The Dark Side of Personality - Psychopathy

Features of Psychopathy (Cleckley, 1941)

• Superficial charm & good intelligence

• Absence of delusions

• Lack of anxiety

• Unreliability

• Untruthfulness and insincerity

• Lack of remorse and shame

• Inadequately motivated antisocial behaviour

• Failure to learn by experience

• Ego centricity and incapacity for love

• Lack of affect

• Lack of self reflection

• Unresponsiveness in interpersonal relations

• Suicide threats not carried out

• Impersonal sex life, trivial

• Failure to follow any life plan

Development of Psychopathy as a Clinically Defined Personality Disorder

• 1952: DSM – Antisocial reaction/Psychopathic personality with asocial and amoral trends

• 1985: Psychopathy Checklist (Hare – based on Canadian forensic populations)

• 1991: Psychopathy Checklist Revised (PCL-R) – considered “gold standard” of diagnostic tool

• Debate over the proportion of forensic relevant behaviour (i.e., in comparison to Cleckley)

• Now considered a dimensional rather than categorical construct

Two-Factor Model of Psychopathy

• Lykken (1948):

  • Galvanised skin response test

  • Anxiety levels differentiated psychopaths into two groups:

    • Primary psychopathy:

      • “specific mental disease…having in particular a virtual absence of any redeeming social interaction”

    • Secondary psychopathy:

      • “Presence of “psychoses and neuroses that have a strong antisocial or delinquent aspect”

Characteristics of Primary Psychopathy (PP)

• Personality and affective aspects of psychopathy:

  • Pathological lying

  • Manipulation

  • Lack of remorse

  • Premeditated behaviour

  • Callousness

Characteristics of Secondary Psychopathy (SP)

• Lifestyle and behavioural features of psychopathy:

  • Parasitic lifestyle

  • Impulsiveness

  • Reactively violent

  • Antisocial behavior

Evidence for the 2-Factor Model

• Primary psychopathy:

  • Inability to discriminate between pleasant and unpleasant sounds (Verona et al., 2004)

  • Poor perceptual processing of distracting stimuli – goal focused (Zeier et al., 2009)

  • Reduced attention to emotion cues and ability to change mood (Malterer et al., 2008)

  • Positive response to negative stimuli (Ali et al., 2009)

• Secondary psychopathy:

  • Higher levels of anxiety, depression and suicidal ideation (Vaughn et al., 2009)

  • Negative urgency – act impulsively to relieve currently experienced negative emotions (Anestis et al., 2009)

  • Borderline Personality characteristics, poor interpersonal functioning, mental disorders (Skeem et al., 2007)

Different Explanatory Theories

• Reinforcement Sensitivity Theory (Gray, 1981):

  • Behavioural Inhibition System (BIS)

    • Avoidance behaviour in response to threat of harm

  • Behavioural Activation System (BAS)

    • Regulates appetitive behaviours, approach behaviours to reward, & impulsivity

  • PP = weak BIS

  • SP = strong BAS

• Response Modulation Theory (Newman & colleagues)

  • Attentional processing deficit – can’t attend to peripheral information that presents threat and distress cues (or insufficient allocation of attentional resources)

  • Higher order cognitive processes mediate neural functioning

  • Perseveration in gambling task (Newman & Kosson, 1986)

    • Can’t alter attention focus

  • Impairment in rule learning & error monitoring (von Borries et al., 2009)

• Low-fear model of psychopathy (Blair, 2005; 2006)

  • Deficient amygdala, paralimbic system, & orbito-frontal cortex (neural regions associated with fear and emotion processing)

  • Explains:

    • Deficient aversive conditioning

    • Reduced autonomic response and startle threat to anticipated threat

    • Poor passive avoidance learning

  • PP: Neurological and cognitive deficits leads to inadequate moral socialisation

Neurobiological Characteristics of SP

• Deteriorated prefrontal cortex grey matter – bad decision making (Raine et al., 2000)

• Unequal balance of activity between PFC and subcoritcal regions – impulsive and not premeditated violence (Raine et al., 1998)

• Various other neural regions

• Differences in inter-hemispheric functioning

Neurotransmitters

• Serotonin transporter gene 5-HTTLPR:

  • Long allele version associated with PP

    • Attentional deficits

    • Impaired aversive conditioning

    • Perserveration

    • May shape amygdala functioning (Glenn, 2011)

    • Neuronal hypoactivity

  • Short allele associated with SP

    • Associated with hypersensitive psychopathologies such as depression, anxiety and substance abuse (Glenn, 2011)

How Does Psychopathy Develop?

• Callous-unemotional (CU) traits (in children)

  • Emerge from 2-years old

  • Under strong genetic influence from 7-16 years (estimates of 40-78% heritability)

  • Stability maintained genetically

  • Children with CU traits – more pervasive and less treatable – failure of moral socialisation

  • CU traits pertain more to PP

  • Less likely to make eye contact with their mother

  • Have problems in recognising fearful body poses and faces

  • Emotionally unresponsive to others distress

  • Less responsive to fearful eyes

Nature and Nurture

• CU traits may even protect against adverse rearing environment

• Antisocial behaviour (ASB) is moderately influenced by genetics as well as shared and non-shared environmental factors

• Harsh parenting is strongly related to ASB in children who are normal for CU traits

• CU traits promote high ASB and criminality beyond what would be expected by adverse parenting alone

• Gene x environment interactions (epigenetics) need to be considered (no longer nature Vs nurture debate)

Successful Psychopathy

• Psychopaths are charming, lack of anxiety, and articulate, but also guiltless, callous and self centered (Lilienfeld et al., 2015) – happy to deceive people

• “…the typical psychopath will seem particularly agreeable and make a distinctly positive impression when he is first encountered… indications of good sense and sound reasoning will emerge… normal and pleasant person is also one of high abilities” (Cleckley 1982)

• Interpersonal aspects – positively associated with verbal IQ, fluid intelligence, creativity, practicality and analytical thinking (c.f. Ullrich et al., 2008)

  • Useful for navigating social situations

  • Over-represented in high achieving professions (e.g., lawyers, psychiatrists, managers etc.)

  • Levels of psychopathy higher in business studies students (Wilson & McCarthy, 2011)

  • “Business psychopathy” (Francis & Lilienfeld, 2012)

• Models of successful psychopathy

  • Differential severity model

  • Moderated expression model – protective factors (e.g., good parenting, better higher order thinking)

  • Differential-configuration model - Successful psychopaths higher in extraversion and conscientiousness, and low levels of agreeableness and disinhibition

  • Fearless dominance:

    • Presidents

    • Leadership positions in organisations

    • High-risk occupations

    • Heroism?

Narcissism vs. Psychopathy

• Psychopathic individuals can be narcissistic

• But narcissists are not necessarily psychopathic

• Grandiose narcissistic traits:

  • Superior sense of self; egoism; self-centred; over-confident; hyper-competitive; status seeking

• Narcissism is in some ways much better for you:

  • Sociable; confident in social situations; entertaining (on first encounter)

  • Resilience and psychological well-being in the context of high self-esteem

  • Low loneliness, anxiety and neuroticism

• Psychopathy has considerably worse outcomes psychologically and health wise – mortality, disease, physical ailments, injuries, substance misuse, tobacco use and risky sexual behaviour

Psychopathy as an Evolutionary Adaptation?

• “Male-typical”, cheater strategy

• Resources and mates through cheating

• Short-term relationships, risky sexual behaviour, unrestricted sociosexuality, casual sex, exploitative, and aggressive mating tactics

• Primary psychopathy as the genetically inherited, fast life-history strategy “cheater strategy”

  • Frequency dependent – 1% of the population

• SP as a conditional adaptation to an adverse environment (Glenn, 2011)

  • SP is a “phenocopy” of PP (Mealey, 1995)

  • Still attractive to members of the opposite sex (sensation seeking, impulsive, risk-taking)

Sex Similarities in Psychopathy

• Primary psychopathy

  • Fear and emotion processing deficits

  • Low empathy

  • Resiliency against adverse life experiences

  • Fewer substance abuse problems

  • Low anxiety

  • Less agreeableness

  • Callousness

• Secondary psychopathy

  • Same adverse emotional style

  • Antisocial, violent and criminal behaviour

  • Alcohol and substance misuse

  • Mental health problems

  • High anxiety levels

Sex Differences in Psychopathy

• Women:

  • Less likely to engage in either proactive or reactive violence – will use indirect or relational aggression instead

  • Commit non-violent crimes such as theft and prostitution

  • More likely to internalise behaviour (self-harm and running away)

  • Greater degree of psychopathology (especially in SP)

  • More psychiatric interventions (SP)

  • Suicide attempts (SP)

  • Internalising symptoms (SP)

  • Differences between PP and SP less distinct – both report feelings of alienation, high stress reactivity, high N, shame and anxiety

  • Does the behaviour relate to the same underlying psychopathic traits? E.g., promiscuity as exploitative or sensation seeking

• Why the difference?

  • Remains largely unexamined

  • Estrogen may be a protective factor against abnormal neural functioning in psychopathy related brain regions such as the amygdala

  • Genes have a stronger influence in ASB in women – for men environmental factors are more important

  • Poor quality father relationship especially relevant to SP behaviours in women

  • So contribution of genes and environments as in men but look to be differently callibrated

Controversies with the 2-Factor Model (Skeem, Cooke & Michie)

• Emphasis on criminality – emphasis on “unsuccessful” psychopathy, and over- emphasis on antisocial and violent behaviour; according to Cleckley, criminality is not a defining feature (notion of Clecklyan psychopathy)

• What is measured by the PCL-R has replaced psychopathy as a construct

• 3-factor model (Cooke & Michie, 2001):

  • Arrogant & deceitful personality style

  • Deficient affective experience

  • Impulsive & irresponsible behavioural style

How to Diagnose Psychopathy

• Psychopathy Checklist Revised (PCL-R)- 20 items scored (0, 1, or 2) http://www.hare.org/

• Based on Hare’s two-factor model:

  • Factor 1:

    • Interpersonal (1, 2, 4, 5)

    • Affective (6, 7, 8, 16)

  • Factor 2:

    • Lifestyle (3, 9, 13, 14, 15)

    • Antisocial (10, 12, 18, 19, 20)

• Collateral and interview information used to score personality traits and behaviour

• Score of >25 is concerning, >30 = psychopathy. Av score in general population is 5

• Women >18 for clinical consideration

Issues Over Assessment

• Reliability of inter-rater scoring (e.g., Edens et al., 2010)

• Which side the assessor is on in criminal case

• Predictability of future behaviour

• Co-morbidity

Psychopathy and Treatment

• We still don’t fully “know” what psychopathy is

• Not a single disorder but actually a “dimensional configuration of traits” (Polaschek & Daly, 2013)

• Essential to differentiate between PP and SP – “failure to account for these variants… may dilute or conceal differential treatment effects” (Polaschek & Daly, 2013)

• What should be included in the diagnosis even?

  • Adaptive aspects?

  • Adverse aspects?

• Are criminal and AS behaviour part of the disorder or a symptom of it?

How to Treat Psychopathy?

• Only recently accepted that offenders are treatable

• Best to view PCL-R diagnosis as indicative of a high-risk offender and therefore should receive intensive treatment

• How is treatment judged? Is this affected by psychopathy (i.e., uncooperative client)?

• Again – issue with what psychopathy is – what is part of the “disorder” and what are its symptoms/criminal risk – are they causing the problem with treatment?

Background to Controversy with Psychopathy Treatment

• Typically considered unlikely (Cleckley, 1941)

• Various studies had demonstrated that psychopaths were not treatable or even made them worse (Rice et al., 1992)

• But multiple confounding/unaccounted for factors – precise mechanism impossible to define

• Other studies – issues with methodology and contradictory findings (Seta & Barbaree 1999; Barbaree, 2005; Looman et al., 2005)

• Overall – no conclusive evidence either way (treatment or presence of P)

• Very few studies – different levels of scrutiny (randomised control trials probably impossible)

Psychopathy and Crime

• Key predictor in violent offending. Factor 2 is more predictive (unstable antisocial lifestyle) than Factor 1 (Affective and Interpersonal) (Leistico et al., 2008; Coid et al., 2008)

• 3 ½ times more likely to commit violent crimes (Hare & McPherson, 1984)

• Psychopaths more likely to commit violent crimes for material gain while non-psychopaths motivated by strong emotional arousal

• More likely to reoffend and at a quicker rate (Hart, Kropp and Hare, 1988; Harris, Rice and Cormier, 1991)

• Psychopathic murderers are much more likely to have committed predatory premeditated murder.

Psychopathy and Sexual Offending

• Olver & Wong (2006) studied psychopathy and recidivism in a sample of federally incarcerated sex offenders (incl. 10-year follow-up).

• Rapists and mixed offenders had higher total and Factor 2 psychopathy scores than child molesters and incest offenders.

• PCL-R was a weak predictor of sexual recidivism. But predicted nonsexual violent recidivism and general recidivism.

• Interaction effect between sexual deviance and psychopathy indicating psychopathy could potentiate sexual recidivism.

Psychopathy and Criminal Responsibility

• Are psychopaths fully criminally responsible for their actions?

• Are they only partially responsible for their actions? (defence?)

• Can they understand court proceedings? (fit to plead)

• Is psychopathy a mitigating or aggravating factor that should be considered when sentencing?

• Is the crime relevant?

• “As better knowledge emerges of the psychological features of psychopathy, it brings with it questions about the moral understanding of individuals diagnosed with psychopathy. In particular it challenges whether criminal responsibility should be assigned in the absence of an understanding of why behaviour was morally wrong” (Carson, 2007)

• “The legal system should treat psychopaths like people with very low IQs who are not fully responsible for their actions because psychopaths have low emotional IQ… Maybe as a society we shouldn’t be executing you because your have this (brain) difference” (Kiehl, 2005)

• Does diagnosis of P have a prejudicial effect on jurors in capital punishment cases?

  • Edens et al. (2003)

    • Participants significantly more likely to support the death sentence when offender was described as having psychopathic traits

    • The extent to which participants considered the offender to have psychopathic traits also significantly predicted support of the death penalty despite mitigating factors (adverse childhood)

  • Edens et al. (2005)

    • Expert testimony – when psychopathy, 60% of participants supported the DP, compared to psychotic (30%) or not mentally disordered (38%)

    • Defendant is being put to death not for the offence but because of psychopathic traits

  • Cox et al. (2013)

    • Defendants evaluated as being higher in psychopathic traits, more likely to be given the death sentence

  • Lloyd et al. (2010)

    • PCL-R scores were related to trial outcome with regards to treatability