Week 7: Psychopathy

• Psychopathy is a construct that has been recognized since the early 1800s at which time Pinel described the condition as manie sans delire (insanity without delirium)

• Since that time, many others have recognized that some individuals seemingly have no conscience and appear to look out for only themselves and to have wanton disregard for others

• Hervey Cleckley, The Mask of Sanity (1941), described the psychopath as an individual who was characterized by 16 different traits: superficial charm and good intelligence; absence of delusions and other signs of irrational thinking; absence of 'nervousness' or other psychoneurotic manifestations; unreliability; untruthfulness and insincerity; lack of remorse or shame; inadequately motivated antisocial behavior; poor judgment and failure to learn by experience; pathological egocentricity and incapacity for love; general poverty in major affective reactions; specific loss of insight; unresponsiveness in general interpersonal relations; fantastic and uninviting behavior with drink and sometimes without; suicide rarely carried out; sex life impersonal, trivial, and poorly integrated; failure to follow any life plan

• These Cleckleyan criteria can be reduced to five factors: (1) an inability to develop warm, genuine relationships with others, a lack of empathy and a callous disregard for the rights and feelings of others; (2) an unstable, transient lifestyle, with an absence of long-term commitments or plans; (3) a general inability to accept responsibility for persistent antisocial behavior; (4) an absence of clinically significant intellectual and psychiatric problems; (4) and the presence of weak or unstable behavioral controls

• McCord & McCord (1964) described the "loveless, guiltless" nature of the classic criminal psychopath

• Hare's work stemmed from the work of Cleckley and the PCL and PCL-R (and the newest revision) have been derived through both theoretical and empirical methodology

• Talking only about CRIMINAL psychopaths here; probably the very best psychopaths are those that have not been caught and perhaps do not commit criminal activity (although doubtful); may be in trusted and prestigious positions of power where they are able to manipulate people without appearing as if they are doing so

Psychopathy and APD

• There is good agreement concerning the key features of psychopathy, according to research conducted with psychiatrists, psychologists, criminal justice personnel, experimental psychopathologists, and even the lay public

• Discuss the evolution of the APD criteria from DSM-II through DSM-IV; a move away from the 2-factor model of psychopathy and a focus in on the behavioral components of psychopathy (antisocial personality disorder)

• The DSM-III, DSM-III-R, and DSM IV criteria for antisocial personality disorder represent a radical departure from clinical tradition (DSM-I and DSM-II) as they focus mainly on antisocial behaviors (Factor 2) based on the assumption that clinicians cannot validly or reliably assess interpersonal/affective characteristics (Factor 1)

• Dissatisfaction with APD as per DSM-III and higher was a major motivating factor for the development of the PCL

• Psychopathy encompasses an emotional component in addition to the behavioral component

• Only about 15-25% of incarcerated offenders meet criteria for Psychopathy (approx. 80% of incarcerated offenders are diagnosed with APD)

Without Conscience (Hare, 1993)

• Without conscience (1993) describes there being about 2 million psychopaths in North America; 100,000 in New York city

• Prevalence of psychopathy is about the same as that of schizophrenia (estimates range from 0.2% to 2% and the average is usually estimated to be between 0.5% and 1%)

• Gives brief newspaper snippets of the characteristics of some well-known criminal psychopaths (see pp. 3-5)

The PCL-R

The PCL-R consists of 20 items.

1. Glibness/Superficial Charm

2. Grandiose Sense of Self-Worth

3. Need for Stimulation/Proneness to Boredom

4. Pathological Lying

5. Conning/Manipulative

6. Lack of Remorse or Guilt

7. Shallow Affect

8. Callous/Lack of Empathy

9. Parasitic Lifestyle

10. Poor Behavioral Controls

11. Promiscuous Sexual Behavior

12. Early Behavioral Problems

13. Lack of Realistic, Long-Term Goals

14. Impulsivity

15. Irresponsibility

16. Failure to Accept Responsibility for Own Actions

17. Many Short-Term Marital Relationships

18. Juvenile Delinquency

19. Revocation of Conditional Release

20. Criminal Versatility

• The PCL-R can be reduced to two stable factors (some evidence for three factors but unstable at this point)

• Factor 1--comprises the affective and interpersonal style of the individual and includes such items as superficial charm, grandiosity, lying and manipulativeness, affective shallowness, absence of remorse, and lack of empathy.

Items loading on Factor 1

1. Glibness/Superficial Charm

2. Grandiose Sense of Self-Worth

4. Pathological Lying

5. Conning/Manipulative

6. Lack of Remorse or Guilt

7. Shallow Affect

8. Callous/Lack of Empathy

16. Failure to Accept Responsibility for Own Actions

• Factor 2--comprises the more behavioral aspects of psychopathy and includes items describing an impulsive, antisocial lifestyle including early behavior problems, juvenie delinquency, aggressive behavior, proneness to boredom, absence of planning, and irresponsibility as an adult. The characteristics of APD reflect mainly this second factor of the PCL-R.

Items loading on Factor 2

3. Need for stimulation/Proneness to Boredom

9. Parasitic Lifestyle

10. Poor Behavioral Controls

12. Early Behavioral Problems

13. Lack of Realistic, Long-Term Goals

14. Impulsivity

15. Irresponsibility

18. Juvenile Delinquency

19. Revocation of Conditional Release

Items that do not load on either factor

11. Promiscuous Sexual Behavior

17. Many Short-Term Marital Relationships

20. Criminal Versatility

• Although there are other instruments that have been developed to measure psychopathy, the PCL-R is perhaps the most well-known instrument; Hare's work has made a large impact in this area; the PCL-R is the main instruments used to assess psychopathy throughout Canada, USA, Finland, Sweden, and other parts of Europe.

• Regardless, the other instruments all tap into the same set of characteristics and all appear to conceptualize psychopathy in a similar manner.

Psychopathy and Crime

• Psychopathy is implicated in a disproportionate amount of serious repetitive crime and violence

• Psychopaths are more criminally active throughout much of their life span than are other offenders (Hare, 1991; Hare, Strachan, & Forth, 1993)

• Psychopaths generally more violent than non-psychopaths; 97% psychopaths v. 74% non-psychopaths received at least one conviction for violent crime (Hare, 1981)

• Inmates with high PCL scores much more likely to have been convicted for a violent offense that with low PCL scores (Hare & McPherson, 1984)

• Mean number of charges per-year-free for violent offenses was 3X higher for psychopaths than nonpsychopaths; mean number of charges per-year-free was 5.06 v. 3.25 for nonpsychopaths (Hare & Jutai, 1983)

• Psychopaths are more likely to engage in a variety of different types of aggressive acts than are nonpsychopaths (Hare & McPherson, 1984)

• PCL correlated significantly with global ratings of institutional violence (Hare & McPherson, 1984)

• Wong (1984) compared psychopaths (PCL above 30) with nonpsychopaths (PCL less than 20) and found that (1) psychopaths committed more than twice as many offenses per-year-free, (2) psychopaths committed almost 9x the number of institutional offences, (3) psychopaths had their first contact with the law at an earlier age, and (4) psychopaths engaged in significantly more threatening behavior and acts of violence

• PCL-R scores have been found to correlate significantly with (1) number of prior violent offenses, (2) number of prior nonviolent offenses, (3) number of prison terms served, and (4) months spent in prison (Hart & Hare, 1989)

• Serin (1991) found that psychopaths were more than twice as likely to have used a weapon, threats, or instrumental aggression, both inside and outside of prison

• Some evidence that the antisocial and criminal activities of at least some male psychopaths decrease in frequency and severity with age; Hare, McPherson, & Forth (1988) reported that the criminal activities of male psychopaths were more extensive than those of other persistent offenders until age 35-40 and then they sharply decreased; age related changes more dramatic for nonviolent than violent offenses (violent offending remained steady whereas nonviolent offending decreased)

• PCL-R scores have also been used to predict (as opposed to post-dict criminal behavior and recidivism) and PCL-R tends to make a significant contribution to these prediction over and above relevant criminal history and demographic variables

• When using PCL-R scores to predict who will fail on parole or mandatory supervision, psychopaths not only violated the condition of release faster than nonpsychopaths but they also received more suspensions and presented more supervisory problems during the release period (Hart, Kropp, & Hare, 1988)

• When divided into H, M, and L groups using the PCL-R, there was a positive relationship between group membership and violating the conditions of release (the percentage of criminals in each of these groups to violate the conditions of release was highest for H, then M, then L). Similarly, the probability of remaining out of prison for one year (survival analyses) was highest for L and then decreased for M, and even more for H (Hart, Kropp, & Hare, 1988)

• Psychopaths tend to have a greater chance of failing on parole or mandatory supervision and they tend to fail at a faster rate than nonpsychopaths (Serin, Peters, & Barbaree, 1990)

• PCL-R scores appear to make significant contributions in predicting violent outcomes (Harris, Rice, & Cormier, 1991) (some studies have found that it predicts better than criminal history and demographic variables and other risk assessment instruments-Serin, Peters, & Barbaree, 1990)

• Rice, Harris, & Quinsey (1990) found that the PCL-R scores were predictive of post-release sexual and violent offenses and that a combination of PCL-R scores and phallometric measures of sexual arousal was as effective at predicting sexual offenses than was a battery if demographic, psychological, and criminal history variables

Summary of Criminal Careers

• Psychopaths begin their criminal careers earlier, commit more types of offenses, and offend at higher rates than do nonpsychopaths

• There is some evidence of "burnout" in the antisocial behavior of psychopaths, starting at about age 35. However, this burnout hold true for only nonviolent offenses and, even after burnout, psychopaths still commit crimes at a rate equal to that of serious and persistent nonpsychopathic offenders

• Psychopathy predicts recidivism on conditional release as well as or better than do actuarial risk instruments. In general, psychopaths recidivate at a rate if 3-4 times higher than that of nonpsychopaths

• Even while incarcerated or institutionalized, psychopaths engage in more disruptive behavior than do nonpsychopaths

Summary of Violence

• Psychopathy is a robust predictor of violence and violent recidivism in offenders-even among mentally disordered offenders, where the base rate of psychopathy is relatively low

• Psychopaths tend to engage in instrumental (calculated) violence, as opposed to expressive (affective, catathymic) violence. Psychopaths tend to threaten strangers with weapons and to be motivated by vengeance, retribution, or money. Nonpsychopaths tend to batter, sexually assault, or use weapons against female relatives (spouses, daughters), and are motivated by anger, jealousy, or sexual arousal

• Psychopaths tend not to be specialized sexual offenders; they are criminally versatile. However, rapists may be more psychopathic than other types of sexual and nonsexual offenders, and psychopathy is associated with recidivism among rapists

• Even while incarcerated or institutionalized, psychopaths commit more violent misconducts than do nonpsychopaths

Psychopathy and Mental Disorder

• Hart & Hare (1989) found that psychopaths were significantly less likely that nonpsychopaths to have any Axis I disorder other than substance use and significantly more likely to have antisocial personality disorder

• Hart, Hare, & Heilbrun (1992) found no difference between psychopaths and nonpsychopaths in the prevalence, type, or severity of schizophrenia-related disorders; correlation between PCL and psychotic diagnoses was r = .04

• Psychopathy, as measured by the PCL-R, has been found to be significantly associated with both alcohol and drug abuse/dependence disorders in some studies (Smith & Newman, 1990) and with just drug abuse/dependence disorders in other studies (Hemphill, Hart, & Hare, 1990)

• There does not appear to be any increased prevalence of neuropsychological dysfunction or impairment in psychopaths as compared to nonpsychopaths

Treatment of Psychopathy

• There have been few controlled studies of treatment response in well-defined groups of psychopaths. However, milieu therapy frequently has been recommended as the treatment of choice for psychopathy.

• In recent studies evaluating the effectiveness of intensive milieu therapy programs for incarcerated or institutionalized offenders, psychopaths showed less motivation, effort, and improvement in treatment than did nonpsychopaths; psychopaths were also more likely to have multiple, serious, or violent security-related problems during treatment and to terminate treatment prematurely.

• After treatment, psychopaths have a higher rate of general and violent recidivism than do nonpsychopaths; there is some evidence that milieu therapy may even increase the recidivism rate of psychopaths

Cognition, Language, and Affect

• Psychopaths have normal intellectual and neuropsychological functions, at least as measured by standardized tests

• Psychopaths exhibit a passive avoidance learning deficit and a dominant response set on experimental tasks

• Linguistic (and perhaps emotional) processing in psychopaths shows weak cerebral lateralization relative to nonpsychopaths

• Psychopathy, particularly Factor 1 of the PCL-R, is associated with problems in processing emotional information

• Psychopaths seem adept at focusing on events of interest to them and at "tuning out" unpleasant or threatening stimuli

• Psychopaths have an unusual style of verbal and nonverbal communication

There is a decent explanation for why/how psychopaths operate on page 227 of the Hart & Dempster article.