The Prognostic Utility of Personality Traits Versus Past Psychiatric Diagnoses: Predicting Future Mental Health and Functioning

Past psychiatric diagnoses are central to patient case formulation and prognosis. Recently, alternative classification models such as the Hierarchical Taxonomy of Psychopathology (HiTOP) proposed to assess traits to predict clinically relevant outcomes. In the current study, we directly compared personality traits and past diagnoses as predictors of future mental health and functioning in three independent, prospective samples. Regression analyses found that personality traits significantly predicted future first onsets of psychiatric disorders (change in [∆] R2 = .06–.15), symptom chronicity (∆ R2 = .03–.06), and functioning (∆ R2 = .02–.07), beyond past and current psychiatric diagnoses. Conversely, past psychiatric diagnoses did not provide an incremental prediction of outcomes when personality traits and other concurrent predictors were already included in the model. Overall, personality traits predicted a variety of outcomes in diverse settings beyond diagnoses. Past diagnoses were generally not informative about future outcomes when personality was considered. Together, these findings support the added value of personality traits assessment in case formulation, consistent with the HiTOP model.

A cluster analytic examination and validation of adult victim sexual offending subtypes in two Canadian samples

The development and validation of sexual offense perpetrator typologies remains a useful endeavor with implications for theory and correctional/clinical practice. Most such typologies—which rely on factors such as the individual’s motivation for offending—have not been validated empirically. The current study utilized a validated sexual violence risk-needs instrument, the Violence Risk Scale—Sexual Offense version (VRS-SO; Wong, Olver, Nicholaichuk, & Gordon [2003, 2017], Regional Psychiatric Centre and University of Saskatchewan, Saskatoon, Canada), to develop and validate an empirically-derived adult victim sexual offense (AVSO) typology through model-based cluster analysis of dynamic risk-need domains. The study featured two treated samples of men (n = 283 and 169) convicted for contact sexual offenses against adult victims. A three-cluster solution was identified and replicated across the two samples: high antisociality high deviance (HA-HD), high antisociality low deviance (HA-LD), and low antisociality low deviance (LA-LD). External validation analyses demonstrated that HA-HD men had more dense sexual offense histories, were more likely to be diagnosed with a paraphilia, and had the highest rates of sexual recidivism (Sample 2 only). By contrast, the HA-LD men had greater concerns on indexes of nonsexual criminality, particularly high base rates of antisocial personality and substance use disorders, and high rates of general violent recidivism (particularly Sample 1). The findings suggest that the VRS-SO factors may have utility in discriminating between AVSO types to inform sexual offending theory, case formulation, and risk management.

Dynamic Risk Factors and their Utilisation in Case Formulation: A New Conceptual Framework

<p>The social pressure on policy makers and clinicians working with sexual offenders to reduce recidivism is extreme. A result of this pressure is the amount of research investigating risk-related features that has surged over the last few decades. Risk assessment has progressed from unstructured clinical judgement to development of risk factors that correlate with recidivism to predict levels of risk, and more recently, to forensic case formulation. This thesis concentrates on two key issues with forensic case formulation that has been largely neglected thus far. First, forensic case formulations rely heavily on the use of dynamic risk factors as causes of offending. The concern is that dynamic risk factors are composite constructs not causal mechanisms. Second, forensic case formulation models do not explain how to use an offender’s information and their risk factors to hypothesise about the cause of their offending leading to issues of reliability. To address these issues, the RECFM consists of five phases that guides clinicians on how to appropriately use forensic case formulation. The Risk Etiology Case Formulation Model (RECFM) aims to incorporate a reconceptualised version of dynamic risk factors using an Agency Model to identify the interaction of agent and context that causes offending behaviour. By using the RECFM, treatment can be targeted to the individual and their specific causes of offending, which will lead to better results in reducing recidivism. The aim of this thesis is to provide a forensic case formulation model is comprehensible for clinicians and that targets the causes of offending.</p>

Dynamic Risk Factors and their Utilisation in Case Formulation: A New Conceptual Framework

<p>The social pressure on policy makers and clinicians working with sexual offenders to reduce recidivism is extreme. A result of this pressure is the amount of research investigating risk-related features that has surged over the last few decades. Risk assessment has progressed from unstructured clinical judgement to development of risk factors that correlate with recidivism to predict levels of risk, and more recently, to forensic case formulation. This thesis concentrates on two key issues with forensic case formulation that has been largely neglected thus far. First, forensic case formulations rely heavily on the use of dynamic risk factors as causes of offending. The concern is that dynamic risk factors are composite constructs not causal mechanisms. Second, forensic case formulation models do not explain how to use an offender’s information and their risk factors to hypothesise about the cause of their offending leading to issues of reliability. To address these issues, the RECFM consists of five phases that guides clinicians on how to appropriately use forensic case formulation. The Risk Etiology Case Formulation Model (RECFM) aims to incorporate a reconceptualised version of dynamic risk factors using an Agency Model to identify the interaction of agent and context that causes offending behaviour. By using the RECFM, treatment can be targeted to the individual and their specific causes of offending, which will lead to better results in reducing recidivism. The aim of this thesis is to provide a forensic case formulation model is comprehensible for clinicians and that targets the causes of offending.</p>

A Summary of Current Findings on Quality of Life Domains and a Proposal for Their Inclusion in Clinical Interventions

Whilst the assessment of quality of life (QoL) and well-being has burgeoned in the past 50 years, there still remains relatively little research into its treatment in psychology, in spite of the launching of such approaches as positive psychology to widen the ambit of interventions to promote well-being. We posit that there are a number of outstanding QoL areas that could be integrated into standard therapeutic procedures, and that this would this result in an increase in well-being as a therapeutic outcome. To investigate this an exploratory search of the literature was undertaken of associations between improvements in a life domain and increased well-being or QoL. Ten domains (relationships, work, money, health, and leisure, mindfulness, self-esteem, resolution of past life events, mental style and life management skills) were identified. In view of the substantial evidence of the cumulative impact of these domains upon well-being, it is proposed that conducting a unidimensional clinical intervention that focuses only on the presenting issue is not sufficient. Implications and possible therapeutic pathways are discussed and it is recommended that practitioners include such QoL domains in their assessment, case formulation, and intervention planning.