Saint Leo University Week 3 Investigate Methods of Violence Discussion

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Discuss your thoughts on the information that has been posted by your professor and discuss its relevance and implications to the field of criminal justice. Your remarks can be opinion, but they must be based on your experience, research, and/or prior learning. Use this exercise to converse with your fellow colleagues about issues that are important to the field of criminal justice. Of interest is a dialogue of opinions, thoughts, and comments. Be sure to discuss both sides of the issue as noted in the actual question posting.

Kolla, N., Meyer, J., Bagby, R., & Brijmohan, A. (2017). Trait anger, physical aggression, and violent offending in antisocial and borderline personality disorders. Journal of Forensic Sciences, 62(1), 137-141. doi:10.1111/1556-4029.13234

1. Compare and contrast the various strengths and weaknesses of the “clinical” and “actuarial” approaches to risk assessments of aggressive and violent individuals.
2. Discuss why or why not you view this methodology as being valid and reliable.
3. Identify how the risk assessment process might assist you in your professional capacity.

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J Forensic Sci, January 2017, Vol. 62, No. 1 doi: 10.1111/1556-4029.13234 Available online at: PAPER PSYCHIATRY & BEHAVIORAL SCIENCES Nathan J. Kolla,1,2,3,4 M.D., Ph.D.; Jeffrey H. Meyer,3,4 M.D., Ph.D.; R. Michael Bagby,1,4,5 Ph.D.; and Amanda Brijmohan,6 B.Sc. Trait Anger, Physical Aggression, and Violent Offending in Antisocial and Borderline Personality Disorders ABSTRACT: Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are common conditions in forensic settings that present high rates of violence. Personality traits related to the five-factor model personality domains of neuroticism and agreeableness have shown a relationship with physical aggression in nonclinical and general psychiatric samples. The aim of the present investigation was to examine the association of these personality traits with violence and aggression in ASPD and BPD. Results revealed that trait anger/hostility predicted self-reported physical aggression in 47 ASPD and BPD subjects (b = 0.5, p = 0.03) and number of violent convictions in a subsample of the ASPD participants (b = 0.2, p = 0.009). These preliminary results suggest that high anger and hostility are associated with physical aggression in BPD and ASPD. Application of validated, self-report personality measures could provide useful and easily accessible information to supplement clinical risk assessment of violence in these conditions. KEYWORDS: forensic science, antisocial personality disorder, borderline personality disorder, anger, violence, personality traits Human aggression is a behavioral phenomenon at least partially driven by personality characteristics of the individual (1,2). A promising approach to understanding the link between personality and aggressive behavior has been the application of validated personality constructs. One conceptualization that has attracted the attention of researchers in the field is the five-factor model (FFM) of personality (3). The FFM is an extensively validated dimensional trait model of personality that organizes personality traits into five higher-order trait domains: neuroticism, extraversion, conscientiousness, agreeableness, and openness-to-experience. Each of these higher-order personality trait domains is composed of six lower-order personality trait facets. The domains and facets of the FFM are culturally universal (4) and heritable (5). Although the model was empirically derived from normative samples, it has been replicated in psychiatric patient samples (6). In studies of nonclinical samples that have employed the FFM, personality traits indicative of high neuroticism and/or low agreeableness (e.g., antagonism) have shown robust linkages with self-reported violence and physical aggression (7–9). The main objective of the 1 Department of Psychiatry, University of Toronto, Toronto, ON, Canada. Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, ON, Canada. 3 CAMH Research Imaging Centre, Toronto, ON, Canada. 4 Institute of Medical Science, University of Toronto, Toronto, ON, Canada. 5 Department of Psychology, University of Toronto, Toronto, ON, Canada. 6 Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada. Received 7 Jan. 2016; accepted 3 April 2016. 2 © 2016 American Academy of Forensic Sciences present investigation was to examine the association of these personality traits with aggression and violence in a clinical sample characterized by pathological aggression and violence. Borderline personality disorder (BPD) and antisocial personality disorder (ASPD) are frequently encountered psychiatric conditions in forensic settings that present high levels of externalized aggression. Longitudinal studies suggest that deficits in emotion regulation may moderate the association of BPD with externalizing physical aggression (10,11), whereas high trait anxiety (12), impulsivity (13), hostile attribution bias (14), and anger (15) have been identified as risk factors for violence in ASPD. Low empathy (16) and rebelliousness (17) additionally have been shown to characterize the personality structure of violent offenders. Although these characteristics broadly map to the neuroticism and agreeableness dimensions of the FFM, the relationship between FFM domains and physical aggression or violence has not been extensively studied in BPD or ASPD. Given recent calls for broadening the scope of risk assessment in psychiatric populations to consider general measures of personality (18), research that aims to identify personality traits salient to externalized aggression in BPD and ASPD could potentially inform clinical assessments of risk in these conditions. The study hypotheses were guided by the aforementioned research linking personality attributes of neuroticism and agreeableness to aggression. The first hypothesis was that FFM personality traits captured by neuroticism and agreeableness, and previously shown to relate to aggression in ASPD or BPD, would be associated with self-reported physical aggression. The second hypothesis was that these traits would also be associated with violent convictions in the ASPD subjects. 137 138 JOURNAL OF FORENSIC SCIENCES Methods Participants All study components were approved by the Research Ethics Board for Human Subjects at the Centre for Addiction and Mental Health, Toronto, Ontario, Canada. Each participant provided written consent after study procedures had been explained. A total of 71 subjects participated in the study: 20 males with ASPD, 27 females with BPD, and 24 healthy controls. Personality Disorder Subjects ASPD Subjects—Subjects with ASPD were recruited from the community and federal correctional services halfway houses. ASPD was diagnosed following clinical assessment and use of the Structured Clinical Interview for DSM-IV, Axis II Disorders (SCID-II) (19) by a forensic psychiatrist (NJK), who also administered the Structured Clinical Interview for DSM-IV, Axis I Disorders (SCID-I) (20). To rule out confounds of major mood or psychotic disorders, exclusion criteria included a history of mania, hypomania, or psychotic illness. Current non-alcohol substance abuse or dependence and comorbid BPD were also exclusionary. BPD Subjects—BPD participants were recruited from the community, inpatient psychiatric wards, and the dialectical behavior therapy clinic at our institution. BPD subjects were clinically assessed by NJK using the SCID-I and SCID-II. Bipolar disorder, psychotic illness, comorbid ASPD, and current substance use or dependence were designated as exclusion criteria. Control Subjects—Healthy controls were recruited from the community and were clinically assessed by NJK with the SCIDI and SCID-II. Healthy controls had no history of psychiatric illness. Additional Study Criteria All study participants were non-smoking and provided negative urine toxicology tests for illicit substances. A subset of the ASPD and BPD subjects had previously participated in neuroimaging studies led by our group (21,22). Measures NEO Personality Inventory – Revised—The NEO Personality Inventory – Revised (NEO PI-R) is an extensively validated and reliable self-report measure of adult personality that is based on the FFM and provides dimensionally based, norm-referenced test scores for the higher-order domain and lower-order facet personality traits of this model (6,23). The NEO PI-R captures normal to abnormal personality characteristics (6). Personality traits with empirical support for an association of aggression or violence with ASPD or BPD were specifically assessed. These included traits related to neuroticism (anger/hostility, anxiety, impulsiveness, self-consciousness) and traits indexed by the agreeableness dimension (tender-mindedness, compliance, and altruism). All subjects completed the NEO PI-R. Aggression Questionnaire—The Aggression Questionnaire (AQ) is a widely used self-report measure that assesses aggression, hostility, and anger (24). The physical aggression subscale includes nine items indexing behaviors relating to physical violence toward others and destruction of property. The physical aggression subscale demonstrates good psychometric properties in violent forensic psychiatry patients (25). All subjects completed the physical aggression subscale of the AQ. Additional Measures—All participants were administered the Wechsler Test of Adult Reading – Revised to provide an estimate of full-scale IQ (26). Violent Convictions Official criminal records were available for 17 of the 20 ASPD subjects. The following crimes were designated as violent offenses for the purposes of the study: homicide, attempted murder, sexual assault, assault, robbery, criminal harassment, and uttering threats. Statistical Analysis Demographic, clinical, and personality data were compared between personality disorder and healthy control groups using chi-square tests for categorical data, independent samples t tests for normally distributed continuous data, and Mann–Whitney U tests for non-normally distributed variables. In the personality disorder group (ASPD and BPD subjects combined), multiple linear regression was applied to estimate the association of personality traits of interest (e.g., anger/hostility, anxiety, impulsiveness, self-consciousness, tender-mindedness, compliance, and altruism) with physical aggression. In the subset of ASPD subjects, the counts of violent convictions obtained from official criminal records were modeled using negative binomial regression. Use of negative binomial regression is recommended for modeling offending count data, because data tend to be overdispersed (27). As trait aggression is highly associated with violent offending in ASPD, personality traits associated with physical aggression in the multiple linear regression were included as independent variables in the negative binomial regression. Results Sample Characteristics Comparisons of the personality disorder and healthy control groups are presented in Table 1. Groups were similar in age and level of education. The healthy group had more years of formal education and higher IQs. As expected, the personality disorder group exhibited higher rates of comorbid psychiatric illness. The personality disorder group self-reported higher trait physical aggression; higher levels of anger/hostility, anxiety, impulsiveness, and self-consciousness; and lower compliance levels. Do Personality Traits Predict Physical Aggression in Personality Disorders? The personality traits anger/hostility, anxiety, impulsiveness, self-consciousness, tender-mindedness, compliance, and altruism were used in a standard regression analysis to predict physical aggression. The correlations of the variables are presented in Table 2. As shown, all correlations except the ones between physical aggression and impulsiveness or altruism were statistically significant. The prediction model was statistically KOLLA ET AL. TABLE 1––Demographic and clinical characteristics. Characteristics † Healthy Controls (n = 24) Age 34.9  9.8 Years of Education‡*** 14.0  2.1 ‡* Estimated IQ 106.5  1.0 % Male/Female*** 57.4/42.6 Psychiatric Comorbidities % With major depressive 57.4 disorder*** % With bipolar or psychotic 0 disorder % With anxiety disorder*** 48.9 % With lifetime drug abuse 29.8 or dependence** Substances % Current smoker 0 % With positive drug screen 0 Medications % Taking psychotropic 21.3 medications*** Buss Perry Physical Aggression 25.7  1.0 Score‡*** NEO PI-R Personality Traits (raw scores) Anger/hostility‡*** 20.3  6.5 Anxiety‡*** 21.4  6.8 Impulsiveness‡*** 21.6  5.6 Self-consciousness‡*** 21.1  6.1 Tender-mindedness‡ 21.1  5.4 §*** Compliance 14.8  5.8 Altruism‡ 20.8  5.7 Conduct-Disordered Behavior Number of conduct disorder 4.3  3.7 symptoms‡*** 139 ANGER IN PERSONALITY DISORDERS anger/hostility, which is indexed by the squared semi-partial correlation, was relatively low (~7%). Personality Disorder Subjects (n = 47) ‡ . Does Anger/Hostility Predict Violent Convictions in ASPD? 34.8  8.0 16.0  1.8 112.2  8.0 100/0 The percentage of ASPD subjects with each type of violent offense is displayed in Table 4. Because the distribution of the outcome variable (counts of violent convictions) exhibited greater variability than expected under a Poisson distribution, a negative binomial regression model was specified. Anger/hostility was included as a predictor variable in the model, as it was the only variable associated with physical aggression in the foregoing multiple linear regression. Results indicated a significant overall model (v2 = 8.5, degrees of freedom = 1, p = 0.003) with a significant influence of trait anger/hostility on number of violent convictions (b = 0.2, standard error = 0.07, 95% confidence interval = 0.04 0.3, p = 0.009). 0 0 0 0 0 0 0 Discussion 14.3  5.1 10.8 10.6 13.7 12.5 21.5 19.6 23.3        The main study finding is that trait anger/hostility predicted physical aggression in a clinical sample of BPD and ASPD subjects. Although this investigation sampled a range of personality traits empirically related to aggressive behavior, trait anger/hostility emerged as the sole predictor of physical aggression. The second main study finding is that trait anger/hostility predicted the number of violent convictions in the ASPD subsample. These results have implications for understanding the relationship between maladaptive personality traits and physical aggression in personality disorder populations and for exploring the clinical usefulness of targeted personality assessment as a component of overall risk assessment. The association of high trait anger and physical aggression in our sample converges with findings from alternative research paradigms that have investigated the behavioral and neural correlates of increased anger. For example, in a competitive reaction time task, healthy subjects with high anger were shown to deliver a higher intensity level of electrical shock to sham opponents than subjects with low anger under conditions of high provocation. In a functional magnetic resonance imaging experiment that examined brain activation patterns following interpersonal provocation, dorsal anterior cingulate cortex (dACC) activation was found to correlate with self-reported anger, while the degree of activation of the dACC and prefrontal cortex (PFC) differed as a function of baseline aggression (28). Experimental manipulations that have elicited aggressive behavior in BPD and ASPD with high trait anger similarly highlight functional abnormalities of the PFC (29), suggesting that interventions targeting high anger 4.5 4.7 3.9 4.5 4.4 4.3 4.0 0.1  0.3 † Values are expressed as mean  standard deviation, except where indicated. ‡ Mann–Whitney U test. § Independent samples t test. *p < 0.05; **p < 0.01; ***p < 0.001; IQ, intelligence quotient; NEO PIR, NEO Personality Inventory – Revised. significant (F7,39 = 4.7, p = 0.001) and accounted for approximately 45% of the variance of physical aggression. Physical aggression was predicted by higher levels of anger/hostility (p = 0.03); a trend association was also observed between low levels of compliance and physical aggression (p = 0.088). The raw and standardized regression coefficients of the predictors together with their correlations with physical aggression, in addition to their squared semi-partial correlations and structure coefficients, are presented in Table 3. With the sizable correlations between predictor variables, the unique variance explained by TABLE 2––Correlations between personality variables and trait physical aggression in antisocial and borderline personality disorder subjects. Variable 1. 2. 3. 4. 5. 6. 7. 8. Buss Perry Physical Aggression Anxiety Anger/Hostility Self-consciousness Impulsiveness Altruism Compliance Tender-mindedness 2 0.293* – 3 0.360** 0.427*** – 4 0.277* 0.726*** 0.368** – 5 0.031 0.590*** 0.528*** 0.477*** – 6 0.192 0.126 0.535*** 0.091 0.225 – 7 0.558*** 0.060 0.638*** 0.080 0.265* 0.456*** – 8 0.262* 0.156 0.258* 0.351** 0.047 0.572*** 0.415** – All correlations between the personality variables and physical aggression were significant except for those of impulsiveness and altruism with physical aggression. *p < 0.05; **p < 0.01; ***p < 0.001. 140 JOURNAL OF FORENSIC SCIENCES TABLE 3––Association of personality traits with physical aggression in personality disorder subjects. Model Constant Anxiety Anger/Hostility* Selfconsciousness Impulsiveness Altruism Compliance Tendermindedness Beta Pearson r sr2 Structure Coefficient b SE-b 30.482 0.360 0.744 0.390 10.922 0.296 0.331 0.320 0.244 0.487 0.238 0.293 0.360 0.277 0.021 0.071 0.021 0.434 0.533 0.410 0.132 0.316 0.545 0.018 0.288 0.293 0.311 0.295 0.073 0.182 0.320 0.010 0.031 0.192 0.558 0.262 0.003 0.016 0.043 0.000 0.046 0.284 0.827 0.388 The dependent variable was the Buss Perry physical aggression score. R2 = 0.675; Adjusted R2 = 0.456; sr2 is the squared semi-partial correlation; b = unstandardized regression coefficient; SE, standard error. *p < 0.05. TABLE 4––Percentage of antisocial personality disorder subjects with each type of violent crime conviction. Category of Violent Crime Homicide Attempted Homicide Sexual Assault Assault Robbery Criminal Harassment Uttering Threats % 6.0 0 0 88.0 59.0 0 35.0 Percentages add up to greater than 100%, because some subjects had more than one type of violent conviction (n = 17). BPD have distinct neurobiological underpinnings (21,22). While externalized aggression is a DSM-5 diagnostic criterion for both disorders and several laboratories investigating aggression include mixed samples of ASPD and BPD subjects (34–36), it is likely that there are subtle differences in the personality characteristics of ASPD and BPD underlying high trait physical aggression. Larger samples would be required to parse out these relationships. Second, we chose to limit the study of BPD to females and ASPD to males given the challenges of recruiting males with BPD and females with ASPD (37). As some authors have remarked, “Women who are antisocial but not borderline and borderline men who are not antisocial are rare and subsequently difficult to enroll” ([37], p. 566). Future studies should endeavor to meet this challenge. Third, the main outcome variable in the study relied upon self-reported physical aggression, which may not be reflective of actual aggressive behavior. However, trait anger/hostility predicted both self-reported aggression and number of violent convictions in the ASPD subsample, suggesting a relationship between self-report and behavioral measures of physical aggression in this sample. A final limitation is that personality traits were also self-reported. In conclusion, trait anger/hostility predicted self-reported physical aggression and violence in a clinical sample of BPD and ASPD participants. The validity of the results is strengthened by the observed relationship of self-reported anger with behavioral correlates of aggression and self-report measures. In addition to structured professional judgment and actuarial measures, clinicians may consider including validated, self-report measures of personality in their overall risk assessments of BPD and ASPD subjects. References expression could also be evaluated for their influence on the neurocircuitry underlying maladaptive anger. Forensic psychiatrists and psychologists are regularly called upon to offer assessments of risk of future violence. Although some structured professional judgment approaches to risk assessment (30) guide assessors to consider maladaptive personality traits relevant to anger, these tools do not provide a measure of personality functioning in quantitative terms. Interestingly, we found in our small sample of ASPD participants that a continuous measure of trait anger/hostility was able to predict number of violent convictions. An exciting new direction in violence prediction research involves investigation of potential risk biomarkers using neuroimaging techniques (31). However, several ethical, scientific, and practical considerations limit the immediate clinical utility of such applications, among which is the expense of costly neuroimaging procedures. On the other hand, validated personality inventories are inexpensive and easily administered tools that could provide supplementary information to existing clinical risk assessment approaches. Several limitations of the present investigation should be noted. First, our sample size was relatively small and may have lacked sufficient power to detect smaller but clinically relevant predictors of aggressive and violent behavior. To address this issue and increase the robustness of the analyses, BPD and ASPD subjects were combined into a single group. Although ASPD and BPD have been conceptualized as different aspects of the same disorder manifested in a gender-specific manner (32), it is now widely accepted that the two conditions are separate disorders (33), with growing research to suggest that ASPD and 1. Bettencourt BA, Talley A, Benjamin AJ, Valentine J. Personality and aggressive behavior under provoking and neutral conditions: a meta-analytic review. Psychol Bull 2006;132(5):751–77. 2. Ramirez JM, Andreu JM. Aggression, and some related psychological constructs (anger, hostility, and impulsivity) – some comments from a research project. Neurosci Biobehav Rev 2006;30(3):276–91. 3. Costa PTJr, McCrae RR. Revised NEO Personality Inventory (NEO-PIR) and NEO Five-Factor Inventory (NEO-FFI). Odessa, FL: Psychological Assessment Resources, 1992. 4. McCrae RR, Allik J. The Five-Factor Model Across Cultures. New York, NY: Kluwer-Plenum, 2002. 5. Jang KL, McCrae RR, Angleitner A, Riemann R, Livesley WJ. Heritability of facet-level traits in a cross-cultural twin sample: support for a hierarchical model of personality. J Pers Soc Psychol 1998;74(6):1556– 65. 6. Bagby RM, Costa PT Jr, McCrae RR, Livesley WJ. Replicating the five factor model of personality in a psychiatric sample. Personality Individ Differ 1999;27(6):1135–9. 7. Caprara GV, Barbaranelli C, Zimbardo PG. Understanding the complexity of human aggression: affective, cognitive, and social dimensions of individual differences in propensity toward aggression. Eur J Pers 1996;10(2):133–55. 8. Miller JD, Lynam DR. Psychopathy and the five-factor model of personality: a replication and extension. J Pers Assess 2003;81(2):168–78. 9. Sharpe JP, Desai S. The Revised NEO Personality Inventory and the MMPI-2 Psychopathology Five in the prediction of aggression. Personality Individ Differ 2001;31(4):505–18. 10. Scott LN, Stepp SD, Pilkonis PA. Prospective associations between features of borderline personality disorder, emotion dysregulation, and aggression. Personal Disord 2014;5(3):278–88. 11. Newhill CE, Eack SM, Mulvey EP. A growth curve analysis of emotion dysregulation as a mediator for violence in individuals with and without borderline personality disorder. J Pers Disord 2012;26(3):452–67. 12. Hodgins S, De Brito SA, Chhabra P, C^ote G. Anxiety disorders among offenders with antisocial personality disorders: a distinct subtype? Can J Psychiatry 2010;55(12):784–91. KOLLA ET AL. 13. Blackburn R, Coid JW. Psychopathy and the dimensions of personality disorder in violent offenders. Personality Individ Differ 1998;25(1):129– 45. 14. Sch€onenberg M, Louis K, Mayer S, Jusyte A. Impaired identification of threat-related social information in male delinquents with antisocial personality disorder. J Pers Disord 2013;27(4):496–505. 15. White HR, Widom CS. Intimate partner violence among abused and neglected children in young adulthood: the mediating effects of early aggression, antisocial personality, hostility and alcohol problems. Aggress Behav 2003;29(4):332–45. 16. Jolliffe D, Farrington DP. Empathy and offending: a systematic review and meta-analysis. Aggress Violent Behav 2004;9(5):441–76. 17. Quinsey VL, Coleman G, Jones B, Altrows IF. Proximal antecedents of eloping and reoffending among supervised mentally disordered offenders. J Interpers Violence 1997;12(6):794–813. 18. Skeem JL, Miller JD, Mulvey E, Tiemann J, Monahan J. Using a fivefactor lens to explore the relation between personality traits and violence in psychiatric patients. J Consult Clin Psychol 2005;73(3):454–65. 19. First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin S. Structured clinical interview for DSM-IV Axis II personality disorders, (SCID-II). Washington, DC: American Psychiatric Press, 1997. 20. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition (SCID-I/P), Version 2. New York, NY: Biometrics Research, New York State Psychiatric Institute, 2002. 21. Kolla NJ, Chiuccariello L, Wilson AA, Houle S, Links P, Bagby RM, et al. Elevated monoamine oxidase – a distribution volume in borderline personality disorder is associated with severity across mood symptoms, suicidality, and cognition. Biol Psychiatry 2016;79(2):117–26. 22. Kolla NJ, Matthews B, Wilson AA, Houle S, Bagby RM, Links P, et al. Lower monoamine oxidase – a total distribution volume in impulsive and violent male offenders with antisocial personality disorder and high psychopathic traits: an [11C] harmine positron emission tomography study. Neuropsychopharmacology 2015;40(11):2596–603. 23. Digman JM. Personality structure – emergence of the five-factor model. Annu Rev Psychol 1990;41:417–40. 24. Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol 1992;63(3):452–9. 25. Hornsveld RH, Muris P, Kraaimaat FW, Meesters C. Psychometric properties of the aggression questionnaire in Dutch violent forensic psychiatric patients and secondary vocational students. Assessment 2009;16 (2):181–92. . ANGER IN PERSONALITY DISORDERS 141 26. Wechsler D. Manual of the Wechsler Adult Intelligence Scale – revised (WAIS-R). New York, NY: Psychological Corporation, 1981. 27. Gardner W, Mulvey EP, Shaw EC. Regression-analyses of counts and rates: poisson, overdispersed poisson, and negative binomial models. Psychol Bull 1995;118(3):392–404. 28. Pihl RO, Lau ML, Assaad JM. Aggressive disposition, alcohol, and aggression. Aggress Behav 1997;23(1):11–18. 29. Denson TF, Pedersen WC, Ronquillo J, Nandy AS. The angry brain: neural correlates of anger, angry rumination, and aggressive personality. J Cogn Neurosci 2009;21(4):734–44. 30. New AS, Hazlett EA, Newmark RE, Zhang J, Triebwasser J, Meyerson D. Laboratory induced aggression: a positron emission tomography study of aggressive individuals with borderline personality disorder. Biol Psychiatry 2009;66(12):1107–14. 31. Nadelhoffer T, Bibas S, Grafton S, Kiehl KA, Mansfield A, SinnottArmstrong W. Neuroprediction, violence, and the law: setting the stage. Neuroethics 2012;5(1):67–99. 32. Paris J. Antisocial and borderline personality disorders: two separate diagnoses or two aspects of the same psychopathology? Compr Psychiatry 1997;38(4):237–42. 33. Paris J, Chenard-Poirier MP, Biskin R. Antisocial and borderline personality disorders revisited. Compr Psychiatry 2003;54(4):321–5. 34. Douglas KS, Hart SD, Webster CD, Belfrage H. HCR-20 V3: assessing risk for violence. Burnaby, Canada: Mental Health, Law, and Policy Institute, Simon Fraser University, 2013. 35. Coccaro EF, Berman ME, Kavoussi RJ. Assessment of life history of aggression: development and psychometric characteristics. Psychiatry Res 1997;73(3):147–57. 36. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edn. Arlington, VA: American Psychiatric Association, 2013. 37. Lobbestael J, Arntz A, Cima M, Chakhssi F. Effects of induced anger in patients with antisocial personality disorder. Psychol Med 2009;39 (4):557–68. Additional information and reprint requests: Nathan J. Kolla, M.D., Ph.D., FRCPC Centre for Addiction and Mental Health Research Imaging Centre 250 College Street, Room 436 Toronto, ON M5T 1R8 Canada E-mail: Copyright of Journal of Forensic Sciences (Wiley-Blackwell) is the property of WileyBlackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
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Methods of Violence Discussion
Thesis statement: The risk assessments of aggressive and violent individuals have found that
aggression character or behavioral phenomenon that is partly driven by the personality behaviors
of a person or an individual
1. Clinical Approach and Actuarial Approach


Methods of Violence Discussion
Institution Affiliation




The risk assessments of aggressive and violent individuals have found that aggression
character or behavioral phenomenon is partly driven by the personality behaviors of a person or
an individual (Kolla, Meyer, Bagby & Brijmohan, 2017). The two approaches in risk assessment
on view here are the actuarial approach and the clinical approach. The actuarial approach is also
known as or referred to as ...

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