Do clinicians weight risk factors differently in men and women when formulating violence risk judgments?

Violence risk assessment has serious implications for legal decision making. Thus, it is critical to identify potential sources of bias that may disadvantage evaluees. The present study examined whether the strength of the relationship between violence risk factors and judgments of violence risk was moderated by patient sex when employing the Historical-Clinical-Risk Management-20, Version 3, a widely used instrument for assessing violence risk.

We hypothesized that seven static risk factors-Violence (H1), Other Antisocial Behaviors (H2), Problems With Relationships (H3), Substance Use (H5), Personality Disorder (H7), Traumatic Experiences (H8), and Violent Attitudes (H9)-would differ by patient sex in average presence ratings, and the strength of associations between risk factor presence and severity and violence risk judgments would be moderated by sex.

Civil psychiatric patients (N = 151) were rated using the Historical-Clinical-Risk Management-20, Version 3, by graduate students through interviews and records review. Risk factor presence and relevance and summary risk ratings were converted to a 3-point ordinal scale; a severity rating was calculated by multiplying Presence × Relevance.

Men scored higher on the presence of Violence (d = .43), Antisocial Behaviors (d = .52), Substance Use (d = .35), and Violent Attitudes (d = .67), whereas women scored higher on Traumatic Experiences (d = .62). Moderation analyses showed generally stronger associations between risk factors (both presence and severity) and violence risk judgments for men compared to women in models predicting Case Prioritization and Imminent Violence. No significant interaction effects emerged in models predicting Serious Physical Harm.

Both the presence and severity of several hypothesized risk factors had less influence on violence risk judgments for women. One interpretation of these findings is that clinicians place less emphasis on these risk factors in making overall risk judgments (i.e., a potential sex bias), although other possible explanations exist. The implications of these results are discussed. (PsycInfo Database Record (c) 2026 APA, all rights reserved).