Psychopathy and ASPD Flashcards
General History
Ancient Greece - ‘unscrupulous man’ -> psychopathy
Figures of insanity - always been present
1800’s - madness with the insanity
P’s with an apparent “perversion of the moral faculties”
Lombroso - theories about criminals - facial features
Brain differences? - R and L brain being out of balance?
ASPD - History
- cause is unknown
- inherited traits BUT family life also increases the liklihood of developing the disorder
- abnormalities in nervous system development?
- prenatal exposure - smoking?
- ASPD P’s - require more sensory input for normal brain function
- e.g. serotonin levels of brain regions such as PFC? (linked with impulsively and aggressive behaviour?)
- environment - always plays a big part
- parental influences - ASPF behaviour in themselves influencing the children?
- attachment?
ASPD and Psychopathy links
Closely linked!
- not all ASPD P’s are psychopaths
- all psychopaths tend to have ASPD
- key differences between the two!
Gregory et al (2012) - ASPD without P and ASPD with P
Identified structural GM differences between persistent violent offenders with ASPD + P against those with just ASPD
- using MRI scans
- ASPD + P - significantly reduced GM volumes bilaterally in the anterior rostral PFC and temporal poles relative to offenders with just ASPD and non-offenders
- reductions - not attributable to substance disorders
- reduced GM volume within areas implicated in empathic processing, moral reasoning and processing of prosocial emotions such as guilt and embarrassment may contribute to the profound abnormalities of social behaviour observed in P
- differences between with and without P - it is a distinct phenotype?
DSM-IV and DSM-V definition of Personality Disorder
“an enduring pattern of inner experience and behaviour that devotees markedly from the expectations of the individuals culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment”
DSM-V for PD - changes?
Change from ‘pervasive pattern’ to ‘adaptive failure/impaired sense of self identity / failure to develop effective interpersonal functioning’
What are the 6 types of personality disorders?
Antisocial/Psychopathic Avoidant Borderline Obsessive-Compulsive Narcissistic Schizotypal
Antisocial / Psychopathic PD
- egocentric, non-conforming, unethical, callous, deceitfulness, manipulative, irresponsible, risk-taking
DSM-V ASPD
Impairments in self-funtioning (a or b):
a. IDENTITY - ego-centrism
b. SELF-DIRECTION - goal-setting based on personal gratification, absence of pro-social internal standards associated with failure to confirm ti lawful or culturally normative ethical behaviour
Impairments in interpersonal functioning (a or b)
a. EMPATHY - lack of concern for feelings, needs or suffering of others; lack of remorse after hurting or mistreating others
b. INTIMACY - incapacity for mutually intimate relationships, exploitation is a primary means of relating to others, deceit and coercion, dominance or intimidation used to control others
Pathological personality traits in the following domains:
- ANTAGONISM - manipulativeness, deceitfulness, callousness, hostility
- DISINHIBITION - irresponsibility
DSM-V ASPD
- some explanation
Impairments in personality functioning and the P’s personality trait expression - relatively stable across time and situations
Not better understood as normative for the P’s developmental stage or socio-cultural environment
Not due to direct physiological effects of a substance or a general medical condition
P is at least 18 years old
NICE assessment
Need to conduct a full assessment of:
- antisocial behaviours
- personality functioning, coping strategies, strengths and vulnerabilities
- co-morbid disorders
- the need for treatment, social care and support and occupational rehabilitation or development
- domestic violence or abuse
If in specialist service:
- can check severity using PCL-R or PCL-SV as a part of a structured clinical assessment
Problems with assessing / diagnosing ASPD?
- under-recognised disorder
- when identified, other significant co-morbid disorders are often not detected
- important concerns about assessing risk of violence and risk of harm to self and others
- asking about feelings, behaviours etc - many P’s feel as if nothing is wrong with their behaviour so difficulties here - not chosen to undertake treatment!
- normally referral from court or prison
- therapeutic alliance - KEY - but how do you establish this with someone who does not want treatment?
- what about bringing in family support - PROBLEM - coming from a dysfunctional family, may not be the best thing to do then!
PCL-R - Hare
- psychopahty checklist-revised
- 20 item inventory of perceived personality traits and recorded behaviour
- semi-structured interview along with a review of ‘collateral information’
- each item - different scores - 0, 1 or 2
- score of 30 or above = diagnosis of psychopathy
- variety of questions asked - co-morbidity, relationships, anger and control, family history, school days etc
- extreme end = serial killers
- 40 = absolute maximum score - a prototypical psychopath will achieve this!
Psychopathy - useful?
Is it a disorder or can it be advantageous?
- psychopaths can be very successful
- e.g. business men, CEO’s, surgeons, soldiers etc
- so is it adaptive and advantageous?
Lilienfeld et al (2012) - Fearless dominance
- some features of a psychopathic personality (e.g. fearlessness, interpersonal dominance) can be adaptive in certain leadership positions!
- tested in 42 US presidents
- FD (boldness associated with psychopathy) was associated with better rated presidential performance, leadership, pervasiveness, crisis management, congressional relations and allied variables
- also associated with several largely or entirely objective indicators of presidential performance, e.g. initiating new projects and being viewed as a world figure
Pegrum and Pearce (2015) - Doctors and psychopathy
Doctors - faced with a range of situations with stress etc
- psychiatric morbidity, long work hours, divorce, surgeon duties, medical lawsuits etc
Some of the traits associated with a psychopathic personality are perhaps selected out in those P’s rising to the top of the medical profession?
- preternatural calmness under pressure
- apparent indifference to human suffering when making life-or-death situations
- calmness needed for intense situations
High pressure situations - is when they become calm!
- so will we find these traits more in medical staff?
Pegrum and Pearce (2015) - Doctors and psychopathy
- method and results
No other studies assessing psychopathic personality traits among doctors in teaching and general hospitals
- 172 doctors using the short form of the Psychopathic Personality Inventory
- overall mean score for doctors = 131
- mean score on general public = 119 (previously tested)
Surgeons and Paediatricians = highest scores!
- surgeons - stress immunity and fearlessness
- paeds - stress immunity, fearlessness and carefree non-playfulness
Stress immunity - overriding personality trait of doctors
> showing that traits associated with psychopathy can be useful for certain situations?!
Sociopathy
More to be a product of the environment that you are in?
