Skip to main content
SpringerLink
Log in

Predicting Short-Term Institutional Aggression in Forensic Patients: A Multi-Trait Method for Understanding Subtypes of Aggression

  • Original Article
  • Published:
Law and Human Behavior

Abstract

Accurately predicting inpatient aggression is an important endeavor. The current study investigated inpatient aggression over a six-month time period in a sample of 152 male forensic patients. We assessed constructs of psychopathy, anger, and active symptoms of mental illness and tested their ability to predict reactive and instrumental aggression. Across all levels of analyses, anger and active symptoms of mental illness predicted reactive aggression. Traits of psychopathy, which demonstrated no relationship to reactive aggression, were a robust predictor of instrumental aggression. This study (a) reestablishes psychopathy as a clinically useful construct in predicting inpatient instrumental aggression, (b) provides some validation for the reactive/instrumental aggression paradigm in forensic inpatients, and (c) makes recommendations for integrating risk assessment results into treatment interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. In the state the study occurred in, individuals found not guilty by reason of insanity (NGRI) have the legal right to petition for conditional release every 6 months. As such, even a patient who could remain in the hospital for the rest of his life could be conditionally released 6 months after being found NGRI.

  2. Interpretation of AUC curves are as follows: .90–1 excellent; .80–.90 good; .70–.80 fair, .60–.70 poor; and .60–.50 are considered fail and indicate chance performance.

  3. For the sake of comparison we predicted verbal aggression. The criterion variables that were significant predictors of verbal aggression included WARS Part A (AUC = .71) and Part B (AUC = .77), BPRS Resistance (AUC = .68), BPRS Activation (AUC = .66), and PCL:SV Lifestyle (AUC = .65) and Antisocial tendencies (AUC = .67).

References

  • Buffington-Vollum, J., Edens, J. F., Johnson, D. W., & Johnson, J. K. (2002). Psychopathy as a predictor of institutional misbehavior among sex offenders: A prospective replication. Criminal Justice and Behavior, 29, 497–511. doi:10.1177/009385402236730.

    Article  Google Scholar 

  • Carmel, H., & Hunter, M. (1993). Staff injuries from patient attack: Five years’ data. The Bulletin of the American Academy of Psychiatry and the Law, 21, 485–493.

    PubMed  Google Scholar 

  • Cornell, D. G., Warren, J., Hawk, G., Stafford, E., Oram, G., & Pine, D. (1996). Psychopathy in reactive and instrumental violent offenders. Journal of Consulting and Clinical Psychology, 64, 783–790. doi:10.1037/0022-006X.64.4.783.

    Article  PubMed  Google Scholar 

  • Daffern, M., & Howells, K. (2007a). Aggressive behaviour in high-risk personality disordered inpatients during prison and following admission to hospital. Psychiatry, Psychology and Law, 14, 26–34. doi:10.1375/pplt.14.1.26.

    Article  Google Scholar 

  • Daffern, M., & Howells, K. (2007b). Antecedents for aggression and the function analytic approach to the assessment of aggression and violence in personality disordered patients within secure settings. Personality and Mental Health, 1, 126–137. doi:10.1002/pmh.16.

    Article  Google Scholar 

  • Daffern, M., Howells, K., & Ogloff, J. (2007). Interaction between individual characteristic and the function of aggression in forensic psychiatric inpatients. Psychiatry, Psychology and Law, 14, 17–25. doi:10.1375/pplt.14.1.17.

    Article  Google Scholar 

  • Douglas, K. S., & Skeem, J. L. (2005). Violence risk assessment: Getting specific about being dynamic. Psychology, Public Policy, and Law, 11, 347–383. doi:10.1037/1076-8971.11.3.347.

    Article  Google Scholar 

  • Doyle, M., & Dolan, M. (2006). Evaluating the validity of anger regulation problems, interpersonal style, and disturbed mental state for predicting inpatient violence. Behavioral Sciences & the Law, 24, 783–798. doi:10.1002/bsl.739.

    Article  Google Scholar 

  • Duffy, D., Doyle, M., & Ryan, T. (2004). Risk assessment and management in acute mental health care. In M. Harrison, D. Howard & D. Mitchell (Eds.), Acute mental health nursing: From acute concerns to the capable practitioner (pp. 144–161). Thousand Oaks, CA: Sage Publications, Inc.

    Google Scholar 

  • Foley, S. R., Kelly, B. D., Clarke, M., McTigue, O., Gervin, M., Kamali, M., et al. (2005). Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis. Schizophrenia Research, 72, 161–168. doi:10.1016/j.schres.2004.03.010.

    Article  PubMed  Google Scholar 

  • Fontaine, R. G. (2007). Disentangling the psychology and law of instrumental and reactive subtypes of aggression. Psychology, Public Policy, and Law, 13, 143–165. doi:10.1037/1076-8971.13.2.143.

    Article  Google Scholar 

  • Gadon, L., Johnstone, L., & Cooke, D. (2006). Situational variables and institutional violence: A systematic review of the literature. Clinical Psychology Review, 26, 515–534. doi:10.1016/j.cpr.2006.02.002.

    Article  PubMed  Google Scholar 

  • Grevatt, M., Thomas-Peter, B., & Hughes, G. (2004). Violence, mental disorder, and risk assessment: Can structured clinical assessments predict the short-term risk of inpatient violence? Journal of Forensic Psychiatry & Psychology, 15, 278–292. doi:10.1080/1478994032000199095.

    Article  Google Scholar 

  • Guy, L. S., Edens, J. F., Anthony, C., & Douglas, K. S. (2005). Does psychopathy predict institutional misconduct among adults? A meta-analytic investigation. Journal of Consulting and Clinical Psychology, 73, 1056–1064. doi:10.1037/0022-006X.73.6.1056.

    Article  PubMed  Google Scholar 

  • Haggard-Grann, U. (2007). Assessing violence risk: A review and clinical recommendations. Journal of Counseling and Development, 85, 294–301.

    Google Scholar 

  • Haim, R., Rabinowitz, J., Lereya, J., & Fenning, A. (2002). Predictions made by psychiatrists and psychiatric nurses of violence by patients. Psychiatric Services (Washington, D.C.), 53, 622–624. doi:10.1176/appi.ps.53.5.622.

    Google Scholar 

  • Hare, R. D. (1996). Psychopathy: A clinical construct whose time has come. Criminal Justice and Behavior, 23, 25–54. doi:10.1177/0093854896023001004.

    Article  Google Scholar 

  • Hare, R. D. (2003). Technical manual for the Revised Psychopathy Checklist (2nd ed.). North Tonawanda, NY: Multi-Health Systems.

    Google Scholar 

  • Hare, R. D., & McPherson, L. M. (1984). Violent and aggressive behavior in criminal psychopaths. International Journal of Law and Psychiatry, 7, 35–50. doi:10.1016/0160-2527(84)90005-0.

    Article  PubMed  Google Scholar 

  • Hart, S. D., Cox, D., & Hare, R. D. (1996). Manual for the psychopathy checklist: Screening Version. Toronto, ON: Multi-Health Systems.

  • Hart, S. D., Cox, D. N., & Hare, R. D. (1995). Manual for the screening version of the psychopathy checklist revised (PCL:SV). Toronto, ON: Multi-Health Systems.

    Google Scholar 

  • Harrison, D. (2002). Structure and timing in limited range dependent variables: Regression models for predicting if and when. In Measuring and analyzing behavior in organizations: Advances in measurement and data analysis (pp. 446–497). San Francisco: Jossey-Bass.

  • Hildebrand, M., de Ruiter, C., & Nijman, H. (2004). PCL-R psychopathy predicts disruptive behavior among offenders in a Dutch forensic psychiatric hospital. Journal of Interpersonal Violence, 19, 13–29. doi:10.1177/0886260503259047.

    Article  PubMed  Google Scholar 

  • Hill, C. D., Neumann, C. S., & Rogers, R. (2004). Confirmatory factor analysis of the Psychopathy Checklist: Screening Version in offenders with Axis I disorders. Psychological Assessment, 16, 90–95. doi:10.1037/1040-3590.16.1.90.

    Article  PubMed  Google Scholar 

  • Hill, C. D., Rogers, R., & Bickford, M. E. (1996). Predicting aggressive and socially disruptive behavior in a maximum security forensic psychiatric hospital. Journal of Forensic Sciences, 41, 56–59.

    PubMed  Google Scholar 

  • Hunter, M., & Carmel, H. (1992). The cost of staff injuries from inpatient violence. Hospital & Community Psychiatry, 43, 586–588.

    Google Scholar 

  • Jackson, R. L., Neumann, C. S., & Vitacco, M. J. (2007). Impulsivity, anger, and, psychopathy: The moderating effect of ethnicity. Journal of Personality Disorders, 21, 289–304. doi:10.1521/pedi.2007.21.3.289.

    Article  PubMed  Google Scholar 

  • Kockler, T. R., Stanford, M. S., Nelson, C. E., Meloy, J. R., & Stanford, K. (2006). Characterizing aggressive behavior in a forensic population. The American Journal of Orthopsychiatry, 76, 80–85. doi:10.1037/0002-9432.76.1.80.

    Google Scholar 

  • Leistico, A. R., Salekin, R. T., DeCoster, J., & Rogers, R. (2008). A large-scale meta-analysis relating the Hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32, 28–45. doi:10.1007/s10979-007-9096-6.

    Article  PubMed  Google Scholar 

  • Logan, C. H., & Gaes, G. (1993). Meta-analysis and the rehabilitation of punishment. Justice Quarterly, 10, 245–263. doi:10.1080/07418829300091811.

    Article  Google Scholar 

  • Martin, T., & Daffern, M. (2006). Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting. Journal of Psychiatric and Mental Health Nursing, 13, 90–99. doi:10.1111/j.1365-2850.2006.00920.x.

    Article  PubMed  Google Scholar 

  • Martin, S. L., & Terris, W. (1991). Predicting infrequent behavior: Misconceptions surrounding misclassification errors. Forensic Reports, 4, 141–148.

    Google Scholar 

  • McDermott, B. E., Edens, J. F., Quanbeck, C. D., Busse, D., & Scott, C. L. (2008). Examining the role of static and dynamic risk factors in the prediction of inpatient violence: Variable- and person-focused analyses. Law and Human Behavior, 32, 325–338.

    Article  PubMed  Google Scholar 

  • Meehl, P. E., & Rosen, A. (1955). Antecedent probability and the efficiency of psychometric signs, patterns, and cutting scores. Psychological Bulletin, 52, 194–216. doi:10.1037/h0048070.

    Article  PubMed  Google Scholar 

  • Meloy, J. R. (2000). Violence risk and threat assessment: A practical guide for mental health and criminal justice professionals. San Diego, CA: Specialized Training Services.

    Google Scholar 

  • Meloy, J. R. (2006). Empirical basis and forensic application of affective and predatory violence. The Australian and New Zealand Journal of Psychiatry, 40, 539–547. doi:10.1111/j.1440-1614.2006.01837.x.

    Article  PubMed  Google Scholar 

  • Miller, H. A. (2006). A dynamic assessment of offender risk, needs, and strengths in a sample of pre-release general offender. Behavioral Sciences & the Law, 24, 767–782. doi:10.1002/bsl.728.

    Article  Google Scholar 

  • Mills, J. F., & Kroner, D. G. (2003). Anger as a predictor of institutional misconduct and recidivism in a sample of violent offenders. Journal of Interpersonal Violence, 18, 282–294. doi:10.1177/0886260502250085.

    Article  Google Scholar 

  • Monahan, J. (1981). Predicting violent behavior: An assessment of clinical techniques. Beverly Hills, CA: Sage.

    Google Scholar 

  • Morrissey, C., Mooney, P., Hogue, T. E., Lindsay, W. R., & Taylor, J. L. (2007). Predictive validity of the PCL-R for offenders with intellectual disability in a high security hospital: Treatment progress. Journal of Intellectual & Developmental Disability, 32, 125–133. doi:10.1080/13668250701383116.

    Article  Google Scholar 

  • Nolan, K. A., Czobor, P., Roy, B. B., Platt, M. M., Shope, C. B., Citrome, L. L., et al. (2003). Characteristics of assaultive behavior among psychiatric inpatients. Psychiatric Services (Washington, D.C.), 54, 1012–1016. doi:10.1176/appi.ps.54.7.1012.

    Google Scholar 

  • Nolan, K. A., Volavka, J., Czobor, P., Sheitman, B., Lindenmayer, J., Citrome, L. L., et al. (2005). Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder. Journal of Psychiatric Research, 39, 109–115. doi:10.1016/j.jpsychires.2004.04.010.

    Article  PubMed  Google Scholar 

  • Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monahan & H. J. Steadman (Eds.), Violence and mental disorder: Developments in risk assessment (pp. 21–59). Chicago: University of Chicago Press.

    Google Scholar 

  • Novaco, R. W., & Taylor, J. L. (2004). Assessment of anger and aggression in male offenders with developmental disabilities. Psychological Assessment, 16, 42–50. doi:10.1037/1040-3590.16.1.42.

    Article  PubMed  Google Scholar 

  • Olver, M. E., Wong, S. C. P., Nicholaichuk, T., & Gordon, A. (2007). The validity and reliability of the Violence Risk Scale–Sexual Offender version: Assessing sex offender risk and evaluating therapeutic change. Psychological Assessment, 19, 318–329. doi:10.1037/1040-3590.19.3.318.

    Article  PubMed  Google Scholar 

  • Overall, J. E., & Gorham, D. R. (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.

    Article  Google Scholar 

  • Pepe, M. S. (2003). The statistical evaluation of medical tests for classification and prediction. Oxford: Oxford University Press

    Google Scholar 

  • Quanbeck, C. D., McDermott, B. E., Lam, J., Eisenstark, H., Sokolov, G., & Scott, C. L. (2007). Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatric Services (Washington, D.C.), 58, 521–528. doi:10.1176/appi.ps.58.4.521.

    Google Scholar 

  • Quinsey, V. L., Jones, G. B., Book, A. S., & Barr, K. N. (2006). The dynamic prediction of antisocial behavior among forensic psychiatric patients: A prospective study. Journal of Interpersonal Violence, 21, 1539–1565. doi:10.1177/0886260506294238.

    Article  PubMed  Google Scholar 

  • Reiss, D., Grubin, D., & Meux, C. (1999). Institutional performance of male ‘psychopaths’ in a high-security hospital. Journal of Forensic Psychiatry, 10, 290–299. doi:10.1080/09585189908403682.

    Article  Google Scholar 

  • Rogers, R., Salekin, R. T., Hill, C., Sewell, K. W., Murdock, M. E., & Neumann, C. S. (2000). The Psychopathy Checklist–Screening Version: An examination of criteria and subcriteria in three forensic samples. Assessment, 7, 1–15. doi:10.1177/107319110000700101.

    Article  PubMed  Google Scholar 

  • Rogers, R., & Shuman, D. W. (2005). Fundamentals of forensic practice: Mental health and criminal law. New York: Springer Science + Business Media.

    Google Scholar 

  • Shafer, A. (2005). Meta-analysis of the Brief Psychiatric Rating Scale factor structure. Psychological Assessment, 17, 324–335. doi:10.1037/1040-3590.17.3.324.

    Article  PubMed  Google Scholar 

  • Simourd, D. J. (2004). Use of dynamic risk/need assessment instruments among long-term incarcerated offenders. Criminal Justice and Behavior, 31, 306–323. doi:10.1177/0093854803262507.

    Article  Google Scholar 

  • Taylor, J. L., DuQueno, L., & Novaco, R. W. (2004). Piloting a Ward Anger Rating Scale for older adults with mental health problems. Behavioural and Cognitive Psychotherapy, 32, 467–479. doi:10.1017/S135246580400164X.

    Article  Google Scholar 

  • Unrau, Y. A., & Coleman, H. (1998). Understanding and interpreting polytomous logistic regression: Applications to research on social work practice. Research on Social Work Practice, 8, 223–235. doi:10.1177/104973159800800206.

    Article  Google Scholar 

  • Vitacco, M. J., Neumann, C. S., Caldwell, M. F., Leistico, A., & Van Rybroek, G. J. (2006). Testing four models of the Psychopathy Checklist: Youth Version and their association with instrumental aggression. Journal of Personality Assessment, 87, 74–83. doi:10.1207/s15327752jpa8701_06.

    Article  PubMed  Google Scholar 

  • Vitacco, M. J., Neumann, C. S., & Jackson, R. (2005). Development of a four-factor model of psychopathy: Associations with ethnicity, gender, violence, and intelligence. Journal of Consulting and Clinical Psychology, 73, 466–476. doi:10.1037/0022-006X.73.3.466.

    Article  PubMed  Google Scholar 

  • Waldheter, E. J., Jones, N. T., Johnson, E. R., & Penn, D. L. (2005). Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness. The Journal of Nervous and Mental Disease, 193, 609–618. doi:10.1097/01.nmd.0000177788.25357.de.

    Article  PubMed  Google Scholar 

  • Walters, G. D., Gray, N. S., Jackson, R. L., Sewell, K. W., Rogers, R., Taylor, J., et al. (2007). A taxometric analysis of the Psychopathy Checklist: Screening Version (PCL:SV): Further evidence of dimensionality. Psychological Assessment, 19, 330–339. doi:10.1037/1040-3590.19.3.330.

    Article  PubMed  Google Scholar 

  • Wang, E. W., & Diamond, P. M. (1999). Empirically identifying factors related to violence risk in corrections. Behavioral Sciences & the Law, 17, 377–389. doi :10.1002/(SICI)1099-0798(199907/09)17:3<377::AID-BSL351>3.0.CO;2-M.

    Article  Google Scholar 

  • Ward, T., & Eccleston, L. (2004). Risk, responsivity, and the treatment of offenders: Introduction to the special issue. Psychology, Crime & Law, 10, 223–227. doi:10.1080/10683160410001662726.

    Article  Google Scholar 

  • Wollert, R. (2006). Low base rates limit expert certainty when current actuarials are used to identify sexually violent predators: An application of Bayes’s theorem. Psychology, Public Policy, and Law, 12, 56–85. doi:10.1037/1076-8971.12.1.56.

    Article  Google Scholar 

  • Wong, S., & Gordon, A. (2006). The Validity and Reliability of the Violence Risk Scale: A treatment-friendly violence risk assessment tool. Psychology, Public Policy, and Law, 12, 279–309. doi:10.1037/1076-8971.12.3.279.

    Article  Google Scholar 

  • Wong, S., & Hare, R. D. (2004). Guidelines for a psychopathy treatment program. Toronto, ON: Multi-Health Services.

    Google Scholar 

  • Woodworth, M., & Porter, S. (2002). In cold blood: Characteristics of criminal homicides as a function of psychopathy. Journal of Abnormal Psychology, 111, 436–445. doi:10.1037/0021-843X.111.3.436.

    Article  PubMed  Google Scholar 

  • Yudofsky, S. C., Silver, J., Jackson, W., Endicott, J., & William, D. (1986). The Overt Aggression Scale for the objective rating of verbal and physical aggression. The American Journal of Psychiatry, 143, 35–39.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Mendota Mental Health Institute, Madison, WI, USA

    Michael J. Vitacco, Gregory J. Van Rybroek, James D. Tomony & Emily Saewert

  2. University of North Texas, Denton, TX, USA

    Jill E. Rogstad

  3. The University of Wisconsin-Madison, Madison, WI, USA

    Laura E. Yahr

Authors
  1. Michael J. Vitacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory J. Van Rybroek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jill E. Rogstad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura E. Yahr
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James D. Tomony
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emily Saewert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Vitacco.

About this article

Cite this article

Vitacco, M.J., Van Rybroek, G.J., Rogstad, J.E. et al. Predicting Short-Term Institutional Aggression in Forensic Patients: A Multi-Trait Method for Understanding Subtypes of Aggression. Law Hum Behav 33, 308–319 (2009). https://doi.org/10.1007/s10979-008-9155-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10979-008-9155-7

Keywords

Search

Navigation