An Economic Analysis of Crime Costs Associated with Psychopathic Personality Disorder and Violence Risk

• Author: Dylan T. Gatner,Kevin S. Douglas,Madison F. E. Almond,Stephen D. Hart,P. Randall Kropp
• DOI: http://doi.org/10.1177/00938548221140366
• Published date: 01 May 2023
• Date: 01 May 2023

CRIMINAL JUSTICE AND BEHAVIOR, 2023, Vol. 50, No. 5, May 2023, 729 –746.

DOI: https://doi.org/10.1177/00938548221140366

Article reuse guidelines: sagepub.com/journals-permissions

© 2022 International Association for Correctional and Forensic Psychology

729

AN ECONOMIC ANALYSIS OF CRIME COSTS

ASSOCIATED WITH PSYCHOPATHIC

PERSONALITY DISORDER AND VIOLENCE RISK

DYLAN T. GATNER

Simon Fraser University

British Columbia Mental Health & Substance Use Services

KEVIN S. DOUGLAS

Simon Fraser University

Helse Bergen Sikkerhet Kompetansesenter

University of Oslo

MADISON F. E. ALMOND

Simon Fraser University

STEPHEN D. HART

Simon Fraser University

University of Bergen

P. RANDALL KROPP

Simon Fraser University

British Columbia Mental Health and Substance Use Services

Given substantial national crime costs and that psychopathic personality disorder (PPD) is a robust predictor of recidivism,

a research gap exists concerning the cost of crime attributable to adults with PPD. The current study employed a bottom-up

cost of illness approach to estimate the association between PPD and crime costs among Canadian men incarcerated in the

federal correctional system (n = 188). Participants were rated using the Psychopathy Checklist–Revised (PCL-R) and the

Historical-Clinical-Risk Management–20 (HCR-20, version 2). Group mean crime costs were highest for participants who

scored highly on the PCL-R and were rated high risk on the HCR-20, and higher scores on both measures were associated

with prospective costs accrued from violent and nonviolent recidivism. The findings highlight the need to improve the treat-

ment and management of high-risk individuals with prominent psychopathic features, as it has the potential for significant

financial savings for criminal justice systems.

Keywords: psychopathy; cost of illness; crime costs; violence; risk assessment

Psychopathic personality disorder (PPD; psychopathy) is a psychiatric condition marked

by deficits in interpersonal (e.g., manipulativeness and dominance), emotional (e.g.,

callousness and shallow affect), and behavioral (e.g., impulsivity and irresponsibility)

AUTHORS’ NOTE: Correspondence concerning this article should be addressed to Dylan T. Gatner,

Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia,

Canada V5A 1S6; e-mail: dylan.gatner@phsa.ca.

1140366CJBXXX10.1177/00938548221140366Criminal Justice and BehaviorGatner et al. / Crime Costs Associated With Psychopathy

research-article2022

730 CRIMINAL JUSTICE AND BEHAVIOR

functioning (Cooke et al., 2012; Hare, 1991). Associations have been observed between

PPD and multiple negative outcomes, such as suicidality (e.g., Verona et al., 2012), illicit

substance use (Ellingson et al., 2018; Sellbom et al., 2017), and problems within intimate

relationships (e.g., Mooney et al., 2019) and the workplace (e.g., Mathieu & Babiak, 2016).

Given these problematic correlates, it is unsurprising that psychopathy results in substantial

dysfunction and has been conceptualized as a severe personality disorder (Cooke & Logan,

2015; Crego & Widiger, 2015).

The phenomenon of psychopathy or PPD is often measured and assessed in applied set-

tings using the Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003). PCL-R scores

have been co-opted as proxies for assessment of future violent offending (Hemphill & Hare,

2004), although the tool was not intended to be a comprehensive risk assessment tool and

psychopathy remains only one of many risk factors for violence (Hart, 1998). Still, research

has shown robust moderate associations between PCL-R scores and antisocial outcomes

(Douglas et al., 2015; Singh et al., 2011). Those with PPD are more likely to engage in

violence and reoffend with greater severity across diverse samples (i.e., adult and juvenile

correctional, psychiatric; Baskin-Sommers et al., 2013; Guy et al., 2010; Howard et al.,

2014; Leistico et al., 2008). In particular, in comparison with Factor 1 (interpersonal and

affective features) features, PCL-R Factor 2 features (antisocial history and impulsivity

features) have had stronger predictive effects with antisocial outcomes (see Leistico et al.,

2008; Yang et al., 2010).

Beyond its bivariate association with recidivism and violence, PPD can also be clinically

relevant to case formulation in risk assessment and risk management recommendations, as

it can help explain why someone chooses to commit violence at the idiographic level (Cooke

& Logan, 2015; Gatner et al., 2022; Guy et al., 2010). Numerous explanatory mechanisms

have been proposed that link PPD and violence, including fearlessness, diminished empa-

thy, and deficient learning from punishment (Berkout et al., 2013) or early maladaptive

schemas (i.e., insufficient self-control and mistrust; Chakhssi et al., 2014). In sum, the

empirical and conceptual associations that psychopathy holds with crime and violence

might explain why scholars have suggested that PPD imposes an enormous social burden

(Hare, 1999; Reidy et al., 2015). However, there have been only a few attempts at quantify-

ing this burden empirically.

ECONOMIC BURDENS OF MENTAL AND PERSONALITY DISORDERS

Cost of illness (COI) research involves calculating the economic costs attributable to dis-

ease by combining epidemiological data and financial information (Segel, 2006), which has

influenced decision-making (e.g., Bloom et al., 2012) for different social systems (e.g., crimi-

nal justice and health care systems). The COI approach can be split into (a) top-down meth-

odology, which examines the total expenditure cost based on disorder prevalence and related

costs (Segel, 2006; Tarricone, 2006), and (b) bottom-up methodology, which estimates indi-

vidual unit costs and multiplies these costs by their usage from a particular sample, which can

then be extrapolated to a system or group level (Chapko et al., 2009; Tarricone, 2006). These

studies have demonstrated that serious mental illnesses such as schizophrenia have substantial

financial burdens in different countries (i.e., 94 million to 102 billion USD; Chong et al.,

2016; Goeree et al., 2005). More broadly, it has been asserted that mental disorders have sig-

nificant financial impacts on societal systems, globally (Whiteford et al., 2013).