Psychopathy and malingering of psychiatric disorder in criminal defendants

Because the use of deception is an important clinical characteristic of psychopathy, there is intuitive appeal to the idea that psychopathy and malingering are associated. There is, however, very little research showing that psychopaths are more likely to malinger. We classified a sample of criminal defendants as high, moderate, or low in psychopathy, based on PCL-R scores, and compared their scores on indices typically used to detect malingering on the MMPI-2, the PAI and the SIRS. The high psychopathy group scored significantly higher on the MMPI-2 F and F-K; the PAI NIM, and the SIRS, but not the MMPI-2 Fb, F(p), or the PAI RDF or Mal, lending some support for the DSM-IV recommendation that malingering should be considered whenever there is a diagnosis of antisocial personality disorder. Logistic regression analysis (LGA) revealed that Factor I but not Factor II of the PCL-R significantly discriminated malingerers from nonmalingerers with 75% correct classification. However, receiver operating characteristic (ROC) analysis revealed that psychopathy ratings had poor sensitivity and specificity in the detection of malingering. Calculation of the percentages of those exceeding accepted cut-offs on each of the malingering measures revealed that a high percentage of severe psychopaths did not attempt to feign psychiatric disorder. The results suggest that psychopathy is not a clinically useful indictor of malingering. The results are discussed in terms of confirmatory bias and the impact such a bias could have on the evaluation of criminal defendants.     

Psychopathy is related to negative affectivity but not to anxiety sensitivity

Although the hypothesis that psychopathic individuals are characterized by a reduced capacity for experiencing anxiety is central to many theories of psychopathy, most prior studies have examined anxiety and fear measures generally considered outdated in the literature. Moreover, prior findings are mixed, with several studies reporting no relationships between psychopathy and anxiety, and others suggesting negative relationships for the affective, interpersonal aspects of the disorder and positive relationships for the antisocial behavior dimension. To examine whether psychopathy dimensions are associated with contemporary measures of anxiety, the Anxiety Sensitivity Index and State Trait Anxiety Inventory-Trait scale were administered to 157 male inmates. Participants also completed the MMPI-derived Welsh Anxiety Scale (WAS), commonly used in psychopathy studies. Analyses provide no evidence for a negative relationship between psychopathy's affective, interpersonal factor and anxiety sensitivity after controlling for trait anxiety. Trait anxiety and WAS scores were positively associated with the antisocial behavior dimension of psychopathy. Findings do replicate prior relationships between the WAS and psychopathy, suggesting the WAS may measure aspects of negative affectivity that differ from anxiety.     

Psychopathy, antisocial personality, and suicide risk

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.     

Psychopathy and Responsibility

Some philosophers have argued that the psychopath serves as the ultimate test of the limits of moral responsibility. They hold that the psychopath lacks a deep knowledge of right and wrong, and that Kant's ethics arguably offers the most plausible account of this moral knowledge. On this view, the psychopath's lack of moral understanding is due to a cognitive failure involving practical reason. I argue that the deep knowledge of right and wrong consists of emotional and volitional components in addition to a cognitive one. Hence it is mistaken to claim that the psychopath's moral deficiency is due solely to a cognitive failure, or that his lack of the deep knowledge of right and wrong can be explained entirely in terms of a defect of practical reason. I refer to empirical research to show that the Kantian model of practical reason does not provide a satisfactory account of responsibility of the psychopath in particular or of moral agents in general. On the basis of both philosophical and empirical considerations, I argue that the psychopath is at least partly responsible for his behaviour.     

Psychopathy and internalism

Do psychopaths make moral judgments but lack motivation? Or are psychopaths’ judgments are not genuinely moral? Both sides of this debate seem to assume either externalist or internalist criteria for the presence of moral judgment. However, if moral judgment is a natural kind, we can arrive at a theory-neutral criterion for moral judgment. A leading naturalistic criterion suggests that psychopaths have an impaired capacity for moral judgment; the capacity is neither fully present nor fully absent. Psychopaths are therefore not counterexamples to internalism. Nonetheless, internalism is empirically problematic because it is unable to explain psychopaths’ moral deficits.     

Neurological malingering

The detection of malingering in terms of neurologic signs and symptoms is described, including malingered coma, simulated deafness, feigned blindness, feigned weakness, and diminished sensation. While neurologic malingering is not an actual diagnosis, it is best detected through medical procedures. To identify malingering, the physician must demonstrate that the malingered sign or symptom is not caused by a diagnosable order and is instead clearly a consequence of the subject's volition.     

Psychopathy and traumatic stress

This study examined the relationship between psychopathy and traumatic stress. First, a sample of 48 male patients in a security hospital was assessed using the Psychopathy Checklist (Hare, 2003) and the Stanford Acute Stress Reactions Questionnaire (SASRQ; Cardena, Classen, Koopman, & Spiegel, 1996). Linear regression analyses suggested that the affect deficit component of psychopathy was the best negative predictor of avoidance, dissociation, and re-experiencing symptoms. The 13 highest-scoring psychopathy participants were then compared to the 13 lowest-scoring participants. Psychopaths differed from controls in terms of number but not type of traumatic events. They obtained significantly lower SASRQ total score, reflecting a lower level of traumatic symptomatology. The results are discussed in connection with the emotional deficit component of psychopathy.     

Correlates of malingering

The author presented anonymous questionnaires to 172 patients and 160 medical students to assess the frequency and correlates of malingering in various groups in a medical center on a V.A. campus. The results indicate that sociopaths, drug abusers, and alcoholics are more prone to malinger than other individuals, supporting previous assertions that mental health professionals should have a higher index of suspicion for malingering in these diagnostic groups. Race and age were found to have small but significant correlations with malingering, but at present, this finding must be viewed cautiously. No association was found between somatization disorder and malingering.     

Risky business: Psychopathy,framing effects,and financial outcomes

Using a risky-choice framing paradigm, we investigated (a) the extent to which psychopathic features shape behavioral responses to potential losses vs. potential gains and (b) how these relations bear on real-world economic decision-making in a community sample (N =  475). Associations among psychopathic features, risk-seeking, sensitivity to framing, and financial practices were also examined. Disinhibition manifested positive relations with risk-seeking and maladaptive financial practices, whereas boldness manifested positive relations with risk-seeking and adaptive financial practices. Individuals high in disinhibition and/or meanness were significantly less likely to endorse risk seeking in negative frames. Results provisionally suggest boundary conditions for framing effects; in particular, certain psychopathic traits may render individuals modestly less susceptible to framing or bias them towards risk-taking in positive frames.     

Psychopathy and Trait Emotional Intelligence

Psychopathic individuals are infamous for their chronic and diverse failures of social adjustment despite their adequate intellectual abilities. Non-cognitive factors, in particular trait emotional intelligence (EI), offer one possible explanation for their lack of success. This study explored the association between psychopathy and EI, as measured by the Psychopathy Checklist - Revised (PCL-R; Hare, 2003) and Trait Meta-Mood Scale (TMMS, Salovey, Mayer, Golman, Turvey & Palfai, 1995). Consistent with the Response Modulation (RM) model of psychopathy (Newman & Lorenz, 2003), low-anxious psychopathic individuals had significantly lower scores on TMMS Repair and Attention compared to controls. Consistent with proposals by Patrick and Lang (1999) regarding PCL-R factors, these EI deficits related to different aspects of the psychopathy construct. Correlations revealed significant inverse associations between PCL-R factor 1 and Attention and PCL-R factor 2 and Repair. We propose that the multi-dimensional EI framework affords a complementary perspective on laboratory-based explanations of psychopathy.     

Hare Psychopathy Checklist-Revised

The Hare Psychopathy Checklist-Revised (PCL-R) is among the most frequently used instruments for the assessment of psychopathic traits. In the scope of the German adaptation of the PCL-R, normative data were collected from a sample of adult male offenders. Based on these data the factor structure and reliability of the German language version of the PCL-R are discussed in the first section of the article. The assessment of a model with four facets and two superordinate factors showed a very good agreement with the empirical data. In addition, examination of interrater agreement and internal consistency indicated that the PCL-R is a reliable measure. In the second part of the paper recommendations are provided for the correct application of the PCL-R. The focus lies on the correct performance, evaluation and interpretation of PCL-R test results with respect to key indices and the dimensional structure of the psychopathy construct.     

An examination of the Validity of the Elemental Psychopathy Assessment: Relations with Other Psychopathy Measures,Aggression, and Externalizing Behaviors

The Elemental Psychopathy Assessment (EPA) is a new self-report measure of psychopathy designed to assess the personality traits associated with psychopathy from a Five Factor Model perspective. The current study examined the validity of the EPA in sample of undergraduates by examining the relations between the EPA scales and three validated self-report psychopathy instruments, as well as assessments of aggression, substance use, and antisocial behavior. The EPA scales manifested strong convergent validity with the extant psychopathy measures and an expected pattern of relations with measures of externalizing behaviors. Overall, the EPA appears to be a promising measure of psychopathy which provides new opportunities to explore the underlying structure of this construct and parse its relations with constructs central to its nomological network.     

Psychopathy and the personality dimensions of psychoticism,extraversion and neuroticism

The Eysenck Personality Questionnaire (EPQ) was administered to 173 male prison inmates for whom reliable assessments of psychopathy were available. Psychopathy was significantly correlated with the Psychoticism (P) scale (r = 0.16) and the Lie scale (r = 0.14), but not with the Extraversion (E) or Neuroticism (N) scales. Zone (octant) analysis indicated that psychopathy was not associated with any particular combination of P, E and N scores. Additional analyses, based on the discriminant function procedure described in the EPQ manual, indicated that inmates with high assessments of psychopathy were significantly less psychiatrically abnormal, in the EPQ sense, than were those with low assessments of psychopathy. A series of comparisons was also made between the P scale and a 22-item psychopathy checklist. The P scale was significantly correlated with six of the items, and with factors 1 (r = 0.30) and 4 (r = 0.19) that emerged from a principal components analysis of the checklist. Factor 1 is related to an impulsive, unstable lifestyle with no long-term commitments and factor 4 to the early appearance of antisocial behavior. It is argued that the P scale reflects the criminal, antisocial aspects of psychopathy and that the results probably have no direct implications for the suggestion that psychopathy and psychoticism are related in some fundamental way. A canonical analysis indicated that some interesting relations may exist between the EPQ variables and the psychopathy factors.     

Mythos and Mental Illness: Psychopathy, Fantasy, and Contemporary Moral Life

Medical accounts of the absence of conscience are intriguing for the way they seem disposed to drift away from the ideal of scientific objectivity and towards fictional representations of the subject. I examine here several contemporary accounts of psychopathy by Robert Hare and Paul Babiak. I first note how they locate the truth about their subject in fiction, then go on to contend that their accounts ought to be thought of as a "mythos," for they betray a telling uncertainty about where "fact" ends and "fantasy" begins, as well as the means of distinguishing mental health from mental illness in regard to some social roles.