Change during forensic treatment in psychopathic versus nonpsychopathic offenders

Psychopathy in forensic psychiatric patients and other criminal offenders is associated with higher criminal recidivism rates. Moreover, many forensic mental health professionals believe that psychopaths are not amenable to treatment. The present study examines whether patients with psychopathy demonstrate change during forensic psychiatric treatment. Seventy-four personality disordered offenders who had been convicted for serious violence were rated on the the Hare Psychopathy Checklist-Revised and assessed repeatedly on risk-related behaviors during 20-months of inpatient forensic treatment. Group- and individual-level analyses showed no significant differences between psychopathic and non-psychopathic patients on adaptive social behavior, communication skills, insight, attribution of responsibility, and self-regulation strategies. However, a subgroup of psychopaths (22%) deteriorated during treatment with regard to physical aggression, whereas none of the non-psychopathic patients did (p < 0.01). Our findings demonstrate that, contrary to clinical lore, treatment does not make a majority of psychopaths worse, but there are significant differences between psychopaths and non-psychopaths in treatment responsiveness.