1. Psychopathy and Criminal Recidivism in Female Offenders A 10-Year Follow-up of a Nationwide Sample Weizmann-Henelius, Ghitta Grönroos, Matti Eronen, Markku Gammelgård, Monica Putkonen, Hanna 9th Nordic Symposium of Forensic Psychiatry 2011

2. Background  Psychopathy has been identified as a robust predictor of both future violence and general criminal recidivism Hemphill, Hare, & Wong, 1998; Leistico, Salekin, DeCoster, & Rogers, 2008: Salekin, Rogers, & Sewell, 1996  The PCL-R is the most frequently used operational definition of psychopathy and part of most violence risk assessment tools Quinsey, Harris, Rice, & Cormier, 1998; Webster, Douglas, Eaves, & Hart, 1997  Research has been conducted in male populations and the applicability of the construct to females raises concerns Forouzan & Cooke, 2005; Kreis, 2009; Nicholls & Petrila, 2005; Logan & Blackburn, 2009

3. 9th Nordic Symposium of Forensic Psychiatry 2011 Background  Women have  Lower total and factor scores  Lower base rates of psychopathy Salekin, Rogers, Ustad & Sewell. 1998; Vitale Smith, Brinkley & Newman, 2002; Weizmann-Henelius, Viemero, & Eronen, 2004  The Three-factor model is a better fit for female data than the traditional two-factor model Jackson, Rogers, Neumann, & Lambert. 2002; Warren et al., 2003; Weizmann- Henelius, Putkonen, Grönroos, Lindberg, Eronen, & Häkkänen, 2010  Gender differences in item factor loadings, comorbidity and manifestation of psychopathy Cale & Lilienfeld, 2002; Forouzan & Cooke, 2005; Kreis, 2009; Salekin, Rogers, & Sewell, 1997; Schrum & Salekin, 2006 cont’d…

4. 9th Nordic Symposium of Forensic Psychiatry 2011 Background  Studies on predictive validity of the PCL-R in females have been conflicting Verona & Vitale, 2007  Some studies report PCL-R to be a valid predictor for both general and violent recidivism in females Nicholls, Ogloff, & Douglas, 2004; Loucks & Zamble, 2000; Richards, Casey, & Lucente, 2003  The Affective and Interpersonal factor 1 has been a moderate predictor  The Behavioral and Lifestyle factor 2 has not been an accurate predictor Richards, Casey, & Lucente, 2003; Salekin, Rogers, Ustad, & Sewell, 1998  Other studies report that PCL-R has not predicted violent recidivism de Vogel & de Ruiter, 2005; Warren et al., 2005 cont’d…

5. 9th Nordic Symposium of Forensic Psychiatry 2011 Aim of the Study  The aim of the study was to examine the predictive validity of psychopathy for violent and non-violent criminal recidivism among female offenders during a 10-year follow-up.

6. 9th Nordic Symposium of Forensic Psychiatry 2011 Methods – the s ample  A nationwide sample of violent female offenders 61 (56%) female offenders of a total of 109 Incarcerated in 1999 – 2000 The average follow period was 8.1 years (SD 2.5; range 0.5-10.7) and median 9.2 years 50 (82 %) offenders had been released 48 offenders had been assessed for psychopathy

7. 9th Nordic Symposium of Forensic Psychiatry 2011 Background Mean age 45.1 (SD 10.7, range 28-70) 18 (38%) married or in a common-law relationship 34 (71%) children 8 (17%) cared for their children 26 (54%) vocational examination 9 (19%) working at the time of data collection Methods – the sample cont’d…

8. 9th Nordic Symposium of Forensic Psychiatry 2011 Psychiatric history 39 (81%) diagnose of personality dirsorder 27 (56%) antisocial Pd 19 (40%) borderline Pd 14 (29%) been in inpatient care 4 (8%) diagnose of psychosis 36 (75%) substance abuse or dependency Methods – the sample cont’d…

9. 9th Nordic Symposium of Forensic Psychiatry 2011 Methods – the sample Criminal history 29 (60%) homicide conviction 19 (40%) conviction of other violent offences 33 (69%) prior non-violent offences 30 (63%) at least two convictions of violent crimes 19 (40%)victim emotionally close to the offender cont’d…

10. 9th Nordic Symposium of Forensic Psychiatry 2011 Methods – data collection Initial data collected in 1999-2000 Official records A structured interview The PCL-R Data on recidivism collected in July 2010 from the National Crime Register Recidivism defined as reconviction of a violent or a non-violent offence during the follow-up period.

11. 9th Nordic Symposium of Forensic Psychiatry 2011 Methods – data analyses Predictive validity of the PCL-R was evaluated using ROC analyses and Pearson point-biserial correlation. Binary logistic regression was used to examine the relationship between violent recidivism and dichotomous scores of the PCL-R items rated as present or absent.

12. 9th Nordic Symposium of Forensic Psychiatry 2011 Results – recidivism Of the 48 offenders  16 (33.3%) were reconvicted of a violent crime  2 of homicide  1 of attempted homicide  13 of assault  11 (22.9%) were reconvicted of a non-violent crime  21 (43.8%) of either a violent or non-violent crime  None of the forensic psychiatric patients had reoffended

13. 9th Nordic Symposium of Forensic Psychiatry 2011 Results Prevalence of psychopathy  10 (20.8%) cut-off ≤ 25  6 (12.5%) cut-off ≤ 30 cont’d…

14. 9th Nordic Symposium of Forensic Psychiatry 2011 Results a Mann-Whitney U-test PCL-R Violent recidivists n = 16 Non-violent recidivists n = 32 p a Mean SD Factor 1 2.1 1.8 1.9 1.8.585 Factor 2 4.8 2.3 4.2 2.3.372 Factor 3 6.4 1.8 4.4 3.2.041 Factor 4 5.0 1.9 3.1 2.7.018 Total score20.3 6.715.3 9.4.032 Three-factor13.3 5.110.3 6.4.072 cont’d…  PCL-R: difference between violent and non-violent recidivsts

15. 9th Nordic Symposium of Forensic Psychiatry 2011 Results  ROC analysis: Violent Recidivism a Standard error * p <.05 PCL-RAUCSE a 95%CI b r PB Factor 1.548.086[.378-.717].067 Factor 2.579.088[.407-.751].136 Factor 3.682*.076[.533-.830].322* Factor 4.710*.074[.566-.854].350* Total score.691*.076[.542-.841].272 Three-factor.660.079[.505-.816].235 cont’d…

16. 9th Nordic Symposium of Forensic Psychiatry 2011 Results  ROC analysis: Non-Violent Recidivism a Standard error * p <.05 PCL-RAUCSE a 95%CI b r PB Factor 1.671.077[.521-.822].098 Factor 2.623.088[.450-.796].216 Factor 3658.077[.502-.804].212 Factor 4.633.083[.470-797].119 Total score.689*.077[.539-.839].201 Three-factor.709*.076[.561-.857].220 cont’d…

17. 9th Nordic Symposium of Forensic Psychiatry 2011 Results  Adjusted ORs with 95% CI of significant PCL-R items a Adjusted for time of release from incarceration PCL-R ItemAdjusted a Impulsivity 8.8 (1.0–75.6) Revocation of Conditional Release 7.7 (1.5-40.0) Criminal Versatility16.2 (1.9-139.6) cont’d…

18. 9th Nordic Symposium of Forensic Psychiatry 2011 Conclusions  The predictive validity of the PCL-R in the female sample was not found to be good  neither for violent recidivism  nor for non-violent recidivism  Impulsivity, which is an important characteristic of psychopathy, borderline and antisocial personality disorders, is crucial in female violent and non-violent recidivism

19. 9th Nordic Symposium of Forensic Psychiatry 2011 Conclusions  Gender differences in predictive accuracy of psychopathy may be related to  the kind of offences conducted by males and females  Psychopathy manifests differently in women  Inability of the PCL-R to capture the symptoms in women  the PCL-R may not assess psychopathy accurately in women  The PCL-R should be modified for women a new instrument should be developed cont’d…

20. 9th Nordic Symposium of Forensic Psychiatry 2011 Thank you for your attention! Ghitta Weizmann-Henelius Vanha Vaasa Hospital Finland ghitta.weizmann-henelius @ vvs.fi