WOMEN WHO LOVE PSYCHOPATHS PRESENTED BY: SHARON O’HARA Clinical Director Sexual Recovery Institute Los Angeles CA DEBORA

WOMEN WHO LOVE PSYCHOPATHS PRESENTED BY:

SHARON O’HARAClinical DirectorSexual Recovery InstituteLos Angeles CAhttp://www.sexualrecovery.com/

DEBORA WARDLOWNova Outpatient RecoveryPublic Psychopathy EducationInstitute of Relational Harm [email protected]

MAVIS HUMES BAIRDMHB Consulting LLC Trauma & Addictions Recovery SpecialistRecovery Coach [email protected] Copyright 2012 Mavis Humes Baird

http://www.sexualrecovery.com/

mailto:[email protected]

mailto:[email protected]

Psychopathic Spectrum

Partners of PsychopathicSpectrum

Partners of Sex Addicts

Sex Addicts

Sex Addicted

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Psychopath Partner of a Psychopath

Sex Addicted Partner of a Sex Addict

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Copyright 2012 Mavis Humes Baird

Research Study by Sandra Brown MA and Liane Leedom MD

• 75 women worldwide completed study• Full Histories, via clinical interview• Temperament /Traits Assessment

– TCI “Temperament and Character Inventory” by Robert Cloninger

• Self- reporting of Symptoms– Open-ended questioning

• Relationship dynamics– Open-ended questioning

Partners of PsychopathsPartners of Psychopaths


Women Who Love Psychopaths• Significant other- not recognized or diagnosed as Psychopath• Typical “domestic violence survivor”• Labeled codependent• A relationship/sex addict• Assumed to be Dependent Personality Disorder

Partners of Psychopaths

Psychopaths

• Hide behind mask- called “Disorder of Social Hiding”

• ‘Self report’ is a problem-lying is one of the main traits

• Not diagnosed• Do not think they need help• Many therapists aren’t looking for one in their

office.


Look for:• Lack of remorse• Lack of empathy• Impulsive- do not think of consequences• Grandiose• Takers- sexual needs• Blame shifting• Present excellent first impression• Manipulation• Pathological liars


Look for:

• Exploit others• Smooth talker/charismatic• Pity play• Self centeredness• Lack of accountability• Mood disorders• Inability to see own unacceptable behaviors• Distorted understanding of other’s perceptions


Who Are Psychopaths?

• Interpersonal

– Glibness– superficial charm

– Grandiose sense of self-worth

– Pathological lying

– Conning—manipulative

• Affective

– Lack of remorse or guilt

– Shallow affect

– Callous—lack of empathy

– Failure to accept responsibility

• Lifestyle

– Need for stimulation

– Parasitic lifestyle

– Lack of realistic, long-term goals

– Impulsivity

– Irresponsibility

• Antisocial

– Poor behavioral controls

– Early behavioral problems

– Juvenile delinquency

– Revocation of conditional release

– Criminal versatility

•Score of 30-40 on the Hare’s Psychopathy Check List (Revised)


RED FLAGS of Relationships

• Moves quickly• Overly attentive• Mirrors or mimics

interests/hobbies• Isolates from friends/family• Love bombing• He is: dominant, grandiose,

belittling

Sandra Brown, The Institute’s Model of Care Approach 2012



Honeymoon Phase

• Luring• Eye gazing• Sexual Bonding• Idealizing• Rapid pacing• Overwhelming and

distracting her



Intensity• Intense to experience• Charismatic• Exciting• Magnetic pull/vortex• Sexual Bonding• Positive memory storage• Trance- focus on one

thing to the exclusion of other things



Intensity

• Low impulse control• Excitement seeking• Power and dominance• High sex drive• Intense pursuit



Language

• Insights into thoughts and outlook• Use language related to self more than others.• Excellent storytellers• Successfully “con” others• Communication disrupted - lack of insight• Linguistical differences• Mimic/Parrot• Gas lighting



Her Super Traits-most highly elevated• Extraversion/Excitement Seeking• Relationship Investment• Competitiveness• Hyper-Empathy• Attachment• Sentimentality• Low Harm Avoidance• Cooperation• Responsibility and Resourcefulness

Research by Sandra Brown M.A. and Liane Leedom, M.D.


Psychopaths & Their PartnersFrom Sandra Brown’s Model (Brown, 2012):

*In comparison to Hare’s list of psychopath traits

Traits of a Psychopath Supertraits of Partners

+Excitement seeking+Extraversion+Dominance+Competitiveness—Sentimentality—Tolerance+/—Friendliness—Empathy—Helpfulness—Compassion—Responsibility—Purposefulness—Resourcefulness—Self-Acceptance—Loyalty—Trust—Bonding—Attachment

+Excitement seeking+Extraversion+Dominance+Competitiveness+Sentimentality+Tolerance+Friendliness+Empathy+Helpfulness+Compassion+Responsibility+Purposefulness+Resourcefulness+Self-Acceptance+Loyalty+Trust+Bonding+Attachment

Brown, S. (2012). Supertraits: Developing a New Outlook. In S. Brown (Comp.), Training Materials for The Institute's Model of Care Approach 2009 (2012 ed.). Author.

*Impulsivity

*Lacks goals*Is irresponsible

*Lacks remorse/empathy



Points of attraction




Why do Super Traits matter?

• Affect patterns of selection

• Affect tolerance• Start out as least

dependent type on planet

• Sees others through who she is


Women in the Study:

Higher than normal:•Suggestibility•Dissociation/trance•Hypnosis Related to: Pacing•Exhaustion•Increased focus•PTSD


Inevitable Harm

• Too much empathy• Plus high bonding• Plus high sentimentality• Plus low harm avoidance• = inevitable harmSandra Brown, Women Who Love Psychopaths



Event Cycle

• Rage• Faked insight• Tender• Bribery• Mutual pathology• Other woman• Carrot dangling• Medical Issues

From Sandra Brown MA, The Institute’s Model of Care Approach 2012Partners of Psychopaths


Dichotomies

• Bonding/Abandonment• Idealizing/Devaluing her• Protection/Risk• Trust/Distrust• Excitement/Exhaustion• Child-like/Adult Mystery• Loving/Loathing

Sandra Brown MA, The Institute’s Model of Care Approach 2012Partners of Psychopaths


Treatment Options for the Partner• Pathology education• PTSD treatment• Bibliotherapy• Anticipate behavior• Understand risk of “Super Traits”• Understand patterns of selection• Understand intensity• Unique dynamics and dichotomies• Recognize “red flags”• Relapse prevention• Mindfulness• Self care• Get a great life!

Sandra Brown MA, The Institute’s Model of Care Approach 2012Partners of Psychopaths

Therapists Might:

• Misread• Misdiagnose• Minimize• Explain away• Believe fabrications as plausible explanations• Not recognize acting ability

Sex AddictsPsychopathic Spectrum

Mental Health Professionals

• “Psychopathy is often misread, misdiagnosed, minimized, or explained away by professionals whose jobs require regular interaction with psychopaths.” Mental health professionals… “might believe a psychopath’s complete fabrications as seemingly plausible explanations.”

– FBI Law Enforcement Bulletin July 2012

Psychopathy: An Important Forensic Concept for the 21st Century


Mental Health Professionals• “Psychiatrists are often helplessly manipulated by

the psychopath; just as are the psychopath’s other victims.” Dr. Ken Magid, “High Risk, Children Without a Conscience.”

• “There are psychopathic personalities in the highest echelons of government, and even within the religious hierarchies in America. You just can’t assume that a person with the title judge or hospital orderly got there honestly and won’t manipulate the hell out of you.” Psychologist Schreibman to H. Cleckley 2/10/86


Character Disturbance byDr. George K. Simon

• “Aggressive personalities strive for the dominant position at all times and all circumstances. This premise is very hard for the average person to understand, let alone accept. It’s incomprehensible for most of us to conceive that in every situation, every encounter, every engagement, the aggressive personality is predisposed to jockey with us for the superior position, even with no recognizable need to do so. The failure to understand and accept this, however, is how aggressive personalities so often succeed in their quest to gain advantage over others.”

From the book, Character Disturbance by Dr. George Simon


Therapists Might:• Believe clients think and feel as much as

therapist does• Become target of manipulation• Become target of “head games”• Expect different dynamics in these sessions• Get caught in drama triangles• Not want to diagnose• NOT DIAGNOSE• PSYCHOPATHS DON’T THINK THEY NEED HELP

and MIGHT PRESENT AS LEVEL HEADED next to traumatized spouse







Sex Addicts



Things That Create CONFUSION CONFUSION about Psychopaths

• No ONE definition for the disorder• Term ‘psychopath’ is often misused or overused; Not in DSM

• Clinicians filter clients’ symptoms “through their own lenses”

• Misdiagnosed as Cluster C, Asperger’s, Bipolar, Addiction, impulse control disorder, leadership qualities, ‘lucky.’

• Repercussions of misdiagnosis and mistreatment

• Several personality assessment tools don’t assess for pathology– examples: Meyers-Briggs, 16 PF, Enneagram

• Most clinicians not trained to spot or diagnose psychopathy

• Clinicians tend to under-refer clients to other specialists

• Some assessment tools (such as the MMPI) do successfully flag PDs and PD traits but until recently none tested for psychopathy (PCL-R– NEW!)



Things That Create CONFUSION CONFUSION about Sex Addicts

• No ONE definition for the disorder• Term ‘sex addict’ is often misused or overused; Not in DSM• Clinicians filter clients’ symptoms “through their own lenses”• Misdiagnosed as Axis II, OCD, Bipolar, red-blooded, ‘lucky.’• Repercussions of misdiagnosis and mistreatment• Most assessment tools don’t assess for sex addiction• Most clinicians not trained to spot or diagnose sex addiction• Clinicians under-refer clients to other specialists • Some assessment tools (such as the MMPI) do successfully flag a few

traits but until recently none tested for sex addiction (SDI-R– NEW!)

Sex Addicts


Things That Create CONFUSION CONFUSION about Partners and Relational Trauma

• No consensus on whether partners/families have their own disorder.• Terms (codependency, PTSD, love addiction) are often misused or overused; Not in

DSM• Clinicians may filter clients’ symptoms “through their own lenses”• Misdiagnosed as Axis I, Axis II, Love addiction, inhibition, ‘unlucky.’• Repercussions of misdiagnosis and mistreatment• Most assessment tools don’t assess for relational trauma• Many clinicians are not trained to spot or diagnose relational trauma and • Clinicians tend to under-refer clients to other specialists • Some assessment tools (such as the MMPI) do successfully flag relational trauma and

betrayal but until recently none tested for it (PTSI-R and Sandra Brown’s checklists NEW!)

• Family and addictions therapists can tend to assign responsibility equally, disregarding domestic violence, hostage syndromes and betrayal bonding, and disregarding AAMFT ethical guidelines for same.




•Empathy for the small group or “the family”

No one

Everyone

Some

• Empathy for all living things

•Empathy for one specific group or demographic

•Empathy for one person or “the couple”

•Empathy for the self only or no one

MOST OF US DON’T HAVE EMPATHY FOREVERYONE or ALL THE TIME.

Empathy is a Difficult Diagnostic Criterion(benevolently imagining what others are experiencing)

CONFUSIONCONFUSION

Super-empathic PsychopathicEmpathic Sociopathic

Empathy for one team or political party or side in a drama


Empathy; too much or too little?

• “Empathy is our ability to identify what someone else is thinking or feeling and to respond to those with an appropriate emotion.”

Simon Baron-Cohen author of The Science of Evil: On Empathy and the Origins of Cruelty

• Another way to put it is; Grasp of and care for what others are experiencing; benevolent acknowledgment or concern; compassion.





““FIRST THOUGHT WRONG”FIRST THOUGHT WRONG”A Recovery Mantra for Partners of PathsThirteen Rules to Dealing with a Sociopath in Everyday Life(Taken from Martha Stout’s The Sociopath Next Door)

Partners of Psychopaths Copyright 2012 Mavis Humes Baird

1. Accept that some people have NO CONSCIENCE2. In contest between your instincts and the role someone has taken, GO WITH YOUR INSTINCTS3. When considering a new relationship, PRACTICE RULE 2 when considering the claims and promises someone makes, and the responsibilities they have.4. QUESTION AUTHORITY5. SUSPECT FLATTERY6. If necessary, redefine your concept of respect. IS IT BASED ON FEAR?7. DO NOT join the game.8. The best way to protect yourself is to avoid him, TO REFUSE ANY KIND OF CONTACT OR COMMUNICATION!9. QUESTION YOUR TENDENCY TO PITY10. DO NOT try to redeem the unredeemable11. NEVER AGREE, out of pity or any other reason, to help a sociopath conceal his or her true character.12. DEFEND YOUR PSYCHE.13. LIVING WELL IS THE BEST REVENGE.

““BE MINDFUL”BE MINDFUL”A Recovery Mantra for Partners of Sex Addicts

1. They are JUST DEVELOPING a conscience.2. GO WITH YOUR INSTINCTS about what they tell you, and if you aren’t

sure ASK OUR SUPPORT SYSTEM what they think.3. Remember that IT TAKES AT LEAST A YEAR to get to know someone,

and that it will take awhile to learn the ‘sober personality’4. QUESTION the addict when they take an authoritative stance.5. SUSPECT FLATTERY, or take it with a grain of salt especially if they

have used it before to feed the addiction.6. DO NOT define ‘respect’ for the addict by fear of abandonment.7. Find your own pace of recovery; if the addict is trying to manipulate

you, DON’T GIVE IN TO THE GAME.8. If the addict is dangerous or is negatively affecting your life, PROTECT

YOURSELF.9. Question your tendency to pity or feel CODEPENDENT GUILT for the

addict’s well-being.10. LET THEM redeem themselves by changing over time; do not redeem

them when they don’t deserve it.11. Never agree to LIE to feed the addiction.12. Individuate yourself, DEFEND your psyche.13. Live well, learn SELF-CARE.



Hope for the Future“Partners with Relational Trauma”

• DSM-5 suggests a continuum for measuring empathy, intimacy, etc.• As this develops, it will reinforce and inform cases for clinicians, for family members,

and for the criminal justice system• Expect to see a dialectical shift in our understanding of personality via contributions

in competing fields• Re-conceptualizing psychopathy spectrum disorders and re-educating the public will

lead to greater understanding and support for families• By creating a valid and reliable grid for assessing risk and severity, we will be

empowered to responsibly advise precautions

It's entirely possible that as a group we tend to downplay psychopathy as a primary driver of hypersexual, chronically deceptive or similarly problematic sexual behavior. I've had discussions with an articulate advocate of the "trauma model" of partner recovery who thinks that we as a profession need to do a much better job of closely assessing our clients for the presence of narcissistic and antisocial personality disorders. I've become more sensitized to this position and think it's probably a fair assessment.

– Bill Herring to SASH Listserv 2012





Partners of PsychopathicSpectrum


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Sex Addicted Partner of a Sex Addict

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“Partners with Relational Trauma”Copyright 2012 Mavis Humes Baird

A brief overview and sample of Sandra Brown’s Institute for Relational Harm Reduction

– Website– Newsletter– Psycho-education– 5 Day Training

• Manual• Treatment protocols

– Self Tests– Data Collection and Study Results– Coaching – Retreats– Referrals– Advocacy for Social Change

Sandra Brown, Jennifer Young, Susan Murphy-Milano et al: Model of Care Approach



Overview of IRHR’s Training for Professionals

Book, CDs, an invaluable manual, checklists and worksheets

• 5 Days– Day 1: psychoeducation on PDs, presenting traits and

psychopathy– Day 2: overview of relationship patterns with a path, discuss

attachment and bonding– Day 3: neuroscience of pathology and of women who are

attracted to paths; evening case presentations– Day 4: PTSD as a result of the relationship, explanation of PTSD

and how to deal with it– Day 5: coaching



More about Robert Hare’s assessment The Psychopathy Check List, Revised (PCL-R)

• Psychopathy Checklist, Revised

– Must be certified

– Semi-structured interview

• Can be biased

– Predictive validity, construct validity

– Receives royalties

• PCL-SV to screen

• Best diagnostic tool we have for psychopathy

– Measures “Personality” (Interpersonal/Affective) and “Lifestyle” (Lifestyle/Antisocial)

• Not a DSM recognized diagnosis yet

– What to submit to insurance?

• Future work needs to be done to establish convergent validity



ReferralsPsychopathic Spectrum

For treating psychopathic spectrum clients:

•Read through the DSM V website or sign up for a clinical update to educate yourself on changes to the DSM•Buy the PCL-SV (for screening only)

https://ecom.mhs.com/(S(ruyld5zm5mno5l45ba0hm0jd))/inventory.aspx?gr=saf&prod=pcc-sv&id=pricing&RptGrpID=pcs

•Buy the PCL-R Manualhttp://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAapclr&Mode=summary

•Become certified to administer the Hare PCL-R:

http://www.hare.org/training/•Micro-expression Face Recognition Training•Linguistic differences training•Sex offender treatment conference attendance; certification

Sex Addicts




http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAapclr&Mode=summary

http://www.pearsonassessments.com/HAIWEB/Cultures/en-us/Productdetail.htm?Pid=PAapclr&Mode=summary

http://www.hare.org/training/

ReferralsFor your clients

Support networks:• Yahoo groups/Google Groups for women in toxic, abusive or

pathological relationships• Domestic Violence/ women’s empowerment organizations, meetings

and retreats• Safe Relationships Magazine

Sandra Brown, M.A. Institute for Reduction of Relational Harmhttp://saferelationshipsmagazine.com/•LoveFraud websiteCalls it sociopathy, same clear messageshttp://lovefraud.com/

For you• Seek Domestic Violence training and learn basic screening protocols

for mental health practitioners• Use PTSI with all partners• incorporate IRHR materials with Partners’ treatment• Martha Stoudt’s 13 tips• Betrayal Bond by Patrick Carnes PhD.




http://saferelationshipsmagazine.com/

http://lovefraud.com/

The End


Sex Addicts

What we are looking for is someone who perhaps due to physical factors to do with abnormal brain connectivity and chemistry, lacks a conscience, has few emotions and displays an inability to have any feelings, sympathy or empathy for other people

Then I’m your man.

But they’re few and far between…right?

• 1% of general male population

• 15-20% of prison population

• 4% of corporate professionals

• Higher concentration in places of power, where there is easy prey: politics, corporations, even helping professions such as ours

• These high scores were positively associated with charisma and presentation style• These were negatively associated with responsibility and performance.Babiak, Neumann and Hare

(Behavioral Sciences and the Law, 2010, 28,174-193)



-People assume people are good-Blind obedience (Milgrim)-The Halo Effect-Corporate “movers and shakers”-Leadership traits

-Ability to lie, mimic leaders-Good performer-Charm vs. charisma-Lack of affect makes ‘hard stuff’ easy-Risk-taking seen as impressive

Source: Babiak, P., & Hare, R. D. (2007). Snakes in Suits. New York, USA: Harper.

CORPORATE PSYCHOPATHS

But He’s Charming and Successful…Psychopathic Spectrum

Sex Addicts


Different Types of Corporate Psychopaths: Consider applications to Sex Addict population

The classic style has a high score on interpersonal, affective, lifestyle and antisocial measures.

The macho style has a low score on interpersonal and affective lifestyle and a high score antisocial measures. AKA ‘the do-er’

The manipulative style has a low score on interpersonal and affective lifestyle and a high score antisocial measures. AKA ‘the say-er’

(From ‘Snakes in Suits’ pg. 27, 185-186)

superficiality, grandiosity, deceit

lacks remorse & empathy

impulsive, lacks goals,irresponsible

poor behavior controls, antisocial behavior

High

Low

Traits


Sex Addicts


Commonly Co-Occurring Traits

• Manipulative

• Hypersexual

• Substance abuse

• Gambling, spending, stealing, other $

• Rule-breaking

• Lack trust or respect of authorities

• Dominant


CONFUSIONCONFUSION

Sex Addicts


Wide Range of Opinion on Treatability of Psychopaths

Dialectical Behavioral Therapy

Neuroscience

Developmental Psychology Neuropsychology

Trauma/Addictions Fields

Teaching empathy

Harm reduction

Partner Violence Specialty

Criminal Justice

YES

NO

-Oxytocin creates empathy-Omega-3s create empathy-Limbic system, hippocampus, amygdala-Teaching empathy-Mirror neurons-Arousal patterns/threshold-Therapy shown to strengthen the illness

CONFUSIONCONFUSION



Alcoholics AnonymousPerspective

Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot and will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they are born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest. (The Big Book, pg. 58)


Addict, Psychopathic, Both, Neither

• Active and recovering addicts may display traits of personality disorders.• Diagnosis of PD often on hold for first six months of sobriety. Before this time, diagnosis is usually provisional.

– Common wisdom in 12 Step tradition is to wait for substantial step work to be completed.– Certain kinds of reactive character armoring may be diagnosed as PD, but more amenable to treatment. – Get to know and use a full range of assessment tools so you are making a thorough diagnosis. Reliable measures include: SDI-R MMPI, PTSI, PCL-R

• Do you tend to ascribe PD traits to addiction? Or are you more likely to look for personality but not grasp applicability of addiction?• Possible misdiagnosis because of socio-cultural differences: role definition, sexism, etc.

– Ex: Men are more likely to be diagnosed as ‘Narcissistic’ and women as ‘Borderline’ when they have similar presenting symptoms.• Conceptualize each case as whether personality problem is secondary to addiction, addiction is secondary to personality problem, or both are equally dominant. Do both run the motor?Safety First!• Be aware that treatment can make the personality disorder stronger.• Know your limits and have referral options ready.• Use written safety plans and contracting.



PG. 18Payson, E. D. (2002). The wizard of oz and other narcissists: Coping with the one-way relationship in work, love, and family. Julian Day.


At best, what happens when we apply Addiction Treatment Models for Psychopathy

… and for aiding Partners of Psychopaths?

• Is addiction-type remission possible for psychopathy or is this concept a contradiction in terms?– Further clarification of the connection/separation between

the addictive disease paradigm and traits of personality disorders.

– Criteria has been developed via AA, Carnes, Gorski, Mellody that defines and tracks a range of distinctions, etc.

• Being used to help validate treatment– Viewing psychopath through ‘arousal’ or ‘stimulation’

perspective or as helped via regulation practices– Managing its symptoms, traits similarly to, or as part of,

addictions• 12 Steps for PD Recovery?• Path-Anon?


Sex Addicts


-The DSM IV-R did not include psychopathy - other than to say that Antisocial Personality Disorder.is sometimes called psychopathy.

- DSM definition of ASPD and ‘psychopathy’ definitions agree up to a point.

-Hare and Neumann wrote that ASPD was used as a way to better define psychopathy, but got lost along the way; “When [ASPD was] introduced by DSM-III in 1980 the intention was to provide a reliable means of measuring the traditional construct of psychopathy by focusing on easily measured antisocial behaviors, albeit at the expense of inferred personality traits fundamental to psychopathy, which were considered too difficult to measure reliably” (Hare & Neumann, 2009, p 795).

“Identifying someone as ‘having’ [ASPD] is about as nonspecific and scientifically unhelpful as diagnosing a sick patient as having a fever or an infectious or a neurological disorder” (Hare & Neumann, 2009, pg. 796).

The ICD-10 has changed from ICD-9 and uses Dissocial Personality Disorder instead.

The DSM IV-R & Antisocial Personality Disorder vs. Psychopathy Definitions



What’s the difference btwn DSM IV-R and Hare/defs of psychopathy?

•Engaging in violence•Functioning within or without of societal constraints•Frustration tolerance•Concern for punishment/learning from punishment •Dyssocial vs. APD•“…APD diagnoses are strongly coordinated with social deviance (factor 2) components of psychopathy as measured by PCL-R, but only weakly correlated with its interpersonal and affective (factor 1) components” (Hare, 2003, pg 6)•“…APD place[s] more emphasis on antisocial and criminal behaviors and less emphasis on personality traits [than PCL-R and other psychopathy definitions” (Hare, 2003, pg 5)

Hare, R. D. (2003). Hare psychopathy checklist-revised: (PCL-R) 2nd edition (2nd ed.).



Rationale for DSM-5 Proposed Changes

• Extensive co-occurrence among PDs• Extreme heterogeneity among patients receiving the

same diagnosis• Lack of synchrony with modern medical approaches

to diagnostics thresholds• Temporal instability• Poor coverage of personality psychopathology• Poor convergent validity

See www. dsm5.org



The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by:1. Impairments in self functioning (a or b):

a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical

behavior. AND

2. Impairments in interpersonal functioning (a or b):a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or

intimidation to control others.B. Pathological personality traits in the following domains:

1. Antagonism, characterized by:a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one‘s ends.b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one‘s actions on others; aggression; sadism.d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.

2. Disinhibition, characterized by:a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and

promises.b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing

and following plans.c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless

initiation of activities to counter boredom; lack of concern for one‘s limitations and denial of the reality of personal danger.C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural

environment.E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication)

or a general medical condition (e.g., severe head trauma).F. The individual is at least age 18 years.



“The importance of these findings cannot be overemphasized. These data mean that the entire PD literature is built upon shifting sands: had each of the thousands of PD studies been conducted with a different PD assessment, the study participants would have been a largely different set of individuals, thus yielding study results that would be different to an unknown degree. In contrast, the proposed DSM-5 personality trait set is based on an extensive research literature whose origins are more than half a century old, culminating in recent years in a consensual, highly robust, personality traits hierarchical structure that has a high degree of convergent and discriminant validity across a wide rage of measures, primarily questionnaires, but also encompassing structured interviews. Further, this structure has been shown to be invariant across clinical and non-clinical populations, including being influenced by overlapping genetic and environmental factors, and to be sufficiently comprehensive as to capture the variance in– and thus to provide coverage for– personality disorders”

DSM 5 Rationale for new conceptualization of PDs



• Set to be published in May 2013• Dissocial Personality Disorder criteria are very consistent

with Hare’s definition and could substitute• Diagnosis on a ‘spectrum basis’• Now includes rule-outs for acute substance impairment,

general medical conditions, developmental stages and socio-cultural environmental factors

• http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=16#

DSM-V**This information is consistent with DSM-V website postings as of 9/10/2012. Updates may have been made since then.

Please consult www.dsm5.org



The Causes

• Genetics

• Early trauma or neglect

– Parenting styles

– What is their ‘reality’?

• Cultural

– “Born under a bad sign”

• Socioeconomic

– Natural selection

We’re not sure where exactly psychopathy comes from.There are many ideas, but not one consensus.



Pathology and Addiction

• Disease or disorder?• Chronic or acute?• Progressive or stable?• Incurable or curable?• Treatable or untreatable?



One of the Most Vocal Critics of the PCL-R

• Israeli writer who has received diagnoses of

Borderline PD, Narcissistic PD, psychopathy

– Has a criminal record

• Huge online presence (check YouTube)

http://www.youtube.com/watch?v=YclFOwcfxCI

• In I, Psychopath by Ian Walker

• Scored high for psychopathy in PCL-R (says 13)

• His website:

http://samvak.tripod.com/indexqa.html

• Critiques the PCL-R



http://www.youtube.com/watch?v=YclFOwcfxCI

http://samvak.tripod.com/indexqa.html

Some Comic RefliefPsychopathic Spectrum


Personality

A personality is related to how a person •Thinks•Feels•Relates•Behaves

Documents

WOMEN WHO LOVE PSYCHOPATHS PRESENTED BY: SHARON O’HARA Clinical Director Sexual Recovery Institute Los Angeles CA DEBORA