Psychopathy and the DSM-IV criteria for antisocial personality disorder

The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. We describe an alternative to the approach taken in the rev. 3rd ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. We also discuss the multisite APD field trials designed to evaluate and compare four criteria sets: the DSM-III-R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th ed. of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist.     

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.     

Substance-related disorders among juvenile offenders: what role do psychopathic traits play?

Substance use disorders are associated with psychopathy, a personality disorder that is heterogeneous in both adults and youth; secondary variants of psychopathy with comorbid psychopathology and primary variants without comorbidity show distinct correlates and outcomes. In adult criminal populations, secondary variants report greater substance abuse compared with primary variants. The primary aim of this study is to replicate and extend these findings to a juvenile offender population. Compared with primary variants of juvenile psychopathy, secondary variants (a) reported significantly more frequent substance use--particularly alcohol--within the 6 months prior to incarceration (d = .43), (b) were almost twice as likely to abuse substances while incarcerated, and (c) were more likely to be diagnosed with a current Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV; American Psychiatric Association, 2000) substance use disorder. Practical implications for working with justice-involved youth are discussed.     

An empirical study of object relations and defensive operations in antisocial personality disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (greater than or equal to 30) and the moderate psychopaths (less than 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-III-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

Construct validity of psychopathy in a community sample: a nomological net approach.

The construct validity of psychopathy was examined within a sample of 326 male and female university students. The interpersonal circumplex served as a nomological net for the examination of convergences between psychopathy measures and convergent and discriminant validity with a measure of personality disorders was examined using a matrix approach. Measures included: (a) Antisocial scale of the Personality Assessment Inventory (Morey, 1991); (b) Self-Report Psychopathy scale (Hare, 1991); (c) Psychopathic Personality Inventory (Lilienfeld & Andrews, 1996); (d) Personality Diagnostic Questionnaire-4 (Hyler, 1994); and (e) Interpersonal Adjective Scales Revised-Big 5 (Trapnell & Wiggins, 1991). Results indicated (a) substantial convergence between psychopathy measures; (b) high convergent validity between psychopathy measures and antisocial personality disorder; and (c) high discriminant validity from other personality disorders. The prevalence of psychopathy within this non-forensic sample is also discussed.     

Using the FFM to conceptualize psychopathy: a test using a drug abusing sample

The present study examined whether psychopathy can be understood as a constellation of traits from the Five Factor Model (FFM) of personality. Using a prototype matching approach, we examined the ability of the Revised NEO Personality Inventory (NEO PI-R; Costa & McCrae, 1992) to represent psychopathy in a sample of 297 male and female known crack cocaine abusers. Importantly, we examined the convergence and divergence between FFM psychopathy and other personality disorders assessed using the FFM. FFM psychopathy was correlated with self-reports of antisocial behavior, drug use, risky sex, and externalizing and internalizing disorder symptoms. As expected, there was overlap in the relations between psychopathy and several Cluster B personality disorders, but there were also important points of divergence. These results further extend the nomological network of FFM psychopathy and provide additional support for considering psychopathy a constellation of personality traits from a general model.     

An Empirical Study of Object Relations and Defensive Operations in Antisocial Personality Disorder

This study assessed the object relations, defensive operations, and level of psychopathy and narcissism in a group of antisocial personality disordered offenders. The Rorschach protocols of 33 subjects who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-111-R], American Psychiatric Association, 1987) criteria for antisocial personality disorder were analyzed utilizing Kwawer's (1980) criteria for borderline object relations categories (borderline phenomena), the Lerner and Lerner (1980) Defense Scale, and a number of experimental criteria including Cooper and Arnow's (1986) defense criteria. Level of narcissism was assessed utilizing Exner's (1973) Self-Focus Sentence Completion Test. Hare's Psychopathy Checklist was used as an independent variable to determine a subject's level of psychopathy. Those subjects scoring 30 or more on the psychopathy checklist were compared to subjects scoring less than 30. The level of narcissism or proportion of defenses did not differ significantly between the severe psychopaths (230) and the moderate psychopaths (< 30). The severe psychopaths produced a significantly greater number of borderline object relations. I conclude that antisocial individuals tend to be highly egocentric, and that narcissism is one component of psychopathy. Severe psychopaths, as a group, tend to be more borderline in their functioning than those exhibiting moderate levels of psychopathic disturbance. I also conclude that individuals who are incarcerated for felony offenses and also meet the DSM-111-R criteria for antisocial personality disorder exhibit degrees of borderline personality organization.     

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.     

Callous-Unemotional Traits Modulate Brain Drug Craving Response in High-Risk Young Offenders

Adults with psychopathy have a high propensity for substance abuse, generally starting from a young age. This investigation tested hypotheses about differences in the neural responses associated with drug craving among high-risk young offenders with histories of abuse of stimulants and other drugs as a function of psychopathic traits. Fifty-four male adolescents (44 with a history of stimulant abuse and 10 controls) incarcerated at a maximum-security facility (M age = 17.08 years) completed a drug-cue exposure task while brain hemodynamic activity was monitored using functional magnetic resonance imaging (fMRI) with a mobile MRI scanner stationed at the facility. Psychopathic traits were assessed using the Hare Psychopathy Checklist: Youth Version (PCL:YV). In the stimulant abuser group, drug cues elicited activity in classic reward circuitry. Consistent with studies of adult psychopathic traits and substance abuse, there was a negative association between PCL-YV scores and hemodynamic response related to drug craving in the amygdala and ACC in youth with a history of stimulant abuse. However, there were considerably more negative associations between the PCL:YV and hemodynamic response among youth than adults and this was primarily due to callous-unemotional traits rather than interpersonal or behavioral traits. The implications for how personality traits modulate motivations for drug-seeking behavior among adolescent offenders are discussed.     

Commentary on Reconceptualizing Personality Disorder Categories Using Trait Dimensions

The present study examined Widiger and Lynam's (1998) hypothesis that psychopathy can be represented using the Five-Factor Model (FFM) of personality. Participants in the study consisted of 481 21-22-year-old men and women who are part of an ongoing longitudinal study. Psychopathy was assessed by the degree of similarity between an individual's NEO-PI-R and an expert-generated FFM psychopathy prototype. The expert-based prototype supported the account of Widiger and Lynam (1998), as did the correlations between the NEO-PI-R Psychopathy Resemblance Index (PRI) and the individual personality dimensions. The PRI was also related in predicted ways to measures of antisocial behavior, drug use, and psychopathology. The results support the contention that psychopathy can be understood as an extreme variant of common dimensions of personality, and underscore the utility of a dimensional model of personality disorders.     

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality,Internalizing, and Externalizing Disorders

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model. Kevin A. Yoder and Susan L. Longley made equal contributions to this paper.     

Psychopathy in Bulgaria: The cross-cultural generalizability of the Hare Psychopathy Checklist

The generalizability of the psychopathy construct to Eastern European cultures has not been well-studied, and no prior studies have evaluated psychopathy in non-offender samples from this population. The current validation study examines the factor structure, internal consistency, and external validity of the Bulgarian translation of the Hare Psychopathy Checklist: Screening Version. Two hundred sixty-two Bulgarian adults from the general community were assessed, of which 185 had a history of substance dependence. Confirmatory factor analysis indicated good fit for the two-, three-, and four-factor models of psychopathy. Zero-order and partial correlation analyses were conducted between the two factors of psychopathy and criterion measures of antisocial behavior, internalizing and externalizing psychopathology, personality traits, addictive disorders and demographic characteristics. Relationships to external variables provided evidence for the convergent and discriminant validity of the psychopathy construct in a Bulgarian community sample.     

Factor structure of the psychopathic personality inventory: validity and implications for clinical assessment

Psychopathy is a personality disorder characterized by impulsive antisocial deviance in the context of emotional and interpersonal detachment. A factor analysis of the subscales of the Psychopathic Personality Inventory (PPI) yielded evidence for 2 factors. One factor showed relations with external criteria mirroring those of the emotional-interpersonal facet of psychopathy, including high dominance, low anxiety, and venturesomeness. The other factor showed relations paralleling those of the social deviance facet of psychopathy, including positive correlations with antisocial behavior and substance abuse, negative correlations with socioeconomic status and verbal ability, and personality characteristics including high negative emotionally and low behavioral constraint. Findings support using the PPI to assess these facets of psychopathy in community samples and to explore their behavioral correlates and genetic-neurobiological underpinnings.     

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes.     

The problems of internal validation without a theoretical context: the different conceptual underpinnings of psychopathy and the disruptive behavior disorder criteria

G. L. Burns (2000) has concluded that the Psychopathy Screening Device's content is limited because it contains items that overlap with criteria for several disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The problem with G. L. Burns's analysis is that it was conducted without an adequate understanding or specification of the conceptual underpinnings of either the construct of psychopathy or the constructs assessed by the DSM criteria. This reply attempts to clarify these conceptual frameworks to illustrate that to judge the adequacy of the content of a measure of psychopathy by comparing it with DSM criteria is inconsistent with the differing theoretical frameworks underlying these classification systems. Forcing measures of psychopathy to be designed around DSM criteria leads to inadequate measures of psychopathy and can limit advances both in our understanding of developmental precursors to psychopathy and in the classification of DSM disorders.     

The role of gender in the clinical presentation of patients with borderline personality disorder

This study examined gender differences in the pattern of comorbid disorders and degree of impairment among outpatients with borderline personality disorder (BPD). A total of 130 outpatients with BPD were assessed for various lifetime impulse-related disorders and post-traumatic stress disorder and for indices of impairment. Compared with women with BPD, men with BPD reported significantly more lifetime substance abuse disorders, antisocial personality and met criteria of intermittent explosive disorder that did not overlap with a diagnosis of BPD. Women with BPD reported significantly more lifetime eating disorders than men with BPD. No gender differences were found in degree of overall impairment. These results suggest that male and female patients with BPD, although equally distressed, present with different lifetime patterns of impulse-related disorders.     

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

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

Psychopathy 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.     

Psychological implications of the Psychopathy Q-sort

The construct validity of the Psychopathy Q-sort (PQS; Reise & Oliver, 1994) was investigated by correlating it with an array of observer-based and self-report personality measures in a sample of 350 men and women assessed at the Institute of Personality Assessment and Research (IPAR). High discriminant validity of the PQS was indicated by a pattern of significant correlations with self-report measures of the Cluster B personality disorder scales of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1980) and the absence of correlations with scales belonging to Clusters A and C of the manual. The PQS also correlated positively with the California Psychological Inventory measures of social poise and assurance and correlated negatively with measures of normative control of impulse. Gender differences in psychopathy were explored using Adjective Check List (Gough & Heilbrun, 1983) ratings provided by IPAR staff observers and by 76 pairs of spouses.     

Convergence and divergence among self-report psychopathy measures: a personality-based approach

The study examined, in a sample of 346 undergraduates, the convergence and divergence of three self-report measures of psychopathy; the Psychopathic Personality Inventory (Lillienfeld & Andrews, 1996), the Self-Report Psychopathy scale (Hare, Harpur, & Hemphill, 1989), and the Five Factor Psychopathy Index (Miller, Lynam, Widiger, & Leukefeld, 2001). Measures demonstrated strong convergence at the total score level, but weak convergence at the factor level. Correlations with domains and facets of the NEO Personality Inventory-Revised (Costa & McCrae, 1992) provided personality parsings of each measure. Across measures, psychopathy was composed of low Agreeableness, low Conscientiousness and a blend of high and low facets of Neuroticism and Extraversion. Divergence among subscales was due to differences in personality characteristics assessed. Additionally, the potential moderating effects of sex were also examined, but very few were identified. Implications of these results and future directions are discussed.