The Journal of Forensic Psychiatry & Psychology

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/rjfp20

Dysfunctional personality traits and demographic

variables associated with violence risk in male
sexual offenders: a study on Italian adult inmates

Antonella Somma , Andrea Fossati , Fulvio Carabellese , Gianluca Santoro ,

Adriano Schimmenti , Vincenzo Caretti & Felice Carabellese

To cite this article: Antonella Somma , Andrea Fossati , Fulvio Carabellese , Gianluca Santoro ,
Adriano Schimmenti , Vincenzo Caretti & Felice Carabellese (2020): Dysfunctional personality
traits and demographic variables associated with violence risk in male sexual offenders:
a study on Italian adult inmates, The Journal of Forensic Psychiatry & Psychology, DOI:
10.1080/14789949.2020.1857425

To link to this article: https://doi.org/10.1080/14789949.2020.1857425

Published online: 07 Dec 2020.

Submit your article to this journal

Article views: 23

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=rjfp20
THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY
https://doi.org/10.1080/14789949.2020.1857425

Dysfunctional personality traits and demographic

variables associated with violence risk in male sexual
offenders: a study on Italian adult inmates
Antonella Somma a, Andrea Fossati a, Fulvio Carabellese b,
Gianluca Santoro c, Adriano Schimmenti c, Vincenzo Caretti d

and Felice Carabellese e

a
School of Psychology, Vita-Salute San Raffaele University, Milan, Italy; bSchool of Medicine,
Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy;
c
Kore University of Enna, Enna, Italy; dDepartment of Human Studies, LUMSA University,
Rome, Italy; eSection of Criminology and Forensic Psychiatry, Department of Internal
Medicine, University of Bari Aldo Moro, Bari, Italy

ABSTRACT
Sexual offending is a highly relevant public health problem. The effectiveness of
policies and interventions aimed at the reduction of violent (sexual and nonsex­
ual) recidivism depends on our ability to develop accurate risk assessment tools.
To assess the association between violence risk and psychopathy and dysfunc­
tional personality traits in sexual offending, a national sample of 82 male sex
offenders were administered the Italian translations of the HCR-20 V-3, the
Psychopathy Checklist-Revised, and the Personality Inventory for DSM-5.
Selected demographic variables were significantly and non-negligibly associated
with increased risk of violence; moreover, specific PID-5 traits were found to be
significantly, positively, and non-negligibly associated with sexual offender’s
increased risk for violence. According to our findings, sexual offenders who
were not working before conviction, have to serve a long time in jail, manifest
prominent observer-rated psychopathy features, and report high scores on
restricted affectivity, intimacy avoidance, callousness, distractibility, and irrespon­
sibility, over and above their PID-5 psychopathy-related personality profile and
PCL-R total score, are likely to have an increased risk for general violence. Our
findings suggested that personality dysfunctions, as they are assessed relying on
both PCL-R and PID-5, may play a major role as risk factors for general violence in
male adult sexual offenders. Overall, our study provided useful data for increasing
the understanding of the risk for general violence among male adult sexual
offenders.

ARTICLE HISTORY Received 22 July 2020; Accepted 23 November 2020

KEYWORDS Sexual offending; violence risk; psychopathy; personality inventory for DSM-5; HCR-20;
PCL-R

CONTACT Fulvio Carabellese carabellese.fulvio@gmail.com

© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 A. SOMMA ET AL.

1. Introduction
Sexual offending is a highly relevant public health problem, which raises high
concern in the population, mass media and in crime policy making (e.g., Eher
et al., 2019; Schmucker & Lösel, 2015). Recent data suggest that up to 5% of the
Western male population present sexually offensive behaviors against children
and up to 10% commit sexual violence against adult at least once in their
lifetime (Dombert et al., 2016; Krahé et al., 2015, 2014). Given the long-term
negative consequences affecting many victims of sexual violence (e.g., Martin
et al., 2011), sex offending is usually considered among the most dangerous of
all crime and offender types by citizens (e.g., Levenson et al., 2007).
Although empirical studies consistently showed low sexual recidivism rate
among persons with prior sexual offense involvement (e.g., Fanniff et al.,
2017; Hanson et al., 2018; Jennings, 2015; Ozkan et al., 2020; Piquero et al.,
2012; Sample & Bray, 2003, 2006; Zimring et al., 2009, 2007), sexual offenders
demonstrate higher rates of nonsexual violent recidivism than rates of sexual
recidivism (Hanson & Bussière, 1998; Langan et al., 2003; Parkinson et al.,
2004).
From this perspective, developing accurate risk assessment tools for the
criminal justice system is crucial (e.g., Lussier & Davies, 2011). Indeed, the
effectiveness of policies and interventions aimed at the reduction of both
sexual and nonsexual recidivism depends on our ability to predict who is
most at risk of reoffending (e.g., Van den Berg et al., 2018).
Recently, risk formulation has been given a strategical role in risk assess­
ment (Hopton et al., 2018); structured professional judgment which includes
assessment and treatment programs has increasingly taken the place of
unstructured approaches (Hopton et al., 2018). While the importance of
assessing risk for sexual recidivism is without question, less empirical atten­
tion has focused on the assessment of risk for general (nonsexual and sexual)
aggression among sexual offenders (Cartwright et al., 2018). Interestingly,
Cartwright et al. (2018) carried out a study on the predictive validity of the
Historical-Clinical-Risk Management-20 Version 2 (Webster et al., 1997), Short-
Term Assessment of Risk and Treatability (Webster et al., 2006), and Static-
99 R (Hanson & Thornton, 1999) in predicting institutional nonsexual aggres­
sion in a sample of 152 sexual offenders in a large secure forensic state
hospital. Cartwright et al. (2018) findings supported the validity of the HCR-
20, START, and to a lesser extent, the Static-99 R, suggesting the importance
of structured violence risk assessments in sex offenders in the criminal justice
system. Moreover, Cartwright et al. (2018) results suggested that general
violence risk assessment instruments, such as the HCR-20, have a place in
the assessment and management of sexual offenders beyond the assessment
of risk for sexual recidivism.
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 3

The HCR-20 Version 3 (Douglas et al., 2013), represents one of the most
widely used measure to assess the risk for violence (verbal and physical acted
or even attempted violence) since it allows for both risk evaluation and
design of risk management strategies, and has shown to be provided with
sound reliability and validity data (e.g., Douglas & Belfrage, 2014; Doyle et al.,
2014; Strub et al., 2014). Additionally, the formulations of the HCR-20 in its
Version 3 confirmed the scale as an assessment and management tool
(Hopton et al., 2018). Thus, not surprisingly, it is widespread adopted
(Douglas et al., 2014), and several translations of the HCR-20 are available,
including the Italian one (Caretti et al., 2019). Interestingly, the HCR-20
Version 3 can be used to evaluate risk for violence both in the clinical or
legal contexts.
Eher et al. (2019) suggested that broadening our understanding of vio­
lence risk factors among sexual offenders may represent a strategy to prevent
sexual crimes recidivism. Although mental disorders are not enough to
account for sex crimes, they can be considered among risk factors
(Moulden & Marshall, 2017). Interestingly, antisocial lifestyle and paraphilic
concerns were reported as the two most relevant predictors for sex crime
relapse among sex offenders (e.g., Hanson & Morton-Bourgon, 2005).
Evaluating the role of personality dysfunction as violence risk factors
among sexual offenders may be challenging because of the heterogeneity
of sexual offender populations. For instance, Eher et al. (2019) found a high
percentage (50.1%) of sex offenders with personality disorder in a sample of
1346 sexual offenders sentenced either for a sex crime against adults (50.1%)
or children (49.9%). However, Craig et al. (2005) observed that sex offenders
showed significantly lower scores on personality pathology measures when
compared to violent offenders, while not differing significantly from general
offenders on the same measures. Even the relationship between sexual
violence and psychopathy is somewhat controversial, although there is
a dearth of studies on this topic. Porter et al. (2000) convincingly showed in
a large (N = 329) inmate sample that patterns of psychopathy, assessed using
the Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003), differed in
various sex offender groups. Both rapist and mixed rapist/molester groups
showed significant greater mean scores on the PCL-R when compared to
offenders who abused children.
Moreover, offenders who had sexually victimized both children and adults
were 2–10 times more likely than other offenders to receive a psychopathy
diagnosis; rather, no consistent associations between psychopathic features
and being a child molester was documented (Porter et al., 2000). In contrast,
Schimmenti et al. (2014) examined a group of 87 Italian male inmates who
were convicted of violent crime and found that child sexual abusers in their
sample reported higher scores on the PCL-R, and especially its interpersonal-
affective factor, than adult rapists and other violent criminals.
4 A. SOMMA ET AL.

Personality disorder categories in use since the third edition of Diagnostic

and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric
Association, 1980) have been shown to be affected by several limitations,
including temporal instability, extensive comorbidity, and lack of empirically
validated cutoffs (Widiger & Trull, 2007). To overcome these problems, the
DSM-5 (American Psychiatric Association, 2013) provided in Section III an
alternative model of personality disorder (AMPD). Traditional PD diagnoses
were reported in DSM-5 Section II (which reprints DSM-IV [American
Psychiatric Association, 1994] axis II PD symptom criteria). A key component
of the DSM-5 AMPD is system of empirically validated domains and traits of
maladaptive personality (Krueger & Markon, 2014). This AMPD component
represents a synthesizes of the available dimensional models of personality
pathology (e.g., Clark, 2007).
The AMPD includes five general maladaptive personality domains –
namely, Negative Affectivity, Detachment, Antagonism, Disinhibition, and
Psychoticism – which may be divided into 25 specific dysfunctional person­
ality traits (e.g., Risk-taking, Callousness, Hostility, Manipulativeness, etc.). It
should be observed that the AMPD allows for assessing traits that represent
core features of psychopathy – e.g., callousness and deceitfulness (Somma
et al., 2020; Strickland et al., 2013) – while allowing for evaluating a broader
spectrum of dysfunctional personality dimensions.
The DSM-5 AMPD system of dysfunctional personality dimensions may be
assessed through the Personality Inventory for DSM-5 (PID-5; Krueger et al.,
2012). The PID-5 is a 220-item self-report questionnaire with a 4-point
response scale; it yields 25 trait scales that can be combined to also delineate
5 domain scales (Negative Affectivity, Detachment, Antagonism,
Disinhibition, and Psychoticism). Notably, the PID-5 has been translated in
a number of languages, including Italian (Fossati et al., 2013). Although the
PID-5 has proved to be useful also among forensic population (e.g., Dunne
et al., 2018; Hopwood & Sellbom, 2013), to the best of our knowledge has
never been used in sexual offender samples.
Recently in Italy the law n. 69 of 19 July 2019 has expanded the treatment
opportunities of the sex offender, who can voluntarily undergo
a psychological treatment with the aim of recovery and support. If the
treatment as a positive outcome, it allows to access alternative measures to
detention in prison. Then, an accurate assessment of the personality profile of
the sex offender may be useful, with the help of validated tools, in order not
only to select the perpetrators of sexual crimes to whom to allow
a therapeutic path but also to build a treatment tailor-made to address
individual treatment needs according to Risk-Need-Responsivity approach
(RNR; Andrews et al., 1990).
Against this background, we aimed at evaluating the relationship between
DSM-5 AMPD dysfunctional personality traits, as they were operationalized in
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 5

the PID-5, psychopathy, as it was operationalized in the Psychopathy

Checklist-Revised (PCL-R; Hare, 2003), and violence risk assessed using the
HCR-20 Version 3, in a sample of Italian male sexual offender. In particular, we
expected that both the PCL-R total score and the PID-5 scales measuring traits
related to antagonism and disinhibition (e.g., callousness, deceitfulness, risk
taking, and impulsivity) show significant relationships with the HCR-20
Version 3 total score. We also tried to evaluate if the PID-5 trait scale profile
was able to provide information on the risk of violence, as it was operationa­
lized in the HCR-20 Version 3, even when the effect of psychopathy was held
constant. In the present study, the role of selected demographic variables as
potential predictors of risk of violence among sexual offender was also
assessed. In order to make the sample more homogeneous, we took into
consideration only perpetrators convicted of sexual offenses, excluding from
the study sample those who had also been responsible for other crimes.

2. Materials and methods

2.1 Participants
The sample consisted of a total of 88 adult male inmates who were serving
their sentences for sexual offending (75% against children under 14 years) in
jails in Northern (n = 45; 51.2%), Central (n = 31; 35.2%), and Southern (n = 12,
13.6%) Italy. The University centers involved in the research guaranteed
uniformity and homogeneity in data collection. Participants’ mean age was
48.90 years, SD = 13.28 years. To be included in the sample, participants had
to be of adult age (i.e., 18 years of age or older), should have been sentenced
for sexual offending, should have no history of previous convictions for non-
sexual crimes, and should not have been sentenced for also for other non-
sexual crimes. The requirements to participate in the study were provided to
the Ministry of Justice which proceeded to select the sample, providing us
only with the lists of potential subjects to be enrolled with prior consent. No
information on previous convictions have been provided by the Ministry of
Justice.
Six (6.8%) participants yielded incomplete responses on the PID-5 or
refused to be administered the HCR-20 Version 3. The small number of
participants who provided incomplete data prevented us from formally
comparing completers and non-completers. The final sample was composed
of 82 adult, male sexual offenders who were serving their sentences in prisons
in Northern (n = 41, 50.0%), Central (n = 30, 38.6%), and Southern (n = 11,
13.6%) Italy. Participants’ mean age was 49.89 years, SD = 12.84 years; the
average time to be served in prison (available only for a sub-set of partici­
pants; n = 25) was 6.36 years, SD = 3.03 years (min. = 2 years, max. = 13 years).
Seventy-nine (96.4%) participants had no mental disorder diagnosis; two
6 A. SOMMA ET AL.

(2.4%) participants had a depressive disorder diagnosis and one (1.2%) parti­
cipant received a personality disorder diagnosis during imprisonment. The
diagnoses were based on medical report of the intra-prison psychiatric
service.
Considering the educational level, two (2.4%) participants had grammar
school degree, 24 (29.3%) participants had junior high school degree, 35
(42.7%) participants had high school degree, and 21 (25.6%) participants
had university degree. Thirty-six (43.9%) participants were not working before
conviction, whereas 46 (56.1%) participants had a regular job before convic­
tion. Fifty-one (62.2%) participants were involved in a stable (i.e., sentimental
relationship lasting more than 1 year) relationship with an adult partner; 70
(85.4%) participants started a family before conviction. Nine (11.00%) partici­
pants were homeless before conviction, whereas 73 (89.0%) participants had
permanent home before conviction.

2.2 Measures
2.2.1 Historical-clinical-risk managment-20 version 3 (HCR-20 version
3; Douglas et al., 2013)
The HCR-20 Version 3 is a risk assessment instrument comprising 10 static
Historical risk factors (e.g., ‘History of Problems with Violence’) and 10
dynamic risk factors for violence. For research purposes, a total score out of
40 is generated. Indeed, an assessment can then be made regarding an
individual’s case prioritization, risk for future violence, risk of serious physical
harm, and risk of imminent violence (0 = low, 1 = moderate, 2 = high). The
HCR-20 has been shown to be provided with validity in predicting nonsexual
aggression (Cartwright et al., 2018); moreover, the application of structured
violence risk assessments in sex offender samples has been suggested (e.g.,
Cartwright et al., 2018). It is correct to add that Cartwright et al. (2018) has
suggested the use of HCR-20 as useful, although this has not been specifically
validated for this type of offender. The HCR-20 Version 3 showed sound
psychometric properties also in its Italian translation (Caretti et al., 2019). In
our sample, the internal consistency reliability (i.e., Cronbach’s α value) for the
HCR-20 Version 3 total score was.90.

2.2.2. Psychopathy checklist revised (PCL-R; Hare, 2003)

The PCL-R is a rating scale that uses a semi-structured interview, case history
information, collateral information, and predetermined scoring criteria to rate
20 items on a 3-point scale according to the extent to which they apply to
a given individual. We relied only on the PCL-R total score as a measure of
psychopathy. Total PCL-R scores can vary from 0 to 40, reflecting the degree
to which the individual matches the prototypical psychopath. Interviews
lasted from about 60 min to almost 90 min. The Italian translation of the
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 7

PCL-R has been extensively validated (Caretti et al., 2011). A threshold score of
PCL-R equal to or greater than 25 was established to identify the condition of
psychopathy, as indicated in studies conducted on European populations
(Hicks et al., 2010; Kreis Mette & Cooke, 2011; Strand & Belfrage, 2005) and as
applied in previous Italian studies (Carabellese et al., 2020, 2019, 2018).
In the present sample, the internal consistency reliability (i.e., Cronbach’s α
value) for the PCL-R total score was .85.

2.2.3 Personality inventory forDSM-5 (PID-5; Krueger et al., 2012)

The PID-5 is a 220-item questionnaire with a 4-point response scale, which
was explicitly designed to measure the proposed DSM-5 AMPD traits and
domains. The PID-5 provides 5 domain scales and 25 trait scales; each PID-
5-SF trait scale includes only 4 items.
The PID-5 had been validated also in its Italian translation (Fossati et al.,
2013). In the present study, the PID-5 questionnaires were scored blind to
the HCR-20 Version 3 scores. In the present study, Cronbach’s α values were
suggestive of adequate internal consistency reliability for all the PID-5
scales, M = .81, SD = .05, min. Cronbach’s α value = .76, max. Cronbach’s α
value = .88.

2.3 Procedures
The study was performed in compliance with the rules and recommendations
provided by the ethics committee of the Ministry of Justice and with all the
necessary authorizations from the Penitentiary Administration Department of
the Ministry of Justice. It was part of a national research project in collabora­
tion with the Ministry itself, whose role was to provide data on the validity of
the Italian version of the HCR-20 Version 3 (Caretti et al., 2019).
Participants had to sign a written informed consent form. In the present
study, we adhered to the Italian Association of Psychology (2015) ethical
norms for research on human participants. Researchers were not provided
with any information other than that contained in the medical and personal
records of each participant for privacy reasons.
Participants were administered the HCR-20 Version 3 and the PCL-R in the
prisons where they were serving their sentences by trained raters who were
kept blind to the study aims (i.e., they only knew that data on the HCR-20
Version 3 validity were at issue). All raters involved in the present study were
trained in the use of the HCR-20 Version 3 and PCL-R by the same Italian
official licensed trainer. The multi-center design of the study and the security
norms of Italian prisons prevented us from establishing the inter-rater relia­
bility of the HCR-20 and PCL-R scores, respectively. Assistant researchers who
administered and scored the PID-5 were kept blind to the aim of the
study, too.
8 A. SOMMA ET AL.

In the present study, participants were administered the official Italian

translations of the HCR-20 Version 3 (Caretti et al., 2019), PCL-R (Caretti
et al., 2011), and PID-5 (Fossati et al., 2013) measures. The translation proce­
dure for these measures has been detailed elsewhere (e.g., Caretti et al., 2011,
2019; Fossati et al., 2013). Power analyses showed that a Pearson r value of
.30, suggestive of medium effect size, could be identified with a power of .79
for a .05 two-tailed significance level in our sample of 82 adult sexual
offenders.

2.4 Data analyses

Cronbach’s α coefficient was used to assess measure internal consistency
reliability.
The Kolmogorov-Smirnoff one-sample test was used to evaluate if the
HCR-20 Version 3 total score was normally distributed in our sample.
Student t-test was used to assess the significance of the effect of the dichot­
omous variables on the HCR-20 Version 3 total score. One-way ANOVA was
used to evaluate if the HCR-20 Version 3 mean total scores were homoge­
neously distributed across educational level groups. Cohen’s d coefficient and
partial η2 coefficients were used as effect size measures for Student t-test and
one-way ANOVA omnibus F test, respectively. The Pearson r coefficient was
used to evaluate bivariate associations between the HCR-20 Version 3 total
score, and the PID-5 trait scale scores and the PCL-R total score, as well as
between the HCR-20 Version 3 total score and participants’ age. Spearman
r was used to evaluate the association between participant’s time to be
served in jail and the HCR-20 Version 3 total score, because this association
could be tested only in a sub-group of 25 sexual offenders. To evaluate the
presence of significance associations between the HCR-20 Version 3 total
score and the PID-5 traits scale scores after controlling for the effect of the
PCL-R total score, partial correlation analyses were carried out. The small size
of our sample prevented us from carrying out multivariate analyses.

3. Results
The Kolmogorov-Smirnoff test yielded non-significant results for the HCR-20
Version 3 total score, Kolmogorov-Smirnoff z = 0.86, p > .40, suggesting that
the HCR-20 Version 3 total scores were normally distributed in our sample of
male sexual offenders. The associations between the HCR-20 Version 3 total
score and demographic variables are listed in Table 1.
The descriptive statistics and Pearson r values for the relationships
between the HCR-20 Version 3 total score, and the 25 PID-5 trait scale score
and the PCL-R total score are summarized in Table 2. Cohen d values repre­
sent the effect size of the comparisons between the PID-5 trait scale mean
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 9

Table 1. The associations between the HCR-20 version 3 total score and demo­
graphic variables.
Demographic Variables HCR-20 Version 3 Total Score
Participants’ age r =.10
Participant’s time to be served in prison r =.60***
Spearman r =.50*
Participant’s being involved in a stable relationship t(80) = −0.14, d = −0.03
Participant’s having started a family before conviction t(80) = 0.31, d = 0.10
Participants’ education level F (3, 78) = 1.41, partial η2 =.05
Not having a work before conviction t(80) = 2.59*, d = 0.58
Being homeless before conviction t(80) = 3.50***, d = 1.24
Note. d: Cohen d Values.
* p <.05
** p <.01
*** p <.001

scores and the corresponding mean scores that were observed for the PID-5
trait scales in the Italian extended normative sample (N = 2147) (see Table 2
footnote b). The significance of the individual Cohen’s d coefficient was
assessed computing independent-sample Student t-tests (see Table 2 foot­
note a). Interestingly, adopting a PCL-R total score ≥ 25 was used to identify
psychopathy, only nine (11.0%) sexual offenders met criteria for psychopathy
diagnosis; when a PCL-R cut off score of 30 (or greater) was used, only three
(3.7%) sexual offenders qualified for a psychopathy diagnosis. On average,
the PID-5 trait scale scores were non-negligibly intercorrelated, median
r value = .39, SD = .14, suggesting possible multicollinearity issues in multiple
regression analyses.
The partial r analyses for the associations between the HCR-20 Version 3
total score and the PID-5 trait scales scores controlling for the effect the PCL-R
total score in our sample of male adult sexual offenders are summarized in
Table 3. Bold highlights the PID-5 trait scale scores that showed significant
raw bivariate correlations (i.e., Pearson r values) with the HCR-20 Version 3
total score (see Table 3 footnote a).

4. Discussion
Notwithstanding the limited size of our sample, our data strongly supported
Carpentieri et al. (2017) indications that both psychopathy and DSM-5 AMPD
dysfunctional personality traits should be assessed to improve the knowledge
of general risk of violence, even among male adult sexual offenders (e.g.,
Cartwright et al., 2018). Confirming and extending Carpentieri et al. (2017)
seminal observations, our data seemed to suggest that not working before
conviction (being unemployed refers to the time when the crime was com­
mitted) was significantly and non-negligibly associated with sexual offender’s
increased risk of violence, at least as it was operationalized in the HCR-20
Version 3 total score. Although we were able to obtain this information only
10 A. SOMMA ET AL.

Table 2. Personality disorder for DSM-5 trait scale scores and HCR-20 version 3 total
score descriptive statistics and pearson r coefficient values for the relationships between
the HCR-20 total score and the personality disorder for DSM-5 trait scale scores in
a sample of male adult sexual offenders (N = 82).
HCR-20 Total
PID-5 Trait Scales (Domains) r M SD d
Anxiousness (NA) .11 1.36 1.00 0.36 **
Emotional lability (NA) .14 1.06 0.71 −0.05
Hostility (NA) .28 * 0.77 0.64 −0.30 **
Perseveration (NA) .13 0.89 0.55 −0.10
Restricted affectivity (NA) .34 ** 0.87 0.60 0.02
Separation insecurity (NA) .05 0.86 0.72 0.09
Submissiveness (NA) .15 0.75 0.69 0.09
Anhedonia (Detachment) .13 0.84 0.56 −0.06
Depressivity (Detachment) .19 0.82 0.84 0.57 ***
Intimacy avoidance (Detachment) .34** 0.86 1.08 0.24 *
Suspiciousness (Detachment) −.01 1.20 0.62 0.37
Withdrawal (Detachment) .14 1.02 0.62 0.62 ***
Attention seeking (Antagonism) .23* 0.74 0.66 −0.19
Callousness (Antagonism) .27* 0.45 0.43 −0.04
Deceitfulness (Antagonism) .16 0.47 0.48 −0.23 *
Grandiosity (Antagonism) .00 0.57 0.51 −0.06
Manipulativeness (Antagonism) .22* 0.50 0.57 −0.16
Distractibility (Disinhibition) .23* 0.79 0.65 −0.03
Impulsivity (Disinhibition) .31** 0.89 0.77 −0.21
Rigid perfectionism (Disinhibition) .11 1.24 0.66 0.19
Risk taking (Disinhibition) .33** 1.02 0.64 −0.18
Irresponsibility (Disinhibition) .38*** 0.70 0.58 0.19
Eccentricity (Psychoticism) .29** 0.66 0.61 −0.19
Perceptual dysregulation (Psychoticism) .16 0.48 0.66 −0.07
Unusual beliefs (Psychoticism) .16 0.64 0.84 0.06
Psychopathy Checklist-Revised .54*** 15.16 7.11 –
M 15.55
SD 7.88
Notes
a
PID-5: Personality Inventory for DSM-5; NA: Negative Affectivity. The significance of the individual
Cohen’s d coefficient was assessed computing independent-sample Student t-tests.
*p <.05
**p <.01
***p <.001
b
Cohen d values represent the effect size of the comparisons between the PID-5 trait scale mean scores
and the corresponding mean scores that were observed for the PID-5 trait scales in the Italian extended
normative sample (N = 2147).

for a limited sub-group of participants, our data suggested that number of

years that sexual offenders had to serve in prison was positively, significantly,
and substantially correlated with the HCR-20 Version 3 total score.
Confirming and extending previous data (Hart & Logan, 2011), our data
seemed to show that selected personality dysfunctions, as they are assessed
relying on both PCL-R and PID-5, may play a major role as risk factors for
general violence in male adult sexual offenders. Although shared method
variance may have inflated our findings, the association between the HCR-20
Version 3 total score and the PCL-R total score was suggestive of a large effect
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 11

Table 3. The associations between the HCR-20 version 3 total score and the
personality inventory for DSM-5 trait scale score after controlling for the
effect of the psychopathy checklist-revised total score in male adult sexual
offenders: partial correlation analysis results (N = 82).
HCR-20 Version 3 Total Score
Personality Inventory for DSM-5 Trait Scales Partial r
Anxiousness (Negative Affectivity) .08
Emotional lability (Negative Affectivity) .16
Hostility (Negative Affectivity) .19
Perseveration (Negative Affectivity) .17
Restricted affectivity (Negative Affectivity) .29 **
Separation insecurity (Negative Affectivity) .05
Submissiveness (Negative Affectivity) .08
Anhedonia (Detachment) .21
Depressivity (Detachment) .14
Intimacy avoidance (Detachment) .34 **
Suspiciousness (Detachment) −.03
Withdrawal (Detachment) .13
Attention seeking (Antagonism) .17
Callousness (Antagonism) .24 *
Deceitfulness (Antagonism) .17
Grandiosity (Antagonism) .07
Manipulativeness (Antagonism) .17
Distractibility (Disinhibition) .24 *
Impulsivity (Disinhibition) .18
Rigid perfectionism (Disinhibition) .16
Risk taking (Disinhibition) .16
Irresponsibility (Disinhibition) .29 **
Eccentricity (Psychoticism) .11
Perceptual dysregulation (Psychoticism) .10
Unusual beliefs (Psychoticism) .07
Note
a
Bold highlights the Personality Inventory for DSM-5 trait scale scores that showed
significant raw bivariate correlations (i.e., Pearson r values) with the HCR-20 Version 3
total score.
* p <.05; ** p <.01.

(Cohen, 1988) of psychopathy as a risk factor for general violence in our

sample.
Interestingly, in our study 11 self-reported DSM-5 AMPD dysfunctional
personality traits were found to be significantly, positively, and non-
negligibly associated with sexual offender’s increased risk for violence.
However, when the effect of psychopathy was held constant in partial corre­
lation analyses, the relationships between the HCR-20 Version 3 total score
and the self-reports of hostility, attention-seeking manipulativeness, impul­
sivity, risk taking, and eccentricity became non-significant. This finding
seemed to suggest that these DSM-5 AMPD dysfunctional personality traits
represented psychopathy-related personality features, at least as they were
operationalized in the PID-5. Rather, sexual offender’s indifference and aloof­
ness in normatively engaging situations (i.e., PID-5 Restricted affectivity scale),
12 A. SOMMA ET AL.

avoidance of close or romantic relationships, (i.e., PID-5 Intimacy avoidance

scale), lack of concern for feelings or problems of others (i.e., PID-5
Callousness scale), difficulty maintaining goal-focused behavior, including
both planning and completing tasks (i.e., PID-5 Distractibility scale), and
disregard for – and failure to honor – financial and other obligations or
commitments (i.e., PID-5 Irresponsibility scale) remained significantly asso­
ciated with increased risk for violence in our sample of male adult sexual
offenders, even when the effect of psychopathy was controlled for. This
finding was highly consistent with Carpentieri et al. (2017) indications on
the need for assessing both psychopathy and PID-5 dysfunctional personality
dimensions in predicting risk for violence in offender populations.
Regrettably, the limited size of our sample prevented us to carry out
multiple regression/relative importance weight analyses. However, our bivari­
ate association and partial correlation analysis results allowed us to identify
a possible profile of the male adult sexual offender who is at risk for general
violence. According to our findings, sexual offenders who have a history of
homelessness before conviction, were not working before conviction, have to
serve a long time in prison, manifest prominent observer-rated psychopathy
features, and report high scores on restricted affectivity, intimacy avoidance,
callousness, distractibility, and irresponsibility, over and above their PID-5
psychopathy-related personality profile and PCL-R total score, are likely to
have an increased risk for general violence.
Although it was beyond the major aims of our study, our findings seemed
to be in line with the scientific literature suggesting a possible heterogeneity
of dysfunctional personality profiles among sexual offenders (e.g., Laajasalo
et al., 2020). Our results suggested that only a minority of our participants (i.e.,
3.7%-11.0%, depending on the PCL-R cut-off score) met PCL-R criteria for
psychopathy. Moreover, when the PID-5 trait scale average scores that were
observed in our sample were compared with the corresponding average
scores that were computed in the extended Italian normative sample of the
PID-5, significant differences were observed only for a few scales – namely,
Anxiousness (+), Hostility (-), Depressivity (+), Withdrawal (+), and
Deceitfulness (–) – with Cohen’s d values that were suggestive of moderate
or small-to-moderate differences by conventional standards (Cohen, 1988).
Interestingly, the PID-5 dysfunctional trait scale profile that seemed to sig­
nificantly differentiate our sample of sexual offenders from the extended
Italian normative sample was somewhat akin to the passive, lonely and shy
profile frequently reported to characterize a sub-group of male pedophiles, as
well as other types of sex offenders (Okami & Goldberg, 1992).

Limitations
Of course, our findings should be considered in the light of several limitations.
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 13

Participants were not randomly selected and represented a convenient

study group, rather than a sample actually representative of the Italian sexual
offender population. This strongly limits the generalizability of our findings
and stresses the need for further studies on this topic. We limited our atten­
tion to male sexual offenders; indeed, recent meta-analytic data called into
question the hypothesis that sex offending is rarely observed among female
subjects (Cortoni, Babchishin, & Rat, 2016). However, female sexual offenders
are more common among juvenile offenders than adult offenders (Cortoni
et al., 2017), and sexual abuse perpetration is disproportionately male (Smith
et al., 2017).
The design of or study was cross-sectional in nature; thus, we were not
able to test any causal hypothesis concerning personality pathology as an
antecedent of risk for violence among sexual offenders. The size of our
sample was small, preventing us to carry out multivariate analyses; however,
power analysis suggested that we had adequate power (i.e., .79) for detecting
a moderate r value (i.e., r = |.30|; Cohen, 1988) for a significance level of .05.
Although the PID-5 represents a sound measure of maladaptive personality
traits (e.g., Fossati et al., 2013), in the present study we relied only on self-
report assessment of dysfunctional personality traits. This method choice may
be useful in avoiding method effects (e.g., shared method variance); however,
it limits the generalizability of our findings to interview-based measures of
personality dysfunction. In the present study, we were not able to assess the
inter-rater reliability of the HCR-20 Version 3 and PCL-R total scores. Indeed,
this represents a major limitation of our study, although both study design
and Italian prison norms makes it extremely difficult to test rater agreement in
studies on offender populations.
In any case, both measures showed sound psychometric properties in
Italian forensic samples. Moreover, it should be observed that a possible
increase in measurement error (i.e., poor reliability) is likely to lead to under­
estimating associations with fallible measures of other constructs (Nunnally &
Bernstein, 1994); in turn, this is likely to place our findings on the conservative
side. Finally, we focused on general risk for violence, using an accurate self-
report measure of this construct. However, we were not able to assess the risk
for sexual violence or specific recidivism. As a whole, these limitations badly
stress the need for further studies before accepting our conclusions.

5. Conclusions
Even keeping these limitations in mind, the present study provided useful
date for increasing the understanding of the risk for general violence
among male adult sexual offenders, suggesting the importance of carefully
considering psychopathy and self-reported dysfunctional personality traits,
along with selected demographical variables. Also, our data seemed to
14 A. SOMMA ET AL.

show that personality dysfunctions, as they are assessed relying on both

PCL-R and PID-5, may play a major role as risk factors for general violence
in male adult sexual offenders. Further studies on the relationships
between dysfunctional personality traits and sex offending should rely
on informant-based assessment of personality. Moreover, future investiga­
tions could consider the associations between personality traits and risk
for both sexual and non-sexual violent recidivism among juvenile sexual
offenders. As a whole, our findings suggest that both psychopathy and
DSM-5 AMPD dysfunctional personality traits should be assessed to
improve the knowledge of general risk of violence in male adult sexual
offenders.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This research did not receive any specific grant from funding agencies in the public,
commercial, or not-for-profit sectors.

ORCID
Antonella Somma http://orcid.org/0000-0003-2982-505X
Andrea Fossati http://orcid.org/0000-0001-9368-4058
Fulvio Carabellese http://orcid.org/0000-0002-2648-8062
Gianluca Santoro http://orcid.org/0000-0002-9762-1510
Adriano Schimmenti http://orcid.org/0000-0001-5181-2648
Vincenzo Caretti http://orcid.org/0000-0002-1984-1729
Felice Carabellese http://orcid.org/0000-0001-9942-6754

References
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental
disorders (3rd ed.). Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental
disorders (4rd ed.). Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Author.
Andrews, D., Bonta, J., & Hoge, R. (1990). Classification for effective rehabilitation:
Rediscovering psychology. Criminal Justice and Behaviour, 17(1), 19–52. https://doi.
org/10.1177/0093854890017001004
Carabellese, F., Felthous, A. R., La Tegola, D., Rossetto, I., Franconi, F., Lucchini, G., &
Catanesi, R. (2020). Female psychopathy: A descriptive national study of socially
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 15

dangerous NGRI female offenders. International Journal of Law and Psychiatry, 68,
101455. https://doi.org/10.1016/j.ijlp.2019.101455
Carabellese, F., Felthous, A. R., La Tegola, D., Rossetto, I., Montalbò, D., Franconi, F., &
Catanesi, R. (2019). Psychopathy and female gender: Phenotypic expression and
comorbidity: A study comparing a sample of women hospitalized in maximum
security facility with women who were criminally sentenced and imprisoned.
Journal of Forensic Sciences, 64(5), 1438–1443. https://doi.org/10.1111/1556-4029.
14039
Carabellese, F., Felthous, A. R., Rossetto, I., La Tegola, D., Franconi, F., & Catanesi, R.
(2018). Female residents with psychopathy in a high-security Italian hospital.
Journal of American Academy of Psychiatry and the Law, 46(2), 171–178. https://
doi.org/10.29158/jaapl.003744-18
Caretti, V., Manzi, G. S., Schimmenti, A., & Seragusa, L. (2011). PCL-R. Hare psychopathy
checklist–revised. OS Giunti.
Caretti, V., Scarpa, F., Ciappi, S., Castelletti, L., Catanesi, R., Carabellese, F. F., &
Schimmenti, A. (2019). HCR-20 V3. Assessing risk of violence. Hogrefe.
Carpentieri, R., Schimmenti, A., Ferracuti, S., Nicolò, G., Pompili, P., Tessari, G., &
Caretti, V. (2017). Valutazione della pericolosità sociale e del rischio di recidiva
criminale attraverso un sistema di assessment integrato [Assessment of social
danger and the risk of criminal recurrence through an integrated assessment
system]. Psichiatria e Psicoterapia, 36(3), 138–151.
Cartwright, J. K., Desmarais, S. L., Hazel, J., Griffith, T., & Azizian, A. (2018). Predictive
validity of HCR-20, START, and static-99R assessments in predicting institutional
aggression among sexual offenders. Law and Human Behavior, 42(1), 13–25. https://
doi.org/10.1037/lhb0000263
Clark, L. A. (2007). Assessment and diagnosis of personality disorder: Perennial issues
and an emerging reconceptualization. Annual Review of Clinical Psychology, 58(1),
227–257. https://doi.org/10.1146/annurev.psych.57.102904.190200
Cohen, J. (1988). Statistical power analysis (2nd ed.). Erlbaum.
Cortoni, F., Babchishin, K. M., & Rat, C. (2016).The Proportion of Sexual Offenders Who
Are Female Is Higher Than Thought. Criminal Justice and Behavior, 44(2), 145–162.
doi:10.1177/0093854816658923
Cortoni, F., Babchishin, K. M., & Rat, C. (2017). The proportion of sexual offenders who
are female is higher than thought: A meta-analysis. Criminal Justice and Behavior, 44
(2), 145–162. https://doi.org/10.1177/0093854816658923
Craig, L. A., Browne, K. D., Stringer, I., & Beech, A. (2005). Sexual recidivism: A review of
static, dynamic and actuarial predictors. Journal of Sexual Aggression, 11(1), 65–84.
https://doi.org/10.1080/13552600410001667733
Dombert, B., Schmidt, A. F., Banse, R., Briken, P., Hoyer, J., Neutze, J., & Osterheider, M.
(2016). How common is men’s self-reported sexual interest in prepubescent chil­
dren? The Journal of Sex Research, 53(2), 214–223. https://doi.org/10.1080/
00224499.2015.1020108
Douglas, K. S., & Belfrage, H. (2014). Interrater reliability and concurrent validity of the
HCR-20 version 3. International Journal of Forensic Mental Health, 13(2), 130–139.
https://doi.org/10.1080/14999013.2014.908429
Douglas, K. S., Hart, S. D., Webster, C. D., & Belfrage, H. (2013). HCR-20V3. Assessing risk
for violence. [Burnaby, British Columbia]: Mental Health, Law, and Policy Institute,
Simon Fraser University.
Douglas, K. S., Hart, S. D., Webster, C. D., Belfrage, H., Guy, L. S., & Wilson, C. M. (2014).
Historical-clinical-risk management-20, version 3 (HCR-20V3): Development and
16 A. SOMMA ET AL.

overview. International Journal of Forensic Mental Health, 13(2), 93–108. https://doi.

org/10.1002/bsl.2134
Doyle, M., Archer-Power, L., Coid, J., Constantinos, K., Ullrich, S., & Shaw, J. (2014).
Predicting post-discharge community violence in England and Wales using the
HCR-20V3. International Journal of Forensic Mental Health, 13(2), 140–147. https://
doi.org/10.1080/14999013.2014.906517
Dunne, A. L., Gilbert, F., & Daffern, M. (2018). Investigating the relationship between
DSM-5 personality disorder domains and facets and aggression in an offender
population using the personality inventory for the DSM-5. Journal of Personality
Disorders, 32(5), 668–693. https://doi.org/10.1521/pedi_2017_31_322
Eher, R., Rettenberger, M., & Turner, D. (2019). The prevalence of mental disorders in
incarcerated contact sexual offenders. Acta psychiatrica Scandinavica, 139(6),
572–581. https://doi.org/10.1111/acps.13024
Fanniff, A. M., Schubert, C. A., Mulvey, E. P., Iselin, A. M. R., & Piquero, A. R. (2017). Risk
and outcomes: Are adolescents charged with sex offenses different from other
adolescent offenders? Journal of Youth and Adolescence, 46(7), 1394–1423. https://
doi.org/10.1007/s10964-016-0536-9
Fossati, A., Krueger, R. F., Markon, K. E., Borroni, S., & Maffei, C. (2013). Reliability and
validity of the personality inventory for DSM-5 (PID-5) predicting DSM-IV person­
ality disorders and psychopathy in community-dwelling Italian adults. Assessment,
20(6), 689–708. https://doi.org/10.1177/1073191113504984
Hanson, R. K., Harris, A. J. R., Letourneau, E., & Helmus, L. M. (2018). Reductions in risk
based on time offense-free in the community: Once a sexual offender, not always
a sexual offender. Psychology, Public Policy, and Law, 24,(1), 48–63. https://doi.org/
10.1037/law0000135
Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual
offenders: A meta-analysis of recidivism studies. Journal of Consulting and Clinical
Psychology, 73(6), 1154–1163. https://doi.org/10.1037/0022-006X.73.6.1154
Hanson, R. K., & Thornton, D. (1999). Static-99: Improving actuarial risk assessments for
sex offenders. (User Report 1999–02). Ottawa: Public Safety Canada
Hanson, R.K., & Bussière, M.T. (1998). Predicting relapse: A meta-analysis of sexual
offender recidivism studies. Journal of Consulting and Clinical Psychology, 66(2),
348–362.
Hare, R. D. (1991). Manual for the revised psychopathy checklist (1st ed.). Multi-Health
Systems.
Hare, R. D. (2003). The hare psychopathy checklist—revised (2nd ed.). Multi-Health.
Hart, S. D., & Logan, C. (2011). Formulation of violence risk using evidence based
assessments: The structured professional judgement approach. In P. Sturney &
M. McMurran (Eds.), Forensic case formulation (pp. 83–106). Wiley-Blackwell.
https://doi.org/10.1002/9781119977018.ch4
Hicks, B. M., Vaidyawathan, U., & Patrick, C. J. (2010). Validating female psychopathy
subtypes: Differences in personality, antisocial and violent behaviour, substance
abuse, trauma, and mental health. Personality Disorders: Theory, Research, and
Treatment, 1(1), 38–57. https://doi.org/10.1037/a0018135
Hopton, J., Cree, A., Thompson, S., Jones, R., & Jones, R. (2018). An evaluation of the
quality of HCR-20 risk formulations: A comparison between HCR-20 version 2 and
HCR-20 version 3. International Journal of Forensic Mental Health, 17(2), 195–201.
https://doi.org/10.1080/14999013.2018.1460424
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 17

Hopwood, C. J., & Sellbom, M. (2013). Implications of DSM-5 personality traits for
forensic psychology. Psychological Injury and Law, 6(4), 314–323. https://doi.org/10.
1007/s12207-013-9176-5
Italian Association of Psychology (2015). Ethical code. Assemblea Generale dei Soci AIP,
27 marzo 2015. https://aipass.org/node/11560.
Jennings, W. G. (2015). Innovations and advancements in sex offender research.
Routledge.
Krahé, B., Berger, A., Vanwesenbeeck, I., Bianchi, G., Chliaoutakis, J., Fernández-Fuertes,
A. A., . . . Hellemans, S. (2015). Prevalence and correlates of young people’s sexual
aggression perpetration and victimisation in 10 European countries: A multi-level
analysis. Culture, Health & Sexuality, 17(6), 682–699. https://doi.org/10.1080/
13691058.2014.989265
Krahé, B., Tomaszewska, P., Kuyper, L., & Vanwesenbeeck, I. (2014). Prevalence of
sexual aggression among young people in Europe: A review of the evidence from
27 EU countries. Aggression and Violent Behavior, 19(5), 545–558. https://doi.org/10.
1016/j.avb.2014.07.005
Kreis Mette, K. F., & Cooke, D. J. (2011). Capturing the psychopathic female:
A prototypicality analysis of the comprehensive assessment of psychopathic per­
sonality (CAPP) across gender. Behavioral Sciences & the Law, 29(5), 634–648. https://
doi.org/10.1002/bsl.1003
Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012). Initial
construction of a maladaptive personality trait model and inventory for DSM-5.
Psychological Medicine, 42(9), 1879–1890. https://doi.org/10.1017/
S0033291711002674
Krueger, R. F., & Markon, K. E. (2014). The role of the DSM-5 personality trait model in
moving toward a quantitative and empirically based approach to classifying per­
sonality and psychopathology. Annual Review of Clinical Psychology, 10(1), 477–501.
https://doi.org/10.1146/annurev-clinpsy-032813-153732
Laajasalo, T., Ellonen, N., Korkman, J., Pakkanen, T., & Aaltonen, O. P. (2020). Low
recidivism rates of child sex offenders in a Finnish 7-year follow-up. Nordic Journal
of Criminology, 21(1), 103–111. https://doi.org/10.1080/2578983X.2020.1730069
Langan, P. A., Schmitt, E. L., & Durose, M. R., 2003. Recidivism of sex offenders released
from prison in 1994 (NCJ 198281). Government Printing Office.
Levenson, J. S., Brannon, Y. N., Fortney, T., & Baker, J. (2007). Public perceptions about
sex offenders and community protection policies. Analyses of Social Issues and
Public Policy, 7(1), 137–161.Doi: 10.1111/j.1530-2415.2007.00119.x.
Lussier, P., & Davies, G. (2011). A person-oriented perspective on sexual offenders,
offending trajectories, and risk of recidivism: A new challenge for policymakers, risk
assessors, and actuarial prediction? Psychology, Public Policy, and Law, 17(4),
530–561. https://doi.org/10.1037/a0024388
Martin, S. L., Macy, R. J., & Young, S. K. (2011). Health and economic consequences of
sexual violence. In J. W. White, M. P. Koss, & A. E. Kazdin (Eds.), Violence against
women and children (Vol. 1: Mapping the terrain, pp. 173–195). American
Psychological Association.
Moulden, H. M., & Marshall, L. E. (2017). Major mental illness in those who sexually
abuse. Current Psychiatry Reports, 19(12), 105. https://doi.org/10.1007/s11920-017-
0863-x
Nunnally, J. C., & Bernstein, I. R. (1994). Psychometric Theory. McGraw-Hill.
18 A. SOMMA ET AL.

Okami, P., & Goldberg, A. (1992). Personality correlates of pedophilia: Are they reliable
indicators? Journal of Sex Research, 29(3), 297–328. https://doi.org/10.1080/
00224499209551651
Ozkan, T., Clipper, S. J., Piquero, A. R., Baglivio, M., & Wolff, K. (2020). Predicting sexual
recidivism. Sexual Abuse, 32(4), 375–399. https://doi.org/10.1177/
1079063219852944
Parkinson, P. N., Shrimpton, S., Oates, R. K., Swanston, H. Y., & O’Toole, B. I. (2004).
Nonsex offences committed by child molesters: Findings from a longitudinal study.
International Journal of Offender Therapy and Comparative Criminology, 48(1), 28–39.
https://doi.org/10.1177/0306624X03257246
Piquero, A. R., Farrington, D. P., Jennings, W. G., Diamond, B., & Craig, J. (2012). Sex
offender and sex offending in the Cambridge study in delinquent development:
Prevalence frequency, specialization, recidivism, and (dis)continuity over the
life-course. Journal of Crime and Justice, 35(3), 412–426. https://doi.org/10.1080/
0735648X.2012.688527
Porter, S., Fairweather, D., Drugge, J., Hervé, H., Birt, A., & Boer, D. P. (2000). Profiles of
psychopathy in incarcerated sexual offenders. Criminal Justice and Behavior, 27(2),
216–233. https://doi.org/10.1177/0093854800027002005
Sample, L. L., & Bray, T. M. (2003). Are sex offenders dangerous? Criminology & Public
Policy, 3(1), 59–82. https://doi.org/10.1111/j.1745-9133.2003.tb00024.x
Sample, L. L., & Bray, T. M. (2006). Are sex offenders different? An examination of
rearrest patterns. Criminal Justice Policy Review, 17(1), 83–102. https://doi.org/10.
1177/0887403405282916
Schimmenti, A., Passanini, A., & Caretti, V. (2014). Interpersonal and affective traits of
psychopathy in child sexual abusers: Evidence from a pilot study sample of Italian
offenders. Journal of Child Sexual Abuse, 23(7), 853–860. https://doi.org/10.1080/
10538712.2014.938210
Schmucker, M., & Lösel, F. (2015). The effects of sexual offender treatment on recidi­
vism: An international meta-analysis of sound quality evaluations. Journal of
Experimental Criminology, 11(4), 597–630. https://doi.org/10.1007/s11292-015-
9241-z
Smith, S. G., Basile, K. C., Gilbert, L. K., Merrick, M. T., Patel, N., Walling, M., & Jain, A.
(2017). National intimate partner and sexual violence survey (NISVS): 2010–2012 state
report. National Center for Injury Prevention and Control, Centers for Disease
Control and Prevention.
Somma, A., Borroni, S., Sellbom, M., Markon, K. E., Krueger, R. F., & Fossati, A. (2020).
Assessing dark triad dimensions from the perspective of moral disengagement and
DSM–5 alternative model of personality disorder traits. Personality Disorders: Theory,
Research, and Treatment, 11(2), 100–107. Advance online publication. https://doi.
org/10.1037/per0000388
Strand, S., & Belfrage, H. (2005). Gender differences in psychopathy in a swedish
offender sample. Behavioral Sciences & the Law, 23(6), 837–850. https://doi.org/10.
1002/bsl.674
Strickland, C. M., Drislane, L. E., Lucy, M., Krueger, R. F., & Patrick, C. J. (2013).
Characterizing psychopathy using DSM-5 personality traits. Assessment, 20(3),
327–338. https://doi.org/10.1177/1073191113486691
Strub, D., Douglas, K., & Nicholls, T. (2014). The validity of version 3 of the HCR-20
violence risk assessment scheme amongst offenders and civil psychiatric patients.
International Journal of Forensic Mental Health, 13(2), 148–159. https://doi.org/10.
1080/14999013.2014.911785
 THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 19

Van den Berg, J. W., Smid, W., Schepers, K., Wever, E., van Beek, D., Janssen, E., & Gijs, L.
(2018). The predictive properties of dynamic sex offender risk assessment instru­
ments: A meta-analysis. Psychological Assessment, 30(2), 179–191. https://doi.org/
10.1037/pas0000454
Webster C., Douglas K., Eaves D., Hart S. (1997). Assessing risk for violence, version 2.
Burnaby, Canada: Mental Healt, Law and Policy Institute. Simon Fraser University.
Webster, C.D., Nicholls, T.L., Martin, M.L. Desmarais, S.L. & Brink, J. (2006). Short-Term
Assessment of Risk and Treatability (START): The case for a new structured profes­
sional judgment scheme. Behavioral Sciences & the Law, 24(6), 747–766. doi:Doi:
10.1002/bsl.737
Widiger, T. A., & Trull, T. J. (2007). Plate tectonics in the classification of personality
disorder: Shifting to a dimensional model. American Psychologist, 62(2), 71–83.
https://doi.org/10.1037/0003-066X.62.2.71
Zimring, F. E., Jennings, W. G., Piquero, A. R., & Hays, S. (2009). Investigating the
continuity of sex offending: Evidence from the second Philadelphia birth cohort.
Justice Quarterly, 26(1), 58–76. https://doi.org/10.1080/07418820801989734
Zimring, F. E., Piquero, A. R., & Jennings, W. G. (2007). Sexual delinquency in Racine:
Does early sex offending predict later sex offending in youth and young adulthood?
Criminology & Public Policy, 6(3), 507–534. https://doi.org/10.1111/j.1745-9133.2007.
00451.x
Zinzow, H. M., & Thompson, M. (2015). A longitudinal study of risk factors for repeated
sexual coercion and assault in US college men. Archives of Sexual Behavior, 44(1),
213–222. https://doi.org/10.1007/s10508-013-0243-5