Module 11: Psychopathic Personality LECTURES

Question 1

Media Portrayals and lay audience perceptions of Psychopathic Individuals:

Answer 1

 A classic example is serial killers most people think of
the case of Ted Bundy who killed 100 women or
Hannibal the cannibal (charming and manipulative).
 Not commonly thought of is female psychopathic
personality examples, it’s rare, glen close in fatal
the attraction was actually psychopathic and not BPD
(alludes to the diagnosis being hard to determine) she
had shallow emotional reactions which were used
strategically to get her way.
 Mr. Rusefald who is a US politician.
 Ant Deckman who commits non-violent crimes and he
asked a movie crew to make a documentary on him to
find out if he was in fact psychopathic (narcissism).

Question 2

Explaining Psychopathy? From someone who has been convicted for serious crimes and scores high in psychopathic traits:

Answer 2

 I didn’t have any feelings for anyone but myself.
 All I cared about was me feeling good and I didn’t care
who I hurt in the process.
 I was unempathetic; I don’t think I knew what empathy
was.

Question 3

What is the core characteristic of a psychopathic personality?

Answer 3

Emotional detachment which refers to shallow affect and low empathy.

Question 4

What is Bob Hare’s Model Four-Factor Model of Psychopathy?

Answer 4

(A) Emotional Detachment
e.g. low empathy and shallow affect.
(B) Interpersonal Problems
e.g. manipulation, interpersonal domination, using
people.
(C) Impulsive Lifestyle
e.g. reckless stimulation seeking, instability in life, no
set plan.
(D) Antisocial Behaviour
e.g. illegal or harmful behaviours which begin in
childhood (bullying, rumour spreading,
aggression, drug use, vandalism etc.).

Question 5

What is Bob Levinson’s Model of Psychopathy?

Answer 5

Primary Psychopathy:
 Emotional Detachment
   e.g. low empathy and shallow affect.
 Interpersonal Problems
   e.g. manipulation, interpersonal domination, using 
          people.
= personality-based effective component

Secondary Psychopathy:
 Impulsive Lifestyle
e.g. reckless stimulation seeking, instability in life, no
set plan.
 Anti-social Behaviour
e.g. illegal or harmful behaviours which begin in
childhood (bullying, rumour spreading,
aggression, drug use, vandalism etc.).
= behavioural component

Question 6

What is Scott Linienfields’s Model of Psychopathy?

Answer 6

Fearless Dominance:
 Emotional Detachment
 Interpersonal Problems
*fearless: not easily intimidated or threatened by other
people. Dominance: manipulative behaviour in order to
get what they want.

Self-Centred Impulsivity:
 Impulsive Lifestyle
 Antisocial Behaviours
*narcissism and goal-directed behaviour at the expense 
 of others.

Question 7

What is Chris Patrick’s Triadic Model of Psychopathy?

Answer 7

Boldness/Meanness:
 *personality-based
 emotional detachment & interpersonal problems.

Meanness/Disinhibition:
 impulsive lifestyle and antisocial behaviour

Question 8

Is their a DSM or ICD-10 Diagnostic Criteria for Psychopathy?

Answer 8

No. The closest related diagnostic criteria we have are Anti-social PD and Disassociative PD. However, these criteria do not encompass all characteristics associated with a psychopathic personality (i.e., PCL-R scale).

For example, both ASPD and DPD does not include superficial charm, poor behavioural control, grandiose sense of self, parasitic behaviour, promiscuous sexual behaviour, a failure to accept responsibility and lack of suicide.

Only ASPD misses shallow affect, lack of empathy.

Only DPD misses failure to plan ahead, no psychosis and no manic episode.

The PCL-R misses no suicide, no delusions and no nervousness.

Question 9

What are the two main ways to measure psychopathic personality?

Answer 9

(A) Clinical Interviews & Intensive File Review

(B) Self-Reports

Question 10

which psychopathic personality scale is predominantly used in clinical interviews?

Answer 10

PCL-R

Question 11

Which clinical scale of psychopathy is used on youth?

Answer 11

PCL-YV

Question 12

Which clinical scale of psychopathy is used for clinical screening?

Answer 12

PCL:SV

*is a condensed scale with fewer items which is used for screening purposes.

Question 13

Which clinical scale of psychopathy CAN be used without an extensive file review?

Answer 13

ICU. Which is used to measure callous-unemotional traits in children.

Question 14

Can you conduct a clinical interview without an extensive file review?

Answer 14

No.

Question 15

Can we measure Psychopathy using self-report measures?

Answer 15

Yes. We do not directly ask them questions related to whether or not they think they’re psychopathic. We ask questions about the traits, behaviours, thoughts and affects linked to high levels of psychopathy instead to avoid them lying or manipulating their answers.

Question 16

Epidemiology of Psychopathy (Male vs Female):

(A) ASPD in Adults
(B) Prisoners
(C) In the General Population

Answer 16

(A) Adults with antisocial 
     behaviours: Men (16.5%) 
     Women (8.5%)
(B) Prisoners with a PCL-R 
     score above 30 i.e., high in 
     psychopathic traits: Men 
     (30-15%) Women (9-32%).
(C) PCL-R Scores in the 
      general population (can 
      not use PCL-R in the 
      general population but the 
      prevalence rate is 
      estimated to be) Men (less 
      that 1%) Women (not 
      enough stats).

*Psychopathy is NOT common 
 in the general population. A 
 large number of violent 
 offenders incarcerated 
 display psychopathic 
 personality traits but NOT all 
 of them are.

Question 17

What percentage of the prison population meet the criteria for:

(A) ASPD
(B) ASPD and Psychopathy

Answer 17

• 50% of the prison population 
  show antisocial personality 
  traits.
• Only a subset of the prison 
  population who meet the 
  criteria for antisocial 
  personality disorder will also 
  meet the criteria for 
  psychopathy.
• This is due to the DSM 
  Criteria for dissocial and 
  antisocial personality 
  disorders NOT capturing all 
  the criteria listed by Cleckley 
  to be characteristic of 
  psychopathic individuals.

Question 18

(11) Facts on Psychopathy:

Answer 18

• Psychopathy does overlap 
  with other personality 
  disorders such as antisocial, 
  narcissistic and histrionic 
  personality disorders.
• Psychopathy is not a 
  psychiatric diagnosis in the 
  DSM or ICD-10; therefore, it 
  is not referred to as a 
  disorder. 
• People can be high is 
  psychopathy and NOT meet 
  the criteria for ASPD.
• Psychopathy is an important 
  field of research because 
  people high in psychopathy 
  have a higher and quicker 
  rate of recidivism.
• Psychopathic personality 
  traits are continuous NOT 
  categorical. We know this 
  because ratings of 
  psychopathic personality 
  populations exhibit a normal 
  distribution meaning people 
  will score high and low on 
  psychopathy.
• Men’s distribution is flatter 
  balanced distribution. In 
  contrast, a higher rate of 
  women score low and PCL-R 
  > 20 is rare.
• There is no clinical cut off at 
  which we say someone is or 
  isn’t psychopathic, we would 
  say some score higher or 
  lower on psychopathy but 
  not view them as distinct 
  groups.
• Callous-unemotional traits 
   are precursors of 
   psychopathic traits:
o We do use psychopathy as a 
   term for children, we 
   generally refer to callous 
   unemotional traits.
o CU’s are relatively stable 
   over adolescence (high CU 
   in childhood & high ASPD in 
   adulthood).
o Stability or persistence of 
   CU’s depends on genetic 
   rather than environmental 
   factors.

Question 19

Where does psychopathy come from?

(A) What are the Two
Predominant Theories?

Answer 19

(A) The fear deficit hypothesis:
    a. Based on evidence which 
        demonstrates that highly 
        psychopathic individuals 
        react less to threats.
     b. Lower physiological 
         responses i.e., startle 
         response, skin 
         conductance, heart rate 
         or blood pressure etc.
      c. Brain areas related to 
          fight or flight response is 
          the amygdala. The 
          theory states that 
          people high in 
          psychopathy show a 
          deficit in amygdala 
          responses.
(B) The attention-allocation 
      hypothesis:
    a.	Argues that deficits of 
        psychopathy are  
      context- 
        dependent i.e., they do 
        not occur all the time 
        (globally).
     b. Deficits occur when 
         these cues are 
         distractors i.e., in their 
         peripheral, and are not 
         directly relevant to goal- 
         directed behaviour.

Question 20

Evidence for the Fear-Deficit Hypothesis:

Answer 20

• The amygdala is important in 
   learning, aversive classical 
   conditioning, in which an 
   individual’s learns to inhibit 
   their behaviours in order to 
   avoid an aversive 
   consequence (i.e., 
   punishment).
• In Birbaumer et al. (2005) 
  they paired a neutral face 
  (NS) with an electric shock 
  (US) to form a CR where their 
  skin conductance of arousal 
  when presented with the CS 
  demonstrating they’ve learnt 
  a negative association with 
  the face and the shock. 
• Psychopathic individuals 
  (blue) are flat, they show no 
  signs of associative learning 
  in which they’ve paired the 
  neutral face with the aversive 
  shock.
• Looking at their brain activity 
  we can see lots of activity in 
  the amygdala and insula in 
  healthy controls (emotional 
  learning) but NOT in 
  psychopaths.

*psychopaths react differently 
  to healthy controls to 
 threatening stimuli-muted fear 
 response rather than absent 
 response.

As a consequence, people high in psychopathy have high recidivism rates because prison is not an affective punishment, an associative pairing from their behaviour to prison does not occur.

Question 21

Evidence for the Attention-Allocation Hypothesis:

Answer 21

*High and Low psychopathic 
 individuals did not differ in 
 performance their attention 
 was on the threatening 
 stimulus. Deficit only occurs in 
 highly psychopathic 
 individuals when their 
 attention is distracted.
*fear-potentiated startle 
 response

*Brain regions associated with 
 emotional learning such as 
 the amygdala was      
 reduced inactivation in highly 
 psychopathic traits but only in 
 the early alternative fours 
 condition when their attention 
 was distracted (Larson et al. 
 2013).

Question 22

How can we measure fast processes?
*that are relevant to sensory 
 processing to identify and 
 respond to threatening stimuli 
 in our environment which has 
 an inherent emotional 
 component.

Answer 22

(A)	EEG’s
    a.	Measure electrical 
        cortical activity in the 
        brain regions and 
        aggravate them into one 
        signal to analysis.
    b.	Activity signals are 
        derived from the whole 
        brain you cannot focus 
        on one brain region 
        when measuring activity.
     c. Is a really good method 
         for observing immediate 
         activity following a 
         stimulus relative to FMRI 
         studies which are harder 
         to see.

Question 23

Example EEG Study on Psychopathy?

Answer 23

Example study: Eisenbarth et al. 2013.

• Faces are a common stimulus 
  in our environment which 
  humans are quick to process 
  and are relevant to threat 
  perceptions 
  (approach/avoidance 
  orientations).
• Overtime, faces are perceived 
  to be more sensitive to facial 
  expressions than other 
  potential threats like sharks 
  etc. which are not commonly 
  in our environment.
• ANGRY FACES:
o 170ms after a face is shown 
   both high and low 
   psychopathic individuals 
   exhibit a negative reaction in 
   brain activity.
o Between 200-300ms after 
   face exposure high 
   psychopathic individuals 
   show a shallower processing 
   and emotional response to 
   faces than low psychopathic 
   individuals.
• FEARFUL FACES:
o We see a similar pattern in 
   which individuals high in 
   psychopathy show reduced 
   brain reactivity relative to 
   individuals low is  
   psychopathy in response to 
   fearful faces.

*In other words, this demonstrates that highly
psychopathic individuals show a muted
response to threatening stimuli in terms of
physiological arousal relative to individuals low
in psychopathy.
*psychopathic individuals show lower reactivity
to emotional cues when their not in their
attentional focus.

Question 24

How do deficits and fear, arousal and emotion link to behaviour?

Answer 24

(A) There is a correlation 
      between low fear and 
      recidivism rates which is 
      theorized to inhibit 
      aversive classical 
      conditioning which 
      undermines the 
      effectiveness of prison as 
      a punishment.
(B) No Arousal, linked to 
     inhibitions to social 
     interactions (violent, and 
     non-violent interactions).
(C) No emotion linked to no 
     emotional empathy 
     (perceiving and responding 
     to other people’s distress).

Question 25

Psychopathic traits (Low Fear) and its relevance to treatment outcome:

Answer 25

o Sewall & Olver et al., 2018:
o Found a “survival curve” in 
   sex offenders.
o Surviving refers to living life 
   after prison without 
   committing another crime.
o People who:
 Low PCL-R, High Risk, Low 
   change (most of them were 
   re-convicted)
 Low PCL-R, High Risk, High 
   change (had quickest 
   recidivism rates)
 High PCL-R score, High risk, 
   No change (large risk of 
   recidivism).

*these groups are most at risk 
 of recidivism are those who 
 are high risk i.e., it is NOT
 primarily defined by 
 psychopathy because low 
 psychopathy scores 
 correlated with high risk as 
 well.
* individuals perceived to be 
  the most likely to recidivism 
  are those who score high 
  in PCL-R and are High risk 
  but those who demonstrate 
  high change in response to     
  treatment actually show a 
  decrease in risk of 
  recidivism.

Question 26

Is Treatment for individuals who score high in psychopathic traits effective in reducing recidivism?

Answer 26

Yes. For those who are HIGH in psychopathic traits and, High in Risk and High in change treatment can be effective in reducing recidivism.

Question 27

Psychopathic traits (No Emotion) and its relevance to e Professional Success (professional satisfaction and material success):

Answer 27

 Does being unempathetic make you more successful in the pursuit of our goals?

 Found that:
• Fearless dominance is +0.04 
  is predictive of professional 
  satisfaction (primary 
  psychopathy).
• However, self-centred 
  impulsivity is -0.05 predictive 
  of professional satisfaction 
  (secondary psychopathy).
• Fearless dominance is +0.01 
  predictive of material 
  success (primary 
  psychopathy).
• Self-centred impulsivity is 
  -0.003 predictive of marital 
  success (secondary 
  psychopathy).

Question 28

Summary:

Answer 28

1. Psychopathy is a personality 
   trait which is:
 Dimensional
 Not a disorder
 Is related to low empathy
 Is related to low threat 
   reactivity
 Which leads to leads 
   attention to potentially 
   threatening cues