Impaired Pavlovian conditioned inhibition in offenders with personality disorders

Certain types of violent offending are often accompanied by evidence of personality disorders (PDs), a range of heterogeneous conditions characterized by disinhibited behaviours that are generally described as impulsive. The tasks previously used to show impulsivity deficits experimentally (in borderline personality disorder, BPD) have required participants to inhibit previously rewarded responses. To date, no research has examined the inhibition of responding based on Pavlovian stimulus–stimulus contingencies, formally “conditioned inhibition” (CI), in PDs. The present study used a computer-based task to measure excitatory and inhibitory learning within the same CI procedure in offenders recruited from the “personality disorder” and the “dangerous and severe personality disorder” units of a high-security psychiatric hospital. These offenders showed a striking and statistically significant change in the expression of inhibitory learning in a highly controlled procedure: The contextual information provided by conditioned inhibitors had virtually no effect on their prepotent associations. Moreover, this difference was not obviously attributable to nonspecific cognitive or motivational factors. Impaired CI would reduce the ability to learn to control associative triggers and so could provide an explanation of some types of offending behaviour.     

Fearlessness in juvenile offenders is associated with offending rate

Poor fear conditioning is a correlate of violent offending in adults, but there is no evidence concerning juvenile offenders. Our aim was to compare emotional learning in juvenile offenders and controls and establish whether crime rate is related to seriousness of emotional learning problems. To this end, emotional learning was assessed in 42 juvenile offenders by measuring skin conductance responding (SCR) during fear conditioning. Compared to controls, juvenile offenders showed lower conditioned SCRs to visual stimuli associated with a subsequent aversive stimulus and the magnitude of the SCR during fear acquisition was inversely associated with the number of their recorded offences. These findings suggest that juvenile offenders have impairments in the neural systems that subserve emotional learning. The implication is that using punitive measures to control persistent offenders is unlikely to be effective in an identifiable group of juvenile offenders.     

Inhibitory control and negative emotional processing in psychopathy and antisocial personality disorder

The field of personality disorders has had a long-standing interest in understanding interactions between emotion and inhibitory control, as well as neurophysiological indices of these processes. More work in particular is needed to clarify differential deficits in offenders with antisocial personality disorder (APD) who differ on psychopathic traits, as APD and psychopathy are considered separate, albeit related, syndromes. Evidence of distinct neurobiological processing in these disorders would have implications for etiology-based personality disorder taxonomies in future psychiatric classification systems. To inform this area of research, we recorded event-related brain potentials during an emotional-linguistic Go/No-Go task to examine modulation of negative emotional processing by inhibitory control in three groups: psychopathy (n = 14), APD (n = 16), and control (n = 15). In control offenders, inhibitory control demands (No-Go vs. Go) modulated frontal-P3 amplitude to negative emotional words, indicating appropriate prioritization of inhibition over emotional processing. In contrast, the psychopathic group showed blunted processing of negative emotional words regardless of inhibitory control demands, consistent with research on emotional deficits in psychopathy. Finally, the APD group demonstrated enhanced processing of negative emotion words in both Go and No-Go trials, suggesting a failure to modulate negative emotional processing when inhibitory control is required. Implications for emotion-cognition interactions and putative etiological processes in these personality disorders are discussed.     

AX+, BX- discrimination learning in the fear-potentiated startle paradigm: possible relevance to inhibitory fear learning in extinction

The neural mechanisms of fear suppression most commonly are studied through the use of extinction, a behavioral procedure in which a feared stimulus (i.e., one previously paired with shock) is nonreinforced repeatedly, leading to a reduction or elimination of the fear response. Although extinction is perhaps the most convenient index of fear inhibition, a great deal of behavioral work suggests that postextinction training conditioned stimuli are both excitatory and inhibitory, making it difficult to determine whether a neural manipulation affects inhibition, excitation, or some combination thereof. For this reason we sought to develop a behavioral procedure that would render a stimulus primarily inhibitory while at the same time avoiding some of the issues raised by the traditional conditioned inhibition paradigm, namely second-order conditioning, external inhibition, and configural learning. Using the fear-potentiated startle paradigm, we adapted an AX+, BX- training procedure in which stimuli A and X were presented simultaneously and paired with shock, and stimuli B and X were presented simultaneously in the absence of shock. In testing, high levels of fear-potentiated startle were seen in the presence of A and AX and much lower levels were seen in the presence of B and AB, as would be predicted if stimulus B were a conditioned inhibitor. We believe this method is a viable alternative to the traditional conditioned inhibition training procedure and will be useful for studying the neural mechanisms of fear inhibition.     

Dangerous and severe personality disorders: a new personality concept from the United Kingdom

In 1998, we in England were shocked by the apparently motiveless murders of a mother and two of her children when they were traveling home from school in a rural area. Subsequently a patient with personality disorder, being monitored by the forensic psychiatric services, was convicted of their murders. The government was determined to prevent this type of offense from recurring and in 1999 introduced a new concept, dangerous and severe personality disorder (DSPD). This subsequently became a treatment and assessment program for individuals who satisfy three requirements: (1) have a severe disorder of personality, (2) present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover, and (3) the risk of offending should be functionally linked to the personality disorder. The implications of this program are discussed with regard to international systems of classification and service provision. We also attempt to place DSPD in the wider context of psychiatric participation in the management of personality disordered offenders.     

The MCMI-III personality disorders scores predicted by the NEO-FFI-R and the ZKPQ-50-CC: a comparative study

This study was designed to compare the NEO-FFI-R versus the ZKPQ-50-CC in their relationships with the fourteen MCMI-III personality disorder scales in a Spanish non-clinical sample (N = 674). Previous studies showed consistent relationships between the Five Factor Model and the DSM-IV personality disorders (PD), but there is no comparative study between both Five Factor and Zuckerman's personality models. The aim was to replicate previous results about relationships between the Big-Five and PDs using the revised short version of the NEO-PI-R, and to compare the NEO-FFI-R versus the ZKPQ-50-CC regarding the relationships with MCMI-III personality disorder scales. Results showed no sharp differences between the NEO-FFI-R and ZKPQ-50-CC scales. Each instrument explained around 30% of the PDs MCMI-III scales variance. Using conjointly the 10 personality scales from the NEO-FFI-R and ZKPQ-50-CC, the PDs accounted variance rose to 38%. Differences and similarities between both short personality questionnaires are discussed.     

Pattern of comorbidity among anxious and odd personality disorders: the case of obsessive-compulsive personality disorder

The aim of this study was to examine the pattern of comorbidity among obsessive-compulsive personality disorder (OCPD) and other personality disorders (PDs) in a sample of 400 psychiatric inpatients. PDs were assessed using the Semistructured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Odds ratios (ORs) were calculated to determine significant comorbidity among OCPD and other axis II disorders. The most elevated odds ratios were found for the cooccurrence of OCPD with cluster A PDs (the "odd" PDs, or paranoid and schizoid PDs). These results are consistent with those of previous studies showing a higher cooccurrence of OCPD with cluster A than with cluster C ("anxious") PDs. In light of these observations, issues associated with the nosologic status of OCPD within the Diagnostic and Statistical Manual of Mental Disorders clustering system remain unsettled.     

Dependency,impulsivity, and self-harm: traits hypothesized to underlie the association between cluster B personality and substance use disorders

Cluster B personality disorders (PDs) (i.e., antisocial, borderline, histrionic, and narcissistic) typically show a high degree of comorbidity with substance use disorders (SUDs). Previous research suggests that the broad-based personality domains of Disinhibition and Negative Temperament/Neuroticism may be common factors to both types of disorders. Using a two-phase process (i.e., screening and follow-up), this study examined three lower-order personality traits (i.e., dependency, impulsivity, and self-harm) that fall within the Disinhibition and Neuroticism domains. The study evaluated the hypotheses that these traits (a) are related both to cluster B PDs and to SUDs; and (b) underlie the association between the two types of disorders. Results indicate that impulsivity and self-harm play a significant role in cluster B PDs and SUDs, as well as in their association with each other. However, dependency was not associated with either type of disorder. These results indicate that sets of individual traits can be of significant utility in understanding the comorbidity between PDs and SUDs.     

Conditioned and latent inhibition in taste-aversion learning: clarifying the role of learned safety.

Experiments 1-3 investigated the applicability of the classical conditioning concept of conditioned inhibition to taste-aversion learning. Rats made ill after drinking saccharin and subsequently administered a "safe" exposure to saline (or casein hydrolysate) evidenced an enhanced preference for the safe fluid (relative to either a third, slightly aversive, solution or to water) when compared to controls in which saccharin was not previously poisoned. Such active condition inhibition was significantly reduced in Experiment 4 when two safe exposures to saline preceded saccharin-illness pairings. These results indicate that conditioned inhibition can be established in a taste-aversion procedure and that a latent inhibition manipulation reduces the ability of a taste to become a signal for safety. Implications of these findings for the learned safety theory of taste-aversion learning and the relevance to bait-shyness of principles established within the classical conditioning paradigm are considered.     

Bad or Mad? Personality disorders and legal responsibility-the German situation

Criminal offenders have a high rate of personality disorders (PDS), especially Antisocial Personality Disorders and psychopathy, but criminal acts are not necessarily the result of PD. Findings from psychiatric research suggest that the development of PD is influenced by genetic factors, that can result in deviant traits in temper, emotionality and cognitive style. There is general agreement that those peculiarities and vulnerabilities find their expression and structure only under a complex interplay of stimulating or impairing environmental influences. Do these genetic factors-or other factors-diminish a person's criminal responsibility? There is no difficulty in diagnosing PDs, but the challenging questions arise in forensic assessments of defendants for criminal responsibility who have a PD. This article discusses the German legal situation and special problems created by the term of "diminished" criminal responsibility. In contrast to the Anglo-American legal situation, the German criminal law obliges the court to order an indeterminate forensic - psychiatric confinement, in addition to punishment, if the offender had acted under diminished criminal responsibility and is now still considered to be dangerous. The convicted offender remains under the control of the criminal court during psychiatric hospitalization. The change from handling the personality disordered offender as a criminal to handling him as someone with a mental disorder creates a social option for extended state interventions, including indeterminate hospitalization.     

The Collaborative Longitudinal Personality Disorders Study (CLPS): overview and implications

The Collaborative Longitudinal Personality Disorders Study (CLPS; Gunderson et al., 2000) was developed to fill gaps in our understanding of the nature, course, and impact of personality disorders (PDs). Here, we review published findings to date, discuss their implications for current conceptualizations of PDs, and raise questions that warrant future consideration. We have found that PDs are more stable than major depressive disorder, but that meaningful improvements are possible and not uncommon. We have confirmed also that PDs constitute a significant public health problem, with respect to associated functional impairment, extensive treatment utilization, negative prognostic impact on major depressive disorder, and suicide risk. At the same time, we have demonstrated that dimensional models of PDs have clinical validity that categories do not, especially greater temporal stability. Furthermore, dimensional personality traits appear to be the foundation of behaviors described by many PD criteria. Taken together, our results lead us to hypothesize that PDs may be reconceptualized as hybrids of stable personality traits and intermittently expressed symptomatic behaviors.     

Pigeons' withdrawal from an appetitive conditioned inhibitor under two training procedures

The approach-withdrawal behaviour of pigeons to a red keylight was measured under three conditions; a negative contingency (NC) between keylight and food reinforcement, a CI or conditioned inhibition procedure where the keylight was non-reinforced in compound with a tone which was reinforced when presented alone, and a random control procedure (RC). The keylight-food contingencies in CI and NC were identical, and keylight and food presentation frequency were the same in all conditions. Subsequently the effect of adding the red keylight to a novel CS+ during or after excitatory conditioning was examined (summation test of inhibition). The inhibitory procedures, CI and NC, generally yielded similar functions for the acquisition of withdrawal, and the results of the withdrawal and summation measures were positively correlated. The implications of the results for theories of the acquisition and behavioural action of conditioned inhibitors are discussed.     

Fear inhibition and species specific defense reaction termination may contribute independently to avoidance learning

A series of three experiments was conducted to test the proposal of Cicala and Owen (Learning and Motivation, 1976, 7, 356–367) that warning signal termination reinforces avoidance learning by permitting fear to dissipate and that a feedback signal reinforces avoidance learning through conditioned inhibition of fear. A CER procedure with a second-by-second analysis was used to measure fear elicitation and fear reduction following classical conditioning or avoidance training. The results show that a feedback signal produces rapid and marked fear reduction, suggesting an inhibitory process. Although warning signal termination produced fear reduction, the slowness of this process suggests fear dissipation and not an inhibitory process. The combination of both events reduced fear no more effectively than a feedback signal alone. It is suggested that warning signal termination is effective in some avoidance learning situations not because it reduces fear, but possibly because it helps terminate an avoidance response that closely resembles a species specific defense reaction.     

Opinions of personality disorder experts regarding the DSM-IV personality disorders classification system

OBJECTIVE: To survey the opinions of personality disorder (PD) experts on possible revisions in the classification system for PDs in the DSM-V. METHOD: Four hundred members of two international associations, the Association for Research on Personality Disorders, and the International Society for the Study of Personality Disorders, were asked to take a 78-item web survey. RESULTS: Of the experts who completed the survey (N = 96), 74% felt that the DSM-IV's categorical system of PD diagnosis should be replaced. Eighty percent felt that PDs are better conceived of as personality dimensions or illness spectra, than as categories. The most frequently endorsed alternative system for PDs was a mixed system of categories and dimensions. Most experts preferred the PDs to remain on Axis II. Only 31.3% wanted the term, "Borderline Personality Disorder," retained in the DSM-V. CONCLUSIONS: A clear majority of the PD experts were dissatisfied with the current diagnostic system for PDs.     

Child Pornography Offending Seen Through Three Theoretical Lenses

Understanding the complex issues surrounding child pornography offending is still in its infancy, and questions regarding the etiological underpinnings of sexually deviant interests and behaviors for these offenders remain both salient and unanswered. This article considers these questions through the lenses of three psychological theories of behavior: (1) social learning theory, (2) courtship disorder theory, and (3) behavioral economics. The development and maintenance of child pornography offending, as well as the potential for off-line escalation of those behaviors, from each theoretical perspective is discussed and the implications for theoretically grounded clinical practice is explored.     

Konsumenten illegaler Internet-Pornographie – psychische Auffälligkeiten und Risiken der Straffälligkeit

Internet sex offending, especially child pornography, is widespread and numbers of convictions are increasing steadily worldwide. The still sparse data from research as well as empiricism from risk assessment and therapeutic work suggest the following: Internet sex offender as well as child abusers are represented in all social classes and all age ranges. Both show similarities in dependent, avoidant and partially schizoid social interaction as well as in anxiety. However the personality organisation of child abusers is usually less structured and tends towards personality disorder, especially with emotionally instable and antisocial traits. Usually pedophilia can be diagnosed in child abusers. Internet sex offenders on the other hand have fewer prior convictions, are less likely to fail in the community, have a very low risk of sexual recidivism and only part of them fulfil the diagnostic criteria for pedophilia. There is no clear evidence for an escalation from internet sex offending to child abuse. The essential characteristics for an escalation are well known and should lead to immediate therapeutic intervention as well as psychological strain should. Only few institutions worldwide provide professional help to support the ones concerned to reduce stigma and thus prevent recidivism and child abuse.     

Sex bias in the diagnosis of personality disorders: A different approach

There has been considerable controversy regarding a possible sex bias in the diagnosis of personality disorders (PDs). However, prior research has at times confused a bias within clinicians who fail to adhere to the diagnostic criteria with a bias within the diagnostic criteria. Rather than assess whether females are more likely than males to be diagnosed with a respective disorder, the current study assesses whether the thresholds for the diagnosis of female-typed PDs are lower than the thresholds for male-typed PDs. Subjects completed two self-report inventories for the DSM-III-R personality disorders, and three inventories that assessed 30 aspects of personality dysfunction organized with respect to social dysfunction, occupational dysfunction, and personal distress. There was no indication that the diagnostic thresholds for personality disorders that occur more often in females is lower than the thresholds for the personality disorders that occur more often in males. The implications of these findings for the issue of sex biased diagnoses are discussed.