Faculty Bibliography

The heterogeneity of violent behavior is often overlooked in risk assessment despite its importance in the management and treatment of psychiatric and forensic patients. In this study, items from the Personality Assessment Inventory (PAI) were first evaluated and rated by experts in terms of how well they assessed personality features associated with reactive and instrumental aggression. Exploratory principal component analyses (PCA) were then conducted on select items using a sample of psychiatric and forensic inpatients (n = 479) to examine the latent structure and construct validity of these reactive and instrumental aggression factors. Finally, a confirmatory factor analysis (CFA) was conducted on a separate sample of psychiatric inpatients (n = 503) to evaluate whether these factors yielded acceptable model fit. Overall, the exploratory and confirmatory analyses supported the existence of two latent PAI factor structures, which delineate personality traits related to reactive and instrumental aggression.

This study examined the classification accuracy of measures of cognitive effort, as well as the impact of estimated IQ and psychiatric symptoms on these measures in a sample of hospitalized pretrial criminal defendants. A criterion-groups design was used to classify patients into those suspected of feigning (n=25) and those believed to be genuinely mentally ill (n=93). The Test of Memory Malingering (TOMM), Dot Counting Test (DCT), and Rey Fifteen-Item Memory Test (RMT) were roughly comparable to the SIRS-2 in classifying patient groups but the Validity Indicator Profile (VIP) Verbal subscale was not. Several measures of cognitive effort increased detection of suspected feigning over the SIRS-2 alone. However, among genuinely mentally ill psychiatric patients, level of estimated intelligence was significantly associated with scores on each of the measures of cognitive effort (rs=.38 to .65), with false positive rates in excess of 30% for patients with estimated intelligence in the Extremely Low range. Performance on measures of cognitive effort was only modestly associated with types, but not total severity of psychiatric symptoms. Implications for the assessment of feigning in clinical settings are discussed.

The Rey Fifteen Item Test (RMT; Rey, 1941) is one of the most commonly used measures to assess the validity of cognitive and memory deficits. A recent recognition trial has been developed to enhance sensitivity of the RMT (Boone, Salazar, Lu, Warner-Chacon, & Razani, 2002). The RMT was administered to 116 forensic patients hospitalized for restoration of competency to stand trial who were classified by treating psychiatrists as "genuine" or "feigning," and 36 community simulators. Consistent with previous research, the recognition trial increased the sensitivity of the RMT from 44% to 64% among suspected feigners, while decreasing specificity from 82.4% to 74.7% among genuine patients. The optimal cut score for maximizing specificity was 11 in this sample, while the optimal cut score for enhancing the utility of the RMT as a screening measure was found to be 24. Implications of using the RMT with recognition trial as a screening tool in forensic psychiatric assessment are discussed.

Forensic patients with antisocial personality disorder (APD) were compared to forensic patients without APD on a validated measure of malingering (Structured Interview of Reported Symptoms [SIRS]). Results indicated that patients with APD were not significantly more likely to exceed accepted cutoff scores on the SIRS (i.e., 17.9% vs. 11.6%, respectively), nor were they more likely to be suspected of malingering by clinicians (17.9% vs. 18.6%). Although there was a high level of disagreement between clinicians' determination of malingering and classification by the SIRS, this relationship was not significant. Furthermore, patients with APD who were suspected by clinicians to be malingering were not more likely to be classified as responding genuinely using the SIRS. These findings challenge the recommendation issued by the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) that advises clinicians to be highly suspicious of malingering in the presence of APD.

The goal of the present article is to show how specific dialectical behavior therapy (DBT) strategies and techniques can supplement traditional psychiatric emergency room (ER) practice by potentially increasing outpatient treatment compliance in parasuicidal patients with borderline personality disorder traits. Unlike the traditional psychiatric approach, DBT provides emotionally dysregulated patients with a framework for understanding their chaotic interpersonal lives. The authors stress the importance of implementing paradoxical interventions, which aim at unbalancing the patient and increasing readiness for change, in the context of validation, which aims at acceptance and restores the communicative function of emotions. The authors illustrate--through case examples drawn from a large, metropolitan hospital--how emergency room clinicians using DBT strategies can enhance readiness for change.

Stalking is the deliberate shadowing or harassing of an individual, which causes alarm, through varied criminal means, and with amorous/malevolent intent. Stalking is a crime that has gained increasingly more attention over the last decade, attaining notoriety due to the volume of celebrity victims. Notwithstanding the prevalence of stalking, there is a paucity of literature on the etiology or treatment and management of stalking behaviors. The literature that does exist includes a number of studies attempting to categorize stalking behaviors based on the perpetrator's relationship with the victim. These studies have found that the majority of stalking cases involve an individual attempting to re-establish a relationship (Meloy, 1998). The Stalker Habilitation Program is an examination of the relevant literature as related to effectively synthesizing an understanding and treatment of stalking perpetrators. A large proportion of stalkers are diagnosed within the Cluster B personality disorders (Kienlen et al. 1997; Meloy, 1998; Meloy & Gothard, 1995; Mullen et al., 1999). The academic literature has also provided that a significant proportion of stalkers possess borderline traits (McCann, 2001; Zona, Palarea, & Lane, 1998) and with similar patterns in domestic abusers (Dutton, 1998). These traits are usually romanticizing and then devaluing partners, volatile anger, vacillating moods, and fear of abandonment. The program has put forth a treatment regiment, based on Dialectical Behavior Therapy (Linehan, 1993a; 1993b), an empirically supported treatment for borderline personality disorder.