Chapter 11 Flashcards
Pinel’s view on psychopathy - 1801
“manie sans delikre” - madness without delusions
what is psychopathy
a clinical syndrome characterizeed by a callous, selfish, remorseless use of individuals disregard for the feelings and concerns of others
cleckley’s metaphor of electrcity conductor
on their own they might get up to their own tasks but when they are around other people that it when it a problem
James Prichard view on psychopathy - 1883
moral insanity - patients who commited illegal/immoral acts - knew what they were doing but didn’t care
16 clecklian criteria description
the psychopath checklist is based on this
- This list was made by observations of cleckley
- These are more correlates of psychopathy rather than factors of it
16 clecklian criteria
- Superficial charm and good “intelligence”
- Absence of delusions and other signs of irrational thinking
- Absence of “nervousness” or psychoneurotic manifestations
- Unreliability
- Untruthfulness and insincerity
- Lack of remorse and shame
- Inadequately motivated antisocial behavior
- Poor judgment and failure to learn by experience
- Pathologic 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
Factor 1 - first dimension - interpersonal/affective characteristics
-How people relate to other people – social and interactions with others
–The personality traits of psychopathy
- Superficial and Glib
- Egocentric and Grandiose
- Pathologically Deceitful and
- Lacks Guilt and Remorse
- Shallow Emotions
- Callous Lack of Empathy
development of PCL - robert hare
– Cleckley’s criteria were operationalized in the form of a research scale for assessing psychopathy.
– Called the Psychopathy Checklist (PCL), measuring a constellation of emotional, interpersonal, and behavioral characteristics.
Julius Koch view on psychopathy
psychopathic inferiority - personality disorder - primarily biologically predetermined rather than enviroment
Emil Kraepelin
first to suggest there may be diff types of psychopathy
- born criminals
- morbid liars
- spendthrifts
- vagabonds
main problem of psychopathy in the 18th century
became wastebasket category - including different mental/personality disorder
George Partridge view on psychopathy
was being applied to many diverse disorders and replaced with sociopathy
- delinquent
- inadequate
- emotionally unstable
Karpman + Ariet
defined psychopathy as a personality disorder
- early onset of antisocial behaviours
- a need for immediate gratification
- high self worth
- impulsive + irresponsible
- lacking anxiety
- being callous
Hervey Cleckley definition of psychopathy
appearing normal yet lacking in remorse/empathy - impulsive, deceptive, grandiose
- mask of sanity
- a lack of emotional reaction
- partial psychopath or psychopath as psychiatrist
- provided the first detailed clinical descriptions
cultural differences of psychopathy
NA + Oceania higher on lifestyle features
Western Europe - higher on affective features
Western europe + Africa + South Asia - anti-social features
- outside of NA lower than isnide - UK is the lowest
DSM - I definiton of psychopathy
chronically anti-social, lacking loyalty, was callous, lacking judgement, immature, rationlize their anti-social behaviours
DSM-I classification of psychopathy
sociopath
DSM - II classification of psychopathy
antisocial personality
DSM -III
antisocial personality disorder - behaviour vs personality since behaviour is better for clinical assesments
DSM - 5
must be diagnosed with conduct disorder + show 3/7 adult symptoms
international classification of psychopathy
dissocial personality disorder - more of the interpersonal + attractive features
why are the voices of psychopathics ignored
difficulty in obtaining access to participants
privacy and ability
can psychopaths detect vulnerability
yes, they can identify previous abuse by gait cues
psychopaths identifying vulnerability stats
sexual/violent crimes ident. + gait cues by Factor 1
sexual/violent crimes ident. by Factor 2
Models for the causes of psychopathy
affective deficit model
attention model
developmental models
genetic models
brain based models
affective deficit model
there is a core deficit of something in psychopaths either
- emotion - general theory of emotional deficit
- fear - low fear hypothesis
- biological emotion processes - specific emotion deficit theory
low fear hypothesis - affective deficit model
not responsive to punishment and won’t avoid anti-social behaviour
general theory of emotional deficit
general lack of ability to experience + appreciate emotion
specific emotional deficit theory + intergration emotion systems theory
impairment to recognize sadness + distress
focuses on amygdala + ventromedial prefrontla cortex
emotion does not inhibit violence
attention model
focuses on cognitive rather than emotional
reponse modulation deficit
response modulation deficit
once individuals have focused their attention on certain features, won’t modify response - explains why emotion does not affect violence
developmental models
importance of emotion in development of consience AND key role of parents - make connection between misbehaviour + impose sanctions
different methods for callous emotional traits AND impulsive conduct
developmental model for callous/emotional traits
born with predisposition to fearlessness = insensitive, little arousal, ignore consequences
developmental model for impulsive conduct problems
inadequate socializing enviroments, low intelligence, no inhibition, lack of planning = antisocial acts
genetic models
consistently found a large significant heritable component to psychopathic traits - children, adolescents, and adults
strong genetic influence
no evidence for sex differences
brain based models
neuroimaging - reduction in prefrontal, rostral temporal, and ventral frontal lobe grey matter
- less hippocampus
- less amygdala
- less volume in the anterior cingulate cortex
- reduced connectivity between ventral frontal and amygdala
- reduced connectivity between dorsal frontal cortex and limbic system
critics of self report
- psychopathic clients are dishonest
- they don’t have enough insight
- asking about emotion without ever having it
advantages of self report
measure unobservable
easy quick and inexpensive
detect invalid reasoning
interrater reliability
examples of self report for psychopathy
psychopathic personality inventory
self report psychopathy scale
triarchic psychopathy measure
rater based assesments for psychopathy
more resources - interview, collateral info, inter rater reliability
forensic settings
- hare psychopathy checking list, and screening version
- comprehensive assessment of psychopathic personality
4 types of ways asses psychopathic traits in youth
- youth psychopathic traits inventory
- antisocial process screening device
- inventory of callous/unemotional traits
- hare psychopathy checking
concerns of labelling psychopathic children
negative consequences
traits are common features of normally developing youth
stability of psychopathic traits from childhood to adolescence and on to adulthood
cluster A of DSM 5
eccentric and odd behaviour
cluster B of DSM 5
dramatic, emotional, and erratic behaviour
Cluster C of DSM 5
anxious and dearful
factor 2 - antisocial lifestyle - criminal behaviour + lifestyle components
- impulsive
- poor behaviour controls
- need for excitement
- lack of responsibility
- early behaviour problems turns into adult antisocial behaviour
3 ways of assesing psychopathy
– 1.) Psychopathy Checklist-Revised (PCL-R; Hare,1991, 2003) and the Screening Version (SV; Hart, Cox,& Hare, 1995) – best way to assess psychopathy
– 2.) Self-Report Inventories
– 3.) DSM-5 Antisocial Personality Disorder Criteria
DSM - 5 antisocial personality disorder criteria issues with asses psychopathy
inapproporiate way – does not exist here – defines psychopathy as sociopathy – factor 2 without the factor 1 characteristics
PCL-R assessing process
- Broad characteristics split into 20 different characteristics
- Scored using file information & semi-structured interview
- Each item follows 3-point scale: 0, 1, or 2
- Scores range from 0 to 40
- A minimum score of 30 required for diagnosis; 25 often used for research purposes d/t low balling F1
high for factor 1
people who skirt the law - high for factor 1 - might not act out in illegal ways
why can’t psychopaths only have factor 2
- People with antisocial behaviour cannot differentiate between characteristics of themselves versus screwing other people over
how many factors in psychopathy
– 2 factors (Interpersonal and affective characteristics; Chronic antisocial behavior)
- – 4 facets (Interpersonal, Affective, Lifestyle, Antisocial; PCL-R 2nd ed.; Hare, 2003)
association between SRI’s and PCL-R
- Medium to large associations (r = .30-.50) between SRIs and PCL-R
problems with SRI
– 1.) Old measures primarily assess Factor 2 – PPIP do better than this but they don’t test deceitfulness – realize what you are trying to measure and will not answer honestly
– 2.) SRIs inadequately control for deceitfulness
– 3.) Psychopathic persons lack insight into emotional and personal characteristics
is psychopathy similar to antisocial personality disorder (DSM-5)
- Pervasive pattern of disregard for and violation for the rights of others, since age 15, as indicated by three (or more) of the following:
- 5 of these factor 2 – more lifestyle
- Only a couple of them focus on factor 1
- Failure to conform to social norms
- Deceitfulness
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness
- Reckless disregard for safety of self or others
- Consistent irresponsibility
- Lack of remorse
argument against PCL-R
predictive validity for institutional violence is poor and field reliability is weak
field reliability
– can two separate clinicians arrive at basically the same score on the tool
aversial allegiance
defence = lower score, prosecution = higher score
counterargument for PCL-R invalidity
Meta-analyses demonstrate PCL-R has satisfactory predictive validity for institutional violence and field reliability, particularly when not administered in adversarial contexts
interclass correlation
0.75 = good
PCL-R in high stake hearings
– ICC lower in high stakes proceedings than routine correctional samples
– Issue of adversarial allegiance – in high stakes
* PCL-R ratings biased depending on the side retaining the clinician
– Critique of “poor” field reliability (actually “good” to “excellent”)
- Below 0.4 for poor
PCL-R used to assess risk for institutional violence
PCL-R/SV robust small to medium effects for predicting institutional violence; weak predictor not substantiated
mad or bad
– Psychopathic persons are not psychotic or “crazy”.
– Comorbidity with major mental illness is rare.
– Understand the law and can be held accountable for their actions.
how well does PCL-R predict violence
– 85-97% of psychopaths - at least one violent crime.
– Approximately 50-75% recidivism rate for non-sexual violence - that is a lot
– Psychopathic persons more likely to commit acts of assault, vandalism, kidnapping, armed robbery, fighting, and to have used a weapon.
More likely to have prior and future convictions for crimes of violence.
– No more likely to commit murder or sexual assault than nonpsychopathic men
why psychopaths have equal chance of murder and sexual assault compared to non psychopaths
- 2nd degree murder – occurs in emotional context – psychopathy usually does not drive the motive for this crime
- Sexual crime – also an emotional component that is only somewhat correlated with psychopathy
which factor greatily predicts recidivism
2
why does factor 2 greatly predict recidivism
associated more with central 8 - especially past history
biological markers for psychopath
- amygdala disfunction
- orbitofrontal cortex disfunction - hyperarousal
- aversive conditioning and learning
- genetics - inherited psychopathic tendencies
- neurochemical - lack or influex of certain neurochemicals
- low autonomic arousal and diminished startle reflex
- low left hemisphere language organization
what did ben karpman propose in terms of subtypes of psychopathy
idioparhic - primary subtype of psychopathy usually genetically based
symptomatic - secondary subtype of psychopathy with underlying mental condition and trauma
latent class analysis
clusters of people who group together on a tool
how are subtypes created
latent class anaylsis
number of subtypes in psychopathy
2-4
primary subtype of psychopathy proposed by karpman
clecklian psychopathy
callous and unemotional features + interpersonal features
* Low anxiety, high fearlessness
* Low emotional distress
* High narcissism
* Less responsive to intervention
* Larger neurobiological component
* Higher proportion in Caucasian persons
secondary subtype of psychopathy proposed by karpman
- Characterized by high anxiety
- Other types of emotional distress and mental health concerns (e.g., depression)
- More responsive to treatment
- Higher proportion in ethnic minorities
- Greater aggression, delinquency, institutional infractions
cleckley 1941 - conclusion on treatment of psychopathy
Cleckley, 1941
“…we do not at present have any kind of psychotherapy that can be relied upon to change the psychopath fundamentally.” p 438-439
suedfeld and landon - conclusion on psychopathic treatment
‘‘review of the literature suggests that a chapter on effective treatment should be the shortest in any book concerned with psychopathy. In fact, it has been suggested that one sentence would suffice: No demonstrably effective treatment has been found’’ (p. 347)
harris and rice - treatment of psychopaths
…no effective interventions yet exist for psychopaths. Indeed, some treatments that are effective for nonpsychopaths actually increase the risk represented by psychopaths.’’ (p. 563 in Patrick, 2006 Ed.)
ontario study on psychopathic treatment in a mental health facility
- Therapeutic community setting
- Locked in a small group handcuffed together – confront each other
- Administered hallucinogenic medicine
Results - Two groups: treatment or not then divded into psychopathic or non
- High psychopathic + treatment– ¾ reoffended
- Non psychopathic + treatment – did not reoffend
- theatrogenic effect – treatment makes it worse
problem with ontario therapy
did not follow RNR
why have earlier studies produced negative outcomes
Characteristics of
Ineffective Programs?
* Little or no staff supervision
– Put psychopathic men in charge of running programs
Don’t follow RNR
* Over-treating the offenders
* Mixing high and low risk offenders
* Failure to target criminogenic need
* Inappropriate therapeutic foci
* Unresponsive interventions
– Nude encounter groups
– LSD used to reduce defensiveness
what did salekin conclude that a treatment needed for psychopathy
- Updated 2002 meta-analysis – added 9 new studies
- Much improved study designs and intervention
– Structured risk/psychopathy assessment & outcome evaluation, use RNR principles
– Long term follow up - Some with positive treatment effects
- Reduction in violence and reoffending with treatment.
- Literature definitely moving in the right direction…
- Most were evidence involved and CBT
- Structured psychopathic assess
- Structures risk assess
negative therapeutic correlates
– Decreased treatment progress
– Increased dropout – higher score on facets and lower change on treatment
– Weaker working alliances, especially the bond between client and therapist – affective facet had signifact inverse relationships with change in therapy
- Affective – most callous unemotional traits = more likely to dropout, least treatment change, weakest working alliances
what should be the goal of psychopathic treatment
want people to be less violence - hurt fewer people - prosocial needs
how much can each factor of psychopathy change
factor 1 is stable over age groups
factor 2 declines over age
why is factor 1 not a great predictor of violence
doesnt change over life span and isnt focusing on criminogenic needs
two component model for the treatment of psychopathic clients
- Component 1 – Interpersonal Component
– Manage Factor 1 as a responsivity issue – adapt services to tolerate and manage charcateristics WITHOUT focusing all intervention on these - Component 2 – Criminogenic component
– Target criminogenic needs (linked to Factor 2) as per the risk and need principles - Central 8
- All symptoms are common targets for intervention
behaviours that interfere with therapy of psychopaths
- Manipulative behavior, lying, conning
- Irresponsibility
- Staff splitting
- Glibness, superficial charm
- Flirtatious, sexualized, inappropriate behaviors
- Attempts or threats of self harm
- Anger, abusiveness, aggression, and intimidation
factor 1 treatment implications
- Manage treatment interfering behaviors (as responsivity characteristics) to ensure program integrity
– Careful staff selection, training, support & supervision
– Team work & team coherence
– Build working alliance, use motivational interviewing approaches
– Boundary maintenance
– Monitor offender activities
factor 2 treatment implications
- Treatment should focus on changing PCL-R Factor 2 (antisociality) characteristics to reduce violence
- Use dynamic risk assessment tools to assess criminogenic needs
- Use CBT/skills training to address thoughts, feelings and behaviors linked to violence/sexual violence
clearwater and ABC Programs - VRS-SO Assessed Treatment Change and Sexual and Violent Recidivism in a High Risk Treated Sexual Offense Sample
- 156 treated men with sexual offense history attended Clearwater Program
– High intensity, CBT/RNR based program
– VRS-SO used to assess risk and change in treatment
– PCL-R used to assess psychopathy (M = 20.2, SD = 7.4) - Followed up a mean 10 years post-release
Eb above 1 = recidividm, lower than 1 = not recidivism
15-20% reduction in sexual and violent recividivism
clearwater and ABC programs - VRS Assessed Treatment Change and Violent Recidivism in a
High Risk, Psychopathic Sample
- 152 treated violent federally sentenced men attended the Aggressive Behaviour Control (ABC) Program
- High intensity, CBT/RNR based risk reduction treatment
- VRS used to assess risk and change in treatment
- 94% VRS score >50; mean score =61
- (DSPD VRS mean score = 61 [Kirkpatrick et al., 2009])
- 64%, PCL-R >25
- 27% PCL-R > 30; sample mean PCL-R = 26
- (DSPD mean 28.3 [Kirkpatrick et al., 2009])
- 8-10% reduction in overall violent recidivism
