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Psychopathy and Violence Risk — MRCPsych Paper B MCQ

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ModerateForensic PsychiatryPsychopathy and Violence RiskMRCPsych Paper B

A 30-year-old man with antisocial personality disorder is assessed in a forensic service. He displays superficial charm, grandiosity, lack of remorse and manipulative behaviour. A trained clinician obtains a PCL-R score of 32. Which statement best describes the relationship between this finding and his risk of future violence?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Higher psychopathy scores are associated with violent recidivism but should be integrated with other risk factors in a structured assessment

Explanation lettering: B = shown as A · A = shown as B · D = shown as C · C = shown as D

The correct answer is B. Psychopathy measured using the PCL-R is meaningfully associated with violent and general recidivism, so a high score is relevant to risk formulation. It is not, however, a deterministic or standalone violence-risk prediction. NICE recommends combining a standardised measure such as the PCL-R with detailed historical and clinical information and a formal structured assessment such as the HCR-20. Antisocial personality disorder does not make the PCL-R irrelevant (A), and psychopathic traits are not generally protective (C). Substance misuse may independently increase and aggravate risk, but is not required for psychopathy to be associated with violence (D). Although the PCL-R primarily measures psychopathy severity, this does not prevent it contributing to a broader risk formulation (E).

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. https://www.nice.org.uk/guidance/cg77/chapter/Recommendations