Lecture 6 - Mental Disorders, Psychopathy and Crime

THE MEDIA, MENTAL ILLNESS & CRIME

• The visibility of mental illness issues within the justice system has increased, in part due to media sensationalism of crimes and perpetrators.

• News media often focuses on criminal trials and proceedings, contributing to public awareness and scrutiny.

• There is a growing emergence of programs and discussions around mental health, ranging from informative journalism to expert commentary.

• Media portrayal can perpetuate racial biases and stereotypes regarding mental illness.

• The fear associated with mental illness is often influenced by media depictions, particularly in violent contexts.

• Some media portrayals (e.g., "Silence of the Lambs") evoke stronger reactions than others, affecting public perceptions of mental illness and crime.

• Public opinion tends to view individuals with severe mental illnesses, such as schizophrenia, as dangerous, reinforced by media narratives.

• The media plays a significant role in shaping the public's understanding of mental disorders through its portrayal of symptoms and behaviors.

Definitions

• MDOs (Mentally Disordered Offenders) include individuals with severe mental disorders like schizophrenia and other offenders who may not fit conventional definitions of mental disorders but still require attention.

• The DSM (Diagnostic and Statistical Manual of Mental Disorders) is widely used for classifying and diagnosing mental disorders, detailing symptoms for various psychological disorders.

• The DSM is currently in its fifth edition, with updates made in March 2022.

• The latest version of the DSM no longer includes the axial system used for classification in previous editions.

• In the axial system, disorders were categorized into Axis 1 (e.g., mood disorders, anxiety disorders) and Axis 2 (e.g., personality disorders, intellectual disabilities).

• Axis 1 disorders tend to have episodes of symptoms with varying severity, while Axis 2 disorders are more pervasive and stable over time.

• Changes in the DSM can have implications in criminal justice and criminal responsibility.

• Individuals with Axis 1 disorders may be more likely to be diverted toward treatments due to their symptoms affecting intent.

• Axis 2 disorders might not disrupt the ability to understand right from wrong, potentially influencing mental disorder offender classifications.

• The DSM is a valuable tool for diagnosing mental illnesses, but it also faces criticisms and limitations, particularly regarding its application in understanding criminality among non-criminal populations, such as women and older individuals

PREVALENCE OF MENTAL DISORDERS: OFFENDERS & COMMUNITY (BUTLER ET AL., 2006)

• Research by Gotler and colleagues in 2006 in Australia compared the prevalence rate of mental illness among 916 prisoners to a community sample of over 3,000 individuals.

• Community samples were weighted to ensure accurate comparison.

• The study found prevalence rates of mental illness to be about 80% among prisoners compared to just 31% in the community sample.

• This suggests that mental disorders are approximately 2.5 times more prevalent in prisoners than in the general community.

• Certain disorders, such as antisocial personality disorder, were found to be significantly more prevalent in offenders, with rates approximately 20 times higher.

• Similar studies in other countries have reported that offenders consistently show greater prevalence rates of disorders compared to the general population.

MENTAL DISORDER BY CRIME

• The table provides a breakdown of mental disorders across three different types: robbery and sexual offenses.

• Robbery offenders were most likely to have been diagnosed with mental disorders.

• There is no indication of specialization among offenders, suggesting that each category involves similar mental health issues.

• There is a clear need for correctional facilities to be adequately trained to provide appropriate interventions for mental health issues.

SERIOUS PROBLEM – WHY?

• Prisons are not designed to manage individuals with serious mental illnesses, leading to various issues.

• Large numbers of seriously mentally ill individuals in prisons present multiple challenges.

• Inmates may befriend others in similar situations, complicating management.

• Due to impulsive thinking, some inmates pose significant threats to management within facilities.

• A notable incident involved an inmate eating clothing and a styrofoam container due to severe mental illness.

• Studies indicate high rates of suicides among inmates with serious mental illnesses.

• There is often inappropriate identification of inmates needing help, leading to a lack of proper treatment.

• Even among identified individuals, treatment options are frequently limited and inadequate.

• Comorbid substance abuse is common among offenders with mental disorders, complicating treatment.

• Many mentally ill offenders in correction systems are not coordinated with necessary mental health services.

• This disorganization contributes to higher recidivism rates compared to non-mentally ill prisoners.

• Canada has made improvements by building infrastructure focused on providing mental health care in prisons, employing mental health teams.

• New adjustment and screening tools are now in place in Canadian facilities, such as the Jail Mental Health Screen and the Computerized Mental Health Screening System.

ASHLEY SMITH: A PREVENTABLE DEATH?

• The case of Ashley Smith illustrates the consequences of high rates of mental illness in the prison population.

• Ashley Smith was a 19-year-old incarcerated in federal prison in Kitchener, Ontario.

• In October 2007, while on suicide watch, Ashley killed a child.

• As a teenager, Ashley had multiple offenses that led to her being in and out of juvenile court.

• In 2003, she was diagnosed with ADHD, conduct disorder, borderline personality disorder, and narcissistic personality disorder.

• Between 2006 and 2007, she was transferred 17 times to eight different institutions across the provinces.

• In October 2007, Ashley requested a transfer to a psychiatric facility and was placed on formal suicide watch.

• On October 19, she attempted to hang herself, and guards did not respond to her situation for 45 minutes.

• After being found, Ashley was pronounced dead, leading to disciplinary actions against prison board officials.

• Her family filed an $11 million lawsuit against the Canadian government for negligence, settled in 2011.

• The incident led to recommendations on improving the correctional system's response to inmates with mental health issues.

• The case underscores the need for correctional facilities to train staff to provide appropriate care for mentally ill offenders.

IMPORTANT LEGAL CONCEPTS

• The legal process involving mental illness in courts presents unique challenges and considerations:

  • Individuals with serious mental illnesses may not necessarily end up in psychiatric hospitals but can contact the courts.

  • Courts review cases to determine if individuals should be diverted to the mental health system.

  • Methods used by courts include fitness tests to assess if someone can stand trial and tests for criminal responsibility.

  • The legal distinction includes actus reus (a bad act or wrong doing) and mens rea (guilty mind or criminal intent).

  • Both components must be met for an individual to be found guilty.

  • The court is responsible for establishing both the act and the mental state at the time of the criminal offense.

  • Actus Reus = a wrongful deed

  • Mens Rea = criminal intent

FITNESS TO STAND TRIAL (FST)

• Before the hearing, the ability to stand trial relates to understanding the nature and consequences of the crime.

• Under mental health law, an accused person may be deemed unfit to stand trial if they cannot understand the trial's nature and communicate with their lawyer due to a mental disorder.

• It seems unfair to try an accused individual who cannot participate in their own defense due to a mental disorder.

• When the court finds someone unfit to stand trial, it must provide a conventional release within 40 days.

• The court cannot order an absolute discharge; the review board must consider public protection and the reintegration of victims into society.

• An individual found unfit to stand trial will remain under the authority of the review board for a determined period or until deemed fit for trial or charges are withdrawn.

• Such individuals do not enter the criminal justice system but are redirected to mental health services.

• If later deemed fit, they will be tried for the original charges.

• To be found not criminally responsible due to a mental disorder, two criteria must be established: 1) the individual suffers from a mental disorder, and 2) they lack the capacity to understand the nature or quality of their actions or did not understand that the act was wrong at the time of the crime.

CRIMINAL RESPONSIBILITY

• A person with a mental disorder may not understand their actions, making punishment inappropriate; treatment is necessary instead.

• Having a mental disorder does not exempt individuals from responsibility; courts assess the impact of the disorder on behavior.

• Courts determine if a mental disorder directly affects an individual's ability to appreciate their behavior and thoughts.

• Many cases involving those found Not Criminally Responsible (NCR) are heard by the court, including involvement from a scrutiny board (typically consisting of a lawyer and psychiatrist).

• The composition of the scrutiny board varies by province; in Ontario, it is chaired by a judge or lawyer.

• NCR individuals are neither convicted nor guilty; the court provides one of three dispositions:

  1. Absolute discharge

  2. Conditional discharge

  3. Extension of the disposition

• The goal is to provide the least burdensome and least restrictive disposition for the individual.

• Common conditions for discharge may include abstaining from drugs/alcohol and complying with mental health treatment.

NCRMD: COMMON MISCONCEPTIONS

• Common misconceptions suggest that expenditures related to NCR (Not Criminally Responsible) may be as high as 30-37%.

• In reality, NCR cases are much lower, at around 1%.

• In Canada, the estimated prevalence of NCR is only 7 to 9 cases per 10,000 claims.

• NCRMD (Not Criminally Responsible on Account of Mental Disorder) applies to about 2 out of every 1,000 adult criminal cases.

• Discussion on accessibility to mental health services highlights notable impacts, including the handling of NCRMD cases involving confused individuals.

UNSUCCESSFUL ATTEMPTS

• Jonathan Lee Jr., also known as the Killer Clown, was arrested in summer 1978 after being suspected of the disappearance of a 15-year-old boy.

• Police investigation uncovered the skeletons of over 30 individuals in his home.

• His lawyer attempted an insanity defense, claiming he was a paranoid schizophrenic, but it was unsuccessful.

• He was convicted of 33 murders and initially sentenced to death, but his sentence was commuted to life imprisonment due to a 1970s California decision.

• Mark David Chapman pled guilty to the murder of John Lennon on December 8, 1980, after shooting him outside his apartment in New York City.

• Chapman’s defense claimed he was in a delusional and toxic psychotic state.

• He later instructed his lawyer to pursue a defense based on his will as determined by God.

• Chapman was sentenced to 20 years to life imprisonment.

• Jeffrey Dahmer was an American serial killer and sex offender who admitted to killing his victims.

• He pled not guilty for reasons of insanity, claiming he knew what he was doing but could not control his actions.

• His insanity plea was rejected, and he was sentenced to 15 consecutive life terms with an additional term for a homicide committed in Ohio in 1970.

• Individuals found NCR (Not Criminally Responsible) may not be confined for long, contrary to public belief, which assumes longer confinement times; actual confinement tends to be around 30 months.

NCRMD: COMMON MISCONCEPTIONS

• In Canada, the length of time allowed before someone's first court date is longer for NCRMD (Not Criminally Responsible on Account of Mental Disorder) than for other discharges.

• Laws regarding remedies are granted to society in the Oxford district.

• There is a community misconception about the dangers posed by NCRMD individuals.

• One study found that only 4% of NCRMD individuals have committed violent crimes, compared to an average of 31% for other offenders.

TYPES OF MENTAL DISORDER IN NCRMD (LATIMER & LAWRENCE, 2006)

• The primary diagnosis indicated does not include any comorbid disorder conditions.

• About half of the diagnoses were single diagnoses, while nearly 30% had two diagnoses and nearly 20% had multiple diagnoses.

• The most common disorder was schizophrenia, followed by affective disorders (e.g., depression, bipolar disorder) and those that were symptomatic but did not meet diagnostic criteria.

• Dementia disorders and organic syndrome disorders, like significant brain injuries from trauma, were also noted.

• The report excludes breathing conditions or disorders.

• The index events were significant; if there were more in both periods, the majority of NCRMD cases were liable to the next level with the main categories combined across levels 1, 2, and 8.

TYPES OF INDEX OFFENCES IN NCRMD (LATIMER & LAWRENCE, 2006)

• Although not mentioned on this slide, there were differences in index diagnoses.

  • Individuals diagnosed with intellectual disabilities were more likely to be charged with delusional disorders and substance abuse disorders, increasing the likelihood of violence charges.

  • NCRMD (Not Criminally Responsible on Account of Mental Disorder) represents a unique aspect of criminal charges; the focus is on whether the defendant is responsible for the offense rather than the act itself.

  • The defense of fitness to stand trial does not serve as a defense against criminal charges; it is intended to postpone the trial process if the defendant's mental state at the time of the trial is compromised.

  • Thus, the question becomes whether the defendant is fit to participate in their trial.

COMPARISON OF NCRMD AND FITNESS

• put the table in your notes

ARE PEOPLE WITH MENTAL ILLNESS VIOLENT?

• Media coverage often connects violent offenders to mental illness, despite questions about general violent behavior in mentally ill individuals.

• Reports may focus on perpetrators receiving psychiatric treatment, influencing public perception of mental illness and violence.

• Association between mental health, criminality, and violence has been studied for over 20 years with varied findings.

• Key points:

  • Majority of individuals with serious mental disorders do not engage in violence.

  • Individuals with serious mental disorders are more likely to commit violence than those without.

  • Those with serious mental disorders are more likely to be victims of violence.

  • Co-occurring mental disorders and substance abuse increase risks of violence.

• Causal mechanisms linking mental disorders to violence are not fully understood.

• Additional research is needed to clarify the relationship and potentially inform public understanding to avoid misconceptions.

COMMAND HALLUCINATIONS

• Hallucinations can be auditory in nature.

• 30 to 50% of individuals experience hallucinations, with varying relationships to violence.

• Some hallucinations can be nonviolent, while others may relate to self-harm or directed violence.

• A study found that 29% of hallucinations had violent content, while 71% were nonviolent.

• Many individuals do not obey commands given in their hallucinations.

• 15% of individuals acted on commands to harm themselves or others.

• The experience of chronic hallucinations is more often linked to nonviolent actions than violent ones.

• Commands believed to be justified by the patient may lead to higher incidences of violent responses.

• Delusions often involve beliefs with little grounding in reality.

DELUSIONS: THREAT-CONTROL OVERRIDE SYMPTOMS

• Narrativity refers to the misinterpretation of perceptions or experiences.

• Examples include beliefs of being persecuted or thinking one is the messiah.

• Researchers define TCO (Threat-Control-Override) symptoms as psychotic symptoms that make a person feel threatened and include thoughts that override self-control.

• Questions related to TCO symptoms may include feelings of being controlled by external forces or thoughts overriding one's mind.

• Studies indicate that both threat and control aspects of TCO symptoms can predict violent behavior, suggesting the need for better manipulation in therapy approaches.

• Some studies, however, have not found a direct link between control over violence and TCO symptoms, indicating variability.

• Differences in experience of TCO symptoms may exist between men and women.

• In one study, male and female patients reported experiencing TCO symptoms more significantly, with a focus on violent behaviors like hitting partners or engaging in physical fights.

LINK BETWEEN MENTAL DISORDERS, SA, TCO & VIOLENCE (SWANSON ET AL., 1996)

• In one study, male and female patients reported experiencing violent behaviors such as hitting partners or children and getting into physical fights.

• Responses indicated a higher rate of violence in the community, around 11%.

• The study suggested that individuals diagnosed with mental disorders may not inherently be violent but rather face societal stigma and disruptions to their community settings.

• There is a concern about being misclassified or misunderstood as committing nuisance or disruptive behaviors.

CRIMINALIZATION OF MENTAL DISORDER

• Criminalization of Mental Disorder: refers to the processing of individuals with mental disorder through the criminal justice system for committing nuisance or disruptive behaviours instead of treating these individuals as patients in the mental health system

• Deinstitutionalization: refers to the large-scale transferring of psychiatric patients out of dedicated hospital facilities and into community-based settings

• In 1939, Lionel Penrose identified a connection between the size of the mental health system and overall population.

• Factors included population therapy, asylums, and twin studies linked to mental health.

• Expansion of mental health services led to undermining of facilities, resulting in fewer available beds.

• Communities are often unprepared, lacking structured housing and rehabilitation services.

• Individuals with mental health issues struggle to access food, shelter, and medication.

• This situation contributes to complex issues like homelessness.

• Assessing the effects of deinstitutionalization is challenging due to limited data on mental disorders in communities.

• Community samples often show higher rates of violent acts among deinstitutionalized individuals.

• There is an association between mental illness and violence; mental illness may predict violent behavior.

• Many mentally ill offenders often commit crimes at age 30 and older.

LINK BETWEEN MENTAL ILLNESS, VIOLENCE, AND CRIME?

• Early onset of antisocial behavior is often not identified as a mental disorder.

• Some studies indicate higher overall levels of violence among individuals with antisocial personality and substance abuse disorders.

• Schizophrenia marginally increases the risk of violent criminal offenses.

• However, definitive conclusions about the relationship between mental illness and violence are complex:

  • Literature exists stating that mentally ill individuals are no more violent than those without.

  • Some literature suggests they are just as violent or even more violent.

• Command hallucinations have been directly linked to acts of violence.

• Specific characteristics of certain mental illnesses might influence the risk of violence.

PSYCHOPATHY

WHAT IS PSYCHOPATHY?

• Psychopathy is challenging to define and diagnose, as it lacks physical symptoms seen in other disorders.

• It is characterized by a pattern of interpersonal, affective, behavioral, and antisocial traits.

• Key characteristics of psychopathy include:

  • Glib or superficially charming demeanor

  • Manipulative behavior

  • Lack of remorse or guilt

  • Pathological lying

  • Irresponsibility and impulsiveness

  • Callous, parasitic lifestyle

  • Promiscuous sexual behavior

  • History of childhood antisocial problems

• Psychopaths exhibit a deficit in natural empathy.

• The combination of these traits increases the likelihood of success through manipulation, making it an adaptive life strategy.

• They are assertive, avoid procrastination, focus on positives, and do not take failures personally.

• Psychopaths maintain composure under pressure and are effective in everyday and business scenarios.

• However, psychopathy is sustainable only in small numbers within society.

Video

• Psychopaths often appear charming and nice on the surface, masking their darker tendencies.

• They exhibit traits that may seem crazy but are not classified as mentally ill.

• Characterized by severe emotional detachment, they often do not feel normal emotions.

• They lack remorse, empathy, and love, responding inappropriately to emotional situations.

• Pathological lying and manipulation are common behaviors among psychopaths.

• Psychopaths behave like predators at the top of the social food chain, viewing others as prey.

• They attempt to impose their values onto others, despite having a different moral framework.

• The research on psychopathy often emphasizes the predator-prey dynamic.

• Psychopaths are typically male and struggle with emotional depth compared to others.

• They are capable of understanding the consequences and morality of their actions but choose to disregard them.

PSYCHOPATHS IN PRISON POPULATIONS

• A small group of psychopaths exerts a disproportionate influence within the cultural system.

• Approximately 10 to 25% of offenders are psychopaths.

• Conversely, only about 1 to 2% of the general population exhibits highly psychopathic traits.

• Psychopathy is a strong predictor of recidivism (recommitting crimes).

• Incarcerated psychopaths have committed an average of four violent crimes by age 40.

• 80% of psychopaths released from prison commit another crime, usually within three years, compared to 50% of the general population.

• The number of psychopaths may be overestimated, depending on the DSM version and clinical cutoff used.

• The more accurate percentage of people with psychopathic tendencies may be around 1%.

• Highly violent psychopaths may be as rare as one in 100,000 or one in a million.

PSYCHOPATHS AS SERIAL KILLERS

• The psychopaths are even more represented when you focus on serial killers

• It is estimated that close to 90% of serial killers are psychopaths compared to less than 1% of that general population.

PSYCHOPATHY AND SERIAL KILLERS

• So although research seems to suggest that serial killers are psychopathic, it is important to note that psychopaths are not serial killers.

• So as mentioned previously, psychopaths are particularly strong in good men and have been referred to as snakes in suits.

• So those psychopaths who are very good at what they do in business have also been referred to as accessible than paths.

PSYCHOPATHY: ASSESSMENT ISSUES

• Self-report inventories involve questionnaires with statements linked to psychopathic characteristics.

• Two widely used self-report scales for adults:

  • Psychopathic Personality Inventory Revised

  • Self Report Psychopathy Scale

• Business Scan and Beam Scan are developed to assess psychopathy-related features in the business domain.

• Issues with self-report scales include:

  • Psychopaths may be dishonest and seek tangible benefits.

  • They engage in "viewing delay," lying or misrepresenting themselves.

  • Psychopaths may lack insight into their traits and behaviors, making self-reporting unreliable.

  • They may not understand remorse or the impact of their actions on others, often regretting being caught instead.

• Advantages of self-report measures:

  • Can measure emotional traits not easily observable by others (e.g., feelings of anger).

  • Easy to administer, quick, and inexpensive.

  • Many scales include measures to detect invalid responding.

  • Eliminates concerns regarding inter-rater reliability since individuals complete the scale themselves.

• The second method of assessment is observer ratings, typically involving parents or teachers assessing children for psychopathic features.

• Two commonly used observer rating scales for children:

  • Child Psychopathy Scale

  • Antisocial Process Screening Device

• The third assessment method is the Structured Clinical Approach, utilizing interviews and related files to assess psychopathic traits, commonly in forensic settings.

• Two popular structured clinical scales:

  • Hare Psychopathy Checklist for adults

  • Hare Psychopathy Checklist Youth Version for adolescents and children (somewhat controversial).

PSYCHOPATHY IN YOUTH - HARE PSYCHOPATHY CHECKLIST: YOUTH VERSION (PCL:YV)

• Until about 10 to 15 years ago, there was little attention to the presence of psychopathic traits in children or youth. However, studies have been increasingly focused on understanding the origins of psychopathy during development.

  • Scales to measure psychopathic traits in children model after the PCLR (Psychopathy Checklist Revised) used for adults.

  • One of the most common scales for assessing psychopathy in youth is the Hare Psychopathy Checklist Youth Version.

  • This scale consists of 20 items rated on a three-point scale, using a semi-structured interview and file information.

  • It was designed to assess psychopathic traits in juvenile justice samples and has been validated for boys and girls aged 12 to 18.

  • The 20 items measure the four factors of psychopathy: interpersonal, affective, behavioral, and antisocial.

PSYCHOPATHY IN YOUTH: CONCERNS

• Summary of concerns regarding measuring psychopathy in youth:

  • Measuring psychopathy in youth aims to better understand the origins of the disorder for treatment purposes.

  • Concerns include the inflation of psychopathy scores due to general adolescent characteristics, as normal developmental activities may be mistakenly classified as criminal.

  • High ratings of psychopathic traits are rare in community youth; approximately 80% of community youth males score very low on PCLYP.

  • The issue may be more prominent with PCLR compared to PCLYV, designed for the adolescent population.

  • The stability of psychopathic traits from childhood to adolescence and into adulthood is questioned due to significant developmental changes during adolescence.

  • Studies show parental ratings of psychopathic traits are highly stable, but new traits rarely develop in previously low-scoring children in adolescence.

  • Psychopathic traits exhibit moderate to high rank order stability across the lifespan; those high on traits often remain high, while those low remain low.

  • Most changes in psychopathic traits occur during adolescence, typically leading to a decrease in traits.

  • Further research is needed to understand why some traits remain stable while others decrease.

  • Labeling youth as psychopaths can create stigma, leading to negative perceptions and consequences such as being viewed as uncontrollable, reduced access to rehabilitation, and potential transfer to adults in criminal trials.

  1. Scores on measures of psychopathy may be inflated by general characteristics of adolescence

  2. Stability of psychopathic traits

  3. Negative consequences of labelling youth as ‘psychopaths”

  • “Damning” issue

“DAMNING” LABEL: POTENTIAL FOR STIGMA

• Several studies investigate the effects of different labels (e.g., psychopath, conduct disorder) on decision-making in lecturers.

• Both labels of psychopathy and conduct disorder are associated with ratings of higher risk.

• Describing underlying traits has a stronger impact on decision-making than the label itself.

• The strongest influence on decision-makers is a history of antisocial behavior.

• The effect of psychopathy on treatment decisions is mixed; some studies recommend treatment more often for youth described as psychopathic.

• Wording significantly matters in descriptions:

  • If stated "Michael meets the diagnostic criteria for psychopathy," there is little impact.

  • If stated "Michael is a psychopath," there is a stronger negative impact, leading to harsher sentences.

HARE PSYCHOPATHY CHECKLIST-REVISED (PCL-R)

• The Hare Psychopathy Checklist Revised (PCLR) is the most commonly used measure for assessing psychopathy in adults.

• The PCLR evaluates demographic, criminological, social, and psychological domains.

• The assessment is conducted through interviews, file reviews, and case history analysis.

• It is designed for use with correctional and forensic psychiatric samples.

• Validated for men and women aged 18 and older.

• The scale consists of 20 items rated on a three-point scale (0 to 2):

  • 0: No evidence of a psychopathic trait

  • 1: Some evidence but not complete

  • 2: Trait definitely present

• Total scores range from 0 to 40; higher scores indicate a higher level of psychopathy.

• Information for scoring is gathered from various documents (e.g., court transcripts, police reports, psychologist reports, victim impact statements) rather than solely from interviews due to the deceptive tendencies of psychopaths.

Psychopathy

• put a screenshot in your notes

• PCLR originally described a two-factor model:

  • Factor one: Interpersonal effective component

  • Factor two: Lifestyle and UT social component

• Recent research indicates items on the PCLR form a four-facet structure:

  • Interpersonal

  • Affective

  • Lifestyle

  • Antisocial

• The four-facet solution is supported by subsequent research.

Facets Breakdown:

1. Interpersonal:

   • Glib with superficial charm

   • Grandiose view of self-worth

   • Pathological lying

   • Cunning and manipulative

2. Affective:

   • Remorselessness and lack of guilt

   • Emotionally shallow

   • Lacking in empathy

   • Callousness

   • Denying responsibility for harmful actions

3. Lifestyle:

   • Need for stimulation

   • Impulsivity and irresponsibility

   • Few realistic long-term goals

   • Exploitative or parasitic lifestyle

4. Antisocial:

   • Poor behavioral control

   • Versatility in criminal behavior

   • Behavioral problems in early life

   • Juvenile delinquency

   • Early release from prison often revoked

• Items like promiscuous sexual behavior and multiple short-term marriages contribute to total PCLR scores but do not load onto any specific factor.

• Mean PCLR scores for various populations are presented on the slide

MEAN PCL-R SCORES

• A score of 30 or higher is typically needed to consider someone psychopathic.

• The cutoff score for diagnosing psychopathy has been debated in psychology and psychiatry.

• In 1991, Hare recommended that only those scoring 30 or above should be classified as psychopathic.

• This high threshold was intended to reduce false positives but also raises false negatives.

• The general population usually scores around 4 or 5 on psychopathy assessments.

• Female criminals may score lower on psychopathy checklists compared to males.

• Assessments are often tested more on men, which may limit their effectiveness for women.

• Female psychopaths may exhibit traits not adequately captured by existing measures.

ARE YOU A PSYCHOPATH?

PSYCHOPATHY: ASSOCIATIONS WITH CRIME, VIOLENCE AND RECIDIVISM

• Research has established a strong link between psychopathic traits and criminal/aggressive behavior in adults and children.

• Psychopathic traits help identify individuals who start their criminal careers at an early age and engage in violence and predatory behavior throughout their lives.

• Results from three meta-analyses show that higher psychopathy scores in adults and youth are associated with increased recidivism.

• Psychopaths are more likely to engage in overt aggression compared to non-psychopaths.

• For both adolescents and adults, the lifestyle and anti-social features (Factor Two) have greater predictive value than interpersonal and affective features (Factor One).

• Psychopaths are sensation seekers and risk-takers, often putting themselves in high-risk situations.

• They are impulsive and fail to consider alternatives or consequences of their violent actions.

• Psychopaths are unemotional and do not appreciate the consequences of their crimes.

• They are suspicious, perceiving hostile intent in others, and exhibit selfish and arrogant behaviors, desiring power and control over others.

PSYCHOPATHY: MOTIVES FOR MURDER (WOODWORTH & PORTER, 2002)

• A study conducted by a reporter in 2050 examined the relationship between psychopathy and characteristics of criminal homicide among 125 Canadian offenders:

  • 125 homicides were classified as either reactive or instrumental.

    • Reactive murders: high impulsivity and emotionality; often the result of extreme provocation (e.g., crimes of passion).

    • Instrumental murders: cold-blooded, premeditated, motivated by external goals.

  • 26 offenders committed more than one homicide, indicating significant violence.

  • Results confirmed the hypothesis that homicides committed by psychopathic offenders were significantly more instrumental than those by non-psychopaths.

    • 93% of homicides committed by high-scoring psychopathic offenders were primarily instrumental in nature.

    • Only 28% of low-scoring non-psychopathic offenders committed primarily instrumental homicides.

    • Non-psychopathic offenders were more likely to commit primarily reactive and instrumental violence (51%), but psychopathic offenders were more inclined towards instrumental homicides.

SURVIVORS OF PSYCHOPATHS (PAGLIARO & FORTH, IN PRESS)

• Limited research exists on the experiences and effects of being victimized by psychopaths.

• An Internet survey was conducted to recruit 600 victims of psychopaths.

• Sample composition: 12% men, 80% included psychopathy of the perpetrator.

• Psychopathy was measured using a 64-item dimensional inventory with a five-point Likert scale (1 = strongly disagree, 5 = strongly agree).

• Participants rated modified statements to reflect their personal experiences and feelings as survivors.

• A 'don't know' option was included for questions requiring intimate knowledge of the individual.

• Total possible scores ranged from 64 to 320, with a minimum score of 128 used in the study for integration of psychology.

RELATIONSHIP WITH THE PSYCHOPATH

• The slide presents a breakdown of victims' relationships with psychopaths.

• 75% of participants were in past or present intimate relationships with the identified psychopath.

• Most victims had personal knowledge of the psychopath, as they were closely and frequently involved.

• Victims experienced cycles of discretion management and threats/coercion from the psychopaths.

• Victims had a high level of exposure, with some interacting with the psychopaths for years.

• Majority of victims were ex-significant others, followed by current significant others, family, and friends.

DID YOU NOTICE ANYTHING UNUSUAL ABOUT HIM/HER WHEN YOU FIRST MET?

• Quotes from victims of psychopaths regarding initial impressions:

• One victim noted that after several dates, the psychopath wanted to get married.

• Another victim observed that the psychopath wanted to keep track of her at all times, asking for details about her day and tracking her friends.

• One victim described the relationship as one major deception, stating the psychopath lies as easily as normal people breathe.

• Another victim commented on the psychopath's pathetic demeanor while sharing his miserable life story.

• “After several dates he wanted to get married.”

• “The first thing I noticed is that he wanted to keep track of where I was at all times, he wanted to know every detail of my day, and he wanted to keep track of my friends and he also found a way of hacking into my computer to keep track of my activity.”

• “The whole relationship was one major deception. She lies the way normal people breathe.”

• “His pathetic look as he told me his miserable life story. It melted my

  heart.”

IMPACT OF VICTIMIZATION ON PHYSICAL AND MENTAL HEALTH

• Interactions with psychopaths in the sample are linked to higher negative mental health consequences compared to physical health consequences.

• About 80% of respondents reported that victimization had an extreme effect on their mental health.

• Being a victim of a psychopath can lead to very negative thoughts.

NOTICE ANY RED FLAGS? The video

• Identifying psychopaths is not a straightforward task.

• Video will provide suggestions for recognizing psychopaths.

• Insights will come from victims and psychopaths themselves.

• It's crucial to be aware of what psychopaths can do to be prepared.

• Experts offer a survival guide to protect oneself from psychopaths.

• Watch for individuals who seem overly charming and promising without hesitation.

• Don't be swayed by superficial appearances, smiles, or fast talk.

• Enter new relationships with caution; those who seem too perfect may not be genuine.

• Trust instincts and ask numerous questions about any feelings.

• Be aware of personal vulnerabilities and blind spots that psychopaths may exploit.

• Establish and maintain strict boundaries to prevent loss of control.

• If targeted, consider cutting losses and seeking professional help.

• Understanding the red flags and nature of psychopathy can help minimize potential damage.

KRUEGER CASE

• Discussion will focus on treating psychopathy using the Krueger case as an example.

• David Krueger, born Peter Woodcock, was a Canadian serial killer and child rapist, arrested for killing three young children in Toronto between 1956 and 1957 as a teenager.

• He was placed in a psychiatric facility and diagnosed as a psychopath.

• After completing a treatment program, he was deemed greatly improved and transferred to a medium-security hospital in Brockville.

• At Brockville, he fell in love with a psychiatric teacher, who rejected his advances.

• Within one hour of his first week, Woodcock stabbed the teacher to death.

• Woodcock was supervised by Bruce Hamill, a former patient who had previously killed an elderly woman in 1977 and was an accomplice in the murder.

• Both Woodcock and Hamill were returned to Oak Ridge.

• Woodcock later remarked that the treatment program made him more adept at manipulating others.

• He spent 53 years in custody, mainly at Oak Ridge, and died there in March 2010 on his 71st birthday.

PSYCHOPATHY AND TREATMENT

• The case highlights the belief that psychopathy is largely untreatable.

• Psychopaths are aware of their wrongdoing but do not care about it.

• Treatment is difficult as psychopaths see nothing wrong with their behavior and choose to live their lives as they do.

• As a result, psychopaths are not popular or responsive patients in treatment settings.

• Limited research exists on the effectiveness of treatment for psychopaths, but initial studies suggest poor responses to treatment.

• One study reported discouraging results regarding the treatment of psychopathic offenders, showing little improvement in recidivism rates.

PSYCHOPATHY AND TREATMENT (RICE, HARRIS, & CORMIER, 1992)

• Researchers examined 176 treated and 146 untreated patients over a follow-up period of 10 years.

• Evaluated an intensive therapeutic community believed suitable for psychopaths.

• The community was largely peer-operated and involved intensive group therapy for up to 80 hours a week.

• The goal was to foster empathy and responsibility among peers.

• The program operated for a decade in a maximum security psychiatric hospital and drew worldwide attention for its novelty.

FAILURE FOLLOWING TREATMENT: VIOLENT OFFENCES

• New results indicate treatment did not reduce recidivism among psychopaths.

• Follow-up after 10 years showed lower violent recidivism for non-psychopaths but higher for psychopaths.

• Psychopaths had poor adjustment and problem behaviors during the program despite achieving positions of trust.

• Researchers speculate that non-psychopaths improved social skills, leading to pro-social behaviors.

• Psychopaths used new skills to better manipulate and exploit others.

• Treated psychopaths showed increased offending behavior post-treatment.

• Recent findings suggest better outcomes in newer treatment settings.

• Participants who dropped out tended to reoffend violently more than those who completed treatment, which showed positive gains with reduced risk of sexual and violent recidivism.

CONCLUSION: TREATMENT

• Research on treating psychopaths suggests:

  • Psychopaths are resistant to traditional treatment modalities.

  • They are more likely to drop out of other treatments.

  • More disruptive in group therapy settings.

• Youth with psychopathic traits show more amenability to treatment.

• Empirical literature on this is still quite limited.

• Recent studies yield more promising findings:

  • Cognitive behavioral treatment effective for youth with psychopathic traits if intense and sustained.

  • Early interventions are important for treatment effectiveness.

  • A study indicated treated violent adolescent offenders had a 21% recidivism rate, while untreated had 49%.

• It is premature to conclude psychopaths are untreatable.

• Treatment should focus on specific, changeable factors linked to criminal behaviors, such as behavioral and lifestyle traits.

• High-intensity cognitive behavioral programs have shown some success.

Video

• The discussion centers on whether psychopathy is tied to features or infrastructure, with environmental, family, and genetic factors all playing roles.

• The etiology of psychopathy involves a mix of neurobiological, psychological, and personality factors, alongside moral and learning influences.

• Research on identical twins suggests there's a significant genetic contribution to the development of psychopathy, linked to a low level of arousal and the need for intense sensory stimulation.

• Neurobiological theories indicate abnormalities in the right hemisphere of the brain in psychopaths, although more research is needed to determine if these are inherent or exacerbated by lifestyle.

• Key brain regions, such as the amygdala and orbitofrontal cortex, are thought to be involved in psychopathy.

• Research by Dr. Matthew Shea focuses on cognitive and emotional processes underlying antisocial personality traits.

• Studies show psychopaths may struggle with recognizing emotions but excel in identifying fear, which aligns with predatory thinking concerning potential victims.

• Dr. Michael Koenigs uses MRI scans to identify how psychopathic brains respond to pleasure, showing aberrant circuitry tied to moral judgment.

• The debate persists on whether psychopaths are inherently bad or shaped by their environments and experiences, particularly during abusive or stressful childhoods.

• Various experts note that while there's no cure for psychopathy, appealing to a psychopath's self-interest may yield some therapeutic gains.

• Early intervention is suggested as crucial in addressing antisocial behavior in children with psychopathic traits.

• Dr. Dunham likens psychopathic traits to sliders in a mixing desk, indicating that certain traits can be heightened or toned down based on context.

• Research indicates that psychopathic traits can lead to success in certain professions, including CEOs, lawyers, and surgeons, due to traits like charisma, fearlessness, and focus under pressure.

• Media representations can glorify some psychopathic traits, often depicting them as desirable or advantageous in competitive fields.

PSYCHOPATHY: CONCLUSIONS

• Emotions play little role in their thinking, language, and behaviors

• Their approach to the world is predatory

• They do not play by our rules, nor do they care about our feelings and welfare

• They put on a good show

• It is hard not to get sucked in!