PCL-R Total Score Research Articles

Do PCL-R scores from state or defense experts best predict future misconduct among civilly committed sex offenders?

In a recent study of sex offender civil commitment proceedings, Murrie et al. (Psychol Public Policy Law 15:19-53, 2009) found that state-retained experts consistently assigned higher PCL-R total scores than defense-retained experts for the same offenders (Cohen's d > .83). This finding raises an important question about the validity of these discrepant scores: Which type of score, state or defense evaluator, provides the most useful information about risk? We examined the ability of PCL-R total scores from state and defense evaluators to predict future misconduct among civilly committed sex offenders (N = 38). For comparison, we also examined predictive validity when two state experts evaluated the same offender (N = 32). Agreement between evaluators was low for cases with opposing experts (ICCA,1 = .43 to .52) and for cases with two state experts (ICCA,1 = .40). Nevertheless, scores from state and defense experts demonstrated similar levels of predictive validity (AUC values in the .70 range), although scores from different types of state evaluators (corrections-contracted vs. prosecution-retained) did not. The finding of mean differences between opposing evaluator scores, but similar levels of predictive validity, suggests that scores from opposing experts in SVP cases may need to be interpreted differently depending on who assigned them. Findings have important implications for understanding how rater disagreement may relate to predictive validity.

Associations among childhood abuse and psychopathy facets in male sexual offenders.

In the search for causes of psychopathy, the literature historically focuses on biological and temperamental differences. In comparison, this literature overshadows that of psychosocial risk factors for the development of psychopathy, namely childhood maltreatment. The current study examines the association between specific types of maltreatment (i.e., physical, emotional, sexual abuse, neglect) and PCL-R total and facet scores among a sample of 223 adult men convicted of sexual offenses and evaluated for civil commitment. Results indicate that childhood sexual abuse is associated with higher PCL-R total scores and facets tapping a grandiose and manipulative interpersonal style, impulsive-irresponsible lifestyle, and antisocial behavior. Also, childhood physical abuse and neglect are associated with antisocial behavior. Emotional detachment traits of psychopathy (i.e., lack of empathy, shallow affect) are associated with childhood neglect for child molesters, although rapists scored higher on these traits irrespective of neglect history. Theoretical and practical implications are discussed.

Psychopathy, PCL-R, and MAOA genotype as predictors of violent reconvictions

The Revised Psychopathy Checklist (PCL-R) has shown a moderate association with violence. The efficacy of PCL-R in varying monoamine oxidase A ( MAOA) genotypes is, however, unexamined. The aim of this study was to investigate the effect of PCL-R and psychopathy on the risk for violent reconvictions among 167 MAOA genotyped alcoholic offenders. Violent reconvictions and PCL-R scores among violent offenders were assessed after a 7-year non-incarcerated follow-up. Regression analysis was used to evaluate the alcohol exposure and age-adjusted effect of PCL-R score and psychopathy on the risk for reconvictions among differing MAOA genotypes. Results suggest that the PCL-R total score predicts impulsive reconvictions among high-activity MAOA offenders (6.8% risk increase for every one-point increase in PCL-R total score, P = 0.015), but not among low-activity MAOA offenders, whereas antisocial behavior and attitudes predicted reconvictions in both genotypes (17% risk increase among high-activity MAOA offenders and 12.8% increase among low-activity MAOA offenders for every one-point increase in factor 2 score). Both narcissistic self-image with related interpersonal style (factor 1 score) and psychopathy (PCL-R ≥ 30) failed to predict future violence. Results suggest that the efficacy of PCL-R is altered by MAOA genotype, alcohol exposure, and age, which seems important to note when PCL-R is used for risk assessments that will have legal or costly preventive work consequences.

PCL-R Psychopathy and its Relation to DSM Axis I and II Disoders in a Sample of Male Forensic Patients in a Belgian Security Hospital

The purpose of this study was to examine the relationship between the psychopathy, assessed using the PCL-R, and DSM Axis I and II disorders in a Belgian adult male forensic patients (N= 84). Regarding Axis I disorders, diagnoses of psychopathy were associated only with diagnoses of substance abuse/dependence. Regarding Axis II disorder, psychopathy diagnoses were associated with antisocial personality disorder. This relationship was asymmetrical, as psychopathy was highly predictive of antisocial personality disorder but not vice versa. Furthermore, there was a significant positive association between antisocial personality disorder and PCL-R total scores, Factor 1 and 2 scores, and Facet 1, 3, and 4 scores. There was also a significant positive correlation between narcissistic personality disorder and PCL-R Factor 1 and Facet 1 scores. These findings are congruent with the international research literature and have potential therapeutic relevance, as Cluster B disorders including antisocial personality disorders are associated with low treatment motivation and compliance (Widiger & Corbitt, 1997; Robins, Tipp, & Przybeck, 1991). Overall, diagnoses of psychopathy were rather specific and unrelated to most major mental disorders (psychoses, mood or anxiety disorders) and personality disorders (Clusters A and C).

Backgrounds and characteristics of arsonists

The aim of this study was to gain more insight in the backgrounds and characteristics of arsonists. For this, the psychiatric, psychological, personal, and criminal backgrounds of all arsonists ( n = 25), sentenced to forced treatment in the maximum security forensic hospital “De Kijvelanden”, were compared to the characteristics of a control group of patients ( n = 50), incarcerated at the same institution for other severe crimes. Apart from DSM-IV Axis I and Axis II disorders, family backgrounds, level of education, treatment history, intelligence (WAIS scores), and PCL-R scores were included in the comparisons. Furthermore, the apparent motives for the arson offences were explored. It was found that arsonists had more often received psychiatric treatment, prior to committing their index offence, and had a history of severe alcohol abuse more often in comparison to the controls. The arsonists turned out to be less likely to suffer from a major psychotic disorder. Both groups did not differ significantly on the other variables, among which the PCL-R total scores and factor scores. Exploratory analyses however, did suggest that arsonists may differentiate from non-arsonists on three items of the PCL-R, namely impulsivity (higher scores), superficial charm (lower scores), and juvenile delinquency (lower scores). Although the number of arsonists with a major psychotic disorder was relatively low (28%), delusional thinking of some form was judged to play a role in causing arson crimes in about half of the cases (52%).

Inter‐rater reliability of the PCL‐R total and factor scores among psychopathic sex offenders: are personality features more prone to disagreement than behavioral features?

Despite considerable support for the inter-rater reliability of the Hare Psychopathy Checklist--Revised (PCL-R; Hare, 1991, 2003) in research contexts, there is increasing concern that scores from this instrument may be considerably less stable across examiners in applied contexts, particularly when scoring is based on separate interviews. The present study examines archival data from a sample of imprisoned sex offenders (n = 20) who obtained relatively high PCL-R total scores (> or =25) and were administered this instrument on a second occasion by a different examiner. Intraclass correlations for the total and Factor 2 score were lower than those generally reported in research studies. Of greater concern, Factor 1 scores were only negligibly related to each other (ICC(A,1) = .16). Correcting for potential range restriction among these high scoring individuals resulted in total and Factor 2 score measures of agreement that were somewhat more consistent with published research, but Factor 1 continued to display exceedingly poor agreement across examiners.

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence of psychopathy, and the distribution and correlates of psychopathic traits in a representative national sample of prisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage, cross-sectional survey of prisoners in England and Wales in 1997 (n=496). Poisson regression analysis was carried out to examine independent associations between correlates and PCL-R total and factor scores. The prevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and 1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlated with younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial, narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disorders or schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among male prisoners in England and Wales but lower than in most previous studies using selected samples. However, most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme of a spectrum of social and behavioral problems among prisoners.

The Utility of the Personality Assessment Inventory in the Assessment of Psychopathy

To assess the utility of the Personality Assessment Inventory (PAI; Morey, 1991) in the assessment of psychopathy, 92 male criminal defendants were administered the Psychopathy Checklist Revised (PCL-R; Hare,1991) and the PAI. Included were only those defendants who produced valid PAI protocols. Those scoring at least 30 on the PCL-R scored significantly higher on the Antisocial Features subscales ANT-A (Antisocial Behaviors) and ANT-S (Stimulus Seeking) than either the Low (PCL-R; total less than 20) or Moderate (PCL-R; total = 20–29) psychopathy groups. No significant differences between psychopathy groups were observed for ANT-E (Egocentricity). Regression analyses with PCL-R total, factor 1 and factor 2 of the PCL-R as the criteria, and the Antisocial Features subscales as the predictors revealed that only ANT-A significantly correlated with PCL-R total score and ANT-A and ANT-S with Factor 2. None of the Antisocial features scales correlated significantly with PCL-R factor 1. The results demonstrate that the PAI is capable of assessing the behavioral but not the affective/interpersonal aspects of psychopathy.

Do some evaluators report consistently higher or lower PCL-R scores than others? Findings from a statewide sample of sexually violent predator evaluations.

This study examined whether some evaluators tend to report consistently higher or lower scores than other evaluators for offenders on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991, 2003). Data for the study were PCL-R total scores for 321 sex offenders, evaluated by 1 or more of 20 different state-contracted evaluators, during a process of screening for civil commitment as sexually violent predators. More than 30% of the variability in PCL-R scores was attributable to differences among evaluators, with mean PCL-R scores given by 2 of the most prolific evaluators differing by almost 10 points. In a subsample of 22 offenders evaluated with the PCL-R on 2 or more occasions, evaluator agreement (intraclass correlation -sub(A,1) = .47) was low. Together, these findings raise concerns about the field reliability of the PCL-R and suggest the need for research examining field reliability of other measures used in forensic assessment.

Deliberate self-harm and suicide attempt in custody: Distinguishing features in male inmates' self-injurious behavior

Self-injurious behavior involving deliberate self-harm and suicide attempts by inmates while under custodial authority is a major problem for prisons and jails (prevalence, legal obligation for suicide prevention, and stress for officers). The differentiation of “serious” vs. “non-serious” and often manipulative suicide attempts as distinct phenomena, each with its own clinical features, is controversially discussed in current literature and a challenge for every diagnostician. If distinct clinical presentations and histories can be observed, an estimation of the seriousness of each act of self-injurious behavior can be simplified, whereby appropriate treatment of the individual case becomes possible. The aim of the study was to find differences between self-injurious behavior of “low seriousness” (i.e. low lethality and low suicidal intent) and of “high seriousness”. Therefore, inmates showing self-injurious behavior were divided into subgroups of deliberate self-harm and suicide attempters on the basis of the act's intent and lethality. This was followed by a comparison of the clinical presentations of the individual inmates constituting the subgroups. Hence, 49 inmates showing self-injurious behavior were interviewed and tested with a variety of instruments (SCID-I and II, PCL-R, BDI-II, BHS, BSS, SIS, etc.), and their prison and health files were examined. The results indicate significant correlations between seriousness and some demographic, prison-related variables as well as different measures of depression. Negative, but nonsignificant correlations could be observed with regard to cluster B personality disorders. The PCL-R total score as well as PCL-R factor 1 showed a statistical trend for negative correlations with measures of seriousness. Inmates showing deliberate self-harm and suicide attempters seem to differ in a number of ways. Implications on how the individual prisoner should be treated are discussed.

Examining the utility of the PCL:SV as a screening measure using competing factor models of psychopathy.

The correspondence between the Hare Psychopathy Checklist: Screening Version (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995) and the Hare Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991, 2003) was examined in forensic (N = 175) and correctional (N = 188) samples. Intermeasure correlations for Total scores (.95 forensic, .94 correctional) and the original 2-factor, D. J. Cooke and C. Michie's (2001) 3-factor, and R. D. Hare's (2003) 4-facet models (range = .87-.95) were high. Area under the curve values for the PCL:SV were .98 in both samples (cutoff = PCL-R Total score of 25). The PCL:SV performed well as a screen, maximizing false positive relative to false negative errors. Close correlations for prediction of violent recidivism in the correctional sample were obtained for the PCL-R (.42) and PCL:SV (.37). Results indicate the robust relation between the measures is maintained whether they are completed on the basis of file review only or file plus interview and whether the same or different raters score the measures.

Évaluation du trouble de la personnalité sadique en relation avec la psychopathie auprès de patients internés en hôpital psychiatrique sécuritaire

The population was composed of 76 male patients (mean age=36.14). All of them having committed a violent offence indexed in their institutional file: (1) sexual offences on children; (2) rapes of adult women; (3) homicide offence; and (4) assaults and batteries. TPS was defined by the following 8 diagnostic criteria as described in DSM III-R: 1) has used physical cruelty or violence for the purpose of establishing dominance in a relationship; 2) humiliates or demeans people in the presence of others; 3) has treated or disciplined someone under his or her control unusually harshly; 4) is amused by, or takes pleasure in, the psychological or physical suffering of others; 5) has lied for the purpose of harming or inflicting pain on others 6) gets other people to do what he or she wants by frightening them 7) restricts the autonomy of people with whom he or she has a close relationship; 8) is fascinated by violence, weapons, martial arts, injury, or torture. These criteria were assessed from (a) clinical and institutional files and (b) clinical collateral informations. TPS assessment was conducted by two -trainees in clinical psychology (kappa=0.87; n=20). The assessment of psychopathy was conducted according to the guidelines of the Hare psychopathy checklist manual (PCL-R, 1991, 2003): coding of clinical and institutional files and semi-structural clinical interviews. The PCL-R is mainly composed by 2 factors: factor 1 "Emotional detachment" describing the core psychological component of psychopathy, and factor 2 "Chronically antisocial factor" reflecting behavioral instability and antisocial life style. The total cut-off score for the inclusion of the diagnosis was 25. The prevalence of TPS in the population was 25% (n=19) and is congruent with the large range described in the literature (0.5 to 33%). The most frequent criteria were 6 (gets other people to do what he or she wants by frightening them), 1 (has used using physical cruelty or violence for the purpose of establishing dominance in a relationship) and 3 (has treated or disciplined someone under his or her control unusually harshly). The most sensible criteria were: 7 (restricts the autonomy of people with whom he or she has a close relationship), 8 (major interest for violence) and 4 (pleasure in the psychological or physical suffering of others). The most specific criteria were: 3 (has treated or disciplined someone under his or her control unusually harshly), 6 (gets other people to do what her or she wants by frightening them), 4 (takes pleasure in the psychological or physical suffering of others) and 1 (has used physical -cruelty or violence for the purpose of establishing dominance in a relationship). As concerns psychopathy, the mean of factor 1, factor 2 and the PCL-R total scores were 7.40, 9.08 and 18.67. Thus, 38% of patients were considered as "low psychopaths", 36% were considered as "moderate psychopaths" and 26% were considered as "high psychopaths". In spite of few significant positive correlations between some TPS and PCL-R criteria, TPS diagnosis was not significantly correlated with factors 1, factor 2, nor with total score of the PCL-R. The mean psychopathy total score did not differ between sadistic and non-sadistic patients. Moreover, a two ways ANOVA comparing PCL-R factors 1 and 2 did not reveal any differences between sadism and non-sadism. Again, these comparisons did not support hypothesis of a strong association between TPS and psychopathy.

Reliability and Factor Structure of the Dutch Language Version of Hare's Psychopathy Checklist-Revised

The present study examined the interrater and internal reliability and factor structure of the Dutch language version of the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) in a sample of 107 patients admitted to a forensic psychiatric hospital. In addition, we evaluated the potential role of two different information sources, real-life interview versus videotaped interview, when scoring the PCL-R. Interrater reliabilities of individual items and the PCL-R total score were good to excellent. Good agreement on the categorical diagnosis of psychopathy was also obtained (weighted Cohen's k = .63 for simultaneous comparison of three raters). The internal consistency of the PCL-R was found to be high, as indicated by a Cronbach's alpha of 0.87, with an alpha of 0.83 for both Factor 1 and Factor 2. Comparisons between real-life and videotaped interview demonstrated that the information source did not influence the raters' coding. Confirmatory factor analysis (CFA) indicated that the two-factor structure obtained by Hare (1991) in the standardization samples did not fit the current data well. CFA also failed to confirm the three-factor model identified by Cooke and Michie (2001). Exploratory principal components analysis using oblique rotation extracted two main factors, which accounted for 44% of the variance. It is concluded that the Dutch language version of the PCL-R can be reliably rated by trained professionals, its factor structure resembles the traditional two-factor model to some extent, and future research should include larger samples of different populations such as prisoners and general psychiatric patients.

Generality of Psychopathy Checklist—Revised factors over prisoners and substance-dependent patients.

The Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) is an often-used device for assessment of adult antisociality. This research examined generalizability by replicating the 2-factor model for a sample of 326 male prisoners and assessing its congruence and relative reliability and specificity among 620 substance-dependent patients. Generality was assessed also across addiction subtypes (opioid, cocaine, and alcohol), age, gender, and ethnicity. The 2-factor model was found inappropriate for the substance-dependent samples, whereas a unidimensional model represented by the PCL-R total score was found generalizable across prison and substance-dependent samples.

Use of the Personality Assessment Inventory to assess psychopathy in offender populations.

The authors investigated the validity of the Antisocial Features (ANT) scale of the Personality Assessment Inventory (PAI; L. C. Morey, 1991) with respect to assessments of psychopathy in 2 offender samples. Study 1 included 46 forensic psychiatric inpatients who were administered the Screening Version of the Hare Psychopathy Checklist (PCL:SV; S. D. Hart, D. N. Cox, & R. D. Hare, 1995). In Study 2, 55 sex offenders were administered the Hare Psychopathy Checklist--Revised (PCL-R; R. D. Hare, 1991). ANT scores correlated highly with the PCL:SV total score (r = .54) and moderately with the PCL-R total score (r = .40). ANT tapped primarily behavioral symptoms of psychopathy rather than interpersonal and affective symptoms. Also, ANT had low to moderate diagnostic efficiency regarding diagnoses of psychopathy, suggesting that it may be better used as a dimensional rather than categorical measure of this construct.