The Index Offence Representation Scales; a predictive clinical tool in the management of dangerous, violent patients with personality disorder?

Abstract

Background Forensic professionals attach considerable importance to their patient's description of his or her index offence which is frequently used to inform the patient's management and predict future behaviour. However, despite the cardinal importance of the index offence there is no systematic approach to examining and formulating the patient's offence narrative. Aim To examine whether a clinical tool, which tapped into the patient's capacity to mentalize, could be developed from the index offence narratives of violent, personalitydisordered patients. To see whether this tool would capture how the patient represents his or her index offence and predict the patient's progress, in terms of institutional aggression, pro-social behaviour, inter-personal relationships and psychiatric symptomatology. Method This was a prospective, cohort study. The index offence narratives of 66 violent, personality disordered patients were obtained from a semi-structured interview and used to generate the Index Offence Representational Scales (IORS). The predictive validity of these scales was investigated across a range of outcome variables, controlling for the association between initial and final value of the dependent variable. Results The degree of interpersonal violence and malevolence as measured by the IORS predicted subsequent violent behaviour. In contrast to their actual aggressive behaviour these patients rated themselves as having fewer symptoms on the SCL-90-R and problems in interpersonal relationships on the IIP. A more empathic victim representation on the IORS predicted those patients who engaged better in the hospital's therapeutic regime. Conclusions The IORS may prove a useful tool to help clinicians predict both institutional aggression and pro-social engagement in these difficult to manage patients. Future replication studies would be useful to further validate the IORS.

States of Mind With Respect to Adult Attachment and Reflective Functioning in a Sample of Men Detained for Stalking: Evaluation and Clinical Implications

“…In this study, we used a cross-sectional design based on the administration of two clinical interviews in a sample of detained male stalkers in two northwest Italian correctional facilities. The research design focused on the textual data gathered from the AAI (George et al, 1985) and the Index Offense Interview (IOI; McGauley et al, 2013), which we analyzed at two levels using the standard coding procedure and interpretative phenomenological analysis (IPA; Brocki & Wearden, 2006;Levitt et al, 2017), within the context of qualitative analyses. We adopted the qualitative approach because it is traditionally used in clinical psychology (e.g., Silverman, 2016) and in attachment studies (Bateman & Fonagy, 2016;Main, 1993) to shed light on subjects' narrative mental content.…”

A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder

“…Deficits in social cognition in general and the capacity to link mental states to behaviour in particular are commonly identified in association with antisocial behaviour [28, 29]. Some (but not all [30]) individuals with ASPD show a blend of perspective-taking problems and difficulty in reading others’ mental states [31–37]; this is consistent with the mentalization literature’s deficit theory as well as other theories of antisocial behaviour [38, 39]. It has been suggested that one pathway to adult antisocial personality leads from early child conduct disorder via alcohol abuse in early adolescence to compromised function (and maturational delay) of the cognitive control system, of which mentalization is a part [40, 41], and which matures throughout adolescence and into early adulthood.…”

Cognitive mechanisms in a sample of detained stalkers: Evaluation of dissociative tendencies, impaired reflective function, and ruminative thought.

“…In addition, two clinical interviews were administered to the part of the sample who agreed. These instruments were the AAI (George et al, 1985) and the IOI (McGauley et al, 2013), which were recorded, transcripted verbatim, and then analyzed applying the RFS (Fonagy et al, 1998).…”

“…Similarly, Veglia and Castellino (2013), in a sample of 27 imprisoned Italian sex offenders, from RFS applied to both attachment and crime narratives, found clearly inadequate RF for the age and intelligence of the participants, and in some cases, negative, absent, weird, or distorted RF. Especially, when they are were telling their offence in the Index Offence Interview (IOI; McGauley et al, 2013), the RF tended to decline, when the participants were asked to reason on what they thought or felt when aggressive, about what they believed that the victim could have felt or thought. They showed, in these reports, a deep disconnection between emotions, desires, intentions, beliefs, and actions.…”