Psychopathy and Personality Disorders

What is psychopathy?

Personality elements predisposing one to criminal and other antisocial behaviours

Who is the construct of psychopathy not appropriately applied to?

Law-abiding, self-serving individuals

What is nearly essential to be considered a psychopath?

Criminal history

Why are psychopaths seldom successful?

They lack drive and motivation to defer gratification/make sacrifices

How has psychopathy diagnosis evolved?

From theoretical/attributional (Pinel and Pritchard) to behavioural

What is the goal of DSM diagnosis?

Objective, observable terms with internal consistency

What are the qualities of the PCL-R?

Includes both objective, and more subtle personality aspects

What did Pinel call psychopathy?

Manie sans delire

-Mania without delirium

What did Pinel argue of psychopathy?

Intact intellectual functioning with high levels of social irresponsibility

What did Rush classify antisocial behaviour as?

A congenital defect of moral derangement

What did Rush's classification of psychopathy imply?

It's in the domain of medicine and must be treated physically

What term was coined by Pritchard regarding psychopathy/antisocial functioning?

Moral insanity

What was Pritchard's definition of moral insanity?

Intellectual faculties that sustained little/no injury, are manifested in the state of feelings, temper, or habits

What does Pritchard's definition imply?

Acute trauma caused psychopathy (sustained injury)

What isn't really considered in Pritchard's definition of moral insanity? Why?

Feelings

-Can't be objectified

What were Kraepelin's seven psychopath subtypes?

Excitable, unstable/impulsive, eccentric, liar, swindler, antisocial, and quarrelsome

What does Kraepelins seven subtypes show similarity to?

Eysencks three factor model

How has Kraepelins subtypes remained in current psychopathy conceptualization?

Not as discrete subtypes, but the ideas remain in the PCL-R items

What did Kahn's fourteen subtypes include?

Nervous, anxious, sensitive, compulsive, excitable, hyperthymic, depressive, moody, affectively cold, weak willed, sexually perverse, hysterical, fantastically cranky, and eccentric

What of Kahn's fourteen subtypes are problematic to our current ideas of psychopathy?

Nervous and anxious

What did Cleckley postulate about psychopathy?

It was semantic dementia

-Loss of brain function in understanding meaning

What did Johns and Quay state of psychopaths?

They know the words but not the music

What is the problem in understanding psychopathy?

It is virtually impossible to generalize findings from one group to the next

-Lack of consistency

What work by Cleckley provided many diagnostic criteria for present day use?

The Mask of Sanity

What is the downfall of Cleckley's big 16?

Researchers/clinicians have to rely on inference to know if characteristics are present

-Kind of unreliable

What are Cleckley's big 16?

1. Superficial charm and good intelligence

2. Absence of delusions and other signs of irrational thinking

3. Absence of nervousness/psychoneurotic manifestation

4. Unreliability

5. Untruthfulness and insecurity

6. Lack of remorse or shame

7. Inadequately motivated antisocial behaviour

8. Poor judgement and failure to learn by experience

9. Pathological egocentricity, incapacity for love

10. General poverty in major effective reactions

11. Specific loss of insight

12. Unresponsiveness in general interpersonal relations

13. Fantastic and uninviting behaviour with drink (sometimes without)

14. Suicide rare (generally not depressed)

15. Sex life impersonal and poorly integrated

16. Failure to follow any life plan

What features of the big 16 are removed from Hare's PCL?

Sex life, lying, etc.. aren't themselves psychopathic

How old do you have to be to receive an antisocial personality disorder diagnosis in the DSM?

18

What is the DSM criteria for antisocial personality disorder?

A. Pervasive pattern of disregard for and violation of the rights of others since 15 years indicated by three of the following:

- Failure to conform to social norms with respect to lawful behaviours (acts that are grounds for arrest)

-Deceitfulness: lying, use of aliases, conning for pleasure (or not)

-Impulsivity/failure to plan ahead

-Irritability/aggresiveness (fights/assaults)

-Reckless disregard for safety of self and others

-Consistent irresponsibility (lack of consistent work, honouring financial obligations)

-Lack of remorse, indifference to hurting others

What is the type of pattern of work expected in a psychopath?

40-50 jobs

-End because they have something better to do or were fired

What was the hybrid approach of the DSM 5 supposed to be?

6, not 10 personality disorders

What were the cluster B disorders in the hybrid model of the DSM-5?

Antisocial/psychopathic, borderline, and MAYBE narcissistic

What are the definitions of cluster B disorders based on in the hybrid model of the DSM-5?

Criteria based on criteria rated on a four point scale

What did the hybrid model of DSM account for in diagnosing personality disorders?

Variability and changes in intensity overtime

What was severity of disorder rated on in the hybrid DSM model?

5 point scale

What were the two factors of criteria proposed for antisocial/psychotic disorder in the hybrid DSM model?

Antagonism and Disinhibition

What are the qualities of antagonism?

-Callousness

-Aggression

-Manipulativeness

-Hostility

-Deceitfulness

-Narcissism

What are the qualities of disinhibition?

-Irresponsibility

-Recklessness

-Impulsivity

What are the qualities of antisocial/psychotic disorder scored on in the hybrid model of the DSM?

Scale of 0-3 (four point)

How is the score on qualities used to make a global severity rating in the hybrid DSM model?

Rated 1-5

5- very good match (exemplifies type)

4- good match (significantly resembles type)

3- moderate match (prominent features)

2- slight match (minor features)

1- no match (doesn't apply)

How may the DSM swing back by using the hybrid model?

Moves from extremely behavioural to allowing some clinical inference

Why would histrionic people not be psychopathic?

They aren't criminally motivated

Why would narcissistic people not be psychopathic?

They have the ability to care

Why would the change to the hybrid model have been useful?

-Reduces category overlap

-Less arbitrary diagnostic threshold

-Move from categorical to dimensional concept

-Recognize that symptom severity fluctuates with time

What is the DSM criteria for conduct disorder?

A. Repetitive and persistent pattern of behaviour violating societal rules/norms, shown in 3 or more in the past 12 months, and at least 1 in the past 6 months:

1. Aggression

-Bullies others

-Initiates fights

-Used a weapon to harm others

-Been physically cruel to people

-Been physically cruel to animals

-Stolen while confronting a victim (robbery)

-Forced someone into sex

2. Destruction of property

-Deliberately engaged in fire setting with intention to cause serious damage

-Deliberately destroyed other's property

3. Deceitfulness or theft

-Broken into someone else's property

-Lies to obtain goods or favours

-Stolen items of non trivial value without confronting (theft)

4. Serious violations of rules

-Stays out despite prohibitions (before 13)

-Run away from home overnight at least twice or for one lengthy period (from parental or surrogate home)

-Truant from school before 13

B. Disturbance in behaviour causes clinically significant impairment

C. If individual is 18+, do not meet antisocial criteria

When can you not diagnose antisocial PD?

When behaviour was done under the influence, or done for intoxicants

Why doesn't conduct disorder predict antisocial personality disorder?

The vast majority of youth offenders aren't life course persistent

-Only 5-6% are

How does personality show similarities to a persons face?

Core features are recognizable early on

-Remain throughout the life

How can an adult be diagnosed with conduct disorder?

They're a manchild

What did DSM-5 changes allow for the addition of to conduct disorder criteria?

Callous-unemotional presentation

When would a person qualify as callous-unemotional?

1. Lack remorse or guilt

2. Callous-lack empathy

3. Unconcerned about performance

4. Shallow or deficient affect

What has Hare advocated for?

Standardized diagnostic scheme based on behavioural criteria as well as characteristics described by Cleckley (but operationalized)

What is the interrater reliability of the PCL-R items?

0.42-0.86

-total score reliability is 0.78 with single rater and 0.87 when two-rater teams are used

What PCL-R score is a psychopath?

30+

What is desired in scoring the PCL-R?

Extreme scores

-Distant means between psychopaths and non

What is the correlation between PCL-R scores and ASPD diagnoses?

0.48

What happens when the number of ASPD criteria met is correlated with PCL-R score?

Correlation increases to 0,72

How many people who meet PCL-R psychopath criteria meet DSM 3 criteria for ASPD?

79.2%

How many ASPD individuals are definable as psychopaths?

30.2%

What did Lykken find of the passive avoidance learning of psychopaths compared to non psychopaths?

Psychopaths didn't experience anxiety, didn't undergo reinforcement by avoidance, and therefore didn't show passive avoidance to shock stimuli

What is passive avoidance?

Withholding doing something to avoid aversive response

What is active avoidance?

Doing something to avoid aversive response

What was Lykken's sequencing experiment like?

-20 decision points requiring pressing one of four switches (like Simon says)

-Press correct switch=green, onto next set

-Press wrong switch=red light in two, shock by pressing the fourth

-Shock=anxiety=negative reinforcement by learning task

Why were the psychopaths shocked more times?

Anxiety wasn't produced, so correct responding wasn't reinforced

What did Chesno and Kilmann find helped assist psychopaths in learning?

Extraneous stimulation

How was Chesno and Kilmann's experiment set up?

Psychopaths were compared to non psychopaths (both divided into 3 levels of anxiety) were compared in avoidance learning in 3 different noise levels

-Received shock if pressed wrong button, or failed to press right button (passive and active)

What was found in the errors made by low anxious psychopaths?

Significantly more active errors (pressed button when numbers went presented) in the low noise (35 dB) condition

-Made no more errors when noise was higher

What was the role noise level played in errors made by psychopaths?

The louder the noise, the less errors were made

-Quieter the noise, the more errors

What increased central stimulation in Chesno and Killman's experiment?

Noise or shocks

What was the change made in Schmauk's experiment?

Employed similar experiment to Lykken but used 3 types of punishment

-Shock, verbal, monetary fine

-Fourth condition was told they could get $8 for perfect performance

How did giving a fine differ from financial loss for Schmauk's experiment?

Shock was positive punishment, loss was negative

What psychopath groups performed the worst in Schmauk's experiment?

Those punished by shock or verbal feedback, not by financial punishment

What does electric shock do in psychopaths?

Improves central arousal

What is more effective in punishing psychopaths?

Negative punishment: take away something they like

What was Siegal's experiment?

Allowed subjects to turn over cards from 11 decks, decks increased in number of face cards by 10% (could change deck whenever)

-Number card? Gain one cent

-Face card? Lose one cent

What was measured in Siegal's experiment?

Response suppression

What was predicted in psychopath response suppression?

It would be poorest when probability of punishment was most uncertain

What was found in psychopaths response suppression in Siegal's experiment?

Responses were significantly less suppressed than controls

-Greatest difference was in the 5th (40% face) to 9th (80% face) decks

-Were comparable in very low or very high punishment decks

How did psychopaths compare to controls in estimating payoff rates of decks in Siegal's experiment?

Just as accurate

-Appreciated risks just as much

What explained the failure for psychopaths to suppress response in Siegal's experiment?

Impulsiveness

-Forced delay removed between group difference

What does a P300 evoked potential mean?

Positive (increased voltage) direction, 300 msec or more after stimulus

Where are P300s best recorded?

Parietal area

What was Kiehl's visual oddball task?

Subject attends and reacts to common and low probability tasks

-50 ms presentation of a white square

-Press key after common event

-Boring, even for attentive subjects

What is a commission error?

Pressed key when shouldn't have

What is an omission error?

Failed to press key when should have

What emerged in the visual oddball task when comparing psychopaths to controls?

-Common/oddball P300 differences were smaller in psychopaths

-P300s were less lateralized in psychopaths

What do P300 differences imply about psychopaths?

Psychopaths have trouble allocating and sustaining attention

What did Gorenstein find regarding psychopaths?

FL impairment

-Differed significantly on neuropsychological tests compared to controls

What is implied in Hare's inability to replicate Gorenstein's findings?

Different definitions of psychopathy accounted for different findings

When will psychopaths show response suppression punishment effects?

As long as competing reinforcement contingencies aren't in place

What allows psychopaths to integrate new information?

Forced delay in response

How do psychopaths differ in cognition?

Differ in some cognitive processes

What is the level of impairment in psychopaths intellect/neuropsychological function?

None

When can a psychopath not perform well on a semantic decision task?

If the words have emotional meaning, they can't relate them

How does a psychopath perform on dichotic listening tasks?

Poorly, can't divide attention

What does Blackburn suggest should be included in the manifestation of psychopathy?

Element of neurotic conflict

How many items are on the PCL-R?

20

What are PCL-R items scored out of?

0, 1 or 2

What is the maximum PCL-R score?

37 or 38

What does Hare advocate for in PCL-R scoring?

Polythetic approach, compare degree ratee matches the prototype