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False allegations of abuse in child custody cases are an all-too-common phenomenon. Typically, one parent accuses the other parent of physical and/or sexual abuse of their child to gain leverage in their court proceeding. Nothing can befuddle or sidetrack a custody case more than an allegation of abuse. This is particularly important because judges tend to award primary physical custody to the parent who made the allegation, even if the accused parent’s actions are not substantiated. Thus, false allegations can be a powerful weapon to limit or deny custody and/or visitation in a vindictive manner.

Handling an allegation of abuse is a sensitive and thorny problem for attorneys and judges. All allegations of abuse must be taken seriously. While a strong visceral reaction to an abuse allegation is expected, it can be counterproductive. A rushed response can make the situation worse. In contrast, a wait-and-see attitude leaves the door open for a thorough evaluation before a disposition is decided upon. In essence, evaluation needs to occur before disposition.

Let us be clear: false allegations of abuse are a form of parental alienation. Alienation involves the concerted effort of one parent to undermine the other parent’s relationship with their child. Nothing could be worse than a custody decision that is based on a false allegation. And once a custody decision has been issued, modification of it is burdensome and an uphill challenge.

Clinical psychologists, psychiatrists, and other mental health professionals are often turned to in cases of abuse allegations. The court appoints them to evaluate the parties involved and to make recommendations. Allegations of abuse call for a coordinated effort between the judge, the attorneys, and the court-appointed evaluator.

A clinical approach to evaluating allegations of abuse presented here is based on years of experience with hundreds of cases of abuse allegations. This approach consists of sequential steps that should be taken. The evaluation process is aimed at determining whether an allegation of abuse has occurred or not—in other words, whether the allegation has been fabricated by a parent with the intent of sabotaging and harming the other parent.

The evaluation of possible abuse must include both parents and the child. Seeing just the child, just the accused parent, or just the accusing parent is not sufficient to understanding the entire narrative. All 3 individuals must be a part of the evaluation process. After all, we want our conclusions and recommendations to be based on full and accurate information. This can only be accomplished with the participation of all 3 individuals

The accused parent is often advised by his/her attorney not to participate in the evaluation process with the psychologist or psychiatrist. This is ill-conceived advice. By doing so, the mental health professional will be deprived of critical information that can shine a light on the falsity of the claim. Otherwise, all the information will be coming from the accusing parent, whose allegation will gain weight if it is not disputed.

It is always a good idea for the child in such a case to be seen for an independent forensic evaluation. This would be in addition to the child’s involvement with the court-appointed evaluator.

If this is the first allegation of abuse, and it is occurring during a child custody case, its validity must be questioned. In fact, there is a significant probability that the allegation is false. It is unlikely that a parent’s first abuse of a child will occur after a child custody case has been opened. Thus, if a parent does not have a history of abusing the child, it is not likely that the first abuse is occurring during the legal proceeding.

A series of allegations against a parent during a child custody proceeding is also a major red flag. An accusing parent often believes that multiple allegations against the other parent are more convincing to a judge than a single allegation. But repeated abuse of a child during a circumscribed time period—during a child custody case, for example—is quite improbable.

Detecting a false allegation is easier with the use of a timeline. Marking the major occurrences in a child custody case can show the specific sequence of events. A false allegation of abuse may occur during the custody case and not before. It may also occur in response to legal action taken by the other parent. For example, if a mother files for full custody of her child, this sets the stage for the father to report a false allegation of abuse against the mother, with the hopes that the allegation will derail the mother’s quest for custody. The motive of the false allegation can be detected by examining its place on the timeline of events.

Children between the ages of 3 and 7 years are easily coached by one parent against the other. False allegations of abuse often include unwitting help from the children. Children want to please their primary parent. They are easily swayed, cajoled, convinced, and brainwashed. It is difficult for them to know the truth once a parent has coached them extensively. False allegations can involve older children and teenagers as well, but their coaching is more easily transparent and even admitted to by the adolescent in question.

There are 5 common reasons why a parent will lodge a false allegation of abuse against the other parent. There are certain powerful beliefs that an accusing parent will have that lead to the promulgation of false allegations (

If any of these beliefs are discovered, the allegation of abuse is likely to be false. Detecting these beliefs in a parent requires careful interviews over several sessions. A parent will never admit to fabricating a false allegation. The clinician must be skilled enough to see through the typical defensiveness, deceitfulness, and/or distractions of an offending parent.

Harmful and false beliefs by the accusing parent can also be detected through interviews with the child and the accused parent. Usually, the child or the accused parent will provide critical clues as to the accusing parent’s belief system. These clues can be pieced together to provide a full understanding of the destructive dynamics at play. Bits and pieces of information will fit together into a detailed narrative that exposes the falseness of the allegation at hand. But, again, the accusing parent will never recant and will never apologize for his/her underhanded attempt at relationship interference.

Critical Points to Keep in Mind During the Evaluation

Once an allegation of abuse has been declared by a parent, the following process should ensue:

1. The Judge should appoint a clinical psychologist or a psychiatrist to evaluate the child and both parents. This evaluation must include interviews, psychological testing, and a review of collateral data (emails, texts, recordings, pictures, and others). The evaluator should have access to other independent assessments of the allegation, such as DHR investigations or a forensic evaluation of the child.

2. The clinical psychologist or psychiatrist must be experienced in child custody evaluations.

3. There should be a wait-and-see attitude about the allegation until the evaluation process has been fully completed.

4. Attorneys should not respond to an allegation of abuse by filing motions for dramatic or extreme action, such as obtaining full custody of the child.

5. Giving a parent temporary custody until the matter is settled may make sense, especially if the child’s physical safety is of acute concern.

6. The evaluation by the mental health professional should be aimed at determining the validity of the stated allegation of abuse.

7. The attorneys must not try to sabotage the evaluator in order to win their case. The evaluator’s conclusions and recommendations should be given strong weight.

A false allegation of abuse by a parent should be met with firm consequences, such as a fine, supervised parenting time, court-ordered counseling, and/or loss of primary custody. Swift and decisive consequences will stop future false allegations of abuse.

A false allegation must be considered a form of parental alienation. By being involved in one way or another, the child learns to be dishonest, deceitful, manipulative, conflictual, and blaming. The love the child should have for both parents is compromised and even destroyed by the process of a false allegation. False allegations of abuse must not be tolerated in the court system.

The accusing parent may not be appropriate for primary custody. Even shared custody may not be a good idea. A parent’s willingness to fabricate an allegation of abuse against the other parent is a poor prognostic indicator. It is not simply an accident or a mistake. A false allegation is an intentional and purposeful attempt to undermine the child custody proceeding.

A false allegation of abuse is serious business. It represents a psychiatric emergency. As such, it must be handled and dealt with in a direct and timely manner. A child’s mental health and well-being depend upon it.

is a licensed clinical psychologist in private practice in Birmingham, Alabama. His forensic practice focuses on child custody and alienation cases. He is also a clinical associate professor in the Department of Psychology at the University of Alabama at Birmingham.

A clinical approach to detecting false allegations of abuse in child custody cases.

Finding the Difficult Truth 

C. A child molester is by definition a pedophile

What does the scientific evidence tell us about treatment for pedophilia? The answer might surprise you.

Mini Quiz: Treatment for Pedophilia?

(COVID-19) pandemic has brought a lot of unknowns into the practice of medicine. Doctors are trying to see patients while keeping their patients, themselves, and their staff safe from infection and balancing the threat of being sued for not taking the proper precautions. Stephanie Sheps, vice president of claims at Coverys Specialty Insurance Company, a medical liability insurance provider, shared her thoughts on liability risk in the age of COVID-19 in an interview with 

There are the obvious risks, including transmission of COVID-19, both to patients and to staff. It is a novel issue because we do not fully understand this virus yet, and things continue to evolve daily. Based on patient and provider awareness and precautionary measures taken to mitigate these risks, I believe that the greater liability stems from pandemic-related or contextual realms. Pandemic risks are those that do not involve the diagnosis, transmission, or treatment of COVID-19, but are instead related to the changes in how health care is being delivered or not delivered. These risks include the denial of services to patients because of lack of capacity and lack of 

Medical visits, especially for checkups and management of 

, that are deferred or held virtually present some risk. There is a reason we see our providers in person: they get to put eyes on the patient, they get to take labs, they get to really assess the patient using all of their senses. When that is limited by doing visits through telehealth, I think that could present some greater risk in the future.

Are there oversights that make practices more vulnerable to COVID-related lawsuits?

Yes and no. These are common issues that would have existed before COVID-19, like the failure to document informed consent or informed refusal of treatment. Obviously, there are specific risks related to exposure in the office. The greatest risk right now, however, is that providers are so focused on these COVID-related safety issues that they may overlook traditional typical patient safety and risk mitigation efforts.

Have there been any cases that offer insight into how the courts will look at these COVID-19 issues?

It is a little bit early in the lifecycle to consider potential suits related to COVID-19. Not many have been filed related to COVID-19 that are not just contextual or pandemic-related, as it takes some time for things to wind their way through the court system. There was 1 decision in the federal district court in New York that remanded a case filed in the federal courts, but it was remanded back to the states so that it would not have the protections of the 

Public Readiness and Emergency Preparedness Act

Are there any states or regions where COVID-related actions are more prevalent than others?

Again, it is a little too soon to tell where things are more prevalent because not a lot has been filed in terms of COVID-specific lawsuits. We will likely see more case activity in states that do not have specific immunity for COVID-related countermeasures. Some of those are legislated, some of those are by executive order, but those states will probably see more activity. We will probably see more activity in states without tort reform, or states that do not have caps on noneconomic damages. Finally, states that have had limited or no specific guidance on public health and safety measures like wearing masks, by logical extension, may see more claims activity related to COVID-19 because those states are more likely to have more patients who contract COVID-19. Everything, just like the virus, continues to spread exponentially in the states that have passed legislation to help protect businesses from COVID-related lawsuits.

Do the state legislation protecting businesses from COVID-related suits help medical practices?

Absolutely, they do. The broadest protection comes from the federal extension of the PREP Act, which happened in March of this year. The PREP Act provides immunity to certain individuals, in this case, health care providers, for countermeasures taken to deal with health crises during. Many states have taken the initiative to invoke their own state-related 

, and some of those are even stronger, broader, and more encompassing to protect health care providers than the PREP Act itself. There are good protections out there for health care providers, but like anything else, there are ways around them.

What should practices do to minimize their risk from COVID-related legal action?

One of the things that we have been advocating is to continue traditional risk management and clinical risk management practices, and also employ tactical risk management. Those are things that we need to do now in anticipation of the claims we might have to defend in the future. For tactical risk management, we bucket our recommendations into timeline, record keeping, and memory. We recommend that health care providers, their practices, as well as facilities, keep a very detailed timeline of everything that has transpired related to the pandemic. If cases come up, most will be heard by a jury 3 to 4 years from now. With any luck, this pandemic will be a distant memory by then, and juries will need real reminders of what things were like.

It is important to be proactive about keeping records. We want to memorialize them on a timeline. Note the date that the first COVID-19 case appeared in your practice, the date testing became available, and the dates of any declaration of a state of emergency in your jurisdiction. Note dates when PPE was limited. Any dates relating to staffing shortages, furloughs, or reallocations should also be listed. These dates are critical.

In terms of record keeping, make sure that you have 

, including the purchase orders, letters from suppliers, etc. It is also important to have records of patient logs, like when they had visitors, when they left, or dates when the visitation may have been limited or flatly refused.

Document staff training, along with any furloughs and leaves of absence for providers who were concerned about the disease. Maintain a floor plan noting how isolation works for patients that are COVID-19 positive or suspected COVID-19 positive. Also, keep evidence of any reviews of quality assurance or compliance. These tasks contribute to preserving memory.

Memorialize the subject matter experts within your facility, including human resources and office manager personnel. If a deposition is later needed during litigation , you do not want to have to think back to who was working in 2020; you want to have that recorded. If possible, have a video of a day in the life at your facility or practice. It is so important, since memories fade, to get a context and to have a living example of how you functioned during this pandemic to 

 what it was like to deliver health care during a pandemic.

Remember, the strategy behind tactical risk management is that it is never too late to start. It will be more difficult to gather documents in the future. It will benefit the defense to have all of this information in 1 place, starting with your timeline; then connecting to all of your records and documentation; and finally preserving the memories of the actual people who are in charge of those decisions, creating the protocols, and following state federal guidelines with respect to the pandemic.

Does the typical malpractice insurance policy cover COVID-related claims?

Typically, yes, a medical professional liability policy covers what we call professional services, which is insurance company lingo for rendering medical care. However, most policies exclude willful or intentional conduct and many also exclude gross negligence.

 is the vice president of claims at Coverys. She is also a member of the International Association of Defense Counsel, the Professional Liability Underwriters Society, and serves as vice chairperson of the Professional Liability Foundation of Massachusetts

Does the typical malpractice insurance policy cover COVID-related claims? That question and more answered.

Physician Liability During COVID-19: What You Need to Know To Protect Your Practice

 in terms of the harm caused to individuals, the damage caused to property, and the financial implications for individuals and society. Between 2010-2014, an estimated 261,330 intentional fires were reported to US municipal fire departments each year, resulting in 440 deaths, and 1310 injuries, and the economic cost of fire setting was estimated to be as high as $328.5 billion per year.

 In the United States, 1 in 100 adults self-reported a lifetime history of deliberate fire setting; 38% of these fire settings persisted beyond the age of 15 years.

 Although estimations of the number of people who set fires within a population are almost certainly imprecise due to methodological limitations such as variations in study design, definition of fire setting used, data analysis techniques, ungeneralizable samples, and response bias, they do provide insight into the scale of the problem.

Various terminology, with somewhat different meanings, has been used within the literature to describe offending behavior that involves fire (

 are terms used to describe intentional fires set within specific contexts (eg, legal or psychiatric), 

 is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Comorbidity is common among adults who set fires. Common diagnoses include personality disorder, psychosis, substance dependence, and mood disorders.

 Reported prevalence rates of pyromania are relatively low, ranging between 0 to 10% of adults who set fires.

 Lower cognitive functioning, intellectual disabilities, and other developmental disorders (eg, autism) are also common, although exact prevalence varies widely depending upon the population sampled (ie, inpatient, community, prison samples).

Despite the development of reliable and valid assessment tools in other areas of offending behavior (eg, sexual offending), the systematic development of tools specific to fire setting has been slower to progress. Nevertheless, several tools have been developed to support the process of systematically collecting and collating clinical information from a range of sources (eg, self and informant reports, behavioral observations, file reviews and clinical assessments) in order to formulate risk and identify treatment needs and intervention plans for individuals who set fires (eg, the Tranah Firesetting Inventory,

 St Andrew’s Fire and Arson Risk Instrument,

 Northgate Firesetter Risk Assessment-2.0,

). These tools do not represent validated risk assessments for fire setting, however, a few fire-specific psychometric measures have been developed to assess fire-related factors (although they lack sufficient evaluation) (

Most recently, the properties of the Fire Interest Rating Scale, Fire Attitudes Scale and the Identification with Fire Questionnaire were analyzed using factor analysis and 4 clinically relevant constructs identified across the 3 scales (ie, the Four Factor Fire Scales): 

However, data collected to validate these measures was limited (eg, ungeneralizable/small samples). Nevertheless, despite fire specific measures not having undergone rigorous reliability and validity evaluations, they can still be used by experienced clinicians as part of a comprehensive assessment.

Those who engage in fire setting are often complex individuals with a diverse set of treatment or intervention needs warranting a specialist approach that reduces their risk of further offending. Most specialist treatment programs are underpinned by a 

approach, targeting a range of criminogenic needs and factors associated with fire setting, including cognitive distortions, poor problem solving, communication difficulties, self-regulation deficits, and relapse prevention. Treatment often includes a component on fire safety education and the consequences of fire setting, while also address­ing a range of associated interpersonal problems (eg, low self-esteem, social competence difficulties, and poor goal setting). 

 summarizes empirically evaluated treatment programs.

Existing interventions that target fire setting behavior in adults include an adapted version of the Fire Awareness Child Education UP (FACE-UP).

 More recently, a cognitive-behavioral group-based intervention for individuals with developmental disabilities called the Northgate Firesetters Treatment program was developed.

 Investigators reported follow-up data for 24 participants (16 men, 8 women) who completed the Northgate Firesetters Treatment Programme, between 4 years and 12 years, 9 months posttreatment. The majority of participants (n = 17) were living in community settings and only 1 female participant was reported to have set a further fire, although suspicions were raised concerning another 2 participants.

 Despite these positive findings, both of these treatment programs are grounded in theoretical perspectives that predate more recent advancements in the field (ie, Functional Analysis Theory,

). Furthermore, their effectiveness are limited in their comparability to other generic interventions, small sample sizes, and lack of robust evidence in terms of their effectiveness in reducing reoffending.

The Firesetting Intervention Programme for Prisoners (FIPP)

 and the Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO)

 are based on the latest comprehensive theory of fire setting: the Multi-Trajectory Theory of Adult Firesetting (M-TTAF).

 The M-TTAF integrates parts of existing psychological theory that are supported by empirical evidence including psychological vulnerabilities, developmental factors, cultural factors, social learning factors, biological factors, and contextual factors related to fire setting into a detailed multifactorial theory.

Following a pilot evaluation of the FIPP, positive findings were reported posttreatment on measures related to fire interest/problematic associations with fire, offence supportive attitudes (ie, fire specific, violent, antisocial), locus of control, and anger regulation, which were stable at 3 month follow-up.

 However, the evaluation of the FIPP was conducted solely with adult males in a prison environment; thus, its effectiveness for women and adults with 

intellectual and developmental disabilities

 has yet to be established. Consequently, the FIP-MO was developed to address fire setting and fire-related risk behaviors for both men and women across secure forensic psychiatric hospitals in the United Kingdom. Significant improvements on self-reported interests, beliefs and attitudes about fire, as well as improvement in anger expression.

It is important to note that due to the paucity of research on fire setting by adults with intellectual and developmental disabilities, the generalizability of the M-TTAF to such groups, and the interventions underpinned by it, has yet to be established. Further, despite evidence suggesting that between 0.4% to 43.6% of adults who set fires have intellectual and developmental disabilities,

 no treatment program to date has been rigorously evaluated for this population. Yet, there is evidence to suggest this small but important group have different characteristics and offence specific treatment needs requiring a 

 Nevertheless, the FIPP and FIP-MO represent the first standardized specialist interventions for individuals who deliberately set fires and have been subject to a multisite research evaluation, with results showing that they are effective in reducing some of the fire setters’ key deficits.

Evidence suggests general recidivism is as high as 60% among adults who set fires; reoffending with fire is much lwer with estimates between 4% and 16%.

 However, the operational definition of recidivism, study methodology, setting and sample populations vary widely. Nevertheless, recidivism has been largely associated with younger age, single relationship status, a diagnosis of personality disorder, a history of criminal offending, an interest in fire, and a number of attributes suggestive of childhood disturbance.

 Furthermore, reported length of stay in hospital for adults with intellectual and other developmental 

 and history of fire setting vary from 950 days to 1725 days.

 However, very few studies have included details pertaining to length of stay, which is inevitably effected by many confounding variables, such as mental health, engagement in treatment, previous offending history that are not accounted for within the data.

Whilst there have been significant advancements in our understanding of deliberate fire setting in recent years, further research is urgently needed to understand the etiology of fire setting and to further develop specialist assessment and treatment protocols. In particular, little is known about the relationship between cultural factors and fire misuse, gender-specific factors, or the needs of individuals with intellectual and/or other developmental disabilities. In addition, research on fac­tors that influence the maintenance and desistance process for fire setting will aid the construction of valid and reliable risk assessment tools and ensure individualized treat­ment approaches are taken and practice is evidence based. Focusing on these areas will also ensure that treatment efforts evolve to meet the needs of individuals who have set fires regardless of the treatment setting.

is a postgraduate researcher at the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent, UK. 

 is a lecturer in forensic psychology at theSchool of Psychology, Victoria University of Wellington, New Zealand, and Honorary Lecturer in Forensic Psychology at the University of Kent, UK. 

is a chartered psychologist and lecturer in forensic psychology and intellectual and developmental disabilityat the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent. Ms Collins and Dr Barnoux have nothing to disclose regarding this article. Dr Tyler is involved in providing training and evaluating the FIPP and FIP-MO programs and has received funding from Fire and Emergency New Zealand to conduct research on their Fire Awareness Intervention Programme (FAIP) for youth.

1. Home Office. Fire statistics data tables. May 14, 2020. Accessed July 23, 2020. 

https://www.gov.uk/government/statistical-data-sets/fire-statistics-data-tables

2. Campbell R. Intentional fires. National Fire Protection Association. July 2017. Accessed July 23, 2020. https://www.nfpa.org/News-and-Research/Data-research-and-tools/US-Fire-Problem/Intentional-fires

Accessed July 23, 2020. http://www.stoparsonuk.org/arson/documents/Arson-Prevention-Forum-Booklet.pdf

4. Zhuang J, Payyappalli VM, Behrendt A, Lukasiewicz K. 

. National Fire Protection Association. October 2017. Accessed July 23, 2020. https://www.nfpa.org/News-and-Research/Data-research-and-tools/US-Fire-Problem/Total-cost-of-fire-in-the-United-States

5. Blanco C, Alegria AA, Petry NM et al. Prevalence and correlates of fire setting in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). 

6. Vaughn M, Fu Q, DeLisi M, et al. Prevalence and correlates of fire setting in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions. 

Diagnostic and Statistical Manual of Mental Disorders, DSM-V. 

8. Bell R, Doley R, Dawson D. Developmental characteristics of adults who set fires: are recidivist offenders distinctive? 

9. Geller JL, Bertsch G. (1985). Fire-setting behavior in the histories of a state hospital population. 

10. Lindberg N, Holi MM, Tani P, Virkkunen M (2005). Looking for pyromania: characteristics of a consecutive sample of Finnish male criminals with histories of recidivist fire-setting between 1973 and 1993. 

11. Lees-Warley G, Rose J. What does the evidence tell us about adults with low intellectual functioning who deliberately set fires? a systematic review

. International Journal of Developmental Disabilities

12. Tranah T, Nicholas J. Interventions for young people with intellectual disabilities who commit arson. 

13. Taylor JL, Thorne I, Slavkin ML. Treatment of fire-setting behaviour. In: Lindsay WR, Taylor JL,Sturmey , eds.

 Offenders with Developmental Disabilities

14. Long CG, Banyard E, Fulton B, Hollin CR. (2014). Developing an assessment of fire-setting to guide treatment in secure settings: The St Andrew's fire and arson risk instrument (SAFARI). 

15. Taylor JL, Thorne I. Northgate firesetter risk assessment. Unpublished manual. Northgate and Prudhoe NHS Trust; 2005.

16. Taylor JL, Thorne I, Robertson A, Avery G. (2002). Evaluation of a group intervention for convicted arsonists with mild and borderline intellectual disabilities. 

17. Murphy G, Clare I. Analysis of motivation in people with mild learning disabilities (mental handicap) who set fires. 

Firesetting: Addressing Offending Behavior.

 Redcar and Cleveland Psychological Service; 1997.

19. Gannon TA, Ó Ciardha C, Barnoux MFL. The Identification with Fire Questionnaire. CORE-FP, School of Psychology, University of Kent; 2011.

20. Gannon TA, Barrowcliffe E. Firesetting in the general population: The development and validation of the Fire Setting and Fire Proclivity Scales. 

21. Ó Ciardha C, Tyler N, Gannon TA. (2015). A practical guide to assessing adult fire setters’ fire-specific treatment needs using the Four Factor Fire Scales. 

22. Hayes A. Climbing the ladder of reform. 

23. Taylor JL, Robertson A, Thorne I, Belshaw T, Watson A. Responses of female fire‐setters with mild and borderline intellectual disabilities to a group intervention. 

Journal of Applied Research in Intellectual Disabilities. 

24. Taylor JL. Roots, referrals, risks and remedies for offenders with intellectual disabilities. Paper presented at: A Risky Business, BPS conference. October 2014. University of Manchester, UK.

25. Jackson H, Glass C, Hope S. (1987). A functional analysis of recidivistic arson. 

26. Fineman KR. Firesetting in childhood and adolescence. 

27. Fineman KR. A model for the qualitative analysis of child and adult deviant behavior. 

The Firesetting Intervention Programme for Prisoners (FIPP). 

Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO) Version 2.0.

 CORE-FP. University of Kent and Kent Forensic Psychiatry Services, NHS; 2014.

30. Gannon TA, Ó Ciardha C, Doley RM, Alleyne E. The Multi-Trajectory Theory of Adult Firesetting (M-TTAF). 

31. Gannon TA, Alleyne E, Butler H, et al. Specialist group therapy for psychological factors associated with fire setting: Evidence of a treatment effect from a non-randomized trial with male prisoners. 

32. Tyler N, Gannon TA, Lockerbie L, Ó Ciardha C. An evaluation of a specialist fire setting treatment programmed for male and female mentally disordered offenders (the FIP-MO). 

33. Ritchie EC, Huff TG. Psychiatric aspects of arsonists. 

34. Dickens G, Sugarman P, Ahmad F, Edgar S, Hofberg, K, Tewari S. Characteristics of low IQ arsonists at psychiatric assessment. 

35. Alexander RT, Chester V, Green FN, Gunaratna I, Hoare S. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment outcomes. 

Journal of Intellectual and Developmental Disability

36. Rice ME, Harris GT. Firesetters admitted to a maximum security psychiatric institution: Offenders and offenses. 

37. Ducat L, McEwan TE, Ogloff JR. An investigation of fire setting recidivism: factors related to repeat offending. 

The development of an actuarial model for arson recidivism

39. Dickens G, Sugarman P, Edgar S, Hofberg K, Tewari S, Ahmad F. Recidivism and dangerousness in arsonists. 

The Journal of Forensic Psychiatry & Psychology

Gunaratna I, Hoare S. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment outcomes

Journal of Intellectual and Developmental Disability.

41. Edwards MJ, Grace RC. The development of an actuarial model for arson recidivism. 

42. Dickens G, Sugarman P, Edgar S, et al. Recidivism and dangerousness in arsonists. 

The Journal of Forensic psychiatry & Psychology

43. Alexander RT, Chester V, Green FN, et al. Arson or fire setting in offenders with intellectual disability: clinical characteristics, forensic histories, and treatment out-comes. 

44. Taylor JL, Thorne I, Robertson A, Avery G. Evaluation of a group intervention for convicted arsonists with mild and borderline intellectual disabilities. 

Fire setting is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Understanding Adult Fire Setting, Pyromania, and Arson

American Academy of Psychiatry and the Law

 (APPL) recently presented James L. Knoll IV, MD, with the Seymour Pollack Award, for notable achievements in the education and teaching of forensic psychiatry. The award was presented at the 

Knoll, director of Forensic Psychiatry and professor of Psychiatry at 

State University of New York (SUNY) Upstate Medical University

 in Syracuse, NY, said he was honored and humbled to receive the award. He added that it was the support of AAPL, SUNY Upstate, and New York State’s Office of Mental Health that has allowed him the opportunity to pursue his passion for teaching, writing, and forensic investigation. He added that the award further inspires him to explore the interface between psychiatry and the law, as well as train the next generation of forensic psychiatrists.

 (2010 to 2014), is a nationally recognized expert in forensic psychiatry who has made significant contributions to the research on mass murder and violence. He is chair of the Threat Assessment Subcommittee of the Syracuse School Safety Task Force and has spoken nationally and consulted with law enforcement, including the Department of Justice, National Institute of Justice, and the Federal Bureau of Investigation (FBI).

Knoll is one of only a handful of psychiatrists in the country to be accepted as an associate fellow of the 

International Criminal Investigative Analysis Fellowship

; the fellowship meets regularly at the FBI National Academy in Quantico, VA. Before moving to New York, he was the director of Psychiatric Treatment Services for the New Hampshire State Prison system, where he was responsible for the oversight of New Hampshire’s insanity acquitee patient population. Knoll has served as an expert witness in cases of national prominence, such as the “Cleveland Strangler” serial murder case of Anthony Sowell, and the “137 shots” Cleveland Police shooting case. He has served as a stalking risk assessment consultant for law enforcement and victims of stalking for more than 20 years.

A prodigious writer, Knoll’s works include:

; and the series “Tales from the New Asylums” can be found 

 (where he served as co-editor and contributing editor).

• Textbooks of forensic psychiatry, such as: 

Principles & Practice of Forensic Psychiatry

The Oxford Textbook of Correctional Psychiatry

Clinical Assessment of Malingering and Deception.

• A vast compendium of articles on the Jonestown mass murder-suicide (

1. 2020 AAPL Annual Meeting Livestream Program. October 7-18 & 24-25, 2020. Accessed November 6, 202. https://www.aapl.org/docs/pdf/20200930131518616.pdf

Editor in chief emeritus of Psychiatric Times, James L. Knoll IV, MD, was recently recognized for notable achievements in the education and teaching of forensic psychiatry. 

National Leader in Forensic Psychiatry Receives Prestigious Award

SPECIAL REPORT: FORENSIC PSYCHIATRY, PART II

-Special Report Chair: James L. Knoll IV, MD

Psychopathy is a personality disorder characterized by lack of empathy, grandiosity, shallow affect, deceitfulness, impulsivity, irresponsibility, and disregard for the well-being or rights of others. Few syndromes in medicine have carved as deep of a niche in human cultural thought as the one occupied by psychopathy. The mythos of the psychopath is born of both in extremis of its infamous case examples and of past deficiencies in the empirical research. However, the scientific landscape for psychopathy has expanded significantly over recent decades, and discourse around treatment has become more optimistic.

, sociopath, and antisocial are often used interchangeably by clinicians, they are not equal. Psychopathy and sociopathy both describe the same personality syndrome. However, many experts identify them as separate but overlapping entities with distinct etiological mechanisms.

 Psychopathy remains empirically the better described of the 2 and is the term most often used to denote the cluster of personality traits in question.

The term antisocial is often clinically used as a short-hand reference to the DSM-V diagnosis of antisocial personality disorder (ASPD), which is based almost entirely on behaviors. A lack of empathy and disregard for the safety of others are neither necessary nor sufficient for the diagnosis. In contrast, psychopathy is a set of personality traits which may or may not be associated with obvious misconduct. It must not be assumed that an individual who meets diagnostic criteria for ASPD also has psychopathic/sociopathic personality traits, because this is often not the case.

Psychopathy seems to have some degree of hereditability, although genetic and epigenetic factors are not entirely sufficient to account for disorder. A prevalence of between 15% to 25% has been described in incarcerated populations, and approximately 1% in the general population, with a male to female ratio of about 3:1.

 One study found 4% of corporate managers exhibited significant psychopathic traits.

Psychopathy has been associated with deficits in multiple cognitive domains, including attention, judgement of risk and reward, and the emotional processing.

 The brains of individuals with psychopathy have identifiable structural and functional differences from the brains of those without, which appear to account for some of the cognitive and behavioral manifestations of the disorder. Reduced gray matter volumes in the amygdala and multiple areas of the prefrontal cortex have been described. On fMRI, psychopathic brains have exhibited dysfunctional activity in the default mode network, including limbic and paralimbic structures.7 People with psychopathy have also been found to exhibit impaired communication between the visual prefrontal cortex and the amygdala.8 Increased activity in the ventral striatum in the context of reward expectancy has also been described in association with criminal activity among those with psychopathy.

Unsurprisingly, psychopathic personalities are identified more frequently in forensic than community settings. The odds of encountering a patient with psychopathy in the general outpatient setting, however, are significant. As with other personality syndromes, these patients often present to a psychiatrist seeking treatment for a comorbid condition, and only through careful assessment does the character pathology become apparent to the clinician. Psychopathy is most often associated with substance use disorders and with other Cluster B personality syndromes, such as narcissistic personality disorder.

The impairment caused by this condition should not be underestimated. In the forensic setting, this is usually evident. In the community, however, impairment may be less conspicuous. Deficits in attention and risk-reward assessment may result in harmful financial decisions, poor judgement at work, gambling, and other impulsive behaviors. Callousness, deceitfulness, and grandiosity may lead to brief and combustive relationships. One may encounter a patient who cannot seem to maintain employment despite ability and qualification; instrumentally engages socially with others and is undisturbed when relationships fall apart; and exhibits a pattern of poor decision making accompanied by a psychological scotoma for personal responsibility. Psychopathic personality traits may also present adaptively in one domain of life, such as a boardroom

, and maladaptively in another, such as marriage.

While incarceration is the definitive “treatment” for some, psychopathy exists on a spectrum like any other mental disorder; more recent research suggests the condition is capable of responding to treatment. 

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