psyc 337 - psychopathology and antisocial personality disorder

first mentions of psychopathology

Philippe pinel - mania without delirium. koch - psychopathic inferiority. from German word psychopastiche - suffering soul

cleckley's 16 features of psychopathy 3 categories

shallow-deceptive features, behavioral deviance features, mask features

shallow deceptive features

untruthfulness and insincerity. lack or remorse or shame. general poverty in major affective reasons. pathological egocentricity and incapacity for love. specific loss of insight. unresponsiveness in general interpersonal relations.

behavioral deviance features

inadequately motivated antisocial behavior. poor judgment and failure to learn by experience. unreliability. fantastic and uninviting behavior with and sometimes without drink. sex life impersonal, trivial and poorly integrated. failure to follow any life plan.

mask features

superficial charm and good intelligence. absence of delusions and other signs of irrational thinking. absence of nervousness or psychoneurotic manifestations. suicide rarely carried out

hare psychopathy checklist - revised (PCL-R) - development

hare, based on work with male offenders and forensic populations in Vancouver

hare psychopathy checklist - revised (PCL-R) - administration

administered by a mental health professional. semi structured interview and reviewed of collateral information

hare psychopathy checklist - revised (PCL-R) - scores

20 items, scores 0-40. 0=does not apply, 1 = partially applies, 2 = definitely applies. cut off scores for North America is 30 for clinical, often 25 for research

hare psychopathy checklist - revised (PCL-R) - use

assessment in high security psychiatry units, correctional settings, research, risk assessment, violence, recidivism.

psychopathy factors

1 is interpersonal/affective, 2 is social deviance

factor 1 facets

interpersonal and affective

factor 2 facets

lifestyle and antisocial

interpersonal facet

glibness/super charm. grandiose self worth, pathological lying, conning/manipulative.

affective facet

lack of remorse or guilt. shallow affect, callous/lack of empathy. failure to accept responsibility for actions

lifestyle facet

need for stimuli. prone to boredom. parasitic lifestyle. lack of realistic, long term goals. impulsivity, irresponsibility.

antisocial facet

poor behavioral controls. early behavioral problems. juvenile delinquents. revocation of condition release. criminal versatility

ted bundy facet 1

Superficial charm / glibness

• Charismatic and socially engaging

• Approached women politely and confidently

• Former girlfriend described him as "warm, loving and intelligent"

Grandiose sense of self-worth

• Portrayed himself as intellectually superior

• Believed he was smarter than investigators and tried to manipulate law

enforcement and the media

Pathological lying

• Used multiple aliases when approaching victims

• Admitted during interviews that deception became habitual and ea

Conning / manipulative behavior

• Pretended to have a broken arm (fake cast) and asked women for help loading

items into his car, then abducted the

ted bundy facet 2

Lack of remorse or guilt

• "Guilt...it's this mechanism we use to control people. It's an illusion" - Bundy

• "I don't feel guilty for anything...I feel guilty for people who feel guilt" -Bundy

Shallow affect

• Emotions appeared rehearsed rather than genuine

• Appeared calm, controlled and relaxed when discussing murders

Callous / Lack of empathy

• Extreme violence and objectification of victims

• Returned to crime scenes to revisit victims' bodi

Failure to accept responsibility

• Denied all crimes until he confessed to 30 murders on death row

• Externalized responsibility (blamed pornography)

• "I'm a victim of circumstances", "The press demonizes me" -Bundy

ted bundy facet 3

Need for stimulation / proneness to boredom

• Engaged in risk-taking behaviors, including returning to crime scenes

• Escaped from jail twice and continued offending

Parasitic lifestyle

• Relied on others financially

Impulsivity

• Described himself as an "amateur" and an "impulsive killer" in his early years

• Some murders occurred opportunistically rather than through elaborate planning

Lack of realistic long-term goals

• Attended law school briefly but barely attended class because he was too busy

committing crimes

Irresponsibility

• Struggled with stable employment and financial obligation

ted bundy facet 4

Poor behavioral controls

• Escalated quickly from voyeurism to theft to serial homicide

Early behavioral problems

• Reports suggest early deviant behaviors

Revocation of conditional release

• 1977 courthouse escape

• 1977 jail escape in Colorado

Juvenile delinquency

• Engaged in theft and other delinquet behaviors as a youth

Criminal versatility

• Bundy's criminal activity included: burglary, assault, kidnapping, serial homic

triarchic model of psychopathology

boldness, meanness, disinhibition. difficult temperament is disinhibition and means. low fear is meanness and boldness. psychopathy is all 3

boldness

fearless dominance, low anxiety, thrill/adventure seeking

meanness

arrogance, lack of close relationships, instrumental aggression, exploitative behavior, physical cruelty to animals and humans

disinhibition

impulsivity, negative affectivity, neuroticism, anger, emotion dysregulation

other measures of psychopathy

hare psychopathology checklist - youth version for adolescents. self report measures, but these are significantly less reliable than the PCL-R due to self report biases, poor insight, and manipulation

psychopathy as a construct

psychopathy is primarily a personality construct characterized by affective and interpersonal traits, including charm, manipulation, and a lack of empathy

ASPD as a dsm-5 diagnosis

antisocial personality disorder is classified in the dsm-5 defined by a pervasive pattern of disregard for others rights, impulsivity, and deceitfulness. it emphases behavioral patterns over personality traits

conduct disorder dsm 5 criteria

aggression to people and animals. destruction of property, deceitfulness or theft. serious violations of rules. specify onset

conduct disorder onset

childhood onset type is at least one symptom prior to 10. adolescent onset type is no symptoms prior to age 10. unspecified onset is not enough info.c

conduct disorder specifier

with limited prosocial emotion. lack of remorse or guilt, callous - lack of empathy, unconcerned about performance, shallow or deficient affect

what is closest dsm diagnosis to psychopathy

conduct disorder with limited prosocial emotion specifier

antisocial personality disorder diagnosis - A

a pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three or more of the following.

failure to confirm to social norms with respect to lawful belabors, deceitfulness, impulsivity or failure to plan ahead, irritability and aggressiveness, recklesss disregard for safety of self or others, consistent irresponsibility, lack of remorse

antisocial personality disorder diagnosis - B

aged at least 18 years

antisocial personality disorder diagnosis - C

evidence of conduct disorder before age 15

antisocial personality disorder diagnosis - D

antisocial behavior occurs outside course of schizophrenia or bipolar disorder

aspd does not equal psychopathy

ASPD: dsm diagnosis, behavioral focus, conduct disorder before 15, no empathy deficit required, 3 to 5 prevalence, categorical - present or absent.

Psychopathy: research construct, affective and behavioral, no developmental requirement, callousness is core, 1 to 2 prevalence, dimensional - scored on continuum

most psychopaths meet aspd criteria, most ppl with aspd are not psychopaths

prevalence for aspd and psychopathy

aspd course

cannot be diagnosed before 18. chronic course, yet becomes less evident by age 40. less engagement in criminal behaviors

psychopathy course

can emerge eerily in life, moderately stable from adolescence to adulthood. multiple developmental trajectories exist. most youth show low levels, with a smaller group showing increasing or persistently high levels. those with chronically high traits have the greatest risk for violence and criminal behavior

Moffit's Developmental Taxonomy

adolescence limited course, life persistent course. supported by neurological differences in AL and LCP offenders

adolescence limited course

origins in social processes, begins in adolescence, driven by maturity gap, desists in early adulthood.

life course persistent

interaction between neuropsychological vulnerabilities and adverse environments. beings in childhood. persists into adulthood

etiological and risk factors - biological

genetics, neurobiology differences, ans

etiological and risk factors - environmental

attachment and early caregiving, parenting styles and family, prenatal and perinatal factors, SES and neighborhood. peers and substances

genetics

modest to high heritability of psychopathic traits - additive genetic influences account for 29-59 percent of variance. strongest evidence for callous-unemotional CU traits.

implicated genes

MAO-A - low activity variants + maltreatment + aggression riskl

DRD4, COMT - dopameinergic pathways, reward sensitivity and impulsivity. some genes common with autism. no single psychopathy gene - environment shapes expression

prefrontal cortex

abornmalities and less connectivity with amygdala. affects impulse control, emotional processing, self regulation, decision making, moral reasoning, planning

amygdala

psychopathy - reduced volume and reactivity. aspd and antisocial behavior - some evidence of greater threat related reactivity. affects fear processing and emotional learning

reduced connectivity between vmPFC and amygdala

reduced communication may impair how emotional signals guide decision making in psychopathy

Blairs violence inhibition mechanism model

non psychopath - distress cues to amygdala activation to aversive response to aggression inhibited

psychopath - distress cues to impaired amygdala to no aversive response to aggression continues

reward and punishment sensitivity - psychopathy

reduced sensitivity to fear, threat, and punishment cues. heightened dopaminergic reaction in response to reward cues

reward and punishment sensitivity - antisocial personality disorder

punishment insensitivity. difficulty inhibiting reward driven behavior

reward and punishment sensitivity - overall

deficits in learning from emotional and reinforcement signal may contribute to persistent antisocial behavior

fearlessness theory

low arousal plus low punishment sensitivity equals failure to learn from consequences

sensation seeking theory

low arousal to seeks stimulation tor each optimal level

ans

car example

low alarm system (reduced fear and threat sensitivity) plus weak brakes (reduced behavioral inhibition and control) plus strong accelerator (increased approach motivation and dominance related processes_

psychopathy and empathy for pain study

fMRI design of 24 blocks

12 blocks imagine-self ("Imagine these situations were happening to you")

12 blocks imagine-other ("("Imagine these situations were happening to someone else")

low psychopathy participants - increased reaction to imagining others pain, lower when imagining their own

high participants - increased reaction to imagining own pain, suppressed reaction when imagining others pain

attachment and early caregiving

Early attachment relationships shape how children learn trust, emotion

regulation and empathy. Insecure and disorganized attachment

are associated with higher risk for conduct problems, antisocial behavior and psychopathic traits. Evidence of devaluation of attachment bonds in psychopathic individuals. Attachment disruption may contribute to difficulties forming relationships and responding to others' distress

parenting style risk factor

harsh, inconsistent, neglectful, poor supervision, physical punishment

family structure risk factor

separation from parent, frequent caregiver change, large sibling group

parental characteristics risk factor

criminality, substance use, mental illness, delinquent siblings

home environment risk factor

high conflict, domestic violence exposure

protective factors risk factor

strong family functioning and parental support, practical parental modeling, warm parenting

family illustration for ted bundy

grew up believing his grandparents were his parents and his mother was his sister, creating confusion about family identity. reports describe a violent and a volatile grandfather and a tense home environment. family instability and secrecy may have contributed to early emotional insecurity and social difficulties

prenatal and perinatal factors

associated with antisocial behavior. unwanted conception, no exposure to or shorter duration of breastfeeding, prenatal alcohol tobacco/nicotine and psychotropic drug exposure, maternal stress/depression, severe maternal nutritional deficiency during pregnancy, lead exposure. For psychopathy specifically, evidence is more limits: prenatal risk factors appear to interact with temperament (e.g., low fear) and early caregiving rather than acting as direct causes

SES structural disadvantages

low SES, poverty/SES deprivation

environmental stressors

neighborhood violence, resource scarcity, chronic stress exposure.

contextual risk

can amplify risk for antisocial behavior, not a direct cause in isolation

antisocial behavior as adaption to adversity?

ASPD is disproportionately diagnosed in low sea and minority populations, raises questions about diagnostic bias. does antisocial behavior in some contexts reflect a protective survival strategy rather than disorder? in adverse social environments - higher psychopathic traits give socially adaptive outcomes, gains status, influence, and mating opportunities in harsh social environments

peers and substances

association with antisocial or deviant peers increases risk for delinquency and substance use. low empathy and fearlessness associated with early affiliation with deviant peers. social learning, modeling and reinforcement of antisocial behavior. callous - unemotional traits show associations with antisocial behavior and substance use. substance use and antisocial traits frequently co occur, often linked to impulsivity and sensation seeking. peers and substance use can reinforce and escalate antisocial behaviors, especially in individuals with underlying vulnerabilities

job posting analysis

hill and Scott conducted content analysis of 25 job positions for executive positions. 96 percent of executive job ads included traits overlapping with psychopathic characteristics. corporate environments may unintentional reward or select for psychopathic interpersonal traits

successful versus unsuccessful psychopathy

some individuals with psychopathic traits avoid criminal conviction and function in high status or competitive environments. factors associated with successful psychopathology: Fearlessness, Stress immunity, Social potency, Normal of superior cognitive performance, Professional achievement, Stable SES, Leadership, Pride, Aversion to punishment, and Better executive functioning, impulse control and planning ability. both groups share interpersonal and affective traits but unsuccessful psychopaths tend to show higher impulsivity and antisocial behavior. psychopathy may involve similar personality traits expressed through different behavioral outcomes depending on self control and context

gender differences

aspd 3x more common in men than in women. men show more physical aggression and criminal behavior. may be a product of socialization, women show more relational aggression, manipulative, and interpersonal conflict. impulsivity and aggression may be more self directed in women. pclr and aspd criteria were developed in male offender samples, which may underestimate antisocial traits in women

why treatment is challenging

Core affective deficits remove emotional levers that therapy often

relies on Motivation for treatment (Psychopathy diagnosis associated with a 30% increase in program dropout, Often court-mandated rather than voluntary) Therapeutic relationship challenge, Can be verbally/ emotionally abusive or threatening, Manipulation (e.g., staff-splitting), Less responsive to evidence-based approaches (Aggressive Behavioural Control Program) treatment pessimism

psychopathic and treatment outcomes

psychopaths who participated in the therapeutic community exhibited higher rates of recidivism than the psychopaths who did not

unethical treatments

treatments of 80 hours per week. men locked in small rooms to discuss issues and confront each other, little staff patient contact (offenders running their own treatment. hallucinogens and sedatives administered. group pressures, nude encounter groups, deprivation

Review of studies on the treatment of psychopathy (Salekin et al., 2010)

n = 8 treatment studies on adult samples; n = 5 on youth samples

Treatment effects found to be small

Child and adolescent populations derive greater benefit

Treatment for psychopathy should focus on risk management and behavioral outcomes rather than altering core personality trait

affective approaches

contingency management (rewards to reinforce desirable behaviors), improved social functioning (addiction severity). schema therapy (may improve social functioning day until patients gain unsupervised leave), dialectical behavior therapy. may reduce self harm

risk responsivity model

risk need responsivity, risk - psl used as risk assessment tool. psychopathic offender show greater risk levels and criminogenic needs. may benefit from high intensity services. needs - greater density and severity of all criminogenic needs except financial issues. Focus on teaching skills through behavioral and cognitive-behavioral techniques. Offers education and/or vocational skills training, assistance with familial reconnection, assistance for community reintegration. Emphasis on patient-provider relationship. Responsivity: high psychopathic offenders should be assigned more senior staff, intervention should be done in small teams with specific instructions to avoid staff splitting

consequences of stigma

individuals with aspd are perceived by members of the jury as more violent, yet sane and responsible for their actions. most court officials to not consider it to be a real psychiatric illness, implications for severity of sentence. staff hold negative attitudes toward individuals with personality disorders in correctional settings - perceived as manipulative and resistant. distress may be minimized. reduces empathy and access to mental health support