Almar J. Zwets

The four-factor model of the Psychopathy Checklist-Revised: Validation in a Dutch forensic inpatient sample

In The Netherlands, the Ministry of Security and Justice requires the assessment of the Psychopathy Checklist-Revised (PCL-R; Hare, 1991; Hare, 2003) in all forensic psychiatric inpatients. To examine the four-factor structure of the Psychopathy Checklist-Revised, confirmatory factor analysis (CFA) was conducted using a Dutch sample of forensic psychiatric inpatients (N=411) and the results indicated acceptable fit. Also, using multiple group CFA, the four-factor model provided an acceptable fit in both patients with a personality disorder and patients with a psychotic disorder, and there was reasonably good evidence of measurement invariance between these two subgroups. Furthermore, correlations with external measures of aggression and personality traits provided additional support for the validity of the four-factor model in patients with a personality disorder. In patients with a psychotic disorder fewer significant correlations with external measures were found. Taken together, the results support the use of the four-factor structure in Dutch offenders who are detained under hospital order.

High and Low Aggressive Narcissism and Anti-social Lifestyle in Relationship to Impulsivity, Hostility, and Empathy in a Group of Forensic Patients in the Netherlands

In a group of 148 violent offenders, 14 offenders were diagnosed as psychopaths (PCL-R score 30+); 46 as middle group psychopaths (PCL-R score 21–29); and 88 as non-psychopaths (PCL-R score −21). To measure impulsivity, empathy, and hostility in the three groups, clinical diagnoses of psychologists and psychiatrists were used and classified in the HKT-30. Based on Hares PCL-R classification, psychopaths scored more problematic on impulsivity, empathy, and hostility than the middle group and non-psychopaths. Differences between the middle and psychopathic group were small. Individuals who scored high on Factors 1 and 2 showed significantly more problematic behavior on impulsivity, empathy, and hostility than individuals with a low score. Empathy and hostility contributed significantly to the prediction of Factor 1 (high aggressive narcissism; R2 = 22%), and empathy and impulsivity contributed significantly (not for impulsivity but meaningful) to the prediction of Factor 2 (high antisocial lifestyle; R2 = 22%).

Aggression Replacement Training for Violent Young Men in a Forensic Psychiatric Outpatient Clinic

The effects of Aggression Replacement Training (ART) were explored in a group of Dutch violent young men aged 16 to 21 years, who were obliged by the court to follow a treatment program in a forensic psychiatric outpatient clinic. To evaluate the training, patients completed a set of self-report questionnaires at three moments in time: at intake/before a waiting period, after the waiting period/before the training, and after the training. During the waiting period, the patients did not change on most measures, although they displayed a significant increase in anger. The patients who completed the therapy scored significantly lower on psychopathy than the patients who dropped out. The training produced significant decreases in physical aggression and social anxiety and showed trends toward a decline in self-reported hostility, general aggression, and anger. After the training, the patients scored comparably with a reference group on measures of hostility and aggressive behavior. Altogether, these results provide tentative support for the efficacy of the ART for violent young men referred to forensic psychiatric outpatient settings.

Implicit attitudes toward violence and their relation to psychopathy, aggression, and socially adaptive behaviors in forensic psychiatric inpatients

In order to investigate the relation between implicit attitudes toward violence and different aspects of violent and social behavior in Dutch forensic psychiatric inpatients, an implicit association test was related to measures of psychopathy, aggression, and socially adaptive behaviors. Results indicated that all patients had negative implicit attitudes toward violence. Although implicit attitudes toward violence were unrelated to several self-report measures of aggression, there was a significant positive relation between these attitudes and the antisocial facet of psychopathy. Furthermore, it was found that implicit attitudes toward violence were significantly negatively associated with coping behaviors and the level of moral awareness, indicating that patients with more negative implicit attitudes toward violence more often reported these behaviors, which can be assumed to inhibit aggression. As the present study was only correlational in nature, our findings need to be further explored in prospective research.

Psychomotor Therapy as an Additive Intervention for Violent Forensic Psychiatric Inpatients: A Pilot Study

ABSTRACT The first results of psychomotor therapy (PMT) as an additional component to Aggression Replacement Training (ART) were explored in a group of forensic psychiatric inpatients (N = 37). Patients were divided into two groups: ART+PMT (experimental group) and ART+Sports (control group). Primary outcome measures of aggression, anger, and social behavior, and secondary outcome measures of coping behavior and bodily awareness during anger were administered on three occasions: pretreatment, posttreatment (after 35 sessions), and follow-up (15 weeks after the final session). The combined group (experimental and control group) showed clinically significant improvements on observed social behavior, observed aggressive behavior, and self-reported anger, but there were no differences in treatment effects between the experimental group and the control group on these primary outcome measures. However, on secondary outcome measures of bodily awareness during anger and coping behavior, the experimental group displayed somewhat more improvement than the control group. Altogether, the results of this pilot study indicate that the addition of PMT to a treatment program for violent forensic inpatients may indeed result in improvements on specific treatment goals of PMT, whereas its effects on aggressive behavior needs further examination.

The psychometric properties of the Anger Bodily Sensations Questionnaire (ABSQ)

The Anger Bodily Sensations Questionnaire (ABSQ) is a newly developed self-report instrument for measuring bodily sensations related to anger in interpersonal situations. In this study, we investigated the psychometric properties of the ABSQ in a sample of 70 offenders and a sample of 100 secondary vocational students. Results indicated that the internal consistency and test-retest reliability of the instrument were good. An explorative factor analysis carried out on the ABSQ data of the combined sample yielded three factors. Support was found for the concurrent validity of the instrument. In both samples, the total score of the ABSQ showed positive correlations with measures of bodily awareness, social anxiety, anger, and aggression. Altogether, results suggest that the ABSQ appears to be a reliable and valid questionnaire. Further research is needed to examine the psychometric properties of the ABSQ in larger offender and non-clinical samples.

Are Child Abusers Sexually Attracted to Submissiveness? Assessment of Sex-Related Cognition With the Implicit Association Test

Child sexual abuse is associated with social anxiety, low self-esteem, and intimacy deficits. This, in combination with the core belief of a dangerous world, might suggest that child abusers are sexually attracted to submissiveness. The Implicit Association Test (IAT) was used to examine this hypothesis. Results indicated that child abusers have a stronger sexual preference for submissiveness than rapists, although there were no differences between child abusers and non-sexual offenders. Multinomial logistic regression analysis revealed that submissive–sexy associations have incremental value over child–sex associations in differentiating child abusers from other offenders. The predictive value of both implicit associations was explored by correlating IAT scores with measures for recidivism risk, aggression, and interpersonal anxiety. Child abusers with stronger child–sex associations reported higher levels of interpersonal anxiety and hostility. More research on implicit cognition in sex offenders is required for a better understanding of what these and similar implicit measures are exactly measuring and what role implicit cognition may play in sexual offending.

Behavior on the ward of personality-disordered inpatients and chronically psychotic inpatients during a three-year stay in a Dutch forensic psychiatric hospital

To gain insight into the behavior of a group of personality-disordered patients and a group of chronically psychotic patients during their stay in a Dutch forensic psychiatric hospital, data on these patients were collected biannually for seven years. Three aspects of the patients’ behavior were examined: the prediction of institutional behavior shortly after admission, changes in the patients’ behavior on the ward during their stay in hospital, and the prediction of these changes. In the personality-disordered patients, observed irritation/anger and aggressive behavior on the ward turned out to be positively related to psychopathy, the PCL-R lifestyle and antisocial facets, and the neuroticism domain. A positive relationship was also found between aggressive behavior on the ward and trait anger. In the chronically psychotic patients, a positive relationship was found between irritation/anger and the PCL-R interpersonal and lifestyle facet. During a stay of three years, the aggressive behavior of both patient subgroups, which was already low at the start, did not decrease further, but their prosocial behavior increased. In the personality-disordered patients, relatively high scores on the antisocial facet of the PCL-R indicated an increase in prosocial behavior, whereas in the chronically psychotic patients no relationship was found between any PCL-R facet and behavior change. Effect studies on treatment programs for forensic psychiatric inpatients have to contend with the problem of a low base rate of institutional aggression. Therefore, we advise that such studies focus not only on a decrease in negative behaviors but also on an increase in positive behaviors.

The Adapted Version of the Sociomoral Reflection Measure (SRM-AV) in Dutch Forensic Psychiatric Patients

We developed a new instrument for measuring moral maturity in Dutch forensic psychiatric patients with the Sociomoral Reflection Measure-Short Form as a starting point. This instrument contains 11 propositions to which respondents indicate their own perceived level of importance and justifications of their choices. Twenty new statements were added to these 11 propositions. Justifications of the responses were scored with the aid of a seven-point scale, each point representing a (transitional) level of moral maturity. In order to have a practical instrument, we deleted 11 items with the lowest interrater reliability of the 31 items. The internal consistency, interrater reliability and test-retest reliability of the new instrument with the remaining 20 items (SRM-AV) were good. Validity was supported by significant correlations with age, psychopathy, agreeableness, and verbal aggression. Patients scored significantly lower on the SRM-AV than two non-clinical control groups. For the time being, the SRM-AV appears to measure moral maturity in forensic psychiatric patients in a reliable and valid way.

The Sexual Violence Risk-20: factor structure and psychometric properties

Abstract Although the Sexual Violence Risk-20 (SVR-20) is widely used, its psychometric properties have only been investigated in a limited number of studies. This study explored the factor structure of the SVR-20 and examined its psychometric properties. Confirmatory factor analysis (CFA) was used to examine the fit of the original three-domain model of the SVR-20. The CFA showed that the original structure was not satisfactory. Exploratory principal components analysis (PCA) was conducted in search of a more optimal factor structure. Psychometric properties (i.e., internal consistency, predictive value, and convergent validity) of both the original domains and alternative factors were investigated. The PCA and subsequent CFAs pointed in the direction of an alternative, more optimal three-factor solution. The three alternative factors were labeled as Antisociality, Sexual deviance, and Problematic thinking and produced better internal consistency coefficients than the original domains. However, the validity of the SVR-20 was modest and no evidence was found indicating that the alternative factors were better in this regard as compared to the original domains. Despite the overall superiority of actuarial measures in predicting recidivism, the structured professional judgment of the SVR-20 proved to be more predictive of sexual, violent, and general recidivism than its actuarial scoring method.