Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy?

Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.     

The relationship between psychopathic features, violence and treatment outcome: the comparison of three youth measures of psychopathic features

Few studies have compared self-report and clinician-administered measures of youth psychopathic features in juvenile-justice settings in terms of antisocial behavior and treatment indices. In a sample of 85 adjudicated delinquents, the predictive validities of the Antisocial Process Screening Device (APSD), the modified Childhood Psychopathy Scale (mCPS), and the Hare Psychopathy Checklist: Youth Version (PCL:YV) were tested. Three indices of institutional antisocial behavior (physical aggression; verbal aggression; administrative infractions) and two indices of treatment progress (time to treatment level promotion; whether treatment levels were dropped) were used as external correlates. The self-report measures (mCPS more so than APSD) were more consistently and strongly related to antisocial behavior and to the days required to progress in treatment than the PCL:YV. The following issues are discussed: (i) implications of the potential impact of measurement format on the understanding and predictive validity of youth psychopathy features and measures; (ii) the differential predictive validity of self-report versus clinician-administered measures; and (iii) the potential practical utility of measures of psychopathic features in youth.     

Psychopathy traits and the processing of emotion words: Results of a lexical decision task

Research has indicated that individuals possessing psychopathic traits exhibit a deficit in the processing of emotional stimuli. Lexical decision task studies found that psychopathic individuals do not demonstrate affective facilitation in processing emotional words relative to nonpsychopathic individuals. However, these investigations have not examined processing of discrete affective categories and their relation to the callous/unemotional (F1) and impulse control/antisocial (F2) factors of psychopathy. Sixty undergraduate men completed a self-report measure of psychopathy traits and a lexical decision task assessing response latencies to anger, sadness, fear, and happiness words. Results reflected an association between F2 and a heightened experience of anger, whereas F1 was associated with a diminished experience of sadness. Findings are discussed in terms of the relation to existing research using alternative methods of processing affect.     

Psychopathic Personality Traits and Somatization: Sex Differences and the Mediating Role of Negative Emotionality

Although a number of investigations have provided evidence for an association between antisocial personality disorder and somatization disorder, the variables underlying this association remain unknown. We examined the relations among measures of primary and secondary psychopathy, somatization, and negative emotionality (NE) in 150 undergraduates. Somatization was positively and significantly correlated with measures of secondary, but not primary, psychopathy, and the relations between secondary psychopathy indices and somatization tended to be significantly stronger in females than in males. Some support was found for the hypothesis that the association between secondary psychopathy and somatization is mediated by NE, but not for the hypothesis that low levels of behavioral inhibition lead to somatization. Although the present findings are consistent with the possibility that somatization is a sex-differentiated manifestation of secondary psychopathic traits, replication of these findings in clinical samples will be necessary.     

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.     

The reliability, stability, and predictive utility of the self-report version of the Antisocial Process Screening Device

The psychometric properties of the self-report version of the Antisocial Processes Screening Device (APSD; Frick & Hare, 2001), a rating scale developed to assess traits associated with the construct of psychopathy in youth, was tested in a sample of 91 non-referred young adolescents with an average age of 13.38 (SD = 1.75) at the initial assessment. The sample was recruited from a large community-wide screening, where youth with conduct problems and youth high on psychopathic traits were over-sampled. The sample was reassessed three times at yearly intervals. The self-report scores on the APSD showed moderate correlations with parent ratings of psychopathic traits, were moderately stable across 1-2 years, and showed significant correlations with measures of antisocial behavior both concurrently and predictively. One major weakness of the self-report ratings was the low internal consistency of the subscales, which were much lower than the internal consistency found on the parent report version of the scale.     

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.     

Secondary psychopathy,but not primary psychopathy,is associated with risky decision-making in noninstitutionalized young adults

Although risky decision-making has been posited to contribute to the maladaptive behavior of individuals with psychopathic tendencies, the performance of psychopathic groups on a common task of risky decision-making, the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994), has been equivocal. Different aspects of psychopathy (personality traits, antisocial deviance) and/or moderating variables may help to explain these inconsistent findings. In a sample of college students (N = 129, age 18–27), we examined the relationship between primary and secondary psychopathic features and IGT performance. A measure of impulsivity was included to investigate its potential as a moderator. In a joint model including main effects and interactions between primary psychopathy, secondary psychopathy and impulsivity, only secondary psychopathy was significantly related to risky IGT performance, and this effect was not moderated by the other variables. This finding supports the growing literature suggesting that secondary psychopathy is a better predictor of decision-making problems than the primary psychopathic personality traits of lack of empathy and remorselessness.     

Self-reported psychopathy: a validation study.

Two studies are reported examining the reliability and validity of Levenson's Self-Report Psychopathy Scale (LSRP; Levenson, Kiehl, & Fitzpatrick, 1995) in a noninstitutionalized population. The first study used 1,958 undergraduates to examine the factor structure of the LSRP and its relation to serious antisocial behavior and common dimensions of personality. The second study (n = 70) included performance tasks known to discriminate psychopathic from nonpsychopathic prisoners. Results of the studies support the reliability and validity of the LSRP. The 2-factor structure of the inventory was strongly replicated in a series of confirmatory factor analyses. Predicted relations were observed between the LSRP and other self-report instruments of delinquency. In addition, the factors of the LSRP demonstrated the predicted divergent relations to traditional personality traits. Finally, psychopathic undergraduates showed deficits in response modulation similar to those observed in incarcerated psychopaths. Implications for psychopathy in general are also discussed.     

Psychopathic traits and externalizing behaviors: a comparison of self- and informant reports in the statistical prediction of externalizing behaviors

It has long been assumed that features associated with psychopathy, such as a lack of insight and deceitfulness, may compromise the utility of self-report measures, particularly for understanding the relations between these traits and important outcomes (e.g., offending). Unfortunately, little research has explicitly examined the relations between self- and informant reports of psychopathy and their relations to these outcomes. The current study examined the incremental validity of self- and informant reports of psychopathic traits, assessed with 3 validated psychopathy measures, in the statistical prediction of externalizing behaviors (EBs). To reduce shared method variance, self- and informant reports of EBs (i.e., substance use, antisocial behavior, gambling, and intimate partner violence) were examined separately. Results indicate that both self- and informant reports of psychopathy are related to EBs and provide some degree of incremental validity, although self-reported psychopathy scores proved slightly more useful than other-reported psychopathy scores. These findings suggest that, in nonforensic settings, psychopathy data derived from both self- and other-reported psychopathy measures have utility in understanding the relations between psychopathic traits and EBs.     

Child Psychopathy: Theories,Measurement, and Relations with the Development and Persistence of Conduct Problems

To develop more accurate explanatory and predictive models of child and adolescent conduct problems, interest has grown in examining psychopathic traits in youth. The presence or absence of these traits may help to identify unique etiological pathways in the development of antisocial behavior. The current review provides a detailed summary and analysis of (a) the conceptualization and measurement of child and adolescent psychopathy, (b) research on relations between psychopathic traits and a range of conduct problems and associated variables, (c) efforts to utilize data on child and adolescent psychopathy to delineate a subgroup of youth whose conduct problems share a relatively homogenous etiology and developmental trajectory, and (d) current challenges and limitations in the study of youth psychopathy and directions for future research efforts. Specific sections include the origins of the youth psychopathy construct, conceptualization and measurement, relations between psychopathic traits and conduct problems, relations between measures of psychopathy and measures of individual and contextual variables, efforts to identify a unique subgroup of children with conduct problems using psychopathic traits, and finally, challenges that face the field and goals for the next generation of research.     

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.     

Assessing the basic traits associated with psychopathy: development and validation of the Elemental Psychopathy Assessment

A new self-report assessment of the basic traits of psychopathy was developed with a general trait model of personality (five-factor model [FFM]) as a framework. Scales were written to assess maladaptive variants of the 18 FFM traits that are robustly related to psychopathy across a variety of perspectives including empirical correlations, expert ratings, and translations of extant assessments. Across 3 independent undergraduate samples (N = 210-354), the Elemental Psychopathy Assessment (EPA) scales proved to be internally consistent and unidimensional, and were strongly related to the original FFM scales from which they were derived (mean convergent r = .66). The EPA scales also demonstrated substantial incremental validity in the prediction of existing psychopathy measures over their FFM counterparts. When summed to form a psychopathy total score, the EPA was substantially correlated with 3 commonly used psychopathy measures (mean r = .81). Finally, in a small male forensic sample (N = 70), the EPA was significantly correlated with scores on a widely used self-report psychopathy measure, disciplinary infractions, alcohol use, and antisocial behavior. The EPA provides an opportunity to examine psychopathy and its nomological network through smaller, more basic units of personality rather than by scales or factors that blend these elements.     

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.     

Psychopathy and COVID-19: Callousness,impulsivity, and motivational reasons for engaging in prevention behavior

Two direct replication studies were conducted to investigate the associations of psychopathic traits with engagement in COVID-19 prevention behavior and motivational reasons for engaging in such behavior. College undergraduate students completed two self-report measures of psychopathic traits based on the four-factor conceptualization of psychopathy (callous affect, manipulative tendency, erratic lifestyle, criminal tendency) and the triarchic conceptualization of psychopathy (meanness, disinhibition, boldness). Participants then reported the degree to which they engaged in COVID-19 prevention behavior currently and in the past, and reported their self-focused and other-focused motivational reasons for doing so. Results aggregated across both studies (N = 292) revealed that traits reflecting emotional callousness and impulsivity independently predicted lower levels of other-focused reasons for engaging in prevention behavior. Moreover, controlling for other-focused reasons appreciably reduced negative associations of emotional callousness and impulsivity with prevention behavior. The results provide insight into points of convergence in conceptualization and measurement of psychopathy from multiple theoretical perspectives and the importance of considering the impact of divisive personality traits on motivation to protect others during pandemics.     

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.     

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.     

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 Traits in Boys With and Without Attention-Deficit/Hyperactivity Disorder: Concurrent and Longitudinal Correlates

To investigate the role of psychopathic traits in a clinical and comparison sample, we obtained dimensional California Child Q-Set (CCQ) personality profiles for 66 preadolescent boys with attention-deficit/hyperactivity disorder (ADHD) and 56 comparison boys during naturalistic summer programs and correlated each boy's CCQ profile with an expert-derived CCQ psychopathy prototype. These scores, representing each boy's degree of similarity to the prototype, were significantly associated with concurrent externalizing diagnoses and symptoms and, with statistical control of these externalizing features, concurrent measures of objectively observed noncompliance, overt and covert antisocial behavior, and peer sociometric nominations indexing peer rejection. Psychopathic traits were not associated with peer acceptance. CCQ psychopathy dimension scores also predicted severity of delinquency at a 5-7-year prospective follow-up, with statistical control of age, baseline externalizing diagnoses and symptoms, and baseline objective observations of antisocial behavior. Predictions held when overt behavioral items from the CCQ, which may have overlapped with the delinquency outcome criterion, were eliminated. Despite these strong effects, a plethora of false positives were evident in the prospective predictions to delinquency status. We discuss research and clinical implications of measuring psychopathic traits in childhood.