Psychodynamische Psychotherapie bei antisozialen und psychopathischen Störungen der Persönlichkeit

Important theoretical basic principles of the psychodynamic treatment of patients with antisocial and psychopathic personality disorders are presented. Focusing on delinquency and general orientation to the structural level of the personality organization should be integrated. Indications of treatment difficulties, countertransference problems and technical principles are given. Skepticism of the treatment is poorly evidence-based and forensic psychotherapy of these patient groups should be intensified.     

Interaction between Prenatal Maternal Stress and Autonomic Arousal in Predicting Conduct Problems and Psychopathic Traits in Children

Evidence has suggested that neurobiological deficits combine with psychosocial risk factors to impact on the development of antisocial behavior. The current study concentrated on the interplay of prenatal maternal stress and autonomic arousal in predicting antisocial behavior and psychopathic traits. Prenatal maternal stress was assessed by caregiver’s retrospective report, and resting heart rate and respiratory sinus arrhythmia (RSA) were measured in 295 8- to 10-year-old children. Child and caregiver also reported on child’s antisocial behavior and psychopathic traits. Higher prenatal maternal stress was associated with higher caregiver-reported antisocial and psychopathy scores, even after the concurrent measure of social adversity was controlled for. As expected, low heart rate and high RSA were associated with high antisocial and psychopathic traits. More importantly, significant interaction effects were found; prenatal stress was positively associated with multiple dimensions of psychopathic traits only on the conditions of low arousal (e.g., low heart rate or high RSA). Findings provide further support for a biosocial perspective of antisocial and psychopathic traits, and illustrate the importance of integrating biological with psychosocial measures to fully understand the etiology of behavioral problems.     

Psychopathie,antisoziale Persönlichkeitsstörung und Sexualdelinquenz

In today’s field of forensic psychiatry, psychopathy is seen as a subtype of antisocial personality disorder and includes manipulative behavior, egocentric and arrogant characteristics, high-risk behavior as well as a lack of empathy. Empirical data on the prevalence of psychopathy and antisocial personality disorder among offenders greatly vary depending on the study design and the composition of the sampled population. Offenders who committed both violent and sex offenses seem to have antisocial traits with a higher probability than offenders who committed only violent or only sex offenses. In the context of criminal responsibility and risk assessment for sex offenders, antisocial and psychopathic traits have a negative impact on the prediction of recidivism. Many study results, even though not all, additionally indicate that the combination of psychopathic traits and sexual deviance (i.?e. for example a paraphilic disorder such as sexual sadism) in sex offenders may be associated with a particularly high risk to reoffend. Due to the specific interpersonal characteristics (e.?g., dominant, provocative behavior, exaggerated self-esteem), therapeutic treatment of sex offenders with antisocial and psychopathic traits is often difficult. The regular supervision by the therapist is considered to be crucial to avoid harmful relationship dynamics or distorted perception of the therapist.     

Brain abnormalities in antisocial individuals: implications for the law

With the increasing popularity in the use of brain imaging on antisocial individuals, an increasing number of brain imaging studies have revealed structural and functional impairments in antisocial, psychopathic, and violent individuals. This review summarizes key findings from brain imaging studies on antisocial/aggressive behavior. Key regions commonly found to be impaired in antisocial populations include the prefrontal cortex (particularly orbitofrontal and dorsolateral prefrontal cortex), superior temporal gyrus, amygdala-hippocampal complex, and anterior cingulate cortex. Key functions of these regions are reviewed to provide a better understanding on how deficits in these regions may predispose to antisocial behavior. Objections to the use of imaging findings in a legal context are outlined, and alternative perspectives raised. It is argued that brain dysfunction is a risk factor for antisocial behavior and that it is likely that imaging will play an increasing (albeit limited) role in legal decision-making.     

Relations between self-serving cognitive distortions,psychopathic traits,and antisocial behavior in a non-clinical sample of adolescents

The aim of the present study was to assess the relative contributions self-serving cognitive distortions and psychopathic traits to adolescent antisocial behavior. Participants were 972 high-school students who completed self-report questionnaires. Hierarchical multiple regression analyses showed that self-serving cognitive distortions, psychopathic traits, as well as their interaction term were significant predictors of antisocial behavior in both genders after adjustment for the main other cognitive, psychopathological and sociofamilial variables. High levels of self-serving cognitive distortions were associated with more extensive antisocial behavior among participants with higher scores on psychopathic traits. This result may have implications for prevention and treatment.     

Relations between self-serving cognitive distortions, psychopathic traits, and antisocial behavior in a non-clinical sample of adolescents

The aim of the present study was to assess the relative contributions self-serving cognitive distortions and psychopathic traits to adolescent antisocial behavior. Participants were 972 high-school students who completed self-report questionnaires. Hierarchical multiple regression analyses showed that self-serving cognitive distortions, psychopathic traits, as well as their interaction term were significant predictors of antisocial behavior in both genders after adjustment for the main other cognitive, psychopathological and sociofamilial variables. High levels of self-serving cognitive distortions were associated with more extensive antisocial behavior among participants with higher scores on psychopathic traits. This result may have implications for prevention and treatment.     

Callous-Unemotional Traits Only Versus the Multidimensional Psychopathy Construct as Predictors of Various Antisocial Outcomes During Early Adolescence

The aim of this study was to compare callous-unemotional (CU) traits versus the multidimensional psychopathy construct in their ability to predict future and stable antisocial behavior. At baseline, a community sample of 996 Cypriot 12-year old adolescents (52% girls) completed measures that tap conduct problems (CP) and psychopathic traits, including CU. CP, aggression, and substance use were self-reported at 1–3 year follow-ups. Youths were assigned to six mutually exclusive groups based on their baseline levels of CP and psychopathic traits. Youth with CP scoring high on all three psychopathic traits dimensions (Psychopathic Personality?+?CP) showed the most robust and highest risk for future and stable CP, aggression, and substance use, followed by youth who were high on all three psychopathic traits dimensions but displayed no concurrent CP (Psychopathic Personality Only) and CP youth with low levels of psychopathic traits (CP Only). Youth with CP who merely manifested callous-unemotional traits (Callous-Unemotional?+?CP) were only at risk for future CP. The findings suggest that the CU traits-based approach for subtyping children with CP is less informative compared to a subtyping approach using various psychopathic traits dimensions in predicting future and stable forms of various antisocial outcomes. These findings and their consistency with prior work indicate the need for additional research to examine the various psychopathic traits dimensions rather than focusing solely on CU traits, especially for CP subtyping purposes.     

Gender, Somatization, and Psychopathic Traits in a College Sample

The structure of psychopathic traits and their association with somatization symptoms were investigated in a sample of 199 undergraduate college students enrolled in introductory psychology classes. Using multiple measures of psychopathic traits, an iterated principal axis (IPA) analysis revealed two dimensions of psychopathy that were similar to ones typically found in forensic samples. One dimension focused on a cold, callous, and unemotional interpersonal style and the second dimension focused on an impulsive and antisocial lifestyle. These two dimensions emerged for both men and women, although the correlation between the two was somewhat higher for men than women. Also, the callous and unemotional dimension was negatively correlated with somatization symptoms, and the impulsive and antisocial dimension was positively associated with somatization symptoms. This pattern of associations was similar for both men and women and it suggests that somatization symptoms may be one aspect of the high rate of negative affectivity experienced by antisocial individuals.     

Child and adolescent psychopathy: Assessment issues and treatment needs

The identification of psychopathic traits in childhood and adolescence is a topic of growing interest for scientific research. The development of models to predict violent behavior, together with efficient preventive and therapeutic programs, is a major goal when assessing youths with psychopathic traits. This paper focuses on the construct of child and adolescent psychopathy, while approaching historical and conceptual issues. By discussing the “state of the art” of the construct, we will analyze different instruments to assess psychopathy in children and adolescents, as well as the available treatment modalities. Finally, we will present possible lines for research and clinical intervention according to an evolutionary approach to anger and antisocial behavior.     

A Rorschach Investigation of Narcissism and Hysteria in Antisocial Personality

We investigated Rorschach responses associated with narcissism and hysteria in a group of antisocial personality disordered offenders. The Rorschach protocols of 42 subjects who met the criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) for antisocial personality disorder were analyzed using Exner's (1986) criteria for pairs, reflections, and personal responses, and Gacono's (1988) criteria for the impressionistic response. Severe, or primary psychopaths (n = 21), scoring ≥30 on the Hare (1980) Psychopathy Checklist (PCL), were compared to moderate, or secondary pscyhopaths (n = 21), scoring <30 on the PCL. The mean number of pair and impressionistic responses did not significantly differ for the two antisocial groups. The highly psychopathic group, however, did exhibit a significantly greater mean number of reflection and personal responses. We discuss pair and reflection responses and their relationship to narcissism in psychopathic disturbance. We recommend interpreting the personal response within the context of the psychopathic character and view personal responses as expressions of narcissism and omnipotence in highly psychopathic subjects. We also hypothesize that the impressionistic responses are indicative of primitive dissociative processes and hysteria in psychopathic subjects, and that their presence provides construct validity for the work of Guze (1976) and others who suggested an underlying histrionic dimension to psychopathy.     

Quantifying the psychopathic stare: Automated assessment of head motion is related to antisocial traits in forensic interviews

Clinicians have long noted that individuals with high psychopathic traits exhibit unique interpersonal style often observable during forensic interviews. Here we develop an automated approach for quantifying head dynamics during video-recorded naturalistic clinical interviews. We expected head dynamics would be related to psychopathic traits. As predicted, dwell times indicate that those with higher levels of psychopathic traits are characterized by more stationary head positions, focused directly towards the camera/interviewer, than were individuals low in psychopathic traits. These associations were primarily driven by developmental/antisocial features of psychopathy, indicating that those with severe and life-course persistent antisocial behavior exhibit more rigid and focused orienting of their head during interpersonal communication. These results encourage more research into the automated quantification of behavioral manifestations of personality to support clinical observations that psychopaths exhibit unique qualities in non-verbal interpersonal communication.     

The inclusion of antisocial behavior in the construct of psychopathy: A review of the research

The psychopathic personality, or the construct of this disorder, has a long and contentious history. Psychopathy has been identified anecdotally for centuries; however, the ability to accurately define this construct continues to challenge researchers and clinicians. Of preliminary concern is the relevance of antisocial behavior to this disorder. Theoretical conceptualizations of psychopathy have changed over the past 65 years. Some have stressed the interpersonal and affective deficits of psychopathy [Cleckley, H. (1941). The mask of sanity (1st ed.). St. Louis, MO:C.V. Mosby.], while later conceptualizations have included both personality traits as well as antisocial behavior as criteria of psychopathy [Hare, R. D. (1991/2003). The Hare Psychopathy Checklist—Revised. Toronto, Canada: Multi-Health Systems]. This article will review the literature, particularly the relevance of antisocial behavior to the core personality structure of the psychopath. In doing so, historical theories will be reviewed, followed by later theoretical and empirical research. A great deal of this research has been conducted over the past 15 years, since the publication of the Psychopathy Checklist (PCL) and the Psychopathy Checklist-Revised (PCL-R; [Hare, R. D. (1991/2003). The Hare Psychopathy Checklist—Revised. Toronto, Canada: Multi-Health Systems]). The PCL-R has provided the field of psychopathy research with a consistent measurement device, and, therefore will be discussed at length. The limitations of the psychopathy construct will be discussed as well as needed future research and the policy implications of such research.     

Psychopathy and the ability to read the “language of the eyes”: Divergence in the psychopathy construct

The capacity to interpret others people's behavior and mental states is a vital part of human social communication. This ability, also called mentalizing or Theory of Mind (ToM), may also serve as a protective factor against aggression and antisocial behavior. This study investigates the relationship between two measures of psychopathy (clinical assessment and self‐report) and the ability to identify mental states from photographs of the eye region. The participants in the study were 92 male inmates at Bergen prison, Norway. The results showed some discrepancy in connection to assessment methodology. For the self‐report (SRP‐III), we found an overall negative association between mental state discrimination and psychopathy, while for the clinical instrument (PCL‐R) the results were more mixed. For Factor 1 psychopathic traits (interpersonal and affective), we found positive associations with discrimination of neutral mental states, but not with the positive or negative mental states. Factor 2 traits (antisocial lifestyle) were found to be negatively associated with discrimination of mental states. The results from this study demonstrate a heterogeneity in the psychopathic construct where psychopathic traits related to an antisocial and impulsive lifestyle are associated with lower ability to recognize others' mental states, while interpersonal and affective psychopathic traits are associated with a somewhat enhanced ability to recognize others' emotional states.     

Unique roles of antisocial personality disorder and psychopathic traits in distress tolerance

Previous research indicates that individuals with antisocial personality disorder (ASPD) evidence low distress tolerance, which signifies impaired ability to persist in goal-directed behavior during an aversive situation, and is associated with a variety of poor interpersonal and drug use outcomes. Based on theory and research indicating that psychopathic traits are associated with hypo-reactivity in emotional responding, a unique hypothesis emerges where psychopathic traits should have the opposite effect of ASPD and be related to high levels of distress tolerance. In a sample of 107 substance-dependent patients in an inner-city substance use residential treatment facility, this hypothesis was supported. ASPD was related to lower distress tolerance, while psychopathic traits were related to higher distress tolerance, with each contributing unique variance. Findings are discussed in relation to different presentations of distress tolerance as a function of psychopathic traits among those with an ASPD diagnosis.     

A Rorschach investigation of narcissism and hysteria in antisocial personality

We investigated Rorschach responses associated with narcissism and hysteria in a group of antisocial personality disordered offenders. The Rorschach protocols of 42 subjects who met the criteria from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) for antisocial personality disorder were analyzed using Exner's (1986) criteria for pairs, reflections, and personal responses, and Gacono's (1988) criteria for the impressionistic response. Severe, or primary psychopaths (n = 21), scoring greater than or equal to 30 on the Hare (1980) Psychopathy Checklist (PCL), were compared to moderate, or secondary pscyhopaths (n = 21), scoring less than 30 on the PCL. The mean number of pair and impressionistic responses did not significantly differ for the two antisocial groups. The highly psychopathic group, however, did exhibit a significantly greater mean number of reflection and personal responses. We discuss pair and reflection responses and their relationship to narcissism in psychopathic disturbance. We recommend interpreting the personal response within the context of the psychopathic character and view personal responses as expressions of narcissism and omnipotence in highly psychopathic subjects. We also hypothesize that the impressionistic responses are indicative of primitive dissociative processes and hysteria in psychopathic subjects, and that their presence provides construct validity for the work of Guze (1976) and others who suggested an underlying histrionic dimension to psychopathy.     

Psychopathic Traits and Delinquency Trajectories in Adolescence

The utility of psychopathic traits predicting various forms of antisocial behavior has been demonstrated extensively. However, there are mixed results concerning which of the three psychopathic personality dimensions—callous and unemotional traits, grandiose and manipulative interpersonal style, impulsive-irresponsible behavior—is the best predictor of antisocial behavior in adolescence. In this study, we examined developmental trajectories of antisocial behavior over four years in adolescence and psychopathic traits as predictors of these trajectories. Participants were 811 adolescents from a longitudinal community sample (M _age = 14). Results showed that four trajectories described the development of antisocial behavior from early to middle adolescence in the current sample. Both grandiose-manipulative traits and impulsive-irresponsible behavior were significant predictors of the high and elevated trajectories whereas callous-unemotional traits were not. Our findings underline the importance of studying the dimensions of the psychopathy constructs uniquely and independently of each other.     

Psychopathic personality traits and temporal perspective: A test of the short time horizon hypothesis

A number of authors have proposed that psychopathic individuals possess an abnormally constricted time horizon (i.e., foreshortened sense of the future). This hypothesis was tested among 101 undergraduates, who were administered a battery of (1) self-report indices of psychopathic personality traits, antisocial behavior, and normal-range personality traits; (2) self-report indices of time perspective; (3) projective tests of time perspective; and (4) laboratory tasks assessing time estimation and capacity for foresight and impulse control. Measures of psychopathy/antisocial behavior tended to be negatively correlated with several self-report indices assessing preoccupation with the future and with a projective task assessing the frequency of thoughts concerning future events, although only one of the correlations with this latter task was significant. In most cases these correlations were not attributable to the variance shared by measures of psychopathy/antisocial behavior and measures of (low) anxiety-proneness, although several correlations decreased substantially after levels of harmavoidance were controlled. In contrast, measures of psychopathy/antisocial behavior were negligibly correlated with laboratory tasks. These results provide mixed support for the short time horizon hypothesis and suggest that further attention to the role of method factors in investigations of future time perspective is warranted.     

The King of Norway: negative individuation,the hero myth and psychopathic narcissism in extreme violence and the life of Anders Behring Breivik

The paper discusses negative individuation and the hero myth as developmental concepts. It is suggested that in negative individuation healthy psychological development is hindered and goes astray. Aggression then becomes the central psychic system. Repressed anger is the core element in psychopathic narcissism (Diamond) and malignant narcissism (Kernberg). Both Diamond and Kernberg extend narcissistic personality structure to antisocial, psychopathic personality in an effort to better understand extreme violence. According to Freud, love (libido) and hate (the death drive) are the major motivational systems in the human psyche. In contrast to Freud, Jung sees libido as a life force in general, not simply as a sexual drive. Jung writes about evil and the shadow but does not present a comprehensive theory of the negative development of an individual's life. The concept of negative individuation connects the shadow and the death drive with psychopathology, psychiatry and psychotherapy. In this paper, I explore these concepts in the light of contemporary affect theory according to Kernberg. I also ask how ideology is tied to extreme violence and how it is possible that narcissistic personality structures can lead to such radically different outcomes as were manifested in the lives of Anders Behring Breivik and Steve Jobs.     

The association between persistent disruptive childhood behaviour and the psychopathic personality constellation in adolescence: A twin study

This study tested if persistent externalizing behaviour and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in childhood are associated with personality and behavioural aspects of the psychopathic personality constellation in adolescence. The target sample consisted of all 1,480 twin pairs born in Sweden between 1985 and 1986. Parent‐reported externalizing behaviour and ADHD symptoms were obtained when the participants were 8–9 and 13–14 years old. Personality and behavioural aspects of the psychopathic personality constellation were measured with self‐report questionnaires when the participants were 16–17 years old. Persistent externalizing behaviour in childhood was associated with both psychopathic personality and antisocial behaviour in adolescence. However, within twin‐pair analyses showed that genetic factors explained the association between persistent externalizing behaviour and psychopathic personality, while shared environmental factors explained the association between persistent externalizing and antisocial behaviours. We conclude that persistent externalizing behaviour is a genetically influenced precursor of psychopathic personality among boys.