Chapter 16: Psychopathy as

Psychopathology Key Developments in Assessment, Etiology, and

Treatment

Jennifer E. Vitale

Joseph P. Newman

Diagnostic Criteria

Hervey Cleckley (1941/1988):The Mask of SanityOutlined 16 core traits of psychopathy Six traits most strongly influencing modern

conceptualization of the syndrome• Superficial charm and good intelligence• Lacking in remorse or shame • Inadequately motivated antisocial behavior• Poor judgment and failure to learn by experience• Incapacity for love• General poverty in major affective reactions

Diagnostic Criteria

Hervey Cleckley (1941/1988): The Mask of Sanity

Diagnostic Criteria

McCord and McCord (1964)Emphasis on:

• Aggression• Impulsivity• Excitement-seeking• Guiltlessness• “Warped capacity for love”

DSM criteria for sociopathy/antisocial personality disorder included overlapping characteristics but were developed independently of the psychopathy literature

Assessment of Psychopathy

Psychopathy Checklist (PCL; Hare, 1980)

Designed to capture prototypical psychopathy as conceptualized by Cleckley

Cleckley criteria converted into 22 items scored using a semi-structured interview and institutional file review

Revised version of the measure removed two items (PCL-R; Hare, 2003)

Provided a reliable method for assessing the syndrome and fueled much of the research conducted in the 1990s and 2000s

Assessment of Psychopathy

PCL-R Controversies Two factor structure

• Factor 1: Affective/Interpersonal • Factor 2: Impulsive/Antisocial Lifestyle• Some argue a three factor structure is more

appropriate (Cooke et al., 2006)

Violence as a “core” feature of the psychopathy syndrome (e.g., Bishop & Hare, 2008; Cooke et al., 2006)

Generalizability of the instrument to alternative groups (e.g., incarcerated women, delinquent juveniles)• Much of early PCL-R research relied on North

American, Caucasian, male, incarcerated samples

• Question its use for psychopathy assessment in noninstitutionalized samples

Alternative Measures of Pscyhopathy

• PCL-Screening Version (PCL:SV; Forth, Brown, Hart, & Hare, 1996) and Self-Report Psychopathy Scale (SRP-II, -III; e.g., Williams & Paulhus, 2004)

• Direct descendants of PCL-R• Designed to be used in noninstitutional contexts

• PCL-Youth Version (PCL: YV; Forth, Kosson, & Hare, 2003)

• PCL-R descendant• Based on assumption that psychopathy syndrome observed in

adults can be extended back into adolescence

• Antisocial Process Screening Device (ASPD; Frick & Hare, 2001)

• 20-item rating scale that can be used as a self-report measure or a teacher/parent report measure

Alternative Measures of Pscyhopathy

• Youth Psychopathic Traits Inventory (YPI; Andershed, Kerr, Statin, & Levander, 2002)

• Correlates moderately with factors of PCL:YV• Primary and Secondary Psychopathy Scales (SRPS; Levenson, Kiehl, &

Fitzpatrick, 1995)• 26-item self-report measure • “Primary Scale”• “Secondary Scale”

• Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996)• 187-item self-report measure• 8 subscales: Machiavellian Egocentricity, Coldheartedness, Social Potency,

Carefree Nonplanfulness, Fearlessness, Impulsive Nonconformity, Blame Externalization, and Stress Immunity

• Psychopathy Resemblance Index (PRI)• Index of a Five Factor Model (FFM) based psychopathy prototype (Lynam & Widiger,

2001; Miller & Lynam, 2003).

Prevalence of Psychopathy

North American Male Offenders15%–49% (e.g., Herve, Mitchell, & Cooper, 2004; Salekin, Rogers,

Ustad, & Sewell, 1998)

North American Female Offenders9%–20% (Lehman & Ittel, 2012; Salekin et al., 1997; Vitale et al., 2002)

Psychological Models and Somatic Factors

Fearlessness/Fear-Conditioning AbnormalitiesFowles (1980)

• Psychopathy associated with deficits in functioning of the behavioral inhibition system (BIS; e.g., Gray & McNaughten, 2000) and normal behavioral activation system (BAS) functioning

• Psychopathic individuals should show poor punishment learning and weak behavioral inhibition

• Evidence: Low levels of neurotic anxiety and punishment sensitivity (e.g., Newman, MacCoon, Vaugn, & Saden, 2005), increased levels of passive avoidance errors (e.g., Lykken, 1957), decreased electrodermal responsivity in anticipation of aversive events (e.g., Arnett, Howland,

Smith, & Newman, 1993), abnormalities in eye-blink responses (e.g.,

Anderson, Standford, Wan, & Young, 2011), reduced startle potentiation (Vaidyanathan et al., 2011).

Psychological Models and Somatic Factors

Fearlessness/Fear-Conditioning Abnormalities

Lykken (1955)

• Focus on fearlessness as a trait, which impedes normal socialization and results in the cluster of symptoms associated with psychopathy

• Evidence: Lower scores on self-report measures of fearfulness, poor electrodermal conditioning, deficits in passive avoidance performance (Lykken, 1957)

Psychological Models and Somatic Factors

Amygdala AbnormalitiesBlair (2006)

• Focuses on role of amygdala in psychopathy

• Psychopaths should show abnormalities in tasks that involve the formation of associations between a conditioned stimulus and unconditioned stimulus, between a conditioned stimulus and affect representation, and between a conditioned stimulus and valenced sensory properties of the unconditioned stimulus associations

• Evidence: Impairment in aversive conditioning tasks, which involve amygdala-specific learning (e.g., Flor et al., 2002), reduced amygdala activation during such aversive conditioning tasks (e.g., Veit et al., 2002), reductions in amygdala volume (e.g., Ermer, Cope, Nyalakanti, Calhoun, & Kiehl, 2012), abnormalities in amygdala structure (Boccardi et al., 2011)

Psychological Models and Somatic Factors

Response Modulation and Attention Response Modulation Hypothesis (RMH; e.g., Gorenstein & Newman, 1980) Abnormalities in selective attention undermine ability of psychopaths to

consider contextual information that modulates goal-directed behavior of healthy individuals

“Attention bottleneck” hampers simultaneous processing of multiple channels of information (Newman & Baskin-Sommer, 2011)

Psychopathic individuals less able to process full range of affective and nonaffective stimuli and their associated meanings

Evidence: Psychopathic individuals commit more passive avoidance errors when focused on responding to a reward (e.g., Newman & Kosson, 1986) and fear potentiated startle is only impaired when attention is directed away from threat relevant information (Baskin-Sommers et al., 2011)

Psychological Models and Somatic Factors

Genetics

Nonshared environmental factors appear to account for the majority of variance in psychopathy (e.g., Blonigen, Hicks, Kreuger, Patrick, & Iacono, 2006; Larsson, Andershed, & Lichtenstein, 2006)

Additive genetic factors account for a portion of the variance in psychopathy (e.g., Bezdijan, Raine, Baker, & Lynam, 2011; Blonigen et al., 2006)

Negligible influence of shared environmental factors (e.g., Larsson et al., 2006)

Peer relationships may account for the potent influence of nonshared environmental factors (Manke, McGuire, Reiss, Hetherington, & Plomin, 1995)

Treatment of Psychopathy

Treatment prognosis for psychopathy has historically been considered to be poor (e.g., Hare, Clark, Grann, & Thorton, 2000)

Some studies have found increased rates of early discharge from therapeutic programs, less motivation, and overall improvement in psychopaths (Olgoff, Wong, & Greenwood, 1990)

A program geared toward increasing empathy and responsibility for peers was associated with higher recidivism in psychopathic individuals in prison (Rice, Harris, & Cormier, 1992)

Other studies show psychopaths demonstrate poor program adjustment and higher attrition (e.g., Berger, Rotermund, Vieth, &

Hohnhorst, 2012), and lower levels of therapeutic gain (Chakhssi, deRuiter, & Berstein, 2010)

Treatment of Psychopathy

Some recent studies point to potential therapeutic gain, particularly for adolescent individuals with psychopathic traits

A program aimed at increasing motivation, positive emotion, and decreasing callousness in youth led to significant decreases in psychopathy scores (Salekin, Tippey, & Allen, 2012)

Another intervention aimed at altering harsh and inconsistent parenting led to decreases in psychopathy scores (McDonald, Dodson, Rosenfield, & Jouriles, 2011)

Treatment of Psychopathy

Future DirectionsDe-emphasis on treatments geared at building social

skills or empathyCreation of behavior modification programs with goals of

reducing harm caused by psychopaths (Harris & Rice, 2006)

Expansion of interventions for children and adolescents with psychopathic traits

Turn to research on the etiology of psychopathy to create better treatment strategies suited to specific deficits seen in the disorder (Wallace, Schmitt, Vitale, & Newman, 2000)