Psychopathy

This is an old revision of this page, as edited by 207.6.38.198 (talk) at 06:55, 5 January 2006 (The more recent Four-factor model of the PCL-R and the PCL: SV has been added). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Revision as of 06:55, 5 January 2006 by 207.6.38.198 (talk) (The more recent Four-factor model of the PCL-R and the PCL: SV has been added)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)

It has been suggested that this article be merged into Antisocial personality disorder. (Discuss)

Medical condition

Psychopathy
Specialty	Psychology

"Psychopathy" is a four-faceted (in the current most accepted analyses) personality disorder involving interpersonal, affective, lifestyle, and antisocial/rule-breaking dimensions:

Interpersonal: Psychopaths are manipulative, grandiose, egocentric, and deceitful.
Affective: Psychopaths have shallow emotions, and are lacking in empathy, guilt, and remorse.
Lifestyle: Psychopaths are impulsive, irresponsible, and sensation seeking.
Antisocial: Psychopaths have early behavior problems, poor behavioral controls, and a tendency to early, persistent rule-breaking behavior.

Washington State Legislature defines a "Psychopathic personality" to mean the existence in any person of such hereditary, congenital or acquired condition affecting the emotional or volitional rather than the intellectual field and manifested by anomalies of such character as to render satisfactory social adjustment of such person difficult or impossible.

Psychopathic Disorder is legally defined in the UK Mental Health Act as "a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned".

The DSM-IV-TR's conceptualization of psychopathy is covered by antisocial personality disorder, although there is some dispute over the theoretical and practical equivalence of the two constructs (with psychopathy being measured on the Hare Psychopathy Checklist - Revised). The ICD-10 names it dissocial personality disorder.

Diagnostic criteria (PCL-R test)

In contemporary research and clinical practice, psychopathy is most commonly assessed with the Hare Psychopathy Checklist- Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale according to specific criteria through file information and a semi-structured interview. The items are as follows:

Factor 1: Aggressive narcissism

Glibness/superficial charm
Grandiose sense of self-worth
Pathological lying
Conning/manipulative
Lack of remorse or guilt
Shallow affect
Callous/lack of empathy
Failure to accept responsibility for own actions

Factor 2: Socially deviant lifestyle

Need for stimulation/proneness to boredom
Parasitic lifestyle
Poor behavioral controls
Early behavioral problems
Lack of realistic, long-term goals
Impulsivity
Irresponsibility
Juvenile delinquency
Revocation of conditional release

Traits not correlated with either factor

Promiscuous sexual behavior
Many short-term marital relationships
Criminal versatility

Score 0 if the trait is absent, 1 if it is possibly or partially present and 2 if it is present. The item scores are summed to yield a total score ranging from 0 to 40 which is then considered to reflect the degree to which they resemble the prototypical psychopath. A score higher than 30 supports a diagnosis of psychopathy. Forensic studies of prison populations have reported average scores of around 22 on PCL-R; control "normal" populations show an average score of around 5.

A note of caution: the test must be administered by a trained mental health practitioner under controlled conditions for it to have any validity.

A Three-Factor Model of Psychopathy

Cooke and Michie eliminated criteria related to criminal incarceration and juvenile delinquency and statistically analyzed three factors of psychopathy. This allows for a conception of the psychopathic personality that is better applicable outside forensic populations.

Arrogant/Deceitful Interpersonal Style

Glibness/superficial charm
Egocentricity/Grandiose sense of self-worth
Pathological lying
Conning/Manipulative

Deficient Affective Experience

Lack of remorse or guilt
Callous/Lack of empathy
Shallow affect
Failure to accept responsibility for own actions

Impulsive/Irresponsible Behavioral Style

Need for stimulation/Proneness to boredom
Parasitic lifestyle
Lack of realistic, long-term goals
Impulsivity
Irresponsibility

(Cooke, Mitchie 2001)

A Four-Factor Model of Psychopathy

Hare, Neumann, Rogers, and others have criticized the three-factor model for using questionnable procedures and analyses to retain and omit items. They have provided strong evidence for a four-factor model of the PCL-R and the Psychopathy Checklist: Screening Version (PCL: SV). The four-factor model adds an Antisocial factor (early, persistent, serious rule-breaking) to the three-factor model:

Interpersonal

* Glibness/superficial charm
* Egocentricity/Grandiose sense of self-worth
* Pathological lying
* Conning/Manipulative

Affective

* Lack of remorse or guilt
* Callous/Lack of empathy
* Shallow affect
* Failure to accept responsibility for own actions

Lifestyle

* Need for stimulation/Proneness to boredom
* Parasitic lifestyle
* Lack of realistic, long-term goals
* Impulsivity
* Irresponsibility

Antisocial

* Early behavior problems
* Poor behavioral controls
* Juvenile delinquency
* Violation of conditional release
* Criminal versatility

Traits not asociated with any factor
   * Promiscuous sexual behavior 
   * Many short-term marital relationships

(Hare, 2003; Hare & Neumann, 2005; Neumann, Hare, Vitacco, & Wupperman,in press; Vitacco, Rogers,Neumann,Harrison,& Vincent,2005).

The four-factor model also fits the PCL: SV, which does not contain any criminal items.

 (Hill, Neumann, & Rogers, 2005; Vitacco, Neumann, & Jackson, 2005;

Portrayal of psychopaths in the media

Psychopaths in popular fiction and movies generally possess a number of standard characteristics which are not necessarily as common amongst real-life psychopaths. The traditional "Hollywood psychopath" is likely to exhibit some or all of the following traits which make them ideal villains.

High intelligence, and a preference for intellectual stimulation (music, fine art etc.)
A somewhat vain, stylish, almost "cat-like" demeanor
Prestige, or a successful career or position
A calm, calculating and always-in-control attitude

It is this last feature which is probably most at odds with the typical real-life psychopath: an individual with APD is much more likely to be impulsive, disorganised and short-tempered rather than the smooth-talking, self-disciplined characters portrayed by Anthony Hopkins (Hannibal Lecter in The Silence of the Lambs), Christian Bale (Patrick Bateman in American Psycho), Jack Nicholson ( The Joker (comics) in 1989's Batman (film) and Kiefer Sutherland (in Phone Booth). Perhaps more accurate portrayals of psychopaths are Don Logan (Ben Kingsley in Sexy Beast), Doyle Hargrave (Dwight Yoakam in Sling Blade), and Frank Booth (Dennis Hopper in Blue Velvet), all of whom are crude, impulsive characters who relentlessly torment other people.

It has also been suggested that Bram Stoker based his Count Dracula on a real person (actor manager Henry Irving see http://www.bookpage.com/9604bp/nonfiction/bramstoker.html ) and, in so doing, may well have left us one of the first ever detailed, fictionalised portraits of a psychopath. Count Dracula fits the stereotype of the "Hollywood Psychopath" he predates so perfectly that it would be reasonable to consider him something of a prototype.

In popular culture, "psychopath" is often used interchangeably with "serial killer" (such as the characters in slasher films) though the terms are not synonymous. It is, however, true that most serial killers are also psychopaths.

Psychopathy's relationship with other mental health disorders

Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder. PCL-R Factor 1 is correlated with narcissistic personality disorder and histrionic personality disorder. PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality.

PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence. PCL-R Factor 1, in contrast, is associated with extroversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).

Potential warning signs

As a child, three warning signs are often found in individuals with Antisocial Personality Disorder when diagnosed by a psychiatrist. These are a longer-than-usual period of bedwetting, cruelty to animals, and/or pyromania. Obviously, not all children who exhibit these signs grow up to be psychopaths, but these signs are found in significantly higher proportions than in the general population.

Many people are aware that a lack of moral conscience could indicate that they are dealing with a psychopath, fewer are aware that a Psychopath also has a markedly distorted sense of the potential consequences of his actions, not only for others, but also for himself. Put simply, he does not, for example, recognise realistically the risk of being caught, disbelieved or injured as a result of his choices.

Citations

Cooke D.J., Michie C. "Refining the construct of psychopathy: Towards a hierarchical model." Psychological Assessment, 2001, 13 (2), 171-188.

Hare, R. D. (2003). "The Psychopathy Checklist-Revised, 2nd Edition." Toronto: Multi-Health Systems.

Hill, C. D., Neumann, C. S., & Rogers, R. (2004). "Confirmatory Factor Analysis of the Psychopathy Checklist: Screening Version (PCL:SV) in Offenders with Axis I Disorders." Psychological Assessment, 16, 90-95.

Neumann, C. N., Vitacco, M. J., Hare, R .D., & Wupperman, P. (in press). "Deconstructing the 'Reconstruction' of Psychopathy: A Comment on Cooke, Michie, Hart, & Clark. Journal of Personality Disorders.

Vitacco, M. J., Neumann, C. S.,& Jackson, R.(2005). "Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence." Journal of Consulting and Clinical Psychology, 73, 466-76.

Vitacco, M. J., Rogers, R., Neumann, C. S., Harrison, K., & Vincent, G. (2005). "A comparison of factor models on the PCL-R with mentally disordered offenders: The development of a four factor model." Criminal Justice and Behavior, 32, 526-545.

External Links

Category:

Personality disorders