Lifespan Psychopathy Flashcards
Hervey Cleckley Influence in the Field of Psycopathy
- Created a set of criteria for the characteristics of psychopathy based on his experiences with psychiatric patients
- He narrowed the psychopathy construct, including positive adjustment, chronic behavioural deviance, emotional-interpersonal deficits
- Forms basis for modern conceptualisations
Positive Adjustment (Cleckley)
- Superficial charm and good “intelligence”
- Absence of delusions/irrational thinking
- Absence of nervousness, anxiety or neuroses
- Would rarely carry out suicide
Chronic Behavioural Deviance (Cleckley)
- Inadequately motivated antisocial behaviour
- Poor judgement / failure to learn from experience
- May be told something is wrong or punished for it but they continue to do it despite
- Unreliability
- Fantastic and uninviting behaviour with/without drinking
- Sex life impersonal, trivial, poorly integrated
- Failure to follow any life plan
Emotional-interpersonal deficits (Cleckleys Construct)
- Thought to be the most core symptom of psychopathy
- Untruthfulness and insincerity
- Lack of remorse or shame, which is most recognised
- General poverty in major affective reactions
- Pathological egocentricity and incapability for love
- Specific loss of insight
- Unresponsiveness in
general interpersonal relations, they may be living their lives like healthy human beings but their emotional experiences are not typical
Prevalence of Psychopathy
- 1% of people have psychopathic traits in comparison with antisocial behaviour being about 10%
- These 1% are causing more than $460 billion societal costs because of the crimes they commit, the cost of health services and damage to victims etc
Of all criminal offenders:
- 50-90% have antisocial personality disorder
- 16-25% of this group have psychopathy
- 4% of white collar “successful psychopaths” outside of criminal settings
DSM Definition of Antisocial Personality Disorder
- Pervasive pattern of disregard for/violation of others’ rights occurring since age 15 (3 or more):
- Repeated criminal behaviour
- Repeated lying or conning of others
- Impulsivity or poor planning
- Irritability and aggressive behaviour
- Reckless disregard for others’ safety
- Chronic irresponsibility
- Lack of remorse (this has come under controversy because people believe this should only be specific to psychopathy)
Robert Hare Influence on the Field of Psychopathy
- Developed the psychopathy checklist (PCL) and its derivatives
- Connected Cleckley’s clinical work in a structured, standardised system for prison measures
- Addressed lack of objective psychopathy measures
- Initially validated in relation to global and checklist measures of Cleckley psychopathy
- 1980, revised in 1991
How is the Psychopathy Checklist by Robert Hare Assessed?
- Semi-structured face to face interview covering a lot of the domains of their life
- Pick up elements that might be consistent with 20 different criteria
- Supplemented by detailed review of institutional file material (there is a lot of dishonesty, so you cannot verify what they say)
The Basics of Scoring the PCL-R
Each item scored on a 3 point scale
- 0 = item does not apply to individual
- 1 = item applies to individual but only somewhat, or mixed evidence
- 2 = item describes individual in most respects
Item scores summed to generate total and factor scores
- 30+ psychopath
- 21-29 intermediate
- <20 non-psychopath
- Not particularly a scientific measure, arbitrary choice
PCL-R: Items and Structure
- Psychopathy split between factor 1 (interpersonal facet - affective facet) and factor 2 (lifestyle facet - antisocial facet)
- Sometimes argued
Paul Frick and Measuring Youth Psychopathy
1st Gen Instrument: Antisocial Process Screening Device (APSD)
- found that what predicted it most in children was in the affective domain
- callous-unemotional traits (CU) subscale
The Development of Adding a Classification for CU Traits
a lot of children from ODD or CD had some slightly distinct enough traits to warrant new classification
CU Traits and Police Contact
- Groups with CU traits and conduct disorder had the largest contact with the police
- Kids with conduct disorders plus CU traits, their conduct problems are more severe, engaging at all different sides of delinquency, started delinquency much earlier, more proactive and reactive aggression
- More likely to have ASPD as adults, and more likely to have psychopathy
- CU increases risk
- “Punishment doesn’t work”
Reactive VS Proactive
- reacting
- bullying, planned, hurting others for no personal defence
High PCL Scorers are:
- Disproportionate criminal involvement- versatile offenders
- Most severe and violent - predatory aggression
Predictor of future violence and criminal involvement - general and violent recidivism - nonviolent and violent infractions
- Unique causal factors
- Poor response to treatment
Sex Differences in Psychopaths
- Less prevalent in women than men
- More sexual promiscuity, prostitution, use of nonviolent sexual coercive tactics and relational aggression in women
- Overlap with PD, somatization
- Predictor of suicide-related behaviours
- Higher rates of abuse, neglect, and trauma
- Less research for women than men
What Causes Conduct Disorders with Limited Prosocial Emotions (Callous and Emotional Traits)?
- Parent-child coercive cycle is less important for people with these traits
- As parenting becomes more dysfunctional the number does not change
People with CU not Reading the Room
Transgression –> victim’s distress cues or parent’s threat cues –> negative emotional state –> guilt/empathy
- Callous traits do not show a negative emotional state in the same way
- Do not learn that process, so it doesn’t inhibit their negative behaviour
The Idea of “Unempathetic Brains” in Psychopathy
- The amygdala looks different
- Can’t process fear expressions
Brain Differences in CU Subtype of CP
- Amygdalas are underactive in callous traits
- CU problems it is overactive
violent psychopaths smaller amygdala volume
CU Traits and Punishment Learning
- Less aversive to punishment as they do not learn from them
- They struggle to learn consequences and changes to contingencies
- They struggle to link the consequence of an action with their own behaviour
Theory of attention deficit
- Reward-driven, goal-directed, miss everything happening on the periphery
CU Traits and Behavioural Genetics
- Twin studies show greater contribution of conduct problems in youth with CU traits, as a result of more severe conduct problems or ADHD symptoms presenting in childhood
- CP traits only is 30% of the test population
- of this 30%, 80% of people have CU + CP, suggesting that there is greater genetic risks instead of environmental ones
-*look over for context of statistics
Can Psychopathy be Treated?
- Strong pessimistic opinions despite the lack of information in the field
- This conclusion is largely based on one unconventional study that made patients worse, however it didn’t use any modern treatment so as a point of comparison it is not good
- Mainly poorly designed and carried out studies in this field
- Treatment effective in reducing re-offending in juvenile offenders
- Early intervention with children with CU CP is promising
Philippe Pinel Recognition of Psychopathy
Insanity without delirium
Issues with Cleckley’s Model
- Lacks an operational definition
Hard to put all their findings to get one overall reason why someone may have this problem, bringing forth theories
- Fearlessness
- Restricted reactivity to emotionally-distressing cues
- Attentional deficit (bad multitasking, over fixation on their goals, even if it results in a punishment)
- Deficit in associative learning style (know what the punishment is, but they don’t care about the distress involved that may put them there)
3P’s Framework
- Pervasive - consistent across different contexts
- Pathological - causes significant impairment
- Persistent
(*later edit and provide more context)
Why is the DSM Bad at Assessing Psychopathy
- ASPD is too broad
Use the PCL-R instead
- Dsm focuses on behaviour more than personality
- This provides a more specific basis for diagnosis
Why use PCL-R
- Focuses on the personality traits and behavioural indicators
- Specificity, accuracy
- Predictive validity
- Structured and standardised assessment
Limitations of the PCL-R
- As it is recorded in the jail system there is nothing to check against for non-criminals
- Self-report
- Binary, may be different circumstances of severity
