Predicting Severity of Violent Recidivism by Aggression Type:

What do Risk Instruments, Cognitive and Personality Scales Contribute?

by

Melanie Dawn Douglass

A thesis submitted in conformity with the requirements for the degree of Master’s of Arts

Graduate Department of Psychology

University of Toronto

© Copyright by Melanie Dawn Douglass (2009)

 ii

Predicting Severity of Violent Recidivism by Aggression Type:

What do Risk Instruments, Cognitive and Personality Scales Contribute?
Melanie Dawn Douglass
Master’s of Arts, 2009
Graduate Department of Psychology
University of Toronto

Abstract

This study provides an initial analysis of how effective commonly used risk

assessment and psychological tests are in postdicting the severity of the index offense and

the individual’s most severe offense in a forensic inpatient sample. The study involved a

chart review of risk assessment measures, cognitive and personality tests, and

criminological data for 65 patients at St. Joseph’s Hamilton Mountain Centre for Mental

Health Care. The results found a significant correlation between the Wechsler

Abbreviated Scale of Intelligence (Wechsler, 1997) and index offense severity.

Moreover, an aggression typology (Nussbaum, Saint-Cyr, & Bell, 1997) showed

promising signs in differentiating severity by offender type. The study also suggests that

further research is necessary in this area, given the limited relationship found between

risk instruments and severity of violence, though the risk assessment measures did show

good concurrent validity.

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Acknowledgements

I would like to acknowledge the innumerable contributions of my supervisor, Dr.

David Nussbaum, and thank him for his guidance and assistance. I would also like to

thank Dr. Jennifer Tackett for her role as my subsidiary supervisor and for her valued

input to this project. I gratefully acknowledge Dr. Mini Mamak of McMaster University

and St. Joseph’s Hamilton Mountain Centre for Mental Health Care for her assistance in

making the data available, and navigating the complexities of a multi-institution study. I

would also like to thank Dr. Gerald Cupchik for acting as my third reader and providing

helpful and insightful comments.

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Table of Contents

Cover Page…………………………………………………………………………………i
Abstract (max 150 words, 137 right now)…………………..…………………………….ii
Acknowledgements………………………………………………………………………iii
Table of Contents…………………………….…………………………………………..iv
Introduction………………….……………………………………………………………1
Literature Review.....………………………………………………………………..….3
Hypotheses…………………………………………………………………………..…9
Methods………………………………………………………………………………….10
Participants……………………………………………………………………………….10
Outcome Measures……………………………………………………………………….11
Akman Normandeau Severity Scale………………………………………………….11
Violence Density for Evaluation of Likelihood of Violent estimate in this Sample…11
Violence Risk Assessment Measures…………………………………………………….11
Hamilton Anatomy of Risk Management…………………………………………….11
Historical, Clinical, Risk Management-20 Version 2………………………………..12
Psychopathy Checklist Revised………………………………………………………12
Violence Risk Assessment Guide…………………………………………………….13
Aggression Typology Classification…………………………………………………..…13
Cognitive Measures……………………………………………………………………...14
Repeatable Battery for the Assessment of Neurological Status……………………...14
Stroop Colour and Word Task………………………………………………………..14
Trail Making Test…………………………………………………………………….14
Wechsler Abbreviated Scale of Intelligence…………………………………………15
Personality Measure……………………………………………………………………..15
Personality Assessment Interview……………………………………………………15
Procedures………………………………………………………………………………..16
Results……………………………………………………………………………………17
Descriptive Statistics………………………………………………………………….17
Correlational Analyses………………………………………………………………..17
Regression with Most Severe Offense………………………………………………..19
Regression with Index Offense……………………………………………………….20
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Typology Based Between Groups Analysis………………………………………….21

Discussion……………………………………………………….……………………….22
References……………………………………………………………….……………….30
Appendix A………………………………………………………………………………36
Table 1………………………………………………………………………………..36
Table 2………………………………………………………………………………..37
Table 3………………………………………………………………………………..39
Table 4………………………………………………………………………………..40
Table 5………………………………………………………………………………..41
 Predicting Severity of Violence 1

Predicting Severity of Violent Recidivism by Aggression Type: What do Risk

Instruments, Cognitive and Personality Scales Contribute?

Introduction
The judicial system is charged with reconciling the seemingly contradictory tasks

of protecting society from potentially aggressive individuals, while attempting to

preserve the rights and freedoms of those who have offended violently in the past but

may desist from future violence. To help the judicial system, psychologists and other

forensic mental health professionals have developed a number of empirically validated

violence risk instruments to predict an individual’s likelihood to re-offend (recidivate)

violently. These instruments enable forensic clinicians to assist the judiciary process in

helping to identify, sentence, and potentially rehabilitate individuals according to the risk

they pose to society. Existing risk prediction instruments have focused entirely on the

likelihood of violent recidivism. For example, the historical and static Violent Risk

Assessment Guide (VRAG; Harris, Rice, & Quinsey, 1993) is reported to predict future

violence moderately well as indicated by an Area Under the Curve (AUC – a detection

theory based prediction statistic - within risk assessment the AUC is the probability that

any given violent offender will score higher on a risk measure than a randomly chosen

non-violent individual; Pozullo, Bennell, & Forth, 2006) value of 0.75 (Rice & Harris,

1995). Similar levels have been reported for other actuarial and more recent dynamic

instruments (e.g., the Self Appraisal Questionnaire; Loza & Loza, 2001). Relatively

unstudied, despite being required under Canadian law (e.g., Winko v. British Columbia,

1997; Schneider, 2000), is the issue of the severity of future offenses that an individual

might commit. Indeed, the Supreme Court of Canada in Winko (1997) stated that, for an
 Predicting Severity of Violence 2

individual to be held under the aegis of a (Canadian) provincial or territorial Review

Board, the Crown must demonstrate that the individual represents a significant risk to the

safety of the public and that this is not satisfied by a high likelihood of trivial harm or a

small likelihood of great harm. Rather, a foreseeable likelihood of significant physical or

psychological harm must exist to invoke an indefinite sentence (Winko v. British

Columbia, 1997). To date, the issue of re-offense severity has received little attention,

although appreciation of re-offense severity may be more important than a simple "he

will or he won't" prediction.

Nussbaum, Douglass, Watson, MacEacheron, & Bass (2009) have noted the

absence of studies investigating the issue of predicting severity and describe the legal

requirements that underline the importance of this lacuni. In particular, they noted that,

in order to qualify for an indeterminate sentence in either previously aggressive mentally

disordered or non-mentally disordered offenders, the law requires a projection that the

individual is likely to commit a serious offense in the future (Nussbaum et al., 2009). By

use of similar wording to describe criteria for indeterminate sentencing in Mentally

Disordered Offenders (MDO) and typical criminals, the Criminal Code of Canada (CCC)

implies that identical legal criteria apply to both sections of legislation.

While it might be argued intuitively that a moderately high risk prediction

probability in the presence of any previous violent offenses imply satisfaction of the

significance threshold, this assumption has not been subjected to empirical investigation.

Many findings in the past have refuted intuitive projections. For example, in a classic

study, Milgram (1963) found that participants who believed they were administering

near-lethal levels of electric shock failed to cease even when collaborators complained of
 Predicting Severity of Violence 3

chest pain and begged them to stop, a finding that is not only counter-intuitive, but

continues to shock the scientific community. Therefore, it is necessary to conduct

empirical studies to investigate the relationship between psychometric measures, previous

criminal history, and the prediction of criminal severity in the future.

Predicting recidivism is a key component of forensic-correctional work.

Actuarial and structured clinical judgment tools certainly enhance one’s ability to

formulate an opinion about risk, but no tool specifically addresses how severe a criminal

act is likely to be. The aim of the present study was to assess the extent to which a

collection of commonly used risk instruments are associated with severity of MDO’s

previous violent episodes. The current (i.e., index) offense (reflecting a possible violence

“end-point”) and most severe violence (reflecting a possible violence apogee) were used

as separate outcome variables.

Literature Review

The relationship between the widely researched VRAG (a 12-item measure for

predicting whether an individual will reoffend) and severity, as measured by the 20-point

version of the Akman Normandeau scale, was reported by Harris et al (2003), who found

that the VRAG’s correlation with severity was 0.18. They also found that the VRAG’s

correlations with severity improved to 0.35 when victim-injury was measured using only

the seven scores for violent offending, presumably discarding the non-violent offense

values (Harris et al., 2003). It must be noted that a correlation of 0.35 accounts for 12.25

% of the variance in severity. Neither of the two other measured scales, (i.e., the

RRASOR and the Static-99) significantly correlated with severity or victim injury (Harris

et al., 2003).
 Predicting Severity of Violence 4

The lack of research in this area as well as low rates of accuracy in predicting

severity are particularly troublesome when its importance is considered. Cunningham

and Sorensen (2007) studied 136 individuals incarcerated for capital murder. They

measured institutional violence in the first months of incarceration. Counter-intuitively,

Cunningham & Sorensen (2007) found that severity was inversely related to frequency of

violence in a study of close-custody inmates in Florida’s correctional system.

These two studies underscore the importance of empirically investigating this

issue. Whether violence inside the prison system is similar in nature to that which occurs

outside of the correctional system or not, current risk assessment measures, based solely

on probabilities, rather than the severity of violent recidivism are inadequate. It is vital

that information regarding severity of offending be known in order for those working in

the judicial system to make informed decisions, particularly when these decisions result

in the wellbeing of those living and working in our communities.

Another study which points to the importance of examining severity was

conducted by Hilton, Harris, and Rice (2007). They conducted an archival review of 522

spousal assault incidents evaluating the role of police intervention (Hilton et al., 2007).

They found that arrest was associated with higher perceived risk of recidivism, the

amount of injury inflicted on the victim, and the perceived seriousness of the incident

(Hilton et al., 2007). Arrest, however, only had a beneficial effect (i.e. reduced the rate

of recidivism) in low-risk cases (Hilton et al., 2007). However, given the previously

mentioned link between high frequency and low-severity of violence (Cunningham &

Sorensen, 2007), ignoring severity of reoffense may lead to policies that put victims at

greater-than-necessary risk.
 Predicting Severity of Violence 5

Consequently, it is important to study factors related to, and possibly predictive

of, violence severity. Severity, to date, has been over-looked and represents a serious gap

in the current state of knowledge within the field of forensic psychology. This study is

the first to examine the association between the existing risk instruments and the severity

of previously committed violent crimes in forensic psychiatric inpatients.

Although the issue of severity is relatively under-studied, limited information has

been gathered regarding the severity of violence. One study conducted by Porter,

Woodworth, Earle, Drugge, and Boer (2003) looked at the difference between

psychopathic and non-psychopathic offenders and the amount of violence used during

sexual homicides. They compared the offenses for characteristics of the victim, the

relationship between the victim and the assailant, and the type of violence committed and

found that thrill seeking and lack of empathy were associated with the severity of violent

homicide (Porter et al., 2003). They also found that psychopathy was correlated with

sexual sadism and that these were both linked with instrumental and extreme violence,

suggesting that psychopaths are more likely than non-psychopaths to derive sexual and

non-sexual pleasure from sadism (Porter et al., 2003). Finally, it was found that

education was inversely linked with severity of the crime, with those having the most

advanced educational attainment committing the least violent acts within the group

committing homicides (Porter et al., 2003).

This relationship to severity was ironically not mentioned as a consideration

underlying why psychopathy, as measured by the Psychopathy Checklist (PCL; Hare,

2003) is considered the best single predictor of violence (Pozullo et al., 2006). It

underscores the possibility that psychopathy could contribute to the assessment of

 Predicting Severity of Violence 6

severity of violence as it has proved to be in the probability of violence. The link

between instrumental violence and severity may be less predictable because according to

the theory, the extent of violence is to a large extent dependent on the compliance or

tenacity of the victim.

A second study of the relationship between severity of violence and psychometric

measures was conducted as part of a doctoral thesis by Watson (2008). The individual

variables achieving statistical significance included an increasing victim injury level,

diagnosis, an increasing number of realistic defensive responses in the “Definitely

Provoke” condition, the individual's first non-violent offense occurring at a lower age, a

decreasing number of non-realistic defensive responses in the “Might Provoke”

condition, a lower number of past violent offenses, and a higher degree of elementary

school maladjustment (Watson, 2008).

Violence has also been shown to be highly associated with alcohol abuse. Tateno,

Jorge, and Robinson (2003) conducted a study on the aggressive behavior of brain injury

patients in Iowa. They found that the severity of aggressive behavior was significantly

linked to a history of drug and alcohol abuse, frontal lobe lesions, and the diagnosis of

major depression (Tateno et al., 2003). Related to this, Marcus and Reio (2002)

conducted a study on intimate partner abuse on college campuses in the United States.

They found that there was a positive association between alcohol consumption and the

extent of injury experienced by the victim of the abuse (Marcus & Reio, 2002). It is

therefore likely that information relating to substance abuse and aggression will prove

informative to the present study.

 Predicting Severity of Violence 7

In addition, Beggs and Grace (2008) have found a relationship between

psychopathy, intelligence, and offending in a sample of child molesters. They found that

psychopathic and sadistic offenders had low intelligence and were more likely to have a

subsequent sexual offense than other offenders in the sample (Beggs & Grace, 2008),

suggesting that there may be a link between low intelligence and severe offending. This

is corroborated by the work of Langevin and Curnoe (2008) who found that individuals

with learning disorders were over-represented in the sample in comparison to the general

population (Langevin & Curnoe, 2008).

Finally, as a rare study examining institutional violence, Almvik, Rasmussen, and

Woods (2006) examined violent acts performed by psycho-geriatric and nursing ward

patients in two Norwegian nursing homes over a three month period. They found that 32

of the 82 patients committed acts of violence, with injury resulting from these acts only

on rare occasions (Almvik et al., 2006). The most common reason behind these attacks

was that the patient had been denied something that they had requested, resulting in

frustration and resultant anger. The largest number of the incidents occurred during

personal care tasks (Almvik et al., 2006). This suggests that the majority of these

altercations could be classified as irritable aggression, suggesting that this form of

violence is of the greatest concern in clinical settings. While it is true that victim injury

only occurred on rare occasions, it must be noted that the study only ran for a three month

period and was conducted in a supervised setting.

For the purpose of this study it is necessary to discuss the work of Nussbaum,

Saint-Cyr, and Bell (1997) who adapted the established animal aggression typology in

order to classify human violence most prevalent in the criminal justice system by type.
 Predicting Severity of Violence 8

The three relevant subtypes consist of Predatory, Irritable, and Defensive aggression.

Predatory aggression refers to tangibly motivated aggression (e.g. robbing a bank,

muggings etc.). This is carried out in an emotionless fashion, has a tangible goal and is

terminated with successful goal achievement. Severity of assault is governed by

necessity for goal attainment. Irritable aggression is carried out under the emotional

context of anger, and is typically disproportional to the seriousness of the provocation

(e.g., insults in bars, minor criticism concerning a sensitive issue, etc.). Termination of

the assault usually occurs when the individual is exhausted. Defensive aggression

generally occurs when an individual perceives a threat to his or her safety from another

individual. It typically involves the emotional experience of fear or anxiety. While

defensive aggression is not typically a concern for the criminal justice system, it does

become a concern if the perception of a threat is unrealistic and is a product of

persecutory delusions or hallucinations (Nussbaum et al., 1997, Levi, 2004). Attack is

initiated when perceived options for escape are absent and termination results when the

threat has been allayed. Due to the delusional nature of the majority of these cases, most

defensive acts intersecting the forensic system are perpetrated by mentally-disordered

offenders processed by the forensic system.

The necessity of developing new approaches to predict violence severity assumes

that existing risk instruments are incapable of the task, but, as noted above, too few

studies exist to evaluate of this issue. Identification of an acceptably valid approach to

severity predictions would clearly impact the judicial system by reliably informing

decision-makers of the potential consequences should a violent relapse occur. This

knowledge could also translate into greater insight regarding resource allocation of scarce
 Predicting Severity of Violence 9

rehabilitation resources within the dominant “Risk, Needs, Responsivity Principle”

(Andrews, Bonta, & Hoge, 1990) promoting enhanced community safety and likelihood

of offender rehabilitation. It is worth noting that a similar severity-typology has proved

useful in work on wife-abusers (Delsol, Margolin, & John, 2006). The researchers

classed 72 male batterers by their violence type based on Holtzworth-Munroe and

Stuart’s (1994) typology of male batterers (Delsol, Margolin, & John, 2006). They then

performed a latent class analysis of severity of physical aggression, generality of

violence, and psychopathology and found a significant difference between the types in

ᵪ
terms of victim injury level [ 2(4, 153) = 56.12, p = < .001] (Delsol, Margolin, & John,

2006).

Hypotheses

Given Cunningham and Sorensen’s (2007) finding that there is an inverse

relationship between violence severity and frequency of violence, and the suggestion that

severity is related to intelligence (Beggs & Grace, 2008), we predicted that severity

would show a stronger relationship with the cognitive tests than with the risk instruments

that are designed to predict recidivism rates.

We also predicted that individuals would differ in their severity of violence based

on their aggressive typology. This prediction was based on the fact that two of the three

offender types’ aggression patterns are situation dependent. For defensive-delusional

offenders, their aggression pattern is dependent on the level and type of danger that they

perceive as well as the escape routes that are available from the threat. Predatory

offenders’ severity of violence is also dependent on the situation because their actions are

goal-driven and once they achieve the intended target outcome their attack will stop;
 Predicting Severity of Violence 10

therefore their level of violence will depend on the amount of resistance they encounter in

trying to attain their goal. There is no such end-point inherent in the actions of Irritable

aggressors; therefore, we predicted that these offenders would score higher in the severity

of both their index offense and their most severe offense on record in comparison to the

other two offender types.

Methods

Participants

This study involved a chart review of a psychiatric inpatient sample at the

Forensic Program at the St. Joseph’s Hamilton Mountain Centre for Mental Health Care.

Approval to conduct the study was received from the University of Toronto/Toronto Area

Health Science Network and the St. Joseph’s Health Care/McMaster University Research

Ethics Boards, since the primary author and her supervisor are affiliated with the

University of Toronto while the data were gathered from St. Joseph’s Health Care Centre

affiliated with McMaster University.

The participants consisted of 65 inpatients under an Ontario Review Board

disposition and were residing in the Medium and Minimum secure units of the Forensic

Service at St. Joseph’s Healthcare during the study. The mean current age of the 62 men

and three women in the study was 40.63 (SD = 13.67), with a range of 19 to 75 years. Of

the 65 participants, 51 had been diagnosed with an axis I disorder, 2 with an axis II

disorder, and 12 with a comorbid axis I/axis II disorder.

Outcome Measures

The Akman and Normandeau Severity Scale (Akman & Normandeau, 1967)

provides a mean of consistently scoring violent and non-violent criminal activities for
 Predicting Severity of Violence 11

severity. Each crime is ranked between 1 and 28, with one indicating a threat of violent

action, and a score of 28 indicating injuries resulting in the death of the victim. For this

study, a Windsordised (Howell, 2007) cap of 15 was used in order to prevent a few high

scores on the scale from skewing the data while retaining their information. As all of the

crimes in the analysis were of a violent nature, the section of the scale dealing with non-

violent crimes was not used in these analyses.

Violence Density for Evaluation of Likelihood of Violence estimate in this Sample

was defined as the individual’s number of years past the age of majority (age-18; as

criminal offenses prior to that age are not listed on the CPIC record) divided by the

number of offenses that individual had committed since 18. This outcome measure was

used to control for the fact that age and amount of time spent incarcerated, limits the

number of offenses that an individual is able to commit. The violence density was

therefore used as a standardized measure of violent tendency.

Violent Risk Assessment Measures

Hamilton Anatomy of Risk Management (Chemovitz & Mamak, 2007). The

Hamilton Anatomy of Risk Management (HARM) is a clinical risk assessment tool

developed at St. Joseph’s Healthcare, CMHS, Forensic Service, to evaluate inpatient risk.

The HARM is a structured clinical judgment tool that guides the assessor to consider both

historical (i.e. childhood maladjustment) and dynamic risk factors (i.e. insight of mental

disorder) in formulating short term predictions of aggression. The HARM also directs

the clinician to formulate a plan to modify risk with the introduction of appropriate

interventions. At present, the tool is used as a clinical guide on the forensic service.
 Predicting Severity of Violence 12

Historical, Clinical, Risk Management-20 Version 2 (Webster, Douglas, Eaves &

Hart, 1997a). The Historical, Clinical Risk Management-20 Version 2 (HCR-20) is a

structured professional judgment approach to risk assessment designed to predict violent

behavior in correctional and forensic psychiatric patients. It consists of 20 items

organized into three main scales of risk assessment: Historical (past violence, age at first

violent offense, relationship instability, employment instability, relationship problems,

major mental disorder, psychopathy, early maladjustment, personality disorder, prior

supervision failure), Clinical (lack of insight, negative attitudes, active mental disorder

symptoms, impulsivity, treatability), and Risk Management (feasibility of plans, exposure

to destabilizers, level of personal support, stress, likelihood of treatment compliance).

Psychopathy Checklist-Revised: 2nd Edition (Hare, 2004). The Psychopathy

Checklist-Revised: 2nd Edition (PCL-R-2) measures the construct of psychopathy. It is a

20-item rating scale with two factors (Interpersonal and Affective) broken down into two

facets each (Interpersonal Traits and Affective Style for Factor 1 and Impulsive and

Irresponsible Behavior, and Antisocial Lifestyle for Factor 2). Individuals are given a

score between 0 and 2 for each item from information gleaned partly from a semi-

structured interview but more vitally from an extensive review of files going back to

early childhood. Given the 20 items scores on a 0, 1, 2 basis, the maximum possible

score is 40, and the generally accepted cut score for a “diagnosis” of psychopathy is 30.

While a debate exists as to whether the construct of psychopathy is better conceptualized

dimensionally (Skeem, Poythress, Edens, Lilienfeld, & Cale, 2003) or categorically

(Skilling, Harris, & Rice, 2002) there is no debate that PCL scores above 25 are clearly

indicative of higher risk levels, even if “sub-diagnostic”. The PCL-R is the most
 Predicting Severity of Violence 13

commonly used tool involved in risk assessments globally as studies show that

psychopathy as measured by the PCL-R is perhaps the single best predictor of violent

recidivism (Walters, 2003).

Violence Risk Assessment Guide (Harris, Rice, & Quinsey, 1993): The Violence

Risk Appraisal Guide (VRAG) consists of a 12-item measure designed to assess the long-

term risk for violent recidivism in offenders with and without mental disorders. The

twelve predictor variables used in the VRAG consist of: Hare Psychopathy Checklist-

Revised score, elementary school maladjustment, diagnosis of any personality disorder,

young age at index offense (reverse coded), separation from biological parents prior to

age 16, failure on prior conditional release, prior non-violent offenses, single marital

status at time of offense, diagnosis of schizophrenia (reverse coded), victim injury

(reverse coded), history of alcohol problems, and victim gender. From these risk

measures, the individual is placed in one of nine risk categories (or “Bins”) with an

ascending associated risk of violent recidivism occurring within ten years. It should be

noted that the definition of violent recidivism predicted by the VRAG was sustaining a

charge for a violent offense, and not a judicial finding of guilt or self-reported violent

crimes.

Aggression Typology Classification

The classification of offenders based on the aggression typology of Nussbaum et

al. (1997) followed the protocol outlined in Levi (2004). The participant’s CPIC records

were used for classification of aggression type (Levi, 2004). If the majority of the

offences were goal-driven (i.e. not provoked, no presence of paranoid thoughts), the

individual was classified as predatory. If the majority of the offences resulted from
 Predicting Severity of Violence 14

provocation or an escalating exchange with another individual, the patient was identified

as irritable and if the crime resulted from paranoid thoughts, the individual was identified

as defensive-delusional.

Cognitive Measures

Repeatable Battery for the Assessment of Neuropsychological Status (Randolf,

1998): The Repeatable Battery for the Assessment of Neuropsychological Status (R-

BANS) is a neuropsychological screening measure that assesses memory, attention,

language, and visuo-spatial skills.

Stroop Colour and Word Test (Stroop, 1935): The Stroop Colour and Word Test

(Stroop) presents a series of colour and word mismatches where the participant has either

to name the colour or the word. It has been associated with cognitive flexibility,

resistance to interference from outside stimuli, creativity, psychopathology, and cognitive

complexity and clearly plays a role in many interrelated cognitive processes which

determine an individual’s ability to successfully cope with cognitive stress and to process

complex input. Of particular utility for this study is the Stroop’s ability to reflect

inhibition of a pre-potent cognitive response. It has been linked to activation of the

Anterior Cingulate Gyrus (ACG) that is involved in conflict monitoring and subsequent

inhibition (Nabeyama, et al., 2008).

Trail Making Test (Reitan, 1992): The Trail Making Test (TMT) is a measure of

scanning, visuomotor tracking, divided attention, and cognitive flexibility. It is

administered in two parts, A and B. In Part A, the subject must draw lines to connect

consecutively numbered circles on a work sheet. In Part B, the subject connects the same

number of consecutively numbered and lettered circles on another worksheet by

 Predicting Severity of Violence 15

alternating between the two sequences. TMT-B is most relevant as it reflects one’s

ability to switch out of a particular behavioral set and again mirror inhibitory capacity as

the first step in the switching process. Speed of processing is also implicit to the Trail

tasks, especially Trails A.

Wechsler Abbreviated Scale of Intelligence (Wechsler, 1999): The Wechsler

Abbreviated Scale of Intelligence (WASI) consists of two subscales with two subtests

each, to estimate verbal intelligence (Vocabulary and Similarities) and performance

intelligence (Block Design and Matrix Reasoning) respectively. It is a short but reliable

and valid test [the correlation between the WASI and the full scale Wechsler Adult

Intelligence Scale (WAIS; Wechsler, 1997) is .82] which measures cognitive ability in

the form of an intelligence quotient (Wechsler, 1999). This is relevant to the proposed

study as it is possible that Irritable aggressors have decreased intellectual ability leading

to an inability to generate non-violent social solutions to frustrating problems, resulting in

increased anger and uncontrolled Irritable aggression.

Personality Measure

Personality Assessment Interview (Morey, 1991): The Personality

Assessment Inventory (PAI) is a multi-dimensional self-report measure of personality

traits with 344 items consisting of 22 scales, 4 validity scales, 11 clinical scales, 5

treatment scales, and 2 interpersonal scales with no overlap on items scored on each.

This study specifically examined the Anxiety, Aggression and Drug scales as they had

showed relationships with aggression in a previous study (Levi, 2004; Levi, Nussbaum &

Rich, 2009).
 Predicting Severity of Violence 16

Procedures

The above clinical information was previously collected from the patients during

their assessments as were their criminal histories (Canadian Police Information Centre or

CPIC Records.).

Statistical analyses were completed using SPSS (SPSS Inc.). A chart review was

performed using patient files from the Forensic Program at St. Joseph's Mountain Health

Care Centre. The most severe historical act, the average severity of all the individuals’

violent criminal acts as well as the index offense (IO) were rated on the Akman

Normandeau severity scale. Severity was rated both across all aggression types and

individually for Predatory, Irritable and Delusional Defensive types. Results were

analyzed in two complimentary ways. Firstly, correlations were calculated for each of

the clinical scales and the outcome variables. Secondly, observed severity levels were

predicted in four separate regression equations; one for the Risk Instruments, one for the

WASI scales, one for the Trail Making Test, and one for the Personality Assessment

Inventory. This division was necessary because not all measures were available for each

individual. The risk measures were used together to see if they were predictive of severity

when used in combination, the WASI and Trails were kept separate because they test

unique aspects of the individual; this is also why the Personality Assessment Interview

was kept separate from the WASI and Trails.

The patients under analysis were not actively involved in the research as this was

a chart review using data purged of identifiers. As noted, ethical approval to conduct the
 Predicting Severity of Violence 17

study was obtained from both the University of Toronto/TAHSN and McMaster

University/St. Joseph’s Research Ethics Boards.

Results
Descriptive Statistics:

With regard to past criminal activities, 18.46% of the most severe offenses

involved no or slight victim injury, 55.4% involved assault where the victim was treated

in hospital and released, 15.4% involved assault where victim was hospitalized and kept

beyond 24 hours, 3.1% involved a sexual assault, 4.6% was for murder, 1.5% was for

mischief. The mean number of past offenses was 6.4 (SD = 11.47). With regard to the

offense types, 44.61% were classified as “Defensive/Delusional”, 32.31% percent as

Irritable, and 23.08% as Predatory (Instrumental). The violence density (the mean

number of crimes committed per year since an individual had attained their majority) for

the sample was 0.32 (SD = 0.52).

In terms of the index offense, 38.5% involved no or slight victim injury, 33.8%

involved victims of assault who were treated and released, 10.8% involved assault where

the victim was hospitalized, 3.1% involved sexual assault, 4.6% were murder charges,

and 6.2% were for mischief. In 14 cases (24.6%), the index offense was the only offense

on record and therefore was coded as both the index offense and the severest offense in

the individual’s criminal history. Table 1 shows a full list of demographic information

for the group.

Correlational Analyses

Correlational analyses were performed utilizing the risk and psychometric scales

and a) Most Severe Offense, b) Severity of Index offense, c) Number of Offenses, and d)

Violence Density. They were broken down in this manner because of the study’s two
 Predicting Severity of Violence 18

objectives: first to determine whether existing risk instruments or psychometric measures

of cognitive function or personality traits are associated with severity or frequency of

violent offending. Secondly, to learn the same with respect to the most severe offense

assuming it was not the index offense, since the index offense may not be indicative of

their most egregious criminal act.

Table 2 reflects the correlation between the psychometric measures and offense

frequency and severity. As is evident in the table, the only significant correlation in

terms of severity was found between the index offense and the WASI verbal subscale (r =

-.341, p = .042, n = 36), sharing approximately 12% of common variance. It is certainly

true that a large number of measures were examined, and it is often argued that under

these circumstances a Bonferroni adjustment should be used. However, Pernager (1998)

argues that such adjustments are unnecessary and often counter sound statistical

inference. If a more conservative p-value of .04 were used (Howell, 2007), the WASI

verbal scale would approach significance. The other cognitive measures, including Trails

A and B, the Stroop Colour and Word task, and the Repeatable Battery for the

Assessment of Neurological Skills were not highly correlated to either the index or

historically highest offense severity (all p-values greater than .05).

Perhaps the most significant of the null findings is that the number of violent

offenses is not correlated with either the index offense severity (r = .012, p = .992, n =

65) or the severest offense (r = .000, p = .994, n = 65). Moreover, the severity of the

index offense was not correlated with violence density (r = .046, p = .718, n = 65) nor

was violence density correlated with severity of the severest offense in an individual’s

criminal history (r = -.019, p = .882, n = 65). This observed disconnection between

 Predicting Severity of Violence 19

frequency and severity suggests why there is no relationship between the VRAG and

PCL-R, designed to identify likelihood and not severity, and index offense severity (r = .

022, p = .903, n = 34 and r = -.174, p = .290, n = 39, respectively) or with the most severe

historical violence (r = .189, p = .285, n = 34 and r =.025, p = .879, n =39). The

Hamilton Anatomy of Risk Management proved unrelated to severity ratings of either

index offense (r = .200, p = .26, n = 33), or most severe offense (r = .002, p = .990, n =

63), or with violence density (r = .174, p = .332, n = 33).

As both age and amount of time spent within a hospital or prison setting affects

the number of crimes an individual is able to commit, each individual’s violence density

(number of offenses/number of years since the age of 18) was calculated and this was

correlated with the risk instruments. The correlation between the VRAG and violence

density was strong (r = .512, p = .002, n = 34) as was the correlation between the PCL-R

and violence density (r = .519, p = .001, n = 39). However, there was no relationship

between the HCR-20 and violence density (r = .079, p = .746, n = 19) nor was there a

relationship found between violence density and the HARM (r = .174, p = .332, n = 33).

Finally, as in the clear majority of reports in the literature (Leistico, Salekin,

DeCoster, & Rogers, 2008; Walters, 2003), in this sample, Factor 2 was more

highly associated with number of offenses than was Factor 1. Consistently, Factor 2

correlated more highly with the other risk instruments compared to Factor 1 (see Table

5). This makes the current sample representative of the majority of samples reported in

the literature.

Regression with Most Severe Offense

 Predicting Severity of Violence 20

Despite the fact that only one measure (the WASI Verbal Scale) proved to have

a strong association with offence severity, regression equations were performed because

of past findings that variables that do not show univariate significance may show

multivariate significance, particularly when sample sizes are relatively small (Matsubara,

et al., 2008). Therefore, regression analyses were performed to evaluate the predictive

ability of the various risk instruments and psychometric scales to predict the severity of

1) the most severe offense and 2) the index offense. Given the limited sample sizes made

more acute by the clinical reality of fewer available cases for the psychometric

instruments, the regression analyses were of necessity further broken down by a) WASI,

b) Trail Making test, c) the risk assessment tests, d) the Personality Assessment

Interview. For the WASI, the resulting prediction equation was not statistically

significant with R = .321, R2 = .103, and Adjusted R2 = .019 [F(3, 32) = 1.228, p = .316;

See Table 3]. The resulting prediction equation for the Trail Making Test, found no

relationship with R = .288, R2 = .083, and Adjusted R2= .007 [F(2, 24) = 1.088, p = .353;

See Table 3]. The resulting prediction equation for a combination of the risk assessment

tools was also not significant with R = .400, R2 = .160, and Adjusted R2 = .040 [F(4, 28) =

1.330, p = .283; See Table 3]. Finally, the prediction equation for the Personality

Assessment Interview was weak with R = .133, R2 = .018, and Adjusted R2 = .-.081

[F(3,30) = .179, p = .910; See Table 3].

Regression with Index Offense

The regression analyses for the index offence were again broken down by a)

WASI, b) Trail Making test, c) the risk assessment tests, d) the Personality Assessment

Interview due to the limited sample sizes. For the WASI, the resulting prediction
 Predicting Severity of Violence 21

equation was not significant with R = .373, R2 = .139, and Adjusted R2 = .058 [F(3, 32) =

1.723, p = .182; See Table 4. The resulting prediction equation for the Trail Making

Test, also found no relationship with R = .106, R2 = .011, and Adjusted R2= -.071 [F(2,

24) = 1.36, p = .873; See Table 4]. Given the limited sample sizes, the regression

analysis for the risk assessment measures was performed using the VRAG, PCL-R Total

Score, Factor 1, and Factor 2 only. When this regression was run, the resulting prediction

equation for the risk assessment tools was not significant with R = .346, R2 = .120, and

Adjusted R2 = -.006 [F(4, 28) = .952, p = .449; See Table 4. Therefore, the risk measures

did not demonstrate a reliably effective way of predicting the severity of the index

offense. Finally, the resulting prediction equation for the Personality Assessment

Interview also found no relationship with R = .162, R2 = .026, and Adjusted R2= -.071

[F(3, 30) = .268, p = .848; See Table 4].

Typology Based Between Groups Analysis

Finally, in order to test the hypothesis that the offense typology could prove

useful in helping to predict severity, a between-groups analysis was performed to see if

severity differed by type of offender. Here, the results were promising. For the index

offense, the delusional offenders had significantly more severe offenses (based on the

Akman Normandeau Scale; Akman & Normandeau, 1967) than the predatory offenders

when the least significant difference was tested (mean difference = 2.278, p = .023). This

may reflect a subtlety of the Aggression Typology Model, since Predatory offense

severity is controlled to a significant degree by the victim. Victims who relinquish the

demanded object are spared further violence. Alternately, delusional schemes that

furnish no escape to the deluded patient (e.g. plot by the CIA or Al Quieda) must
 Predicting Severity of Violence 22

necessarily involve incapacitation of the victim, who in the delusion frame of reference,

is the perceived aggressor. Tempering this is the fact that no significant between-group

differences were found for the severity of the most severe offense on record. The mean

difference between delusional offenders and irritable offenders was .952 (p = .236), the

mean difference between irritable offenders and predatory offenders was .714 (p = .450),

and the mean difference between delusional offenders and irritable offenders was 1.667

(p = .064).

Discussion

In summary of the findings, while the risk instruments correlated with both

frequency of violence and violence density, they were not significantly correlated with

severity of the index offense, or with the severity of the most severe offense on record.

When placed together in a regression equation, the resultant R (0.40) was not statistically

reliable (p = 0.16.) In addition, there was no relationship found between the severities of

the index and most severe offenses. However, there was a stronger relationship between

the WASI and the severity of the index offense. Finally, one of the most promising

findings was the difference between the aggression types in terms of severity of violence

in the Index Offense, offering limited support for the aggression typology. The

implications of these findings and the limitations of this study are discussed below.

As expected, the risk instruments worked well in predicting the number of

offenses in an individual’s criminal history, as well as the violence density. This supports

the body of literature in this area with has found that the risk instruments in use work

well in predicting violent recidivism and attests to their relevance to this sample of
 Predicting Severity of Violence 23

forensic patients. By contrast, no single risk instrument was found to reliably predict

severity of either Index or Most Severe Historical offense. As suspected in the

motivation to conduct this study, more emphasis should be placed on predicting the most

severe offense that an individual is likely to commit rather than simply the likelihood of a

violent crime. Models should therefore be developed to predict the severest offense in an

offender’s criminal career.

Additionally, the present study is consistent with Cunningham and Sorensen’s

(2007) finding that the number of previous offenses bears no association with severity of

the index offense, nor with the most severe offense in the individual’s criminal record.

This suggests that there are two kinds of criminals: those with a low tolerance level who,

due to high irritability or low control over impulses, will act out periodically but not

intensely whenever stressors exceed a relatively low threshold for ‘blowing off steam”.

The second type may be closer to what Megargee (1977) described as suffering from

“Over-controlled Hostility” who generally repress or suppress aggressive tendencies but

when their threshold is finally exceeded, a catastrophic consequence results. If

subsequent work demonstrates that this is a reliable distinction, these types may respond

optimally to different rehabilitation strategies and techniques prior and subsequent to

being released to the community.

Related to the above finding, risk instruments, designed to predict the probability

of reoffending, did not individually predict severity of either the index offense or the

most severe offense. Even when the risk instruments were combined in a regression

equation, prediction was no better than chance levels. Given the above finding that

frequency did not correlate with severity, this is hardly surprising as the absence of a
 Predicting Severity of Violence 24

relationship means that the better an instrument was at predicting one, the more

inefficient it would be in predicting the other.

The results show that neuro-cognitive variables (i.e. WASI) individually

correlated somewhat more strongly with the severity of the index offense (for WASI

Verbal Scale, r = -.341, p = .042) than did the individual traditional risk assessment

measures. This supports the tentative link between Intelligence Quotient and severity

seen in aforementioned study conducted by Langevin and Curnoe (2008), where it was

found that individuals with learning disorders were over-represented among sexual

offenders in comparison with the general population. Further research must be conducted

to find which neuro-cognitive aspects are driving this correlation. In the current sample,

the measure that best predicted severity was the WASI verbal scale. This suggests that at

least in this group, there is a link between poor verbal skills and violence escalation.

Possibly, individuals lacking verbal skills to reframe and communicate, when confronted

with a situation which could escalate towards violence, lack the ability to keep the

situation from developing into a physical conflict. It is also possible that their poor

communication skills may have developed a habit of using physical aggression to

communicate and achieve their goals and attain their wants. If confirmed by future

studies, it suggests that developing good communication strategies could be a useful in

anger management and in the rehabilitation of serious offenders. Wilson (1985) note that

some inherited traits, including poor verbal IQ, may lead to increase criminality but does

state that parental training as well as improved preschool education show promise in

preventing a criminal tendency from developing.

 Predicting Severity of Violence 25

This study’s support of neuro-cognitive tests does not mean that the traditional

risk assessment measures are invalid; indeed there is a respectable correlation between

these measures and number of offenses. Validity is always referenced to a particular goal

and the goal of these tools is to predict subsequent recividivism – which this study and

many others have shown that they all do very well. However, it does mean that these

measures, at least individually, should not be taken as indicative of violence severity.

The reliability of using the combination to predict severity must await confirmation in

much larger and diverse forensic and correctional groups. This study shows that, as

suggested by Cunningham & Sorensen (2007), there is a definite difference between the

quantity of crimes an individual commits and the severity of those crimes; as seen by the

near-zero correlation between number of offenses and offense severity. Therefore, it is

reasonable that tools that prove acceptable in predicting frequency would prove

ineffective in predicting the severity and vice versa. Indeed, this explains why neuro-

cognitive tests have not been suggested as a means of predicting recidivism and why it

would be mistaken to expect a measure to prove effective in predicting probability and

severity of recidivism.

Another concept that was supported to some extent by this study is the use of the

aggression typology developed by Nussbaum, Saint-Cyr, and Bell (1997). Given the fact

that, even in this relatively small sample, predatory aggressors committed crimes that

were significantly less violent, there is a suggestion that, in a larger sample, subdividing

the participants by type could prove useful in developing a more precise severity

prediction. It is possible that severity predictors for one type of offenders would be

different from what would predict severity in a second group of offenders and so treating
 Predicting Severity of Violence 26

them separately would be more useful and efficient than conflating together individuals

whose motivations and impulses are different; though direct support of this cannot be

found in the present study. For example, many of the instruments that proved most

efficacious in the study by Levi, Nussbaum, and Rich (2009) were not performed in this

sample. This suggests the necessity of selecting a theoretically related set of measures if

a discriminant analysis is to e successful. However, the distinction in terms of severe

violence is supportive of the model.

The general idea that the offender types should be treated differently is supported

by the work of Porter et al. (2003) who found that individuals who were psychopathic

were much more likely than to exhibit sadistic tendencies. It is therefore possible that the

neurocognitive and personality tests could be enhanced if they are used with an

appreciation for aggression type. Examples of specific targeting of aggression types

include neuro-rehabilitation for impulsive Predatory aggressors to aid their ability to

inhibit approach behaviors in the face of opportunity for immediate gratification. This

inhibition would then allow for cognitive consideration of short and long-term benefits

and desistance in light of the long-term costs. In the Levi et. al. (2009) study, this

appears to be identified by the Iowa Gambling Test (IGT; Bechara Damasio, Damsio &

Anderson, 1994) and may reflect inhibitory inadequacies (associated with limited

serotonin activation) in the face of powerful reward focus (reflecting rapid dopaminergic

activation). Alternately, anger management training may be helpful to those exhibiting

difficulties with Irritable aggression. Individuals demonstrating delusion-generated

defensive aggression towards inappropriately mis-identified attackers are likely best

treated with antipsychotic medication at this time.

 Predicting Severity of Violence 27

Limitations of this Study

The primary limitation of this study, intrinsic to many clinical and forensic

studies, is the small sample sizes, accentuated by attempts to further groups’ aggression

subtypes. This is most clearly manifested in the inability to perform a single, hierarchical

regression analysis with Risk Tools, Cognitive, Personality and Demographic (Criminal

and Psychiatric Histories) because not enough patients had a complete set of data

available. This shortcoming of the present study shows the necessity for institutions to

collaborate on projects, so that small samples may be combined, permitting more

powerful designs and more confident conclusions. A second shortcoming associated with

clinical research is that, even when large populations do exist, it is often not possible to

collect a wide range of tests on all patients, whether due to resistance from the patients,

under-appreciation of the value of appropriately selected psychological tests, or other

practical concerns.

A second way of overcoming the sample size issue would be to test tendency

towards severe violence in non-mentally disordered populations. This could be achieved

through the use of virtual reality simulations (i.e. video games) to see if certain test

measures (i.e. Verbal IQ) predicts increased violence levels within a normal population.

In addition, the aggression typology could be used in a normal sample by testing for

levels of goal-orientated (Predatory), retaliation (Aggressive), and paranoia (Defensive-

delusional).

Another potential shortcoming of this study is the higher than normal proportion

of predatory aggressors which may be inconsistent with the population of offenders with

mental disorders. Given these shortcomings, and the relative rarity of research in this
 Predicting Severity of Violence 28

area, future research needs to be conducted using larger samples sizes, with an emphasis

placed on the role that neuro-cognitive tests may play in predicting severity of offense.

Conclusions

As identified in the introduction, prediction of severity is important for legal

reasons given legal requirements that the potential severity of future crimes be taken into

account when deciding sentencing and parole outcomes (Nussbaum et al., 2009).

Furthermore, it is impossible to understand the full picture and the implications of

research into risk assessment if severity is not placed within the larger framework of risk

research. In addition, severity represents a gap in our understanding of the criminal

psyche which, for purely academic and scientific reasons, needs to be explored.

Our results show that none of the most commonly used instruments work

adequately in predicting severity, albeit in a small sample. It is true that some other

psychological variables (e.g., WASI – VS) show some promise in this capacity but one

single measure cannot be relied upon to differentiate between the diverse types of

offenders. Therefore, future research is required in order to find or develop measures that

will work in determining severity of offense. A single study on 199 forensic psychiatric

inpatients has found that a combination of demographic and clinical variables work well

together (R = .569, Adjusted R2 = .324; for females R = 0.889, Adjusted R2 = 0.791; effect

size set to .25) in predicting severity (Nussbaum et al., 2009). However, that study was

limited by a limited range of typology-related neuropsychological and personality

variables.
 Predicting Severity of Violence 29

Given the findings in this research study, it seems that one key factor to

investigate may be verbal intelligence; therefore, test measures that examine how well an

individual can understand, process, and respond to verbal communication may be

informative. Given the results within the criminal typology, tests that examine

impulsivity (e.g., Balloon Analogue Risk Task, BART; Lejuez, 2002, and the Iowa

Gambling Task, IGT; Bechara, Damasio, Damasio, & Anderson, 1994) may also prove

useful in predicting severity of offense. If successful, such measures would positively

impact the criminal justice system, making our communities a safer place to live and

raise our families in.

Finally, it is worth mentioning that risk assessment involves using knowledge

from various sources to determine what outcome is likely if and when an individual is

released into the community. For example, clear patterns of escalating severity should

not be ignored. Seeking predictors within and across aggression types is also

recommended. Finally, the purpose of risk assessments in the legal arena is the

individual, unlike in insurance company applications, where it is the group. The

insurance company actuary does not care whether it is Mr. A, Mrs. B. or Ms. C who dies

at 36, as long as that risk group as a whole provided sufficient premiums to cover

administrative costs, commissions, early payouts and leave enough for a healthy profit. It

is important that clinicians, legal personnel, and all those connected with the judicial and

forensic mental health system bear this in mind when deciding the consequences meted

out to those convicted of a violent offense.

 Predicting Severity of Violence 30

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library.utoronto.ca/gtx/retrieve.do?contentSet=IAC-documents&resultListType
 Predicting Severity of Violence 36

Appendix A

Table 1

Descriptive Statistics for All Included Variables

Measures
N M(SD) Range
Age 65 40.63 (13.674) 18-75
Number of Violent Offenses 65 6.40 (11.479) 0-57
Severity of Most Severe Offense 65 5.31 (2.817) 1-15
Index Offense Severity 65 4.38 (3.175) 1-15
VRAG 34 4.76 (1.458) 2-8
PCL-R 39 13.85 (6.462) 3-30
Factor 1 39 6.26 (3.084) 1-12
Factor 2 39 7.03 (3.794) 1-18
HCR-20 19 25.47 (5.787) 16-38
Trails A 27 40.43 (12.858) 25-70
Trails B 27 86.96 (32.694) 20-157
Stroop 24 35.25 (13.221) 1-68
RBANS Language 30 25.38 (23.433) .10-80
RBANS Attention 30 19.70 (19.890) .1-55
WASI Total 36 91.31 (16.943) 55-121
WASI Performance 36 93.72 (17.442) 55-126
WASI Verbal 36 89.97 (17.247) 55-123
Predicting Severity of Violence 37
 Predicting Severity of Violence 38

Table 2

Correlations Between Offense Severity/Frequency and the Risk/Psychometric Measures.

Outcome Variable
Measure Most Severe Offense Index Offense Number of Offenses
Num of Off r .000 .012 1.00
p .994 .992 .000
n 65 65 65
VRAG r .189 .022 .475*
p .285 .903 .004
n 34 34 34
PCL-R r .025 -.174 .507**
p .879 .290 .001
n 39 39 39
Factor 1 r .145 -.085 .330*
p .378 .606 .040
n 39 39 39
Factor 2 r -.078 -.218 .579**
p .636 .182 .000
n 39 39 39
HCR-20 r .253 .040 .471*
p .296 .872 .042
n 19 19 19
HARM r .002 .200 .174
p .990 .263 .332
n 33 33 33
WASI Tot r -.272 -.270 -.303
p .109 .111 .072
n 36 36 36
WASI Perf r -.159 -.139 -.355*
p .354 .420 .033
n 36 36 36

**. Correlation is significant at p < .01 (2-tailed).

*. Correlation is significant at p < .05 (2-tailed).
 Predicting Severity of Violence 39

Table 2 continued

Outcome Measure
Measure Most Severe Offense Index Offense Number of Offenses
WASI Verb r -.241 -.341* -.248
p .156 .042 .145
n 36 36 26
Trail A r .288 .068 .223
P .145 .736 .264
n 27 27 27
Trail B r .117 -.050 -.290
p .561 .804 .142
n 27 27 27
RB Lang r .099 .033 -.260
p .604 .863 .166
n 30 30 30
RB Att r -.088 -.096 -.196
p .644 .614 .298
n 30 30 30
Violence r -.019 -.046 .764**
Density p .882 .718 .000
n 65 65 65
PAI Drug r .106 .094 .157
p .527 .575 .346
n 38 38 38
PAI Agg r -.010 -.091 -.166
p .955 .609 .349
n 34 34 34
PAI Anx r .083 .007 -.129
p .641 .968 .467
n 34 34 34

**. Correlation is significant at p < .01 (2-tailed).

*. Correlation is significant at p < .05 (2-tailed).
 Predicting Severity of Violence 40

Table 3

Summary of Regression Analysis for Predicting Severity of the Most Severe Offense in
Criminal History Violence (N = 65)

Variable β
Regression 1 (Risk Assessment Measures)
VRAG .276
PCL-R .035
Factor 1 .432
Factor 2 -.654
Regression 2 (WASI)
WASI Total -.091
WASI Verbal -.314
WASI Performance .050
Regression 3 (Trail Making)
Trail A .283
Trail B .012
Regression 4 (PAI)
PAI Drug .098
PAI Aggression -.060
PAI Anxiety .111
2 2 2 2
Note. R = .160 for Regression 1; R = .103 for Regression 2; R = .083 for Regression 3, R = .018 for
Regression 4.
 Predicting Severity of Violence 41

Table 4

Summary of Regression Analysis for Predicting Severity of the Index Offense in Criminal
History Violence (N = 32)

Variable β
Regression 1 (Risk Assessment Measures)
VRAG .403
PCL-R -.642
Factor 1 .234
Factor 2 -.148
Regression 2 (WASI)
WASI Total .393
WASI Verbal -.733
WASI Performance .032
Regression 3 (Trail Making)
Trail A .100
Trail B -.087
Regression 4 (PAI)
PAI Drug .131
PAI Aggression -.129
PAI Anxiety .061

Note. R2 = .120 for Regression 1, R2 = .139 for Regression 2, R2 = .011. for Regression 3, R2 = .026 for
Regression 4.

Table 5
 Predicting Severity of Violence 42

Correlation between PCL-R factor scores and Risk Instruments

Measures Factor 1 Factor 2

a
PCL-R r .889** .928**
p .000 .000
n 39 39
VRAG r .780** .791**
P .000 .000
n 33 33
HCR-20 r .748 .776**
p .001 .000
n 17 17
HARM r -.362 -.339
p .139 .169
n 18 18
Mean r .695 .708
Without r .806 .832
HARM
**. Correlation is significant at p < .01 (2-tailed).
*. Correlation is significant at p < .05 (2-tailed).

a
This reflects the relationship between the total PCL-R score and its two
constituent factors. Thus the high correlations are unremarkable.