Katrina A. Rufino

Are Forensic Experts Biased by the Side That Retained Them

How objective are forensic experts when they are retained by one of the opposing sides in an adversarial legal proceeding? Despite long-standing concerns from within the legal system, little is known about whether experts can provide opinions unbiased by the side that retained them. In this experiment, we paid 108 forensic psychologists and psychiatrists to review the same offender case files, but deceived some to believe that they were consulting for the defense and some to believe that they were consulting for the prosecution. Participants scored each offender on two commonly used, well-researched risk-assessment instruments. Those who believed they were working for the prosecution tended to assign higher risk scores to offenders, whereas those who believed they were working for the defense tended to assign lower risk scores to the same offenders; the effect sizes (d) ranged up to 0.85. The results provide strong evidence of an allegiance effect among some forensic experts in adversarial legal proceedings.

Field Validity of the Psychopathy Checklist--Revised in Sex Offender Risk Assessment.

Several studies have concluded that scores from Hares (2003) Psychopathy Checklist-Revised (PCL-R) predict reoffense among sexual offenders, but most of those studies examined the predictive validity of scores from trained research staff, not clinicians in the field scoring the measure as part of actual forensic assessments. Therefore, we examined the field validity of PCL-R scores that forensic evaluators assigned to 333 male sexual offenders who underwent evaluations during a civil commitment selection process. Overall, no PCL-R score was a significant predictor of sexually violent recidivism. Facet 4 was the only PCL-R score with an area under the curve (AUC) greater than .50 (AUC = .53, p = .85) and the only PCL-R score that approached statistical significance for predicting the combined category of violent or sexually violent offending (AUC = .63, p = .08). However, scores from a subset of evaluators revealed stronger predictive effects, indicating that predictive validity was higher for scores from some evaluators than others. Overall, these results suggest that the stronger predictive validity values in controlled research studies may not apply to all evaluators when the PCL-R is administered in the field.

On Individual Differences in Person Perception: Raters’ Personality Traits Relate to Their Psychopathy Checklist–Revised Scoring Tendencies

This study investigated raters’ personality traits in relation to scores they assigned to offenders using the Psychopathy Checklist—Revised (PCL-R). A total of 22 participants, including graduate students and faculty members in clinical psychology programs, completed a PCL-R training session, independently scored four criminal offenders using the PCL-R, and completed a comprehensive measure of their own personality traits. A priori hypotheses specified that raters’ personality traits, and their similarity to psychopathy characteristics, would relate to raters’ PCL-R scoring tendencies. As hypothesized, some raters assigned consistently higher scores on the PCL-R than others, especially on PCL-R Facets 1 and 2. Also as hypothesized, raters’ scoring tendencies related to their own personality traits (e.g., higher rater Agreeableness was associated with lower PCL-R Interpersonal facet scoring). Overall, findings underscore the need for future research to examine the role of evaluator characteristics on evaluation results and the need for clinical training to address evaluators’ personality influences on their ostensibly objective evaluations.

When experts disagreed, who was correct? A comparison of PCL-R scores from independent raters and opposing forensic experts.

Researchers recently found that Psychopathy Checklist-Revised (PCL-R; Hare, 2003) scores reported by state experts were much higher than those reported by defense experts in sexually violent predator cases pursued for civil commitment (Murrie, Boccaccini, Johnson, & Janke, 2008), which raised the question of which scores were more accurate. In this study, two independent raters rescored the PCL-R from file review for 44 offenders from that sample who had opposing evaluator scores (allegiance cases) and 44 who had state expert, but not defense expert, scores (comparison cases). The independent raters agreed with one another in their scoring of the allegiance and comparison cases (Intraclass Correlation Coefficient [ICC] ICCA,1 = .95), but they disagreed with both state (ICCA,1 = .29) and defense (ICCA,1 = .14) experts in the allegiance cases. Agreement was stronger between state experts and independent raters for the comparison cases (ICCA,1 = .63), but the independent raters assigned significantly higher PCL-R scores than experts for both the allegiance and comparison cases. These findings suggest that offenders who were selected for rescoring by the defense may have been more difficult to score. Findings also raise questions about the extent to which PCL-R scores based on correctional file review only are comparable to those based on file and interview.

Scoring Subjectivity and Item Performance on Measures Used to Assess Violence Risk: The PCL-R and HCR-20 as Exemplars.

Although reliability is essential to validity, most research on violence risk assessment tools has paid little attention to strategies for improving rater agreement. The authors evaluated the degree to which perceived subjectivity in scoring guidelines for items from two measures—the Psychopathy Checklist–Revised (PCL-R) and the Historical, Clinical, Risk Management-20 (HCR-20)—were related to indices of interrater agreement reported in the research literature. Nine doctoral students with experience scoring the PCL-R and HCR-20 showed a high level of agreement with respect to the amount of subjectivity required to score items. Decreased subjectivity was associated with increased rater agreement for both tools. For the PCL-R, items on aggregate measures that have the strongest effects in predictive validity research (i.e., Factor 2, Facet 4) were rated as the least subjective. For the HCR-20, items on the Historical scale were rated as the least subjective. Implications for measure development and refinement are discussed.

Borderline Personality Symptomatology as a Mediator of the Link Between Child Maltreatment and Adult Suicide Potential

The present study tests borderline personality symptoms as meditational pathways between child maltreatment and suicide potential among college students. A sample of 268 participants completed a questionnaire battery including demographic data, the Comprehensive Child Maltreatment Scale, Inventory of Altered Self-Capacities, and Personality Assessment Inventory. Results: Three multiple mediation models (1 for each type of child maltreatment) were conducted. Results demonstrated that the same set of borderline personality characteristics mediated the relations between each type of child maltreatment (i.e., physical abuse, emotional abuse, and neglect) and suicide potential. The mediating borderline symptoms were affective dysregulation, identity problems, and paranoia. The meditation model is discussed with regard to attachment, trauma, and suicide theories, as well as suicide risk assessment.

A Psychometric Study of the Suicide Cognitions Scale With Psychiatric Inpatients.

The cognitive model of suicide makes specific predictions about the role of cognition in suicide risk. This study examined psychometric properties of the Suicide Cognitions Scale (SCS), an instrument designed to measure suicide-specific cognitions, in a sample of 150 patients (age range, 18-75 years, SD = 14.42; 56% female, 94% White) hospitalized for suicide risk associated with multiple, treatment-resistant psychiatric conditions. Findings revealed strong psychometric properties, including internal consistency and test-retest reliability. Incremental validity beyond depression and hopelessness was demonstrated in the prediction of suicidal ideation. Confirmatory factor analysis examining previously reported factor solutions suggested more consistency with a three-factor solution (Unlovability, Unbearability, and Unsolvability) relative to a two-factor solution. Good sensitivity to treatment response over the course of hospitalization also was demonstrated. The hypothesis of residual risk, derived from cognitive theory and predicting that lack of change in suicide schemas would be associated with higher suicide risk at discharge, was supported. Overall, these findings suggest considerable promise for the SCS as a measure of suicide risk that adds predictive utility to measures of depression and hopelessness, with potential usefulness in planning and monitoring treatment for suicidal individuals.

Implicit Measure of Life/Death Orientation Predicts Response of Suicidal Ideation to Treatment in Psychiatric Inpatients

In this study, we set out to extend empirical research on the Life-Death Implicit Association Test (IAT) by administering the measure to an adult psychiatric inpatient population with suicidal ideation. We sought to examine its association with other suicide-relevant measures and to determine whether it adds predictive utility beyond that offered by other measures of suicide risk. The IAT was administered (N = 124) at biweekly intervals as part of an assessment battery at an inpatient facility for complex, treatment resistant psychiatric disorders (average length of stay: approximately 6 weeks). Multiple regression procedures were utilized to examine relationships among the measures and their predictive utility with respect to suicidal ideation at discharge. Consistent with prior research with other populations, significant associations were found between IAT performance and explicit (self-report and interview) measures of suicide risk. Moreover, the IAT was found to predict suicidal ideation at discharge above and beyond number of prior suicide attempts and admission scores on measures of depression, suicidal ideation, and hopelessness. Change in IAT performance over the course of treatment was observed. The IAT shows promise as an addition to explicit measures conventionally used to estimate suicide risk in psychiatric patients. These findings are consistent with a cognitive vulnerability model of suicide risk.

Change in Experiential Avoidance is Associated with Reduced Suicidal Ideation over the Course of Psychiatric Hospitalization

Growing empirical literature in recent years indicates that experiential avoidance plays a role in a wide variety of psychological disorders and psychotherapeutic interventions. This study explored the view of suicidal ideation as a form of experiential avoidance by examining the association between suicidal ideation and therapeutic change in a sample of 189 adult psychiatric inpatients. Results were consistent with predictions, showing a statistically significant association between scores on the Beck Scale for Suicidal Ideation and the Acceptance and Action Questionnaire-II (AAQ-II). It was further shown that change in AAQ-II scores over the course of hospitalization was associated with change in suicidality, independent of changes in depression severity and hopelessness. Moreover, treatment responders (patients whose suicidal ideation scores dropped significantly over the course of treatment) showed greater drops in experiential avoidance relative to nonresponders. These results are consistent with a view of suicidal ideation (and, by extension, suicide) as a form of experiential avoidance and potentially a therapeutic approach that specifically seeks to reduce experiential avoidance.

Difficulties in emotion regulation in patients with eating disorders

BackgroundA defining characteristic of eating disorders (EDs) is difficulty with emotion regulation (ER). Previous research indicates that ED subtypes demonstrate differing ER difficulties. Specifically, individuals with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) show greater impairment in their ability to regulate emotions in areas such as achieving goals while upset, reacting impulsively to distress, and effectively using coping strategies, as compared to those with Binge Eating Disorder (BED). However, limited research includes the diagnostic category of Eating Disorder, Not Otherwise Specified (EDNOS). The aim of this study was to better understand ER difficulties for all ED diagnoses, especially EDNOS. It was hypothesized that patients with EDs will demonstrate similar ER difficulties as psychiatric patients without EDs and that patients with EDNOS will be similar in their total level of ER difficulties but will differ in their specific types of difficulties in ER as compared to patients with other EDs.MethodsParticipants included 404 adults presenting to an inpatient psychiatric hospital. Psychiatric diagnoses, including EDs, were determined using the Structured Clinical Interview for DSM Disorders. Differences in specific and overall difficulties with ER were examined across psychiatric patients using the multidimensional Difficulties in Emotion Regulation Scale.ResultsResults of this study indicate that individuals with EDs have greater ER difficulties in most domains of ER and that those with BED and EDNOS demonstrate the most significant differences in ER as compared to psychiatric patients without EDs. Additionally, it was found that ED subtypes typically did not differ in terms of specific difficulties in ER. One exception emerged indicating that individuals with BED demonstrated significantly greater difficulty on the Limited Access to Emotion Regulation Strategies subscale as compared to those with EDNOS.ConclusionsResearchers were able to clarify difficulties in ER across ED diagnoses. Results highlight the importance of providing ER skills training for patients with EDs, particularly those with BED and EDNOS, and give insight into the specific areas of ER that may be important for these patients to focus on throughout recovery.