Dangerous/Violence Potential Behaviour

The MacArthur Violence Risk Assessment Study

Monahan and Steadman's (1994) work outlining the beginnings of the MacArthur Violence Risk Assessment Study is sometimes credited with reinvigorating a more collaborative, second [Page 290]generation effort to standardize an actuarial approach in the prediction of violence. Drawing upon a panoply of previously identified but variously operationalized risk variables, Monahan and Steadman adapted a number of standardized tests and variables to operationalize prospective violence risk factors found in four general groupings:

• 1
  Dispositional factors, including anger, impulsiveness, psychopathy, and personality disorders.
• 2
  Clinical or psychopathological factors, including diagnosis of mental disorder, alcohol or substance abuse, and the presence of delusions, hallucinations, or violent fantasies.
• 3
  Historical or case history variables, including previous violence, arrest history, treatment history, history of self-harm, as well as social, work, and family history.
• 4
  Contextual factors, including perceived stress, social support, and means for violence.

Dependent on the referral context and setting, an assessment of potentially violent individuals requires gathering data from each of these four domains.

Assessing Historical, Dispositional, Clinical, and Contextual Factors

Assessing potentially violent individuals begins with a thorough review of documented historical information, whether performed in institutional or community setting. Documentation, often obtained from legal authorities, must be reviewed relating to history of violence (including sexual assault), previous offences, weapon use, and so forth. Contemporary data including mental status markers (acute paranoid ideation, delusions, etc.) can be substantiated from a review of treatment records, staff interviews, and other corroborative sources. Antecedents and consequents surrounding previous violent acts should be noted along with the mode of violence (affective versus predatory). While a history of affective violence in an unmedicated psychotic patient (without concurrent psychopathy or character pathology) will likely respond, first, to neuroleptic intervention and, second, to anger management instruction, the same interventions will not likely impact the psychotic psychopath with a documented history of predatory violence.3 Evaluation of a patient's past violence includes assessment of the cognitive, affective, and behavioural patterns prior to, during, and consequent to violent episodes, as well as any current situational or dynamic factors that could be impacted by immediate intervention.4 In addition to relevant historical, dispositional, clinical, and contextual factors, victim characteristics (age, gender, circumstances) should also be noted.

...