Psychopathy Chapter 4

Nature of the Psychopath debate about the nature of psychopathy revealed in the various labels for it Antisocial personality disorder, dyssocial personality, sociopathy Cleckley (1941) criteria: superficial charm, absence of “nervousness”, unreliability, untruthfulness and insincerity, lack of remorse or shame, inadequately motivated , poor judgment and failure to learn by experience, general poverty in major affective reactions, specific loss of insight, unresponsiveness in interpersonal relations, and failure to follow any life plan

Common Definition: the Psychopathy Checklist-Revised 20 item symptoms rating scale requires clinical/expert judgment data obtained from 2 primary sources review of collateral information (required) interview/observation (recommended)

PCL-R: Factor 1 Glibness/superficial charm Grandiose sense of self-worth Pathological lying Conning/manipulative Lack of remorse or guilt Shallow affect Callous/lack of empathy Failure to accept responsibility for own actions

PCL-R: Factor 2 Need for stimulation/proneness to boredom Parasitic lifestyle Poor behavioral controls Early behavioral problems Lack of realistic, long-term goals Impulsivity Irresponsible Juvenile delinquency Revocation of conditional release

Additional PCL-R Items Promiscuous sexual behavior Many short-term marital relationships Criminal versatility

Types of psychopathy Primary psychopathy Secondary psychopathy Prototypical psychopathy Antisocial acts, irresponsible, lacking empathy, superficially charming Secondary psychopathy Not inherent, cause lies in factors such as low intelligence, some sort of social disadvantage, and impulsivity driven by anxiety

Antisocial Personality Disorder (APD) and Psychopathy APD is listed formally in the DSM-IV TR but the PCL-R items are listed under the associated features APD diagnostic criteria are more behavioral while psychopathy criteria are behavioral and interpersonal/affective Prevalence rates for APD are higher in correctional samples and the community than psychopathy

Relationship of Criminal Behavior and Violence General Violence and Criminal Behavior Single biggest risk factor for violence Commit more violent crimes Commit proportionally more instrumental violence as compared to reactive More likely to inflict serious harm but less likely to murder Different motivations for violence More likely to victimize strangers Burnout not associated with later violence

Sexual Violence May have increased risk for sexual violence Sexual promiscuity Lack of responsiveness in relationships Predictive of sexual recidivism Higher PCL-R scores commit more frequent and more severe levels of violent sexual offenses 10-15% of child molesters and 40-50% of rapists are psychopaths

Violence in Civil Psychiatric Patients Risk of violence much lower than general offenders Importance of psychopathy civil psychiatric patients is less obvious Psychopathy is a strong predictor of violence even in less violent samples

Violence in Domestic Violence Perpetrators Psychopathy of offenders with a history of domestic violence might be useful in predicting future violence Studies differ in terms of domestic abusers or one who has committed domestic violence offenses Relationship between psychopathy and domestic violence is not yet clear

What else do we know about psychopathy? Interpersonal/Affective Cognition/Learning Biological Basis Treatment

Interpersonal/Affective Deficits in non verbal emotional processing Language appears to be superficial Seem to lack affective cognitions Exhibit less fear and anxiety Pseudo/sham emotions Pathological deceit Con and manipulate people

Cognition/Learning Passive-avoidance learning failure to learn to from behaviors that punish general cognitive impulsiveness and hypersensitivity to rewards Narrowed attentional focus specific deficit in automatic processing that results in unresponsiveness to contextual cues

Biological basis May demonstrate reduced fear in anticipation of unpleasant or painful stimuli Do not exhibit global neuropsychological deficits Exhibit functional brain deficits Cerebral cortexes are less active Fail to use certain parts while processing emotional stimuli

Treatment of Psychopaths May be less likely to form emotional attachments needed for effective psychotherapy Stay in program for shorter periods of time Less motivated Violence for treated psychopaths (77%) is higher than untreated psychopaths (55%) Gives them insight into the emotions of others, making them more “effective” criminals Recent studies are challenging the beliefs that treatment is ineffective for psychopaths

Special Groups Women & Psychopathy Probably valid as a construct Prevalence 11-23% Mean PCL-R score for incarcerated women = 13-18 Factor structure appears to be different for women than men, may exhibit symptoms differently Relationship to recidivism not shown to be as strong as with men, but may be related to rapid recidivism

Ethnic and Cross Cultural Differences Comparisons between Caucasian and African-American offenders Preliminary evidence is not suggestive of dramatic differences There are significant different cross-culturally Lower prevalence rates and mean PCL-R scores outside of North America

Children and Adolescents Need to be careful when extended the construct to children and adolescents PCL:YV is the comparison measure Appears to be a viable construct with similar properties as it does in adults Debate about appropriateness of diagnosis

Legal and Ethical Implications Significant increase in the admission of the PCL-R into courts Discrepancy between legal and clinical definitions of psychopathy Capital sentencing Represents the most prevalent use of psychopathy Only a small correlation between PCL-R score and institutional violence and Profound impact on jurors