Lecture 14 - Antisocial personality disorder and psychopathy Flashcards
History and diagnosis of ASPD
Cleckley: comprehensive early description of
psychopathy in 1940s
* behavioral features: impulsivity, antisocial
behavior, sexual deviancy, and irresponsibility
* Also affective and interpersonal traits:
egocentricity, superficial charm, lack of empathy
DSM-III (1980) first includes Antisocial
Personality Disorder
* Strong emphasis on objectively measured
behavioural criteria, to improve diagnostic
reliability
* Affective/interpersonal traits not included as
criteria
DSM
Antisocial Personality Disorder
Is a DSM diagnosis
Psychopathy is not a DSM diagnosis
DSM-5 criteria for ASPD
* A. A pervasive pattern of disregard for and
violation of the rights of others, occurring
since age 15, as indicated by three (or
more) of the following:
* 1. Failure to conform to social norms with
respect to lawful behaviors
* 2. Deceitfulness
* 3. Impulsivity or failure to plan ahead.
* 4. Irritability and aggressiveness
* 5. Reckless disregard for safety of self or
others.
* 6. Consistent irresponsibility
* 7. Lack of remorse
Very behavioural diagnostic
-Doesn’t capture very well the psychology of it
At least 18 to receive diagnosis
Conduct disorder
- Aggression to People and Animals
- E.g., often bullies, has used a weapon to intimidate
others, has been physically cruel to animals - Destruction of Property
- E.g., deliberately engaged in fire setting, deliberately
destroyed property - Deceitfulness or Theft
- E.g., stealing non-trivial items, lies to obtain things
- Serious Violations of rules
- E.g., ignores curfew (before the age of 13), often truant
from school (before 13)
Specifiers:
* Childhood-onset type (prior to age 10)
* Adolescent-onset type (no symptoms prior to
10)
Other Specifiers:
With limited prosocial emotions
* Lack of remorse or guilt
* Callous- lack of empathy
* Unconcerned about performance
* Shallow or deficient affect
- Boys 4x more likely to be diagnosed
- Girls diagnosed at a later age
- In girls, may have different correlates, outcomes
- Teen pregnancy, suicidal behavior
– More pronounced with CD partner - Assortative mating
-People with CD may have tendency to date other people with CD - Associated with more severe negative behavior,
discord, poor parenting - Kids already have heightened genetic load
ASPD vs. Psychopathy
ASPD ≠ Psychopathy
* Cleckley advanced view that psychopath
appears normal on the surface
* Under the mask is a very fundamental, very
severe deficit
* More psychologically- than behaviorallyfocused
* Criminal behavior is only one piece
-Psychopathy does not necessarily mean criminal behaviour
See Cleckley’s 16 criteria for psychopathy
Psychopathy Checklist (PCL) and current
conceptualization
* Robert Hare
* 20-item checklist, rated via interview
and whatever records (school, police,
prison) are available
* Hare also emphasizes that not all
psychopaths criminal
* PCL used widely in N. America
* Parole decisions often rely on PCL
scores
PCL doesn’t capture full picture
Law inforcement, police, politics, medicine
Business!!
Factor 1
Emotional-Interpersonal
* charm, grandiosity
* lying, manipulation
* remorse
* emotional depth
* empathy
Factor 2
Behavioral Deviance
* child behavior problems
* juvenile delinquency
* boredom, impulsivity
* irresponsibility
* violent behavior
ASPD vs. Psychopathy
* In a sample of prison inmates: (Patrick,
2015)
- 70 to 80 percent qualified for ASPD
diagnosis
- 25 to 30 percent met criteria for
psychopathy (PCL)
* ASPD misses non-criminal psychopathy
* Individuals show more
affective/interpersonal features, but
fewer antisocial behaviours, and are rarely
criminalized
Prison inmates sample:
Psychopathy worse offenders than aspd
* Psychopathy single best predictor of
violence and recidivism among prison pop.
Recidivism
* Up to 4x more likely to reoffend (violently)
than other prisoners (Hemphill, 1988)
* Same trend seen in adolescents
Prevalence of ASPD vs. Psychopathy
ASPD
* Between .2% and 3% for males and
females in the general population
* Conflicting reports about gender
differences
* Higher in criminal settings
* Higher also in hospital settings
Psychopathy
* No epidemiological studies
estimating prevalence of
psychopathy
* Tends to be difficult to measure in the
community
* Hare estimates 1% in N. America
* Over-represented in prison settings
- Particularly in maximum-security
prisons
* Female inmate samples: 9-31%
Etiology
Prenatal Factors and Birth
Complications
Pregnancy and birth factors
* low birth weight
* malnutrition (possible protein deficiency) during pregnancy
* lead poisoning
* mother’s use of nicotine, marijuana, other substances during pregnancy
* maternal alcohol use during pregnancy
No direct causal link between factors and conduct problems has been established
* E.g., smoking during pregnancy is robustly associated with increased conduct problems
* Many possible paths linking smoking to conduct problem
* Smoking might alter neurotransmitter systems
* Smoking affects birthweight, and birthweight affects conduct problems
Genes
* Familial aggregation (ASPD)
* Data from twin studies suggest genetic
contributions (e.g., Blonigen, Carlson, Krueger, &
Patrick, 2003)
* Estimates of strength of genetic contributions
varies
* Genetic pathways:
* 1) Genes lead to difficult temperament,
impulsivity, tendency to seek rewards, and
insensitivity to punishment
* 2) Genes may moderate susceptibility to
environmental risk factors
* 3) Genes increase likelihood for child’s
exposure to environmental risk factors (e.g,
parental divorce, maltreatment)
MAOA gene
* MAO-A degrades amine neurotransmitters
* Dopamine
* Norepinephrine
* Serotonin
* More MAO-A results in more degradation,
lower levels of amine neurotransmitters
* Psychological disorders?
* Less MAO-A results in less degradation,
higher levels of amine neurotransmitters
* Psychological disorders?
* Main effect vs. Interactions
MAOA Gene as a diathesis
* Child maltreatment is a robust risk factor for
conduct problems
* But, most children who are maltreated do not go on
to engage in significant criminal behaviors in
adulthood
* Why?
* Different susceptibility to the experience of
maltreatment
* In both humans and mice, decreased activity of the
enzyme is associated with increased aggression
Environment
* Abused or maltreated kids go on to have higher
PCL-R scores (prospective)
* Report more negative upbringing (retrospective)
-hard to separate genetics from parenting
-Gene-environment correlations
* Parents often lack psychological/ physical resources
to cope w/ difficult children– inconsistent
disciplinarians
* Antisocial individuals prefer to associate with
similar others– miss opportunities to learn positive,
pro-social behaviors
* Early criminality/ drug use can eliminate future
opportunities
Interactions
* Potential gene x environment interactions
(Cadoret et al., 2005)
* Adopted-away children of biological parents
with ASPD
* Main effect: adopted children of biological
parents with ASPD were more likely to develop
antisocial traits BUT
* Interaction: EVEN MORE likely to develop if
exposed to an adverse environment
Causes
Societal Influences
* Poverty and neighborhood crime are related to delinquency
* Different possible mechanisms:
- Social cause: living in poverty increases rates of delinquency
- Social selection hypothesis: people with psychopathology drift down to poverty
- Work with children indicates causal association between poverty and disruptive behavior, with parent
supervision as the mediator (Costello et al. JAMA)
- Cultural Factors
- Across cultures, socialization of children for aggression is one of the strongest predictors of aggressive
acts - Liberian child soldiers
- Rates of antisocial behavior vary widely across and within cultures
- Antisocial behavior is associated with minority status in North America, but this is likely due to low SES
Treatment and distress
- Treatment challenging,
- Without distress, little motivation to
change. - There has been some weak evidence that
SSRIs reduce aggressive behaviour and
increase interpersonal skills
Building a better psychopath?
* Some treatments effective in reducing
the rates of reoffending among
criminal offenders.
* However, these treatments can
actually cause rates of reoffending to
increase for psychopaths.
* Treatments that emphasize training in
social skills and empathy may actually
be useful in helping psychopaths
become better at charming or conning
future victims (Vitale & Newman,
2008).
- Liberia’s two civil wars: 1989-1996, 1999-2003
- Killed 10% of the population
- Majority of the population displaced
- Tens of thousands recruited into combat
- Now at peace, but economy suffering,
unemployment is high - Poorly integrated ex-combatants (young men 18
to 35) a concern - Often involved in drugs, crime, high levels of
political violence, often recruited as mercenaries
in other civil wars in the area - How to reduce antisocial behavior in these men?
Treatment
* Christopher Blattman, Julian Jamison, Margaret Sheridan
* Recruited 999 high-risk men from Monrovia
* Homeless, drug-using, and present in neighborhoods known for crime, armed recruitment and
violence
* In the bottom 10th percent for income, average of 8 years of education, earned $68/month, had $34
saving
* 38% were former members of an armed militia
* Sustainable Transformation of Youth in Liberia (STYL)
* 8-week program of group cognitive therapy
* taught skills of self control: to manage anger and emotions, reduce impulsivity, become more conscientious
and persevering, and become more forward-looking
* Also shift self-image from outcast to normal society member
* $200 grant (about 3 months’ wages)
* Randomly assigned to CBT-only (28%), Cash-only (25%), CBT-plus cash (25%), neither (22%)
- Mechanisms of change:
- “Nearly all the subjects we interviewed described
feeling ostracized at baseline, and many reported
that the therapy pushed them to believe they could
be someone better for the first time.” - Change in appearance
- Change beliefs, change behaviors, but also give
them material opportunities in which to make these
changes possible - Have arenas in which to exercise the skills they
learned in therapy - Can perform the “someone better,”– e.g., as an
entrepreneur
Basically
Both cash and therapy = most effective
Material opportunities to make the change possible
Performing that ‘’someone better’’
