This article briefly discusses the historical development of the constructs of paraphilia and psychopathy. An overview of recent developments in the assessment of these constructs for legal purposes is also provided. The historical, clinical, legal, and ethical obligations of clinicians who work with persons suffering from paraphilias and co-morbid psychopathy is then reviewed. An emphasis of the current article is integrating recent developments in the construct of psychopathy into a discussion of sex offender risk assessment and treatment. The co-morbidity of psychopathy and paraphilias as factors in predicting risk of recidivism is reviewed. The need for practitioners to remain cognizant of language requirements in both legal and clinical contexts is addressed. Finally, this article reviews the legal history of sex offender legislation and its evolution into current United States Supreme Court jurisprudence.

Psychopathy is an important construct in adult risk assessment resulting from strong associations to antisocial behavior and criminal recidivism. A recent trend is the downward extension of psychopathic traits to explain juvenile violence. Applying the concept of psychopathy to youthful offenders has great potential; however, its application to adolescence is fraught with uncertainty. This article discusses how the search for causes of violence along with the changing juvenile justice system have encouraged psychopathy to be used for informing policies related to the assessment and treatment of juvenile offenders. Based on established research and clinical practice, we make the case that if applied judiciously, psychopathy can be a critical component in identifying youth most at-risk for short-term violence.

For more than a decade, researchers and practitioners have generally accepted a two-factor model for the Psychopathy Checklist-Revised (PCL-R) composed of core personality features and an antisocial lifestyle. Very recently, Cooke and Michie (2001) proposed a three-factor solution that divided the core personality features into two dimensions while eliminating antisocial behavior. This study of male, mentally disordered offenders (N = 96) directly compared factor models via confirmatory factor analysis (CFA). When using testlets to combine theoretically similar items into single ratings, the nested three-factor model was an excellent fit. Of importance, the development of a four-factor model with the inclusion of antisocial items also produced an excellent fit. Combined with recent research, these findings have important ramifications for the construct validity of the PCL-R.

Etiological models of life-course persistent offending often emphasize behavioral explanations. Suggestions that persistent offenders have psychopathy ignore the distinct non-behavioral features of the psychopathy disorder. Using a three-factor model of the PCL-YV and cluster analysis with 259 incarcerated adolescents, we identified four distinct juvenile subtypes on the basis of affective, interpersonal, and behavioral dimensions. Prospective and retrospective comparisons of antisocial behavior patterns found the cluster comprising all three psychopathy dimensions to be the most chronic and severe. Impulsive features alone were strongly associated with severe antisocial behaviors retrospectively, but not prospectively. Findings rebut the proposal that disruptive behavioral and impulsive symptoms can identify "fledgling psychopaths." Assessments that disregard callous-unemotional traits will likely result in high false positive rates among serious adolescent offenders. Implications for developmental models of chronic offending are discussed in light of the need for further follow-up into adulthood.