The Complexity of Assessing Psychopathy-Associated Aggressivity in Patients with Antisocial Personality Disorder in a Carceral Setting

Background Assessing aggressiveness in forensic psychiatric populations is methodologically challenging, particularly the disparity between assessment measures. Our study addresses the difficulty in psychiatric risk-assessment for aggressiveness in carceral settings. Methods We checked for medical records of detainees with antisocial personality disorder consulting a Prison psychiatric facility, over six months period, that included the psychometric tools: Hare Psychopathy Checklist (PCL), Levenson Self-Report of Psychopathy Scale (LSRP); and Buss Perry Aggression Questionnaire (BPAQ). Results Correlation between aggressiveness BPAQ and clinician-rated psychopathy PCL did not reach significance, in contrast to self-report psychopathy LSRP that was significantly correlated (r = 0.64; p < 0.0001) and extended even for primary (r = 0.51; p < 0.0001) and secondary (r = 0.62; p < 0.0001) psychopathy sub-constructs. Both psychopathy measures PCL and LSRP themselves were not significantly correlated (r = 0.12; p = 0.47) suggesting they assess different aspects of the psychopathology. The strength of correlation between LSRP global score and aggressiveness BPAQ didn’t show significant difference from correlations involving its primary (r = 0.51) and secondary (r = 0.62) psychopathy components, which suggest both components to contribute similarly to the overall aggressiveness. Regression analysis confirmed self-report psychopathy LSRP as a powerful predictor of aggressiveness explaining 41% of variance of global score BPAQ, 32% of physical aggressiveness and 34% of anger. Conclusion Assessment of aggressiveness for legal psychiatric expertise is challenging due to measurement divergence attributable to multiple methodological bias. Proper assessment needs inclusion of other contributing psychological constructs and objective records beyond psychopathy.