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.     

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.     

Troubled or Traumatized Youth? The Relations Between Psychopathy,Violence Exposure,Posttraumatic Stress Disorder,and Antisocial Behavior Among Juvenile Offenders

The current study examined how psychopathy, exposure to violence, and posttraumatic stress disorder (PTSD) are associated with antisocial behavior among 1,354 serious delinquent adolescents from the Pathways to Desistance study. Results showed that psychopathy, violence exposure, and PTSD are independently linked to self-reported involvement of delinquency, even after controlling for respondents’ demographic characteristics. However, the effect of PTSD on antisocial behavior was small. Differential associations were observed between the 2 factors of psychopathy, interpersonal/affective and social deviance, and PTSD symptoms. Specifically, the effect of social deviance characteristics on delinquency was above and beyond that of interpersonal/affective features. In addition, exposure to violence as a victim or witness were uniquely associated with increased delinquent behavior. Findings clarified the relations among psychopathy, violence exposure, PTSD, and antisocial behavior, and highlighted the differential links between psychopathy factors and delinquency.     

The Latent Structure of Psychopathy in Youth: A Taxometric Investigation

Using taxometric procedures, the latent structure of psychopathy was investigated in two studies of children and adolescents. Prior studies have identified a taxon (i.e., a natural category) associated with antisocial behavior in adults as well as children and adolescents. However, features of this taxon suggest that it is not psychopathy but rather a broader class consistent with the construct of life course persistent antisocial behavior. Because the only prior study of youth used a non-clinical sample, the base rate of psychopathy may have been too low to reveal a psychopathy taxon, especially against the background of a broader and more prevalent antisocial behavior taxon. Therefore, this investigation sought to increase the likelihood of finding a psychopathy taxon (should one exist) by increasing its expected base rate through inclusion of clinical cases in the samples studied. Results produced evidence for both a broad antisocial behavior problem taxon consistent with past research and a much lower base rate taxon consistent with prevalence expectations for psychopathy. These findings support the existence of latent taxa for both psychopathy and a broader class of antisocial behavior problems. Further taxometric research appears to be warranted, which should use a broader array of indicators, with greater specificity to psychopathy.     

Treatment and psychopathy in forensic settings

People commonly question whether highly psychopathic offenders are treatable. Little scientific research has addressed this question despite key developments in the last 20 years in two relevant areas: reliable measurement of psychopathy, and effective treatments for reducing criminal and antisocial behavior in offenders. One obstacle to progress is confusion about defining psychopathy; a necessary preliminary step to advancing intervention. After outlining the principal definitional issues, we review past and recent research on psychopathy and treatment, concluding that a handful of newer, well-designed studies suggest grounds for optimism about psychopathy and treatability. Although psychopathy characteristics—along with other indices of criminal risk—signal responsivity challenges, well-conceived programs for higher risk offenders can reduce recidivism in highly psychopathic offenders and appear to do so by reducing dynamic risk factors. There are no clear indications yet of whether PCL-psychopathic offenders differ from other high-risk offenders in their ability to respond to such treatments. The questions of whether psychopathy itself responds to treatment, and if so, what forms such treatment might take have not yet been addressed. We conclude by suggesting that advances will come from the use of more divergent measures of psychopathy, and in particular, dynamic measures of psychopathy traits that will allow us to document whether change is occurring.     

Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: screening version

Recently, psychopathy has become virtually synonymous with the Psychopathy Checklist (PCL) measures. However, the "gold standard" 2-factor model that underlines these measures has been questioned for its uncertain empirical support and emphasis on antisocial behavior that is not specific to psychopathic personality deviation. This study (N = 870 civil psychiatric patients) compares the fit of the traditional 2-factor model with that of a revised 3-factor model of psychopathy. The revised model better describes the structure of the Screening Version of the PCL (PCL:SV) than the traditional model. Although the revised model's exclusion of some items that assess antisocial behavior reduces the PCL:SV's power in predicting patient violence, this model arguably assesses psychopathy in a more specific, theoretically coherent fashion that may reduce misapplications of the construct. Implications for future research are discussed.     

Empathy Deficit in Antisocial Personality Disorder: A Psychodynamic Formulation

Empathic difficulty is a highly consequential characteristic of antisocial personality structure. The origin, maintenance, and possible resolution of this profound deficit are not very clear. While reconstructing empathic ability is of primary importance in the treatment of antisocial personality, not many proven procedures are in evidence. In this article, the author offers a psychodynamic formulation of the origin, character, and maintenance of the empathic deficiency in antisocial personality. The author discusses some of the treatment implications from this dynamic formulation.     

Predictive validity of the Dutch PCL:YV for institutional disruptive behavior: findings from two samples of male adolescents in a juvenile justice treatment institution

The present prospective study examined the predictive validity of the Dutch version of the Psychopathy Check List: Youth Version for disruptive behavior in male adolescents during treatment. The study comprised two samples admitted to different secure treatment institutions in The Netherlands, Jongerenhuis Harreveld (n = 81) and Rentray (n = 66). Overall, the results demonstrate that psychopathy is a significant predictor of institutional disruptive behavior, and physical violence in particular. Furthermore, Hare's traditional Factor 2 was more strongly related to disruptive incidents than Factor 1. By using the recently proposed three- and four-factor models of psychopathy, insight into the pattern of associations between psychopathy dimensions and different types of disruptive behavior was obtained. The antisocial dimension of psychopathy appeared to be more strongly related to severe incidents than the lifestyle dimension. Regression analyses identified significant contributions of the antisocial and lifestyle dimensions to the prediction of incidents. The relatively small degree of variance explained underlines the importance of other risk factors to identify adolescents at risk of disruptive behavior during institutional treatment.     

Psychopathy in a forensic sample – the factor structure of the PCL:SV in a Danish forensic sample

The research literature reveals an ongoing debate regarding the most appropriate conceptualization of psychopathic personality disorder. Specifically, it is discussed to what degree antisocial behavior is part of the conceptualization of the psychopathy construct and what constitutes the best factor model of the Psychopathy Checklist scales. The aim of the present study is to consider the underlying factor structure of the PCL:SV (Psychopathy Checklist Screening Version) in a Danish sample as well as considering the role of antisocial behavior in the psychopathy construct. Data from a Danish forensic patient sample (N = 225) was used and item response theory (IRT), aonfirmatory factor analyses (CFA) and structural equations model (SEM) analyses were carried out. Overall, the findings suggest appropriate item and model fit for the PCL:SV as well as superiority of the three‐factor model over the four‐factor model. The results are discussed in relation to the broader concept of personality disorder as well as clinical practice in regards to violence risk assessments and treatment of psychopathy.     

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.     

Sadistic personality disorder in sex offenders: relationship to antisocial personality disorder and sexual sadism.

To investigate the relationship of sadistic personality disorder (SPD), as defined in the appendix of DSM-III-R, to other personality disorders and to sexual sadism, 70 sex offenders (27 child molesters, 33 rapists, and 10 murderers) were assessed by the International Personality Disorder Examination. In 19 subjects (27.2%) from the total sample, SPD was diagnosed. The highest overlap appeared with borderline personality disorder (31.6%) and antisocial personality disorder (42.1%). However, in four cases SPD was the only personality disorder diagnosed. Factor analysis of the antisocial and sadistic criteria resulted in four major factors--one factor with high loadings on the sadistic criteria and the violent criteria of antisocial personality disorder, two factors with different forms of adult and juvenile aggression, and a fourth factor with high loadings on the antisocial criteria covering exploitative behavior. The results do not support SPD as a discrete disorder. Nevertheless, SPD may be seen as an important subdimension of antisocial personality disorder, distinct from more exploitative forms of antisocial behavior with less violence. Of those patients with SPD, 42.1% also had a DSM-III-R diagnosis of sexual sadism, which may be the most dangerous configuration.     

The Association between Anxiety and Psychopathy Dimensions in Children

Although several theoretical models posit that low levels of anxiety are a risk factor for psychopathy and antisocial behavior, a number of studies have reported elevated levels of anxiety among antisocial individuals. Nevertheless, most investigators in this literature have not distinguished between fearfulness and trait anxiety or attempted to separate the antisocial lifestyle dimension from the callous and unemotional dimension of psychopathy. In a study of clinically referred children (N = 143), we found that (a) measures of trait anxiety and fearlessness (low fearfulness) exhibited low correlations; (b) conduct problems tended to be positively correlated with trait anxiety, whereas callous and unemotional traits tended to be negatively correlated with trait anxiety; and (c) controlling statistically for the effects of one dimension increased the divergent correlations of the other dimension with both trait anxiety and fearful inhibition. These findings bear potentially important implications for the diagnosis and etiology of psychopathy and antisocial behavior and suggest that distinctions between trait anxiety and fearful inhibition, as well as between the two dimensions of psychopathy, may help to clarify longstanding confusion in this literature.     

Who cares when nobody is watching? Psychopathic traits and empathy in prosocial behaviors

Prosocial behaviors are voluntary acts intended to benefit others. Lack of empathy is a core feature of psychopathy, a constellation of personality traits that includes callousness, egocentricity, and antisociality. While psychopathy is often associated with antisocial behavior, its relation to prosociality may depend upon the class of prosocial behavior and facet of psychopathy considered. Public prosocial behavior may be more motivated by extrinsic social rewards than anonymous prosociality, which may be more motivated by empathy and altruistic motives. It was hypothesized that primary psychopathy, especially affective callousness, would be positively and uniquely associated with public prosociality, and inversely associated with anonymous and altruistic prosociality, and that these associations would be mediated by empathy. In contrast, secondary psychopathy was expected to be weakly and inversely associated with all three types of prosocial behavior and with empathy. In an undergraduate student sample (n = 539), unique and interaction effects were tested in hierarchical regression. Predictions were supported for primary psychopathy. Gender did not moderate associations. Theoretical and practical implications are considered.     

A taxometric analysis of the latent structure of psychopathy: evidence for dimensionality

The taxonomic status of psychopathy is controversial. Whereas some studies have found evidence that psychopathy, at least its antisocial component, is distributed as a taxon, others have found that both major components of psychopathy-callousness/unemotionality and impulsivity/antisocial behavior-appear to distribute as dimensions and show little evidence of taxonicity. In the present study, recent advances in taxometric analysis were added to P. Meehl's (1995) multiple consistency tests strategy for assessing taxonicity, and they were applied to Psychopathy Checklist-Revised (R. D. Hare, 2003) ratings of 4,865 offenders sampled from multiple forensic settings. The results indicated that both the individual components of psychopathy and their interface are distributed dimensionally. Both the implications of these results for research in psychopathy and the integration of these findings with previous taxometric studies of psychopathy are discussed.     

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.     

Personality disorder and antisocial deviance: comments on the debate on the structure of the psychopathy checklist-revised

The recent debate on the structure of the Psychopathy Checklist-Revised (PCL-R: Hare, 1991; 2003) has been presented primarily as a statistical issue, but underlying it are longstanding conceptual issues about the relationship of personality concepts to deviant behavior and of psychopathy to criminality and personality disorder. I discuss these issues in this paper. The antisocial items of the PCL-R seem to reflect a propensity to commit crimes that has long been of interest to criminology. This disposition overlaps with, but differs conceptually from personality dispositions, but these surface dispositions do not provide a causal account of criminality. I present data that indicate that the core personality characteristics of psychopathy are more closely related to narcissistic and histrionic personality disorders than to antisocial personality disorder. Overemphasis on involvement in crime has obscured the nature of psychopathy as a disorder of personality characterised by interpersonally harmful behavior that need not necessarily take criminal form.     

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.     

Subtypes of adolescent offenders: affective traits and antisocial behavior patterns

Etiological models of life-course persistent offending often emphasize behavioral explanations. Suggestions that persistent offenders have psychopathy ignore the distinct non-behavioral features of the psychopathy disorder. Using a three-factor model of the PCL-YV and cluster analysis with 259 incarcerated adolescents, we identified four distinct juvenile subtypes on the basis of affective, interpersonal, and behavioral dimensions. Prospective and retrospective comparisons of antisocial behavior patterns found the cluster comprising all three psychopathy dimensions to be the most chronic and severe. Impulsive features alone were strongly associated with severe antisocial behaviors retrospectively, but not prospectively. Findings rebut the proposal that disruptive behavioral and impulsive symptoms can identify "fledgling psychopaths." Assessments that disregard callous-unemotional traits will likely result in high false positive rates among serious adolescent offenders. Implications for developmental models of chronic offending are discussed in light of the need for further follow-up into adulthood.     

Theory of Mind and conduct problems in children: Deficits in reading the “emotions of the eyes”

A significant clinical feature of disorders of antisocial behaviour involves difficulties in social functioning. It has been suggested that deficits in “theory of mind” (ToM) reasoning—the ability to decode others’ emotions and thoughts—may underlie social difficulties in these populations. Success in demonstrating ToM impairment associated with antisocial behaviour and psychopathy in adults and children have been limited. In the current study, parent-reported conduct problems were concurrently measured with performance on an advanced test of ToM developed for children, the Child Eyes Test (Journal of Developmental and Learning Disorders, 5, 47–78). Preadolescent and young adolescent children (n=79) drawn from a community sample were required to identify emotions from photographic stimuli depicting the eye region of the face only. Findings suggested a generalised impairment in ToM in children with conduct problems, as indicated by a significant relationship between poor Eyes Test performance and conduct problems, even when IQ, sex and age were controlled for. The findings are discussed in the context of the amygdala theory of psychopathy, and the neural systems suggested to mediate performance on the Eyes Test.     

Differential Associations Between Psychopathy Dimensions,Types of Aggression,and Response Inhibition

Findings on executive functioning in psychopathy are inconsistent. Different associations between psychopathy dimensions and executive functioning might explain contradicting findings. This study examined the role of psychopathy dimensions and types of aggression in response inhibition among 117 male adolescents (53 antisocial delinquents and 64 controls). Participants completed a self‐report measure of aggression and a GoNoGo task. Psychopathy dimensions were assessed using the Psychopathy Checklist: Youth Version. Although high scores on the antisocial dimension and reactive aggression were associated with poor response inhibition, the affective–interpersonal dimension, proactive aggression, and verbal intelligence (IQ) were related to better response inhibition (two‐factor model). Associations with the affective–interpersonal dimensions did not reach significance. Exploratory analyses showed that affective and antisocial facets accounted for the obtained opposing associations of the affective–interpersonal and antisocial psychopathy dimensions with response inhibition. The interpersonal and lifestyle facets (four‐facet model) were unrelated to response inhibition. Results could not be explained by Attention Deficit Hyperactivity Disorder (ADHD). Findings suggest differential associations between the psychopathy dimensions, types of aggression, and response inhibition. Therefore, a dimensional approach to psychopathy and related concepts, such as aggression, might strongly improve diagnostic procedures. Global scores could mask important differential associations. Aggr. Behav. 38:77‐88, 2012. © 2011 Wiley Periodicals, Inc.