Ruud H. J. Hornsveld

Psychometric Properties of the Aggression Questionnaire in Dutch Violent Forensic Psychiatric Patients and Secondary Vocational Students

The psychometric properties of a Dutch version of Buss and Perrys Aggression Questionnaire (AQ) were examined in a sample of violent forensic psychiatric inpatients and outpatients and a sample of secondary vocational students. The internal consistency, interitem correlations, and item—scale correlations of the subscales Physical Aggression, Anger, and Hostility were good but turned out to be unsatisfactory for the subscale Verbal Aggression. The four-factor structure of the AQ could not be confirmed, but the four-factor structure of a 12-item version (short form) of the AQ, the AQ-SF, produced an acceptable fit. The test—retest reliability of the AQ and AQ-SF total scores was good, although the test—retest reliability of the AQ-SF subscale Physical Aggression was not satisfactory. The validity of both the AQ and AQ-SF could be demonstrated by meaningful correlations with alternative measures of aggression and personality, but inpatients were not found to display higher scores on the AQ or AQ-SF than the students.

The Novaco Anger Scale-Provocation Inventory (1994 Version) in Dutch Forensic Psychiatric Patients

We examined the psychometric properties of the Novaco Anger Scale-Provocation Inventory (NAS-PI, 1994 version) in Dutch violent forensic psychiatric patients and secondary vocational students. A confirmatory factor analysis of the subscale structure of the NAS was carried out, reliability was investigated, and relations were calculated between NAS-PI scores and other measures of personality traits and problem behaviors. The 3-subscale structure of the original NAS could not be confirmed. However, the internal consistency of the NAS and the PI was excellent, and the test-retest reliability of the NAS was good. The validity of the NAS and the PI was supported by a meaningful pattern of correlations with alternative measures of anger and personality traits. Forensic psychiatric outpatients displayed higher NAS scores than secondary vocational students, but inpatients scored even lower than this nonclinical control group. Our preliminary conclusion is that the NAS-PI is a valuable instrument for the assessment of anger in Dutch violent forensic psychiatric patients.

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.

Alexithymia in Dutch violent forensic psychiatric outpatients

Abstract Until now alexithymia has not been investigated in Dutch low-educated offenders who are known for their violent behaviour. We therefore investigated a sample of aggressive forensic psychiatric outpatients, who are characterized by emotional dysregulation in conflict situations. For that purpose we used a Dutch questionnaire, the Bermond-Vorst Alexithymia Questionnaire (BVAQ; Vorst & Bermond, 2001), which we also administered in a sample of secondary vocational students for a comparison. Unfortunately, the five-factor structure of the BVAQ could not be confirmed in both samples, but in the patient sample the test-retest reliability of the total score turned out to be moderate, and meaningful correlations were found with measures of relevant personality domains and problem behaviours. When both samples were compared, patients were found to display significantly higher total scores on the BVAQ than the secondary vocational students, when controlled for age. Therefore, we concluded that alexithymia may contribute to the aggressive behaviour of violent forensic psychiatric outpatients. However, patients as well as students had much higher total scores on the BVAQ than found by Vorst and Bermond (2001) in a sample of Dutch psychology students. This indicates that alexithymia as measured by the BVAQ is also inversely related to educational level and perhaps to intelligence.

Agressiehanteringstherapie voor forensisch-psychiatrische patiënten met geweldsdelicten : ontwikkeling en praktijk

In dit artikel wordt de ontwikkeling van en de praktijk met de agressiehanteringstherapie (AHT) voor volwassen forensisch-psychiatrische patiënten met gewelddelicten in hun voorgeschiedenis beschreven. De therapie maakt voor klinische patiënten deel uit van het behandelprogramma ‘Agressief gedrag’, dat naast de AHT de modulen ‘Psychomotore therapie’, ‘Onderwijs’ en ‘Bewegingsagogie’ omvat. Poliklinische patiënten volgen alleen de AHT. Na beschrijving van de therapie worden praktijkervaringen vermeld met zowel klinische als poliklinische groepen. Overwegingen om de therapie te verlengen of te intensiveren worden afgezet tegen praktische mogelijkheden en de wenselijkheid om onderzoek te doen. Er zijn aanwijzingen dat klinische patiënten die relatief hoog scoren op de dimensie ‘psychopathie’ niet zonder meer voor de AHT geïndiceerd moeten worden.

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.

Domestically and Generally Violent Forensic Psychiatric Outpatients Personality Traits and Behavior

A group of 63 domestically violent patients and a group of 103 generally violent patients at a Dutch forensic psychiatric outpatient clinic are examined with regard to personality traits and problem behaviors to develop treatment programs for domestically violent patients. The domestically violent patients are more unstable from a psychological viewpoint but not more inclined to anger than the average Dutch male. They report less anxiety in situations in which criticism can be given but more anxiety in situations in which someone can be given a compliment. When comparing domestically violent patients with generally violent patients, domestically violent patients score lower on anger as disposition and on aggressive behavior than the generally violent patients do. However, both groups do not differ from each other in their score on the dimension of psychopathy.

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.