Corine de Ruiter

Psychopathy and sexual deviance in treated rapists: association with sexual and nonsexual recidivism.

This study examined the role of the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and sexual deviance scores in predicting recidivism in a sample of 94 convicted rapists involuntarily admitted to a Dutch forensic psychiatric hospital between 1975 and 1996. The predictive utility of grouping offenders based on the combination of psychopathy and sexual deviance was also investigated. Measures were coded from prerelease institutional records. Recidivism (reconviction) data were retrieved from the Judicial Documentation Register of the Ministry of Justice and were related to PCL-R and sexual deviance cores. The follow-up period after release ranged up to 23.5 years (M = 11.8 years). Base rates for sexual, violent nonsexual, violent (including sexual), and general recidivism were 34%, 47%, 55%, and 73%, respectively. For all types of offending, offenders scoring high on the PCL-R (>26) were significantly more often reconvicted than other offenders. The sexual deviance score was found to be a significant predictor of sexual reconviction. Survival analyses provided considerable evidence that psychopathic sex offenders with sexual deviant preferences are at substantially greater risk of committing new sexual offenses than psychopathic offenders without deviant preferences or nonpsychopathic offenders with or without sexual deviance. The findings are discussed in terms of their practical and clinical implications.

Selective processing of threatening information: effects of attachment representation and anxiety disorder on attention and memory

To investigate the effect of the mental representation of attachment on information processing, 28 anxiety disorder outpatients, as diagnosed by the Anxiety Disorders Interview Schedule-Revised, were administered the Adult Attachment Interview and the State-Trait Anxiety Inventory. They also completed an emotional Stroop task with subliminal and supraliminal exposure conditions, a free recall memory task, and a recognition test. All tasks contained threatening, neutral, and positively valenced stimuli. A nonclinical comparison group of 56 participants completed the same measures. Results on the Stroop task showed color-naming interference for threatening words in the supraliminal condition only. Nonclinical participants with insecure attachment representations showed a global response inhibition to the Stroop task. Clinical participants with secure attachment representations showed the largest Stroop interference of the threatening words compared to the other groups. Results on the free recall task showed superior recall of all types of stimuli by participants with secure attachment representations. In the outpatient group, participants with secure attachment representations showed superior recall of threatening words on the free recall task, compared to insecure participants. Results on the recognition task showed no differences between attachment groups. We conclude that secure attachment representations are characterized by open communication about and processing of threatening information, leading to less defensive exclusion of negative material during the attentional stage of information processing and to better recall of threatening information in a later stage. Attachment insecurity, but not the type of insecurity, seems a decisive factor in attention and memory processes.

PCL-R Psychopathy Predicts Disruptive Behavior Among Male Offenders in a Dutch Forensic Psychiatric Hospital:

In this study, the relationship between psychopathy, according to the Dutch language version of Hare’s Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.

Type of discharge and risk of recidivism measured by the HCR-20: A retrospective study in a Dutch sample of treated forensic psychiatric patients

This retrospective study examined the predictive validity of the HCR-20, a violence risk assessment instrument. The HCR-20 as well as the Psychopathy Checklist-Revised (PCL-R) were coded on the basis of file information of 120 patients discharged from a Dutch forensic psychiatric hospital between 1993 and 1999 (average follow-up period 72.5 months). The patients were divided into four groups according to type of discharge: 1) discharge by the court in line with the hospital staffs advice and after a transmural phase; 2) discharge by the court in line with the hospital staff s advice, but without a preceding transmural phase; 3) discharge by the court against the hospital staffs advice; and 4) readmission to another institution. Recidivism data (reconvictions) from the Ministry of Justice were related to the risk assessments. The base rate for violent recidivism was 36%, and 52% for general recidivism. The HCR-20 and PCL-R total scores demonstrated good predictive validity for violent recidivism (AUC = .82 and .75, respectively). The HCR-20 was a significantly better predictor of violent recidivism than unstructured clinical judgment stated in hospital staff s advice to the court. In addition, the HCR-20 total score predicted significantly better than the PCL-R total score, although the difference in AUC values was no longer significant when the item ‘Psychopathy’ was removed from the HCR-20 total score.

Psychological Functioning of Adolescent Transsexuals: Personality and Psychopathology

Adolescent transsexuals were compared with adolescent psychiatric outpatients and first-year university students to determine the extent to which other psychopathology is a necessary condition for the development of transsexualism. Three areas of psychological functioning associated with fundamental psychological disturbances--perceptual inaccuracy, disorders of thought and negative self-image--were assessed by means of the Rorschach Comprehensive System. The group of adolescent transsexuals was found to be intermediate between adolescent psychiatric patients and nonpatients for extent of perceptual inaccuracy. They did not differ significantly from nonpatients with regard to thinking disturbances and negative self-image. The psychiatric patients included significantly more individuals characterized by negative self-image than the other groups. The results support the idea that major psychopathology is not required for the development of transsexualism.

The dual nature of forensic psychiatric practice: Risk assessment and management under the Dutch TBS-order

In this chapter the dual nature of forensic psychiatry as a medical profession on the one hand and a juridical specialism on the other will be the frame of reference from which several aspects of the treatment and risk management of mentally disordered offenders in the Netherlands will be discussed. First, we will focus on the legal provisions that apply in cases in which forensic assessment is conducted. Special attention is paid to the concept of diminished responsibility, which plays a central role in the penal system in the Netherlands. We then turn our focus to the treatment and risk management of mentally disordered offenders in one of the forensic psychiatric hospitals in the Netherlands, the Dr. Henri van der Hoeven Kliniek. Finally, the strengths and weaknesses of forensic psychiatric practice in the Netherlands are discussed.