Anger:The higher a patient scored on the Novaco Anger
Scale in the hospital, the more likely he or she was to be
violent later in the community.These are only bivariate relationships between sin-
gle risk factors measured in the hospital and violence
during the first 20 weeks after discharge into the com-
munity, however. The more important question is how
the risk factors performed when combined as described
above. The MacArthur researchers ultimately com-
bined the results of five prediction models generated by
the iterative classification tree methodology. This com-
bination of models produced results not only superior
to those of any of its constituent models but also supe-
rior to many other actuarial violence risk assessment
procedures reported in the literature. Using only those
risk factors commonly available in hospital records or
capable of being routinely assessed in clinical practice,
the researchers were able to place all patients into one
of five risk classes for which the prevalence of violence
during the first 20 weeks following discharge into the
community was 1%, 8%, 26%, 56%, and 76%.Violence Risk Assessment Software
To operationalize the risk assessment procedures
developed in the MacArthur Violence Risk Assessment
Study, five tree-based prediction models need to be
constructed, each involving the assessment of many
risk factors. It would clearly be impossible for a clini-
cian to commit the multiple models and their scoring
to memory, since different risk factors are to be
assessed for different patients, and using a paper-and-
pencil protocol would be very unwieldy. Fortunately,
however, the administration and scoring of multiple
tree-based models lends itself to software. In clinical
use, the risk assessment instrument developed in the
MacArthur Study consists simply of a series of ques-
tions that flow one to the next on a computer screen—
through the various iterations of each of the models as
necessary—depending on the answer to each prior
question. Under a grant from the National Institute of
Mental Health, the MacArthur researchers developed
such a “violence risk assessment software,” the
Classification of Violence RiskTM.John MonahanSee alsoClassification of Violence Risk (COVR); HCR–20
for Violence Risk Assessment; Violence Risk Appraisal
Guide (VRAG); Violence Risk AssessmentFurther Readings
Banks, S., Robbins, P., Silver, E., Vesselinov, R.,
Steadman, H., Monahan, J., et al. (2004). A multiple
models approach to violence risk assessment among
people with mental disorder. Criminal Justice and
Behavior, 31,324–340.
Monahan, J., & Steadman, H. (Eds.). (1994). Violence and
mental disorder: Developments in risk assessment.
Chicago: University of Chicago Press.
Monahan, J., Steadman, H., Silver, E., Appelbaum, P.,
Robbins, P., Mulvey, E., et al. (2001). Rethinking risk
assessment: The MacArthur study of mental disorder and
violence.New York: Oxford University Press.
Steadman, H., Mulvey, E., Monahan, J., Robbins, P.,
Appelbaum, P., Grisso, T., et al. (1998). Violence by
people discharged from acute psychiatric inpatient
facilities and by others in the same neighborhoods.
Archives of General Psychiatry, 55,393–401.MALINGERING
Forensic assessments must evaluate systematically the
accuracy and forthrightness of individuals referred for
evaluation of psycholegal issues. Among different
response styles that should be considered, malinger-
ing is a cornerstone issue for forensic consultations.
Malingering is defined by the Diagnostic and
Statistical Manual of Mental Disorders(fourth edition;
DSM-IV) of the American Psychiatric Association as a
deliberate fabrication or gross exaggeration of symp-
toms for an external goal. Feigned symptoms and asso-
ciated features may be psychological, medical, or a
combination of both. Forensic psychologists and psy-
chiatrists should note that minor or even substantive
exaggerations do not warrant the classification of
malingering; only grossly exaggeratedsymptoms qual-
ify for malingering. An example of gross exaggeration
would be the deliberate misrepresentation of an occa-
sional thought about one’s demise (e.g., “I wish
I was dead”) as a current suicidal ideation that includes
planning and possible preparation. Because court
reports require precision, forensic psychologists may
wish to operationalize “gross exaggeration.” For such
purposes, the Schedule of Affective Disorders and
Schizophrenia (SADS) provides a criterion-based stan-
dard for rating the severity of reported symptoms.
Many symptoms on the SADS are rated on six
levels of severity: 1 =absent, 2 =slight or subclinical,470 ———MalingeringM-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 470