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Pathological fixation - preoccupation with a person or a cause that is accompanied by deterioration in social and occupational functioning - has been found to precede most cases of targeted violence. It is clinically observed and theorized to have three different cognitive-affective drivers: delusion, obsession, or extreme overvalued belief. Each driver is explained, and case examples are provided in the context of threat assessment. Extreme overvalued belief as a new concept is discussed in detail, both its historical provenance and its demarcation from delusions and obsessions. Threat management for each separate cognitive-affective driver is briefly summarized, based upon current clinical findings and research. Emphasis is placed upon understanding both the categorical and dimensional nature (intensity) of these cognitive-affective drivers, and suggested guidelines are offered for the assessment of such in a clinical examination by a forensic psychiatrist or psychologist., (© 2020 John Wiley & Sons Ltd.)

Increasing anecdotal, empirical, and research evidence indicates mental disorder history is one of the several factors associated with increased risk of involvement in lone-actor terrorist activities. Currently, few studies have been conducted on the mental disorder histories of individuals assessed as at risk of involvement in terrorist activities (Meloy, J Threat Assess Manag 2019;6:93). This pilot study describes demographic, psychiatric, and criminal characteristics of a sample of Scottish individuals identified by the Prevent element of the U.K. national counterterrorism strategy, and outcome data after follow-up at 2 years. Twenty-three individuals were referred to Prevent as posing a national security risk from a county in Scotland. Their records were studied for psychiatric and criminal histories. Nine (39%) had previous psychiatric contact, all were "lone actors", and none were embedded with organized terrorist groups. The most common diagnoses were substance use disorder, personality disorder, depression, and psychotic disorder. The sample displayed factors associated with increased risk of violence including previous offending, early behavioral difficulties, school problems, substance misuse, cluster B personality disordered traits. After 2 years, 44% of the mentally disordered group had re-offended. The offense types were generally similar to those prior to the individual being involved with the Prevent counter terrorism program. Only one of the mentally disordered group committed a further national security offense. In this sample, mental disorder history is overrepresented in individuals who come to the attention of the U.K. Prevent counter terrorism strategy. Further empirical studies with additional power are required to develop the empirical evidence base in this under-researched area., (© 2020 American Academy of Forensic Sciences.)

An extreme overvalued belief is shared by others in a person's cultural, religious, or subcultural group. The belief is often relished, amplified, and defended by the possessor of the belief and should be differentiated from a delusion or obsession. Over time, the belief grows more dominant, more refined, and more resistant to challenge. The individual has an intense emotional commitment to the belief and may carry out violent behavior in its service. Study participants ( n = 109 forensic psychiatrists) were asked to select among three definitions (i.e., obsession, delusion, and extreme overvalued belief) as the motive for the criminal behavior seen in 12 randomized fictional vignettes. Strong interrater agreement (kappa = 0.91 [95% CI 0.83-0.98]) was seen for vignettes representing extreme overvalued belief. Vignettes representing delusion and obsession also had strong reliability (kappa = 0.99 for delusion and 0.98 for obsession). This preliminary report suggests that forensic psychiatrists, given proper definitions, possess a substantial ability to identify delusion, obsession, and extreme overvalued belief. The rich historical foundation of extreme overvalued belief and this small survey study highlight the benefit of inclusion of "extreme overvalued belief" in future glossaries of the Diagnostic and Statistical Manual., (© 2020 American Academy of Psychiatry and the Law.)

This validation study analyses data from a sample of North American terrorist attackers (n = 33) and non-attackers (n = 23) through the lens of the Terrorist Radicalization Assessment Protocol (TRAP-18; Meloy, 2017) utilizing a multivariate statistical approach - multidimensional scaling - to visualize potential clustering (co-occurrence) of risk factors. Rarely done in terrorism research, the results plotted in two-dimensional space show the clustering and co-occurrence of most of the eight proximal warning behaviors among the attackers, but not among the non-attackers, and less of a clustering and association of distal characteristics, but their presence in both attackers and non-attackers. These findings provide further empirical support for the rational-theoretical model of the TRAP-18, a structured professional judgment instrument for threat assessment of lone actor terrorists. It advances the quantitative analysis of operationally relevant and behaviorally observable indicators for use by law enforcement and counterterrorism professionals and their consultants. Findings are discussed in relation to other research on pre-offense behaviors of lone actor terrorists, and recommendations are made for both operational use and further research., (© 2019 John Wiley & Sons, Ltd.)

Individuals with extreme overvalued beliefs often carry out abhorrent and inexplicable acts of violence. They hold odd and bizarre beliefs that are shared by others in their culture or subculture. This creates a dilemma for the forensic psychiatrist because the definition of delusion may not be adequate. We discuss the evolution of the term "overvalued idea" first described in a forensic context by neuropsychiatrist Carl Wernicke in 1892. The overvalued idea is invoked in British scholarship as a definition for beliefs seen in anorexia nervosa, morbid jealousy, paranoid litigious states, and other disorders. This is sometimes referred to as delusional disorder by psychiatrists in the United States. The concept of an extreme overvalued belief has recently been validated and is separate from an obsession or delusion. It plays an important role in identifying fixation as a warning sign in threat assessment. We use this definition in three well-known cases (i.e., Anders Breivik, John Hinckley, Jr., and Ted Kaczynski) to emphasize how form and content of beliefs are critical to understanding the mens rea in violent criminal acts. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition , would be enhanced by the addition of extreme overvalued belief as a definition to differentiate it from idiosyncratic, fixed, false beliefs seen in delusion., (© 2019 American Academy of Psychiatry and the Law.)

Psychopathy has long been conceptualized in terms of an absence of emotion. Yet, recent studies have suggested that the experience of other-directed negative emotions may be more intimately linked to psychopathy than previously acknowledged, although there is limited knowledge concerning the experience of such emotions. The present study examined the disposition to experience two other-directed emotions, spitefulness and contempt, that are conceptually linked with psychopathy but currently are limited in empirical support. Across 2 studies with 3 nonclinical samples (Ns = 1,237, 239, 521), we found evidence that psychopathic traits-as assessed via the Self-Report Psychopathy Scale (SRP; Paulhus, Neumann, & Hare, 2016; Study 1 and Study 2) and the Triarchic Psychopathy Measure (TriPM; Patrick, 2010; Study 2)-were positively associated with spitefulness (Study 1) and contempt (Study 2). These associations were consistent across psychopathy instruments (SRP and TriPM) and dimensions (i.e., the SRP Interpersonal, Affective, Lifestyle, and Antisocial facets, and the TriPM Meanness and Disinhibition dimensions), were stronger for the interpersonal and affective traits of psychopathy, and held when accounting for several theoretically relevant covariates. The only exception concerned the TriPM Boldness scale, which had less consistent associations with contempt. The present findings further our understanding of the emotional experiences related to psychopathy, highlighting the relevance of focusing on other-directed negative emotions, especially those that are interpersonal in nature and share an antagonistic component. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for threat assessment of the individual terrorist. It is a rationally derived theoretical model comprising eight proximal warning behaviors and 10 distal characteristics. Empirical research on the TRAP-18 is reviewed, including both nomothetic and idiographic studies of individual terrorists in both the United States and Europe. Mean interrater reliability is 0.895 (Cohen's kappa), ranging from 0.69 to 1.0. Evidence of criterion validity has been demonstrated, including usefulness of the instrument across various extremist ideologies (jihadism, ethnic nationalism, and single-issue), and its ability to discriminate between thwarted and successful attackers. The instrument appears to advance the domain recommendations of Monahan (2012, 2016) for the risk assessment of the individual terrorist. The TRAP-18 is further discussed as a threat assessment instrument for mental health clinicians. The limitations of the current research provide direction for further studies to assess its reliability and construct, discriminant, and predictive validity.

In some recent cases of lone-actor terrorism, there is evidence the subject acted impulsively, often in response to a triggering event which contained a loss and humiliation. Evidence suggests the subjects acted precipitously, despite planning and preparation carried out in the preceding weeks or months, and their attacks failed to include the often considerable preparation that had been done. The pathway became a runway. The authors recommend the traditional assessment of impulsivity in persons of concern for lone acts of terrorism, as well as other proximal warning behaviors for targeted violence. Both indirect and direct assessment guidelines are proposed, with an emphasis upon self-report, psychological testing, collateral data gathering, and historical records., (© 2017 American Academy of Forensic Sciences.)

The Terrorist Radicalization Assessment Protocol (TRAP-18) is a structured professional judgment instrument for the assessment of individuals who present a concern for lone-actor terrorism. It consists of eight proximal warning behaviors and 10 distal characteristics. Previous research has demonstrated its interrater reliability and some concurrent and postdictive validity. In this article, TRAP-18 is retrospectively applied to the case of US Army psychiatrist and jihadist Malik Nidal Hasan, who committed a mass murder at Fort Hood, Texas in 2009. The strengths and limitations of TRAP-18 as a structured professional judgment instrument for mental health clinicians are discussed, and clinical risk management suggestions are made., (Copyright © 2016 Elsevier Inc. All rights reserved.)

An archival descriptive study of public figure attackers in the United States between 1995 and 2015 was undertaken. Fifty-six incidents were identified, primarily through exhaustive internet searches, composed of 58 attackers and 58 victims. A code book was developed which focused upon victims, offenders, pre-attack behaviors including direct threats, attack characteristics, post-offense and other outcomes, motivations and psychological abstracts. The average interrater agreement for coding of bivariate variables was 0.835 (intraclass correlation coefficient). The three most likely victim categories were politicians, judges, and athletes. Attackers were males, many with a psychiatric disorder, most were grandiose, and most had both a violent and nonviolent criminal history. The known motivations for the attacks were often angry and personal, the most common being dissatisfaction with a judicial or other governmental process (23%). In only one case was the primary motivation to achieve notoriety. Lethality risk during an attack was 55%. Collateral injury or death occurred in 29% of the incidents. Only 5% communicated a direct threat to the target beforehand. The term "publicly intimate figure" is introduced to describe the sociocultural blurring of public and private lives among the targets, and its possible role in some attackers' perceptions and motivations. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Identification is one of eight warning behaviors--superordinate patterns of accelerating risk--that are theorized to correlate with targeted violence, and have some empirical validation. It is characterized by one or more of five characteristics: pseudo-commando behavior, evidence of a warrior mentality, a close association with weapons or other military or law enforcement paraphernalia, wanting to imitate and often surmount previous attackers or assassins, or believing oneself to be an agent to advance a particular cause or belief system. The authors briefly explore the history of the psychology of identification, its current usage, and its application to threat assessment. Four cases are used to illustrate identification as both a process and a product, and a likely motive for targeted violence in some subjects. Its operational relevance for threat assessment is suggested., (Copyright © 2015 John Wiley & Sons, Ltd.)

This study describes the development of the WAVR-21, a structured professional judgment guide for the assessment of workplace targeted violence, and presents initial interrater reliability results. The 21-item instrument codes both static and dynamic risk factors and change, if any, over time. Five critical items or red flag indicators assess violent motives, ideation, intent, weapons skill, and pre-attack planning. Additional items assess the contribution of mental disorder, negative personality factors, situational factors, and a protective factor. Eleven raters each rated 12 randomly assigned cases from actual files of workplace threat scenarios. Summary interrater reliability correlation coefficients (ICCs) for overall presence of risk factors, risk of violence, and seriousness of the violent act were in the fair to good range, similar to other structured professional judgment instruments. A subgroup of psychologists who were coders produced an ICC of 0.76 for overall presence of risk factors. Some of the individual items had poor reliability for both clinical and statistical reasons. The WAVR-21 appears to improve the structuring and organizing of empirically based risk-relevant data and may enhance communication and decision making., (© 2013 American Academy of Forensic Sciences.)

Site visits and crime scene visitation by forensic psychologists and psychiatrists may enhance the accuracy and credibility of their forensic work in criminal, civil, and other important contexts. This ethically sound technique of after-the-fact data collection and verification offers numerous potential benefits to the forensic mental health professional: clarifying the subject's actions, assessing the reliability of witness reports, identifying contextual determinants of behavior, and more fully illuminating subject motivation and decision-making. Limitations and suggested guidelines for conducting site visits are offered. Guidelines include preplanning, arranging for an informed guide to accompany and narrate the visit, and conducting the site visit prior to forensic examinations., (© 2013 American Academy of Forensic Sciences.)

Stalking is a thriving social and criminal concern and a risk inherent in our personal and professional lives. Health care professionals, particularly psychiatrists and other mental health practitioners, are vulnerable to being stalked by their patients and, far from providing helpful insights that discourage the behavior, their training can be a hindrance. Neither a psychiatrist's gender nor seniority confers protection from the protracted vengeance or infatuation of a patient-turned-stalker, any more than does working through the transference and soldiering on. The ensuing social, psychological, and vocational damage can, however, be minimized through early recognition, informed advice, and the support, not censure, of our colleagues.

Leakage in the context of threat assessment is the communication to a third party of an intent to do harm to a target. Third parties are usually other people, but the means of communication vary, and include letters, diaries, journals, blogs, videos on the internet, emails, voice mails, and other social media forms of transmission. Leakage is a type of warning behavior that typically infers a preoccupation with the target, and may signal the research, planning, and implementation of an attack. Nomothetic data suggest that leakage occurs in a majority of cases of attacks on and assassinations of public figures, adult mass murders, adolescent mass murders, and school or campus shootings: very low-frequency, but catastrophic acts of intended and targeted violence. Idiographic or case data illustrate the various permutations of leakage. We discuss the operational importance of the concept, place it in the context of other warning behaviors, emphasize the need for further research, and outline risk management strategies for the mitigation of such acts of violence in both law enforcement and clinical mental health settings., (Copyright © 2011 John Wiley & Sons, Ltd.)

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study., (© 2011 American Academy of Forensic Sciences.)

A case study of a 44-year-old woman who committed a mass murder is presented. Following a chronic course of psychotic deterioration, and a likely diagnosis of paranoid schizophrenia that remained untreated, she returned to her workplace after 3 years from her termination and killed seven people and herself. Her history is reconstructed through investigation of primary and secondary source materials. Although there are very few female mass murderers in recorded criminal history, this case is quite similar to the known research on mass murderers in general. Such individuals often have a psychotic disorder evident in violent and paranoid delusions, show a deteriorating life course before the mass murder, intentionally plan and prepare for their assault, and methodically kill as many individuals as possible before taking their own lives. They typically do not directly threaten the target beforehand, but do leak their intent to third parties--however, in this case, leakage and other obvious warning behaviors did not occur. Such acts are impossible to predict but depend on threat management and target security for risk mitigation., (© 2011 American Academy of Forensic Sciences.)

On September 10, 2003, Anna Lindh, the Swedish Minister for Foreign Affairs, was assassinated. The offender, a 24-year-old man, was a socially isolated, culturally and familially dislocated, yet academically quite competent young man who became enthralled with the habitual criminality of some of his relatives and their associates, and then psychiatrically decompensated in his early twenties. He had a history of serious violence before the crime, including the gross assault with a knife of his alcoholic and abusive father when he was 17, stalking, and extortion. At least a year prior to the assassination, he confided to a friend his desire to attack someone famous in front of many people. A definitive motive for the crime was not possible to establish. This was an act of intended, yet opportunistic violence toward a national political figure. The dynamics of the case are placed in the context of other attacks on Western European and U.S. politicians., (© 2011 American Academy of Forensic Sciences.)

A study of 143 female stalkers was conducted, part of a large North American sample of stalkers (N=1005) gathered from law enforcement, prosecutorial, and entertainment corporate security files (Mohandie, Meloy, Green McGowan, & Williams, 2006). The typical female stalker was a single, separated, or divorced woman in her mid-30s with a psychiatric diagnosis, most often a mood disorder. She was more likely to pursue a male acquaintance, stranger, or celebrity, rather than a prior sexual intimate. When compared with male stalkers, the female stalkers had significantly less frequent criminal histories, and were significantly less threatening and violent. Their pursuit behavior was less proximity based, and their communications were more benign than those of the males. The average duration of stalking was 17 months, but the modal duration was two months. Stalking recidivism was 50%, with modal time between intervention and re-contacting the victim of one day. Any prior actual relationship (sexual intimate or acquaintance) significantly increased the frequency of threats and violence with large effect sizes for the entire female sample. The most dangerous subgroup was the prior sexually intimate stalkers, of whom the majority both threatened and were physically violent. The least dangerous were the female stalkers of Hollywood celebrities. Two of the McEwan, Mullen, MacKenzie, and Ogloff (2009b) predictor variables for stalking violence among men were externally validated with moderate effect sizes for the women: threats were associated with increased risk of violence, and letter writing was associated with decreased risk of violence., (Copyright © 2011 John Wiley & Sons, Ltd.)

In a subsample of a multisite stalking study (Mohandie, Meloy, McGowan, & Williams, 2006) comprising 78 offenders from one site, 77% committed new offenses within an average follow-up of 106 months (8.8 years). Over half (56%) were charged for new stalking related offenses and 33% for violent recidivism. Violent reoffending, including sexual offenses, was predicted by risk factors consistent with existing literature: younger age at first conviction, prior release failures, and criminal history. Stalking recidivism was predicted by pre-index offending scores, using the Cormier-Lang, and prior diagnosis of a mental illness. In addition, stalkers with previously diagnosed mental illness had significantly more police contacts as complainants than those without; their recidivism was also more likely to be non-violent., (Copyright © 2011 John Wiley & Sons, Ltd.)

Fourteen non-terrorist attackers of public figures in Germany between 1968 and 2004 were intensively studied, with a particular focus on warning behaviors, attack behaviors, and the relationship between psychiatric diagnosis, symptoms, and motivations for the assault. A large proportion of the attackers were severely mentally ill, and most likely to be in the potentially lethal rather than the non-lethal group. A new typology of seven warning behaviors was applied to the data, and all were present, most frequently fixation and pathway warning behavior, and least frequently a direct threat. Psychiatric diagnosis could be closely linked to motivation when analyzed at the level of symptom and content of thought, often delusional. Most of the attacks were directed at political figures, and the majority occurred after 1995., (Copyright © 2011 John Wiley & Sons, Ltd.)

Study of risk factors for violence to prominent people is difficult because of low base rates. This study of harassers of the royal family examined factors suggested in the literature as proxies for violence--breaching security barriers, achieving proximity, approach with a weapon, and approach with homicidal ideation. A stratified sample of different types of approach behaviour was randomly extracted from 2,332 Royalty Protection Police files, which had been divided into behavioural types. The final sample size was 275. Significant differences in illness symptomatology and motivation were found for each proxy group. Querulants were significantly over-represented in three of the four groups. There was generally little overlap between the proxy groups. There is no evidence of the proxy items examined being part of a "pathway to violence". Different motivations may be associated with different patterns of risk. Risk assessment must incorporate knowledge of the interactions between motivation, mental state, and behaviour., (Copyright © 2010 John Wiley & Sons, Ltd.)

Detailed comparison of factors associated with abnormal approach to the prominent and with escalation from communication to approach has not hitherto been undertaken. This partially reflects the failure of individual studies to adopt compatible terminologies. This study involves a careful dissection of six public figure studies, three involving U.S. politicians, two Hollywood celebrities, and one the British Royal Family. Common findings were unearthed across six headings. Approachers were significantly more likely to exhibit serious mental illness, engage in multiple means of communication, involve multiple contacts/targets, and to incorporate into their communication requests for help. They were significantly less likely to use threatening or antagonistic language in their communications, except in those cases involving security breaches. These results emphasize the importance of integrating mental health findings and preventive measures into risk management. Approach should not be regarded as a single behavioral category and has multiple motivations. Future studies should adopt standard terminology, preferably taken from the general stalking research., (© 2010 American Academy of Forensic Sciences.)

A case of infanticide committed by a 37-year-old married man, the father of three sons, is reported. Clinically depressed since adolescence, and also diagnosed with obsessive-compulsive disorder and a dependent personality, the subject began to worry about killing someone a decade before the homicide. Increasingly disabled by his major depression, unable to work, and confined in his home, the idea that his only recourse was to kill one of his sons became fixed and frequent. Following his fourth psychiatric hospitalization, he took his 13-month-old son home from day care and drowned him in the bathtub. He then called the police and reported his crime. This sudden act of intentional killing was followed by a period of emotional relief and calmness, clearly illustrating the three stages of chronic catathymic homicide., (© 2010 American Academy of Forensic Sciences.)

Abnormal approach and escalation from communication to physical intrusion are central concerns in managing risk to prominent people. This study was a retrospective analysis of police files of those who have shown abnormal attentions toward the British Royal Family. Approach (n = 222), compared with communication only (n = 53), was significantly associated with specific factors, most notably serious mental illness and grandiosity. In a sample of those who engaged in abnormal communication (n = 132), those who approached (n = 79) were significantly more likely to evidence mental illness and grandiosity, to use multiple communications, to employ multiple means of communication, and to be driven by motivations that concerned a personal entitlement to the prominent individual. Logistic regression produced a model comprising grandiosity, multiple communications, and multiple means of communication, for which receiver operating characteristic (ROC) analysis gave an area under the curve (AUC) of 0.82. The implications of these findings are discussed in relation to those for other target groups.

Background: Public figures are at increased risk of attracting unwanted attention in the form of intrusions, stalking and, occasionally, attack. Whereas the potential threat to the British Royal Family from terrorists and organized groups is clearly defined, there is a dearth of knowledge about that from individual harassers and stalkers. This paper reports findings from the first systematic study of this group., Method: A retrospective study was conducted of a randomly selected stratified sample (n=275) of 8001 files compiled by the Metropolitan Police Service's Royalty Protection Unit over 15 years on inappropriate communications or approaches to members of the British Royal Family. Cases were split into behavioural types. Evidence of major mental illness was recorded from the files. Cases were classified according to a motivational typology. An analysis was undertaken of associations between motivation, type of behaviour and mental illness., Results: Of the study sample, 83.6% were suffering from serious mental illness. Different forms of behaviour were associated with different patterns of symptomatology. Cases could be separated into eight motivational groups, which also showed significant differences in mental state. Marked differences in the intrusiveness of behaviour were found between motivational groups., Conclusions: The high prevalence of mental illness indicates the relevance of psychiatric intervention. This would serve the health interests of psychotic individuals and alleviate protection concerns without the necessity of attempting large numbers of individual risk predictions. The finding that some motivations are more likely to drive intrusive behaviours than others may help focus both health and protection interventions.

We examined the association between psychopathy, assessed using the Hare Psychopathy Checklist-Revised: Screening Version (Hart et al., Manual for the psychopathy checklist screening version (PCL:SV), 1995), and stalking in 61 men convicted of stalking-related offenses. Psychopathic symptoms were rare, but their presence-especially that of affective deficit symptoms-was associated with victimization of casual acquaintances and with several risk factors from the Guidelines for Stalking Assessment and Management (SAM) (Kropp et al., Guidelines for stalking assessment and management, 2008a), including stalking in violation of supervision orders, degree of preoccupation with victims, and targeting of victims with limited access to external resources. The findings suggest that in spite of their rarity, psychopathic traits may be important in the assessment and management of stalking risk.

The frequency and characteristics of suicide by cop cases (SBC) among a large (n = 707) nonrandom sample of North American officer-involved shootings (OIS) were investigated. "Suicide by cop" is when a subject engages in behavior which poses an apparent risk of serious injury or death, with the intent to precipitate the use of deadly force by law enforcement against the subject. Thirty-six percent of the OIS in this sample were found to be SBC with high interrater agreement (intraclass correlation coefficient = 0.93) for category classification. SBC cases were more likely to result in the death or injury of the subjects than regular OIS cases. Most SBC cases were spontaneous, but had clear verbal and behavioral indicators that occurred prior to, and during the event. Findings confirm the trend detected in earlier research that there was a growing incidence of SBC among OIS. SBC individuals had a high likelihood of possessing a weapon (80%), which was a firearm 60% of the time. Half of those with a firearm discharged it at the police during the encounter. Nineteen percent simulated weapon possession to accomplish their suicidal intent. Other findings highlight the histories and commonalities in this high risk group.

The authors present data on a mixed gender sample of 78 adult stalking perpetrators, each of whom was assessed with the Psychopathy Checklist:Screening Version (PCL:SV). Results indicate a generally low frequency of psychopathy in this group, although 15% of the sample was composed of psychopaths. Comparisons between this sample and other forensic samples indicate that both the frequency and degree of psychopathy were lower in the stalking group. The findings support previous theory and empirical findings, including the concept that underlying attachment pathology among stalkers and psychopaths is quite different, and psychopathy--in contrast to other areas of violence risk assessment--is usually not relevant when evaluating dangerousness among stalkers.

The role of psychotic disorders in attacks on British Royalty is examined. In the 23 attacks, there was evidence of psychotic illness at the time in 11 (48%) cases, with evidence of mental disorder in 4 additional ones. These data almost certainly underestimate the contribution of major mental disorder, as psychiatric evaluations were not available on several attackers. Psychotic states do not, however, preclude a rational element to the attackers' grievances. The objective of most attackers was to commit an outrageous act to bring attention to grievances. Nine attackers had stalked their victims. Greater attention to psychiatric disorder among those who harass royalty or other public figures would allow early intervention. Ensuring that the obviously mentally ill stalkers of prominent persons are referred to psychiatric services would meet the needs of most of them for treatment and care, while reducing the chances that a tiny minority will progress to attack.

Objective: The only systematic studies of attacks on public figures come from the USA. These studies de-emphasize the role of mental illness and suggest threats are of no predictive value. This study re-examines these questions through a study of attacks on European politicians., Method: All non-terrorist attacks on elected politicians in Western Europe between 1990 and 2004 were analysed., Results: Twenty-four attacks were identified, including five involving fatalities, and eight serious injuries. Ten attackers were psychotic, four drunk, nine politically motivated and one unclassifiable. Eleven attackers evidenced warning behaviours. The mentally disordered, most of whom gave warnings, were responsible for most of the fatal and seriously injurious attacks., Conclusion: A greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention. Equally importantly, recognition would encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives.

The objective of this paper is to address the empirical basis and forensic application of a bimodal theory of violence. The definitions of affective and predatory violence, the relevant animal and clinical research, and the current empirical evidence in neurochemistry, neuropsychology and psychophysiology are reviewed. Forensic evidence for the relevance of this bimodal theory is investigated. An appropriate methodology for data gathering, and two observational measures along with one self-report measure are explicated. Integration of this bimodal theory into forensic practice is suggested. Affective and predatory modes of violence represent an empirically valid bimodal theory of violence, find application in forensic psychiatry, and scientifically deepen the understanding of discrete violent acts for both retrospective and prospective psychiatric and psychological investigations. This bimodal theory of violence should have a place in forensic psychiatric practice.

A new typology of stalking, RECON (relationship and context-based), is proposed, based upon the prior relationship between the pursuer and the victim, and the context in which the stalking occurs. The static typology yields four groups: Intimate, Acquaintance, Public Figure, and Private Stranger. The typology was tested on a large (N = 1005) nonrandom sample of North American stalkers gathered from prosecutorial agencies, a large police department, an entertainment corporation security department, and the authors' files. Interrater reliability for group assignment was 0.95 (ICC). Discriminant validity (p < 0.01) was demonstrated on a variety of demographic, clinical, pursuit, threat, and violence characteristics among and between groups. Findings confirm and extend the work of other researchers, most notably the very high risk of threats and violence among prior sexually intimate stalkers, the very low risk of threats and violence among public figure (celebrity) stalkers, and the negative relationship between stalking violence and psychosis.

The concept of a dichotomous versus a continuous aggression model continues to be debated within the research literature. The Impulsive/Premeditated Aggression Scale (IPAS; M. S. Stanford, R. J. Houston, C. W. Mathias, et al., 2003) is a newly developed self-report instrument designed to classify an individual's aggressive behavior as predominantly premeditated or predominantly impulsive. The IPAS consists of 30-items that are scored on a 5-point Likert scale. This study used a nonrandom sample of convenience (N = 85) from a forensic state hospital. Principal-components analysis of the 30 items revealed 2 distinct factors (Impulsive and Premeditated Aggression), which accounted for 33% of the variance. The results of this study further validate the bimodal classification of aggression through its application to a forensic sample. The implications for general assessment, diagnosis, and treatment are discussed., (2006 APA, all rights reserved)

The authors examine the crime of stalking, including the cognitive traits, emotional reactions, attachment pathology, violence patterns and sex differences of samples of stalking offenders. They focus on two common types of stalkers: 1) those who sustain pursuit of a former sexual intimate who has rejected them; and 2) those who pursue a stranger or acquaintance who has failed to return the stalker's romantic overtures. The authors discuss data from neuroimaging (fMRI) studies of romantic love which suggest that these forms of stalking may be associated with heightened activity of subcortical dopaminergic pathways of the "Reward System" of the brain, perhaps in combination with low activity of central serotonin. The authors propose that this set of neural correlates may contribute to the stalker's focused attention, increased energy, following behaviors, obsessive thinking about and impulsivity directed toward the victim. To further explore the neural systems associated with stalking behavior, they also discuss several biopsychological phenomena associated with romantic rejection, including the "protest response," "frustration attraction," "abandonment rage" and "mate guarding." They illustrate the parallels between stalking and addiction. They conclude that stalking may be associated with a specific set of biological components and they offer suggestions for further research into this pathological emotional/motivational state.

The case of Aileen Wuornos, executed in Florida for the serial killing of seven men, is studied to determine her degree of psychopathy and the presence or absence of sexuality or sexual sadism as a motivation or gratification for her crimes. The authors, one of whom evaluated the subject shortly before her death, determined that she evidenced a psychopathic personality (PCL-R score 32). She also met DSM-IV-TR criteria for Antisocial Personality Disorder and Borderline Personality Disorder. While her killings ostensibly were carried out during routine acts of prostitution, there was ambiguous evidence that her crimes were sexually motivated or gratifying. Her articulated motivation was robbery and elimination of the witness/victim. After carefully considering all available data, the authors concluded there was no convincing evidence of sexual sadism in either her personal history or her method of committing serial murder, and it remains unclear whether sexual gratification was to some degree a motivating factor in her commission of these offenses. The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history likely contributed to her having serially murdered seven victims.

This investigation evaluated the construct validity of the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996), a self-report measure designed to assess psychopathy. One hundred and two incarcerated females were administered the Kaufman Brief Intelligence Test (K-BIT), an oral alcohol and drug screening measure, a demographic interview, the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), the Psychopathy Checklist-Revised (PCL-R), and the PPI. There were significant correlations among the PPI, MMPI-2 scales, and the PCL-R. In addition, the correlations between the PPI and the separate PCL-R factors were not significantly different from each other, indicating that the PPI is assessing both facets of the psychopathy construct to some extent. A high correlation between the PPI and the DSM-IV criteria, which assesses adult antisocial behaviors, revealed adequate concurrent validity. Nonsignificant or negligible correlations between the PPI and the MMPI-2 scales provided some support for discriminant validity. The results are discussed with respect to the clinical and forensic utility of the PPI, the limitations of the study, and the need for further research., (Copyright (c) 2005 John Wiley & Sons, Ltd.)

The authors review extant research on threats, approaches, attacks, and assassinations of public figures in the United States. Despite the limited number of studies, data exist concerning: 1) threatening letters and approaches to celebrities; 2) attacks and assassinations of public figures, usually the President of the United States; 3) threats and approaches to legislative members of state and federal governments; and 4) threats, approaches, and attacks against federal judicial officials. Similarities and differences across the various studies are discussed. Consistent findings across the studies indicate that direct threats toward the target are unusual and are often correlated negatively with an approach or attack; a significant proportion of subjects are mentally ill and have criminal histories; many subjects evidenced a downward spiral in their lives in the months or year before their approach or attack; and if an attack occurred, it was predatory (instrumental, premeditated) rather than affective (emotional, reactive), and the weapon of choice was a firearm, usually a handgun. Operational guidance and further research recommendations are made.

The violent true believer is an individual committed to an ideology or belief system which advances homicide and suicide as a legitimate means to further a particular goal. The author explores useful sources of evidence for an indirect personality assessment of such individuals. He illustrates both idiographic and nomothetic approaches to indirect personality assessment through comparative analyses of Timothy McVeigh, an American who bombed the federal building in Oklahoma City in 1995, and Mohamed Atta, an Egyptian who led the airplane attacks against the World Trade Center and the Pentagon in 2001. The risks of indirect personality assessment and ethical concerns are identified.

Thirty adult mass murderers and 34 adolescent mass murderers in North America are compared on both offender and offense variables to delineate similarities and differences. Findings indicate a plethora of psychiatric disturbances and odd/reclusive and acting-out personality traits. Predisposing factors include a fascination with weapons and war among many of the adolescents and the development of a "warrior mentality" in most of the adults. Precipitating factors indicate a major rejection or loss in the hours or days preceding the mass murder. Results are interpreted through the lens of threat assessment for targeted violence (Borum, Fein, Vossekuil, & Bergland 1999), recognizing that a fact-based, dynamic behavioral approach is most useful for mitigating risk of such an extremely low-base-rate violent crime., (Copyright 2004 John Wiley & Sons, Ltd.)

Demographic, clinical, and forensic data were gathered in an archival study of 82 female stalkers from the United States, Canada, and Australia. Female stalkers were predominantly single, heterosexual, educated individuals in their mid 30s who had pursued their victims for more than a year. Major mental disorder and personality disorder were suggested, especially borderline personality disorder. They usually threatened violence, and if they did threaten, were more likely to be violent. Frequency of interpersonal violence was 25 percent, but there was limited use of weapons, and injuries were minor. Stalking victims were most likely to be slightly older male acquaintances; but if the victim was a prior sexual intimate of the female stalker, her risk of being violent toward him exceeded 50 percent. Unlike male stalkers who often pursue their victims to restore intimacy, these female stalkers often pursued their victims to establish intimacy. Common emotions and motivations included anger, obsessional thoughts, rage at abandonment, loneliness, dependency, jealousy, and perceived betrayal. Results are interpreted from a clinical and risk management perspective.