Field reliability of the Psychopathy Checklist-Revised among life-sentenced prisoners in Sweden: A follow-up study

The Psychopathy Checklist-Revised (PCL-R) is widely used in forensic and clinical contexts, yet its reliability in high-stakes legal settings remains uncertain. In Sweden, it is routinely applied in court-ordered assessments for life-sentenced prisoners seeking commutation, making score consistency crucial. Sturup et al. (2014) found lower interrater reliability in this context compared with controlled research studies. This study examines whether reliability has increased since their publication and evaluates the incremental contribution of these assessments to structured professional judgment risk classifications.

Due to increased training and experience, we expected improved reliability compared with that of Sturup et al.'s study.

We estimated interrater reliability of PCL-R total and facet scores using intraclass correlation coefficients (ICC) for 76 life-sentenced prisoners (75 males, one female) who had participated in 217 risk assessments by the Swedish National Board of Forensic Medicine (2013-2023). Associations between PCL-R, Historical-Clinical-Risk Management-20, and structured professional judgment risk classifications were tested with ordinal mixed-effects models.

The results mirror those of Sturup et al., indicating no substantial improvement in interrater reliability over the last decade. Specifically, the PCL-R total score had an ICC = .73, and the facet-level ICCs were .88 (antisocial), .65 (interpersonal), .59 (affective), and .59 (lifestyle). Only 27% of score differences between assessments fell within one standard error of measurement, indicating more variability than expected based on the manual. Moreover, Historical-Clinical-Risk Management-20 scores were better predictors of the risk classification than the PCL-R scores, indicating limited incremental value of the latter.

Reliability of the PCL-R in Swedish forensic assessments has not improved over the past decade and remains moderate. Moreover, structured violence risk factors may weigh more heavily in final judgments than psychopathy ratings. While this reliance may limit the impact of variability in PCL-R scoring, caution is warranted when using psychopathy assessments in high-stakes legal decisions. (PsycInfo Database Record (c) 2026 APA, all rights reserved).