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Psychopaths

Anna C. Salter

THE PCL-R (1991, 2003)


Published 20

by Multi-Health Systems (MHS)

items scored from interview & file data item scored on a 3-point scale score 0-40

Each Total

Factor

structure Original (1991): 2 factors Current (2003): 2 factors, 4 facets

Neumann, Hare, & Newman, 2007; NA Samples (male, female offenders, male forensic psychiatric : N = 6929
glib/ superficial .73 grandios e self-w orth pathological lying conning manipulative .73 .71 .80 .65 shallow affec t callous lack empathy fail to acc ept responsibility lack remorse or guilt

Interpersonal

.70

Affective

.82

.66 .42 .50 .55 .51

.59

stimulation seeking impuls ivity .71 .60 irresponsible .58 paras itic orientation lack of realis tic goals

.73

.65 .70

poor behavior controls early behavior problems juvenile delinquency revocation of cond. release

Lifestyle
.73

Antisocial

.67 .54

.60

.64 criminal versatility

APD Base Rate in Forensic Populations


50% to 75%

(Hare, 1996)

Psychopathy Base Rate in Forensic Populations

10% to 20%
(Hare, 1996)

Psychopathy and APD

APD (50 - 80%)

PCL-R Psychopaths (10 - 20%)

All Offenders (100%)

Percentage of Sex Offenders with PCL-R Score of 30+ (Porter et al., 2000)
80

Percentage

64 60

40

35.9

20 6.3 0 ExtraFamilial Molesters

10.8

6.3

Incest Offenders

Mixed Molesters

Rapists

Mixed MolestersRapists

Percentage of Sex Offenders with PCL-R Score of 30+ Across Studies

Child Molesters

5 10%

Rapists Child/Adult

25-30% 60-70% (Hare, 2003)

Subtypes of Psychopathy?

PCL-R scores of 27 or higher

Three

clear clusters or subtypes with high PCL-R scores


Classic

or prototypical: high on all 4 facets

Prototypical (32%)

8 7 6 5 4 3 2 1 0 Facet 1

Facet 2

Facet 3

Facet 4

Macho:

low on Interpersonal, high on

others

Prototypical (32%)

Macho (27%)

8 7 6 5 4 3 2 1 0 Facet 1 Facet 2 Facet 3 Facet 4

Manipulative:

high on Interpersonal and Affective, lower on others

Prototypical (32%) Manipulative (25%) 8 7 6 5 4 3 2 1 0 Facet 1 Facet 2

Macho (27%)

Facet 3

Facet 4

Variations
Prototypical (32%) Manipulative (25%) Macho (27%)

8 7 6 5 4 3 2 1 0 Facet 1 Facet 2 Facet 3 Facet 4

Variations
Prototypical (32%) Manipulative (25%) Macho (27%) Pseudo (16%)

8 7 6 5 4 3 2 1 0 Facet 1 Facet 2 Facet 3 Facet 4

Aspergers Syndrome

Murphy, 2007 13 Aspergers patients at Broadmoor PCL-R scores Mean = 15; varied from 11-22

Variations
Prototypical Manipulative Asperger's Macho Pseudo

8 7 6 5 4 3 2 1 0 Facet 1 Facet 2 Facet 3 Facet 4

Bjrkly, 2009
Table 2 Possible differences between characteristics of violence in Aspergers syndrome and psychopathy.
Characteristic Sensory reactivity Psychopathy Hypo Manipulative Proactive Positive Denial Aspergers Syndrome Hyper Nave Reactive Negative Confession

Interpersonal communication
Typical violence Reinforcement contingency Relating to violence

Findings from these comparisons indicated that there may be substantial differences between the two diagnostic disorders regarding these five criteria.

Psychopathic Aggression

Nature of Aggression/Violence Primarily Reactive


crime of passion extreme provocation self-defense response to threat often relatively uncontrolled

Nature of Aggression/Violence Primarily instrumental


cold-blooded premeditated settle a score goal-directed controlled predatory

Psychopaths capable of both reactive and instrumental aggression/violence But even the reactive aggression/violence is more controlled than in others

Woodworth & Porter, 2002; Porter et al., 2003)

P rimary N ature of C anadian Homicides as a F unction of P C L-R Scores


P R IMAR ILY R EAC T IVE 100 90 P R IMAR ILY INS T R UMENT AL

Percentage of Cases

80 71.8 70 60 50 40 30 20 10 0 LO W P C L-R MEDIUM P C L-R HIG H P C L-R 28.2

P rimary N ature of C anadian Homicides as a F unction of P C L-R Scores


P R IMAR ILY R EAC T IVE P R IMAR ILY INS T R UMENT AL

100 90

Percentage of Cases

80 71.8 70 60 50 40 30 20 10 0 LO W P C L-R MEDIUM P C L-R HIG H P C L-R 28.2 67.4

32.6

P rimary N ature of C anadian Homicides as a F unction of P C L-R Scores


P R IMAR ILY R EAC T IVE 93.3 P R IMAR ILY INS T R UMENT AL

100 90

Percentage of Cases

80 71.8 70 60 50 40 30 20 10 0 LO W P C L-R MEDIUM P C L-R HIG H P C L-R 6.7 28.2 67.4

32.6

Schizophrenia, Psychopathy, Substance Use, & Crime

Schizophrenia, Psychopathy, Substance Use, & Crime


Tengstrm, Hodgins,Grann, Lngstrm, & Kullgren (2004) Criminal history of patients with various combinations of schizophrenia, substance use, and psychopathy Swedish male patients who received pretrial assessments between 1988 and 1993, and were found guilty of violent offences 202 schizophrenics, & 78 offenders who met PCL-R criteria for psychopathy Lifetime convictions since age 15, per year at risk (free)

Number of Convictions Per Year at Risk


6 5 4 3 2 1 0 S S + SUD S+P S + P + P + SUD SUD P

S = schizophrenia SUD = substance use disorder P = psychopathy

Schizophrenia, Psychopathy, Substance Use, & Crime

Among patients with schizophrenia, correlation between PCL-R and number of convictions per year at risk:
General

= .62 Violent = .38

High ratings of psychopathy are associated with earlier ages of first conviction for a criminal offense and more convictions among the men with schizophrenia, just as among men with no mental illness (p. 385).

These findings suggest that among offenders with psychopathic traits, the traits, not substance abuse, are associated with criminal offending (p. 367).

What About Comorbidty

Patients with schizophrenia and many psychopathic features are at high risk for violence
Tengstrm

et al., 2000

Thomson

et al., 2008

PCL-R as a Predictor of Violent Recidivism in Schizophrenic Offenders


1 0.8
PCL-R 0-25

% Surviving

0.6 0.4 0.2 0 0 12 24 36 48 60 72

Tengstrm et al., 2000

Months

PCL-R as a Predictor of Violent Recidivism in Schizophrenic Offenders


1 0.8
PCL-R 0-25

% Surviving

0.6 0.4 0.2 0 0 12 24 36 48 60 72


PCL-R 26-40

Tengstrm et al., 2000

Months

PCL-R as a Predictor of Violent Recidivism in Schizophrenic Offenders


1 0.8
PCL-R 0-25

% Surviving

0.6 0.4 0.2 0 0 12 24 36 48 60 72


PCL-R 26-40

Tengstrm et al., 2000

Months

Dolan & Fullam, in press

24 male patients with schizophrenia (DSM-IV) Secure psychiatric facility in England All convicted for violent offences PCL: SV scores Mean = 12.9 Median split: High, Low psychopathy fMRI while pictures viewed Neutral, anger, disgust, sad, fear Differences between neutral and emotional

Dolan & Fullam, in press

Psychopathic traits in patients with schizophrenia are associated with dysfunction in the prefrontallimbic circuitry over and above that normally associated with schizophrenia alone.

Matching Emotional Tone

A man thrown overboard from a sinking ship A man running from a monster A man surfing on a large wave A woman standing on a yacht A boy carrying a lamp into his room

1. 2. 3. 4.

(Hare, Williamson, et al., 1988; Williamson et al., 1991)

Matching Emotional Tone: Nonpsychopaths

A man thrown overboard from a sinking ship A man running from a monster

Matching Emotional Tone: Psychopaths


A

man thrown overboard from a sinking ship


man surfing on a large wave

Rating Metaphors
6 Point Rating Scale -3 Very Negative +3 Very Positive Man is a worm that lives on the corpse of the earth Love is an antidote for the worlds ills (Herve, Hayes, & Hare, in press)

Attributing Emotions
Stories Design to Elicit Emotions Happiness Sadness Embarrassment Guilt (Blair et al., 1995)

Attributing Emotions
No Differences Between Psychopaths & NonPsychopaths Happiness Sadness Embarrassed

Attributing Emotions
Differences in Psychopaths & Nonpsychopaths Guilt Stories Psychopaths Little guilt to others Indifference or positive emotions, especially intentional harm Happiness for intentional harm

Response to Acts of Violence


Nonpsychopaths Felt Anxiety Guilt Fear

(Walsh, 1999)

Response to Acts of Violence


Psychopaths Felt Excitement Power Satisfaction Justification Increased Self-Esteem

(Walsh, 1999)

Psychopaths & Sexual Offending

Porter et al., in press

310 Male offenders: PCL-R non-sexual sexual: child molesters, rapists, mixed PCL-R predicted nonviolent and violent offenses, but not sexual offenses

Porter et al., in press

But among child molesters, high PCL-R scores predictive of sex offenses Overall, psychopaths (PCL-R of 30 or more) 2 times more likely to receive parole than other offenders They also manage to remain out of prison following release for about half as long as other offenders

Combining Psychopathy and Sexual Deviance


A Bad Idea

Recidivism in Adult Sex Offenders

340 Child molesters and Rapists)

Psychopath = PCL-R scores >25


Nonpsychopaths = all others (Rice & Harris, 1997)

Violent Recidivism in Sex Offenders


Cumulative Proportion Surviving
1 0.8 0.6

Deviant

Nonpsychopaths

Not Deviant
0.4

Not Deviant
0.2

Psychopaths Deviant

0 0 1 2 3 4 5 6 7 8 9 10

Rice & Harris, 1997

Years of Opportunity

Sexual Recidivism in Sex Offenders


Cumulative Proportion Surviving
1

Nonpsychopaths
0.8 0.6 0.4 0.2 0 0 1 2 3 4 5 6 7 8 9 10

Deviant Not Deviant Psychopaths Deviant

Not Deviant

Rice & Harris, 1997

Years of Opportunity

Olver & Wong (2002) 113 sex offenders, 10-year follow-up


PCL-R
Deviant sexual arousal scale based on lifestyle and criminal behaviors PCL> 29 and median split of deviant arousal scale

Sexual Recidivism Rate (%) as a Function of the PCL-R and Deviant Sexual Arousal
60 50 40 30 20 10 0 High/deviant High/nond Low/deviant Low/nond

Olver & Wong (2002)

Psychopathy: Treatment

Psychopathy & Treatment


Non Psychopaths Treated Untreated 22% 39% (Harris, Rice et al., 1994)

Psychopathy & Treatment


Psychopaths Treated Untreated 77% 55% (Harris, Rice et al., 1994)

Psychopathy, Treatment, and Reconvictions in HMP Service


Tx anger-management, social skills

24-month reconviction rate


(Hare, Clark, Grann, & Thornton, 2000)

2-Year Post-release Reconviction Rates in the English Prison Service


90 80 70 60 50 40 30 20 10 0 Untreated
Hare, Clark, Grann, & Thornton (2000)

Percent Reconvicted

Low Factor 1 High Factor 1

Treated

Behavioral Genetics

Blonigen, Carlson, Krueger, & Patrick, Personality and Individual Differences, 2003, 35179-197
Substantial

evidence of genetic contributions to variance in the personality construct of psychopathy.

Blonigen, Hicks, Krueger, Patrick, & Iacono, Psychological Medicine, 2005, 35, 1-12. The interpersonal-affective (Fearless Dominance) and antisocial (Impulsive Antisociality) traits of psychopathy, are equally and substantially heritable with each accounting for roughly half of the total variance in both men and women.

Larrson, Andershed, & Lichstenstien, Journal of Abnormal Psychology, 2006, 115, 221-230.
A

genetic factor explains most of the variation in the psychopathic personality

Behavioral Genetics

Viding, Blair, Moffitt, & Plomin (2005). UK Twin study of 3687 7-year old twin pairs Rated by teachers and parents on items similar to those on the APSD (Frick & Hare, 2001) Assessed heritability: of antisocial behaviors; callous-emotional traits Concluded that genes account for 70% of the individual differences in callousunemotional traits

The core symptoms of psychopathy are


strongly genetically determined

Genetic contribution was highest when callous-unemotional traits were combined with antisocial behaviors

Origins

Behavioral genetics Large-sample twin studies Evaluate heritability of traits that may be precursors to adolescent and adult psychopathy

Referred to as Callous-unemotional (CU) traits

General Findings

Consistent evidence of substantial heritability of CU traits Common genetic factor may underlie CU traits and antisocial behaviors

The Lexical Decision Task


Williamson, Harpur, & Hare, 1991

Words have both denotative (explicit, literal) and connotative


(implicit, implied) meanings The impact of the affective connotations of words can be evaluated by recording: Lexical decision times Brain activity associated with the decisions Event-related potentials (ERPs)

The Lexical Decision Task


Neutral & emotional words, and pronounceable nonwords, briefly presented in random order on a computer screen. e.g.,
RAPE EPRA TREE ETER

Press button as quickly as possible if you saw a word

Reaction Time and Word Type

msec

950

Nonpsychopaths
900

Psychopaths

850

800

750

700

Neutral

Positive
Emotionality of Words

Negative

Williamson, Harpur, & Hare, 1991

Institutional Violence
N = 728 Males PCL-R Score >30 No. with Infractions 44%

<30

16% (Hare et al., 2000)

Institutional Violence
At least 1 infraction
No infractions At least 1 violent infraction Mean PCL-R score: 19.2 14.6

21.0

No violent infractions 13.6 (Hare et al., 2000)