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Psychopathy Assessment — MRCPsych Paper B MCQ

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ModerateForensic PsychiatryPsychopathy AssessmentMRCPsych Paper B

During a comprehensive assessment in a forensic personality disorder service, a 35-year-old man displays superficial charm, grandiosity, pathological lying, callousness, lack of remorse, irresponsibility and a parasitic lifestyle. He also has a persistent history of varied offending. The clinician requires a standardised instrument specifically measuring the severity of these psychopathic traits, rather than a structured violence-risk formulation. Which assessment tool is most appropriate?

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Correct answer: D — Psychopathy Checklist-Revised (PCL-R)

The PCL-R is a 20-item clinician-rated instrument specifically measuring psychopathic traits. The presentation spans its interpersonal features, such as superficial charm, grandiosity and lying; affective features, including callousness and lack of remorse; and lifestyle and antisocial features, including parasitic behaviour, irresponsibility and persistent offending. NICE identifies the PCL-R as a standardised severity measure used in forensic assessment. The HCR-20 V3 instead supports structured formulation and management of violence risk and is not a psychopathy scale. The RSVP assesses sexual-violence risk, SARA assesses intimate-partner violence risk, and SAPROF evaluates protective factors relevant to future violence. Psychopathy scores may inform risk formulation, but the PCL-R should not be conflated with a general violence-risk assessment.

Reference: National Institute for Health and Care Excellence. Antisocial personality disorder: prevention and management, CG77, recommendations 1.3.1.2 and 1.3.2.7, 2009 (current NICE guidance). https://www.nice.org.uk/guidance/cg77/chapter/Recommendations