This study provides an elaborated view of the types of high-risk patients identified by the multiple Iterative Classification Tree (ICT; Banks et al., in press). In particular, because clinicians must assess and treat patients before they are involved in violence, the investigation focuses on identifying subtypes of high-risk patients rather than violent patients in order to determine whether there are meaningful subtypes of patients at high risk for violence. Data were obtained from interviews with 165 patients identified as at risk by the multiple ICT in the MacArthur Risk Assessment Study (Monahan et al., 2001). Overall, these high-risk patients are best classified into 1 of 3 groups: (a) alpha patients (48%), who generally are depressed and abuse drugs heavily, but manifest multiple core traits of psychopathy and have extensive histories or arrest, including those for property crimes; (b) beta patients (38%), who typically are dysphoric, dependent on alcohol and other drugs, and sensitive to personal problems; and (c) delta patients (14%), who typically are delusional, have less drug and alcohol involvement, often experience command hallucinations, and have histories of intensive treatment. These 3 groups are largely consistent with hypothesized subtypes. Moreover, they were identified by applying multiple methods of cluster analyses, integrating the most stable results to develop a consensus cluster solution, and validating that solution on external variables. In short, the groups make theoretical sense, have some sound empirical grounding, and have implications for future research and treatment development efforts. For example, the demonstration that these 3 groups appear to exist provides direction for the next set of advances in risk management and intervention with particularly high-risk patients. Specifically, it provides a framework for systematically investigating the differential effects of particular types of interventions with these patients. Risk assessment and management requires this richer, more differentiated view of high-risk patients to achieve its potential.