Not everything is as it seems: RO DBT and overcontrolled disorders in forensic settings

Abstract

On the night of Sunday, October 1, 2017, 64-year-old Stephen Paddock of Mesquite, Nevada, opened fire on a crowd of concert-goers at the Route 91 Harvest music festival on the Las Vegas Strip in Nevada, leaving 58 people dead and 851 injured. About an hour after Paddock fired his last shot, he was found dead in his hotel room from a self-inflicted gunshot wound. Despite perpetuating the deadliest mass shooting committed by an individual in the United States, police investigators reported that Paddock had no prior criminal record that would indicate he was dangerous. Plus, the shooting was carefully planned (e.g., researching SWAT tactics, renting other hotel rooms overlooking outdoor concerts, and investigating potential targets in other cities). Paddock was twice divorced and single at the time of the shooting, with no known children. His ex-wife described him as intelligent and great with numbers. His doctors described him as "odd" and showing "little emotion". To date his motive remains unknown. Contrary to common assumptions that all (or most) violent acts stem from poor impulse control, emotion dysregulation, and low distress tolerance (i.e. undercontrol), both prior and emerging research has identified an overcontrolled violent offender subtype, for whom acts of violence are rare but seem to be disproportionately more violent and planned compared to undercontrolled offenders. For example, the Congressional Research Service (CRS; Bjelopera, Bagalman, Caldwell, Finklea, & McCallion, 2013) recently released a report that described the most common characteristics and behaviors likely to be seen in perpetrators of public mass shootings based on interviews and data from 78 public mass shootings in the U.S. since 1983. Findings revealed that most perpetrators act alone and carefully planned in advance (see similarities in the description of the Las Vegas shooter above). They reported pervasive feelings of social persecution and ostracism-and were described by others as a loner. Rumination about real or imagined rejections, envy, bitterness, resentment, and revenge were common (CRS; Bjelopera et al., 2013). The Las Vegas gunman (Paddock) described above appears to fit much of this profile. Yet, our understanding of the overcontrolled violent offender and the type of violence associated with moral certitude, excessive inhibitory control, planning ahead, envy, bitterness, and desires for revenge remains poorly understood. The aim of this paper is to outline how recent research in forensic settings may provide a potential way forward to the conundrum posed by the Las Vegas gunman and other violent offenders sharing similar overcontrolled characteristics. The paper outlines how we have used RO DBT to reexamine the diagnostic features of incarcerated offenders and also describes the developmental trajectory our team experienced implementing RO DBT in a maximum-security forensic hospital.