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Understanding Bias in Diagnosing, Assessing, and Treating Female Offenders
Abstract
Long before psychology, bias has existed in science. From the beginning, concerns have been raised about the reliability, validity, and accuracy of social science research (Meehl, 1954). In this chapter, we define and discuss the origins of bias and how it can erode the scientific method. We focus specifically on bias in psychological research, theory, assessment, and treatment. We discuss the range of common misconceptions and misinformation that permeates the female offender literature. Finally, we conclude with ten myths about female offenders and offer guidelines for identifying bias and how to avoid it.
... Stává se, že místo ověřování názorů si tyto názory spíše potvrzujeme, a to hledáním zdrojů "na míru" a igno rováním těch, které nám v našem názoru odporují. V tomto případě se jedná o druh kognitivního zkreslení, který se nazývá konfirmační zkreslení (Cunliffe et al., 2021). Příkladem mohou být různé ezoterické či pseudovědecké teorie, které se šíří na blozích a webových stránkách léčitelů či nadšenců do spirituality. ...
... They tend to be employed in academia and/or influenced by academic research where their conceptual knowledge may stem from a few recent studies (rather than a historically established line of theory). Many studies are also informed by a perspective that lacks Step 1 of the scientific method (direct observation or relevant exposure [active applied work] to the population studied; Cunliffe, Gacono, and Smith, 2021). This glaring omission can create a partial understanding of conceptual issues. ...
In this piece we answer frequently asked question regarding the R-PAS and CS. We present the facts supported by data. A must read for proponents and/or critics of the Rorschach.
... In mixed forensic samples of males and females, PCL-R total scores correlated with ANT and AGG scale scores (Blonigen et al., 2010;Poythress et al., 2010). Higher total PCL-R scores in females correlated with elevated ANT, AGG, and DOM (dominance; self-assured, 1 Rater biases may play a role in the assessment of women including using the PCL-R (e.g., gender bias, affective heuristic, availability heuristics, etc., see Cunliffe et al. (2021) for a full discussion on biases present for assessing women; also see Grann, 2000;Verona & Vitale, 2018). Specifically, if the representative heuristic is present, the rater of the PCL-R has the prototypic male psychopath as their frame of reference, which will result in missing information pertinent to women. ...
Managing the incarcerated population is the primary task within correctional settings. Using psychological assessment to predict institutional behavior, the psychologist has a unique set of skills essential to the management of prisoners. PCL-R, PAI, and Rorschach data were compared with institutional infractions (total, physical, verbal, non-aggressive) among 126 incarcerated women. Multiple binary logistic regression analyses were used which found significant correlations between PCL-R total score, PAI scales (BOR, ANT, VPI), and Rorschach variables (ROD, EGOI, TCI, AgPot, AgPast, SumV, SumC’, MOR) with total, verbal, physical, and nonviolent incident reports. Each of these measures adds incrementally to the assessment and understanding of institutional misbehavior for incarcerated women. Clinical implications of the findings were presented.
Erratum--please note on page 116, the total score of 34 should be 37. Also, the text should read "might receive" instead of receive, accounting for the potential individual items scoring.
Recently in Psychoanalytic Psychology, Gullhaugen et al. (2021) proposed a Dynamic Model of Psychopathy (DMP) to better understand psychopathic traits. Several issues with the authors' methodology, including the use of the Psychopathy Checklist: Screening Version (PCL: SV) as an independent measure and a small sample size (N = 16) relative to their conceptual approach and the number of statistical analyses conducted, limit the conclusions that can be drawn from their data. Additionally, the authors discuss their findings as if the data from this study with all males could apply to women. In this article, we use the methodological issues presented in the Gullhaugen study to discuss problems with the broader psychopathy literature. We also provide a psychodynamic model of psychopathy consistent with theory and empirical data.
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.
Although the construct of psychopathy has received considerable attention in humans, its relevance to other animals is largely unknown. We developed a measure of psychopathy for use in chimpanzees (Pan troglodytes), the Chimpanzee Psychopathy Measure (CPM), and asked 6 raters to complete this index on 34 chimpanzees. The CPM (a) demonstrated satisfactory interrater reliability and internal consistency; (b) exhibited marginally significant sex differences (males > females); (c) correlated positively with measures of extraversion, agreeableness, and observational ratings of agonism, sexual activity, daring behaviors, teasing, silent bluff displays, and temper tantrums, and negatively with observational ratings of generosity; and (d) demonstrated incremental validity above and beyond a measure of dominance. Although further validation of the CPM is needed, these findings suggest that the psychopathy construct may be relevant to chimpanzees.
The authors examined the construct of psychopathy as applied to 103 female offenders, using the multitrait–multimethod matrix proposed by D. T. Campbell and D. W. Fiske (1959). Instruments used in the study included the following: (a) Antisocial Scale of the Personality Assessment Inventory (L. C. Morey, 1991); (b) Psychopathy Checklist—Revised (R. D. Hare, 1990); and (c) Antisocial scale of the Personality Disorder Examination (A. W. Loranger, 1988). Criterion-related validity was also evaluated to determine the relationship between psychopathy and staff ratings of aggressive and disruptive behavior within the institution. Results revealed significant convergence and divergence across the instruments supporting the construct of psychopathy in a female offender sample. The measures of psychopathy demonstrated moderate convergence with staff ratings of violence, verbal aggression, manipulativeness, lack of remorse, and noncompliance. It is interesting to note that an exploratory factor analysis of the PCL–R identified a substantially different factor structure for women than has been previously found for male psychopathy.
The relative susceptibility of individuals and groups to systematic judgmental biases is considered. An overview of the relevant empirical literature reveals no clear or general pattern. However, a theoretical analysis employing J. H. Davis’s (1973) social decision scheme (SDS) model reveals that the relative magnitude of individual and group bias depends upon several factors, including group size, initial individual judgment, the magnitude of bias among individuals, the type of bias, and most of all, the group-judgment process. It is concluded that there can be no simple answer to the question, “Which are more biased, individuals or groups?,” but the SDS model offers a framework for specifying some of the conditions under which individuals are both more and less biased than groups.
Social behavior is ordinarily treated as being under conscious (if not always thoughtful) control. However, considerable evidence now supports the view that social behavior often operates in an implicit or unconscious fashion. The identifying feature of implicit cognition is that past experience influences judgment in a fashion not introspectively known by the actor. The present conclusion—that attitudes, self-esteem, and stereotypes have important implicit modes of operation—extends both the construct validity and predictive usefulness of these major theoretical constructs of social psychology. Methodologically, this review calls for increased use of indirect measures—which are imperative in studies of implicit cognition. The theorized ordinariness of implicit stereotyping is consistent with recent findings of discrimination by people who explicitly disavow prejudice. The finding that implicit cognitive effects are often reduced by focusing judges’ attention on their judgment task provides a basis for evaluating applications (such as affirmative action) aimed at reducing such unintended discrimination.
The differential prevalence of the histrionic and antisocial personality disorders among men and women has been attributed both to sex biases and to actual variation in disorder base rates. The present study assessed the bias and base rate explanations and examined whether sex biases are minimized by the relatively explicit diagnostic criteria in the DSM–III. Psychologists (N = 354) either diagnosed 9 DSM–III disorders from case histories that varied in the ambiguity of the antisocial and histrionic personality disorder diagnoses or rated the degree to which specific features extracted from the case histories met 10 histrionic and antisocial diagnostic criteria. The sex of the patient was either male, female, or unspecified. Sex biases were evident for the diagnoses but not for the diagnostic criteria. The results are discussed with respect to base rate effects, sex biases, and the construction of diagnostic criteria.
A group of 13 authors (GA) shared a statement of concern (SoC) warning against the use of the Hare Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003) to assess risk for serious institutional violence in U.S. capital sentencing cases (DeMatteo et al., 2020). Notably, the SoC was not confined to capital sentencing issues, but included institutional violence in general. Central to the arguments presented in the SoC was that the PCL-R has poor predictive validity for institutional violence and also inadequate field reliability. The GA also identified important issues about the fallibility and inappropriate use of any clinical/forensic assessments, questionable evaluator qualifications, and their effects on capital sentencing decisions. However, as a group of forensic academics, researchers, and clinicians, we are concerned that the PCL-R represents a psycholegal red herring, while the SoC did not sufficiently address critical legislative, systemic, and evaluator/rating issues that affect all forensic assessment tools. We contend that the SoC’s literature review was selective and that some of the resultant opinions about uses and misuses of the PCL-R were potentially misleading. We focus our response on the evidence and conclusions proffered by the GA concerning the use of the PCL-R in capital and other cases. We provide new empirical findings regarding the PCL-R’s predictive validity and field reliability to further demonstrate its relevance for institutional violence risk assessment and management. We further demonstrate why the argument that group data cannot be relevant for single-case assessments is erroneous. Recommendations to support the ethical and appropriate use of the PCL-R for risk assessment are provided.
It is essential to understand that CS validity research does not translated directly to the R-PAS. In this article we dicuss essential issues to consider prior to using the R-PAS in an applied context.
The histories of incarcerated women exhibit a multitude of personality issues including psychopathy, trauma, and interpersonal dependency. Two studies were undertaken to better understand these issues with psychopathic (PCL-R ≥ 30; N = 115) and non-psychopathic (PCL-R ≤ 24; N = 53) women incarcerated for drug, theft, fraud, violence, and sex offenses. In the first study, trauma symptoms were compared on Rorschach variables, TSI-2, and PAI scales. The female psychopathic group experienced more problems related to intrusive experiences and dissociation (TSI-2, Rorschach). In the second study, interpersonal dependency was also examined with the PAI, TSI-2, and Rorschach. The psychopathic females had higher rates of interpersonal dependency (PAI, Rorschach). Based on our findings we discuss the relationship between trauma and interpersonal dependency and the meaning of these testing variables and concepts within the personality functioning of these antisocial women.
In several articles, my colleagues and I have addressed concerns regarding methodological issues with the recent RIM research (see Cunliffe et al., 2012; Gacono, Loving, &Bodholdt, 2001; Smith et. al., 2018). In many studies, the impact of these issues is frequently hidden, masked in a description of statistical procedures and shrouded by the umbrella of a meta-analysis. Findings from these flawed studies influence conclusions that may appear "controversial" but are in actuality an artifact of the individual studies' inadequate design. Alarmingly, such method-related practices negatively impact the scholarly perception of the Rorschach and are frequently cited by editors for rejecting submitted Rorschach studies for publication, based largely on the presence of "controversy" which does not exist. In this brief commentary, the importance of Lambda to the generalizability of Rorschach findings is discussed.
Mihura’s (2019) recent commentary on Smith et al.’s (2018) article, “A Scientific Critique of Rorschach Research: Revisiting Exner’s Issues and Methods in Rorschach Research (1995)” raised several issues surrounding our internal validity criteria and our approach to validating Rorschach research. Mihura also conducted additional statistical analyses that failed to address important, critical issues. In this article, we further clarify the importance of refining internal validity criteria for Rorschach research and Rorschach meta-analytic studies (our 2018 article). We offer this information and analysis to guide the Rorschach consumer toward a better understanding of how to assess the validity of Rorschach data and empirical findings. Criticisms of our criteria for evaluating Rorschach research (inter-rater reliability, IQ/Education level, Rorschach Responses, Lambda/F%, sample size) and our recommendation to include descriptive data for critical variables in all published Rorschach studies contradict accepted standards for Rorschach research. Mihura stated that “the associations between the Rorschach and self-report measures were not used to determine the validity of Rorschach variables” (p. 171) in her meta-analyses. Consequently, we applied our methodological criteria to only Mihura’s externally assessed criteria studies (removing self-report studies; 67%) and found that 91% had three or more problems related to internal validity (13 had counter-intuitive findings). In addition, other central issues related to meta-analyses, application/validation studies, and counter-intuitive findings regarding the Rorschach were discussed.
The Hare Psychopathy Checklist (PCL; Hare, Neumann, & Mokros 2018) scales are among the most widely used forensic assessment tools. Their perceived utility rests partly on their ability to assess stable personality traits indicative of a lack of conscience, which then facilitates behavioral predictions useful in forensic decisions. In this systematic review, we evaluate the empirical evidence behind 3 fundamental justifications for using the PCL scales in forensics, namely, that they are empirically predictive of (1) criminal behavior, (2) treatment outcomes, and (3) a lack of conscience. We found the PCL scales can predict criminal behavior to a statistically significant degree, though with important limitations. We found no evidence of PCL psychopathy being predictive of treatment and rehabilitation outcomes. We found no evidence of PCL psychopathy being predictive of a lack of conscience. These findings disprove widespread beliefs about PCL psychopathy among forensic practitioners and questions the current and future role of the PCL scales in forensic settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved) (Source: journal abstract)
Psychopathy is an essential construct in forensic mental health. While male psychopathy and aggression has been thoroughly studied, less is known about this relationship with female psychopathy. In this article, the relationship between female psychopathy (Psychopathy Checklist-Revised [PCL-R] total, factor, and facet scores) and the Rorschach Aggression indices (Aggressive Movement [AG], Aggressive Content [AgC], Aggressive Past [AgPast], Aggressive Potential [AgPot], Sadomasochistic Aggression [SM]) were examined. Rorschach Aggression indices between female psychopathic (PCL-R total score ≥ 30; N = 84) and non-psychopathic female offenders (PCL-R total score ≤ 24; N = 39) were also compared. PCL-R total score was significantly correlated (p <.05) with AgC,
AgPast, AgPot, and SM and there were also significant correlations between the Aggression scores and PCL-R Factor/facet scores. The female psychopaths produced more AgC, AgPast, and AgPot responses than the non-psychopathic females. Rorschach aggression indices supported theory and suggested that the violence in psychopathic women stems from their identification with aggression and pervasive feelings of entitlement. Psychopathic women evidenced higher levels of these variables than the non-psychopathic offenders. The results add to the link between aggression and psychopathy as well as a better understanding of aggression in female offenders.
Psychopathy as measured by the Hare Psychopathy Checklist-Revised (PCL–R; Hare, 1991, 2003) is related to a range of rule-breaking and antisocial behaviors. Given this association, psychopathy has received considerable attention from researchers and legal professionals over the past several decades. Concerns remain, however, about using PCL-R scores to make precise and accurate predictions in certain contexts, including an individual’s risk for committing serious violence in high-security custodial facilities. After a brief introduction to psychopathy and the PCL-R, we discuss capital sentencing in the United States and then summarize the empirical literature regarding the ability of PCL-R scores to predict violence, with a particular focus on the PCL-R’s ability to predict serious institutional violence. As described, we believe the research demonstrates that the PCL-R cannot precisely or accurately predict an individual’s risk for committing serious violence in high-security custodial facilities. Finally, we present a Statement of Concerned Experts that summarizes our findings and opinions, concluding the PCL-R cannot and should not be used to make predictions that an individual will engage in serious institutional violence with any reasonable degree of precision or accuracy, especially when making high-stakes decisions about legal issues such as capital sentencing.
Based on findings from prior research studies, trauma histories have been found to be ubiquitous in psychopathic women. In this study, the Rorschach Trauma Content Index (TCI) was used to better understand the trauma histories of incarcerated women (N = 180). The TCI was significantly correlated with total reported trauma events, reported sexual abuse, other Rorschach scores (AgPast, ROD), and scales on both the Personality Assessment Inventory and the Trauma Symptom Inventory-2. The TCI may be related more to sexual abuse than physical abuse and the traumatic intrusions appear to be related to borderline features and dependency in this sample. These results suggest that the TCI facilitates our understanding of trauma in the lives of incarcerated women.
Smith et al. (2018) describe their article as “an evaluation as to the extent that individual studies have conformed to [ Exner’s (1995a) ] proposed methodological criteria” (Abstract). However, the authors did not conduct analyses to compare research before and after Exner (1995a) in order to assess its impact nor were the set of criteria they used Exner’s. Instead, they critiqued the individual studies in Mihura and colleagues’ (2013) meta-analyses, declaring all methodologically unsound (including Exner’s). They conjectured that Mihura et al. omitted studies with less “methodological bias” that would have provided more support for Rorschach validity. I explain why most of the criteria they use to criticize the studies’ methodology are not sound. But to directly test their hypotheses, I requested their ratings of study methodology. Findings from studies they rated as having more methodological “issues” (e.g., not reporting IQ or Lambda range) or as being “application studies” – which they said should be excluded – were not less supportive of Rorschach validity as they assumed would be the case. The small effect size associations ( r < |.10|) were also in the opposite direction of which Smith et al. argued to be true, indicating that the criteria by which they evaluated other researchers’ studies were not sound. Our findings do indicate that researchers are responding to the one criterion that is clearly stated in Exner (1995a) , which is Weiner’s (1991) recommendation to report interrater reliability; before 1991, 12% of studies reported interrater reliability, which afterward jumped to 78.4%. Other claims in the article by Smith et al. are also addressed.
This article examines how women’s crime has been reflected in crime statistics and media crime reporting. We employ a long-term historical perspective, looking at developments from the beginning of the 20th century until the present. We describe the overarching processes that underlie the decline in the gender gap in convictions for theft and violent crime, respectively, at different times during the past century. The study also use a new data set comprised of newspaper articles on women’s and men’s offending published by the Swedish press between 1905 and 2015. We compare the trend in the number of articles focused on offences committed by women and men respectively, variations in the offence types that the daily press choose to report on and the overarching explanations for crime that are discussed in the articles. The results show that levels of coverage and the types of crime that attract media attention are strikingly similar for men and women, but throughout the whole period there is a greater need for the newspapers to find reasons for women’s offending. Moreover, there has been no marked increase in the press focus on women’s crime as women have comprised an increasing proportion of those convicted of criminal offences.
In this study, the Psychopathy Checklist-Revised (PCL-R), the Rorschach, and the Personality Assessment Inventory (PAI) were used to elucidate the personality functioning of incarcerated females with sex offenses against minors (FSOAM; N = 31). There was significant convergence among the PCL-R, PAI, and Rorschach data. Both the PAI and Rorschach suggested: 1) borderline/psychotic reality testing and idiosyncratic thinking; 2) damaged sense of self, entitlement, and victim stance; 3) abnormal bonding and dependency; 4) affective instability; 5) impulsivity; and 6) chronic anger. Our comparison with a sample of male pedophiles (N = 36) highlighted gender specific issues with the women. Specifically, the women had more emotional deficits, ego-syntonic aggression, idiosyncratic thinking, and inappropriate attachments. A case study and our findings suggest a conceptual model for understanding the dynamics that result in female sexual offending behavior.
Childhood abuse is associated with increased psychopathic features among girls, but most prior research is based on data from correctional samples of female delinquents and less is known about how specific forms of childhood abuse affect specific features of psychopathy. Using a school-based community sample of 696 girls aged 9-17 years from Barbados and Grenada, the current study examined latent profiles of psychopathic personality traits and their associations with physical, emotional, and sexual abuse. Latent profile analysis (LPA) revealed four distinct psychopathy groups among girls, including a 'low psychopathy' group (41.9% of girls), 'high psychopathy' group (4.8%), 'high interpersonal manipulation and egocentricity' group (37.4%), and a 'moderate psychopathy' group (16%). There was considerable evidence of physical abuse, emotional abuse, and sexual abuse among participants. Sexual abuse was associated with a 116% increased likelihood of membership in the high psychopathy group and a 57% increased likelihood of membership in the high interpersonal manipulation and egocentricity group. These results indicate that sexual abuse is a powerful distal factor in the development of psychopathic personality functioning, especially more severe variants.
Exner’s (1995a) Issues and Methods in Rorschach Research provided a standard of care for conducting Rorschach research; however, the extent to which studies have followed these guidelines has not been examined. Similarly, meta-analytic approaches have been used to comment on the validity of Exner’s Comprehensive System (CS) variables without an evaluation as to the extent that individual studies have conformed to the proposed methodological criteria (Exner, 1995a; Gacono, Loving, & Bodholdt, 2001). In this article, 210 studies cited in recent meta-analyses by Mihura, Meyer, Dumitrascu, and Bombel (2013) were examined. The studies were analyzed in terms of being research on the Rorschach versus research with the Rorschach and whether they met the threshold of validity/generalizability related to specific Rorschach criteria. Only 104 of the 210 (49.5%) studies were research on the Rorschach and none met all five Rorschach criteria assessed. Trends and the need for more stringent methods when conducting Rorschach research were presented.
Psychopathy is considered an essential construct in forensic work (Gacono, 2016). Most methodologically sound studies have involved males rather than females (Smith et al., 2014). Gender differences have been found to be, and continue to be considered important in the assessment and management of forensic populations (Cunliffe et al., 2016). Male psychopaths present as pathologically narcissistic whereas female psychopaths manifest a malignant form of hysteria. Both are pathologically self-focused; however, the grandiosity in males is contrasted by women’s negative self-view. In the current study, male and female psychopaths (males = N = 44; PCL-R M = 33.13; females = N = 46; PCL-R M = 32.93) were compared using select Comprehensive System Rorschach variables. Female psychopaths produced more painful rumination (SumV), helplessness (SumY), and poor self-regard (EGOI ≥ .44 & Fr + rF = 0) than the males. Males were more detached (SumT) than females. Implications for future research, recommendations for these populations, and suggestions for using the PCL-R to assess female offenders are discussed.
The seven articles in this Special Section of the Journal of Psychopathology and Behavioral Assessment underscore the point that, at least in the psychopathy domain, parsimony is frequently an inaccurate scientific heuristic. These articles highlight the multidimensionality of youth psychopathy, suggesting that (a) the full constellation of psychopathy tends to outperform callous-unemotional traits alone in statistically predicting external criteria, (b) psychopathy subdimensions often interact statistically in predicting such criteria, and (c) psychopathy subdimensions often bear markedly different external correlates, including criminal offending, trait anxiety, and emotion processing. I offer five recommendations for future research on psychopathy and argue that that a full comprehension of this condition will require a better understanding of its subdimensions, and their interrelations, placement within the general personality domain, physiological correlates, and genetic and environmental underpinnings.
The first results from the Reproducibility Project: Cancer Biology suggest that there is scope for improving reproducibility in pre-clinical cancer research.
DOI: http://dx.doi.org/10.7554/eLife.23383.001
Background
The purpose of this study is to apply Andersen’s Behavioral Model of Health Service Use to men’s prisons to assess the direct and indirect effects of inmate predisposing characteristics through multiple types of need. Also examined are the effects of prison-specific enabling factors and the variation in use of health services across prisons. This study uses a nationally representative U.S. sample of men incarcerated in state prisons (n = 8816) and generalized structural equation and multilevel modeling. Five types of need—medical condition, illness, dental problem, unintentional injury, and intentional injury—are assessed for their association with use of health services.
Results
Findings indicate that a number of inmate predisposing (age, race, education) and vulnerability (mood/anxiety disorder,) characteristics are associated with use of health services but are partially mediated by enabling and need factors. Each type of medical need has strong direct effects with mood/anxiety disorder emerging as the strongest total effect (including both direct effects and indirect effects through need). There is significant variation in rates of health service utilization across prisons that is not accounted for by the prison-level factors included in the multilevel model.
Conclusions
The varying patterns of health service use across prisons suggest that incarceration may be an important circumstance that shapes health. In other words, where someone is incarcerated may influence their ability to access and use services in response to medical need. It is important that prisons provide integrated services for inmates with mood/anxiety disorder given high comorbidity with other health conditions.
Background
Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients. Methods
PubMed, PsychINFO, PsychARTICLE and CINAHL were searched for peer-reviewed articles published between 1st March 2003 and 31st March 2013. Two reviewers assessed the eligibility of the identified papers based on precise content and quality criteria. The references of eligible papers were examined to identify further eligible studies. ResultsForty two articles were identified as eligible. Seventeen used an implicit measure (Implicit Association Test in fifteen and subliminal priming in two), to test the biases of healthcare professionals. Twenty five articles employed a between-subjects design, using vignettes to examine the influence of patient characteristics on healthcare professionals’ attitudes, diagnoses, and treatment decisions. The second method was included although it does not isolate implicit attitudes because it is recognised by psychologists who specialise in implicit cognition as a way of detecting the possible presence of implicit bias. Twenty seven studies examined racial/ethnic biases; ten other biases were investigated, including gender, age and weight. Thirty five articles found evidence of implicit bias in healthcare professionals; all the studies that investigated correlations found a significant positive relationship between level of implicit bias and lower quality of care. DiscussionThe evidence indicates that healthcare professionals exhibit the same levels of implicit bias as the wider population. The interactions between multiple patient characteristics and between healthcare professional and patient characteristics reveal the complexity of the phenomenon of implicit bias and its influence on clinician-patient interaction. The most convincing studies from our review are those that combine the IAT and a method measuring the quality of treatment in the actual world. Correlational evidence indicates that biases are likely to influence diagnosis and treatment decisions and levels of care in some circumstances and need to be further investigated. Our review also indicates that there may sometimes be a gap between the norm of impartiality and the extent to which it is embraced by healthcare professionals for some of the tested characteristics. Conclusions
Our findings highlight the need for the healthcare profession to address the role of implicit biases in disparities in healthcare. More research in actual care settings and a greater homogeneity in methods employed to test implicit biases in healthcare is needed.
Background
Psychopathy is a specific syndrome that predicts future violent and aggressive behavior in adults. Studies in youth and adults have demonstrated a strong association between early traumatic incidents and later dissocial behavior. Moreover, the impact of personality pathology and emotional dysregulation on aggressive and violent behavior is well established. However, few studies have addressed the relationship between early traumatization and psychopathic traits in adolescents.
Method
The present study examined associations between both general dimensions of personality pathology and early traumatic experiences and the dimensions of psychopathy in 170 male and 171 female adolescent detainees.
Results
Analyses revealed associations between physical abuse, emotional dysregulation and psychopathic traits in delinquent boys but not in delinquent girls.
Conclusion
Hypothesized relationships between trauma, personality pathology could only be confirmed in the lifestyle and antisocial, but not in the core affective and interpersonal facets of psychopathy.
Although female sex offenders have received increased scholarly attention in recent years, and have also gained widespread media attention, minimal research has focused specifically on public perceptions of their behavior. This study explores the nature of public perceptions of a group of offenders on which the media often focus—female teachers who assault adolescent male students—by examining reader comments posted on five Huffington Post articles published from November 2010 to November 2013. Using a thematic coding methodology to analyze over 900 online comments, we found that most comments recognize a current double standard in the sentencing process for female teacher sex offenders compared to their male counterparts. Comments also rely on traditional sexual scripts and/or gender role expectations to either acknowledge or deny a victim’s presence. Contrary to existing research that examined public perceptions and found that more punitive attitudes were expressed toward male sex offenders, these results suggest that the public believes in equality in sentencing for all sex offenders, regardless of gender. These results also confirm prior studies that find that the public perceives adolescent male victims of rape by older women “lucky.”
John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not useful and reform is overdue.
As female sexual offenders increasingly come to the attention of the criminal justice system, a better understanding of the issues related to their assessment and management is required. To that aim, this chapter provides a review of the latest theoretical and empirical knowledge required to conduct the assessment of risk of recidivism and treatment needs of female sexual offenders. The recidivism rates of female sexual offenders and the associated risk factors are examined, the assessment of factors related to sexually offending behaviour among women is discussed, a contrast with those of male sexual offenders is presented, and the implications for their assessment are considered. Throughout the chapter, the importance of understanding the gender‐specific nature of female sexual offending is highlighted. Within this context, suggestions are made for gender‐informed assessment practices.
In their PNAS article, Joel et al. (1) demonstrate extensive overlap between the distributions of females and males for many brain characteristics, measured across multiple neuroimaging modalities and datasets. They pose two requirements for categorizing brains into distinct male/female classes: (i) gender differences should appear as dimorphic form differences between male and female brains, and (ii) there should be internal consistency in the degree of “maleness–femaleness” of different elements within a single brain. Based on these criteria, the authors convincingly establish that there is little evidence for this strict sexually dimorphic view of human brains, counter to the popular lay conception of a “male” and “female” brain. This finding has broad implications not only for the ontology of gender, but also for the statistical treatment of sex in morphometric analyses.
In this chapter, we provide a theoretical and empirically based understanding of antisocial and psychopathic women. We begin by clarifying the differences between psychopathy, sociopathy, and ASPD, and then provide a historical perspective of hysteria. While the underlying personality of the female psychopath is paranoid, malignant hysteria is their predominant personality style (Gacono & Meloy, 1994). Overviews of the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach are offered as a refresher for those experienced clinicians and as a resource for those that are not. Finally, we present group PAI and Rorschach data (also Trauma Symptom Inventory-2 [TSI-2]) for 337 female offenders including subsets of psychopathic (N = 124) and non-psychopathic (N = 57) females. We make note of the differences between female and male psychopaths.
Complexity, the Rorschach 1st factor, is one of the most important components of R-PAS interpretation (Meyer et al., 2011). However, this dimension is problematic on conceptual grounds and has been described as tautological (Meyer, 1992b). In that case, this notion would be unfalsifiable and would appear as unscientific (Popper,1959). In order to study this problem empirically, 98 protocols from the Belgian CS reference sample were submitted to the analysis described in R-PAS manual, replicating Complexity main findings. Protocols were then randomly recorded and submitted to the same analysis which yielded very similar results. In addition, the Complexity scores of real and randomly rescored protocols were highly correlated. We conclude that Complexity main findings do not depend on data, and its reliability in clinical practice is questionable. Means to deal with the dimensional approach to the Rorschach are discussed and alternatives are proposed.
The current article reviews the literature regarding several issues that are relevant to the classification of psychopathy. We make the argument based on the available literature that psychopathy cannot be easily categorized in a qualitative manner but rather is a dimensional construct. We also make the claim that psychopathy is not unitary. Indeed, virtually all available research points to psychopathy being multidimensional and therefore gives rise to the potential of multiple constellations of traits (i.e., subtypes or variants) that fall under the broader umbrella term of psychopathy. We review the literature on subtypes of psychopathy, which is in our opinion the best perspective from which to consider psychopathy classification, with the caveat that such constellations or ‘psychopathy variants’ are also dimensional in nature and would vary in severity. We also added an empirical contribution in which we replicate and expand upon the existing psychopathy subtype literature in a novel way. We end our article with general implications and discussion of future directions in this area.
This article analyses the conflicting narratives surrounding the case of convicted
Canadian offender Karla Homolka. As both a victim and a perpetrator of violent crime
Karla’s actions are positioned precariously between activity and passivity. It is precisely
because of this blurring of boundaries - between agency and victimization - that her case
has received widespread critical discussion. Despite attempts to ‘recuperate’ her narrative
(Morrissey, 2003; Thompson and Ricard, 2009), Karla still presents us with a paradox.
There is a need then to unpack the relationship between Karla’s victimization (non-agency) and her criminal culpability (agency). This paper will consider whether or not
Primo Levi’s (1988) concept of ‘gray zones’ can resolve this paradox.
A meta-analysis was conducted to examine the extent of continued influence of misinformation in the face of correction and the theoretical explanations of this phenomenon. Aggregation of results from 32 studies (N = 6,527) revealed that, on average, correction does not entirely eliminate the effect of misinformation (r = –.05, p = .045). Corrective messages were found to be more successful when they are coherent, consistent with the audience’s worldview, and delivered by the source of the misinformation itself. Corrections are less effective if the misinformation was attributed to a credible source, the misinformation has been repeated multiple times prior to correction, or when there was a time lag between the delivery of the misinformation and the correction. These findings are consistent with predictions based on theories of mental models and offer concrete recommendations for practitioners.
Background:
The hypothesized link between the measles, mumps, rubella (MMR) vaccine and autism continues to cause concern and challenge vaccine uptake.
Objective:
To evaluate whether the MMR vaccine increases the risk for autism in children, subgroups of children, or time periods after vaccination.
Design:
Nationwide cohort study.
Setting:
Denmark.
Participants:
657 461 children born in Denmark from 1999 through 31 December 2010, with follow-up from 1 year of age and through 31 August 2013.
Measurements:
Danish population registries were used to link information on MMR vaccination, autism diagnoses, other childhood vaccines, sibling history of autism, and autism risk factors to children in the cohort. Survival analysis of the time to autism diagnosis with Cox proportional hazards regression was used to estimate hazard ratios of autism according to MMR vaccination status, with adjustment for age, birth year, sex, other childhood vaccines, sibling history of autism, and autism risk factors (based on a disease risk score).
Results:
During 5 025 754 person-years of follow-up, 6517 children were diagnosed with autism (incidence rate, 129.7 per 100,000 person-years). Comparing MMR-vaccinated with MMR-unvaccinated children yielded a fully adjusted autism hazard ratio of 0.93 (95% CI, 0.85 to 1.02). Similarly, no increased risk for autism after MMR vaccination was consistently observed in subgroups of children defined according to sibling history of autism, autism risk factors (based on a disease risk score) or other childhood vaccinations, or during specified time periods after vaccination.
Limitation:
No individual medical chart review was performed.
Conclusion:
The study strongly supports that MMR vaccination does not increase the risk for autism, does not trigger autism in susceptible children, and is not associated with clustering of autism cases after vaccination. It adds to previous studies through significant additional statistical power and by addressing hypotheses of susceptible subgroups and clustering of cases.
Primary funding source:
Novo Nordisk Foundation and Danish Ministry of Health.
This study examined the interdiagnostician reliability and potential gender bias of the DSM-IV/DSM-5 Section II and DSM-5 Alternative Model definitions of borderline personality disorder. A national sample of 123 mental health professionals provided diagnostic judgments on 12 case vignettes selected to represent a range of personality pathology. Two versions of each case were included, one identified as male and the other as female, but which were otherwise identical. Analyses examined the intraclass correlation between clinicians and also examined rates of diagnostic assignments as a function of case gender. Reliability of diagnosis of borderline personality did not differ across the two diagnostic approaches, and concordance of diagnoses across the two systems was significant. The dimensional components of the DSM-5 Alternative Model demonstrated significantly more diagnostic reliability than the DSM-IV categorical diagnoses. The DSM-5 Alternative Model conceptualization of borderline personality can be diagnosed with comparable or greater reliability than the extant DSM-IV definition.
In this study, we examine recidivism in a cohort of 471 registered, adult female sexual offenders for an average follow-up of 18.83 years. About half (52%) of the female sexual offenders were re-arrested for a subsequent offense during the follow-up period. Nine percent were re-arrested for a violent offense, and 7 % were re-arrested for a sexual offense. Recidivists for any offense, compared to non-recidivists, were younger, had more extensive criminal histories, and were more likely to have a sexual assault as an index offense. Recidivists for violent (non-sexual) offenses, compared to non-recidivists, were younger, had more extensive criminal histories, and were more likely to have a male victim for an index offense. Recidivists for sexual offenses, compared to non-recidivists, had more prior arrests for any offense, more prior arrests for alcohol/drug offenses, and were more likely to have an acquaintance victim for an index offense. These results are compared to prior studies.
Due to the smaller proportion of female sex offenders (2%-12% of all sexual offenses) compared with male sex offenders, we know much less about these women to aid in the assessment, treatment, and prevention of their offending behavior compared with men. One promising distinction in female sex offender typology is solo-offending females versus females who offend with a male co-offender. The current study uses a sample of 225 incarcerated female sex offenders to compare solo and co-offending women on variables of psychopathology, criminal history, victim and offender information, and recidivism rates. Results indicate that solo offenders are more likely to have male, unrelated victims, score higher on dominance and aggression, and are more likely to generally recidivate. Solo versus co-offending status was not a significant predictor for sexual recidivism. Implications for assessment and treatment are discussed.
Despite growing interest in psychopathic personality features in juvenile offenders, few studies have examined the relationship between childhood trauma and psychopathy. The present study utilized two datasets: 253 adolescents in a residential facility for juvenile offenders in Pennsylvania and 723 institutionalized delinquents in Missouri. Zero-order correlations and linear regression techniques were employed for boys and girls to examine the relationships between trauma, assessed using the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2) Traumatic Experiences Scale and the Childhood Trauma Questionnaire (CTQ), and psychopathy as measured by the Youth Psychopathic Traits Inventory (YPI) and the Psychopathic Personality Inventory–Short Form (PPI-SF). Results indicate that psychopathy is significantly correlated with childhood trauma. For the Missouri data, trauma significantly predicted psychopathy scores for both boys and girls. These results suggest that nuanced understanding of traumatic history of these adolescents may not only be a pathway to psychopathy but also a critical part of their overall assessment and treatment plan.
Controversial conclusions from meta-analyses in nutrition are of tremendous interest to the public and can influence policies on diet and health. When the results of meta-analyses are the product of faulty methods, they can be misleading and can also be exploited by economic interests seeking to counteract unflattering scientific findings about commercial products.
We respond to Tibon Czopp and Zeligman's (2016) critique of our systematic reviews and meta-analyses of 65 Rorschach Comprehensive System (CS) variables published in Psychological Bulletin (2013). The authors endorsed our supportive findings but critiqued the same methodology when used for the 13 unsupported variables. Unfortunately, their commentary was based on significant misunderstandings of our meta-analytic method and results, such as thinking we used introspectively assessed criteria in classifying levels of support and reporting only a subset of our externally assessed criteria. We systematically address their arguments that our construct label and criterion variable choices were inaccurate and, therefore, meta-analytic validity for these 13 CS variables was artificially low. For example, the authors created new construct labels for these variables that they called "the customary CS interpretation," but did not describe their methodology nor provide evidence that their labels would result in better validity than ours. They cite studies they believe we should have included; we explain how these studies did not fit our inclusion criteria and that including them would have actually reduced the relevant CS variables' meta-analytic validity. Ultimately, criticisms alone cannot change meta-analytic support from negative to positive; Tibon Czopp and Zeligman would need to conduct their own construct validity meta-analyses.
This article utilizes seven cases to describe the behavior of the sociopathic personality in a leadership role. The arenas in which this article focuses include the industrial world, the academic world, and the non-profit organization world. In- depth analysis of several of the cases presented should provide the reader with a better awareness of the sociopathic mind and its propensity for destruction of others, as well as the major focus of this behavior disorder - the need to win, and to win at all costs. Suggestions for dealing with such individuals is presented to further assist the reader in becoming more aware of their methods, behavior, and self-centered focus, as well as how to deal with them.
Since the publication of the Rorschach Inkblot Method (Rorschach, 1921/1942 ), theorists, researchers, and practitioners have been debating the nature of the task, its conceptual foundation, and most important its psychometric properties. The validity of the Rorschach Comprehensive System (CS; Exner, 1974 , 2003; Exner & Weiner, 1995 ) has been supported by several meta-analyses that used different types of nontest external criterion for validating individual variables. In a recent meta-analysis, Mihura, Meyer, Dumitrascu, and Bombel ( 2013 ) found coefficients ranging from modest to excellent for most of the selected CS variables, with 13 of them reported as showing "little to no support." This article focuses on these variables. Although endorsing Mihura et al.'s mainly validating findings, we also suggest that the evidence presented for the little or no validity of these 13 variables is not quite compelling enough to warrant changing their definition or coding, or removing them from the system. We point to some issues concerning the description and interpretation of these variables and the appropriateness of the external criteria used for exploring their validity, and suggest considering these issues in further CS research. Implications of Mihura et al.'s meta-analysis for clinical and forensic practice are discussed.
According to the scientific literature, childrens' cognitive development is not complete until adolescence. Therefore, the problems inherent in children serving as witnesses are crucial. In preschool-aged children, false memories may be identified because of misinformation and insight bias. Additionally, they are susceptible of suggestions. The aim of this study was to verify the levels of suggestibility in children between three and 5 years of age. Ninety-two children were examined (44 male, 48 female; M = 4.5 years, SD = 9.62). We used the correlation coefficient (Pearson's r) and the averages variance by SPSS statistical program. The results concluded that: younger children are almost always more susceptible to suggestibility. The dimension of immediate recall was negatively correlates with that of total suggestibility (r = -0.357 p < 0.001). Social compliance and source monitoring errors contribute to patterns of suggestibility, because older children shift their answers more often (r = 0.394 p < 0.001). Younger children change their answers more times (r = -0.395 p < 0.001).