Multicentre study women in forensic psychiatry 

In 2012, a study was started into characteristics of female forensic psychiatric patients from five Dutch forensic institutions. The major aim of this ongoing study is to gain more insight into criminal and psychiatric characteristics of female forensic psychiatric patients, especially characteristics that may function as risk or protective factors for future violence. Results may have implications for psychodiagnostics, risk assessment and treatment in forensic psychiatric settings, but possibly also in general psychiatry or in the penitentiary system. Overall, this may lead to a better understanding of this specific and growing group of forensic patients and enable mental health professionals to provide the most adequate risk assessment and management for women, thereby effectively preventing violent (re)offending.

In this study, an extensive list of criminal, demographic, psychiatric and treatment characteristics is coded by a group of trained and experienced researchers based on file information. So far, data have been obtained of 300 women and 275 matched men. The patients are - or have been admitted between 1984 and 2014 to Van der Hoeven, Oldenkotte, Woenselse PoortAssen and Trajectum. The women and men were matched on three criteria: year of birth, year of admittance and judicial status.

We are open to collaboration with other settings.

Studies within this project:

1. Comparison 275 female and 275 male forensic psychiatric patients (de Vogel et al., 2016, The Journal of Forensic Psychiatry and Psychology), IAFMHS 2014 presentation)

2. Psychopathy in women (Klein Tuente, de Vogel, & Stam, 2014, click here for more information about the article or see the poster); comparison men (IAFMHS 2014 presentation)

3. Comparison study psychopathy men / women (de Vogel & Lancel, 2016, IAFMHS 2014 presentation, presentation conference on psychopathy, Antwerp December 2014)

4. Female forensic patients with intellectual disabilities (manuscript published in Dutch journal, IAFMHS presentation 2015)

5. Female forensic patients with Borderline Personality Disorder (manuscript in Psychology, Crime & Law)

6. Victimization in female and male forensic psychiatric patients (manuscript submitted, presentation ECVCP 2015)

7. Female arsonists (IAFMHS 2014 presentation)


General conclusion

Overall, a picture emerges of severely traumatized women with complex pathology and a high level of co-morbidity with multiple previous treatment failures and many incidents during treatment. In a second phase, the results were compared to a matched group of 275 male forensic patients. Several significant differences were found with respect to offense histories, index offenses, psychopathology, history of victimization, violence risk factors and incidents during treatment. For example, women had more often committed homicides and arson and less often sexual offenses, were more often diagnosed with Borderline Personality Disorder and had more complex histories of victimization. Furthermore, women showed more previous treatment dropout and violent incidents during treatment.


Research on the FAM

Research on the FAM is still limited. In 2010, a prospective study was started on the clinical value and psychometric properties of the FAM in the Van der Hoeven Kliniek. In a first part of this research good interrater reliability was found for all new FAM items and HCR-20 items with additional guidelines for women, the integrated total score of the HCR-20 and FAM, and the Final risk judgment of violence to others. In a preliminary analysis of a group of 46 women it was found that, overall, the FAM had good predictive validity for incidents of violence to others during treatment, but even more so for incidents of self-destructive behavior during treatment (de Vogel & de Vries Robbé, 2013). In the Dutch multicentre study it was found that the FAM / HCR-20 Historical subscale score was a significant predictor of different types of incidents during treatment (physical violence, verbal violence, verbal threats and arson). Furthermore, the FAM / HCR-20 Historical subscale score significantly predicted if a woman had to be transferred to another ward in the treatment setting, usually because of serious problems. Further research into the predictive validity of the FAM for incidents during treatment and recidivism after discharge will take place in the coming years.