Law and Human Behavior

, Volume 32, Issue 6, pp 511–525 | Cite as

Relation of Antisocial and Psychopathic Traits to Suicide-related Behavior Among Offenders

  • Kevin S. Douglas
  • Scott O. Lilienfeld
  • Jennifer L. Skeem
  • Norman G. Poythress
  • John F. Edens
  • Christopher J. Patrick
Original Paper


Offenders with antisocial traits are relatively likely to attempt suicide, largely because they are more likely to have high negative emotionality and low constraint. Among 682 male offenders, we tested whether negative emotionality, low constraint, and also substance use problems mediated any relationship between antisocial personality disorder (ASPD) and psychopathy on the one hand, and suicide-related behavior (SRB) and ideation on the other. ASPD and the impulsivity/lifestyle features of psychopathy weakly predicted SRB. High negative emotionality and low constraint (but not substance use) mediated the relation between ASPD and SRB. Impulsivity/lifestyle features of psychopathy retained an independent predictive effect. Self-report psychopathy measures added unique predictive variance to the Psychopathy Checklist—Revised. We discuss implications for suicide risk assessment and prevention.


Antisocial personality disorder Psychopathy Suicide Suicide-related behavior 



This research was funded by the National Institute of Mental Health, research grant RO1 MH63783-O1A1, “Personality Features in Social Deviancy.” Kevin S. Douglas also is affilitated with Mid-Sweden University as a Guest Professor of Applied Criminology. Kevin S. Douglas gratefully acknowledges the support of the Michael Smith Foundation for Health Research’s Career Scholar Program.


  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.Google Scholar
  2. Ammons, R. B., & Ammons, C. H. (1962). The Quick Test (QT): Provisional manual. Psychological Reports, 11, 111–161.Google Scholar
  3. Baron, R., & Kenny, D. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  4. Beautrais, A., Joyce, P., & Mulder, R. (2000). Unmet need following suicide attempt: Follow-up of 302 individuals for 30 months. In G. Andrews, & S. Henderson (Eds.), Unmet need in psychiatry: Problems, resources, responses (pp. 245–255). New York: Cambridge University Press.Google Scholar
  5. Beck, A. T., & Weishaar, M. E. (1990). Suicide risk assessment and prediction. Crisis, 11, 22–30.PubMedGoogle Scholar
  6. Benning, S. D., Patrick, C. J., Hicks, B. M., Blonigen, D. M., & Krueger, R. F. (2003). Factor structure of the psychopathic personality inventory: Validity and implications for clinical assessment. Psychological Assessment, 15, 340–350.PubMedCrossRefGoogle Scholar
  7. Black, D. W. (1998). Iowa record-linkage study: Death rates in psychiatric patients. Journal of Affective Disorders, 50, 277–282.PubMedCrossRefGoogle Scholar
  8. Black, D. W., & Braun, D. (1998). Antisocial patients: A comparison of those with and without childhood conduct disorder. Annals of Clinical Psychiatry, 10, 53–57.PubMedGoogle Scholar
  9. Brodsky, B., Malone, K. M., Ellis, S. P., Rebecca, D. A., & Mann, J. J. (1997). Characteristics of borderline personality disorder associated with suicidal behavior. American Journal of Psychiatry, 154, 1715–1719.PubMedGoogle Scholar
  10. Charles, D. R., Abram, K. M., McClelland, G. M., & Teplin, L. (2003). Suicidal ideation and behavior among women in jail. Journal of Contemporary Criminal Justice, 19, 65–81.CrossRefGoogle Scholar
  11. Cleckley, H. (1976). The mask of sanity (5th ed.). St. Louis: Mosby.Google Scholar
  12. Cooke, D. J., & Michie, C. (2001). Refining the construct of psychopathy: Towards a hierarchical model. Psychological Assessment, 13, 171–188.PubMedCrossRefGoogle Scholar
  13. Cooke, D. J., Michie, C., & Skeem, J. L. (2007). Understanding the structure of the Psychopathy Checklist – Revised: An exploration of methodological confusion. British Journal of Psychiatry, 190, s39–s50.CrossRefGoogle Scholar
  14. Cooper, J, Kapur, N, Webb, R., Lawlor, M, Guthrie, E, Mackway-Jone, K, Appleby, L (2005). Suicide after deliberate self-harm: A 4-year cohort study. American Journal of Psychiatry, 162, 297–303.PubMedCrossRefGoogle Scholar
  15. Craig, R. J., & Olson, R. E. (1988). Relationships between Wechsler Scales and Quick Test IQs among disability applicants. Professional Psychology: Research & Practice, 19, 26–30.CrossRefGoogle Scholar
  16. Davison, S., Leese, M., & Taylorm, P. J. (2001). Examination of the screening properties of the Personality Diagnostic Questionnaire 4+ (PDQ-4+) in a prison population. Journal of Personality Disorders, 15, 180–194.PubMedCrossRefGoogle Scholar
  17. DeCato, C. M., & Husband, S. D. (1984). Quick test and Wechsler Adult Intelligence Scale – Revised in a prison’s clinical setting. Psychological Reports, 54, 939–942.Google Scholar
  18. Douglas, K. S., Herbozo, S., Poythress, N. G., Belfrage, H., & Edens, J. F. (2006). Psychopathy and suicide: A multi-sample investigation. Psychological Services, 3, 97–116.CrossRefGoogle Scholar
  19. Dreessen, L., & Arntz, A. (1998). Short-interval test-retest interrater reliability of the structured clinical interview for DSM-III-R personality disorders (SCID-II) in outpatients. Journal of Personality Disorders, 12, 138–148.PubMedGoogle Scholar
  20. Duberstein, P. R., & Conwell, Y. (1997). Personality disorders and completed suicide: A methodological and conceptual review. Clinical Psychology: Science and Practice, 4, 259–376.CrossRefGoogle Scholar
  21. Edens, J. F., Cruise, K. R., & Buffington-Vollum, J. K. (2001). Forensic and correctional applications of the Personality Assessment Inventory. Behavioral Sciences and the Law, 19, 519–543.PubMedCrossRefGoogle Scholar
  22. Edens, J. F., & Ruiz, M. A. (2005). Personality Assessment Inventory Interpretive Report for Correctional Settings (PAI-CS) professional manual. Odessa: PAR, Inc.Google Scholar
  23. Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23,000 prisoners: A systematic review of 62 surveys. Lancet, 359, 545–550.PubMedCrossRefGoogle Scholar
  24. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. (1996). User’s guide for the structured clinical interview for DSM-IV Axis II personality disorders (SCID-II, Version 2.0, July 1996 Final Version). New York: Biometrics Research Department, New York State Psychiatric Institute.Google Scholar
  25. First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., Davies, M., Borus, J., Howes, M. J., Kane, J., Pope, H. G., & Rounsaville, B. (1995). The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part II: Test-retest reliability study. Journal of Personality Disorders, 9, 92–104.Google Scholar
  26. Fleiss, J., Williams, J. B. W., & Dubro, A. F. (1986). The logistic regression analysis of psychiatric data. Journal of Psychiatric Research, 20, 145–209.CrossRefGoogle Scholar
  27. Fossati, A., Maffei, C., Bagnato, M., Donati, D., Donini, M., Fiorilli, M., Novella, L., & Ansoldi, M. (1998). Criterion validity of the Personality Diagnostic Questionnaire-4 (PDQ-4+) in a mixed psychiatric sample. Journal of Personality Disorders, 12, 172–178.PubMedGoogle Scholar
  28. Fruehwald, S., Frottier, P., & Matschnig, T. (2003). The relevance of suicidal behavior in jail and prison suicides. European Psychiatry, 18, 161–165.PubMedCrossRefGoogle Scholar
  29. Guy, L. S., Poythress, N. G., Douglas, K. S., Skeem, J. L., & Edens, J. F. (in press). Correspondence between self-report and interview-based assessments of antisocial personality disorder. Psychological Assessment.Google Scholar
  30. Hare, R. D. (1991). The Hare psychopathy checklist-revised. Toronto: Multi-Health Systems.Google Scholar
  31. Hare, R. D. (2003). The Hare psychopathy checklist-revised (2nd ed.). Toronto: Multi-Health Systems.Google Scholar
  32. Harpur, T. J., Hare, R. D., Hakstian, A. R. (1989). Two-factor conceptualization of psychopathy: Construct validity and assessment implications. Psychological Assessment, 1, 6–17.CrossRefGoogle Scholar
  33. Heila, H., & Lonnqvist, J. (2003). The clinical epidemiology of suicide in schizophrenia. In R. M. Murray (Ed.), The epidemiology of schizophrenia (pp. 288–316). New York: Cambridge University Press.Google Scholar
  34. Hicks, B. M., & Patrick, C. J. (2006). Psychopathy and negative affectivity: Analyses of suppressor effects reveal distinct relations with trait anxiety, depression, fearfulness, and anger-hostility. Journal of Abnormal Psychology, 115, 276–287.PubMedCrossRefGoogle Scholar
  35. Johns, J. (1997). The basic reading inventory (7th ed.). Dubuque: Kendall/Hunt Publishing.Google Scholar
  36. Lester, D. (1998). Adolescent suicide risk today: A paradox. Journal of Adolescence, 21, 499–503.PubMedCrossRefGoogle Scholar
  37. Lilienfeld, S. O. (1994). Conceptual problems in the assessment of psychopathy. Clinical Psychology Review, 14, 17–38.CrossRefGoogle Scholar
  38. Lilienfeld, S. O., & Andrews, B. P. (1996). Development and preliminary validation of a self-report measure of psychopathic personality traits in noncriminal populations. Journal of Personality Assessment, 66, 488–524.PubMedCrossRefGoogle Scholar
  39. Lilienfeld, S. O., & Fowler, K. A. (2006). The self-report assessment of psychopathy: Problems, pitfalls, and promises. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 107–132). New York: Guilford.Google Scholar
  40. Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.Google Scholar
  41. Lykken, D. T. (1995). The antisocial personalities. Hillsdale: Erlbaum.Google Scholar
  42. Maffei, C., Fossati, A., Agostoni, I., Barraco, A., Bagnato, M., Deborah, D., Namia, C., Novella L, & Petrachi, M. (1997). Interrater reliability and internal consistency of the structured clinical interview for DSM-IV Axis II personality disorders (SCID-II), version 2.0. Journal of Personality Disorders, 11, 279–284.PubMedGoogle Scholar
  43. Maris, R. W., Berman, A. L., & Silverman, M. M. (2000). Comprehensive textbook of suicidology. New York: Guilford Press.Google Scholar
  44. Morey, L. C. (1991). Personality assessment inventory: Professional manual. Tampa: Psychological Assessment Resources.Google Scholar
  45. O’Carroll, P. W., Berman, A. L., Maris, R. W., Moscicki, E. K., Tanney, B. L., & Silverman, M. M. (1996). Beyond the tower of Babel: A nomenclature for suicidology. Suicide and Life-threatening Behavior, 26, 237–252.PubMedGoogle Scholar
  46. Patrick C. J. (2006). Back to the future: Cleckley as a guide to the next generation of psychopathy research. In C. J. Patrick (Ed.), Handbook of psychopathy. New York: Guilford Press.Google Scholar
  47. Patrick, C. J., Edens, J. F., Poythress, N. G., Lilienfeld, S. O., & Benning, S. (2006). Construct validity of the Psychopathic Personality Inventory two-factor model with offenders. Psychological Assessment, 18, 204–208.PubMedCrossRefGoogle Scholar
  48. Patrick, C. J., Hicks, B. M., Krueger, R. F., & Lang, A. R. (2005). Relations between psychopathy facets and externalizing in a criminal offender sample. Journal of Personality Disorders, 19, 339–356.PubMedCrossRefGoogle Scholar
  49. Patton, J. H., Stanford, M. S., & Barratt, E. S. (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51, 768–774.PubMedCrossRefGoogle Scholar
  50. Poincare, J. H. (1905/2001). Science and hypothesis. In S. J. Gould (Ed.), The value of science: Essential writings of Henri Poincare (pp. 7–165). New York: Random House.Google Scholar
  51. Poythress, N. P., Edens, J. F., & Lilienfeld, S. O. (1998). Criterion-related validity of the psychopathic personality inventory in a prison sample. Psychological Assessment, 10, 426–430.CrossRefGoogle Scholar
  52. Range, L. M., & Knott, E. C. (1997). Twenty suicide assessment instruments: Evaluation and recommendations. Death Studies, 21, 25–58.PubMedCrossRefGoogle Scholar
  53. Roberts, R. E., Roberts, C. R., & Chen, R. Y. (1998). Suicidal thinking among adolescents with a history of attempted suicide. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1294–1300.PubMedCrossRefGoogle Scholar
  54. Roy, A., & Linnoila, M. (1986). Alcoholism and suicide. Suicide and Life-threatening Behavior, 16, 244–273.PubMedGoogle Scholar
  55. Simon, M. J. (1995). Relationship between the Quick Test and WAIS-R in low-functioning criminal defendants. Psychological Reports, 77, 1001–1002.PubMedGoogle Scholar
  56. Skeem, J. L., & Cooke, D. J. (in press). Is criminal behavior a central component of psychopathy? Conceptual directions for resolving the debate. Psychological Assessment.Google Scholar
  57. Skeem, J. L., Douglas, K. S., & Poythress, N. G. (2004, June). PCL-R psychopathy: Three or four factors? In K. S. Douglas (Chair), Psychopathy: Exploring controversies in its nature, measurement, and application. Symposium paper presented at the annual conference of the International Association of Forensic Mental Health Services, Stockholm.Google Scholar
  58. Skeem, J. L., Poythress, N. P., Edens, J. F., Lilienfeld, S. O., & Cale, E. M. (2003). Psychopathic personality or personalities? Exploring potential variants of psychopathy and their implications for risk assessment. Aggression and Violent Behavior, 8, 513–546.CrossRefGoogle Scholar
  59. Skeem, J., Silver, E., Appelbaum, P., & Tiemann, J. (2006). Suicidal behavior after psychiatric hospital discharge: A prospective study. Behavioral Sciences & the Law, 24, 731–746.CrossRefGoogle Scholar
  60. Skodol, A. E., Rosnick, L., Kellman, D., Oldman, J. M., & Hyler, S. E. (1988). Validating structured DSM-III-R personality disorder assessments with longitudinal data. American Journal of Psychiatry, 145, 1297–1299.PubMedGoogle Scholar
  61. Takahashi, Y. (1993). Depression and suicide. In Kariya, T., & Nakagawara, M. (Eds.), Affective disorders: Perspectives on basic research and clinical practice (pp. 85–98). Philadelphia: Bruner/Mazel.Google Scholar
  62. Tellegen, A. (in press). Manual for the multidimensional personality questionnaire. Minneapolis: University of Minnesota Press.Google Scholar
  63. Teplin, L. A. (1994). Psychiatric and substance abuse disorders among male urban jail detainees. American Journal of Public Health, 84, 290–293.PubMedCrossRefGoogle Scholar
  64. Teplin, L. A., Abram, K. M., & McClelland, G. M. (1996). Prevalence of psychiatric disorders among incarcerated women: Pretrial jail detainees. Archives of General Psychiatry, 53, 505–512.PubMedGoogle Scholar
  65. Traub G., & Spruill J. (1982) Correlations between the Quick Test and the WAIS-R. Psychological Reports, 51, 309–310.Google Scholar
  66. U.S. National Center for Health Statistics. (2003). National vital statistics report. Retrieved March 14, 2004, from
  67. Verona, E., Hicks, B. M., & Patrick, C. J. (2005). Psychopathy and suicidal behavior in female offenders: Mediating effects of temperament and abuse history. Journal of Consulting and Clinical Psychology, 73, 1065–1073.PubMedCrossRefGoogle Scholar
  68. Verona, E., Patrick, C. J., & Joiner, T. E. (2001). Psychopathy, antisocial personality, and suicide risk. Journal of Abnormal Psychology, 110, 462–470.PubMedCrossRefGoogle Scholar
  69. Verona, E., Sachs-Ericsson, N., & Joiner, T. E. (2004). Suicide attempts associated with externalizing psychopathology in an epidemiological sample. American Journal of Psychiatry, 161, 444–451.PubMedCrossRefGoogle Scholar
  70. Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 98, 219–235.CrossRefGoogle Scholar
  71. Weiss, R. D., Najavits, L. M., Muenz, L. R., & Hufford, C. (1995). Twelve-month test-retest reliability of the structured clinical interview for DSM-III-R personality disorders in cocaine-dependent patients. Comprehensive Psychiatry, 36, 384–389.PubMedCrossRefGoogle Scholar
  72. Woodruff, R. A., Clayton, P. J., & Guze, S. B. (1972). Suicide attempts and psychiatric diagnosis. Diseases of the Nervous System, 33, 617–622.PubMedGoogle Scholar
  73. World Health Organization (2000). Preventing suicide: A resource for prison officers. Accessed 8/23/2006 at

Copyright information

© American Psychology-Law Society/Division 41 of the American Psychological Association 2007

Authors and Affiliations

  • Kevin S. Douglas
    • 1
  • Scott O. Lilienfeld
    • 2
  • Jennifer L. Skeem
    • 3
  • Norman G. Poythress
    • 4
  • John F. Edens
    • 5
  • Christopher J. Patrick
    • 6
  1. 1.Department of PsychologySimon Fraser UniversityBurnabyCanada
  2. 2.Emory UniversityAtlantaUSA
  3. 3.University of CaliforniaIrvineUSA
  4. 4.University of South FloridaTampaUSA
  5. 5.Texas A&M UniversityCollege StationUSA
  6. 6.University of MinnesotaMinneapolisUSA

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