Summary
Summary of all articles of course 4.2 etiology of offender types and forensic psychology
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This summary includes all the articles for course 4.2, including notes on all lectures.
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Overview summary block 4.2Week 1
Lau (2019) Latent class analysis identified phenotypes in individuals with SSD
Van Dongen (2014) Antisocial personality characteristics and psychotic symptoms
Darrell-Berry (2016) The relationship between paranoia and aggression in psychosis
Hodgins (2018) Wiley-Blackwell handbook of forensic neuroscience chapter 10
Stephane (2021) Psychopathy
Brazil (2016) Contemporary approaches to psychopathy
Lectures
Week 2
Robertiello (2007) Can we profile sex offenders?
Ward (2016) The integrated theory of sexual offending-revised
Seto (2017) The motivation-facilitation model of sexual offending
Lectures
Week 3
Ward (2018) Neuroscience in forensic settings: origins and recent developments
De Brito (2018) The neurobiological underpinnings of psychopathy
Blair (2019) Dysfunctional neurocognition in individuals with clinically significant psychopathic traits
Van Dongen (2020) The empathic brain of psychopaths
Burgess (2020) A brief review of the relationship of executive function assessment and violence
Jansen (2020) Traumatic brain injury and its relationship to previous convictions, aggression, and
psychological functioning
Allely (2018) Neurobiology of brain injury and its link with violence and extreme single and multiple
homicides
Lectures
Overview important brain areas
Week 4
Poldrack (2018) Predicting violent behavior: what can neuroscience add?
Kiehl (2018) Age of gray matters? Neuroprediction of recidivism
Delfin (2019) Prediction of recidivism in a long-term follow-up of forensic psychiatric patients
McRae (2018) Forensic neuropsychology in the criminal court: a socio-legal perspective
Malatesti (2020) The insanity defense without mental illness?
Lectures
, Week 1 – offender types 1: psychosis and psychopathy
Learning goals:
1. What are disorders mostly associated with insanity?
2. What is the difference between ES, LS and FO? What characterizes them?
3. What is the relationship between paranoid/persecutory delusions and violence?
4. What is psychopathy? How does it differ from ASPD?
5. What is assessed with the PCL-R? What is F1 and F2?
Lau, S. et al. (2019) Latent class analysis identified phenotypes in individuals with
schizophrenia spectrum disorder who engage in aggressive behavior towards others
Evidence demonstrates that both men and women with schizophrenia spectrum disorder (SSD) have
an elevated risk of being convicted of non-violent criminal offences, a higher risk of being convicted of
violent criminal offences, and an even higher risk of being convicted of homicide. As a group,
offenders suffering from SSD seem to be very heterogeneous. Efforts have been made to structure
this heterogeneity, since this could lead to the identification of different patient pathways to criminal
offending.
One of these approaches is Hodgins’ theoretical framework. This is a typology investigating offender
patients suffering from severe mental illness. Evidence has been found for 2 out of 3 subgroups of
offenders affected by SSD; early starters (ES) and late starters (LS). However, differences in
operationalization exist, with ES being either committing an offence before age 18 or being diagnosed
with conduct disorder before age 15, while late starters were operationalized as either committing an
offence after age 18, or not being diagnosed with conduct disorder before age 15.
ES were generally found to have grown up more frequently in deprived families or separated from their
biological parents, to have experienced physical abuse, to perform poorly in school, to have conduct
problems, to use alcohol and illegal substances, and to commit a greater variety and number of crimes
before being diagnosed with severe mental illness, often in addition to a personality disorder.
More recent research has also found evidence for a third subgroup of offenders, late late starters
(LLS) or first offenders (FO). This is a small group of predominantly male offenders in their late 30s
with chronic schizophrenia, but without any prior history of aggressive or antisocial behavior, who
typically engage in (actual or attempted) homicide of those caring for them. The present study is
designed to resolve inconsistencies about the subgroups and their operationalizations.
Early starters (ES)
Patients in the subgroup ‘class 1’ seem to have the best clinical match to Hodgins’ description of early
starters (ES) and are estimated to include 39% of the study population. They most probably face
multiple challenges as minors, including disciplinary sanctions, being diagnosed with a conduct
disorder, receiving mental health treatment, being the victim of physical abuse and emotional neglect,
growing up separated from their biological parents, using legal and illegal substances, repeating a
year in school, and not graduating from mandatory schooling.
Their parents most probably also use illegal substances and alcohol. Patients in this subgroup are
most probably younger than 21 years old when first prodromal symptoms of an SSD are document,
diagnosed, a first psychiatric inpatient treatment is given, and the index offence is committed. They
most probably abuse alcohol and cannabis, but not other illegal substances. They have the highest
probability of receiving more than 5 inpatient treatments and more than 4 criminal registry entries by
the time they enter forensic inpatient treatment. Offences most probably include property crime,
offences against the weapons act, and petty offences such as transgressions of traffic law or the
controlled substances act. They are most likely single, unemployed, and homeless.
Late starters (LS)
Estimated characteristics of this subgroup (estimated to compose 40% of the study population) seem
to best resemble those described as late starters (LS). They reveal the lowest probability of having
experienced physical abuse as minors and the highest probability of refraining from alcohol use. Age
of estimated illness onset, first diagnosis of an SSD, first psychiatric inpatient treatment, as well as first
criminal registry entry is most probably between 21 and 35. Crimes committed seem to be similar to
,those committed by early starters, but include fewer petty offences, fewer property crimes, and fewer
threats and coercion.
First offenders (FO)
Patient characteristics in class 3 (21% of the sample) seem to best fit offenders referred to as late late
starters or first offenders. They have least probably been diagnosed with a conduct disorder as a
minor. They most probably use illegal substances, but least probably cannabis. Age of estimated
illness onset, first diagnosis of SSD, first psychiatric inpatient treatment, first criminal registry entry,
and index offence are most probably after the age of 35. Previous offences are most likely to include
sexual offences, and the index offence is most likely to involve threat or coercion. They are more likely
married and female.
Pertaining to all three subgroups, the two most probable index offences are attempted or executed
homicide and assault, confirming prior research noting there may be more differences in offender than
offence characteristics.
Discussion
The study confirms the existence of the three subgroups of offenders and the results are able to
reduce doubts raised by inconsistencies in prior research. Nonetheless, there are two major
shortcomings when the sole parameter for subgrouping is age at either first symptoms, first inpatient
treatment, or diagnosis. First, offending may delay treatment of SSD and thus result in false
subgroupings of offender patients. Second, whether women are analyzed separately as proposed in
recent research on psychosis in women, or together with male patients may also have an impact. It’s
estimated that 20% of women will be diagnosed with schizophrenia after the age of 40 and generally
4-6 years later than men. Using age at first criminal registry entry may serve as a fair differentiator.
Van Dongen, J. et al. (2014) Anti-social personality characteristics and psychotic
symptoms: Two pathways associated with offending in schizophrenia
Recent reviews have shown that there is a small but significant relationship between psychosis and
(violent) criminal behavior. The relationship between schizophrenia and violent crime, including
homicide, may be stronger than that between schizophrenia and non-violent crimes. A number of
researchers have suggested that there are distinct subgroups of offenders with schizophrenia,
subdividing variously according to age of onset of offending and/or co-morbidity of personality
disorder.
Hodgins has suggested 3 types of offenders with schizophrenia: early starters, late starters, and late
first offenders. Early starters show anti-social personality characteristics early in life, which may be
reflected in a childhood history of conduct problems. They may be similar to the ‘life course persistent’
delinquent group defined by Moffitt, except for the fact that they also develop schizophrenia. Late
starters, also called adult starters, usually start offending in adulthood after the onset of a major mental
disorder, such as schizophrenia. Their criminal behavior is more likely to be attributable to cognitive
and perceptual (positive) symptoms of the disorder.
Hodgins also claims that once late starters have started their criminal behavior, they will repeatedly
engage in criminal behavior and violence towards others, although others have shown that people with
schizophrenia desist earlier than people in the general population or than other psychiatric patients. A
further subgroup of late first offenders, who suddenly commit a very serious offence after the onset of
their schizophrenia, has also been suggested.
An earlier study looked at the three-group typology and found no differences between the three
offender groups regarding positive psychotic symptoms. This seems to be inconsistent with the
hypothesis that the offending of late starters and late first offenders is attributable to positive psychotic
symptoms, whereas that of the early starters is not. The main aim of the present study is to test the
relative role of personality and positive symptoms of schizophrenia within a sample of patients and
non-psychotic offenders.
Is the offending of early starters associated with premorbid anti-social personality disorder?
Anti-social personality diagnosis or traits, psychopathic traits, disruptive behavior disorders and
substance use disorders other than alcohol were more prevalent amongst early starters than non-
, psychotic offenders, as were conduct problems in youth. Early starters were less likely to have used
alcohol than non-psychotic offenders. A higher proportion of early than late starters had anti-social
personality characteristics, substance use diagnoses and conduct problems in adolescence.
Is the offending of late starters and first offenders associated with positive symptoms of the
schizophrenic disorder?
A higher proportion of early starters had persecutory and/or grandiose delusions than did the non-
offenders with psychosis. The same pattern was apparent for the late starters and the late first
offenders. The offender groups with psychosis didn’t differ from each other in the prevalence of
positive symptoms of psychosis.
Discussion
Early starters were similar to the non-psychotic offenders in most aspects of personality measured,
although the early-starter psychosis group was more likely to have specifically documented conduct
disorder problems. The hypothesis that late starters and late first offenders would be more likely to
have positive psychotic symptoms was sustained to the extent that the 2 groups of offenders with
psychosis who started offending after the diagnosis were more likely to have had psychotic symptoms
recorded than the non-offenders with psychosis. This was especially true with respect to grandiose
and persecutory delusions, but the early starters differed from the non-offenders with psychosis in this
respect too.
The results show that early-start offenders are characterized by anti-social personality characteristics,
such as conduct disorder problems at an early age, substance use and anti-social personality disorder
symptoms. Presence of psychotic symptoms pertinent to the offending did not distinguish the groups.
This may be explained in 2 ways. First, it may be that early starters start their offending because of
early anti-social personality characteristics and subsequently develop a schizophrenic disorder, but the
symptoms are co-incidental to their offending. Alternatively, early starters may start their offending
because of anti-social personality characteristics, but subsequent psychotic symptoms are associated
with development or maintenance of the offending.
It seems likely that in both late-onset offending groups, the offending is associated with positive
symptoms of the schizophrenic disorder, especially delusions, but not anti-social personality traits. The
findings are more strongly supportive of the two-pathway model, that there is one that may be
associated with delusions but is as or more strongly associated with anti-social personality
characteristics, and one that is associated more or less purely with delusional ideation.
It should be noted that research has suggested conduct problems may be a precursor of
schizophrenia, but of all the psychosis groups, only the early-start offenders showed this problem. The
results also showed that early starters were more likely to abuse substances other than alcohol. It may
be that conduct problems lead to the misuse of cannabis at an early age, thereby increasing the risk of
developing a psychotic disorder in those who already have this vulnerability.
Darrell-Berry, H. et al (2016) The relationship between paranoia and aggression in
psychosis
While not all people with a diagnosis of schizophrenia are violent, for those who are, violence and
aggression are major contributors to poor treatment outcomes and as such are detrimental to the well-
being of those who receive a diagnosis, their families, and society. Violence and aggression are
thought to exist on a continuum. Aggression has been defined as behavior that is intended to harm,
directed towards others. Violence is aggression that has extreme harm as its goal. Violence and
aggression in people with schizophrenia most often occur during periods of active or untreated
psychosis.
Paranoia, inclusive of persecutory delusions, is a common symptom of schizophrenia and represents
the unsubstantiated, yet intense and tenacious, belief that one is at threat of harm or persecution from
others. Paranoid individuals tend to generate other-blaming, externalizing causal attributions for
negative events, and over-attribute threat to ambiguous stimuli making it a pertinent symptom for
consideration in understanding aggression.
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