Vivienne de Vogel

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.

Protective Factors for Violence Risk in Forensic Psychiatric Patients: A Retrospective Validation Study of the SAPROF

The Structured Assessment of PROtective Factors for violence risk (SAPROF) has recently been developed as a strengths-based addition to the assessment of risk for future violent behavior (de Vogel, de Ruiter, Bouman, & de Vries Robbé, 2009). Following the Structured Professional Judgment (SPJ) model, the positive and predominantly dynamic factors in the SAPROF were designed to counterbalance the assessment of risk as measured by risk assessment instruments, such as the HCR-20. The present retrospective study provides a first validation of the SAPROF in a Dutch sample of 126 forensic psychiatric patients. Analyses showed good interrater reliability, good predictive validity for non-recidivism of violence after clinical treatment for both the SAPROF total score and the SAPROF Final Protection Judgment and good predictive validity for violent recidivism for a combined HCR-20 - SAPROF total score. The predictive validity of the combined HCR-20 - SAPROF measure significantly outperformed the predictive validity of the HCR-20 in this study. Repeated assessments of the same patients over time demonstrated a significant improvement of SAPROF scores during treatment. Overall, the results provide evidence for the relationship between the presence of protective factors and non-recidivism of violence and for the additional value of protective factors in the assessment of risk for future violence. Moreover, the sensitivity of SAPROF scores to change provides support for the usefulness of the instrument in planning and evaluating treatment interventions.The Structured Assessment of PROtective Factors for violence risk (SAPROF) has recently been developed as a strengths-based addition to the assessment of risk for future violent behavior (de Vogel, de Ruiter, Bouman, & de Vries Robbe, 2009). Following the Structured Professional Judgment (SPJ) model, the positive and predominantly dynamic factors in the SAPROF were designed to counterbalance the assessment of risk as measured by risk assessment instruments, such as the HCR-20. The present retrospective study provides a first validation of the SAPROF in a Dutch sample of 126 forensic psychiatric patients. Analyses showed good interrater reliability, good predictive validity for non-recidivism of violence after clinical treatment for both the SAPROF total score and the SAPROF Final Protection Judgment and good predictive validity for violent recidivism for a combined HCR-20 - SAPROF total score. The predictive validity of the combined HCR-20 - SAPROF measure significantly outperformed the predictive validit...

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.

Risk factors and protective factors: a two-sided dynamic approach to violence risk assessment

The complementary use of risk- and protective factors has been one of the major advances in violence risk assessment in recent years. The present study investigates the value of this two-sided approach. The HCR-20 and the SAPROF were coded retrospectively for a sample of 188 patients with a history of violent or sexual offending, discharged from forensic psychiatric treatment. No moderating effect was found for type of offending history. The combined evaluation of risk- and protective factors was found to have good predictive validity for violent recidivism after treatment. Especially, the dynamic factors of both tools proved good predictors of (desistance from) violence at short- and long-term follow-up. Protective factors showed to provide incremental predictive validity over the use of risk factors alone. In addition, evidence was found for an interaction effect between risk- and protective factors. Implications of these findings for treatment planning and risk management are discussed.

Assessing Protective Factors for Sexually Violent Offending With the SAPROF

The Structured Assessment of Protective Factors for violence risk (SAPROF) has recently been developed as a risk assessment tool to focus solely on protective factors for (sexual) violence risk. Research on protective factors for sexual offending is very limited and most risk assessment tools for adult sexual offenders do not incorporate protective factors. The current study investigates the applicability and predictive validity of the SAPROF for forensic psychiatric patients who have sexually offended. For a sample of 83 hands-on sexual offenders, risk assessments were carried out retrospectively with the SAPROF, the Historical Clinical Risk Management–20 (HCR-20) and the Sexual Violence Risk–20 (SVR-20). Results show good interrater reliability and negative correlations between the SAPROF and both risk tools. Predictive validities of the SAPROF protective factors for reconvictions of general and sexual violence were good for short-term (1-3 year) as well as for long-term follow-up (15 year). Moreover, the SAPROF remained a statistically significant predictor of future violence and sexual violence even after controlling for the HCR-20 and the SVR-20. Implications of these findings and recommendations for future research are discussed.

Risk assessment in female forensic psychiatric patients: a quasi-prospective study into the validity of the HCR-20 and PCL-R

This study examined the postdictive validity of the HCR-20 and the PCL-R in a sample of 45 female ex-patients of Dutch forensic psychiatric hospitals. For this purpose the HCR-20 and PCL-R were coded using documented information. Recidivism data were collected from the Dutch Ministry of Justice. Interrater reliabilities for the HCR-20 and PCL-R were excellent. Recidivists and non-recidivists differed significantly in terms of their mean scores on the H (historical) scale of the HCR-20. Their mean scores on the other subscales and their total scores on the HCR-20 and the PCL-R showed no significant differences. The base rate for violent recidivism was 16%. Subscale scores and total scores on the HCR-20 and the PCL-R did not postdict violent recidivism. Risk judgments based on these instruments demonstrated the same poor predictive validity. There are indications that historical items, notably substance abuse and a history of violence, have some predictive value for violent outcome in female forensic psychiatric patients.

Violent women: a multicentre study into gender differences in forensic psychiatric patients

Abstract To gain insight into the relatively small, but increasing group of women in forensic psychiatry, a retrospective multicentre study was started gathering information from the files of 275 female patients of four Dutch forensic psychiatric hospitals on characteristics and violence risk factors. Overall, a picture emerged of severely traumatized women with complex psychopathology with multiple previous treatment failures and many incidents during treatment. The present study investigates specific psychiatric and criminal characteristics of female patients by comparing their data to those of 275 male forensic psychiatric patients. Various prominent differences were found, for example, women had more complex histories of victimization, were more often diagnosed with borderline personality disorder, were more likely to commit homicide and arson and less likely to commit sexual offenses, and were more often involved in inpatient aggression than their male counterparts. Several recommendations for gender-responsive treatment and directions for future research are provided.

Gender Matters: An Introduction to the Special Issues on Women and Girls

Abstract Girls and women represent a minority of forensic mental health and prison populations. However, studies worldwide suggest that there has been a steady increase in the number of girls and women being managed by forensic mental health services and correctional agencies over the past two decades. The vast majority of research in the forensic mental health field, however, remains steadfastly focused on male populations. As such, there are growing concerns about whether the theoretical knowledge we have on male offenders is sufficiently valid and useful for female offenders. There remain substantial gaps in knowledge and debate regarding the importance of gender differences, for instance, in developmental pathways to offending and in violence risk factors and assessment. There is a similar paucity of knowledge on the efficacy of treatment in female offenders and a need for treatment programs that are specifically responsive to the needs and issues of these girls and women. These special issues of the International Journal of Forensic Mental Health dedicated to gender issues in the forensic field marks a substantial effort to enlarge the empirical and theoretical knowledge on (violent) offending, assessment, and treatment in girls and women. In this introduction article, we aim to highlight the relevance of studying gender differences in the forensic field and to provide a brief overview of important gender issues in developmental pathways to offending, gender differences and similarities in the nature of offending, assessment and treatment in forensic mental health care and the criminal justice system. Finally, we provide recommendations for practitioners, researchers, and policymakers to move forward on this topic in the forensic field.

The Use of the HCR-20V3 in Dutch Forensic Psychiatric Practice

In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about the HCR-20V3 were positive. To illustrate the applicability of the HCR-20V3 for risk assessment and management in forensic clinical practice, a detailed forensic case study is presented.In this article, the applicability of the recently published HCR-20V3 for violence risk assessment in forensic psychiatric practice is discussed. This revision of the HCR-20 is the result of a multi-year development process based on worldwide empirical research, clinical expertise and consultation. Recently, the HCR-20V3 was implemented in Dutch forensic psychiatric practice by a research team that was also involved in beta-testing and pilot research into the interrater reliability and predictive validity of the first HCR-20V3 Draft version. This paper presents results of this beta-testing and the pilot study, as well as results from a recently conducted survey into the clinical value and applicability of the Dutch HCR-20V3. Overall, the results demonstrate that the HCR-20V3 is a promising revision with sound psychometric properties and improvements compared to the prior version of the HCR-20 for violence risk assessment and management. Furthermore, the first impressions of 192 workshop participants about...

Gender Differences in the Assessment and Manifestation of Psychopathy: Results From a Multicenter Study in Forensic Psychiatric Patients

abstract Gender differences were explored in PCL-R codings and the manifestation of psychopathy in 197 female and 197 male patients admitted between 1984 and 2013 to one of four Dutch forensic psychiatric hospitals. Four groups were compared with respect to criminological characteristics, historical violence risk factors and psychiatric characteristics including incidents during treatment. The lowered PCL-R cut-off score of 23 as applied in the Female Additional Manual (FAM; de Vogel, de Vries Robbé, van Kalmthout, & Place, 2012) was used to define women with psychopathy. The four groups were: (1) women without psychopathy (PCL-R < 23), (2) women with psychopathy (PCL-R ≥ 23), (3) men without psychopathy (PCL-R < 30), and (4) men with psychopathy (PCL-R ≥ 30). Overall, it was found that women and men with psychopathy show multiple similarities in their personal and criminal histories, but there were also several gender differences. Women with psychopathy compared to men with psychopathy committed more fraud, offended more often out of relational frustration, were more often diagnosed with the Borderline Personality Disorder, and showed less physical violence, but more manipulative and self-destructive behavior during treatment. Overall, women obtained lower scores on the PCL-R than men. Predictive validity of the PCL-R for physical violence during treatment was good for men and moderate for women. When verbal violence was included in the definition of violence, the predictive validity of the PCL-R was good for both the female and male sample. Implications of this study for forensic practice are discussed and several directions for future research are provided.