, poisoned or otherwise harmed

 Patients often become resentful & angry – & may become violent
against those they believe are harming them

 DD of the jealous type – involves the persistent belief that – the

patient’s spouse or lover is unfaithful

 May attempt to restrict the activities of & follow the spouse or

lover

 May resort to physical attack – on the spouse or lover or

someone who is identified as the “other partner” in this “infidelity”

 Mood Disorders

 Mania

 Is defined – as a period of abnormally & persistently elevated,

expansive or irritable mood

 The manic patient – often seeks pleasurable behaviors – that

may have painful consequences

 Mania – can be associated with violence – that results from

extreme psychomotor agitation or irritable mood – associated
with angry outbursts
  Most violence – is not premeditated & is purposeless

 A manic patient – rarely may become violent – as a result of

delusional thinking – in which the patient believes he/she is
being persecuted – because of some special attribute

 It is usually the case with the manic patient – that all impulses
are put into action

 Depression

 This type of patient – is delusional with extreme hopelessness –

feelings that life is not worth living – or delusional feelings of
profound guilt – may result in violence – usually involving
murder – followed by suicide

 Principles in the Assessment of the Risk of Violence

 A well-trained psychiatrist or other mental health professional – should

be able to predict a patient’s short-term violence potential – with
assessment techniques similar to those used in the short-term
prediction of suicide potential

 The evaluator – should not only focuses on the clinical aspects of the
evaluation – i.e., psychopathology – but also take into consideration of
– demographic, historical & environmental factors – that may be related
to – an increased risk of violence

 Even if the patient does not express thoughts of violence – one should
routinely ask as part of every evaluation the subtle question – “Have
you ever lost your temper?”

 if the answer is “yes” – then the evaluator – should proceed with

the evaluation – in terms of how, when & so on – about violence

 When making a decision about violence potential – one should

interview – in addition to the patient – family members, police & other
persons with information about the patient – & violent incidents to
guard against the patient’s minimizing dangerousness

 One should contact or attempt to contact current therapists & past

therapists – & review old charts for previous episodes of violence,
arrest records & other records of judicial proceedings – if such records
are available

 10 Factors in the Assessment of the Risk of Violence

 (1) Appearance of the patient

 The appearance of the patient – may prompt further scrutiny of

the potential for violence
  E.g., loud, agitated, angry-appearing, impatient, refuses
to comply with usual intake procedures, dysarthria
(unclear articulation of speech), unsteady gait (limbs
movement), dilated pupils, tremors (involuntary muscle
contraction & relaxation), & other signs of acute drug or
alcohol intoxication

 (2) Presence of violent ideation & degree of planning/formulation

 Evaluation of violent ideation – includes assessment of how well

planned – is the ideation or threat – that is – the degree of
formulation

 Vague threats of killing someone – e.g., “I’m going to get

even with her or she’ll be sorry to see me” – are not as
serious as – “I’m going to kill my wife with a gun because
she had an affair”

 (3) Intent

 If a patient has thoughts of harming someone – it is important to

explore – whether he/she really intends to do something –
versus just having thoughts of violence

 Merely thought of violence – may not be sufficient for the

clinician to take action – as in warning someone,
changing medication or hospitalizing the patient

 (4) Available means

 If the patient is thinking about getting a gun or has a gun – the

clinician should take a threat of violence – seriously

 The clinician – always should ask a potentially violent

patient – if he/she has a gun or has ready access to
a gun

 Available means – also applies to the physical availability of the

potential victim

 It refers to the daily vulnerability of the potential victim –

as in living in a secluded place or in a city building
without a doorman

 Geography – is another aspect of availability – as to whether the

potential victim is living near or afar from the patient

 (5) Past history of violence of impulsive behavior

 Past violence – increases the risk of future violence – by a

patient
  Episodes of past violence – should be “dissected” in a detailed,
concrete manner – by the clinician

 This includes details – as to the time & place of past

violence, who was present, who said what to whom, what
the patient saw, what the patient remembers, what family
members, friends, or staff remember about the violent
episode, why the patient was violent & what could have
been done to avoid the violence

 Often there is a pattern of escalation of violence

 The past history of violence – should be treated as any other

medical symptom

 That includes – the date of onset, frequency, place &

severity of violence

 (6) Alcohol and drug use

 Intoxication with alcohol & drugs – increases the risk of violence

– while withdrawal from alcohol – also can increase the risk of
violence

 Alcohol intoxication – increases the risk of violence – by

decreasing a person’s inhibitions

 Alcohol also impairs cognition – including intellectual

ability

 Alcohol withdrawal – can produce delirium with disorganized

behavior – & psychosis with paranoid delusional thinking &
hallucinations

 Intoxication with drugs (e.g., cocaine, amphetamines,

hallucinogens, & inhalants) - increases risk of violence – through
grossly impaired judgment & paranoid ideation

 (7) Psychosis

 The presence of psychosis – should make the clinician take

threats of violence very seriously – & make the formal
assessment of violence potential essential – even if threats or
ideas of violence are not apparent

 Psychosis – is not a diagnosis – but a symptom that can be

found in a number of disorders – e.g., schizophrenia, delusional
disorder, neurological & medical disorders, substance abuse
disorders & mood disorders with mania or depression

 When psychosis is present – regardless of the disorder – it

increases the risk of violence
  The paranoid patient – regardless of diagnosis – poses a
problem in that paranoid delusions may not be obvious –
sometimes because the patient attempts to hide them

 Therefore – the evaluator must listen for subtle clues – &

should follow up regarding the assessment of violence
toward others

 Psychotic patients who have auditory hallucinations – regardless

of diagnosis – pose an increased risk of violence – particularly
with command auditory hallucinations

 (8) Personality disorders

 Violence by persons with Antisocial PD – is often vicious &

persistent – without a sense of remorse

 Persons with Borderline PD – can be violent & make suicidal

gestures – when rejected or when feeling rejected by others –
as a result of a broad instability of interpersonal relationships &
impulsivity

 Persons with Narcissistic PD – can be violent occasionally when

angry – at not given what they deserves

 Persons with Paranoid PD – rarely attack people whom they

think are persecuting them – but when violence occurs – it can
be severe – as in mass murder

 Tardiff (2007)

 Persons with Intermittent Explosive Disorder – frequently is

violent during circumscribed episodes with little apparent
precipitating cause – or is out of proportion to any identifiable
cause

 (9) Noncompliance to treatment

 Noncompliance – involves a history of irregular attendance at

scheduled outpatient appointments or other appointments for
treatment or the refusal to take certain medications

 (10) Demographic characteristics

 Increased risk of violence – has been found in young, in males &

in persons coming from environments of poverty, disruption of
families & decreased social control

Ogloff (2006)

 Psychopathy – like the product of complex interactions – between biological

predispositions & social forces
 Psychopathy ≠ Antisocial PD/Dissocial PD

 Antisocial PD (DSM-IV-TR) & Dissocial PD (ICD-10)

 Dissocial PD – focuses more on traditional psychopathy feature – i.e.,

deficits of affect or expressed emotions

 Antisocial PD – emphasizes more on the behavioral difficulties –

related to criminality

 Antisocial PD – 50-80% in prisons – while psychopathy – 15% of prisoners –

based on North American samples

 Hare’s Psychopathy Checklist-Revised (PCL-R)

 Facet 1 – Interpersonal (Factor 1: Interpersonal/Affective)

 (1) Glibness/superficial of charm

 Sweet-talker & deceitful

 (2) Grandiose sense of self-worth

 Narcissistic & think highly of himself

 (3) Pathological lying

 Extremely good liar – that doesn’t feel bad for

continuously lying for his own benefits

 (4) Conning and/or manipulative

 Very sneaky & like to take advantage of others

 Facet 2 – Affective (Factor 1: Interpersonal/Affective)

 (5) Lack of remorse or guilt

 Extremely less likely to fee bad after commit something

bad to others

 (6) Shallow affect

 Emotionless or emotions are very superficial

 (7) Callous and/or lack of empathy

 Insensitive & unsympathetic

 (8) Failure to accept responsibility for own actions

 Tend not to take responsibility for his own actions

 Facet 3 – Lifestyle (Factor 2: Social Deviance)

 (9) Need for stimulation and/or proneness to boredom

 Constantly need for new stimulation & a sensation-seeker

 (10) Parasitic lifestyle

 Tend to be dependent on others

 (11) Lack of realistic & long-term goals

 No future realistic plans

 (12) Impulsivity

 Tend to act without further thought

 (13) Irresponsibility

 Doesn’t like to take any responsibility

 Facet 4 – Antisocial (Factor 2: Social Deviance)

 (14) Poor behavioral controls

 Unable to control his behavior & easy to lose temper

 (15) Early behavioral problems

 Behavioral issues – during childhood & adolescence

 (16) Juvenile delinquency

 Violation of the laws or social norms – during childhood &

adolescence

 (17) Revocation of conditional release

 Early termination of probation or parole

 (18) Criminal versatility

 Commit a wide variety of crimes

 Items not loaded on either factor

 (19) Promiscuous sexual behavior

 Too many casual sexual partners

 (20) Many short-term marital relationships

  Many short marriages or cohabitations

 Comparisons between Antisocial PD & Dissocial PD

 Antisocial PD criteria – are much broader than PCL-R criteria

 Antisocial PD – contains more behaviorally-based (social deviance)

symptoms – while Dissocial PD – contains more affective symptoms

Shaw & Porter (2012)

 Is Psychopathy Stable Over Time?

 Most crime perpetrated by men – in their late adolescence & early

adulthood – after which most offenders commit fewer crimes or may
even stop offending

 However – given their callous personality features – it might be

expected that – offenders with psychopathic traits – would continue to
commit crimes – throughout adulthood

 Hare et al. (1988) – offenders in the psychopathic range – committed

more crimes – than their low-scoring counterparts – between the ages
of 16 & 40 – after which the conviction rate of high-scorers – decreased
substantially relative to low-scorers

 Hare et al. (2002) – high-scorers engaged in more violent & nonviolent

criminal behavior – with the largest group differences – found at
younger ages

 Harpur & Hare (1994) – psychopathic traits – were less prevalent in

older cohorts

 The antisocial & impulsive lifestyle features – decreased with

age

 The affective/interpersonal features of psychopathy (e.g., lack of

remorse) – remained constant across the life span

 Hare (1996) – individuals with psychopathic features – likely do not

change fundamentally with age – but may engage in different types of
antisocial behaviors – as they get older

 Lynam et al. (2007) & Forsman et al. (2010) – psychopathy scores in

early & mid-adolescence – were predictive of adult psychopathy

 Lynam et al. (2009) – psychopathy could be reliably assessed in

children – was stable across various intervals – & predicted
delinquency over time

 Criminal Trajectories
  Psychopathic offenders – are among the most violent, versatile, &
prolific of offenders – committing more offenses & more types of
offense – than nonpsychopathic offenders

 Psychopaths – are significantly more likely than nonpsychopathic

offenders – to engage in other high-risk, thrill-seeking behaviors – e.g.,
extreme drug use, & promiscuous sexual activity

 Most psychopaths – have a varied history – & have a more diverse set
of risks & needs – than normal offenders

 Psychopathy in Children & Youth

 Even children – as young as 3 years of age – can exhibit classic

characteristics of psychopathy – which are predictive of adult
psychopathy

 Callous-unemotional (CU) traits – e.g., lack of guilt, lack of

empathy, & callous use of others – are relatively stable across
childhood & adolescence

 Lawing et al. (2010) – adolescent offenders – high on CU traits –

had a greater number of sexual offense victims, used more
violence with their victims, & engaged in more sexual offense
planning – than those low on these traits

 Instruments – e.g., Childhood Psychopathy Scale (CPS) & the

Psychopathy Checklist-Youth Version (PCL-YV)

 Recidivism Risk

 Young individuals – who have received a psychopathic

diagnosis – are at an elevated risk for offending – compared to
their nonpsychopathic peers

 Psychopathy – is the single most reliable predictor of recidivism

 Corrado et al. (2004) – individuals who scored high on the PCL-

YV – reoffended earlier than did those receiving lower scores –
for both violent & general offenses

 Desistance

 Base rates of recidivism – are high for psychopathic youth – with

frequently reported rates – around 64% for nonviolent offending
& 41% for violent offending

 O’Neill et al. (2003) – psychopathic youth – demonstrated

significantly less improvement over the course of treatment –
than their peers
  Caldwell et al. (2006) – psychopathic youth – who participated in
the intensive treatment – were half as likely to reoffend violently
after 2 years – as those receiving normal treatment

 Show promising advancements – in the treatment of

psychopathic youth

 Females

 Vaughn et al. (2008) – similar to their male counterparts –

adolescent psychopathy in females – were predictive of violent
behavior & theft – but not related to drug abuse

 Specific traits – e.g., carefree nonplanfulness &

narcissisim – played a more pivotal role – in psychopathy
for females

 The interpersonal and affective facets of psychopathy –

are more important – regarding the outcomes of
psychopathic adolescent females than males

 Adolescent psychopathic females – are at an elevated risk for

antisocial behavior & recidivism – compared to their female
peers – but are at a lower risk – than adolescent psychopathic
males

 Violent Offending

 Psychopaths – committed about twice as many violent crimes – as

nonpsychopathic offenders

 Psychopaths – are significantly more likely to engage in the assault &

physical abuse of others – along with increased rates of verbal &
psychological abuse

 Many psychopaths – have been shown to utilize a mixture of both –

instrumental & reactive violence

 Instrumental violence – refers to violence that is employed – as

a means to attain secondary goal

 Reactive violence – involves a response to provocation or a

perceived threat

 Many psychopaths – plan aggressive actions – to attain positive

rewards – & are more likely than other offenders – to perpetrate
serious instrumental violence – e.g., armed robberies

 The emotion recognition & emotional experience deficits – found

among psychopaths – may lead to deficits in their ability – to
empathize with others – resulting in an increased likelihood for
perpetrating instrumental violence
  Psychopaths – sometimes show a violent temper & react explosively to
seemingly minor provocation

 Psychopaths – who offend sexually – are a particularly dangerous type

of predator – in terms of both the severe damage they inflict on their
victims – & the diversity of victims

 Psychopaths – are more likely to abuse substances – which

exacerbate their violent tendencies

 Recidivism Risk

 Psychopathic individuals – who are prone to violence – have a

very high probability of recidivism – particularly violent recidivism

 Pedersen et al., 2010 – 78% of individuals scoring high on the

PCL-Screening Version were reconvicted – & 53% were
reconvicted for a violent crime

 Desistance

 Serin & Amos (1995) – about 1 in 4 psychopathic offenders –

are not reconvicted for a violent offense – even after an 8-year
follow-up

 Psychopaths – who desisted from violent reoffending – had

significantly lower PCL-R Factor 2 scores but higher Factor 1
scores, were older at release, & had better community support –
than violently recidivating psychopaths

 Sex Offending

 Sexual psychopath – refers criminals who sexually deviant behavior is

directed at diverse victim profiles – & who are primarily motivated by
thrill seeking – rather than paraphilias

 An overrepresentation is found among sexual homicide offenders –

with 58-96% meeting the criteria for psychopathy

 Elevated rates of sexual pleasure – from violent offenses – are

found in psychopathic offenders – a characteristic also known as
sadism – which could interfere with treatment effectiveness &
increase recidivism risk

 Desistance

 Extensive meta-analyses support the notion that – sex offender

treatment – reduces recidivism in normal offenders

 The limited research on sexual psychopaths – has provided

much support – for the effectiveness of cognitive-
behavioral therapy (CBT)
  CBT has shown to decrease recidivism rates for normal
sex offenders from 20-43% – to 6.5-8% for sexual
psychopaths

 Sex offender treatment – does not appear to reduce serious

recidivism for psychopaths – to the same degree that it does for
nonpsychopaths
References
Ogloff, J. R. P. (2006). Psychopathy/antisocial personality disorder conundrum.
Australian and New Zealand Journal of Psychiatry, 40, 519-528.
Shaw, J., & Porter, S. (2012). Forever a psychopath? Psychopathy and the criminal
career trajectory. In H. Häkkänen-Nyholm & J. Nyholm (Eds.), Psychopathy
and law: A practitioner’s guide (pp. 201-221). San Francisco, CA: John Wiley
and Sons, Inc.
Tardiff, K. (2007). Violence: Psychopathology, risk assessment and lawsuits. In A.
Felthous & H. Saß (Eds.), The international handbook of psychopathic
disorders and the law: Diagnosis and treatment (vol. 1, pp. 117-133). San
Francisco, CA: John Wiley and Sons, Inc.