Necessary to the effective management of both medical and law enforcement personnel in the hostage and barricaded environment is an understanding of the procedures utilized and skills available. Negotiations in these environments, to include medical facilities, are never “hit or miss” attempts. Serious skill development is required and effective team function is the rule.

Since the development of modern police hostage negotiations techniques in the 1970s, several typologies have been offered for categorizing hostage takers (1, 2, 3, 4, 5, 6, 7 and 8). For example, some frameworks are based on whether the perpetrator has a mental disorder or is a criminal (in some cases, including an additional category for terrorists); still others emphasize whether the victim is a stranger versus a family member. Negotiation strategies based on these categorizations are utilized by hostage negotiators in guiding their interventions. In recent years, conceptualizations of the hostage taker have been modified and restructured. The newer conceptualizations also include subjects in domestic crises (9, 10, 11 and 12). In all cases, an initial assessment and subsequent diagnostic profile is essential for defining the resolution strategies.

One accepted typology for discriminating among hostage takers involves two major categories and at least four subcategories (13, 14, 15 and 16). As reported in Table 23.1, Psychotic Disorders are distinguished from personality or character disorders. Psychotic Disorders are further divided into Paranoid Schizophrenia and Bipolar Disorder. Despite its absence from the DSM-IV (18), the term manic-depression has been retained as a useful working diagnosis for hostage negotiators (3). Generally, hostage negotiators have been confronted with the manic-depressive individual in the depressed state (3).

The typology presented is not intended to be exclusive or exhaustive. As with any attempt to understand human behavior, alterations are made as needed to improve procedures and results. Diagnostic and profiling skills are emphasized and expected. While not always achieved, precision is the goal in all instances.

Character Disorders are subdivided into the Inadequate Personality and the Antisocial Personality. Even though inadequate personality is not an accepted DSM-IV diagnosis (18), it has demonstrated usefulness in discriminating among hostage takers.

As shown in Table 23.1, field diagnoses inform negotiation strategies. For example, the approach effective with
the highly depressed and suicidal individual may prove much less useful with the psychotic or antisocial subject. Although there are still some who take the “shotgun” approach to negotiations, the more refined the diagnosis and understanding of the subject involved, the more accurate and precise the negotiation strategies can be. For instance, although problems sustaining effective work relationships are common to inadequate and antisocial personalities, knowing that the underlying difficulties are vastly different in these subjects can be very useful. The overwhelming nature of the work environment for the inadequate personality is quite different from a work environment in constant turmoil due to the actions of the antisocial subject. Whereas the former frequently quits the job, the latter often gets fired. Understanding such nuances may help to select strategies in negotiating with these individuals. For example, the inadequate personality may need the reassurance of the negotiator that he is doing the best that he can despite his sense of repeated failures. The antisocial personality may need to be approached with ego-enhancing statements that reinforce his self-concept. For instance, it might be suggested that it is the employer’s fault, not the subject’s, that he was fired.