PSYCH 3CC3 Lecture 9: Psychopathy
19 Jun 2018
School
Department
Course
Professor
Note, psychopathy is not a recognized disorder in the DSM-5.
-
The closest thing we have to it is Antisocial Personality Disorder
-
History of Psychopathy as a Construct
Emil Kraepelin (ca 1895):
He identified a group of individuals that he described as being "morally insane"
○
Their behaviour was anti-social and immoral.
○
Defective ability to restrain: "the reckless gratification of immediate egotistical
desires."
○
-
Hervey Cleckley, prison psychologist:
"The Mask of Insanity" (1941-1988)
○
First detailed description of the psychopath.
○
-
Robert D. Hare:
Most influential in psychopathy today.
○
Influenced by Cleckley
○
"Psychopathy: Theory and Research" (1970)
○
Developed Psychopathy Checklist Revised (PCL-R, 1991)
○
-
Cleckley's Construct of Psychopathy
Superficial charm and higher intelligence.
When we see the word "psychopath" we assume "killers" - but the vast majority
of psychopaths never commit a crime in their lives and not all killers are
psychopaths (serial killers usually are).
○
Easy to talk to, not odd/queer, normal.
○
Appear well-adjusted, happy.
○
Free from social and emotional impediments.
○
1.
Absence of delusions and irrational thinking.
Usually free from symptoms of psychological disturbance.
○
Excellent logical reasoning
○
Can forsee the consequences of actions, reflect on mistakes
○
Nothing pathologic, nothing that would be suspicious
○
Normal emotional reactions
○
Healthy ambitions
○
Loyal
○
2.
Absence of nervousness
No symptoms that suggest a psycho-neurosis.
○
Relative immunity from normal anxiety.
○
3.
Unreliability
Generally unreliable, no matter the situation.
○
They don't even care if you confronted them about their behaviour.
○
For some periods, they will stick to their commitments.
○
Inconsistency in inconsistency.
○
4.
Untruthfulness and insincerity.
Disregard for truth.
○
At ease when making serious promises - carries special powers of conviction.
○
5.
Lack of remorse or shame.
Denies responsibility, blames others.
○
Hollow sincerity - sometimes says their problems are all their fault, but they don't
believe it.
○
6.
Inadequately motivated antisocial behaviour.
Doesn't take much to get a psychopath to act badly.
○
7.
Poor judgment (failure to learn from experience).
No punishment will make them change their ways.
○
8.
Egocentricity and incapacity for love.
Varies with the shrudeness of the person.
○
Incapacity for object love which appears to be absolute.
○
Capable of casual fondness that will cause people to matter to him.
○
Good at pretending love for women, children, etc.
○
Pseudo-love - concern for others only in the extent that they will do something
for you.
○
9.
Poverty in major affective reactions.
Conviction in affective expressions, but don't actually feel anything.
○
10.
Specific loss of insight.
He understands that he might be in a psychiatric hospital because of his
behaviour.
○
No capacity to see himself how others see him.
○
Projects and blames problems on others.
○
11.
Unresponsiveness in interpersonal relationships.
Shows no consistent reactions of appreciation - usually shows when he might get
personal gains.
○
12.
Fantastic and uninviting behaviour with drink.
Not in the modern description of psychopathy.
○
Considerable overindulgence in alcohol is common among psychopaths.
○
Rudeness, baffoonish behaviours.
○
Precocious
○
Can lead to some of the outlandish crimes.
○
13.
Threats of suicide rarely carried out.
Show more evidence of immunity from such acts.
○
Habitually work themselves into situations where others would opt to end their
own lives.
○
14.
Impersonal, trivial, and poorly integrated sex life.15.
Failure to follow any life plan.
Whether good or evil, cannot work toward a goal.
○
Appears to go out of his way to fail.
○
16.
DSM-5 Criteria for Antisocial Personality Disorder
Almost always, individuals who meet the criteria for psychopathy meet the criteria for
antisocial personality disorder, but the reverse is not true.
A high proportion of individuals with antisocial personality disorder DO NOT meet
the criteria for psychopathy.
○
-
A pervasive pattern of disregard for and violation of rights of others, occurring since 15
years of age, indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviour … repeatedly
performing acts that are ground for arrest.
1.
Deceitfulness … repeated lying, use of aliases, or conning others for personal
profit or pleasure.
2.
Impulsivity or failure to plan ahead.3.
Irritability and aggressiveness … fights or assaults.4.
Reckless disregard for safety of self or others.5.
Consistent irresponsibility … failure to sustain consistent work behaviour or
honour financial obligations.
6.
Lack of remorse … being indifferent to or rationalizing having hurt, mistreated, or
stolen from another.
7.
-
Individual is at least 18 years of age.
-
Conduct Disorder before age of 15 (3 or more of the following):
Aggression to people and animals.
Bullying, threatening, intimidating others.i.
Physical fights; using a weaponii.
Physically cruel to people, animalsiii.
Stolen face-to-face; forced someone into sex. iv.
1.
Destruction of property2.
Deceitfulness or theft
Theft; shoplifting; forgeryi.
Lied to others for gain or obligation avoidance.ii.
3.
Serious violation of rules (child-like rules)
Out without permission before age 13.i.
Run away twice overnight (or once for a long time).ii.
Repeated truancy before 13.iii.
4.
-
Personal Story:
Young man …
Left Ottawa because police were after him and former friends.
○
Charming, bright, engaging, outgoing, talkative, etc.
○
Always the centre of attention - strongly egocentric.
"One-upper"
§
○
Very strong entrepreneurial streak - usually sales.
○
Always on the verge of a big financial breakthrough - wanted friends to invest.
○
Sold friends things from work for very cheap - found out later that he was
stealing.
○
-
Female insurance broker …
Paid insurance premiums for years.
○
Mom got sick, insurance broker told them to write cheques to her to pay hospital
fees.
○
She was scamming them.
○
-
Best salesmen had high MMPI scores - psychopaths.
-
ASP vs Psychopathy
Canadian Prison Inmates:
50-80% meet criteria for ASP
○
10-25% meet criteria for psychopathy under PCL-R
○
-
Offender types:
Est. 10-15% of child molesters meet criteria for psychopathy.
○
Est. 40-50% of rapists meet criteria for psychopathy.
○
Est. 75-95% of serial murderers meet criteria for psychopathy.
○
-
General population:
Est. 1% meet criteria for psychopathy.
○
-
Recidivism Rates for Psychopaths
Psychopaths reoffend, violate parole, sooner, commit more institutional violence.
-
Psychopathic adolescents more likely to reoffend, escape custody, violate probations.
-
Psychopaths don't even care about consequences, cannot stop themselves from
engaging in these impulsive behaviours.
-
Dr. Robert Hare
Professor Emeritus at UBC.
-
Member of Advisory Board for FBIs CASMIRC
-
Recipient of numerous awards
-
Best known for having developed the PCL-R
-
Psychopathy Checklist
Designed to assess personality style that involves "the remorseless use of others and
subsequent irresponsible and antisocial behaviour."
-
Originally designed as a research tool, but demonstrates utility in predicting violence.
-
Contains 20 items scored 0, 1 or 2 ("no", "somewhat", "definitely") after file review,
interview, collateral interviews.
Assessment is made by the researcher, not self-report.
○
Based on reading case files, doing interviews, etc.
○
Based on prison files (because that's what the PCL-R was designed for).
○
-
Scores of 30 or more indicate psychopathy (max = 40).
-
Psychopathy Checklist (PCL-R)
Glibness, superficial charm1.
Grandiose sense of self-worth2.
Need for stimulation; prone to boredom3.
Pathological lying4.
Conning and manipulative5.
Lack of remorse or guilt6.
Shallow affect7.
Callousness, lack of empathy8.
Parasitic lifestyle9.
Poor behavioural controls10.
Promiscuous sexual behaviours11.
Early behaviour problems12.
Lack or realistic long-term goal13.
Impulsivity14.
Irresponsibility15.
Failure to accept responsibility16.
Many short-term marital relationships17.
Juvenile delinquency (conduct disorder)18.
Revocation of conditional release19.
Criminal versatility20.
PCL-R Two-Factor Solution
Are we really measuring 20 different things?
-
Two-factor solution argues that we're just measuring two things: personality and
behaviour.
-
This is the solution argued by Hare.
-
But there are three items that don't fit into either behaviour or personality?
-
PCL-R Three-Factor Solution
Interpersonal, affective and impulsive/irresponsible lifestyle
-
Leaves out even more items!
-
PCL-R Four Factor Solution
Interpersonal, affective, lifestyle, and antisocial factors.
-
Only things missing are: promiscuous sexual behaviour, many short-term marital
relationships.
-
Factors are intercorrelated
Interpersonal and affective = 0.7
○
Affective and antisocial = 0.51
○
Lifestyle and antisocial = 0.73
○
Lifestyle and interpersonal = 0.5
○
+ cross-correlations
○
Therefore, you can make the argument that you're really just measuring one
thing - psychopathy.
○
-
Psychopathic Personality Inventory (PPI)
Developed in 1990 by Scott Lilienfeld to assess psychopathy in non-clinical, normal
populations.
Normed on undergraduates.
○
-
Revised (PPI-R) in 2005 by Lilienfeld and Widowes.
-
Originally normed with an undergraduate population.
-
Contains 154 items scored on 8 subscale organized into three factors.
-
Self-report - individual indicates the truth of statements for themselves.
-
PPI Factors
Factor 1: Fearless Dominance
Social Potency subscale: interpersonal impact, skill at influencing others.
"Even when others are upset with me I can usually win them over with my
charm."
§
○
Fearlessness subscale: willingness to take physical risks and an absence of
anticipatory anxiety.
"Making a parachute jump would really frighten me."(reverse coded)
§
○
Stress Immunity subscale: sangfroid and absence of tension in anxiety-provoking
situations)
"I can remain calm in situations that would make other people panic."
§
○
-
Factor 2: Impulsive Antisociality
Machiavellian egocentricity subscale: ruthless willingness to manipulate and take
advantage of others.
"I sometimes try to get others to bend the rules for me if I can't change
them any other way."
§
○
Nonconformity subscale: a tendency to attribute responsibility for one's mistakes
to others.
"When I am in a group of people who do something wrong, it seems like I'm
the one who ends up getting blamed."
§
○
Carefree nonplanfulness subscale: an insouciant attitude toward the future.
"I weight the pros and cons of major decisions carefully before making
them." (reverse coded)
§
○
-
Factor 3: Coldheartedness
Callousness, guiltlessness, and absence of empathy.
○
"I have had 'crushes' on people that they were so intense that they were painful."
(reverse coded)
○
-
Relationship between PCL-R and PPI-R
Copestake, Gray and Snowden (2011):
Reported 0.54 correlation between scores on PCL-R and PPI-R in a sample of male
offenders.
○
But no obvious correspondence between PPI-R factors and PCL-R factors.
○
Suggests instruments measure different conceptions of psychopathy, and are not
interchangeable.
Therefore, you should use each for what they've been designed for: PCL-R
for incarcerated individuals, PPI-R for non-incarcerated.
§
○
Similar conclusion reached by Malterer et al (2010).
○
-
Treatments for Psychopaths
Is it possible to reform psychopaths? … the traditional answer is no.
There's nothing that we can do to change their behaviour, and there's even some
evidence to suggest that such attempts would make them worse.
○
-
Gacono et al (1997): "There is nothing the behavioural sciences can offer for treating
those with psychopathy."
-
Skeem et al (2003): Psychopaths are "unmotivated to accept their problematic
behaviour and often lack insight into the nature and extent of their psychopathology."
-
Rice et al (1992): Psychopaths have higher rate of recidivism after participation in
therapy; non-psychopaths have lower rates after participation.
Why? You're giving them skills!
○
-
Skeem et al (2002): Psychopaths with 7 or more treatments over 10 weeks are 3x less
violent that those with fewer.
-
Polascheck (2014):
"Psychopathic characteristics, especially those related to criminal offending, can
change over the life course".
○
There's hope for psychopaths.
○
"Although adult criminals with psychopathy are among the hardest to work with
in treatment, treatment causes them - like other offenders - to reoffend less."
○
"There is no evidence that criminals with psychopathy take advantage of
treatment services to wreak havoc on therapists or the community."
○
"Like other high-risk criminals, those with psychopathy can benefit from
psychological treatment."
○
-
Lewis, Olver & Wong (2013):
Looked at the probability of reoffending as a function of positive therapeutic
change that took place during therapy with psychotherapy.
○
The more positive change seen within a psychopath, the less likely they are to
reoffend.
○
Psychopathic recidivism reduces as a function of amount of change as a result of
psychotherapy.
○
-
Hans Toch
We've pathologized violent criminal behaviours, but de-pathologized their other
personal factors.
-
We've been arguing that there's criminals and non-criminals, where criminals cannot be
helped, we just need to punish them and keep them away from society.
He's saying NO. We can and should help them.
○
-
Books
Confessions of a Sociopath by M.E. Thomas
-
The Psychopath Inside by James Fallon (famous neuroscientist studying psychopathy)
-
Psychopathy
Monday, April 23, 2018
11:05 AM
Note, psychopathy is not a recognized disorder in the DSM-5.
-
The closest thing we have to it is Antisocial Personality Disorder
-
History of Psychopathy as a Construct
Emil Kraepelin (ca 1895):
He identified a group of individuals that he described as being "morally insane"
○
Their behaviour was anti-social and immoral.
○
Defective ability to restrain: "the reckless gratification of immediate egotistical
desires."
○
-
Hervey Cleckley, prison psychologist:
"The Mask of Insanity" (1941-1988)
○
First detailed description of the psychopath.
○
-
Robert D. Hare:
Most influential in psychopathy today.
○
Influenced by Cleckley
○
"Psychopathy: Theory and Research" (1970)
○
Developed Psychopathy Checklist Revised (PCL-R, 1991)
○
-
Cleckley's Construct of Psychopathy
Superficial charm and higher intelligence.
When we see the word "psychopath" we assume "killers" - but the vast majority
of psychopaths never commit a crime in their lives and not all killers are
psychopaths (serial killers usually are).
○
Easy to talk to, not odd/queer, normal.
○
Appear well-adjusted, happy.
○
Free from social and emotional impediments.
○
1.
Absence of delusions and irrational thinking.
Usually free from symptoms of psychological disturbance.
○
Excellent logical reasoning
○
Can forsee the consequences of actions, reflect on mistakes
○
Nothing pathologic, nothing that would be suspicious
○
Normal emotional reactions
○
Healthy ambitions
○
Loyal
○
2.
Absence of nervousness
No symptoms that suggest a psycho-neurosis.
○
Relative immunity from normal anxiety.
○
3.
Unreliability
Generally unreliable, no matter the situation.
○
They don't even care if you confronted them about their behaviour.
○
For some periods, they will stick to their commitments.
○
Inconsistency in inconsistency.
○
4.
Untruthfulness and insincerity.
Disregard for truth.
○
At ease when making serious promises - carries special powers of conviction.
○
5.
Lack of remorse or shame.
Denies responsibility, blames others.
○
Hollow sincerity - sometimes says their problems are all their fault, but they don't
believe it.
○
6.
Inadequately motivated antisocial behaviour.
Doesn't take much to get a psychopath to act badly.
○
7.
Poor judgment (failure to learn from experience).
No punishment will make them change their ways.
○
8.
Egocentricity and incapacity for love.
Varies with the shrudeness of the person.
○
Incapacity for object love which appears to be absolute.
○
Capable of casual fondness that will cause people to matter to him.
○
Good at pretending love for women, children, etc.
○
Pseudo-love - concern for others only in the extent that they will do something
for you.
○
9.
Poverty in major affective reactions.
Conviction in affective expressions, but don't actually feel anything.
○
10.
Specific loss of insight.
He understands that he might be in a psychiatric hospital because of his
behaviour.
○
No capacity to see himself how others see him.
○
Projects and blames problems on others.
○
11.
Unresponsiveness in interpersonal relationships.
Shows no consistent reactions of appreciation - usually shows when he might get
personal gains.
○
12.
Fantastic and uninviting behaviour with drink.
Not in the modern description of psychopathy.
○
Considerable overindulgence in alcohol is common among psychopaths.
○
Rudeness, baffoonish behaviours.
○
Precocious
○
Can lead to some of the outlandish crimes.
○
13.
Threats of suicide rarely carried out.
Show more evidence of immunity from such acts.
○
Habitually work themselves into situations where others would opt to end their
own lives.
○
14.
Impersonal, trivial, and poorly integrated sex life.15.
Failure to follow any life plan.
Whether good or evil, cannot work toward a goal.
○
Appears to go out of his way to fail.
○
16.
DSM-5 Criteria for Antisocial Personality Disorder
Almost always, individuals who meet the criteria for psychopathy meet the criteria for
antisocial personality disorder, but the reverse is not true.
A high proportion of individuals with antisocial personality disorder DO NOT meet
the criteria for psychopathy.
○
-
A pervasive pattern of disregard for and violation of rights of others, occurring since 15
years of age, indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviour … repeatedly
performing acts that are ground for arrest.
1.
Deceitfulness … repeated lying, use of aliases, or conning others for personal
profit or pleasure.
2.
Impulsivity or failure to plan ahead.3.
Irritability and aggressiveness … fights or assaults.4.
Reckless disregard for safety of self or others.5.
Consistent irresponsibility … failure to sustain consistent work behaviour or
honour financial obligations.
6.
Lack of remorse … being indifferent to or rationalizing having hurt, mistreated, or
stolen from another.
7.
-
Individual is at least 18 years of age.
-
Conduct Disorder before age of 15 (3 or more of the following):
Aggression to people and animals.
Bullying, threatening, intimidating others.i.
Physical fights; using a weaponii.
Physically cruel to people, animalsiii.
Stolen face-to-face; forced someone into sex. iv.
1.
Destruction of property2.
Deceitfulness or theft
Theft; shoplifting; forgeryi.
Lied to others for gain or obligation avoidance.ii.
3.
Serious violation of rules (child-like rules)
Out without permission before age 13.i.
Run away twice overnight (or once for a long time).ii.
Repeated truancy before 13.iii.
4.
-
Personal Story:
Young man …
Left Ottawa because police were after him and former friends.
○
Charming, bright, engaging, outgoing, talkative, etc.
○
Always the centre of attention - strongly egocentric.
"One-upper"
§
○
Very strong entrepreneurial streak - usually sales.
○
Always on the verge of a big financial breakthrough - wanted friends to invest.
○
Sold friends things from work for very cheap - found out later that he was
stealing.
○
-
Female insurance broker …
Paid insurance premiums for years.
○
Mom got sick, insurance broker told them to write cheques to her to pay hospital
fees.
○
She was scamming them.
○
-
Best salesmen had high MMPI scores - psychopaths.
-
ASP vs Psychopathy
Canadian Prison Inmates:
50-80% meet criteria for ASP
○
10-25% meet criteria for psychopathy under PCL-R
○
-
Offender types:
Est. 10-15% of child molesters meet criteria for psychopathy.
○
Est. 40-50% of rapists meet criteria for psychopathy.
○
Est. 75-95% of serial murderers meet criteria for psychopathy.
○
-
General population:
Est. 1% meet criteria for psychopathy.
○
-
Recidivism Rates for Psychopaths
Psychopaths reoffend, violate parole, sooner, commit more institutional violence.
-
Psychopathic adolescents more likely to reoffend, escape custody, violate probations.
-
Psychopaths don't even care about consequences, cannot stop themselves from
engaging in these impulsive behaviours.
-
Dr. Robert Hare
Professor Emeritus at UBC.
-
Member of Advisory Board for FBIs CASMIRC
-
Recipient of numerous awards
-
Best known for having developed the PCL-R
-
Psychopathy Checklist
Designed to assess personality style that involves "the remorseless use of others and
subsequent irresponsible and antisocial behaviour."
-
Originally designed as a research tool, but demonstrates utility in predicting violence.
-
Contains 20 items scored 0, 1 or 2 ("no", "somewhat", "definitely") after file review,
interview, collateral interviews.
Assessment is made by the researcher, not self-report.
○
Based on reading case files, doing interviews, etc.
○
Based on prison files (because that's what the PCL-R was designed for).
○
-
Scores of 30 or more indicate psychopathy (max = 40).
-
Psychopathy Checklist (PCL-R)
Glibness, superficial charm1.
Grandiose sense of self-worth2.
Need for stimulation; prone to boredom3.
Pathological lying4.
Conning and manipulative5.
Lack of remorse or guilt6.
Shallow affect7.
Callousness, lack of empathy8.
Parasitic lifestyle9.
Poor behavioural controls10.
Promiscuous sexual behaviours11.
Early behaviour problems12.
Lack or realistic long-term goal13.
Impulsivity14.
Irresponsibility15.
Failure to accept responsibility16.
Many short-term marital relationships17.
Juvenile delinquency (conduct disorder)18.
Revocation of conditional release19.
Criminal versatility20.
PCL-R Two-Factor Solution
Are we really measuring 20 different things?
-
Two-factor solution argues that we're just measuring two things: personality and
behaviour.
-
This is the solution argued by Hare.
-
But there are three items that don't fit into either behaviour or personality?
-
PCL-R Three-Factor Solution
Interpersonal, affective and impulsive/irresponsible lifestyle
-
Leaves out even more items!
-
PCL-R Four Factor Solution
Interpersonal, affective, lifestyle, and antisocial factors.
-
Only things missing are: promiscuous sexual behaviour, many short-term marital
relationships.
-
Factors are intercorrelated
Interpersonal and affective = 0.7
○
Affective and antisocial = 0.51
○
Lifestyle and antisocial = 0.73
○
Lifestyle and interpersonal = 0.5
○
+ cross-correlations
○
Therefore, you can make the argument that you're really just measuring one
thing - psychopathy.
○
-
Psychopathic Personality Inventory (PPI)
Developed in 1990 by Scott Lilienfeld to assess psychopathy in non-clinical, normal
populations.
Normed on undergraduates.
○
-
Revised (PPI-R) in 2005 by Lilienfeld and Widowes.
-
Originally normed with an undergraduate population.
-
Contains 154 items scored on 8 subscale organized into three factors.
-
Self-report - individual indicates the truth of statements for themselves.
-
PPI Factors
Factor 1: Fearless Dominance
Social Potency subscale: interpersonal impact, skill at influencing others.
"Even when others are upset with me I can usually win them over with my
charm."
§
○
Fearlessness subscale: willingness to take physical risks and an absence of
anticipatory anxiety.
"Making a parachute jump would really frighten me."(reverse coded)
§
○
Stress Immunity subscale: sangfroid and absence of tension in anxiety-provoking
situations)
"I can remain calm in situations that would make other people panic."
§
○
-
Factor 2: Impulsive Antisociality
Machiavellian egocentricity subscale: ruthless willingness to manipulate and take
advantage of others.
"I sometimes try to get others to bend the rules for me if I can't change
them any other way."
§
○
Nonconformity subscale: a tendency to attribute responsibility for one's mistakes
to others.
"When I am in a group of people who do something wrong, it seems like I'm
the one who ends up getting blamed."
§
○
Carefree nonplanfulness subscale: an insouciant attitude toward the future.
"I weight the pros and cons of major decisions carefully before making
them." (reverse coded)
§
○
-
Factor 3: Coldheartedness
Callousness, guiltlessness, and absence of empathy.
○
"I have had 'crushes' on people that they were so intense that they were painful."
(reverse coded)
○
-
Relationship between PCL-R and PPI-R
Copestake, Gray and Snowden (2011):
Reported 0.54 correlation between scores on PCL-R and PPI-R in a sample of male
offenders.
○
But no obvious correspondence between PPI-R factors and PCL-R factors.
○
Suggests instruments measure different conceptions of psychopathy, and are not
interchangeable.
Therefore, you should use each for what they've been designed for: PCL-R
for incarcerated individuals, PPI-R for non-incarcerated.
§
○
Similar conclusion reached by Malterer et al (2010).
○
-
Treatments for Psychopaths
Is it possible to reform psychopaths? … the traditional answer is no.
There's nothing that we can do to change their behaviour, and there's even some
evidence to suggest that such attempts would make them worse.
○
-
Gacono et al (1997): "There is nothing the behavioural sciences can offer for treating
those with psychopathy."
-
Skeem et al (2003): Psychopaths are "unmotivated to accept their problematic
behaviour and often lack insight into the nature and extent of their psychopathology."
-
Rice et al (1992): Psychopaths have higher rate of recidivism after participation in
therapy; non-psychopaths have lower rates after participation.
Why? You're giving them skills!
○
-
Skeem et al (2002): Psychopaths with 7 or more treatments over 10 weeks are 3x less
violent that those with fewer.
-
Polascheck (2014):
"Psychopathic characteristics, especially those related to criminal offending, can
change over the life course".
○
There's hope for psychopaths.
○
"Although adult criminals with psychopathy are among the hardest to work with
in treatment, treatment causes them - like other offenders - to reoffend less."
○
"There is no evidence that criminals with psychopathy take advantage of
treatment services to wreak havoc on therapists or the community."
○
"Like other high-risk criminals, those with psychopathy can benefit from
psychological treatment."
○
-
Lewis, Olver & Wong (2013):
Looked at the probability of reoffending as a function of positive therapeutic
change that took place during therapy with psychotherapy.
○
The more positive change seen within a psychopath, the less likely they are to
reoffend.
○
Psychopathic recidivism reduces as a function of amount of change as a result of
psychotherapy.
○
-
Hans Toch
We've pathologized violent criminal behaviours, but de-pathologized their other
personal factors.
-
We've been arguing that there's criminals and non-criminals, where criminals cannot be
helped, we just need to punish them and keep them away from society.
He's saying NO. We can and should help them.
○
-
Books
Confessions of a Sociopath by M.E. Thomas
-
The Psychopath Inside by James Fallon (famous neuroscientist studying psychopathy)
-
Psychopathy
Monday, April 23, 2018
11:05 AM
Note, psychopathy is not a recognized disorder in the DSM-5.
-
The closest thing we have to it is Antisocial Personality Disorder
-
History of Psychopathy as a Construct
Emil Kraepelin (ca 1895):
He identified a group of individuals that he described as being "morally insane"
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Their behaviour was anti-social and immoral.
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Defective ability to restrain: "the reckless gratification of immediate egotistical
desires."
○
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Hervey Cleckley, prison psychologist:
"The Mask of Insanity" (1941-1988)
○
First detailed description of the psychopath.
○
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Robert D. Hare:
Most influential in psychopathy today.
○
Influenced by Cleckley
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"Psychopathy: Theory and Research" (1970)
○
Developed Psychopathy Checklist Revised (PCL-R, 1991)
○
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Cleckley's Construct of Psychopathy
Superficial charm and higher intelligence.
When we see the word "psychopath" we assume "killers" - but the vast majority
of psychopaths never commit a crime in their lives and not all killers are
psychopaths (serial killers usually are).
○
Easy to talk to, not odd/queer, normal.
○
Appear well-adjusted, happy.
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Free from social and emotional impediments.
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1.
Absence of delusions and irrational thinking.
Usually free from symptoms of psychological disturbance.
○
Excellent logical reasoning
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Can forsee the consequences of actions, reflect on mistakes
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Nothing pathologic, nothing that would be suspicious
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Normal emotional reactions
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Healthy ambitions
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Loyal
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2.
Absence of nervousness
No symptoms that suggest a psycho-neurosis.
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Relative immunity from normal anxiety.
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3.
Unreliability
Generally unreliable, no matter the situation.
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They don't even care if you confronted them about their behaviour.
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For some periods, they will stick to their commitments.
○
Inconsistency in inconsistency.
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4.
Untruthfulness and insincerity.
Disregard for truth.
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At ease when making serious promises - carries special powers of conviction.
○
5.
Lack of remorse or shame.
Denies responsibility, blames others.
○
Hollow sincerity - sometimes says their problems are all their fault, but they don't
believe it.
○
6.
Inadequately motivated antisocial behaviour.
Doesn't take much to get a psychopath to act badly.
○
7.
Poor judgment (failure to learn from experience).
No punishment will make them change their ways.
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8.
Egocentricity and incapacity for love.
Varies with the shrudeness of the person.
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Incapacity for object love which appears to be absolute.
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Capable of casual fondness that will cause people to matter to him.
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Good at pretending love for women, children, etc.
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Pseudo-love - concern for others only in the extent that they will do something
for you.
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9.
Poverty in major affective reactions.
Conviction in affective expressions, but don't actually feel anything.
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10.
Specific loss of insight.
He understands that he might be in a psychiatric hospital because of his
behaviour.
○
No capacity to see himself how others see him.
○
Projects and blames problems on others.
○
11.
Unresponsiveness in interpersonal relationships.
Shows no consistent reactions of appreciation - usually shows when he might get
personal gains.
○
12.
Fantastic and uninviting behaviour with drink.
Not in the modern description of psychopathy.
○
Considerable overindulgence in alcohol is common among psychopaths.
○
Rudeness, baffoonish behaviours.
○
Precocious
○
Can lead to some of the outlandish crimes.
○
13.
Threats of suicide rarely carried out.
Show more evidence of immunity from such acts.
○
Habitually work themselves into situations where others would opt to end their
own lives.
○
14.
Impersonal, trivial, and poorly integrated sex life.15.
Failure to follow any life plan.
Whether good or evil, cannot work toward a goal.
○
Appears to go out of his way to fail.
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16.
DSM-5 Criteria for Antisocial Personality Disorder
Almost always, individuals who meet the criteria for psychopathy meet the criteria for
antisocial personality disorder, but the reverse is not true.
A high proportion of individuals with antisocial personality disorder DO NOT meet
the criteria for psychopathy.
○
-
A pervasive pattern of disregard for and violation of rights of others, occurring since 15
years of age, indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviour … repeatedly
performing acts that are ground for arrest.
1.
Deceitfulness … repeated lying, use of aliases, or conning others for personal
profit or pleasure.
2.
Impulsivity or failure to plan ahead.3.
Irritability and aggressiveness … fights or assaults.4.
Reckless disregard for safety of self or others.5.
Consistent irresponsibility … failure to sustain consistent work behaviour or
honour financial obligations.
6.
Lack of remorse … being indifferent to or rationalizing having hurt, mistreated, or
stolen from another.
7.
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Individual is at least 18 years of age.
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Conduct Disorder before age of 15 (3 or more of the following):
Aggression to people and animals.
Bullying, threatening, intimidating others.i.
Physical fights; using a weaponii.
Physically cruel to people, animalsiii.
Stolen face-to-face; forced someone into sex. iv.
1.
Destruction of property2.
Deceitfulness or theft
Theft; shoplifting; forgeryi.
Lied to others for gain or obligation avoidance.ii.
3.
Serious violation of rules (child-like rules)
Out without permission before age 13.i.
Run away twice overnight (or once for a long time).ii.
Repeated truancy before 13.iii.
4.
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Personal Story:
Young man …
Left Ottawa because police were after him and former friends.
○
Charming, bright, engaging, outgoing, talkative, etc.
○
Always the centre of attention - strongly egocentric.
"One-upper"
§
○
Very strong entrepreneurial streak - usually sales.
○
Always on the verge of a big financial breakthrough - wanted friends to invest.
○
Sold friends things from work for very cheap - found out later that he was
stealing.
○
-
Female insurance broker …
Paid insurance premiums for years.
○
Mom got sick, insurance broker told them to write cheques to her to pay hospital
fees.
○
She was scamming them.
○
-
Best salesmen had high MMPI scores - psychopaths.
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ASP vs Psychopathy
Canadian Prison Inmates:
50-80% meet criteria for ASP
○
10-25% meet criteria for psychopathy under PCL-R
○
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Offender types:
Est. 10-15% of child molesters meet criteria for psychopathy.
○
Est. 40-50% of rapists meet criteria for psychopathy.
○
Est. 75-95% of serial murderers meet criteria for psychopathy.
○
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General population:
Est. 1% meet criteria for psychopathy.
○
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Recidivism Rates for Psychopaths
Psychopaths reoffend, violate parole, sooner, commit more institutional violence.
-
Psychopathic adolescents more likely to reoffend, escape custody, violate probations.
-
Psychopaths don't even care about consequences, cannot stop themselves from
engaging in these impulsive behaviours.
-
Dr. Robert Hare
Professor Emeritus at UBC.
-
Member of Advisory Board for FBIs CASMIRC
-
Recipient of numerous awards
-
Best known for having developed the PCL-R
-
Psychopathy Checklist
Designed to assess personality style that involves "the remorseless use of others and
subsequent irresponsible and antisocial behaviour."
-
Originally designed as a research tool, but demonstrates utility in predicting violence.
-
Contains 20 items scored 0, 1 or 2 ("no", "somewhat", "definitely") after file review,
interview, collateral interviews.
Assessment is made by the researcher, not self-report.
○
Based on reading case files, doing interviews, etc.
○
Based on prison files (because that's what the PCL-R was designed for).
○
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Scores of 30 or more indicate psychopathy (max = 40).
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Psychopathy Checklist (PCL-R)
Glibness, superficial charm1.
Grandiose sense of self-worth2.
Need for stimulation; prone to boredom3.
Pathological lying4.
Conning and manipulative5.
Lack of remorse or guilt6.
Shallow affect7.
Callousness, lack of empathy8.
Parasitic lifestyle9.
Poor behavioural controls10.
Promiscuous sexual behaviours11.
Early behaviour problems12.
Lack or realistic long-term goal13.
Impulsivity14.
Irresponsibility15.
Failure to accept responsibility16.
Many short-term marital relationships17.
Juvenile delinquency (conduct disorder)18.
Revocation of conditional release19.
Criminal versatility20.
PCL-R Two-Factor Solution
Are we really measuring 20 different things?
-
Two-factor solution argues that we're just measuring two things: personality and
behaviour.
-
This is the solution argued by Hare.
-
But there are three items that don't fit into either behaviour or personality?
-
PCL-R Three-Factor Solution
Interpersonal, affective and impulsive/irresponsible lifestyle
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Leaves out even more items!
-
PCL-R Four Factor Solution
Interpersonal, affective, lifestyle, and antisocial factors.
-
Only things missing are: promiscuous sexual behaviour, many short-term marital
relationships.
-
Factors are intercorrelated
Interpersonal and affective = 0.7
○
Affective and antisocial = 0.51
○
Lifestyle and antisocial = 0.73
○
Lifestyle and interpersonal = 0.5
○
+ cross-correlations
○
Therefore, you can make the argument that you're really just measuring one
thing - psychopathy.
○
-
Psychopathic Personality Inventory (PPI)
Developed in 1990 by Scott Lilienfeld to assess psychopathy in non-clinical, normal
populations.
Normed on undergraduates.
○
-
Revised (PPI-R) in 2005 by Lilienfeld and Widowes.
-
Originally normed with an undergraduate population.
-
Contains 154 items scored on 8 subscale organized into three factors.
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Self-report - individual indicates the truth of statements for themselves.
-
PPI Factors
Factor 1: Fearless Dominance
Social Potency subscale: interpersonal impact, skill at influencing others.
"Even when others are upset with me I can usually win them over with my
charm."
§
○
Fearlessness subscale: willingness to take physical risks and an absence of
anticipatory anxiety.
"Making a parachute jump would really frighten me."(reverse coded)
§
○
Stress Immunity subscale: sangfroid and absence of tension in anxiety-provoking
situations)
"I can remain calm in situations that would make other people panic."
§
○
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Factor 2: Impulsive Antisociality
Machiavellian egocentricity subscale: ruthless willingness to manipulate and take
advantage of others.
"I sometimes try to get others to bend the rules for me if I can't change
them any other way."
§
○
Nonconformity subscale: a tendency to attribute responsibility for one's mistakes
to others.
"When I am in a group of people who do something wrong, it seems like I'm
the one who ends up getting blamed."
§
○
Carefree nonplanfulness subscale: an insouciant attitude toward the future.
"I weight the pros and cons of major decisions carefully before making
them." (reverse coded)
§
○
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Factor 3: Coldheartedness
Callousness, guiltlessness, and absence of empathy.
○
"I have had 'crushes' on people that they were so intense that they were painful."
(reverse coded)
○
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Relationship between PCL-R and PPI-R
Copestake, Gray and Snowden (2011):
Reported 0.54 correlation between scores on PCL-R and PPI-R in a sample of male
offenders.
○
But no obvious correspondence between PPI-R factors and PCL-R factors.
○
Suggests instruments measure different conceptions of psychopathy, and are not
interchangeable.
Therefore, you should use each for what they've been designed for: PCL-R
for incarcerated individuals, PPI-R for non-incarcerated.
§
○
Similar conclusion reached by Malterer et al (2010).
○
-
Treatments for Psychopaths
Is it possible to reform psychopaths? … the traditional answer is no.
There's nothing that we can do to change their behaviour, and there's even some
evidence to suggest that such attempts would make them worse.
○
-
Gacono et al (1997): "There is nothing the behavioural sciences can offer for treating
those with psychopathy."
-
Skeem et al (2003): Psychopaths are "unmotivated to accept their problematic
behaviour and often lack insight into the nature and extent of their psychopathology."
-
Rice et al (1992): Psychopaths have higher rate of recidivism after participation in
therapy; non-psychopaths have lower rates after participation.
Why? You're giving them skills!
○
-
Skeem et al (2002): Psychopaths with 7 or more treatments over 10 weeks are 3x less
violent that those with fewer.
-
Polascheck (2014):
"Psychopathic characteristics, especially those related to criminal offending, can
change over the life course".
○
There's hope for psychopaths.
○
"Although adult criminals with psychopathy are among the hardest to work with
in treatment, treatment causes them - like other offenders - to reoffend less."
○
"There is no evidence that criminals with psychopathy take advantage of
treatment services to wreak havoc on therapists or the community."
○
"Like other high-risk criminals, those with psychopathy can benefit from
psychological treatment."
○
-
Lewis, Olver & Wong (2013):
Looked at the probability of reoffending as a function of positive therapeutic
change that took place during therapy with psychotherapy.
○
The more positive change seen within a psychopath, the less likely they are to
reoffend.
○
Psychopathic recidivism reduces as a function of amount of change as a result of
psychotherapy.
○
-
Hans Toch
We've pathologized violent criminal behaviours, but de-pathologized their other
personal factors.
-
We've been arguing that there's criminals and non-criminals, where criminals cannot be
helped, we just need to punish them and keep them away from society.
He's saying NO. We can and should help them.
○
-
Books
Confessions of a Sociopath by M.E. Thomas
-
The Psychopath Inside by James Fallon (famous neuroscientist studying psychopathy)
-
Psychopathy
Monday, April 23, 2018 11:05 AM
