519744
research-article2014
IJOXXX10.1177/0306624X13519744International Journal of Offender Therapy and Comparative CriminologyHagenauw et al.
Article
Specific Risk Factors of Arsonists in a Forensic Psychiatric Hospital
International Journal of Offender Therapy and Comparative Criminology 2015, Vol. 59(7) 685–700 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0306624X13519744 ijo.sagepub.com
Loes A. Hagenauw1, Julie Karsten1, Gerjonne J. Akkerman-Bouwsema1, Bert E. de Jager1, and Marike Lancel1
Abstract Arsonists are often treated in forensic settings. However, high recidivism rates indicate that treatment is not yet optimal for these offenders. The aim of this case series study is to identify arsonist specific dynamic risk factors that can be targeted during treatment. For this study, we used patient files of and interviews with all patients that were currently housed at a forensic psychiatric hospital in the Netherlands (14 arsonists, 59 non-arsonists). To delineate differences in risk factors between arsonists and non-arsonists, scores on the risk assessment instrument the Historical Clinical Future–30 (HKT-30; completed for 11 arsonists and 35 non-arsonists), an instrument similar to the Historical Clinical Risk Management–20 (HCR-20), were compared. The groups did not differ on demographic factors and psychopathology. Concerning dynamic risk factors, arsonists had significantly poorer social and relational skills and were more hostile. Although this study needs replication, these findings suggest that the treatment of people involved in firesetting should particularly target these risk factors. Keywords firesetting, recidivism, forensic psychiatry, risk factors, dynamic variables
1GGZ
Drenthe, Assen, The Netherlands
Corresponding Author: Loes A. Hagenauw, Researcher, GGZ Drenthe, Mental Health Services, Department of Forensic Psychiatry, Post box 30007, 9400 RA Assen, The Netherlands. Email: [email protected]
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International Journal of Offender Therapy and Comparative Criminology 59(7)
Introduction Arson is a violent type of criminal act that has devastating personal, financial, and social consequences (Geller, 2008). In the Netherlands, in 2011, 41,000 fires were registered. Of these, 22% of the indoor fires and 66% of the outdoor fires were due to firesetting (Baak & Steenbrink, 2012). Often, arson is thought to be a consequence of psychiatric disorders (Ritchie & Huff, 1999), suggesting that people committing arson should be treated to reduce the risk of future re-offending, that is risk of recidivism. However, arson is a criminal act easily missed in the forensic psychiatric field. As Grant (2010) pointed out, patients are not likely to share information about this behavior unless specifically asked, due to shame and secrecy. This implies that there are more patients in the forensic setting that have been involved in firesetting than are documented. If this is the case, it is unlikely that these patients are referred to appropriate treatment. Moreover, Philipse (2005) showed that 36.4% of arsonists who have been treated in a forensic psychiatric hospital (FPH) are re-convicted for various criminal acts, such as violent and sexual crimes. In contrast, only 16.4% of the non-arsonists who received similar treatment are re-convicted. The relatively high recidivism rate for arsonists found by Philipse, also confirmed by other studies (DeJong, Virkkunen, & Linnoila, 1992; Repo & Virkkunen, 1997; Repo, Virkkunen, Rawlings, & Linnoila, 1997), indicates that a general forensic psychiatric treatment does not suffice and that treatment more specifically tailored to arsonists may be indicated. Recidivism risk is determined by several factors. These are general risk factors— factors that are of importance in all offenders—and specific risk factors—factors particularly relevant for a specific group of offenders, such as arsonists (de Ruiter & Veen, 2005). Both types of risk factors can be divided into static and dynamic risk factors. Static factors, such as gender, are stable and unlikely to change. Dynamic factors, for instance, impulsivity, can be modified. Although static risk factors are useful for predicting recidivism risk in the long run, these factors offer little guidance for treatment. To successfully reduce the risk of recidivism in violent criminal acts, including arson, and non-violent criminal acts, treatment should be aimed at specific dynamic risk factors. That is, treatment should focus on those factors known to predict reoffending and can be changed by therapeutic interventions (Andrews, 1989; de Ruiter & Veen, 2005). However, international studies on dynamic risk factors for arsonists are rare, as most studies investigated static, unchangeable characteristics. In general, arsonists are relatively young, Caucasian males with limited education and a low economic status (Blanco et al., 2010; Grant & Kim, 2007; Leong, 1992; Lindberg, Holi, Tani, & Virkkunen, 2005; O’Sullivan & Kelleher, 1987; Puri, Baxter, & Cordess, 1995; Rice & Harris, 1991; Ritchie & Huff, 1999). Labree, Nijman, van Marle, and Rassin (2010) studied the characteristics of male arsonists (n = 25) and a randomly selected control group of non-arsonists (n = 50) admitted to a Dutch FPH. In this study, the group of arsonists consisted of patients with arson as their index criminal act (i.e., the main reason for their involuntary admission). Arsonists, compared with non-arsonists, had a more extended history of psychiatric treatment, more severe problems with alcohol
Hagenauw et al.
687
abuse, and were less likely to be diagnosed with a psychotic disorder. In addition, arsonists were characterized by low juvenile delinquency and lifelong traits such as high impulsivity and low superficial charm, as measured by the Psychopathy Checklist–Revised (PCL-R; Hare, 2003). Research on specific dynamic risk factors for arsonists amenable to treatment is needed. In addition to specific dynamic risk factors, specific motives for firesetting could also be a useful target for the treatment of arsonists. Pyromania is often the only motive considered, yet motives for firesetting vary greatly (White, 1996; Williams, 2002). Motives for setting a fire include revenge, financial fraud, crime concealment, the desire to be regarded as a hero, sensation seeking or peer pressure, terrorism, a cry for help, or an attempt to self-harm. Alternatively, some arsonists set fire as a direct result of symptoms related to a primary psychiatric disorder, such as schizophrenia, substance abuse, or antisocial personality disorder (Gannon & Pina, 2010; Horley & Bowlby, 2011; Ritchie & Huff, 1999). Even among arsonists, pyromania is not a common diagnosis. Lindberg and colleagues (2005) reported that out of 90 forensic psychiatric patients who had committed arson, only 3% could be diagnosed with pyromania. Williams (2002) stated that even less than 2% of all people who commit arson can receive a diagnosis of pyromania. Recently, Gannon, Ciardha, Doley, and Alleyne (2012) developed the MultiTrajectory Theory of Adult Firesetting (M-TTAF). This theory encompasses five prototypical trajectories leading to firesetting, each describing the characteristics of developmental, biological, psychological, and contextual factors that can lead to firesetting. Evidence based risk factors could be used to fit patients in one or more M-TTAF trajectories, thereby providing a more arson specific treatment program and further reducing recidivism risk. The aim of the current case review was to delineate characteristics of arsonists, their motives, and specific dynamic risk factors, and incorporate these into the best fitting M-TTAF trajectories.
Method Participants and Procedure Participants were recruited from the FPH of the Mental Health Service in Assen, the Netherlands. This is a treatment facility for people with psychiatric disorders who have committed or are at risk of committing a criminal act. The aim of the treatment is to reduce the psychiatric symptomatology and the risk of recidivism. At the time of this study, 73 patients were housed at this hospital. This study includes both information from patient files and patient interviews. As all patients agreed on admission that their files are available to scientific research, all 73 patient files were included in the current study. Regarding the additional patient interview, used for diagnostic purposes, all 73 patients were informed orally about the nature of this study and requested to participate. They were informed of the fact that research data would be anonymised and were not used for judicial purposes. Participation in the
688
International Journal of Offender Therapy and Comparative Criminology 59(7)
additional face-to-face interview (conducted by the authors) was voluntary and rewarded with € 5,-. Of the 73 patients, 9 refused to be interviewed. The majority of these nine patients (n = 6) were diagnosed with a Personality Disorder Not Otherwise Specified (NOS) with cluster B features or a cluster B personality disorder. Six other patients were unable to take part in the interview due to the severity of their psychiatric disorder, mainly schizophrenia or another psychotic disorder. In total, 58 patients participated in the interview (response rate = 88%). No significant differences between compliers and non-compliers were found on gender (94.8% males vs. 80.0% males) χ2(1) = 3.47, p > .05, age (M = 34.4 years, SE = 1.37 vs. M = 34.5, SE = 3.03), t(71) = .04, p > .05, and main psychiatric diagnosis: 48.3% of the compliers had a main diagnosis on Axis I, as did 53.3% of the noncompliers, χ2(1) = .12, p > .05.
Measures Arsonist status and motives. Arsonists and their motives were identified using the Minnesota Impulse Disorders Interview (MIDI; Christenson et al., 1994). This interview assesses impulse control disorders: pyromania, compulsive shopping, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling, and sexual compulsion. Motives for firesetting were categorized in accordance with Williams (2002). In the case of multiple motives, the most salient one was selected. In addition, patient files, including those of the patients who were unable or refused to participate in the interview, were studied to (a) identify arsonists not participating in the interview, (b) identify arsonists not admitting arson in the interview, and (c) obtain demographic data, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) diagnoses and motives for firesetting. This information was obtained from psychiatric pre-trial reports and previous arrest records. DSM-IV diagnoses were taken from patient files. A patient was classified as an arsonist if he or she had set fire deliberately and/or had been previously convicted for arson. Patients who had set fire only before the age of 18 were not classified as arsonists (n = 19). Risk factors. To assess risk factors for aggressive recidivism, the Historical Clinical Future–30 (HKT-30; Werkgroep Risicotaxatie Forensische Psychiatrie, 2003) was used. The HKT–30 is a Dutch structured professional judgment risk assessment method designed for the assessment of risk of future violence in adult offenders. It is based on the Historical Clinical Risk Management–20 (HCR-20; Webster, Douglas, Eaves, Hart, & Ogloff, 1997) and consists of three scales: historical scale (11 items), clinical scale (13 items), and future and situational scale (6 items). All items are scored on a 5-point scale, ranging from 0 to 4. Higher scores indicate higher risk. As a final step, the clinician judges the risk of recidivism to be “low,” “medium,” or “high.” Studies show that risk assessments based on structured professional judgments are more reliable and have a higher predictive validity than unstructured clinical judgments (Douglas, Guy, Reeves,
Hagenauw et al.
689
& Weir, 2008). The reliability and predictive validity of the HKT-30 are comparable to those of the HCR-20 (Hildebrand, Hesper, Spreen, & Nijman, 2005; van den Brink, Hooijschuur, van Os, Savenije, & Wiersma, 2010). For the purposes of this study, data were obtained from the first HKT-30 of each patient, which was scored approximately 6 months after admission to the hospital. A complete data set was available for 46 patients. Clinicians had already filled out the HKT-30 before the start of this study and were therefore unbiased with respect to this investigation.
The M-TTAF The arsonists are classified according to the five trajectories of the M-TTAF. The five trajectories are defined as (a) Antisocial, characterized by offense-supportive attitude, self-regulation issues, antisocial values, and impulsivity; (b) Grievance, defined by self-regulation issues, communication problems, low assertiveness, and hostility; (c) Fire interest, with risk factors: inappropriate fire interest, offense-supportive attitudes, fire fascination, and impulsivity; (d) Emotionally expressive/need for recognition, defined by communication problems, self-regulations issues, impulsivity, and depression; and (e) Multi-faceted, characterized by offense-supportive attitudes, self-regulation and communication problems, fire fascination, antisocial values, and conduct disorder/antisocial personality disorder.
Statistical Analyses To analyze the differences between arsonists and non-arsonists on demographic data, the chi-square test was used. As the assumption for normal distribution was violated, the Mann–Whitney U test (two-sided) was used to analyze the extent to which arsonists differed from non-arsonists with respect to their historical, clinical, and future risk factors. Differences between arsonists and non-arsonists were analyzed on item level only when differences reached significance on subscale level.
Results Characteristics of Arsonists Out of the 73 patients, 14 patients (19.2%) could be classified as arsonist. Of these, eight were identified as arsonist based on their patient file and the MIDI interview. An additional three were not recognized on the basis of their patient files but were identified using the MIDI interview. The remaining three patients did not participate in the interview and were identified as arsonists by their file. None of the arsonists who participated in the interview was identified by his or her file only. Similar to nonarsonists, most arsonists were admitted to the hospital after committing an aggressive criminal act (91.5% and 93.0%, respectively). A criminal act was considered aggressive when coercion or compulsion was used towards persons or objects, resulting in psychological or physical damage (Werkgroep Risicotaxatie Forensische Psychiatrie,
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International Journal of Offender Therapy and Comparative Criminology 59(7)
Table 1. Patient Characteristics (N = 73). Non-arsonists (n = 59) Gender Male Highest education No education High school Some college or higher DSM-IV main diagnoses Axis I Axis II Co-morbid substance dependence/ abuse Admission after committing an aggressive offense
Arsonists (n = 14)
n
%
n
%
56
94.9
11
78.6
24 15 19
41.4 25.9 32.8
6 5 3
42.9 35.7 21.4
32 27 37
54.2 45.8 62.7
4 10 11
28.6 71.4 78.6
54
91.5
13
93.0
Note. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.).
2003). Besides arson, nearly all arsonists (n = 13) were convicted of at least one other type of criminal act, for instance, assault (n = 10) or property crimes without violence (n = 8). There were no significant differences between arsonists and non-arsonists regarding demographic data (Table 1). The arsonist sample consisted of 11 males and 3 females, with a mean age of 33.7 years (SD = 12.5). Although the difference with non-arsonists was only a trend toward significance (p < .1), the majority of arsonists had a main diagnosis on Axis II of the DSM-IV, that is, 71.4% versus 45.8% of the non-arsonists. Of the arsonists with a main diagnosis on Axis II, three suffered from personality disorder NOS and three from a borderline personality disorder (all female). Three patients had a borderline, antisocial, or narcissistic personality disorder or features thereof, and one patient was diagnosed with a mixed personality disorder. Substance abuse/dependency was diagnosed in 78.6% of the cases (10 males and 1 female) and for non-arsonists in 62.7% of the cases. This difference was not significant. Nearly half (46.2%) of the arsonists were intoxicated while setting fire: Three were under the influence of alcohol, one under the influence of drugs, and three were intoxicated by both. Half of the interviewed arsonists and non-arsonists (50.0% vs. 54.0%) had one or more impulse control disorders. All arsonists with an impulse control disorder (n = 4) had an intermittent explosive disorder. One patient had an additional diagnosis of kleptomania, and another patient had an additional diagnosis of compulsive sexual disorder. Most of the non-arsonists with an impulse control disorder had an intermittent explosive disorder (n = 13), followed by pathological gambling (n = 9) and compulsive buying (n = 9).
Hagenauw et al.
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Risk Factors Comparisons between arsonists and non-arsonists on the indicators of the HKT-30 revealed several differences. Total scores on the HKT-30 (U = 87.00, z = −2.72, p < .05, d = .99) of the arsonists exceeded those of non-arsonists, indicating a higher risk for violent recidivism. Especially, the historical (U = 111.50, z = −2.09, p < .05, d = 1.14) and clinical (U = 130.50, z = −2.30, p < .05, d = .90) subscales were significantly higher (Table 2), indicating static as well as dynamic arsonist specific factors that can be targeted during treatment. With respect to historical indicators, arsonists had a more serious history of behavioral problems before the age of 12. These behavioral problems consisted mainly of oppositional behavior, such as getting involved in fights and arguing at home or school. They also had a more extensive history of mental health care: at least one (involuntary) admission in the past. Third, a higher percentage of the arsonists were diagnosed with a psychotic disorder in the past. This includes a diagnosis of schizophrenia, manic depression psychosis, psychogenic psychosis, or other psychotic disorders. Concerning the dynamic, clinical indicators, arsonists were more hostile. They were more passive aggressive and were more easily irritated even without immediate cause. In addition, they had poorer social and relational skills, causing problems in social and relational areas. Regarding the structured professional judgment, all arsonists and 67.6% of the non-arsonists were judged to be at high risk of recidivism. However, the difference between the two groups only reached a trend toward significance (p < .1), which is possibly due to a lack of power.
Motives for Firesetting Motivation for firesetting was assessed by the MIDI or obtained from patient files (Table 3). Four arsonists were motivated by revenge. Other motives for arson were vandalism/boredom/sensation seeking and/or peer pressure, a cry for help, and an attempt to self-harm. For four other patients, the firesetting was a result of psychotic delusions or hallucinations. None of the patients was diagnosed with pyromania. Three-quarters of the interviewed arsonists reported not to feel any lust, gratification, or relief while setting the fire, excluding them from the diagnosis of pyromania. Only one arsonist acknowledged that he had experienced gratification after setting a fire. However, this patient was diagnosed with an antisocial personality disorder, an exclusion criterion for pyromania.
The M-TTAF Although some arsonists fit in multiple trajectories, we classified them in the most appropriate trajectory, based on their dynamic risk factors and motives for setting fire. Four patients fit in the grievance trajectory, three in the antisocial trajectory, and three in the emotionally expressive/need for recognition trajectory. Four arsonists set fire as a result of psychotic delusions or hallucinations. Therefore, none of the M-TTAF trajectories was applicable. This group includes all the female arsonists (n = 3).
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International Journal of Offender Therapy and Comparative Criminology 59(7)
Table 2. Risk Factors HKT-30. Non-arsonists (n = 35) Historical and static indicatorsa Criminal history Violation of conditions regarding treatment and supervision Behavior problems before the age of 12 Victim of violence in youth (till 18 years) History of mental health care Employment history Substance abuse Psychotic disorders Personality disorders Psychopathy Sexual deviance Total score H-indicators Clinic and dynamic indicatorsa Problem insight Psychotic symptoms Substance abuse Impulsivity Empathy Hostility Social and relational skills Self-reliance Acculturation problems Attitude in relation to treatment Responsibility for the offense Sexual preoccupation Coping skills Total score K-indicators Future indicatorsb Agreement on conditions Material indicators Daily activities Skills Social support and network Exposure to destabilisers Total score HKT-30
Arsonists (n = 11)
M
±SD
M
±SD
2.1 2.2
±1.3 ±1.6
2.6 2.6
±1.4 ±0.8
1.0 2.3 2.6 2.6 2.8 1.1 1.8 0.4 0.6 19.4
±1.3 ±1.3 ±1.4 ±1.3 ±1.6 ±1.6 ±1.0 ±0.5 ±1.2 ±7.1
2.0 2.6 3.5 2.5 2.8 2.3 2.4 1.1 0.4 24.6
±1.3* ±1.4 ±1.0* ±1.2 ±1.8 ±1.7* ±0.7 ±1.4 ±0.9 ±5.5*
2.4 0.5 0.8 1.5 2.1 1.3 2.2 1.5 0.8 1.4 1.8 0.2 2.7 19.1
±0.9 ±1.1 ±1.3 ±1.0 ±0.8 ±1.0 ±0.7 ±1.2 ±1.1 ±0.9 ±1.0 ±0.4 ±0.7 ±5.5
2.6 1.6 0.8 2.4 2.3 2.3 3.0 2.1 0.4 2.0 2.3 0.5 2.9 25.0
±0.9 ±1.8 ±1.4 ±1.2 ±0.9 ±1.0* ±0.6* ±1.2 ±0.8 ±1.1 ±0.7 ±0.9 ±0.7 ±7.4*
2.0 3.1 3.1 2.6 2.7 3.3 55.0
±0.8 ±0.8 ±1.3 ±0.8 ±0.8 ±0.9 ±12.6
1.9 2.9 3.3 2.7 2.9 3.7 67.1
±0.8 ±0.9 ±1.0 ±0.9 ±0.5 ±0.5 ±11.5*
Note. HKT-30 = Historical Clinical Future–30. aMann–Whitney U test (two-sided). bDifferences on item level were not tested, as the difference on the Future subscale as a whole did not reach significance. *p=
research-article2014
IJOXXX10.1177/0306624X13519744International Journal of Offender Therapy and Comparative CriminologyHagenauw et al.
Article
Specific Risk Factors of Arsonists in a Forensic Psychiatric Hospital
International Journal of Offender Therapy and Comparative Criminology 2015, Vol. 59(7) 685–700 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0306624X13519744 ijo.sagepub.com
Loes A. Hagenauw1, Julie Karsten1, Gerjonne J. Akkerman-Bouwsema1, Bert E. de Jager1, and Marike Lancel1
Abstract Arsonists are often treated in forensic settings. However, high recidivism rates indicate that treatment is not yet optimal for these offenders. The aim of this case series study is to identify arsonist specific dynamic risk factors that can be targeted during treatment. For this study, we used patient files of and interviews with all patients that were currently housed at a forensic psychiatric hospital in the Netherlands (14 arsonists, 59 non-arsonists). To delineate differences in risk factors between arsonists and non-arsonists, scores on the risk assessment instrument the Historical Clinical Future–30 (HKT-30; completed for 11 arsonists and 35 non-arsonists), an instrument similar to the Historical Clinical Risk Management–20 (HCR-20), were compared. The groups did not differ on demographic factors and psychopathology. Concerning dynamic risk factors, arsonists had significantly poorer social and relational skills and were more hostile. Although this study needs replication, these findings suggest that the treatment of people involved in firesetting should particularly target these risk factors. Keywords firesetting, recidivism, forensic psychiatry, risk factors, dynamic variables
1GGZ
Drenthe, Assen, The Netherlands
Corresponding Author: Loes A. Hagenauw, Researcher, GGZ Drenthe, Mental Health Services, Department of Forensic Psychiatry, Post box 30007, 9400 RA Assen, The Netherlands. Email: [email protected]
686
International Journal of Offender Therapy and Comparative Criminology 59(7)
Introduction Arson is a violent type of criminal act that has devastating personal, financial, and social consequences (Geller, 2008). In the Netherlands, in 2011, 41,000 fires were registered. Of these, 22% of the indoor fires and 66% of the outdoor fires were due to firesetting (Baak & Steenbrink, 2012). Often, arson is thought to be a consequence of psychiatric disorders (Ritchie & Huff, 1999), suggesting that people committing arson should be treated to reduce the risk of future re-offending, that is risk of recidivism. However, arson is a criminal act easily missed in the forensic psychiatric field. As Grant (2010) pointed out, patients are not likely to share information about this behavior unless specifically asked, due to shame and secrecy. This implies that there are more patients in the forensic setting that have been involved in firesetting than are documented. If this is the case, it is unlikely that these patients are referred to appropriate treatment. Moreover, Philipse (2005) showed that 36.4% of arsonists who have been treated in a forensic psychiatric hospital (FPH) are re-convicted for various criminal acts, such as violent and sexual crimes. In contrast, only 16.4% of the non-arsonists who received similar treatment are re-convicted. The relatively high recidivism rate for arsonists found by Philipse, also confirmed by other studies (DeJong, Virkkunen, & Linnoila, 1992; Repo & Virkkunen, 1997; Repo, Virkkunen, Rawlings, & Linnoila, 1997), indicates that a general forensic psychiatric treatment does not suffice and that treatment more specifically tailored to arsonists may be indicated. Recidivism risk is determined by several factors. These are general risk factors— factors that are of importance in all offenders—and specific risk factors—factors particularly relevant for a specific group of offenders, such as arsonists (de Ruiter & Veen, 2005). Both types of risk factors can be divided into static and dynamic risk factors. Static factors, such as gender, are stable and unlikely to change. Dynamic factors, for instance, impulsivity, can be modified. Although static risk factors are useful for predicting recidivism risk in the long run, these factors offer little guidance for treatment. To successfully reduce the risk of recidivism in violent criminal acts, including arson, and non-violent criminal acts, treatment should be aimed at specific dynamic risk factors. That is, treatment should focus on those factors known to predict reoffending and can be changed by therapeutic interventions (Andrews, 1989; de Ruiter & Veen, 2005). However, international studies on dynamic risk factors for arsonists are rare, as most studies investigated static, unchangeable characteristics. In general, arsonists are relatively young, Caucasian males with limited education and a low economic status (Blanco et al., 2010; Grant & Kim, 2007; Leong, 1992; Lindberg, Holi, Tani, & Virkkunen, 2005; O’Sullivan & Kelleher, 1987; Puri, Baxter, & Cordess, 1995; Rice & Harris, 1991; Ritchie & Huff, 1999). Labree, Nijman, van Marle, and Rassin (2010) studied the characteristics of male arsonists (n = 25) and a randomly selected control group of non-arsonists (n = 50) admitted to a Dutch FPH. In this study, the group of arsonists consisted of patients with arson as their index criminal act (i.e., the main reason for their involuntary admission). Arsonists, compared with non-arsonists, had a more extended history of psychiatric treatment, more severe problems with alcohol
Hagenauw et al.
687
abuse, and were less likely to be diagnosed with a psychotic disorder. In addition, arsonists were characterized by low juvenile delinquency and lifelong traits such as high impulsivity and low superficial charm, as measured by the Psychopathy Checklist–Revised (PCL-R; Hare, 2003). Research on specific dynamic risk factors for arsonists amenable to treatment is needed. In addition to specific dynamic risk factors, specific motives for firesetting could also be a useful target for the treatment of arsonists. Pyromania is often the only motive considered, yet motives for firesetting vary greatly (White, 1996; Williams, 2002). Motives for setting a fire include revenge, financial fraud, crime concealment, the desire to be regarded as a hero, sensation seeking or peer pressure, terrorism, a cry for help, or an attempt to self-harm. Alternatively, some arsonists set fire as a direct result of symptoms related to a primary psychiatric disorder, such as schizophrenia, substance abuse, or antisocial personality disorder (Gannon & Pina, 2010; Horley & Bowlby, 2011; Ritchie & Huff, 1999). Even among arsonists, pyromania is not a common diagnosis. Lindberg and colleagues (2005) reported that out of 90 forensic psychiatric patients who had committed arson, only 3% could be diagnosed with pyromania. Williams (2002) stated that even less than 2% of all people who commit arson can receive a diagnosis of pyromania. Recently, Gannon, Ciardha, Doley, and Alleyne (2012) developed the MultiTrajectory Theory of Adult Firesetting (M-TTAF). This theory encompasses five prototypical trajectories leading to firesetting, each describing the characteristics of developmental, biological, psychological, and contextual factors that can lead to firesetting. Evidence based risk factors could be used to fit patients in one or more M-TTAF trajectories, thereby providing a more arson specific treatment program and further reducing recidivism risk. The aim of the current case review was to delineate characteristics of arsonists, their motives, and specific dynamic risk factors, and incorporate these into the best fitting M-TTAF trajectories.
Method Participants and Procedure Participants were recruited from the FPH of the Mental Health Service in Assen, the Netherlands. This is a treatment facility for people with psychiatric disorders who have committed or are at risk of committing a criminal act. The aim of the treatment is to reduce the psychiatric symptomatology and the risk of recidivism. At the time of this study, 73 patients were housed at this hospital. This study includes both information from patient files and patient interviews. As all patients agreed on admission that their files are available to scientific research, all 73 patient files were included in the current study. Regarding the additional patient interview, used for diagnostic purposes, all 73 patients were informed orally about the nature of this study and requested to participate. They were informed of the fact that research data would be anonymised and were not used for judicial purposes. Participation in the
688
International Journal of Offender Therapy and Comparative Criminology 59(7)
additional face-to-face interview (conducted by the authors) was voluntary and rewarded with € 5,-. Of the 73 patients, 9 refused to be interviewed. The majority of these nine patients (n = 6) were diagnosed with a Personality Disorder Not Otherwise Specified (NOS) with cluster B features or a cluster B personality disorder. Six other patients were unable to take part in the interview due to the severity of their psychiatric disorder, mainly schizophrenia or another psychotic disorder. In total, 58 patients participated in the interview (response rate = 88%). No significant differences between compliers and non-compliers were found on gender (94.8% males vs. 80.0% males) χ2(1) = 3.47, p > .05, age (M = 34.4 years, SE = 1.37 vs. M = 34.5, SE = 3.03), t(71) = .04, p > .05, and main psychiatric diagnosis: 48.3% of the compliers had a main diagnosis on Axis I, as did 53.3% of the noncompliers, χ2(1) = .12, p > .05.
Measures Arsonist status and motives. Arsonists and their motives were identified using the Minnesota Impulse Disorders Interview (MIDI; Christenson et al., 1994). This interview assesses impulse control disorders: pyromania, compulsive shopping, kleptomania, trichotillomania, intermittent explosive disorder, pathological gambling, and sexual compulsion. Motives for firesetting were categorized in accordance with Williams (2002). In the case of multiple motives, the most salient one was selected. In addition, patient files, including those of the patients who were unable or refused to participate in the interview, were studied to (a) identify arsonists not participating in the interview, (b) identify arsonists not admitting arson in the interview, and (c) obtain demographic data, Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association [APA], 1994) diagnoses and motives for firesetting. This information was obtained from psychiatric pre-trial reports and previous arrest records. DSM-IV diagnoses were taken from patient files. A patient was classified as an arsonist if he or she had set fire deliberately and/or had been previously convicted for arson. Patients who had set fire only before the age of 18 were not classified as arsonists (n = 19). Risk factors. To assess risk factors for aggressive recidivism, the Historical Clinical Future–30 (HKT-30; Werkgroep Risicotaxatie Forensische Psychiatrie, 2003) was used. The HKT–30 is a Dutch structured professional judgment risk assessment method designed for the assessment of risk of future violence in adult offenders. It is based on the Historical Clinical Risk Management–20 (HCR-20; Webster, Douglas, Eaves, Hart, & Ogloff, 1997) and consists of three scales: historical scale (11 items), clinical scale (13 items), and future and situational scale (6 items). All items are scored on a 5-point scale, ranging from 0 to 4. Higher scores indicate higher risk. As a final step, the clinician judges the risk of recidivism to be “low,” “medium,” or “high.” Studies show that risk assessments based on structured professional judgments are more reliable and have a higher predictive validity than unstructured clinical judgments (Douglas, Guy, Reeves,
Hagenauw et al.
689
& Weir, 2008). The reliability and predictive validity of the HKT-30 are comparable to those of the HCR-20 (Hildebrand, Hesper, Spreen, & Nijman, 2005; van den Brink, Hooijschuur, van Os, Savenije, & Wiersma, 2010). For the purposes of this study, data were obtained from the first HKT-30 of each patient, which was scored approximately 6 months after admission to the hospital. A complete data set was available for 46 patients. Clinicians had already filled out the HKT-30 before the start of this study and were therefore unbiased with respect to this investigation.
The M-TTAF The arsonists are classified according to the five trajectories of the M-TTAF. The five trajectories are defined as (a) Antisocial, characterized by offense-supportive attitude, self-regulation issues, antisocial values, and impulsivity; (b) Grievance, defined by self-regulation issues, communication problems, low assertiveness, and hostility; (c) Fire interest, with risk factors: inappropriate fire interest, offense-supportive attitudes, fire fascination, and impulsivity; (d) Emotionally expressive/need for recognition, defined by communication problems, self-regulations issues, impulsivity, and depression; and (e) Multi-faceted, characterized by offense-supportive attitudes, self-regulation and communication problems, fire fascination, antisocial values, and conduct disorder/antisocial personality disorder.
Statistical Analyses To analyze the differences between arsonists and non-arsonists on demographic data, the chi-square test was used. As the assumption for normal distribution was violated, the Mann–Whitney U test (two-sided) was used to analyze the extent to which arsonists differed from non-arsonists with respect to their historical, clinical, and future risk factors. Differences between arsonists and non-arsonists were analyzed on item level only when differences reached significance on subscale level.
Results Characteristics of Arsonists Out of the 73 patients, 14 patients (19.2%) could be classified as arsonist. Of these, eight were identified as arsonist based on their patient file and the MIDI interview. An additional three were not recognized on the basis of their patient files but were identified using the MIDI interview. The remaining three patients did not participate in the interview and were identified as arsonists by their file. None of the arsonists who participated in the interview was identified by his or her file only. Similar to nonarsonists, most arsonists were admitted to the hospital after committing an aggressive criminal act (91.5% and 93.0%, respectively). A criminal act was considered aggressive when coercion or compulsion was used towards persons or objects, resulting in psychological or physical damage (Werkgroep Risicotaxatie Forensische Psychiatrie,
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Table 1. Patient Characteristics (N = 73). Non-arsonists (n = 59) Gender Male Highest education No education High school Some college or higher DSM-IV main diagnoses Axis I Axis II Co-morbid substance dependence/ abuse Admission after committing an aggressive offense
Arsonists (n = 14)
n
%
n
%
56
94.9
11
78.6
24 15 19
41.4 25.9 32.8
6 5 3
42.9 35.7 21.4
32 27 37
54.2 45.8 62.7
4 10 11
28.6 71.4 78.6
54
91.5
13
93.0
Note. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders (4th ed.).
2003). Besides arson, nearly all arsonists (n = 13) were convicted of at least one other type of criminal act, for instance, assault (n = 10) or property crimes without violence (n = 8). There were no significant differences between arsonists and non-arsonists regarding demographic data (Table 1). The arsonist sample consisted of 11 males and 3 females, with a mean age of 33.7 years (SD = 12.5). Although the difference with non-arsonists was only a trend toward significance (p < .1), the majority of arsonists had a main diagnosis on Axis II of the DSM-IV, that is, 71.4% versus 45.8% of the non-arsonists. Of the arsonists with a main diagnosis on Axis II, three suffered from personality disorder NOS and three from a borderline personality disorder (all female). Three patients had a borderline, antisocial, or narcissistic personality disorder or features thereof, and one patient was diagnosed with a mixed personality disorder. Substance abuse/dependency was diagnosed in 78.6% of the cases (10 males and 1 female) and for non-arsonists in 62.7% of the cases. This difference was not significant. Nearly half (46.2%) of the arsonists were intoxicated while setting fire: Three were under the influence of alcohol, one under the influence of drugs, and three were intoxicated by both. Half of the interviewed arsonists and non-arsonists (50.0% vs. 54.0%) had one or more impulse control disorders. All arsonists with an impulse control disorder (n = 4) had an intermittent explosive disorder. One patient had an additional diagnosis of kleptomania, and another patient had an additional diagnosis of compulsive sexual disorder. Most of the non-arsonists with an impulse control disorder had an intermittent explosive disorder (n = 13), followed by pathological gambling (n = 9) and compulsive buying (n = 9).
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Risk Factors Comparisons between arsonists and non-arsonists on the indicators of the HKT-30 revealed several differences. Total scores on the HKT-30 (U = 87.00, z = −2.72, p < .05, d = .99) of the arsonists exceeded those of non-arsonists, indicating a higher risk for violent recidivism. Especially, the historical (U = 111.50, z = −2.09, p < .05, d = 1.14) and clinical (U = 130.50, z = −2.30, p < .05, d = .90) subscales were significantly higher (Table 2), indicating static as well as dynamic arsonist specific factors that can be targeted during treatment. With respect to historical indicators, arsonists had a more serious history of behavioral problems before the age of 12. These behavioral problems consisted mainly of oppositional behavior, such as getting involved in fights and arguing at home or school. They also had a more extensive history of mental health care: at least one (involuntary) admission in the past. Third, a higher percentage of the arsonists were diagnosed with a psychotic disorder in the past. This includes a diagnosis of schizophrenia, manic depression psychosis, psychogenic psychosis, or other psychotic disorders. Concerning the dynamic, clinical indicators, arsonists were more hostile. They were more passive aggressive and were more easily irritated even without immediate cause. In addition, they had poorer social and relational skills, causing problems in social and relational areas. Regarding the structured professional judgment, all arsonists and 67.6% of the non-arsonists were judged to be at high risk of recidivism. However, the difference between the two groups only reached a trend toward significance (p < .1), which is possibly due to a lack of power.
Motives for Firesetting Motivation for firesetting was assessed by the MIDI or obtained from patient files (Table 3). Four arsonists were motivated by revenge. Other motives for arson were vandalism/boredom/sensation seeking and/or peer pressure, a cry for help, and an attempt to self-harm. For four other patients, the firesetting was a result of psychotic delusions or hallucinations. None of the patients was diagnosed with pyromania. Three-quarters of the interviewed arsonists reported not to feel any lust, gratification, or relief while setting the fire, excluding them from the diagnosis of pyromania. Only one arsonist acknowledged that he had experienced gratification after setting a fire. However, this patient was diagnosed with an antisocial personality disorder, an exclusion criterion for pyromania.
The M-TTAF Although some arsonists fit in multiple trajectories, we classified them in the most appropriate trajectory, based on their dynamic risk factors and motives for setting fire. Four patients fit in the grievance trajectory, three in the antisocial trajectory, and three in the emotionally expressive/need for recognition trajectory. Four arsonists set fire as a result of psychotic delusions or hallucinations. Therefore, none of the M-TTAF trajectories was applicable. This group includes all the female arsonists (n = 3).
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Table 2. Risk Factors HKT-30. Non-arsonists (n = 35) Historical and static indicatorsa Criminal history Violation of conditions regarding treatment and supervision Behavior problems before the age of 12 Victim of violence in youth (till 18 years) History of mental health care Employment history Substance abuse Psychotic disorders Personality disorders Psychopathy Sexual deviance Total score H-indicators Clinic and dynamic indicatorsa Problem insight Psychotic symptoms Substance abuse Impulsivity Empathy Hostility Social and relational skills Self-reliance Acculturation problems Attitude in relation to treatment Responsibility for the offense Sexual preoccupation Coping skills Total score K-indicators Future indicatorsb Agreement on conditions Material indicators Daily activities Skills Social support and network Exposure to destabilisers Total score HKT-30
Arsonists (n = 11)
M
±SD
M
±SD
2.1 2.2
±1.3 ±1.6
2.6 2.6
±1.4 ±0.8
1.0 2.3 2.6 2.6 2.8 1.1 1.8 0.4 0.6 19.4
±1.3 ±1.3 ±1.4 ±1.3 ±1.6 ±1.6 ±1.0 ±0.5 ±1.2 ±7.1
2.0 2.6 3.5 2.5 2.8 2.3 2.4 1.1 0.4 24.6
±1.3* ±1.4 ±1.0* ±1.2 ±1.8 ±1.7* ±0.7 ±1.4 ±0.9 ±5.5*
2.4 0.5 0.8 1.5 2.1 1.3 2.2 1.5 0.8 1.4 1.8 0.2 2.7 19.1
±0.9 ±1.1 ±1.3 ±1.0 ±0.8 ±1.0 ±0.7 ±1.2 ±1.1 ±0.9 ±1.0 ±0.4 ±0.7 ±5.5
2.6 1.6 0.8 2.4 2.3 2.3 3.0 2.1 0.4 2.0 2.3 0.5 2.9 25.0
±0.9 ±1.8 ±1.4 ±1.2 ±0.9 ±1.0* ±0.6* ±1.2 ±0.8 ±1.1 ±0.7 ±0.9 ±0.7 ±7.4*
2.0 3.1 3.1 2.6 2.7 3.3 55.0
±0.8 ±0.8 ±1.3 ±0.8 ±0.8 ±0.9 ±12.6
1.9 2.9 3.3 2.7 2.9 3.7 67.1
±0.8 ±0.9 ±1.0 ±0.9 ±0.5 ±0.5 ±11.5*
Note. HKT-30 = Historical Clinical Future–30. aMann–Whitney U test (two-sided). bDifferences on item level were not tested, as the difference on the Future subscale as a whole did not reach significance. *p=
