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PREDICTION OF INCIDENTS IN A FORENSIC PSYCHIATRIC FACILITY USING
DEMOGRAPHIC AND PSYCHOLOGICAL TEST VARIABLES AND IDENTIFICATION
OF NATURALLY OCCURRING SUBGROUPS OF FORENSIC INPATIENTS USING
CLUSTER ANALYSIS OF MINNESOTA MULTIPHASIC PERSONALITY
ERNEST JOHN BORDINI
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF
THE UNIVERSITY OF FLORIDA
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE
DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
Ernest John Bordini
Al caro Zio Gianni
con ammirazione, e gratitudine.
This research involved a three year odysey which would not have
been possible without much cooperation and support. My first
thanks is to Dr. Jacquelin Goldman who supported this research
from its beginnings and whose enthusiasm, teaching, and clinical
experience served as inspiration. The support and constructive
criticism of Dr. Davis, Dr. Bauer, Dr. Glaros, and the perspective of
Dr. Von Mering contributed much to this undertaking.
Research in institutions requires much cooperation from the
staff and administration of the institution. Much gratitude is
due to the staff and administration of NFETC. The staff's pride,
interest, and pursuit of knowledge is evident in their support of
research and in the quality of care delivered.
Finally, such an odysey would likely shipwreck without the
necessary emotional support through trying times and obstacles.
For this, I am forever grateful to my Marianne.
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ................................. ...... iii
ABSTRACT ................................................. vi
ONE INTRODUCTION..................................... 1
Overview of the Literature on Prediction of
Violence ..................................... 1
Historical Background ........................... 3
Early Research on the Prediction of
Dangerousness ................................. 7
Longitudinal Research of the Correlates of
Violent Behavior ............................ 14
Psychological Test Correlates of Violent
Behavior ....................................... 17
Cluster Analytic Approaches to Classification.... 26
Studies of Predictors of Institutional
Aggression ................................... 28
Prediction Issues ............................. 31
Statement of the Problem ........................ 34
TWO METHOD........................................... 38
Subjects ......................................... 38
The Institution............................... 39
Materials and Measures.......................... 40
Dependent Measures.............................. 49
Analyses ................ ........ ................. 52
THREE RESULTS .......................................... 61
Sample Characteristics.......................... 61
Comparison of Residents Tested by MMPI and
Rorschach............................ .......... 75
Prediction Equations................. .......... 85
Cluster Analyses ................................. 145
Comparisons of Residents Involved and Not
Involved in Incidents.................. ...... 161
FOUR DISCUSSION....................................... 206
Methodological Considerations ................... 206
Demographic Data ................................ 210
Test Characteristics............................ 212
Incidents ........................................ 216
Blockwise Multiple Regression Analyses .......... 216
Summary of Prediction Hypotheses ................ 223
Post-Hoc Analyses ................... .......... 235
Conclusions ...................................... 240
INCIDENT/USE OF FORCE REPORT .................... 245
REFERENCES................................ .... .. ........... 248
BIOGRAPHICAL SKETCH........................................ 257
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fufillment of the
Requirements for the Degree of Doctor of Philosophy
PREDICTION OF INCIDENTS IN A FORENSIC PSYCHIATRIC FACILITY USING
DEMOGRAPHIC AND PSYCHOLOGICAL TEST VARIABLES AND IDENTIFICATION
OF NATURALLY OCCURRING SUBGROUPS OF FORENSIC INPATIENTS USING
CLUSTER ANALYSIS OF MINNESOTA MULTIPHASIC PERSONALITY
Ernest John Bordini
Chairperson: Dr. Jacquelin Goldman
Major Department: Clinical and Health Psychology
Psychologists and psychiatrists often render opinions regarding
the potential dangerousness of individuals in the context of forensic
evaluations and involuntary commitment proceedings. However, early
research suggested predictions of dangerousness resulted in high false
positive rates. In 1984, it was suggested the early research was
overgeneralized and suggested using multivariate and actuarial methods
in more acutely disturbed populations.
The present research investigated the ability of multiple
regression analyses of demographic and psychological test data to
identify residents with high base rates of involvement in institutional
and violent incidents in a maximum security forensic facility. Data
were collected for 451 male residents, the majority of which were
incompetent to stand trial.
A blockwise stepwise multiple regression procedure was used to
develop equations predictive of total incident rate, two types of
aggressive incident rates, use of force incident rates, and fighting
incident rates. Regression models identified groups of residents with
a 75% base rate of incidents, and a slightly greater than 50% base rate
of violent incidents.
Cluster analysis of Minnesota Multiphasic Personality Inventory
(MMPI) profiles has been a useful methodology to identify subgroups of
criminal offenders. The present investigation attempted to identify
naturally occurring subgroups of forensic inpatients by cluster
analyzing 188 MMPI profiles. Results of the analyses indicated a
possible six cluster and a possible three cluster solution. Analyses
failed to validate the six cluster solution.
Significant between group differences were found for the three
cluster solution. The group MMPI profiles differed in terms of
overall profile elevation. The highest MMPI profile elevation
group had the longest mean length of treatment, greatest
proportion of residents involved in use of force incidents, and
greatest proportion of residents with substance abuse histories.
The present study also examined between group differences for
residents involved and not involved in incidents. Differences
with respect to race, education, diagnosis, and test results were
found and discussed in the context of previous research.
Overview of the Literature on Prediction of Violence
In recent years, research on the prediction of violence has been
sparse. Research in the area of forensic psychology shifted
away from an early focus on the prediction of violence, to the
rights of involuntarily committed patients, and later to the
characteristics of insanity acquitees. These shifts often
paralleled political and social concerns of the times. Research
in the area of prediction of violent behavior has been relatively
neglected despite the American Psychiatric Association's (1977)
description of this as one of the most important areas for
research in the interface of psychiatry and the law.
Monahan's (1981) frequently cited book, Predicting Violent
Behavior, may have had an adverse impact on research efforts to
attempt such predictions. His review, which included a focus on
several large scale studies of chronically institutionalized
patients, and studies with overall low incidence rates of
violence, was grossly overinterpreted as indicating that
predictions of violence could not be made, or at most are only
accurate one out of three times. Monahan (1984) concurred that
his review had been overgeneralized by other professionals and
made an appeal for renewed efforts in the area.
Monahan (1984) as well as others (Shah, 1978) suggested the use
of multivariate models which focus on short term predictions of
violent behavior within populations known to have high base rates
or histories of violence. Meehl (1954, 1986) has long advocated the
development of statistical models of prediction. Meehl argued
that such models outperformed clinical predictions and were more
explicit and testable.
Renewed research interest in prediction of violent behavior
has been stimulated by recent events. The increase in the number
of mentally ill involved in the criminal justice system, the
notoriety of Hinkley's assassination attempt on President Reagan,
and the Tarasoff decision have captured media attention with
respect to violent behavior by the mentally ill and has renewed
interest in determinations of dangerousness.
The present study attempted to identify a group of individuals
with a greater than average frequency of institutional violence
by applying a multivariate multiple regression model. The use of
a stepwise regression model allowed for reduction of the number
of possible predictor variables by selecting only those variables
at each stage which added significantly to the variance accounted
for. This technique is suited for research that is primarily
predictive or exploratory in purpose.
A second goal of the present research was to provide additional
information on the characteristics of a population of forensic
inpatients which consisted mostly of individuals adjudicated
incompetent to stand trial. This group has been somewhat
neglected in forensic research. Identification of subgroups of
forensic inpatients was attempted by a cluster analysis of Minnesota
Multiphasic Personality Inventory (MMPI) profiles. This methodology was
previously successful in identifying groups of criminal offenders
(Megargee & Bohn, 1979).
Research conducted in the interface of psychiatry and the law
has shifted in focus over time. Steadman (1984) noted that much of
the earliest research conducted in the early 1960s focused on
the definition of insanity and the implementation of the insanity
defense. Research found that variations of the insanity plea such
as the M'Naughton rule, the ALI test, mens rea, or the Durham
rule had little effect in the number of people who were found not
guilty by reason of insanity (NGBRI). Insanity acquittals were
found to be successful in approximately 2% of the cases in which
insanity was raised as a defense regardless of the particular test
which was applied (Johnson, 1975).
Research conducted in the late 60s shifted in focus to the civil
rights issues of those persons involuntarily hospitalized. This
led to research examining forensic and civil commitment
proceedings and the assumed dangerousness of the committed
forensic patient. Much of this research led to the release of
many individuals who had been involuntarily hospitalized for many
years. Monahan's (1981) review which included studies of these
released patients suggested that predictions of dangerousness
resulted in error at least two out of three times.
Much of the research in the 70s examined the social,
demographic and psychological characteristics of insanity
acquitees. Steadman (1984) noted that an inverse relationship
exists between the amount of research conducted and the size of
the forensic population. Insanity acquitees which comprise
approximately 8% of the mentally ill forensic population have
been the most studied, while mentally disordered sex offenders,
those adjudicated incompetent to stand trial, and the mentally
ill inmate have been largely ignored.
Research in the 70s and early 80s has neglected the prediction
issue despite the fact that since 1970 most states have switched
the requirements for involuntary commitment from one that focused
on need for treatment to one that uses dangerousness as a
criterion (Monahan, 1984). Steadman (1984) emphasized that
there is a large gap between what has been thought to be securely
documented in the area of prediction of dangerousness and what
evidence there exists.
Despite pessimism about the accuracy of predictions of violence
such predictions have been a historical part of the legal
process. Determinations of dangerousness are often embedded in
prognostic statements, classifications, and placements within the
correctional system (Shah, 1978).
Clinicians concerns about the potential dangerousness of the
clients they are treating have been raised by the litigious
medico-legal climate. The Tarasoff decision (Tarasoff vs Regents, the
University of California, 1976), which is frequently overinterpreted as
creating a clinician's "duty to warn" potential victims, made the
prediction issues more salient. Although the same court revised
the language to read that a more general duty to exercise
reasonable care exosts (Givelber, Bowers, & Blitch, 1985), the
controversy concerning clinicians' ability to predict violent
behavior and their responsibility with regards to potential
victims spread to other states and raised issues concerning possible
malpractice suits (Ridgewood Financial Institute, 1985).
The increase in the rate of psychiatric patients with histories
of arrest or violent behavior has renewed research interest with
respect to the dangerousness of the mentally ill. The number of
the mentally ill who are involved in the criminal justice system
has increased. Monahan (1981) reported that in 1947 fifteen
percent of New York patient releases had prior arrests compared
to 40% in 1975. A similar trend is evident in England. Hinton
(1983) reported that in English "security hospitals" there was a
75% increase in admission rates for psychopathic disorders
between 1961 and 1970.
Perhaps as a consequence of deinstitutionalization, more mentally
ill individuals are being arrested. Research conducted after the
1950s indicates that discharged psychiatric patients had higher
arrest rates than the general population whereas research prior
to that time indicated the reverse was true (Monahan, 1981).
Sosowsky (1978) reported that patients admitted to a psychiatric
hospital without a criminal record had subsequent arrest rates
three times that of the general population, and were arrested
five times as often as the general population for violent crimes.
Rubin (1972) reviewed the literature available at that time and
concluded that the reversal in the arrest rates of the mentally
ill was attributable to the increased coexistence of antisocial
behavior and mental illness for young, poor, unemployed, and
unskilled males. Teplin (1984) reported that for similar
offenses mentally disordered citizens are more likely to be
arrested than other citizens and suggested that the trend toward
deinstitutionalization was a factor in this process.
Some of the neglect with respect to research involving prediction
of violence may be a result of the overgeneralization from early
research that clinicians had little ability or expertise in
making such predictions. The five studies which Monahan (1984)
described as forming the core of "first generation" research on
predictions of violence examined predictions that those released
from long-term custodial institutions would engage in violent
behavior. The disappointing results of these attempts were most
likely attributable to the low base rates of the target behavior,
treatment effects, aging, and unspecified effects of long term
Early Research on the Prediction of Dangerousness
Monahan (1984), whose review of the efficacy of clinical
predictions of dangerousness led to much of the pessimism about
attempts at prediction, criticized the overgeneralization and
uncritical acceptance of this "first-generation" of research.
This research suffers from flaws such as attempting to predict
rare events, studying borderline cases, generalizing
pre-hospitalization predictions to post-treatment and release
behavior, and in some studies did not involve any actual
prediction by clinicians at all.
Ethical considerations prohibit the release of individuals
everyone agrees to be dangerous. This constraint necessarily
limits investigations of post-release violence to examining the
behavior of those individuals for whom there was some
disagreement about. This most likely yields biased underestimates of
the efficacy of prediction. A criticism of some studies is that
predictions made concerning need for immediate hospitalization due to
dangerousness were overgeneralized and applied to post-treatment and
Since the studies reviewed by Monahan have been described as
forming the core of the early research, and the cause for the
overgeneralization that violence cannot be predicted, they are
briefly reviewed here.
Kozol, Boucher, and Garofolo (1972) conducted a five year
follow up study of 592 male offenders. Most were convicted of sex
crimes. Of these offenders, 226 were initially judged by the
psychiatric staff to be dangerous and were subsequently committed
to treatment. The court eventually released 49 offenders
contrary to the prediction of dangerousness by the psychiatric
staff. During the five year follow up period only 8% of those
released without a prediction of dangerousness committed a
serious assaultive offense compared to 35% of those released by
the court against the psychiatrist's advice.
The rate of false positives in the Kozol et al. study has
sometimes been cited as evidence of clinicians inability to
predict violent behavior. However, the predictions yielded a
group of individuals which were four to five times as likely to
commit a serious offense than the overall base rate. A further
criticism of this study was that it yielded a biased
underestimate of the efficacy of clinical predictions since the
identified dangerous group consisted of "borderline" cases. The
"dangerous" group actually consisted of only the 20% of cases predicted
dangerous by the clinicians for which the court disagreed (Litwack,
Another set of frequently cited studies followed up on the
court-ordered release of large numbers of institutionalized
individuals presumed to be dangerous. These studies were more
reflective of global or political predictions rather than actual
individually made clinical predictions.
The first of these studies eventually led to the release of
other chronically institutionalized patients which were being
hospitalized for indefinite periods of time because of
"dangerousness" and led to legal reforms of the laws which had
allowed this practice to exist. In this first study one thousand
institutionalized patients held past expiration of their
sentences without a hearing were transferred to civil hospitals
by court order. Steadman and Cocozza (1974) reported the
follow-up of the "Baxtrom" patients.
At the time of transfer, the average age of the Baxtrom
patients was 47. These patients had a mean length of 15 years of
continuous hospitalization. Twenty percent of these patients were
assaultive at any time during the next four years of civil commitment.
Those eventually released were followed for two and one half years.
During this period of freedom only 8% were convicted of any
A "Legal Dangerousness Scale" was constructed in an attempt
to predict subsequent violent arrests. The scale was based on the
presence of a juvenile record, number of previous arrests,
presence of prior convictions for violent crimes, and severity of
the admitting offense. Although only one of three patients
identified by the scale as dangerous were eventually rearrested
for a violent crime, this was four times the overall rearrest rate
for the Baxtrom patients.
In the Baxtrom study, Steadman and Cocozza (1974) found that
few patients over 50-years-old were rearrested for a violent
crime. Seventeen of the twenty arrested for violent crimes after
their release were less than 50-years-old and had a score
greater than five on the above Legal Dangerousness scale.
In a study of Pennsylvania prisoners who won suit for
release partially as a consequence of the Baxtrom decision,
Thornberry and Jacoby (1979) found that 14% of 438 long-term
institutionalized patients engaged in behavior injurious to other
persons within 4 years after their release. Similar to the
Baxtrom patients, the "Dixon" patients had a mean age of 47
years and were institutionalized for a mean of 14 years.
Approximately one of four of the 418 Dixon patients eventually
released were rearrested in a median release time of 30 months.
Fourteen percent of the released Dixon patients were rearrested
or rehospitalized for violent behavior.
As in findings reported from the Baxtrom study, the younger
Dixon patients were more likely to be arrested. Forty percent of
the patients younger than 35-five-years old were rearrested.
Nearly one in four of these younger patients were rearrested for
A major criticism of the Baxtrom and Dixon studies is that
they did not directly address the efficacy of clinical prediction
of violent behavior. These studies did not attempt individual
determinations of dangerousness; instead they challenged the
public opinion that these patients as a group were a threat to
society. In fact, the facility which housed the Dixon patients
employed only one psychiatrist and no Ph.D. psychologists
(Thornberry & Jacoby, 1979). Litwack (1985) suggested these
studies are more appropriately described as studies of "political
prediction" than as attempts at clinical prediction.
In a more successful attempt at identifying a group of
individuals committing post-release offenses, the State of
Maryland (1978) published data for 421 patients treated for 3
years or more at the Patuxent Institution. The court released
286 patients despite a determination of dangerousness by the
psychiatric staff. Of those patients released directly from the
hospital, 46% showed a new offense on their FBI rapsheet within
three years after release. Thirty-nine percent of those
"conditionally released" indicated an offense within the three
year period. Only 7% of the 135 individuals the staff found "safe"
showed such an offense.
The results of the state of Maryland study were challenged by
conflicting data which were reported by Steadman (1977). Steadman
(1984) reanalyzed the data and found that 31% of the patients
recommended for release were arrested for a violent crime in
comparison with 41% of those predicted to be dangerous, making
the original data equivocal. The state of Maryland study can also
be criticized since the dangerous group was likely to be a biased
sample of all individuals predicted to be dangerous by the
clinicians because the group consisted of only the subset of
individuals for which the court disagreed.
In a study of institutional and post-release violence, a group
of 257 patients adjudicated incompetent to stand trial in New
York between 1971 and 1972 were followed by Cocozza and Steadman
(1976). Patients were examined by two pyschiatrists whose initial
finding of dangerousness permitted placement in a facility
administered by the Department of Correctional Services and a
finding of nondangerousness permitted placement to a civil
psychiatric hospital. The average age of this sample was
Of these individuals adjudicated incompetent to stand trial,
60% were predicted dangerous and 40% were predicted not to be
dangerous. The judge disagreed with these predictions in 34 cases,
adjudicating as dangerous 26 the psychiatrists had not predicted to be
dangerous. These disagreements were not discarded in the reported
findings. Subjects were followed in the hospital and in the community
for three years if they were released.
The adjudications of dangerousness were more successful at
identifying individuals likely to be violent in the hospital than those
which would eventually be rearrested for a violent crime.
Those predicted or adjudicated to be dangerous were slightly more
likely to be assaultive in the hospital than those not
adjudicated as dangerous (42% versus 36%).
Ninety-six of of the 154 adjudicated dangerous by the court and
70 of the 103 adjudicated nondangerous were eventually released.
Forty-nine percent of those identified as dangerous versus 54% of those
not identified as dangerous were rearrested. Fourteen percent of the
"dangerous" individuals were rearrested for a violent offense in
comparison to 16% of those adjudicated not to be dangerous, indicating
little difference in the rearrest rates of these two groups.
Although Cocozza and Steadman (1976) interpreted their study as
clearly indicating no psychiatric expertise in predicting who
will be dangerous existed, Litwack (1985) criticized the study as
a general study of clinical prediction of violent behavior. He
indicated that the clinician's predictions were that individuals
were of immediate danger to themselves or others if left at
liberty and were not predictions of the likelihood of
institutional violence or the eventual risk of violence after
they were treated and released.
The inclusion of individuals judged not to be dangerous by the
clinicians but adjudicated so by the court as dangerous is
another criticism of the Cocozza and Steadman study as a pure
study of clinical prediction. The results are biased by inclusion
of residents predicted nondangerous by the clinicians in the
This first generation of research suggested that the global
prediction that chronically institutionalized individuals are all
dangerous is unwarranted. These studies also indicate that while
clinicians may be able to identify subsamples of individuals much
more likely to exhibit violent behavior than the base rate, low
base rates of violent behavior in the population result in a
large number of false positives. Certain demographics such as
age, presence of a juvenile record, number of previous arrests,
presence of prior convictions, and severity of admitting offense
were correlates of violent behavior in these studies.
Longitudinal Research of the Correlates of Violent Behavior
While research concerning the clinical prediction of violent
behavior has been sparse, there is a substantial literature which
has researched the characteristics and histories of violent
individuals or groups of individuals by following large groups of
individuals over time. This research has generally found that
number of previous arrests, history of past violent behavior,
race, and socioeconomic status are correlated with subsequent
Studies examining the role of early childhood predictors of
violence place importance on the presence of fighting in
childhood and juvenile arrest records. Justice, Justice, and
Kraft (1974) reviewed 1500 references of violence in the
psychiatric literature and found that childhood fighting, temper
tantrums, problems in school, and inability to get along with
others were behaviors reported to correlate with later violence.
The association between early violent behavior and later
aggression was also supported in a longitudinal study of 400
males from age 8 to 19. In this sample Lefkowitz, Eron,
Walder, and Heusmann (1977) reported that aggression at age 8
was the single best predictor of aggression at age 19.
In a large study, the records of all boys born in
Philadelphia in 1945 and still living there between their 10th
and 18th birthday were examined by Wolfgang, Figlio, and
Sellin (1972). Thirty-five percent of the boys had at least
one reported contact with the police by age 18. Race and
socioeconomic status were most predictive of delinquency. Thirty
percent of white males compared to 50% of nonwhite males had such
contact. Twenty-six percent of the high socioeconomic status
boys compared to 45% of the low socioeconomic status boys had
such a contact. Wolfgang (1977) reported a follow-up study which
found that by age 30 only 5% of the sample was arrested only
as adults. Individuals with a juvenile record were four times
more likely to be arrested as adults than those without a
A strong relationship between the number of previous arrests
and subsequent violent behavior was evident in the above study.
One of three of those with at least one reported contact with
police by age 18 was arrested as an adult by age 30. The probability
of being arrested a fifth time given four prior arrests was 0.90.
The probability of being arrested for an FBI index offense given four
prior arrests was 0.36. Given 10 prior arrests there was a 0.42
probability of an FBI index arrest. Similar findings were found in a
Washington, DC, research project which analyzed the arrest records of
45,000 defendants. In this study, the probability of rearrest with
five or more previous arrests approached almost certainty (Shah,
Not all criminal groups have high rates of violent
rearrests. Monahan (1981) reported that an "Assaultive Risk
Screening Sheet" was used by the Michigan Department of
Corrections in 1978 to predict arrest for a new violent crime. The
study analyzed 350 variables for 2200 males released on
parole in 1971 over a 14 month period of time. A small
subgroup (5%) of individuals with a 40% recidivism rate was
identified by checking type of crime, nature of institutional
behavior, and presence of arrest before age 15. The overall
base rate of violent arrests was 10% in the Michigan study.
Murphy (1980) replicated this study and found a 32% recidivism
rate for the identified high risk group.
A series of three studies using 4,146 California Youth
Authority wards conducted by the California Department of
Correction was reported by Wenk, Robison, and Smith (1972). Only
6% of the youths studied had been committed due to a violent offense.
A scale was developed which identified a small subgroup 14% of which
subsequently committed a violent act while on parole. Only 5% of the
nonidentified group committed such an act. The use of the scale
resulted in an 86% false positive rate.
Twenty percent of the Youth Authority parolees were assigned
to a potentially aggressive category in a second study (Wenk,
Robison, and Smith, 1972). The rate of conviction and
imprisonment for this group during a one year follow up was only
three per thousand. Finally, 4000 of the youth authority wards
were followed for 15 months after their release. Prediction
of violence based on prior crime as well as 100 other variables
failed to yield better than a 95% false positive rate. The poor
results of the Youth Authority studies illustrate the difficulty
predicting low base rate events accurately.
In the longitudinal studies above fairly consistent results were
found. Presence of a juvenile record, number and type of previous
arrests, race, socioeconomic status, and childhood behavioral
difficulties were associated with later arrests and violent
Psychological Test Correlates of Violent Behavior
Psychological and demographic variables have been used in a
number of studies to discriminate between offenders who have
committed various types of crimes on the assumption that these
variables would also predict to future behavior. While most
studies examined group differences in present test results, some
studies have examined the predictive validity of various
psychological tests. The Rorschach, a projective technique, and
the MMPI, an objective test are frequently used tests which have
generated considerable research interest.
The Rorschach is a projective technique, first introduced in 1921
(Rorschach, 1921), in which the subject is asked to report what the
subject sees when presented each of 10 ambiguous ink blots. Exner
(1974) reviewed a variety of scoring systems (e.g., Beck, Beck, Levitt,
& Molish, 1961; Hertz, 1951; Klopfer, Ainsworth, Klopfer, & Holt, 1954;
Piatrowski, 1957; and Rapaport, Gil, & Schaefer, 1946) and, borrowing
freely from these, developed the Comprehensive Rorschach System (Exner,
1974). Exner's system provided a more standardized method which led to
renewed research interest and instruction in the use of the test
(Hertz, 1987; Ritzler & Alter, 1986; and Piotrowski, Sherry, & Keller,
The Rorschach has been frequently used to aid in the
discrimination between violent and nonviolent persons (e.g., Finney,
1955; Rose & Bitter, 1980; Shagoury, 1971). A number of Rorschach
indices, described below, have been correlated with anger, aggression,
Rorschach R is defined as the number of responses to the
cards. It is generally interpreted as an index of responsiveness
to the environment. High numbers of responses correlate with
intelligence and productivity, while a low number of responses is
suggestive of defensiveness, depression, and possibly malingering
The Rorschach variable X+% is the percentage of total
responses whose form conforms to the physical features of the
blot. It is considered one of the most important determinants and
is generally interpreted as a measure of the ability to perceive
the environment conventionally and realistically (Exner, 1974;
and Ogdon, 1977). An X+% below 70% is considered to raise
questions about perceptual accuracy and reality testing (Exner,
1974). Low percentages have been associated with the responses of
murderers (Wolfgang & Ferracuti, 1967) and proved useful in
discriminating property versus homicide offenders (Shagoury,
The Rorschach variable M refers to the presence of
human movement in a percept and has been a frequently researched
Rorschach variable (Exner, 1974). The frequency and quality of
M have been interpreted as representing internalization,
empathy, inhibition of impulses, and the ability to bridge inner
resources with external reality (Exner, 1974). It is considered
an index of emotional development since children exhibit low
frequencies (Ames, Metraux, & Walker, 1971). Davids (1973)
reported that the frequency of M discriminated between behavioral
aggression ratings of institutionalized boys.
When M is associated with bad form (M-), the likelihood
of psychopathology increases (Beck, 1965; Phillips & Smith,
1953) and suggests deficient social skills and poor interpersonal
relationships (Weiner, 1966). The presence of M- with any
notable frequency (Phillips & Smith, 1953; Weiner, 1966) or
when the ratio M-/M is greater than 1:3 (Phillips & Smith,
1953) suggests an increasing probability of psychosis.
The percentage of human responses, h%, reflects interest and
sensitivity to others (Exner, 1974). Rorschach M and h% were found
to aid in discrimination between a homicide group and a property
crime group (Shagoury, 1971). The ratio W/M, an index of aspirations
versus capacity (Exner, 1974) and was found to be the most powerful
discriminator between aggressive and nonaggressive alcoholics (Haramis
& Wagner, 1980).
The use of color as a response determinant is often
interpreted as an index of affective control and as related to
expression of anger or aggression (Klopfer, Ainsworth, Klopfer,
& Holt, 1954; Phillips & Smith, 1953; Schaefer, 1948; Exner,
1974). The use of color was one of the indices which
discriminated between behavioral aggression ratings of
institutionalized boys (Davids, 1973).
Rorschach weighted Sum C, which is coded as the sum
(1/2FC + CF + 1.5C), represents the sum and quality of the
subjects color responses. Sum C is generally interpreted as
reflective of responsiveness to emotional features of the
environment (Ogdon, 1977). Sum C has been found to be a
useful variable in discriminating between groups of defendants
some of which received psychological evaluation or raised the
insanity plea (Boehnert, 1983) Sum C also was useful in
discriminating between a property crime and a homicide group
The actual content of what is perceived has also been subject
of research with respect to aggressive behavior. A wide variety of
measures of pathological or hostile content have been used in the
literature (i.e., Elizur, 1949; Kane, 1955; Wolf, 1957; Sommer &
Sommer, 1958; Goldfried, Stricker, & Weiner, 1971; Rose &
Bitter, 1980; Shagoury, 1971). Although little or no research
is available contrasting these indices, certain contents have
been hypothesized to correlate with aggressive or deviant
Percepts with a content of blood, sex, religion, food, and
anatomy percepts are believed to be related to sexual,
aggressive, and primitive needs and impulses (Exner, 1974;
Phillips & Smith 1953; Rapaport et al., 1946). The content of
blood is believed to reflect sadistic and destructive impulses
(Phillips & Smith 1953; Rapaport et al., 1946), and sensitivity
and concern with the expression of destructive impulses (Phillips
& Smith, 1953; Rapaport et al., 1946; Davids, 1973). Religious
content is infrequent and believed to be associated with
preoccupation with good and evil and represent displacement of
sexual preoccupation and guilt (Phillips & Smith, 1953). Sexual
content is also rare in nonpatient samples and reflects
psychopathology. Blood responses are frequent in the records of
schizophrenics (Phillips & Smith, 1953).
The Rorschach has been successful at discriminating between
groups of aggressive and nonaggressive individuals. Shagoury
(1971) used a combination of psychological variables in a
discriminant function analysis to differentiate between a
homicide group and a property crime group. Rorschach Sum C,
pathological content, M, negative form level, and the percentage
of human responses were reported to be the most sensitive
Rorschach protocals of alcoholics were analyzed using a
stepwise discriminant function analysis (Haramis & Wagner,
1980). The procedure resulted in the accurate classification of
83% to 87% of the alcoholics into aggressive and nonaggressive
categories. The most powerful discriminator was the ratio W/M.
In another study (Rose & Bitter, 1980), a destructive content
scale was reported to help discriminate between groups of
released offenders which did well in the community for three
years and rapists who reoffended within six months of their
Minnesota Multiphasic Personality Inventory (MMPI)
The MMPI is a 566 item true-false personality
instrument developed at the University of Minnesota in 1941 by
Hathaway and McKinley (Dahlstrom, Welsh, & Dahlstrom, 1972).
It is probably the most frequently administered and researched
personality assessment instrument (Greene, 1980). It is used
cross-culturally and cross-nationally (Butcher & Pancheri,
1976). Ease and economy of administration have made the MMPI a
frequently used assessment instrument in prison settings
(Megargee & Bohn, 1979).
The MMPI yields a profile which consists of three validity and
ten clinical scales. The three validity scales, which assess
test-taking attitude, consist of the "L" (Lie), "F" (Frequency or
Infrequency), and "K" (Correction) scales.
The ten clinical scales were derived in an empirical manner to
discriminate between a criterion group of individuals meeting
certain diagnostic criteria and a control group taken from the
Minnesota population (Greene, 1980). The ten scales consist of
"Hs" (Hypochondriasis--Scale 1), "D" (Depression--Scale 2),
"Hy" (Hysteria--Scale 3), "Pd" (Psychopathic deviate--Scale 4),
"Mf" (Masculinity-femininity--Scale 5), "Pa" (Paranoia--Scale
6), "Pt" (Psychasthenia--Scale 7), "Sc" (Schizophrenia--Scale
8), "Ma" (Hypomania--Scale 9), and "Si" (Social Introversion--
Research utilizing the MMPI has been voluminous. Its frequent
use with correctional populations for screening and
classification has stimulated much research using the instrument
to discriminate between groups of offenders (Megargee & Bohn,
An attempt to discriminate between inmates who had committed
violent offenses and those who had not was made by applying
discriminant function analysis to 141 MMPI profiles of adult male
inmates at a maximum security prison (Jones, Beidleman, &
Fowler, 1981). An equation based on elevations on MMPI scales F,
6, 7, and 8 correctly classified 72.9% of the violent inmates and
80.6% of the nonviolent inmates. Significant differences between
violent and nonviolent groups on these scales have been reported
in a number of studies (e.g., Oliver & Mosher, 1968; Panton, 1959,
1962; Potash, 1956).
Correct classification of 95% of 80 male prisoners into a
group with an arrest record of two or more assaults and a group
which did not have such a record was achieved by the use of a
neuropsychological test battery (Spellacy, 1978). Use of the
MMPI alone to discriminate between these two groups resulted
in a correct classification rate of 79%. The inmates
with previous records of assaults were characterized by
higher elevations on scales F and 6, and lower scores on scales K
Scale score differences between a group of inmates with histories
of violent arrests and those with nonviolent arrests were also
reported by Deiker (1974). Profiles of 168 male prisoners in a
county jail or state correctional institution were analyzed and
yielded significant differences between a group of inmates with
crimes of threat, murder, or battery and a group with mostly
property offenses on scales F, K, 4, 7, 8, and 9. Deiker
suggested that a naysaying response bias may have contributed to
The MMPI profiles of 450 male and female offenders found guilty
and referred for a dispositional evaluation were examined by
McReary (1976). Assaultive offenders were found to have
significantly higher scale 9 scores than nonassaultive offenders.
A larger percentage of offenders with a 4-8/8-4 profile type were
assaultive than offenders with other profile types (4-3, 4-2, and
Lothstein and Jones (1978) found that elevations on scales
F, 4, 6, 7, 8, and 9 characterized a group of adolescent prisoners.
The profile type 8-4 was characteristic of the violent
adolescents. In another study, the sum of scales F, 4, and 9 was
1.5 standard deviations greater in a sample of juvenile
delinquents than a sample from the general population. This sum
demonstrated a reliability coefficient of 0.78 in a study of 426
nineteen year olds in the general population, indicating the
profile was stable across time (Huesman, 1978).
Intelligence Test Results
The hypothesis that intelligence interacts with personality
variables was advanced by Heilbrun (1979) who suggested that
psychopathy predicts violence for less intelligent criminals. Heilbrun
found that in a sample of 76 white Georgia state prisoners 76% of the
offenders with a low IPAT IQ and high psychopathy scores had been
charged with murder or rape. Holland (1981) reported a failure to
replicate Heilbrun's findings. Hinton (1983) reviewed the literature
concerning the predictive validity of intelligence with respect to
violent behavior and found conflicting evidence.
Summary of Test Correlates of Violent Behavior
Classification rates using psychological tests have yielded more
promising results than the limits of prediction suggested by the
early studies reviewed by Monahan (1981).
The studies reviewed suggest psychological test indicators such
as Rorschach color responses, human movement and content, form
quality, and pathological content correlate with aggressive
behavior. Studies utilizing the MMPI as a predictor consistently
report elevations on scales F, 4, 6, 7, 8, and 9 and low scores on
scale K. The use of intelligence measures as a predictor has
yielded less consistent results.
Cluster Analytic Approaches to Classification
One approach to identifying subgroups of offenders has been
the use of cluster analysis of MMPI data. This approach was
successful at identifying subgroups of individuals differing with
respect to type of crime committed and differing with respect to
institutional behavior including violence. Megargee and Bohn's
cluster analytically derived classification system (1979)
stimulated considerable validational research, which suggested
that this method of classification compares favorably with other
offender classification systems. Cluster analysis of MMPI
profiles has also been successful at identifying subgroups of
murderers (Anderson & Holcomb, 1983).
Megargee and Bohn (1979) developed a classification system
of criminal offenders by performing cluster analysis of offender
MMPIs. The classification system consisted of 10 groups based
on MMPI profile characteristics. The groups were derived from a
hierarchical profile analysis of three groups of 100 profiles
each from inmates at a federal medium security facility in
Tallahassee, Florida. The classification system was refined and
cross validated using 1214 additional inmates. Significant
differences between the groups for the number of subjects in
each group who were involved in violent and nonviolent
disciplinary infractions were found. Significant differences
between the groups were also found for reincarceration rates.
Edinger (1979) replicated these findings using 2000 male federal
prisoners and 1500 female state prisoners. Several later studies
used cluster analysis to classify individuals in other settings,
replicating some of Megargee's original groups and identifying
new ones (e.g., Quinsey, 1980; Nichols, 1979; Mrad, Kabacoff,
& Duckro, 1983).
Some failures to replicate between group differences of
Megargee's groups with respect to institutional behavior have
been reported. Megargee's classification system was not effective
at predicting which of 520 inmates from a federal penitentiary
would exhibit antisocial or aggressive behavior (Louscher,
Hosford, & Moss, 1983). Although significant between group
differences were found in number of disciplinary reports, no pair
wise differences emerged.
The relative efficacy of 4 classification systems, including
Megargee's, in predicting inmate institutional adjustment in a
penitentiary setting was examined by Hanson, Moss, Hosford, and Johnson
(1983). Hanson et al. examined demographic variables,
Megargee typology, security designation, and custody
classification data on 337 male inmates. Canoconical
correlations indicated the single best measure of overall
institutional adjustment was total number of disciplinary
reports. The best predictor of disciplinary reports was custody
classification. Being the member of specific Megargee groups was
the single best predictor for days in disciplinary segregation,
good time forfeited, and for positive work ratings.
Studies of Predictors of Institutional Aggression
Monahan (1984) indicated that studies of aggressive behavior in
acute care psychiatric facilities offer valuable data in which to judge
the short term predictive accuracy of psychological and psychiatric
prediction. Studies of aggressive behavior in institutional
settings have provided useful information on aggression within
controlled environments. These studies have provided information
on environmental variables, patient characteristics, and
behavioral correlates of violent behavior.
Studies of institutional aggression have indicated that
environmental variables such as the amount of structure and
activity influence the frequency of aggressive behavior. Age,
race, diagnosis, type of admission, and behavioral ratings of
agitation and psychotic behavior were found to be correlates of
A series of four studies which included 720 male inmates, 16
institutional subsettings, 63 types of infractions, and 30 types
of institutional sanctions was conducted by Edinger and Auerbach
(1978). A factor analysis of situations yielded a differentiation
between situations which had a high amount of staff supervision,
were structured, and in which staff-inmate interaction was
controlled and situations which were characterized as free-time
subsettings. A higher probability of assaults in free settings
than supervised settings was reported.
Although Rogers, Ciula, and Cavanaugh (1980) found a low overall
incidence of aggressive behavior in a 42 bed maximum security
psychiatric unit, they found that time of day and availability of
professional staff were correlated with the frequency of
aggressive incidents. Peak times for aggressive and socially
disruptive incidents were shift changes, meals, and periods of
concentrated treatment programming.
Mealtimes and the beginning of the day were also peak periods
for incidents in a study of three psychiatric hospitals which did
not admit "persistently violent individuals" (Fottrell, 1980).
A few patients were reported to account for the majority of the
incidents. Patients who acted violently towards themselves or
others were younger and more often diagnosed schizophrenic. A
study of battery incidents in a maximum security state hospital
also found that most batteries occurred in the daytime on the way
to meals (Deitz & Rada, 1982).
In the Deitz and Rada study (1982) batterers were reported to
have a longer mean length of hospitalization, were more
frequently prison transfers, and were more frequently nonwhite.
Race was also found to be a significant variable in a study of
5000 incidents occurring over the course of a year at a large
state hospital. Evenson, Sletten, Altman, and Brown (1974) found
that non-whites had higher risk rates for assault and antisocial
behavior. They found that young, unmarried males with deferred
diagnoses had the highest probability of engaging in assaultive
Some studies have examined short term behavioral correlates of
violent behavior within institutions. Few (7%) of the 5164
patients in two state hospitals studied by Tardiff and Sweillam
(1982) assaulted anyone in a three month period. Behavioral
ratings of these patients indicated assaultive patients
were more severely impaired on ratings of such psychotic symptoms
such as delusions, hallucinations, inappropriate affect, bizzare
habits, rituals, and exhibited more antisocial behavior than
nonassaultive patients. Assaultive patients were younger
and more frequently diagnosed nonparanoid schizophrenic, organic brain
syndrome, mentally retarded, or personality disordered.
Behavioral ratings and violent behavior was also examined by
Yesavage, Werner, Becker, and Mills (1982) in a comparison of
voluntary versus involuntary admissions to a 20 bed V.A.
inpatient psychiatric unit during the first week after admission.
Patients who were assaultive scored higher on behavioral
ratings of anxiety, conceptual disorganization, tension,
mannerisms, grandiosity, hostility, suspiciousness, motor
retardation, unusual thought content, and excitement than did
Hostile verbal behavior was used by Werner, Yesavage,
Becker, Brunsting, and Isaacs (1983) in an effort to predict
assaultive behavior by 110 schizophrenic V.A. inpatients. The
authors found that 32% of patients who engaged in hostile verbal
behavior committed an assault.
Type of admission has also been associated with assaultive risk.
In the Yesavage et al. (1982) study involuntary admissions were
rated more hostile than voluntary admissions. Sixty-five percent
of the involuntary admissions versus 47% of the voluntary
admissions incurred a violent incident in the first week of
admission. Rofman, Askinazi, and Fant (1980) compared the
records of 59 involuntary admissions to a V.A. inpatient unit to
59 voluntary admissions during the first ten days of admission.
Forty-one percent of the involuntary admissions versus 8%
of the voluntary admissions were involved in assaultive
The ability to predict behavior or events is a fundamental test
of knowledge. De Groot, quoted in Pedhauzer (1982), stated "If
one knows something to be true, he is in a position to predict,
where prediction is impossible, there is no knowledge" (p. 40).
Although prediction is not identical with explanation, and
may be far removed from causality, it is unlikely meteorologists
would make the evening news solely explaining yesterdays weather.
The importance of predicting violent behavior cannot be
underestimated since such predictions involve the civil liberties
and freedom of individuals. Predicting which individuals would be
violent under what circumstances has been called the paramount
consideration in the interface between mental health and the law
by the president of the American Psychiatric Association (Stone,
The accuracy of such predictions presents important ethical
and legal issues. Factors affecting accuracy involve the
determination of cutting scores and decision rules. While it may
be acceptable to adopt a criterion of more likely than not (51%)
for short-term civil commitment proceedings (Mental Health Law
Project, 1977), the application of a criterion of "a greater than
average probability" (greater than the overall base rate) would
lead to the deprivation of liberty of a large number of people
The selection criterion employed to determine cut scores
determines the rate of true positives to true negatives and the
absolute number of successful predictions. Monahan (1981) urged
that regardless of the selection procedure used, "by all means
the rule should be made explicit" (p. 38).
Task forces of the American Psychiatric Association (1977) and
the American Psychological Association (1978) have maintained
that psychiatrists and psychologists do not possess adequate
information or scientific knowledge to predict violent behavior.
Monahan (1981) suggested the question is not whether or not
predictions of violence could be made, nor whether or not they
should be made, but the question should be how accurately can
they be made and in what circumstances.
The method by which predictions are made is the subject of the
debate between clinical and statistical prediction (Meehl, 1954).
Meehl reviewed the research data in a variety of fields and found
"overwhelming" evidence in favor of statistical prediction. He
found little need to retract "95%" of his position 30 years
later (Meehl, 1986).
Kastermeir and Eglit (1973) suggested that the resistance to
the idea of statistical prediction in the area of prediction of
violent behavior stemmed from the view that legal issues are
intrinsically individualized, the fact that actuarial methods
explicitly acknowledge that errors will be made, uneasiness over
stating the reasons decisions which are made which run counter to
statistical predictions, and concern about loss of status and
jobs to clerks armed with statistical formulae.
To this list Monahan (1981) added that concerns about stating
certain reasons for decisions which are statistically made (i.e.,
race and sex) lead to resistance. Einhorn (1986) indicated that
the unavailability of the required data to make a statistical
prediction, or insufficient time (in the case of emergency
commitment procedures), results in a necessity to rely on clinical
experience and judgement. Increased overall accuracy, explicit,
empirically testable rules, and increased consistency in decision
making are cited as advantages of statistical prediction
Monahan (1981) suggested the issue is not one of clinical versus
statistical prediction, but a question of what can the clinician
do to increase the accuracy of prediction. To accomplish this end
Monahan suggested that determination of the base rate of violence
in the population to which the predictions are to be applied
needed to be made the primary consideration. Megargee (1976)
maintained a similar position and suggested that mental health
professionals should limit themselves to predicting violent
behavior to populations with high base rates of violent behavior
such as those who have already exhibited violence.
Monahan (1981) added that obtaining information on a limited
number of reliable valid predictive relationships was necessary
to limit the reliance on illusory correlations. Monahan (1984)
urged a shift away from clinical attempts at long term
predictions of dangerousness in chronically institutionalized
populations and a shift toward a multidimensional approach to
examining short term predictions.
Statement of the Problem
The early research on attempts to predict violent behavior
focused on long term prediction using chronically
institutionalized samples (Monahan, 1984). Monahan (1984)
suggested that this research has been overgeneralized and that
empirical approaches using a multivariate model which attempt to
make more short term predictions in less chronic populations may
be more fruitful.
Many predictive efforts have failed due to low base rates
(i.e., Michigan Department of Corrections cited in Monahan, 1981;
Steadman & Cocozza, 1974; Wenk, Robison, & Smith, 1972).
Predictive efforts are most likely to be successful when the
target behavior has an approximate 50% base rate (Meehl, 1954).
Previous studies indicate involuntary admissions (Yesevage
et al., 1982; Rofman et al., 1980) and those adjudicated
incompetent to stand trial (Steadman & Cocozza, 1976) have
relatively high base rates of aggressive behavior.
The present study attempts to use a multivariate model which
includes demographic data, arrest history, diagnosis,
institutional variables, and test data to develop multiple
regression equations which identify groups of individuals with
higher than base rate involvement in institutional incidents and
The need for efficient classification systems in forensic
facilities to aid in management and treatment remains (Mrad,
Kabacoff, & Duckro, 1983). Classification systems based on
psychological test results have been as effective or more
effective than clinical predictions at discriminating between
potentially aggressive and nonaggressive groups (Shagoury, 1971;
Spellacy, 1978; Haramis & Wagner, 1980; Jones et al., 1981).
Cluster analysis of MMPI profiles has been successfully
employed in Megargee's MMPI based system for offender
classification (Megargee & Bohn, 1979) and in developing an
MMPI typology of murderers (Anderson & Holcomb, 1983).
Megargee's method has been successfully used to identify
naturally occurring groups of adult offenders (Nichols, 1979), and
half-way house residents (Mrad et al., 1983). Implementation of
Megargee's system was successful at reducing institutional
violence in a medium security federal prison (Megargee & Bohn,
Cluster analysis of the MMPI profiles of forensic patients may
identify new groups which are likely to be unique to forensic
psychiatric facilities. The present study attempted to identify
naturally occurring MMPI subgroups in this population and to
validate the groups by demonstrating between group differences in
demographics, institutional behavior, and independent
psychological test data.
Individuals found incompetent to stand trial have been
relatively ignored in forensic psychological research (Steadman,
1984). A secondary purpose of the present study was to provide
more data on a population of forensic inpatients consisting
predominantly of individuals adjudicated incompetent to stand
trial. Multiple regression procedures were used in an
exploratory investigation of the predictors of the length of time
required to return to competency. It was hoped this would add to
the sparse literature on the subject (e.g., Cuneo, Brelje,
Randolph, & Taliana, 1982; Heller, Traylor, Ehrlich, & Lester,
The hypotheses tested in the current study were as follows.
1. Some weighted combination of psychological test indices and
demographic data derived from multiple regression analysis could
identify residents at higher than base rate risk for becoming involved
in institutional incidents.
2. A similarly derived equation could identify residents at risk
for a) aggressive incidents, b) fights, and c) incidents requiring use
3. Some combination of psychological test indices and demographic
data could predict length of treatment for those residents
adjudicated incompetent to stand trial.
4. Naturally occurring groups of forensic inpatients could be
identified by hierarchical cluster analysis of residents MMPI data.
5. The derived groups would be valid in that significant
differences would be found between the groups on demographic
data, institutional adjustment, and other psychological test
The present research used demographic and psychological test
variables to predict institutional incidents, aggression, and
length of stay for residents in a state forensic psychiatric
facility. The present study also tested the hypothesis that
naturally occurring groups of forensic patients could be
identified by cluster analysis and that the groups would be
significantly different on demographic, test, and behavioral
characteristics. The subjects, institution, and variables used
are discussed below.
Subjects were 451 male residents from a pool of 474 residents
evaluated by the center's Psychology Service between March, 1981, and
April, 1985. Incomplete medical records, conflicting identifying
information, and lost psychological or medical records resulted in the
exclusion of 23 of 474 (4.85%) residents from this study. Residents'
ages ranged from 15 to 64, with a mean age of 30.52.
The Psychology Service was staffed by two full time licensed
Ph.D. clinical psychologists and two assistants who conducted
psychological evaluations as part of a contract with the
Department of Clinical Psychology at the University of Florida.
The assistants were pre-doctoral graduate students with similar
training in psychological test administration and scoring in that
North Florida Evaluation and Treatment Center is a 200 bed maximum
security treatment facility for mentally disordered offenders. Ten
buildings house from 18 to 27 residents. The center is comprised of
four units one of which houses residents participating in a sex
offender treatment program. These sex offenders were not included in
the present study. The 451 residents in the present study consisted of
residents on the three units comprised mostly of residents who had been
adjudicated incompetent to stand trial. A small percentage of those
found not guilty by reason of insanity and transfers from the
department of corrections were also residents on these three units.
Evaluations of residents were routinely completed by the
Psychology Service within the first 30 days of admission.
The Psychology Service files contained evaluations of 474
residents. The evaluation consisted of a clinical interview and
testing. Some tests which were routinely administered included
the MMPI, WAIS-R (Wechesler, 1981) or rarely the Peabody Picture
Vocabulary Test (Dunn, 1965), projective drawings, and the
Rorschach. Variability in the tests administered existed due to
reading difficulties, limited cooperation, and time constraints.
Materials and Measures
The selection of variables used in the present study was based on
previous research findings, and the availability of such data in
existent records. The selection of demographic data to be used in
prediction equations was determined by the previous prediction
literature. An effort was made to use nonredundant summary variables
to minimize the number of independent variables thereby increasing the
stability of the solutions (Pedhazur, 1982).
Admission status was coded as incompetent to stand trial,
not guilty by reason of insanity, prison transfer, and other.
Individuals adjudicated incompetent to stand trial were court
ordered to one of two Florida maximum security psychiatric
facilities if they were also adjudicated to be a danger to
themselves or others and in need of treatment in a secure
facility. Type of admission has been associated with between
group differences in institutional aggressive behavior (Deitz &
Rada, 1982; Yesavage et al., 1982).
Age was coded as the subject's age at time of testing. Race was
coded as white, black, Hispanic ethnic group, and other. Age and
race have been consistently reported to correlate with aggressive
behavior (i.e., Deitz & Rada, 1982; Sweillam, 1982).
Diagnosis was coded from resident's NFETC official discharge
DSM-III diagnosis (American Psychiatric Association, 1980).
Diagnosis has frequently emerged as associated with aggressive
behavior (Evenson et al., 1974; Fottrell, 1980; Tardiff &
Sweillam, 1982) although methods of diagnosis and findings have
not been entirely consistent.
After reviewing the frequencies of each type of diagnosis it was
decided that diagnoses would be coded as no axis-I diagnoses, affective
(for DSM-III major affective disorders, n = 19, or schizoaffective
disorder, n = 8), paranoid schizophrenia, all other types of
schizophrenia, and "other" (this consisted of schizophreniform
disorder, n = 5, post-traumatic stress disorder n = 1, dysthymic
disorder, n = 5, brief reactive psychosis, n = 14, and paranoid
disorder n = 6). Organic brain syndrome (OBS) was coded if the
discharge diagnosis included dementia, epilepsy, or organic
The NFETC discharge diagnoses included few diagnoses of
personality disorder and other diagnoses except mixed personality
disorder (n = 39) and antisocial personality disorder (n = 51).
It was decided personality disorder would be coded as presence of
any Axis-II diagnosis exclusive of antisocial personality disorder
(n = 79). Presence of antisocial personality disorder was coded
The presence of substance abuse or dependence was also coded
separately and was coded as positive if the individual had a
diagnosis of substance abuse or dependence, a history of two or
more alcohol or drug related arrests, or a previous history of
treatment for alcohol or drug dependency.
Marital status and education were coded from medical records.
It was judged that a reliable source of residents employment
status was not readily available. Employment status was not
National Crime Information Center (FBI-NCIC) and Florida
Department of Law Enforcement (FDLE) arrest records were routinely
obtained upon an individual's admission to NFETC. These records were
the source for determining total number of arrests and number of
violent arrests. The age of first arrest was obtained from arrest
records, medical records and reports. Total arrests, violent arrests,
and first recorded arrest were coded by two assistants if they occurred
in Megargee's list of violent offenses (Megargee, 1982).
As a test of the reliability of the assistant's coding the
primary investigator recorded random samples of each assistants
arrest codings. Inter-scorer reliability was assessed between the
principal investigator and Assistant One with r = .9742 (n = 22)
for total arrests, and r = .98333 (n = 22) for violent arrests.
For records coded by Assistant Two and recorded by the principal
investigator, r = .9309 (n = 23) for total arrests, and r = .9827
(n = 23) for violent arrests. These results indicated that the
codings were highly reliable and certainly sufficient for
purposes of the present study.
Residents were routinely referred to Psychology Service for
evaluation within four weeks of admission. Medical records were
reviewed, and residents were interviewed and tested individually.
Residents were informed that a report would be included in their NFETC
records. Among tests routinely administered by psychology services
were the MMPI, WAIS-R, and the Rorschach.
Psychology services administered two forms of the MMPI to
residents. One hundred eighty-three subjects were administered Form-R
of the MMPI and 110 residents were administered the MMPI-168 (Overall,
Higgins, & DeSchweinitz, 1976), a short form of the MMPI. Due to
criticism concerning the equivalency of the two forms (Hoffman &
Butcher, 1975; Ward, Ward, & Moore, 1983) and lack of data concerning
the use of the MMPI-168 in institutionalized forensic populations
(Stevens & Reilley, 1980), 40 randomly chosen Form-R MMPI's were
recorded as MMPI-168s and the resultant K-corrected t-scores compared.
Correlations between Form-R scored and the MMPI-168 scored
profiles yielded correlation coefficients between .37739 and
.93273 (see Table 1). Significant differences were found between
the differently scored profile for K-corrected scores on scales
Hs, Hy, Pd, Mf, Pa, and Sc (see Table 1). On the basis of these
results, MMPI-168s were excluded from the present study to
reduce measurement error.
Mean K-Corrected T-score Differences and Correlations between
MMPI Form-R recorded as MMPI 168: Paired Observations
Scale 168 Score S. D. t prob. correlation
value (one-tailed, p = .05) = .26406
An additional 16 MMPI profiles from residents admitted after April
1985 were included in the cluster analysis to increase the power of the
analysis. Data from residents of the additional 16 profiles were not
included in the multiple regression equations since the full set of
data was not collected. These additional 16 profiles were included in
calculation of the overall mean NFETC MMPI profile.
A subset of MMPI scales was used in the multiple regression
analyses. Scales F, K, 4, 6, 8, and 9 were selected for inclusion
since the literature reviewed suggested these scales were most
consistently found to differ, or discriminate between, aggressive
and nonaggressive groups. All MMPI scales were not used in order
to minimize the variable to sample size ratio, thereby increasing
the stability of the solutions (Pedhazur, 1982).
Psychological Services administered the Wechesler Adult
Intelligence Scale-Revised to residents unless time constraints
precluded administration, the residents mental status at the time or
spoken English would not yield a valid estimate, or if a valid recent
intelligence estimate was available.
Intelligence quotient (IQ score) was coded as the best WAIS-R
estimate available from testing or medical records. The WAIS-R yields
a Full Scale I.Q. (FSIQ), a Verbal I.Q. (VIQ) and a Performance I.Q.
(PIQ). The VIQ is calculated from the subscales of Information,
Arithmetic, Vocabulary, Comprehension, and Similarities. The PIQ is
calculated from the subtests of Picture Completion, Picture
Arrangement, Block Design, Object Assembly, and Coding.
The WAIS-R subtest correlations with each other range from .33
(Digit Span and Object Assembly) to .81 (Vocabulary and Information).
Verbal and Performance IQ's correlate .74. VIQ correlates .95 with
FSIQ, and PIQ correlates .91 with FSIQ.
Since the full WAIS-R was not administered in some cases
prorating or estimation of scores was based on the subtests
administered. Coded IQ was, in order of preference, WAIS-R FSIQ
or prorated FSIQ, WAIS-R VIQ or pro-rated VIQ, WAIS-R PIQ or
prorated PIQ, and previously reported WAIS-R IQ.
Conflicting evidence for the role of intelligence in predicting
recidivism or aggressive behavior exists (Heilbrum, 1979; Hinton,
1983). Heller et al. (1981) found that intelligence test results
were predictive of length of treatment required to restore
competency to stand trial.
The Rorschach was administered and scored using Exner's
Comprehensive Rorschach System (Exner, 1974). The following variables
were selected for use in the multiple regression equations based upon
the previously reviewed literature. Except where noted, the variables
were coded according to Exner's (1974) scoring criterion.
Rorschach R was defined as the total number of responses to
the cards. The Rorschach variable X+% is the percentage of
total responses (excluding pure Color responses) whose form conforms to
the features of the blot and represents good form quality. The
determination of whether or not a percept conforms to a particular
region of the inkblot is primarily determined by the use of frequency
tables (Exner, 1974).
The Rorschach variable M refers to the presence of human
movement in a percept. The frequency and form quality of
M were coded. Rorschach M+ indicates the human movement response
conformed to the features of the blot, whereas M- indicates
the human movement response did not conform to the features of
the blot. To facilitate computation and summarize the quality of
the human movement response, the ratio M- + 100 / (M- + M+) + 100
was used in the present study.
The ratio of responses which include the whole blot, to the
total number of responses which include human movement, W/M
is generally interpreted as an index of aspirations to
current capacity (Exner, 1974). Rorschach W/M was coded as W + 100 /
(M+ + M-) + 100. The percentage of responses which include human
percepts as content was coded as h%.
The use of color as a response determinant is often examined
as an index of affective control and related to expression of
anger or aggression. Responses that include color as a
determinant are coded as FC, CF, or C depending on the relative
weight the individuals responses indicated that either the color
of the blots or the form was primary in determining the percept.
Pure C is coded when the percept is solely based on color as
determinant. The rare Color naming response (e.g., "red") was also
coded as C in the present study.
Rorschach Sum C, which was coded as the sum (1/2FC + CF + 1.5C),
represents the sum and quality of the subjects' color responses. An
index of M to Sum C (EB) was computed as (M+ + M-) + 100 / Sum C + 100.
The ratio EB is reflects the degree to which the person is more prone
to use inner life versus interaction with the world for satisfaction of
important needs (Exner, 1974).
For purposes of this study path% was defined as the ratio:
b + sex + rel + fd + an / R. Percepts with a content of
blood, sex, religion, food, and anatomy percepts are believed to
be related to sexual, aggressive, and primitive needs and
impulses (Exner, 1974; Phillips & Smith 1953; Rapaport, Gil,
& Schaeffer, 1946). This index was created by the present
author since it could be readily coded from Exner's content
categories. Previously published methods of scoring pathological
content were not used since this would require substantial
recoding, often from illegible transcripts of subjects initial
The interscorer reliability of two of the examiners which
administered and scored many of the Rorschach protocals in the present
study has been reported in a previous study (Unger, 1985). Every fifth
response of 30 randomly chosen protocals from a pool of 150 student
protocals were scored by both examiners. Unger (1985) reported
interscorer reliability agreement of 92% for overall responses, 98% for
location, 94% for determinants, and 93% for form quality (X+%).
The primary dependent measures in the multiple regression
equations were coded from NFETC Incident (IR) and use of force (UFR)
reports (Appendix A). These reports were implemented by NFETC in
September 1982. Staff at the center are required to complete an
incident report form for each time a resident threatens or actually
harms another person or property. These reports are reviewed and
signed by supervisors and security for completeness and accuracy.
Time of incident, circumstances, and response to incidents are
coded on the incident report by checking off appropriate
categories. Incident reports are divided into five sections. The
first section indicates the particular people involved in the
Section two indicates the location of the incident.
Section three contained the majority of the data of interest in
the present study. The type of incident was coded on incident reports
as A. Refusal to take medications; B. Violation of standing
procedures; C. Refusal to comply with verbal orders; D. Verbal abuse
toward staff or other residents; E. Resident threatened violence
(toward self or other); and F. Resident performed violence (toward
self or other). Residents response to security was also coded as to
whether the resident complied, resisted verbally, or resisted
physically. More than one problem could be coded during any
Staff response to the incident was coded on incident reports as
A. Verbal orders issued to resident; B. Physical force applied; C.
Condition B watch; D. Placed in observation room (Condition A watch);
E. Nurse called; F. Security called; G. Placed in seclusion room; and
H. Restraints applied.
Building Incident Rates
A separate index file was maintained by NFETC security which
listed incident report numbers by resident. This included any incident
which listed the resident in section I of the report. This file was
used in the present study to calculate building incident rates in the
Indexed incidents were totaled by building and month for
each resident at NFETC (exclusive of sex offender buildings)
between September 1982 and December 1985. For each resident in
the study a total of all incidents occurring in his building
during months he was present for more than 14 days was made. The
number of indexed incidents which involved the particular
resident was subtracted from this number and then divided by the
number of months of the residents stay yielding a building
monthly incident rate for each resident.
Individual Incident Rates
Each resident's total incident rate was calculated from raw
incident report and use of force report data which were collected,
stored, and supervised by NFETC security. In calculating each
resident's incident rate, reports which involved building searches,
reports in which the resident was not directly involved, minor medical
injuries, and reports in which the resident was clearly only the victim
of a verbal or physical assault were not included. Thus, this total
was below each resident's index card total. The total number of
incidents was divided by each resident's length of stay yielding a
monthly incident rate for each resident.
Violent incidents were coded as a subset of the total incident
figure above. An incident was coded as aggressive if it involved
violent physical contact with another resident, staff, or
security. The number of such incidents was divided by each
resident's length of stay to yield a monthly aggressive incident
On occasion, physical aggression would occur following the initial
incident intervention. These incidents were added to each resident's
total violent incidents to yield a monthly rate of extended aggressive
incidents. Thus, aggressive incidents formed a subset of extended
Fights constituted a subset of violent incidents and were coded
from narrative reports. Reports of clearly identified victims of
attacks were excluded, and a monthly fight rate was calculated
for each resident.
Use of force reports were required whenever physical
intervention was required by staff or security to control the
resident and most likely constituted the most serious subset of
incidents. Use of force reports were tabulated by resident and
were used to calculate monthly use of force rate for each
A measure of each building's response characteristics was derived
from examining the rate of physical intervention, restraint, or
seclusion in response to incidents which did not involve actual
physical violence by the resident.
One hundred ninety-four reports were identified which included
verbal aggression, but no physical aggression, or threats of
violence to self or property. These were tabulated by building
and the percentage of these reports which included physical
intervention, restraint, or seclusion by staff was calculated and
coded as building verbal aggression response.
Length of Stay
Resident's length of stay was coded as days between date of
admission and date of discharge. Length of stay was tabulated by
building to yield building average length of stay.
The selection of predictor variables was determined by previous
research findings and the availability of such information in
existing files. K-corrected Minnesota Multiphasic Personality Inventory
(MMPI) scales were used. The MMPIs were not included if the
psychological report indicated evidence of a random response style or
if the profile had a scale K T-score above 70 T. Eleven profiles were
excluded from cluster analysis and multiple regression analyses due to
K scores greater than 70 T.
Prediction equations were generated by sequential application
of stepwise multiple regression to blocks of predictor variables
(Cohen & Cohen, 1975). In this method, the stepwise regression
procedure selects variables from the subset of predictor
variables constituting the "block." At each stage the variable
which has the largest semipartial correlation is entered. When
no predictor variable from the block would make a further
significant contribution to the variance accounted for, the
analysis is terminated. If the addition of a variable results in a
previously entered variable no longer making a significant
contribution, as sometimes happens with highly correlated variables,
the previous variable is removed from the equation.
In a blockwise selection procedure surviving variables from
the previous block which had made a significant contribution are
added to the next block and the stepwise multiple regression
procedure described above repeated until all variables and blocks
are analyzed (Cohen & Cohen, 1975). Resultant equations are
obtained in an a posteriori order based solely on the relative
uniqueness of predictor variables in the sample at hand (Cohen
& Cohen, 1975).
Stepwise multiple regression procedures have been criticized as
being unsuitable for explanatory research. The use of a large number
of predictor variables relative to the sample size results in
capitalization on chance and make overall tests of multiple R-squared
invalid (Cohen & Cohen, 1975). These criticisms are less of a problem
when the research goal is entirely or at least primarily predictive
when the sample size is relatively large relative to the number of
predictor variables, and when the results are cross validated (Cohen
& Cohen, 1975).
A more realistic estimate of the multiple R-squared can be
calculated as a "shrunken R-squared," where shrunken R-squared =
1 ( 1 R-squared) X ( n 1 ) / (n k 1) (Cohen & Cohen,
1975), where n is the sample size and k is the number of
predictor variables. Two estimates of Shrunken R Squared may be
made. A liberal estimate involves calculating k as the number of
variables actually entered into the equation. A conservative
estimate is calculated defining k as the total number of
variables examined prior to the stepwise selection procedure
(Cohen & Cohen, 1975). An estimate of the magnitude of error in
estimating values in other samples is calculated by the standard
error of estimate which yields the estimated standard deviation
of residual errors.
Stepwise multiple regression was applied in blocks to generate
prediction equations for the criterion variables incident rate,
aggressive incident rate, extended aggressive incident rate, fight
rate, and use of force rate. All multiple regression analyses were
performed using Microstat software (Ecosoft, 1984).
The same procedure was used to generate a prediction equation for
length of stay for residents adjudicated incompetent to stand
trial. Prediction equations were then utilized to generate
classification tables for different incident types using various
cutting scores. The resultant classification rates were compared
with classification rates based upon chance (50%) and the overall
The order of block entry was determined by availability of data,
difficulty and costs of obtaining the data, and finally by the
completeness of the data for all subjects. Since all subjects
did not complete all of the psychological tests, test data were
Possible differences between groups of residents who were and
were not administered a Form-R MMPI and between those residents
who were and were not administered a Rorschach were examined using
t-tests. Differences between the groups of residents would pose
limits to the generalization of equations which included test
Categorical variables such as race, diagnosis, building, and,
admission type were coded as dummy variables (Cohen and Cohen,
1975) in the multiple regression analyses (See Table 2). All
analyses used the same order of block entry (Table 3).
Block 1 consisted of the basic demographic variables of age,
education, race, marital status, and admission type. Block 2
Variable Codina for MultiDle Reqression Analyses
black, Hispanic (0,0) = white
married, divorced, other (0,0,0) = never married
not guilty by reason of insanity, other,
(0,0) = incompetent to stand trial
affective disorder, nonparanoid schizophrenia,
paranoid schizophrenia, other axisi,
(0,0,0,0) = no axis I diagnosis
Unit 2, Unit 3, (0,0) = Unit 1
blg. 6, b1g. 7, b1g. 8, b1g. 9, b1g. 10,
blg 13, b1g. 14, (0,0,0,0,0,0,0) = other
Multiple Regression Blocks
BLO C KS
ONE TWO THREE FOUR FIVE SIX SEVEN EIGHT
age Axis I: b1g. b1g. total Rorsch: MMPI: IQ
ed. affect. l.o.s. 6 R F
Race: o. schiz. b1g. 7 arrest X+ % K
black par. scz. rate 8 violent path % 4
Hisp. o. Ax I. b1g. 9 W/M 6
Marital: personal. incid. 10 violent Sum C 8
disorder resp. arrest
married 13 M-/M 9
div. II. 14 M/Sum C
other Unit H %
consisted of discharge diagnoses. Although these diagnoses were
not predictor variables in the chronological sense, it was
assumed these diagnoses were descriptive of the residents and
representative of the syndromes and symptoms for which they were
admitted and treated.
Blocks 3 and 4 represented institutional variables. Block 3
consisted of each resident's building average length of stay,
building incident rate, building response to verbal aggression,
and the unit to which the resident was assigned. These data were
entered before Block 4, which represented the building to which
the resident was assigned, because Block 3 variables contained
more specific and meaningful data.
Block 5 data consisted of the arrest variables of total arrests,
violent arrests, age of first arrest, and presence of violent
current offense. These data were entered after the previous blocks
since it was likely that this type of data would be difficult to
obtain in many instances.
Psychological test data were entered last since all
residents did not complete all tests, the economic cost of
collecting such data, and to assess whether or not psychological
test data would contribute significant additional information
beyond demographic, diagnostic, and institutional data.
The Rorschach variables R, X+%, path%, M- to M, W to M, Sum C, M
to Sum C, and h percent were entered as block 6. Rorschach data were
entered prior to other test data since subjects who completed the
Rorschach represented a larger subsample.
The MMPI scales F, K, 4, 6, 8, and 9 were entered as block 7.
The MMPI data were included prior to the single variable block 8 (I.Q.
score) due to the relative costs of administering an MMPI and an
individually administered Wechsler Adult Intelligence Scale-Revised
The hypothesis that naturally occurring groups of forensic
inpatients could be identified by hierarchical cluster analysis of
K-corrected MMPI T-scores was tested using 188 subjects administered
the test. The MMPI data were cluster analyzed using hierarchical
profile.analysis using Ward's (1963) method and the CLUSTAN (Wishart,
1978) computer program at the Northeast Regional Data Center.
The procedure is an agglomerative hierarchical method which uses
Euclidean distance as the similarity measure and minimizes within
cluster variance (Blashfield & Morey, 1980). Since cases are
not assigned to the nearest cluster after initial assignment by
this procedure, procedure RELOCATE, which does assign cases to
the nearest cluster, was performed.
If the resultant cluster groups are valid, significant
between group differences are expected (Blashfield, Aldenderfer, &
Morey, 1979). Following the RELOCATE procedure multivariate and
univariate anlayses of variance were conducted to test for
between group differences on continuous variables. Chi-square
analyses were conducted for categorical variables.
In a deviation from Megargee's cluster analytic procedure
(Megargee & Bohn, 1979) records with an F scale score greater
than 100-T were not eliminated from the present sample. Random
selection of 32 profiles from the present sample found nine
(35.5%) profiles with F scale scores greater than 100-T. These
profiles were included since they constituted a large part of the
sample to be studied. A large percentage (24%) of a halfway
house sample was eliminated by this procedure in a previous study
(Mrad et al., 1983).
Demographic and Diagnostic Characteristics
The mean age of the 451 NFETC residents in the present sample was
30.5. The racial composition was mixed (Table 4), 44.1% of the
residents were white, 38.4% black, 16.6% were of Hispanic ethnic
origin, and 0.9% "other." The Hispanic group was comprised of 70.6%
residents of Cuban origin, 11% residents of South American origin, 11%
of Puerto Rican origin and 7% other Hispanic origins. Of the Cubans,
56.6% were refugees from Cuban prisons and asylums who arrived in the
United States during the 1980 Mariel boat lift. These refugees
comprised 40% of the entire Hispanic ethnic group.
Few residents were presently married (5.6%), and most had never
been married (69.2%). The mean number of years of education
(9.9) suggests that most of the sample had not graduated high
school. Demographic and diagnostic data descriptive of the
present sample are presented in Tables 4-8.
The majority of residents in the present sample had been
adjudicated incompetent to stand trial (91.4%). The overall
sample had a substantial criminal history (Table 5). Residents
had been previously arrested a mean 7.9 times with a mean
Variable Mean Sample S. D. Minimum Maximum N
Admission Type and Arrest Data
Variable Frequency Percentage
Incompetent to stand trial
Not guilty by reason
Baker Act transfer
from D. 0. C.
Type of Current Arrest:
Minimum Maximum N
Age at First Arrest
1.9 arrests for violent crimes. Although juvenile records
were rarely available, the mean age of first known arrest based
primarily on adult records was 21.8. The majority of residents
were faced with a violent current charge (67.4%). Approximately
10% of the sample had present charges of some form of homicide, and
14% of the sample had a present or past arrest for homicide.
The majority of the residents in the present sample were
suffering from severe forms of mental illness. The modal Axis-I
of diagnosis was schizophrenia (Table 6). Sixty-four percent of
the sample received discharge diagnoses of some type of
schizophrenia. Paranoid schizophrenics made up 41.24% of the
sample, and other forms of schizophrenia accounted for an
additional 22.84%. A substantial minority of residents (23.06%)
received no Axis-I discharge diagnosis.
Personality disorders other than antisocial personality disorder
were not frequently diagnosed (17.5%, Table 7). Antisocial
personality disorder was also not frequently diagnosed (11.3%).
The NFETC residents had frequent histories of alcohol and substance
abuse. Residents with either a discharge diagnosis which included
some form of substance abuse or dependence, history of two or
more substance related arrests, or history of treatment for
substance dependency included 27.7% of the sample. Discharge
diagnoses of organic brain syndromes, or organic personality
syndromes were rare (5.5%).
Residents were fairly evenly assigned to Units (Table 8).
Residents were assigned to Unit and building at admission.
NFETC DSM-III Axis-I Discharge Diagnoses
DSM-III Diagnosis Frequency Percentage
0. No Axis-I Diagnosis (Below) 104 23.06
1. Major Affective Disorder 19 4.21
2. Schizoaffective Disorder 8 1.77
3. Paranoid Schizophrenia 186 41.24
4. Schizophrenia (Other) 103 22.84
5. Schizophreniform 5 1.11
6. Post Traumatic Stress Disorder 1 0.22
7. Dysthymic Disorder 5 1.11
8. Brief Reactive Psychosis 14 3.10
9. Paranoid Disorder 6 1.37
Note: For purposes of multiple regression analyses Major
Affective Disorder and Schizoaffective Disorder were combined
into "Affective Disorders", and diagnoses 5-9 above were
combined into the category "other Axis-I."
Other DSM-III Discharge Diagnoses
DSM-III Diagnosis Frequency Percentage
(not including antisocial personality disorder)
not diagnosed 372 82.48
diagnosed 79 17.52
Antisocial Personality Disorder
not diagnosed 400 88.69
diagnosed 51 11.31
Organic Brain Syndromes
not diagnosed 426 94.46
diagnosed 25 5.54
History of Substance or Alcohol Abuse or Dependence
absent 326 72.28
present 125 27.72
Unit and Building Assignments
Assignment Frequency Percentage
Assignment was made on the basis of available bed space. Unit One,
Unit Two, and Unit Three housed 33.5%, 27.7%, and 38.8% of the sample
of residents respectively. Assignment to buildings was also fairly
evenly distributed, with the following exceptions. Residents from
Building 12 and 15 combined comprised only approximately 5% of the
sample. This was due to changes in the use of these buildings during
the time period of the present study. A somewhat higher proportion of
residents (20%) were assigned to Building 10.
Test data indicated that NFETC residents were poorly functioning
cognitively and emotionally. The mean level of intellectual
functioning was at the very low end of the low average range of
measured intelligence (80.5). This was just slightly above the range of
IQ scores which are indicative of borderline intelligence (70-79).
The MMPI data were characteristic of acutely hospitalized
inpatient populations. The mean MMPI profile (see Table 9) is
presented in Figure 1. This profile included data from an additional
16 residents which were used in the cluster analysis, and eliminated
residents with a scale K score greater than 70 T since these were
Rorschach data are presented in Table 10 along with means and
standard deviations of a nonpatient and a schizophrenic sample
(Exner, 1977). The low percentage of percepts conforming to the
physical features of the blots (59%) is indicative of poor
reality testing and is characteristic of psychotic individuals.
NFETC MMPI Descriptive Statistics
MMPI Form R
Scale Mean Deviation
70 -- ------------------- ------ ------- ---------- -------
L F K Hs D Hy Pd Mf Pa Pt Sc Ma Si
n = 188
Figure 1. Mean Group NFETC MMFI Profile
Rorschach NFETC Descriptive Statistics
n = 325
n = 210
* Exner (1974)
n = 237
Security maintained an index file which listed incident report
numbers whenever a resident was mentioned in an incident report form.
This sometimes included reports in which the resident was only a
witness, only marginally involved, or part of a building wide search.
Indexed incidents were used in the present study to estimate monthly
incident rates on each building. Indexed incident data included all
residents assigned to the three units which did not treat sex
A total of 4466 index file incidents were tallied for the
period between September 1982 and December 1985. A single
incident could be tallied more than once, depending on the number
of residents involved, therefore the present results are an
overestimate of actual building incident rates.
Residents in the present study were those residents who
were tested by Psychological Services. Residents in the present
sample accounted for 2329 (51.4%) of the index file incidents
accounted for by residents exclusive of those residents in
the sex offender unit. The mean number of incidents appearing on
a residents index card was 6.30 (records = 369) for residents
tested by Psychological Services, and 5.410 for residents not
tested (records = 395). A single resident could have more than
one record if he was readmitted, or transferred to another
An index of the number of incidents which occurred on each
residents building during each resident's length of stay was
calculated. Index file incidents were tabulated by building and
month. Each resident's file index incidents were subtracted
from the total number of indexed incidents on their building
yielding a building incident rate which was unique to each
A total of 1367 incident reports were coded from original
Incident and Use of Force Report forms maintained security (Appendix
A). These forms were coded only for the residents in the present
study. Incidents involving building searches and those which did not
directly involve a resident were not coded.
Rates and frequency of individuals involved in different types
of incidents are presented in Table 11. These data indicated that
the frequency of individuals involved in any type of incident
(54.1%) was sufficient to expect a successful attempt at
prediction. The frequency of individuals involved in specific
types of incidents ranged from approximately 20% to 33%, somewhat
less than optimum for predictive attempts but high enough to
warrant an attempt.
An index of each building's response to incidents which were
not physically violent was created. Of the 1367 incident reports
coded, 193 were found to involve some form of verbal aggression
but no actual physical aggression toward staff, security, other
resident, self, or property. Of these verbally aggressive incidents,
70 (36.27%), resulted in physical intervention, restraint, or
NFETC Incident Data
Incident Type: Frequency Percentage
None 207 45.90
One or more 244 54.10
None 325 72.06
One or more 126 27.94
Aggressive Incidents (Extended)
None 300 66.52
One or more 151 33.48
Use of Force Incidents
None 352 78.05
One or More 99 21.95
None 361 80.04
One or More 90 19.96
Type of Incident Mean Sample Minimum Maximum
(Monthly Rate) S. D.
Total 0.3686 0.7377 0 7.088
Aggressive 0.0794 0.1758 0 1.359
Extended 0.1173 0.2575 0 2.473
Use of Force 0.0879 0.3400 0 5.604
Fights 0.0495 0.1287 0 0.968
The rates of verbally aggressive incidents and this type of result was
tabulated by building to yield a percentage coded as "building
response" (Table 12).
Comparison of Residents Tested by MMPI and Rorschach
Since not all residents which were evaluated by Psychological
Services were administered the same battery of tests, the possibility
existed that tested residents would constitute a biased subsample of
all the residents in the study and thereby pose limits to the
generalizability of test findings.
To test the hypothesis that residents administered the Rorschach
or the MMPI were different from those who were not administered
the particular test, a series of t-tests and Chi-square analyses
Those residents administered the MMPI (Form-R) were compared
with the group of residents either not administered the test or
who were administered the short form MMPI-168. Data of residents for
whom the Rorschach was administered and available was compared with
data of residents for whom the Rorschach was not administered or
available. A small, undetermined number of the "no Rorschach group"
may actually have been administered a Rorschach which was not coded in
the present study because it was not scored by the examiner at the time
Building Rates of Physical Intervention, Restraint, or Seclusion
for Verbally Aggqqressive Incidents
VAI PIRS PIRS / VAI
Verbally Aggressive Physical Intervention Building
Building Incidents Restraint / Seclusion Response %
none 8 2 25.0
2 3 0 0.0
6 34 21 61.7
7 16 8 50.0
8 29 9 31.0
9 34 16 47.1
10 21 3 14.3
11 1 0 0.0
12 4 1 25.0
13 13 6 46.2
14 29 9 31.0
15 1 0 0.0
Note: Building was coded as none if it occurred on a building
other than those listed, building was not listed on incident
report, or if incident occurred before resident was actually
assigned to a building.]
Rorschach Group Differences
A comparison of those residents administered the Rorschach and
those who were not yielded the following results. All t-tests and
Chi-square analyses were performed using Microstat software (Ecosoft,
The analyses indicated no significant differences between groups
for any of the variables examined (see Tables 13 and 14). Therefore,
the null hypothesis that no between group differences exist could not
A comparison of residents administered Form-R of the MMPI and
those not was conducted by t-tests and Chi-square analyses. The
analyses yielded the following results.
Residents who had completed the MMPI were found to have
significantly more education (Mean = 10.282) than those not
administered the test (Mean 9.594) (Table 15).
Differences between residents administered the MMPI and those not
were found for discharge diagnoses. Chi-square analysis of Axis-I
diagnoses of "none," major affective disorder, schizoaffective
disorder, paranoid schizophrenia, and other schizophrenia found a
significant difference in the relative frequencies of these diagnoses
for those administered the Rorschach and those not (Table 16).
Proportionately more residents administered the MMPI were diagnosed as
having a major affective disorder than those not administered the test
Comparison Data for Residents Administered the Rorschach and Those Not
Variable No Rorschach Rorschach F prob. d.f.
age of first 21.990
Monthly Incident Rates:
use of force 0.106
Results Chi-Square Comparisons of
Not Tested with Rorschach
NFETC Residents Tested and
Variable Chi-square d. f. prob. n
Comparison Data for Residents Administered the MMPI Form-R and Those
No MMPI MMPI
Variable Group Group F Prob. D.F.
age of first
use of force
84.969 28.733 <.001
189.173 5.916 < .05
Results of Chi-Square Comparisons
Tested with MMPI Form-R
of NFFTC Rpddpnt~ Tp'~tpd and Not
Variable Chi-square d. f. prob. n
of NFFTC Reidnt Tested d Nt...
Chi-square Analysis of MMPI Tested Versus Not Tested Residents:
DSM-III Axis-I Discharge Diagnoses
No Major Schizo- Paranoid Other
Diagnosis Affective Affective Schiz. Schiz.
Frequency 57 5 6 107 79
Pecentage 13.57 1.19 1.19 25.48 18.81
Percentage 14.98 2.74 1.15 26.78 14.83
Frequency 47 14 2 79 24
Percentage 11.19 3.33 .48 18.81 5.71
Percentage 9.79 1.79 .75 17.50 9.69
Chi-square = 23.398, d.f. = 4, p = <.001, n = 420
Analyses also indicated that residents who were administered an
MMPI were proportionately more likely to receive a DSM-III discharge
diagnosis of some type of personality disorder other than antisocial
personality disorder (Table 18).
Residents administered the MMPI were found to have a
significantly higher measured WAIS-R I.Q. score (Mean = 84.969)
than those not tested (Mean = 77.152).
Residents administered an MMPI were found to have a lower length
of stay (Mean = 189.173 days than residents who were not administered
the test (Mean = 235.452 days, F (1,440) 5.916, p < .05.
No significant differences were found between groups for total
incident rate, aggressive incident rate, extended aggressive
incident rate, use of force, or fights (Table 15). Further analyses
(see Tables 15 and 16) failed to find significant differences.
In contrast with comparisons of resident administered and
not administered the Rorschach, significant differences were
found between residents which were or were not administered the
MMPI. Residents administered the MMPI were more educated and
achieved a higher WAIS-R IQ score upon testing.
Differences in rates of DSM-III Axis-I and personality disorder
discharge diagnoses were also found. Residents administered the
MMPI were also found to be discharged sooner than those not
administered the test. These results suggest that the group of
residents who completed the MMPI Form-R may have been functioning
better cognitively and in other ways than those residents not
administered the test.
Chi-square Analysis of MMPI Tested Versus Not Tested Residents:
DSM-III Personality Disorder Diagnosis (Excluding Antisocial
No Diagnosis Personality Disorder
Frequency 235 35
Percentage 52.11 7.76
Percentage 49.38 10.49
Frequency 137 44
Observed 30.38 9.76
Percentage 33.10 7.03
d. f. = 1,
with continuity correction factor = .8.886, p < .01.
without continuity correction factor = 9.655, p < .01.
n = 451
Incident data consisting of total incident rate, aggressive
incident rate, extended aggressive incident rate, use of force
rate, and fighting incident rate was analyzed by stepwise
multiple regression applied to blocks. Variables were entered in
the order of basic demographic data, diagnoses, unit assignment
and building rates, building assignment, arrest data, Rorschach
data, MMPI data, and I.Q. score (Table 3).
An F for each variable to be selected to enter the multiple
regression equations of 3.00 was selected, since it was slightly
more conservative than a F of 2.00 which was described as liberal
by Cohen and Cohen (1975). Lower values of F make it easier for
variables to enter the equation. Selection of this F value
resulted in a significance level of .05 for most variables
entering the equations.
After the multiple regression equation rates were derived, the
ability of the equations to classify residents into incident and
no-incident groups was examined. Classification rates of multiple
regression equations based on demographic data alone and on
demographic plus test data were examined by calculating the
number of residents falling above and below various cutting
scores and comparing the actual number of residents in these
categories who were actually involved in incidents.
Cutting scores were selected as to minimize the false positive
rate while maintaining a high overall classification rate. Two
separate prediction equations were computed for each type of
incident. Separate equations were computed using data exclusive
and inclusive of test data.
A summary of the resultant multiple regression equations which
were results of analyses of the demographic variables only are
presented in Table 19. These demographic results were based on
the entire sample of 451 residents. A summary of the results of
multiple regression analyses of demographic and test data are
presented in Table 20. Since not all residents completed all
tests these results were based on subsamples of residents completing
As can be seen from these summaries, conservative estimates
of Shrunken R-squared, an estimate of the actual population
variance accounted for, are quite small or null. This is due to
the large number of predictor variables originally examined. The
liberal calculations of Shrunken R-squared, based only on the
actual variables entered after the stepwise selection procedure,
offer a much higher estimate of the actual population variance
Analyses were conducted for total incident rates which
included any type of disruptive incident, aggressive incidents,
extended aggressive incidents, incidents requiring the use of
force, and fighting incidents. Separate equations were derived
using only the demographic blocks of variables and those including
the test blocks. Some post hoc analyses were done which varied
Demographic Multiple Regression Summary: Regression
Weiahts and Statistics
Overall Extended Use of
Incident Aggressive Aggressive Force Fight
Variable Rate Rate Rate Rate Rate
L. 0. T.
Table 19 continued
Overall Extended Use of
Incident Aggressive Aggressive Force Fight
Variable Rate Rate Rate Rate Rate
Single Variables Accounting for Largest Proportion of Variance
Variable antisoc hisp hisp hisp blg 14
R-Square .0271 .0272 .0405 .0151 .0446
Demographic and Test Multiple Regression Summary: Regression
Weights and Statistics
Hoc Hoc Ext
Inc Inc Aggr Aggr Aggr Fight
Variable Rate Rate Rate Rate Rate Rate
-.0649 -.0761 -.0563
.0000 .0000 .0000
Table 20 continued
Hoc Hoc Ext
Inc Inc Aggr Aggr Aggr Fight
Variable Rate Rate Rate Rate Rate Rate
Single Variables Accounting for Largest Proportion of Variance
Variable antisoc antisoc hisp hisp hisp blg 14
R-Square .0413 .0402 .0396 .0396 .0345 .0397
the ofder of entry of test blocks, and used additional Rorschach
Total Incident Rates
Results of the multiple regression procedure conducted on overall
incident rates are presented in Table 21. Results of the analysis
prior to entry of test data indicated that each of the variables age,
Hispanic ethnic group, antisocial personality disorder, other Axis-I
diagnosis, and building 14 assignment contributed significantly when
added to the equation.
The resultant multiple regression equation accounted for
10.23% of the incident rate variance, and was significant at the .001
level. Young Hispanic males with a diagnosis of antisocial personality
disorder had the highest predicted incident rates. The diagnosis of
antisocial personality disorder was the single variable which accounted
for the largest proportion of incident rate variance (4.30%), and
was the variable which contributed the highest proportion of
independent variance in the prediction equation.
Classification rates based upon the resultant equation of
predicted rate = -.00816 age + .39952 Hispanic ethnic group +
.97753 anticosial personality disorder + -.26827 other Axis-I
diagnosis + .21660 building 14 assignment + .48961 are presented
in Table 22.
Incident Rate Blockwise Multiple Regression Results
Block 1. Demographic Variab
Step Variable D. F.
1. Hispanic 1,441
Regression Block One results
STD. ERROR OF ESTIMATE =
MULTIPLE R =
SUM of SQUARES D. F.
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