Problem 4

Question 1

What does the so-called mask of sanity refer to when talking about psychopaths ?

Answer 1

Their appearance of “normalcy”

–> although they lack empathy they fake normal emotions so convincingly that they often come across as charming

THUS: they learn to compensate for their emotional deficiencies

Question 2

Name 7 characteristics of psychopaths.

Answer 2

1. Show no signs of mental illness

2. Lack of empathy

–> for which they compensate with their charm

3. Better than average intelligence

4. Trouble making appropriate moral judgments and inhibiting impulses

5. Not good at detecting emotions

–> especially fearful expressions

6. Do not take in new info when their attention is otherwise engaged

7. Have normal physiology except when fixated on a goal

–> e.g will not respond to unpleasant stimuli, no sweat etc

Question 3

Which brain areas are believed to be malfunctioned in psychopaths ?

Answer 3

The Paralympic system

–> includes several interconnected brain regions that register feelings + other sensations

Question 4

Ventromedial prefrontal cortex

Answer 4

Implicated in the processing of risk and fear, as it is critical in the regulation of amygdala activity

–> neighbor to the orbitofrontal cortex

Question 5

Orbitofrontal cortex

Answer 5

Is involved in decision making tasks that involve sensitivity to

1. risk
2. reward
3. punishment

–> damages may lead to problems with impulsive + irrational behavior

Question 6

Which brain regions are part of the paralympic system ?

Answer 6

1. ACC + PCC

–> regulating emotions

2. Orbitofrontal cortex

3. Amygdala

4. Insula

–> fear perception, recognizing violations of social norms

5. Temporal pole

Question 7

What is the role of the paralymbic system ?

Answer 7

1. Emotion processing
2. Goal seeking
3. Motivation
4. Self control

Question 8

Are psychopaths made or born ?

Answer 8

Both,

as genes account for 50% of the variability among those who exhibit antisocial traits, life circumstances are just as important as biological inheritance

e.g. being scarred from childhood, “black sheep” of the family

Question 9

Decompression treatment

(Caldwell)

Answer 9

Refers to intensive one-on-one therapy sessions that aim at ending the vicious cycle in which punishment for bad behavior inspires more bad behavior

–> the youths in this program act out less frequently until able to participate in standard rehabilitation services

Question 10

Why is psychopathy often confused with antisocial personality disorder ?

Answer 10

It is not included in the DSM,

which is why clinicians may often see antisocial personality disorder and psychopaths as the same

–> only 1 in 5 people with antisocial PD have psychopathy

Question 11

Why are psychopaths much more likely than non-psychopaths to get an early release from prison ?

Answer 11

Because they will use their deceptive skills/charms

–> then once released they are (obv.) 4-8x more likely to recidivate violently.

Question 12

Psychopathy

Answer 12

Refers to a personality disorder characterized by remorseless + impulsive antisocial behavior

Question 13

Prevalence of psychopathy

Answer 13

1% in the general population

–> 15-25% in the US prison population

Question 14

Psychopathy checklist revised (PCL-R; Hare)

Answer 14

Refers to a validated measure of psychopaths

–> involves a 60-90 min semi-structured interview to obtain info used to rate 20 psychopathy related items

Question 15

Anterior cingulate cortex (ACC)

Answer 15

Refers to a brain region for motivating and regulating behavior through cognitive + affective mechanisms

Question 16

There has been rising evidence that dysfunction in the PFC plays a major role in psychopathy.

Now can we actually draw a causal relationship from this finding?

Answer 16

No,

the actual cause of psychopathy has not yet been discovered but more evidence has been linked to the paralymbic system, especially the amygdala

–> in addition, neuroimaging has its own limitations making the reliability of conclusion based on imaging data a still developing story

THUS: More psychopaths need to be scanned for more reliability

Question 17

Can psychopaths be also extradited by means of the insanity defense?

Answer 17

The key to criminal responsibility is rationality. As the criminal acts of the MDs are usually irrational and navigated through wrongful perceptions of the world, they simply cannot be held responsible for their actions as they thus weren’t intentional in the most cases.

–> psychopaths on the other hand are hyper rational and not at all deluded about the external world - the question remains whether they perceive the world with sufficient accuracy to be held responsible for their highly RATIONAL manipulations

Question 18

Psychopaths seem perfectly capable of resisting self-harming actions that do not require an understanding of social behavior. When it comes to others though, they might not resist.

Explain why, using an example.

Answer 18

They cannot resist reaching into another persons pocket to take money

–> not because they cannot resist in general but because they do not empathize with the other persons relationship to the money

THUS: They usually commit criminal acts simply because they do not care which consequences their actions may have for others

Question 19

When does psychopathy usually occur?

Answer 19

Early behavioral problems and juvenile delinquency are indicators

–> it does not just appear upon adulthood

Question 20

Why might a prison environment be counterproductive to the wellbeing of a psychopath?

Answer 20

1. Need constant stimulation

–> if nothing happens they make it happen

2. Impulsivity

–> drives for example their sexual promiscuity, criminal versatility, etc.

3. Notoriously parasitic

4. Easily angered over trivialities

Question 21

The received dogma has been that psychopathy is untreatable.

Explain the reasons for this.

Answer 21

Because the

1. psychobiological mechanisms of the disorder remain poorly understood

2. Psychopaths will most likely not accept their diagnosis and are thus less wiling to participate in treatment

3. Group therapy may even worsen their condition as they might learn from other behavioral habits

4. In adults, the brain is already fully developed, which makes it harder to modify behavior

–> adolescents it can still be modified

Question 22

In a study of incarcerated psychopaths, those who received group therapy actually had a higher violent recidivism rate than those who were not treated at all.

Can you give an explanation for this?

Answer 22

Being exposed to the frailties of normal people in group therapeutic settings likely gives psychopaths a stock of ink that makes them better at manipulating those normal people.

Question 23

Why is it so important to educate prison and parole officials about psychopaths?

Answer 23

Because, roughly 20-25% of the prison population are psychopaths.

–> education could help them make better management decisions about them

THUS: ignoring the fact that psychopaths exist in large disproportionate number will distort our penological outcome measures

Question 24

Striatum

Answer 24

1. Consists of ventral + dorsal striatum

2. Has been associated with reward seeking and impulsive behavior

–> not many findings in relation to psychopathy but should not be overlooked

Question 25

What does the seductive allure of neursocientific evidence refer to?

Answer 25

It refers to the perception that neuroscience can provide explanations of human behavior even if such explanations are inaccurate or should be irrelevant

Question 26

What are the most optimal solutions/intervention methods to the ill societal effects of psychopathy?

Answer 26

Preventing the development of its traits

–> prenatal and early childhood years are key developmental periods that are particularly vulnerable to environmental influences

Question 27

How is the PCL-R scored?

Answer 27

1. 20-item clinical rating scale

2. Each item reflects a different symptom or characteristic of psychopathy

3. The items are rated on a 3-point scale

–> 0 = item doesn’t apply 1 = item applies somewhat 2 = item definitely applies

4. Items are summed to yield total scores, ranging from 0-40

=> reflects the degree to which an individual resembles the prototypical psychopath.

Question 28

What are the cut off scores for psychopathy in the PCL-R?

Europe vs North America

Answer 28

Europe

–> higher than 25

North America

–> at least 29

Question 29

What do we know about the brain structures of adolescent psychopaths?

Answer 29

1. There are striatal abnormalities, but they are less clear

–> if a youth has conduct disorder the putamen is enlarged

2. We know less of these differences in youth than for psychopathic adults

–> for adolescents with conduct disorder or even without, the brain differences are not that strong - whereas in adults with psychopathy the differences are clear because the brain is fully developed

Question 30

Schema focused therapy

(Effective therapy form)

Answer 30

As psychopaths sometimes had difficult childhood where they developed bad schemas

–> this form of therapy helps to develop better schemas to stop aversive behaviors

Question 31

Transmagnetic stimulation

Answer 31

Refers to a noninvasive form of brain stimulation where an electric pulse generator is connected to a magnetic coil, which in turn is connected to the scalp

–> controversial in treatment effects

Question 32

Deep brain stimulation

Answer 32

Involves the placement of a neuro-stimulator, which sends electrical impulses, through implanted electrodes, to specific targets in the brain

–> controversial in treatment effects

Question 33

Do all psychopaths end up in prison?

Answer 33

No,

Quite a few psychopaths do not take a criminal path but are seen in the business world where they manipulate others to reach the top

–> corporate psychopaths