Forensic Ch. 4: Psychopathy

Psychopathy Checklist-Revised (PCL-R)

(provided by Robert Hare and is one of the most widely used standard measure of psychopathy, based on clerkley's work) -20 item symptoms 0-2 rating likert scale -requires clinical/expert judgment -scores range from 0 to 40, with 30 and above considered a conservative cut-off score for psychopathy (some studies have used 25) -it has also been used as a continuous variable, with higher the score the more the psycopathy. Data obtained from 2 primary sources: 1. review of collateral information (required) 2. interview/observation (recommended) Most items in the scale are grouped into two categories (factors): Factor 1: interpersonal/affective factors consisting of 8 items Factor 2: socially deviant/antisocial lifestyle, behaviorally factors (e.g., parasitic lifestyle, impulsivity, juvenile delinquency)

Here is what is emerging from findings on attempts to address that question

- presence of psychopathy has been considered the single biggest risk factor in the assessment of future violence - significant relationship found between psychopathy and general criminal recidivism and violent recidivism- more likely to commit more violent and nonviolent crimes - psychopaths commit proportionally more instrumental (planned) violence as compared to reactive - the relationship between psychopathy and instrumental violence is not clear- they also exhibit poor behavioral control, suggesting more possibility for reactive/impulsive violence. - psychopathic violence is referred to "impulsively instrumental" - also psychopaths are more likely to victimize strangers than non-psychopaths - violence committed by psychopaths more likely to occur out of revenge than self defense - most serious crime likely to occur during intoxication- partly due to failure to maintain their emotional control when under the influence - burnout not associated with later violence rate: psychopaths appear to continue to commit higher rates of violence than non-psychopaths even after the age of 40-displaying even greater emotional violence. - more likely to inflict serious harm but less likely to murder-and with less emotional arousal - different motivations for violence

16 characteristics Hare listed to describe the clinical profile of the psychopath

- superficial charm and good intelligence - absence of delusions and other signs of irrational thinking - absence of "nervousness" - Unreliability - untruthfulness and insincerity - lack of remorse or shame - inadequately motivated antisocial behavior - poor judgment and failure to learn from experience - pathological egocentricity and incapacity for love - general poverty in major affective reactions - specific loss of insights - unresponsiveness in interpersonal relations - fantastic and uninviting behavior with drink (sometimes without) - suicide rarely carried out - sex life interpersonal, trivial, and poorly integrated - failure to follow any life plan

Antisocial personality disorder (APD) and psychopathy

-APD is listed formally in the DSM-V but the PCL-R items are listed under the associated features -APD diagnostic criteria are more behavioral (e.g. lying, cheating, and stealing), while psychopathy criteria are not only described in behavioral terms but also interpersonal/affective characteristics -Prevalence rates for APD are higher in correctional samples and the community than psychopathy -psychopathy is narrower and more specific than APD (with only 1% of the general population suffering from it; and only between 15-30% of those with APD also found to suffer from psychopathy) -A successful psychopath tend to exhibit higher intelligence, and more educated, and from higher socioeconomic standing than most psychopaths -likely to be working in corporations or holding political offices

Interpersonal/affective deficits CONTINUED

-deficits in non verbal emotional processing -language appears to be superficial -seems to lack affective cognitions -pseudo/sham emotions -pathological deceit -con and manipulate people

PCL-4: 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

Treatment of psychopaths

-may be less likely to form emotional attachments needed for effective psychotherapy -stay in program for shorter periods of time -less motivates -violence for treated psychopaths is higher (77%) 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

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 -irresopnsible -juvenile delinquency -revocation of conditional release

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

Cognition/learning

-passive-avoidance learning: failure to learn 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 -moral reasoning deficits are in question

Women and psychopathy

-probably valid as a construct -prevalence 11-23% -mean PCL-4 score lower for women than men -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

Additional PCL-R items

-promiscuous sexual behavior -many short-term marital relationships -criminal versatility

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

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

Nature of the psychopath

-we know that 'psychopathy' is a complicated term whose meaning has been the focus of great debate in psychology -the debate has focused on the nature of psychopathy as revealed in the various labels used to refer to it: antisocial personality disorder, dyssocial personality, sociopathy -it is the most important clinical construct in the criminal justice system -it is considered a specific form of antisocial personality disorder, prevalent in individuals who commit a variety of criminal and irresponsible acts -it is a socially devastating disorder but psychopathy should not simply be equated with criminal behavior.

Ethnic and cross cultural differences

Comparisons between caucasian and African American offenders - preliminary evidence is not suggestive of dramatic differences There are significant differences cross-culturally - lower prevalence rates and mean PCL-R scores outside of North America

Alternative 3-factor model

Cooke and Michie (2001) suggested that a three factor model was a more accurate conceptualization of psychopathy: 1. arrogant and deceitful interpersonal style 2. deficient affective experience 3. impulsive and irresponsible behavioral style -items from factor 2 strictly relating to antisocial behavior (criminal versatility, juvenile delinquency, revocation of conditional release, early behavioral problems, and poor behavioral controls) were removed (and thus resulting in a reduced emphasis on criminal behavior.) -remaining items are divided into three factors proposed by cooke and michie listed above -the field started to question the assumption for criminality being a core component of psychopathy and made additional attempts to define it further...

Interpersonal/affective deficits

Interpersonal/affective deficits are central to understanding psychopathy. - For instance, one's ability to maintain good interpersonal and meaningful relations with other people is less likely to occur when one's behavior is characterized by glibness (or doing things with lack of concern and little thought), superficial charm, grandiose sense of self-worth, pathological lying, conning and manipulativeness, lack of remorse and guilt, shallow affect, callous lack of empathy, and failure to accept responsibility for one's actions (all Factor 1 items)

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

Sexual Violence

Psychopaths may have increased risk for sexual violence, particularly among rapists and child molesters-related to sexual arousal in general -role of sexual aggression found in psychopaths and sexual promiscuity -lack of emotional responsiveness in relationships - psychopathy as predictive of sexual recidivism - higher PCL-R scores found to commit more frequent and more severe levels of violent sexual offenses. - 10-15% of child molesters and 40-50% of rapists are psychopaths - mixed rapists/molesters found to have the highest factor 1 scores, suggesting a high level of insensitivity and callousness

secondary psychopathy

caused by specific factors -low intelligence -some sort of social disadvantage -impulsivity driven by anxiety

Relationship of criminal behavior and violence

general violence and criminal behavior: we should keep in mind that there are interpersonal, learning, cognitive, and physiological factors normally at play in the expression of violent behavior -being able to predict violence has been a thorny challenge to forensic scientists continued...

Hervey Clerkley (1941)

one of the first scholars to offer a comprehensive and definite conceptualization of psychopathy in his book "mask of sanity"

2 types of psychopathy

primary psychopathy and secondary psychopathy

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: profound impact on jurors

How should the PCL-R be used?

the PCL-R should not be used as a risk assessment measure, only a diagnostic tool for psychopathy.

PCL-R field research

this measure of psychopathy continues to demonstrate consistent reliability and validity in lab studies but not in practice Field Studies Interrater variability (more problematic) - findings leaned in the direction that favors the side for which the psychologist is asked to do the evaluation Does not predict recidvism - psychologist's experience with PCL-R associated with greater predictive ability Evaluators from the defense and the state equal

Primary psychopathy

with some inherent deficit -prototypical psychopathy -antisocial acts -irresponsible -lacking empathy -superficially charming -absent of any anxiety