Investigating psychopathic personality disorder in women Mette Kreis, M.Sc. Postgraduate Research Student Glasgow Caledonian University Scottish Personality Disorder Network Workshop, Aberdeen, 29 May 2008

Workshop outline 1. Psychopathy and gender 2. Introduction to the CAPP 3. Interactive CAPP activity 4. Presentation of research findings 5. Questions and discussion

Psychopathy and gender Background for PhD research

Psychopathy Severe PD Arrogant and deceitful interpersonal style Deficient affective experience Impulsive and irresponsible behavioural style

Measuring psychopathy Psychopathy Checklist-Revised (PCL-R; Hare, 1991, 2003)  2 Factor model  3 Factor model (Cooke & Michie)  4 Factor model(s) Psychopathy Checklist: Screening Version (PCL:SV; Hart et al., 1995)

Psychopathy in men Serious offending Future violence Recidivism Difficult to treat Difficult to manage

Psychopathy in women Less prevalent Inconsistent violence Inconsistent recidivism Interpersonal violence High co- morbidity Poor treatment response

Problems with PCL-R… Mainly validated with male offenders Not content validated on women Different factor structure across gender Differential expression of some items PCL-R reliable with women? PCL-R valid with women?

No conceptual framework for women No measurement framework BACK TO BASICS! Forouzan & Cooke (2005)

Introduction to the CAPP The Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie)

ComprehensivePersonalityDynamicChange

PPD Domain SymptomAdjectival descriptorsBehavioural indicators

Semi-structured interview File review Staff behavioural rating scale Aid formulation, not diagnose! CAPP-IRS

Interactive CAPP activity

1. Match symptoms with domains 2. Which symptoms do you feel are most relevant to psychopathy? 3. Which (if any) do you feel are most relevant to psychopathy in men and in women?

Presentation of research findings Prototypical analysis of psychopathy across gender

Study aims Map domain of symptoms of psychopathy in women Content validate the CAPP across gender

BIRD FliesWingsFeathers ?

Participants Mean age = 43 Forensic = 10PPD = 10 Mostly psychologists CliniciansMale clients 101 international mental health professionals 55 men46 women

Measure 6) LACKS EMOTIONAL DEPTH How prototypical is this symptom of psychopathy? Low prototypicality High prototypicality Is this symptom more prototypical of psychopathy… IN MEN Equally prototypical IN WOMEN

Prototypical Psychopathy Unempathic Self-centred Uncaring Deceitful Manipulative Unreliable Self-aggrandizing Insincere Lacks remorse Sense of entitlement Self-justifying Lacks emotional depth Results: General ratings

Self-aggrandizing (1.02) Sense of invulnerability (.99) Domineering (.77) Reckless (.73) Aggressive (.71) Lacks emotional stability (.66) Unstable self-concept (.60) Manipulative (.23) Results: Gender differences

Self-centred Deceitful Uncaring Manipulative Unreliable Insincere Lacks remorse Sense of entitlement Self-justifying Lacks emotional depth Unempathic More manipulative? More emotionally unstable? More unstable self-concept? Prototypical psychopathic woman?

What do the results mean? More men are psychopathic? Or are we just less able to recognise the disorder in women? Assessor gender bias? Men are aggressive, women are emotionally unstable Real gender differences in psychopathy?

Conclusions CAPP promising tool for assessing psychopathy across gender More marked gender differences in manifestation of symptoms? Gender awareness in assessment of psychopathy is essential!

Practical implications for assessing psychopathy in women Do not expect to see the same presentation of psychopathy in women as in men Be aware of your own potential male “psychopathy prototype” bias For now, use assessment tools to aid formulation not diagnose!

Questions and discussion

Questions 1. What mechanisms might operate to create gender differences in psychopathy? (or in PD generally) 2. Why would psychopathy be different from other PDs in terms of gender differences? (Hare says it is!)

Mette Kreis Glasgow Caledonian University Psychology Department Cowcaddens Road Glasgow, G4 0BA Tel: Fax: