Reconstructing psychopathy: clarifying the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder

A survey of clinical views suggests that the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder is unclear. To investigate this issue, we evaluated Psychopathy Checklist-Revised ratings (PCL-R; Hare, 1991) using structural equation modeling. One model, referred to as the measurement model, included PCL-R ratings related to antisocial behavior as primary symptoms of psychopathy; a second, referred to as the causal model, included the same PCL-R ratings as secondary symptoms or consequences. Compared to the measurement models, the causal model included more PCL-R items, was more parsimonious, and had equal or superior fit indices. These findings suggest that antisocial behavior is best viewed as a secondary symptom or consequence of psychopathy, In addition, the findings have important implications for future research and clinical-forensic practice, especially concerning the assessment of risk for criminality and violence.     

Antisocial personality disorder and psychopathy: diagnostic dilemmas in classifying patterns of antisocial behavior in sentencing evaluations

Antisocial Personality Disorder (APD) and PCL-R psychopathy are critically examined regarding their application to sentencing determinations. PCL-R psychopathy is emerging in the literature as a more useful forensic diagnostic construct than APD, which appears flawed by multiple weaknesses. These include shifting diagnostic criteria, innumeracy problems, absence of symptom weighting, temporal instability, and the equivalence of some symptoms with substance abuse disorders. Additionally, APD overdiagnosis may result from inattention to issues of social context, trauma history, and symptom pervasiveness. Neither objective nor projective personality testing reliably differentiates APD. Finally, an APD diagnosis does not always indicate criminal, much less incorrigible criminal behavior. By contrast, PCL-R psychopathy results are strongly predictive of criminal behavior and violent recidivism for Caucasian males through mid-life residing in the community. Emerging research with the PCL-R regarding other important populations and contexts is promising but generalization is currently limited. © 1998 John Wiley & Sons, Ltd.     

Reliability and construct validity of the psychopathy checklist - revised for Latino, European American, and African American male inmates

The utility of the psychopathy construct in predicting laboratory deficits, criminal behavior, response to intervention, and recidivism has been well documented in European American populations. However, less is known about the manifestation and correlates of psychopathy in Latino and African American populations. The present study examined the reliability and construct validity of the Psychopathy Checklist - Revised (PCL-R; R. D. Hare, 2003) in 83 Latino inmates compared with matched samples of African Americans and European Americans. Results provide preliminary evidence that the PCL-R provides a reliable and valid measure of psychopathy in Latinos, with generally similar patterns emerging across external correlates; however, some ethnic group differences were noted for relationships between psychopathy indicators and some external correlates.     

The utility of the Psychopathy Checklist-Revised (PCL-R) facet and item scores in predicting violent recidivism

There is relatively limited research on psychopathy in non-Caucasian ethnic groups and even less on the utility of the Psychopathy Checklist-Revised (PCL-R) that focuses on PCL-R facet and item scores in predicting violent recidivism. In this study, we assessed the utility of the PCL-R in prospectively predicting violent versus nonviolent recidivism during an 11-year follow-up window. A high-risk sample of 451 incarcerated Korean male offenders was assessed on the PCL-R at baseline. A total of 445 were reconvicted after release (353 violent and 92 nonviolent recidivists). Psychopathy facet scores were higher in violent compared to nonviolent recidivists. Facet 2 (affective) showed the strongest effect size (Cohen's d = 0.53; Percentage change in odds = 22.6%) in predicting violent recidivism. Analyses of the four items constituting the affective facet indicated that callous/lack of empathy (Percentage change in odds = 134.4%) and failure to accept responsibility (Percentage change in odds = 94.5%) were the strongest predictors of violent recidivism. Findings are to our knowledge the first to document the utility of the PCL-R in distinguishing violent from nonviolent recidivism and highlight the role of affective impairment (particularly lack of empathy) in violent recidivism.     

The accuracy of risk assessment instruments in the prediction of impulsive versus predatory aggression

Actuarial violence risk assessments, many of which include the construct of psychopathy, have been shown to be superior to clinical judgment in the prediction of long-term risk of community violence and recidivism. While these instruments initially appeared to provide similarly accurate judgments of risk of institutional aggression, recent research has indicated that such assessments may be less robust in this setting. One explanation may lie in the types of aggression most frequently observed in each setting. Impulsive (or reactive/affective) is the type of physical aggression most commonly exhibited in psychiatric facilities. This research examines the relationship between risk assessments and aggression in an inpatient forensic setting, with such aggression categorized as impulsive, predatory or psychotic aggression. Consistent with previous research, impulsive aggression was the most frequent type observed (58%). Anger (as measured by the Novaco Anger Scale) and clinical issues (as measured by the HCR-20) were most associated with impulsive aggression, with AUC values of .73 and .71 respectively. In contrast, anger and psychopathy (as measured by the PCL-R) were more associated with predatory aggression, with AUC values of .95 and .84 respectively. Psychotic symptoms were highly associated with psychotically motivated aggression (AUC = .90). These results suggest that traditional violence risk assessments may have limited utility in predicting aggression in an institutional setting and that psychiatric symptoms and heightened affect are more relevant. Copyright © 2008 John Wiley & Sons, Ltd.     

Personality disorders and psychopathy in men convicted for severe intimate partner violence

In this paper, a study of personality disorders and psychopathy in imprisoned male batterers is carried out. A sample of 76 batterers sentenced for a severe offence of violence against their intimate partner was selected. All the participants were assessed with the MCMI-II before beginning a treatment program in prison for gender violence. Likewise, all participants were assessed with the PCL-R in order to identify psychopathic symptoms. According to the results, 86.8% of the sample showed at least one personality disorder. The most prevalent one was the Obsessive-compulsive Personality Disorder (57.8% of cases), followed by the Dependent Personality Disorder (34.2% of cases) and Paranoid Personality Disorder (25%). Regarding psychopathy, the results of PCL-R showed that there were 11 people (14.4% of the sample) who met the criteria for psychopathy or probable psychopathy. Finally, implications of this study for clinical practice and future research in this field are commented upon.     

The Roles of Childhood Maltreatment and Psychopathy in Sexual Recidivism of Treated Sex Offenders

Abstract

The Intensive Treatment Program for Sexual Offenders (ITPSO) at the Correctional Service of Canada (CSC) provides cognitive-behavioral group treatment to federally incarcerated sex offenders. Follow-up data for 81 of these men were examined, looking at psychopathy and childhood maltreatment history as potential predictors of recidivism using Survival Analysis. Offenders who had been placed in foster care as a child were more likely to recidivate; however when PCL-R Factor 2 scores (a history of antisocial behavior) were entered, they predicted over and above foster care history. Childhood physical abuse predicted sexual recidivism; however, childhood sexual abuse and PCL-R scores did not predict sexual recidivism. PCL-R Factor 2 scores predicted violent recidivism.     

The role of psychopathic personality disorder in violence risk assessments using the HCR-20

Antisocial and psychopathic traits are essential to evaluate when assessing risk for violence using the HCR-20. The role of the PCL-R on the HCR-20 was investigated using a series of meta-analytic tests. Across 34 samples in which both tools were rated, AUCs for violence were similar (～.69), and exclusion of the psychopathy item (H7) did not reduce the HCR-20's accuracy. Quantitative synthesis of results from multivariate analyses conducted in 7 raw datasets that used both tools demonstrated that the average probability of observing violence for every point increase on the HCR-20 (without H7), while controlling for the PCL-R, was 23%, whereas for the PCL-R it was -1%. The HCR-20 (without H7) added incremental validity to the PCL-R, whereas the converse was not true, and only the HCR-20 (without H7) possessed unique predictive validity. Results suggest the HCR-20's predictive validity was not negatively impacted by excluding the PCL-R. Areas for future study are discussed, including research on various ways to assess and incorporate into risk assessment personality traits related to violence.     

Validity of factors of the Psychopathy Checklist--Revised in female prisoners: discriminant relations with antisocial behavior, substance abuse, and personality

The validity of the Psychopathy Checklist-Revised (PCL-R) has been examined extensively in men, but its validity for women remains understudied. Specifically, the correlates of the general construct of psychopathy and its components as assessed by PCL-R total, factor, and facet scores have yet to be examined in depth. Based on previous research conducted with male offenders, a large female inmate sample was used to examine the patterns of relations between total, factor, and facet scores on the PCL-R and various criterion variables. These variables include ratings of psychopathy based on Cleckley's criteria, symptoms of antisocial personality disorder, and measures of substance use and abuse, criminal behavior, institutional misconduct, interpersonal aggression, normal range personality, intellectual functioning, and social background variables. Results were highly consistent with past findings in male samples and provide further evidence for the construct validity of the PCL-R two-factor and four-facet models across genders.     

Criterion-related validity of the three-factor model of psychopathy: personality, behavior, and adaptive functioning

The Psychopathy Checklist-Revised (PCL-R) has been conceptualized as indexing two distinct but correlated factors. Previous research has established that these factors demonstrate distinct patterns of relations with external criteria. However, more recent findings suggest that the PCL-R psychopathy construct may encompass three distinguishable factors, reflecting affective, interpersonal, and behavioral symptoms. Here, we evaluated the validity of this newer three-factor model of the PCL-R factors with reference to external criteria from the domains of personality, antisocial behavior; and adaptive functioning in a sample of 310 incarcerated offenders. The interpersonal factor was related to social dominance, low stress reactivity, and higher adaptive functioning; the affective factor was correlated with low social closeness and violent offending; and the behavioral factor was associated with negative emotionality, disinhibition, reactive aggression, and poor adaptive functioning. These findings provide support for the convergent and discriminant validity of these psychopathy facets.     

A bifactor approach to modeling the structure of the psychopathy checklist-revised

To date, models of the structure of psychopathy as assessed by the Psychopathy Checklist-Revised (PCL-R) have taken a higher-order approach in which the factors of the PCL-R are modeled as correlated elements of a higher-order psychopathy construct. Here, we propose an alternative structural model of the PCL-R, the bifactor model, which accounts for the covariance among PCL-R items in terms of a general factor reflecting the overlap across all items, and independent subfactors reflecting the unique coherency among particular groups of items. We present examples of how this alternative structural model can account for diverging associations between different subsets of PCL-R items and external criteria in the domains of personality and psychopathology, and we discuss implications of the bifactor model for future research on the conceptualization and assessment of psychopathy.     

Screening for Psychopathy: Validation of the Psychopathic Personality Inventory-Short Form with Reference Scores

The current study reports validation results for the Psychopathic Personality Inventory (PPI) and its subscales, and for a newly developed PPI-Short Form (PPI-SF) in forensic and non-forensic populations. We also provide criterion reference scores for the PPI and the PPI-SF. In Study 1, we used PPI data from 1,065 participants and supplementary PCL-R data from a subsample of 91 forensic offenders. Mokken scale analysis was used to construct the PPI-SF. In Study 2, PPI-SF and PCL-R data were collected from 60 participants. The study yielded promising but preliminary support for the construct validity of the PPI and the PPI-SF. The PPI-SF is of interest for risk assessment because of its (a) strong relationship with the PCL-R total score and (b) subscales known for their predictive value for violence and criminal recidivism.     

Does treatment really make psychopaths worse? A review of the evidence

We aimed to evaluate critically the evidence behind the perceived inverse association between the degree of psychopathy as reflected by a high score on the Hare Psychopathy Checklist-Revised (PCL-R) and treatment response. A literature search with the key identifiers of PCL-R (or its derivatives) and treatment response produced 24 studies that were then systematically evaluated. This showed that only three studies were of an appropriate research design to answer the question and of these, none met our standard for an acceptable study. We conclude therefore that the commonly held belief of an inverse relationship between high-scores on the PCL-R and treatment response has not been established.     

Psychopathy in women: a review of its clinical usefulness for assessing risk for aggression and criminality

Despite a flurry of studies examining psychopathy in women, and the recent release of the second version of the Hare Psychopathy Checklist--Revised manual, there is still little consensus whether the lateral extension of the current conceptualization of psychopathy to women is appropriate. In particular, very little agreement exists concerning the clinical utility of the Hare psychopathy measures to assess women's risk of future offending and violence. This article presents a comprehensive review of studies of the association between psychopathy, antisocial behavior, and violence, in diverse samples of women, and looks at similarities and differences between these constructs in males and females. Findings from inmates and offenders, civil and forensic psychiatric patients, substance abusers, and community samples indicate a consistently lower base rate of psychopathy among women than among men. With some exceptions, correlates of psychopathy in women relevant to risk assessments for crime and violence tend to be modest and significant, generally mirroring what we see in men. Clinicians and policy makers charged with the care and management of women at risk for criminal offending and violence are likely to find the PCL-R and PCL:SV have clinical utility; however, cautious application is called for and ongoing research is required.     

Coercive and precocious sexuality as a fundamental aspect of psychopathy

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.     

Response perseveration in psychopathic women.

Recent attempts to validate the Psychopathy Checklist-Revised (PCL-R) as a measure of psychopathy in female offenders have been limited by a failure to examine laboratory correlates of the syndrome. We assessed 112 incarcerated women by using the PCL-R and examined their performance on a card perseveration task that has been used to demonstrate response perseveration in psychopathic men. Contrary to prediction, psychopathic women did not perseverate responding when the PCL-R was used either dimensionally or categorically. The authors discuss the implications of the results for the PCL-R and for female psychopathy more generally.     

Two subtypes of psychopathic violent offenders that parallel primary and secondary variants

Although psychopathy usually is treated as a unitary construct, a seminal theory posits that there are 2 variants: Primary psychopathy is underpinned by an inherited affective deficit, whereas secondary psychopathy reflects an acquired affective disturbance. The authors investigated whether psychopathy phenotypically may be disaggregated into such types in a sample of 367 prison inmates convicted of violent crimes. Model-based cluster analysis of the Revised Psychopathy Checklist (PCL-R; R. D. Hare, 2003) and trait anxiety scores in the psychopathic subgroup (n = 123; PCL-R > or = 29) revealed 2 clusters. Relative to primary psychopaths, secondary psychopaths had greater trait anxiety, fewer psychopathic traits, and comparable levels of antisocial behavior. Across validation variables, secondary psychopaths manifested more borderline personality features, poorer interpersonal functioning (e.g., irritability, withdrawal, poor assertiveness), and more symptoms of major mental disorder than primary psychopaths. When compared with the nonpsychopathic subgroup (n = 243), the 2 psychopathic variants manifested a theoretically coherent pattern of differences. Implications for etiological research and violence prevention are discussed.     

The interpersonal measure of psychopathy: construct and incremental validity in male prisoners

The authors examined the construct and incremental validity of the Interpersonal Measure of Psychopathy (IM-P), a relatively new instrument designed to detect interpersonal behaviors associated with psychopathy. Observers of videotaped Psychopathy Checklist-Revised (PCL-R) interviews rated male prisoners (N = 93) on the IM-P. The IM-P correlated significantly with the PCL-R total score. Moreover, the IM-P was preferentially related to the interpersonal rather than the affective and antisocial lifestyle features of psychopathy. IM-P scores were significantly correlated with age, antisocial behaviors, and self-reported fear, anxiety, and socialization (in reverse). Hierarchical multiple regression analyses demonstrated that although the IM-P exhibited incremental validity beyond the PCL-R total score in detecting self-reported fear, anxiety, and several personality traits, it did not exhibit much incremental validity beyond PCL-R Factor 1. These findings raise questions concerning the unique assessment contribution of the IM-P beyond PCL-R Factor 1. Potential reasons for these findings and alternative means of enhancing the interpersonal assessment of psychopathy are discussed.     

Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder.     

Reconstruing the "reconstruction" of psychopathy: a comment on Cooke, Michie, Hart, and Clark

In this comment we highlight critical problems in the estimation of parameters for their hierarchical three-factor model of psychopathy, as assessed with the Hare Psychopathy Checklist, and their interpretation of these factors as causally related to socially deviant behavior. We argue that there is nothing "causal" about a model in which cross-sectional data are used to assert that antisocial tendencies are consequences of other more fundamental psychopathic traits. We present an equally viable model, based on the PCL-R four-factor solution, in which antisocial tendencies play a fundamental role in the construct of psychopathy, consistent with previous research and clinical tradition.