The accuracy of risk assessment instruments in the prediction of impulsive versus predatory aggression

Abstract

Actuarial violence risk assessments, many of which include the construct of psychopathy, have been shown to be superior to clinical judgment in the prediction of long-term risk of community violence and recidivism. While these instruments initially appeared to provide similarly accurate judgments of risk of institutional aggression, recent research has indicated that such assessments may be less robust in this setting. One explanation may lie in the types of aggression most frequently observed in each setting. Impulsive (or reactive/affective) is the type of physical aggression most commonly exhibited in psychiatric facilities. This research examines the relationship between risk assessments and aggression in an inpatient forensic setting, with such aggression categorized as impulsive, predatory or psychotic aggression. Consistent with previous research, impulsive aggression was the most frequent type observed (58%). Anger (as measured by the Novaco Anger Scale) and clinical issues (as measured by the HCR-20) were most associated with impulsive aggression, with AUC values of .73 and .71 respectively. In contrast, anger and psychopathy (as measured by the PCL-R) were more associated with predatory aggression, with AUC values of .95 and .84 respectively. Psychotic symptoms were highly associated with psychotically motivated aggression (AUC=.90). These results suggest that traditional violence risk assessments may have limited utility in predicting aggression in an institutional setting and that psychiatric symptoms and heightened affect are more relevant.

Fearless Dominance and Self-Centered Impulsivity Interact to Predict Predatory Aggression among Forensic Psychiatric Inpatients

“…In their results, Cornell and colleagues reported that Factor 2 correlated with predatory violence. More recent studies suggest that interpersonal features of psychopathy in particular may predict predatory aggression (i.e., controlled aggressive behavior undertaken to achieve a specific goal or outcome) specifically (e.g., Laurell, Belfrage, & Hellström, 2010;McDermott, Quanbeck, Busse, Yastro, & Scott, 2008;Vitacco et al, 2009;Walsh, Swogger, & Kosson, 2009). For example, McDermott, Quanbeck and colleagues reported that the Interpersonal facet of the PCL-R was moderately predictive of prospective incidents of predatory aggression (AUC = .67) among 238 forensic inpatients over an extensive follow-up period.…”

Predicting violence among individuals who engage in self-injury

“…High levels of impulsivity have been associated with violent or aggressive behaviour toward others (Berkowitz, 2008;Edwards, Scott, Yarvis, Paizis, & Panizzon, 2003;Fehon, Grilo, & Lipschitz, 2005), and many researchers classify or define violent behaviours as being either intentional and calculated or primarily impulsive in nature (Baratt, Stanford, Kent, & Felthous, 1997;McDermott, Quanbeck, Busse, Yastro, & Scott, 2008); thus, impulsivity may play an central role in the perpetration of some violent behaviours. In addition, in several well-validated and frequently used guides for assessing risk for violence (e.g., HCR-20; Webster et al, 1997), impulsivity is included as a stand-alone item, and therefore independently contributes to the overall risk assessment and prediction of risk for future violence.…”

The investigation of early warning signs of aggression in forensic patients by means of the ‘Forensic Early Signs of Aggression Inventory’

“…, McDermott et al . ). However, these tools are characterised by a relatively low number of items and a limited capacity to capture idiosyncratic warning signs typical of the individual patient.…”