9 - Psychopathy and Antisocial Personality Disorder

psychopathy

construct that describes an element of personality predisposing one to criminal and other antisocial behaviours

psychopaths are among the ______ -_____

worst criminals

• most extreme, criminally versatile

there are few _______ psychopaths

successful

• seldom have drive and determination for education or hard work

diagnosis of psychopathy has progressed from a purely theoretical and attributional definition to one based primarily on _______ _______

observable behaviours

mania sans delire (Pinel)

condition in which one demonstrates high levels of social irresponsibility despite apparently intact intellectual functioning (people who ought to know better but fail to act)

Benjamin Rush

amongst the first to hypothesize a physiological basis for antisocial behaviour as characterized by his description of “a congenital defect of moral derangement”

moral insanity (Pritchard)

intellectual faculties appear to have sustained little or no injury, while the disorder is manifested principally or alone in the state of the feelings, temper, or habits

Kraepelin’s 7 subtypes of psychopathy

• excitable

• unstable/impulsive

• eccentric

• liar

• swindler

• antisocial (poor social skills)

• quarrelsome

Kahn’s 14 types of psychopathy

• nervous

• anxious

• sensitive

• compulsive

• excitable

• hyperthymic

• depressive

• moody

• affectively cold

• weak willed

• sexually perverse

• hysterical

• eccentric

• fantastically cranky

semantic dementia

rift between words and deeds, saying one thing but doing something completely different

what problem has plagued the study of psychopathy?

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

Cleckley’s big 16 about psychopaths

1. superficial charm and good intelligence

2. absence of delusions and other signs of irrational thinking

3. absence of nervousness or psychoneurotic manifestations

4. unreliability

5. untruthfulness and insincerity

6. lack of remorse or shame

7. inadequately motivated antisocial behaviour

8. poor judgement and failure to learn by experience

9. pathological egocentricity and incapacity for love

10. general poverty in major affective reactions

11. specific loss of insight

12. unresponsiveness in general interpersonal relations

13. fantastic and uninviting behaviour with drink, and sometimes without

14. suicide rarely carried out

15. sex life impersonal, trivial, and poorly integrated

16. failure to follow any life plan

DSM’s APD criteria

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

1. failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest

2. deceitfulness, repeated lying, aliases, conning others

3. impulsivity or failure to plan ahead

4. irritability and aggressiveness, repeated physical fights or assaults

5. reckless disregard for safety of self or others

6. consistent irresponsibility, repeated failure to sustain consistent work or honour financial obligations

7. lack of remorse, indifferent to or rationalizing having hurt, mistreated, or stolen

proposed DSM criteria for antisocial/psychotic

• antagonism (how much create problems for others

  • callousness, aggression, manipulativeness, hostility, deceitfulness, narcissism

• disinhibition (failure to restrain)

  • irresponsibility, recklessness, impulsivity

• rated on severity from 1-5

why would a change to the DSM as a hybrid approach have been helpful?

• reduction in diagnostic overlap

• less arbitrary

• movement from a categorical to dimensional conceptualization

• recognition that symptom severity can fluctuate over time

conduct disorder

a necessary precursor for APD before 15

a repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three or more of the following criteria in the past 12 months, at least one criterion past 6 months

• aggression to people and animals (1-7)

• destruction of property (8-9)

• deceitfulness or theft (10-12)

• serious violations of rules (13-15)

disturbance in beahviour causing clinically significant impairment in social, academic, or occupational functioning

if 18+, and criteria not met for APD

DSM-5 changes to conduct disorder criteria

allows for addition of callous-unemotional presentation qualifier based on

1. lack of remorse or guilt

2. callous-lack of empathy

3. unconcerned about performance

4. shallow or deficient affect

Robert Hare

advocated for, and standardized a diagnostic scheme based on behavioural criteria but also operationalizes characteristics of the sort described by Cleckley

• resulted in PCL-R

psychopathy relationship to APD

almost everybody who meets criteria for psychopathy will meet APD ( 79%)

most APD will not be classified as psychopaths (only 30% of them)

psychopaths show deficient ____ _____ learning compared to controls

passive avoidance

• knowing when to keep quiet or withhold a response to not be punished

• ex., sequencing task

sequencing / mental maze task

• threat of a painful shock should engender anxiety, successful learning of the task would result in fewer shocks (negative reinforcement)

• psychopaths do not develop emotional responses (fear) as readily as normals, Lykken found psychopaths received significantly more shocks

_______ _______ assists psychopaths in learning (Chesno and Kilmann)

extraneous stimulation

• low anxious psychopaths made more active errors (pressing button when numbers signalling shock were not presented) than other groups in the 35 dB condition, but no more errors when background noise was higher

• receiving shocks in low noise condition was beneficial to low anxious psychopaths in terms of increasing their level of central stimulation

what did Schmauk’s punishment study find?

psychopaths performed more poorly only when punished by shock or verbal feedback. Not when financial punishments were used

• electric shock may improve central arousal in psychopaths

which type of punishment is more effective for psychopaths?

negative punishment (taking something away, like money)

What did Siegal find with his cards experiment?

psychopaths’ responses were significantly less suppressed than those of controls except when there was a forced delay to respond

evoked potential studies

examine changes in cortical potentials following presentation of visual or auditory stimulus

changes can be positive (increase in voltage) or negative (decrease in voltage), classified according to altency

P300

electrical potential changes in positive (increased voltage) direction, 300 ms or more after stimulus presentation

• best recorded over parietal area

Kiehl’s visual oddball task

subjects to press a key after a common event, it is long, tedious and boring

differences between psychopathic and non-pscyhopathic groups:

1. smaller common/oddball P300 differences among psychopaths compared to non-psychopaths

   1. magnhitude of P300s larger for non-psychopaths

2. P300s less lateralized in psychopaths

supports conclusion that psychopaths have trouble properly reallocating attention, and in sustaining attention

what did Gorenstein note about frontal lobe injured patients?

found significant differences on neuropsychological tests between psychopaths and non-psychopaths

• Hare was unable to replicate these findings, difference in definitions rather than with the scale

psychopaths more likely to show punishment effects when ______ ______ are used than aversive stimuli

monetary penalties

psychopaths integrate new information poorly unless forced to _____ _____ even for brief period

delay responding

psychopaths _____ be differentiated from controls on tests of intellectual ability or neuropsychological impairment

cannot

the PCL-R

• 20 item checklist

• each item scored 0,1,2

• max score 40

• Hare advocates for polythetic approach, degree to which they match not yes or no

• items pro-rated when info is absent

• both interview and file review contribute