Hostile attribution bias as a dynamic risk factor in civil psychiatric patients and criminal offenders: change over time and relationship to violence and recidivism

Clinicians in applied forensic and clinical settings are increasingly asked to address the issue of risk for future violence or recidivism in their day-to-day practice. Given the severe consequences of under- and over-estimating someone’s level of risk, a vast body of research has identified risk factors associated with these adverse outcomes. Dynamic risk factors can be especially useful from a risk management perspective; however, to date some dynamic risk factors, such as hostile attributional bias (HAB), have been largely ignored in the literature, and little is known about the dynamic nature of the HAB. The purpose of this study was to examine whether the HAB, as measured by the External Hostile Attributions Scale (EHAS; McNiel, Eisner, & Binder, 2003), is a dynamic risk factor with respect to violence and recidivism. Specifically, the aim was to determine whether the EHAS was a significant predictor of these outcomes, whether and how much the EHAS changes over time, and if certain participants showed similar trajectories of EHAS over time. Participants were 118 civil psychiatric patients admitted to a psychiatric ward of a general hospital and 56 criminal offenders who were incarcerated or on probation at the start of the study. Participants completed a semi-structured interview as well as a number of questionnaires at baseline, and completed a shorter interview and the same questionnaires at up to five follow-up interviews after discharge or release. Official criminal records were reviewed at the end of the study. The results of this study partially supported the use of the HAB as a dynamic risk factor with respect to violence and recidivism. The EHAS was a significant predictor of violence and recidivism, especially in the short-term; findings also indicated that EHAS scores changed over time, and that there were some associations between changes over time and adverse outcomes. Finally, results demonstrated that participants’ scores followed similar trajectories over time and that, in some cases, trajectories of EHAS scores were associated with outcomes. Implications for risk management and treatment recommendations are discussed.