Thomas Nilsson

• Doctor of Philosophy
• Professor at University of Gothenburg

This chapter explores the interplay between personality traits, particularly Self-Directedness and Cooperativeness, and psychosocial functioning in children with neurodevelopmental disorders, framed within the ESSENCE model (Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations). By re-analyzing data from Garcia, Anckarsäte...

Forensic mental health services (FMHS) involve restricting certain individual rights to uphold or promote other ethical values – the restriction of liberty in various forms is justified with reference to health and safety of the individual and the community. The tension that arises from this has been construed as a hallmark of the practice and an e...

Objectives Non-adherence to medication is common in the adult ADHD clinical group. The goal of this pre-registered study was to examine whether the DSM-5 Alternative Model of Personality Disorder (AMPD), generality personality dysfunction (LPFS-BF 2.0) or maladaptive personality traits (PID-5), can predict time to premature discontinuation of pharm...

Personality traits and personality disorders are related to ADHD and indicate dysfunction in clinical populations. The goals of this study were to examine how the DSM‐5 Alternative Model of Personality Disorder (AMPD) a) indicates the presence of ADHD and b) communicates information about dysfunction over and above ADHD diagnosis. A sample of 330 a...

Personality traits and personality disorders are related to ADHD and to indicate dysfunction in clinical populations. The goals of this study were to examine how the DSM-5 Alternative Model of Personality Disorder (AMPD) a) indicate presence of ADHD and b) communicate information about dysfunction over and above ADHD diagnosis. A sample of 330 adul...

Modern test theory supplements the more prevalent classic methods for assessing test properties. However, such an assessment of the commonly used sexual recidivism risk assessment instrument, Static-99R, has yet to be attempted. This study evaluated the psychometric properties of said instrument using Rasch analysis. The clinical cohort assessed co...

This study illustrates the impact on forensic psychiatric investigations (FPI) of time-specific scientific theories and moral normative considerations. A comparative historical perspective illustrates historical FPI procedures (i.e. methodology and focus), based on two matched FPI case reports from the 1930s: a man and a woman who had shot their re...

Background There are contradictory research findings regarding whether individuals with Autism Spectrum Disorders (ASDs) are more or less likely to commit crimes. The aims of the current study were to: (1) Describe psychiatric and crime-related characteristics of a large group of offenders with ASD who had undergone a Forensic Psychiatric Investiga...

Introduction Neurofilament light chain protein (NfL) is a fluid biomarker of neural injury measurable in cerebrospinal fluid and blood. Patients with different neurodegenerative disorders and mild traumatic brain injury display elevated levels of NfL. However, so far, elevated levels of NfL have not been demonstrated in persons with psychiatric dis...

Aim In studies on lethal and severe violence, male offenders have historically been in focus while female offenders, in comparison, have often been excluded. In this study, we aimed to characterize female violent offenders and compared those with and without a severe mental disorder (SMD). Method All females charged with lethal or attempted lethal...

Background: The aim of this study was to evaluate criminal outcomes of mentally disordered offenders in compulsory forensic psychiatric care during the year 2010 versus 2018. More specifically, we sought to identify the occurrence of new criminal sentences during ongoing treatment and possible factors associated with recidivistic criminality. Anot...

Background The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings. Methods Here, we investigated these a...

Existing screening instruments for Autism Spectrum Disorder (ASD) might be prone to detect a male manifestation of ASD. Here, we examined the 17 items from the ASD domain in the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC) for Differential Item Functioning (DIF). Data were obtained from the Child and Adolescent Twin Study in Sweden (...

This study presents findings of forensic inpatients’ experiences of their role in the risk assessment process. Eleven patients, recruited from two forensic psychiatric clinics in Sweden, participated in semi-structured interviews which were analyzed using qualitative content analysis. The analysis of their experiences resulted in the information of...

Background: Treatment of mentally disordered offenders (MDOs) is challenging as their behavior and clinical conditions can be traced to a complex constellation of major mental disorders, substance use and antisocial lifestyle. Finding subgroups of these offenders, which could guide treatment and risk assessment, is desirable. There are few long-ter...

Purpose This study compared the characteristics of a population of Swedish patients in forensic psychiatric care in the year 2010 and 2018, with the goal of identifying similarities and differences in sociodemographic and clinical outcomes during the study period. Findings Significant changes in patient characteristics and treatment aspects were f...

Background ADHD is a highly consequential disorder that is estimated to affect 2.5% of the adult population. Emerging models of psychopathology posit that disorders like ADHD can be usefully situated within general models of individual differences in personality, such as those recently implemented in the DSM and ICD for the diagnosis of personality...

‘The Static-99R is one of the most commonly used risk assessment instruments for individuals convicted of sexual offenses. It has been validated for use on many populations, but few studies specifically target and describe individuals with mental disorders. Additionally, research on the discriminative properties (how well the instrument separates r...

Background: ADHD is a highly consequential disorder that is estimated to affect 2.5% of the adult population. Emerging models of psychopathology posit that disorders like ADHD can be usefully situated within general models of individual differences in personality, such as those recently implemented in the DSM and ICD for the diagnosis of personalit...

Background Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff’s knowledge,...

Background: Personality traits, such as self-directedness (SD) and cooperativeness (CO), may be indicative of problematic alcohol and/or drug use. Objectives: The aim of this study was to quantify the association of substance use with SD and CO in a large cohort of adolescents. Method: A total of 6,917 individuals (58% women) at the age of 18...

2020), A bad start: The combined effects of early substance use and childhood ADHD and CD on patterns of criminality, substance abuse and psychiatric comorbidity among young violent offenders. Abstract: Substance abuse, conduct disorder (CD) and attention deficit/hyperactivity disorder (ADHD) are all known risk factors for developing aggressive beh...

This paper presents an in-depth interview study with individuals who are at the same time patients in forensic psychiatric services, and parties in recurring mental health law proceedings (MHLPs). While previous studies have highlighted issues with the rule of law that can arise when MHLPs prioritize concern for the mental health of the patient ove...

There is a lack of knowledge on mentally disordered sex offenders (MDSOs) targeting adult victims, especially regarding recidivism patterns and the specific subgroup with psychiatric disorders. This paper presents index offense data, clinical data, and recidivism patterns over up to 24 years in a cohort of 146 MDSOs, with and without psychotic diso...

Previous research has suggested that personality and cognitive functions are essential in the emergence of persistent aggressive antisocial behaviors and that character maturity could be an important protective factor against these behaviors. The aims of this study were (1) to determine associations between personality traits, intellectual ability,...

Background: Brief screening instruments focusing on autism spectrum disorder (ASD) that can be administered in primary care are scarce; there is a need for shorter and more precise instruments. The Autism-Tics, AD/HD and other Comorbidities inventory (A-TAC) has previously been validated for ASD reporting excellent validity. This study aims to det...

Autism spectrum disorder (ASD) is diagnosed more often in boys than girls. Here, we compared the degree of autism - and related disorders - symptomatology in boys and girls with a registered diagnosis of ASD. We used parent telephone interview A-TAC (Autism-Tics, ADHD and other Comorbidities) ratings of 30,392 twins aged 9 or 12 (including 308 boys...

Identifying associations between Temperament and Character Inventory (TCI) dimensions and PCL-R psychopathy facets in young male offenders

The risk of patients committing violence implies major challenges throughout the care process in forensic psychiatry and brings risk assessments to the fore. The aim was to explore nurses’ experiences of risk assessments for their care planning and risk management in forensic psychiatry. Data were collected through focus groups with 15 nurses. The...

Background: A specific personality profile, characterized by low character maturity (low scores on the self-directedness and cooperativeness character dimensions) and high scores on the novelty seeking temperament dimension of the temperament and character inventory (TCI), has been associated with aggressive antisocial behavior in male prison inmat...

Neurodevelopmental disorders, such as Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD), express aberrant neurocognitive functions in social communication, flexibility, and executive control from an early age, not seldom casting extensive consequences long into adulthood. They exist along a continuum from severe di...

In a sample of twins and their mothers we found, independent of zygosity, two clusters based on differences in the children’s (in)ability to be cooperative and self-directed and her/his level of reward dependence, together with differences in the mother’s levels of cooperativeness, self-directedness, reward dependence, and harm avoidance.

We examined the health effects of cultural activities and Well-Being Coaching among long-term unemployed Swedish young adults. While individuals receiving cultural activities only showed a slight decrease in anxiety, those receiving Well-Being Coaching showed significant increases in subjective well-being and decreases in depression, anxiety, and s...

Previous research has found a complex relationship between psychopathic traits, neurodevelopmental problems (NDPs), and conduct disorder (CD) in children. This study explores associations between psychopathic traits, assessed with the Child Problematic Traits Inventory—Short Version (CPTI-SV), and CD in children with and without coexisting NDPs (i....

Research stresses the importance of physical activity in general psychiatric care. There is very little research made in the area of forensic psychiatric care. The aim of this exploratory, cross-sectional study was to assess various physical, psychological, and health variables of patients under compulsory forensic psychiatric inpatient care, and t...

There is a need for instruments that can be used in correctional settings to measure changes in aggressive behaviors over a limited time period. This study aimed to validate an instrument (the Prison Adjusted Measure of Aggression, PAMA) that assesses specifically the past month's aggressive behaviors and is adapted for use in correctional faciliti...

Background: Reliable and easy to administer screening instruments focusing on neurodevelopmental disorders and associated conditions are scarce. The Autism-Tics, AD/HD and other Comorbidities inventory (A-TAC) has previously been validated and reporting good- excellent validity for several disorders. This article aims to expand these findings by i...

Furthering knowledge of the subset of incarcerated partner violent offenders distinguished by aggression, anger, and hostility is relevant, as these offenders are guilty of the more severe kinds of intimate partner violence (IPV). Our aim was to identify groups with different patterns of IPV among convicted young Swedish male offenders, using data...

The aim of this study was to characterize young dating violent offenders (DVO), and to compare them to the general population and to young offenders with violent crimes directed against other victims. We have used data from the Development of Aggressive Antisocial Behaviour Study, in all 264 young men, 18 to 25 years, convicted of violent crimes an...

Gender specific personality profiles in association with the level of aggressive antisocial behavior in offenders have not been previously investigated. In the present study we analyzed data collected from 65 male and 50 female offenders using structured protocols regarding criminal history (by criminal register data), trait aggression (by the Life...

Background Antisocial personality and psychopathic traits have constantly been found to accompany criminal and aggressive behaviors, but little attention has been given to aspects of character maturity and its relation to such behaviors. The present study investigated (1) whether level of character maturity (low, medium, and high) is associated wit...

Background: Forensic psychiatric patients present a challenge as they manifest severe mental disorders together with criminal behaviour. There are well-known risk factors for criminal behaviour in the general population, yet knowledge of what predicts reconviction in the Swedish forensic population in the long-term perspective is still insufficient...

This 3-year follow-up study compares background variables, extent of criminality and criminal recidivism in the form of all court convictions, the use of inpatient care, and number of early deaths in Swedish institutionalized adolescents (N = 100) with comorbid substance use disorders (SUD) and Attention-Deficit/Hyperactivity Disorder (ADHD) (n = 2...

Early psychosocial adversities and maladjustment, such as childhood maltreatment and school adjustment problems, have been linked to an increased risk of aggressive antisocial behaviors. Yet, clinical studies of subjects at the highest risk of persistence in such behaviors are rare, especially during the life-changing transition years of emerging a...

Homicide committed by female offenders is an understudied phenomenon. This study examines whether incidence rates of male-perpetrated and female-perpetrated homicide have changed from 1990 to 2010, and investigates similarities and differences between male and female homicide offenders, by examining a dataset comprising all cases of homicide in Swe...

Background: The character higher order scales (Self-directedness, Cooperativeness, and Self-transcendence) in the Temperament and Character Inventory are important general measures of health and well-being (Cloninger, 2013). Recent research has found suggestive evidence of common environmental influence on the development of these character traits...

Background. A person-centered approach focusing on the interaction of an individual’s temperament-character-life events is essential in the path of individuals’ well-being. In this context, three character traits, Self-directedness (e.g., self-acceptance, self-control, goal-directed behavior), Cooperativeness (e.g., social affiliation, social toler...

Background. Over the last few decades, an increasing number of studies have suggested a connection between neurodevelopmental problems (NDPs) and body mass index (BMI). Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) both seem to carry an increased risk for developing extreme BMI. However, the results are inconsi...

ABSTRACT FROM: Fazel S, Zetterqvist J, Larsson H, et al. Antipsychotics, mood stabilisers, and risk of violent crime. Lancet 2014;384:1206-14. What is already known on this topic The benefits of antipsychotics and mood stabilisers in the treatment of not only schizophrenia1 and bipolar disorder,2 but also major depression3 and borderline personalit...

It is rule rather than an exception that mental disorders occur in complex and manifold forms, and a number of models have been proposed to explain this co-occurrence or co-‘morbidity’. Autism spectrum disorders (ASD, i.e. autistic disorder, Asperger syndrome, and pervasive developmental disorder – not otherwise specified) are no exemption. Here, t...

This volume is one of the few books to explain in-depth the international crimes behind the scenes of substantive or procedural law. The contributors place a particular focus on what motivates participation in international crime, how perpetrators, witnesses and victims see their predicament and how international crimes should be investigated at lo...

Using a twin-sample, enriched with various types of mental health problems, we found that only one temperament trait (i.e., Persistence), was weakly related to IQ. Measures of agency (i.e, Self- directedness) and communion (i.e., Cooperativeness) were not. Hence, interventions targeting agentic and communal behaviour should not be limited by variat...

Neurobiological determinism has characterized later decades’ scientific approaches to the notion of free will. Scientists suggest that legal responsibility should be adjusted accordingly. We measured the genetic and environmental effects behind self-reported Self-directedness and Cooperativeness in a nation-wide population-based adolescent twin stu...

Rates of recidivism and types of recidivist crime have varied greatly in follow-up studies of child sexual abusers. In this long-term study of a population-based cohort (n = 193) and a nationwide clinic-referred study group (n = 166) of child sexual abusers, rates of recidivism and associations between index descriptors and outcomes were compared b...

Background. Previous research has supported gender-specific aetiological factors in oppositional defiant disorder (ODD) and conduct disorder (CD). The aims of this study were to identify gender-specific associations between the behavioural problems–ODD/CD-like problems–and the neurodevelopmental disorders–attention deficit hyperactivity disorder (A...

The Autism-Tics, AD/HD, and other Comorbidities (A-TAC) inventory is used in epidemiological research to assess neurodevelopmental problems and coexisting conditions. Although the A-TAC has been applied in various populations, data on retest reliability are limited. The objective of the present study was to present additional reliability data. The...

Ever since its historical beginnings during or after the French Revolution, psychiatric pioneers claimed expertise in the field of crime and punishment. Theirs was a humanistic stance directed against the cruel punishments that were considered ‘just’ and ‘necessary’ by their time. Their drive was the Enlightenment world-view, a revolutionary zest f...

To the best of our knowledge, the present register is the only nationwide forensic psychiatric patient register in the world. The aim of this article is to describe the content of the Swedish National Forensic Psychiatric Register (SNFPR) for Swedish forensic patients for the year 2010. The subjects are individuals who, in connection with prosecuti...

Identifying children with childhood-onset neurodevelopmental problems (NDPs, defined here as autism spectrum disorders [ASDs], attention-deficit/hyperactivity disorder [AD/HD], tic disorders [TDs], learning disorders [LDs] and development coordination disorder), using easily administered screening instruments, is a prerequisite for epidemiological...

Background: Accumulating evidence supports an intricate relationship between central nervous system inflammation, stress and personality. There are, however, few studies addressing this relationship in non-psychiatric populations. Objective: To investigate the relationship between inflammatory markers in serum and cerebrospinal fluid (CSF) and pers...

Background: The Child and Adolescent Twin Study in Sweden (CATSS) is an on-going, large population-based longitudinal twin study. We aimed (1) to investigate the reliability of two different versions (125-items and 238-items) of Cloninger's Temperament and Character Inventory (TCI) used in the CATSS and the validity of extracting the short version...

Table S1-Table S3. Table S1. Correlations between TCI dimension in the Brändström study. Correlation coefficients between the 125- and 238-items TCI dimensions showed in the black fields, those within the TCI −238 dimensions in white, and correlations within the TCI-125 dimensions in grey. Table S2. Correlations between TCI dimension in the Garcia...

To explore the links between neurodevelopmental disorders - attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) - and personality in a population-based, genetically sensitive study of children. A population-based sample of 1886 twins aged 9 and 12, enriched for childhood mental health problems, was recruited from the...

Objective: To describe criminal recidivism, especially violent recidivism, in a long-term follow-up of mentally disordered offenders sentenced to different types of sanctions. Subjects and methods: A population-based Swedish cohort of male offenders referred to pre-trial psychiatric investigations between 1988 and 1995, was sentenced to forensic...

The complexity and consequences of psychopathy are still debated, and its relation to other mental disorders, pathological personality traits, and criminality needs to be further investigated by clinical, longitudinal studies using structured diagnostic instruments. The present study used two groups of mentally disordered offenders (N=153) investig...

In this prospective study, mentally disordered perpetrators of severe violent and/or sexual crimes were followed through official registers for 59 (range 8 to 73) months. The relapse rate in criminality was assessed, compared between offenders sentenced to prison versus forensic psychiatric care, and the predictive ability of various risk factors (...

Criminal recidivism was studied during 2 years in a Swedish population-based cohort (N = 318) of mentally disordered male offenders who had undergone a pretrial forensic psychiatric investigation, been convicted in subsequent trials, and been sentenced to forensic psychiatric treatment (FPT; n = 152), prison (n = 116), or noncustodial sanctions (n...

The prevention of aggressive behaviours is a core priority for psychiatric clinical work, but the association between the diagnostic concepts used in psychiatry and aggression remains largely unknown. Outpatients referred for psychiatric evaluations of childhood-onset neuropsychiatric disorders (n=178) and perpetrators of violent crimes referred to...

The prevention of aggressive behaviours is a core priority for psychiatric clinical work, but the association between the diagnostic concepts used in psychiatry and aggression remains largely unknown. Objective We aimed to describe aggression according to the subscales formed in the Life History of Aggression (LHA) in relation to life-time psychiat...

Many international studies show that adolescents in coercive institutional care display high prevalences of mental disorders, especially in the form of disruptive behavior disorders [including attention-deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder, and conduct disorder], anxiety disorders, and mood disorders. High degrees o...

To evaluate the psychometric characteristics of the Swedish version of the Junior Temperament and Character Inventory (J-TCI), it was sent to parents of 9- and 12-yr.-old twins in Sweden. The final number of responders was 196 parents who rated 92 female and 104 male twin pairs. The inventory of one twin, randomly chosen from each pair, was include...

Historically, the Swedish criminal justice system conformed to other Western penal law systems, exempting severely mentally disordered offenders considered to be unaccountable. However, in 1965 Sweden enforced a radical penal law abolishing exceptions based on unaccountability. Mentally disordered offenders have since then been subjected to various...

Neurobiological markers in cerebrospinal fluid (CSF) and in serum, previously found to co-vary with destructive personality traits in violent offenders, were explored in a general population sample of 21 patients undergoing knee surgery. Results on the Karolinska Scales of Personality (KSP) and the Temperament and Character Inventory (TCI) were com...

This prospective study was designed to replicate previous findings of an association between the platelet monoamine oxidase B (MAO-B) activity and factors of relevance for criminal behaviour in a well-documented clinical study population. Subjects (n = 77, aged 17-76 years, median 30 years) were recruited among consecutive perpetrators of severe in...

To test the theory that sexual offenders who abuse very young children (0-5 years) have more severe mental health and psychosocial problems than those who victimize older children, authors compared psychiatric diagnoses, social circumstances, and crime-related data in all sexual offenders against minors referred to forensic psychiatric investigatio...

The development of forensic psychiatric risk assessments is discussed from a clinical point of view using the example of Sweden. A central task in forensic psychiatry has traditionally been to identify dangerous, mentally disordered subjects considered to be prone to commit violent acts. Over time, "dangerousness" has been reworded into "risk". Nev...

What do we know about the prevalence and the specific features of autism spectrum disorders (ASDs) among subjects in forensic psychiatry and special youth centres? A clinical case series consisting of 42 subjects with ASD, recruited from three well-characterized populations in forensic psychiatry and special youth care, was used to determine: 1) th...

To examine age at onset of substance abuse in relation to other factors of relevance to criminal behavior, we compared Life History of Aggression (LHA) scores, traits of psychopathy according to the Psychopathy Checklist--Revised (PCL-R), and violent recidivism in 100 violent offenders with early (before the age of 18) versus late onset of abuse or...

To assess prevalence figures for psychiatric disorders among institutionalized adolescents due to behavioural problems and/or delinquency. Participants were recruited from consecutive referrals to/or treated at two Swedish adolescent units, SIS1 (n = 60) and SIS2 (n = 70) with ranging age of 12-20.3 years (mean age = 16.2; SD = 1.8) during 1 year....

Childhood conduct disorder (CD) and adult psychopathic traits according to the Psychopathy Checklist Revised (PCL-R) were the closest psychiatric covariates to repeated violent crimes and aggression among offenders under forensic psychiatric investigation in Sweden. As psychopathy is not included in the present psychiatric diagnostic systems, we co...

Personality deviations and deficits in cognitive executive function are common among forensic populations. The present study on incarcerated offenders explored whether there are links between the two domains. Personality was assessed using the Temperament and Character Inventory (TCI). Neuropsychological performance, including visual working memory...

This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients. The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the end of treatment...

Objective This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients.Method The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the e...

The purpose of this study was to determine if the assessment of coping capacity, as assessed by the Perception of Cognitive Structure, Emotional and Control Questionnaire (PASEC; Shalit, 1979a, 1979b, 1979c, 1981, 1982a, 1982b; Shalit & Carlstedt, 1984; Shalit et al., 1983), is useful in the treatment of obesity. Participants were 78 consecutive ob...

Many genes have been identified that may play a role in increasing individual susceptibility to obesity. Reduced dopamine function appears to play a role in dysfunctional eating patterns and may predispose some individuals to obesity. The long version of the D4 dopamine receptor gene (D4DR) has been shown to alter receptor function and reduce intra...

Overweight is a significant health problem and perceived by many as a disability. While obese persons in the general population are no more likely to suffer from mental disorders, many obese individuals experience significant difficulties coping with their weight and weight-loss failures. The purpose of this study was to investigate the similaritie...

Describes a reliability study of the Scales of Psychological Capacities (SPC), a new method to assess structural change in psychotherapy. Two designs were used with psychiatric inpatients with severe psychiatric illnesses as the Ss. In the "Cases" design, 2 judges independently assessed a sample of 29 videotaped structural interviews. In the "Judge...