Psychopathy, Antisocial Personality Disorder and offending behaviour.

Question 1

Psychopathy: levels:

Answer 1

Interpersonal level:
- arrogant, superficial, grandiose, manipulative.
Affective level:
- lack empathy, guilt or remorse, shallow effect.
Behavioural level:
- irresponsibility, impulsive, thrill seekers.

Question 2

Four-facet model of PCL-R:

Answer 2

F1 - Interpersonal, Affective.
Facet 1 - Arrogant and deceitful interpersonal style
Facet 2 - Deficient affective experience. .
F2 - Lifestyle, Antisocial.
Facet 3 - Impulsive, irresponsible parasitic lifestyle.
Facet 4 - antisocial manifestations.

Question 3

Psychopathy Subtypes:

Answer 3

Primary:
Affective deficit is constitutional (heritable) in nature.
Low level of anxiety.
instrumental /proactive aggression.
Secondary:
Affective deficit is the result of early (env acquired) psychosocial adversity such as parental abuse or rejection.
High level of anxiety and emotionally volatile.
Reactive and motivated by hate and revenge. (reactive aggression).

Question 4

Psychopathy as a neurodevelopmental disorder:

Answer 4

Callous-unemotional traits (core features of adult psychopathy).
- Lack of guilt, lack of empathy and shallow effect.
Two subtypes of youths with conduct problems.
Youths with high levels of callous-unemotional traits (CP/HCU) are at risk of developing the full-blown adult syndrome of psychopathy.
- severe conduct problems, aggressive and violent behaviour and delinquency.

Question 5

Conduct Disorder in DSM-5.
Must meet full criteria for CD.
Shows two or more of following characteristics (clinician can ask child, parent, or teacher) :

Answer 5

• lack of remorse or guilt
• callous-lack of empathy (unconcerned about others’ feelings)
• unconcerned about performance (school or work)
• shallow or deficient affect (does not express or show emotions).

Question 6

Autonomic abnormalities in Psychopathy:

Answer 6

• Heart Rate (HR):
  Low resting HR has been found in convicted psycho’s
  Also show lower HR following punishment feedback than controls
• Startle response:
  Psycho’s fail to display the normal exaggerated blink potentiation when viewing unpleasant images.

Question 7

Amygdala dysfunction:

Adults with psychopathy and youths with CP/HCU traits have been shown to be impaired on tasks assessing:

Answer 7

• processing emotion and facial expressions of others. - particularly sad and fearful expressions.
• emotional response to threatening stimuli
• ability to learn from reward punishment.

Question 8

Antisocial Personality Disorder:

Answer 8

Exploit, manipulate or violate the rights of others.
Lack concern, regret or remorse about other people’s distress.
Behave irresponsibly and show disregard for normal social behaviour.
Have difficulty sustaining long-term relationships.
Be unable to control their anger.
Lack guilt, or not learn from their mistakes.
Blame others for problems in their lives.
Repeatedly break the law.
Will have a history of CD during childhood: - truancy (not attending school). - delinquency (e.g. crimes or subst misuse and other disruptive aggr beh).

Question 9

Human and financial costs of CD and ASPD:

Answer 9

Significant burden to society as adults:
- Low employment rate
- Do not pay taxes.
- Engage in illicit scams, and cheat.
- Harm and distress to their intimate partners and children and to others due to their antisocial and aggr beh’s.
- Men with ASPD present elevated rates of premature death which likely result from their frequent engagement in reckless beh’s and suicide attempts.
- Elevated rates of mental and physical health problems.
Significant burden to society as children/adolescents:
- Disrupt schooling, are physically aggressive to other children (bullying).
- In adolescence they begin using alcohol and drugs, engaging in criminal activities and become an essential part of the illicit drug trade.

Question 10

Prevalent comorbidities: all below can be comorbid (linked) to ASPD

Answer 10

• Borderline personality disorder
• Schizophrenia
• Depression
• psychopathy
• substance misuse
• ADHD