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Jennifer E. Vitale Joseph P. Newman

Chapter 16: Psychopathy as Psychopathology Key Developments in Assessment, Etiology, and Treatment. Jennifer E. Vitale Joseph P. Newman. Diagnostic Criteria. Hervey Cleckley (1941/1988): The Mask of Sanity Outlined 16 core traits of psychopathy

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Jennifer E. Vitale Joseph P. Newman

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  1. Chapter 16: Psychopathy as Psychopathology Key Developments in Assessment, Etiology, and Treatment Jennifer E. Vitale Joseph P. Newman

  2. Diagnostic Criteria • Hervey Cleckley (1941/1988):The Mask of Sanity • Outlined 16 core traits of psychopathy • Six traits most strongly influencing modern conceptualization of the syndrome • Superficial charm and good intelligence • Lacking in remorse or shame • Inadequately motivated antisocial behavior • Poor judgment and failure to learn by experience • Incapacity for love • General poverty in major affective reactions

  3. Diagnostic Criteria • Hervey Cleckley (1941/1988): The Mask of Sanity

  4. Diagnostic Criteria • McCord and McCord (1964) • Emphasis on: • Aggression • Impulsivity • Excitement-seeking • Guiltlessness • “Warped capacity for love” • DSM criteria for sociopathy/antisocial personality disorder included overlapping characteristics but were developed independently of the psychopathy literature

  5. Assessment of Psychopathy • Psychopathy Checklist (PCL; Hare, 1980) • Designed to capture prototypical psychopathy as conceptualized by Cleckley • Cleckley criteria converted into 22 items scored using a semi-structured interview and institutional file review • Revised version of the measure removed two items (PCL-R; Hare, 2003) • Provided a reliable method for assessing the syndrome and fueled much of the research conducted in the 1990s and 2000s

  6. Assessment of Psychopathy • PCL-R Controversies • Two factor structure • Factor 1: Affective/Interpersonal • Factor 2: Impulsive/Antisocial Lifestyle • Some argue a three factor structure is more appropriate (Cooke et al., 2006) • Violence as a “core” feature of the psychopathy syndrome (e.g., Bishop & Hare, 2008; Cooke et al., 2006) • Generalizability of the instrument to alternative groups (e.g., incarcerated women, delinquent juveniles) • Much of early PCL-R research relied on North American, Caucasian, male, incarcerated samples • Question its use for psychopathy assessment in noninstitutionalized samples

  7. Alternative Measures of Pscyhopathy • PCL-Screening Version (PCL:SV; Forth, Brown, Hart, & Hare, 1996) and • Self-Report Psychopathy Scale(SRP-II, -III; e.g., Williams & Paulhus, 2004) • Direct descendants of PCL-R • Designed to be used in noninstitutional contexts • PCL-Youth Version (PCL: YV; Forth, Kosson, & Hare, 2003) • PCL-R descendant • Based on assumption that psychopathy syndrome observed in adults can be extended back into adolescence • Antisocial Process Screening Device (ASPD; Frick & Hare, 2001) • 20-item rating scale that can be used as a self-report measure or a teacher/parent report measure

  8. Alternative Measures of Pscyhopathy • Youth Psychopathic Traits Inventory (YPI; Andershed, Kerr, Statin, & Levander, 2002) • Correlates moderately with factors of PCL:YV • Primary and Secondary Psychopathy Scales(SRPS; Levenson, Kiehl, & Fitzpatrick, 1995) • 26-item self-report measure • “Primary Scale” • “Secondary Scale” • Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) • 187-item self-report measure • 8 subscales: Machiavellian Egocentricity, Coldheartedness, Social Potency, Carefree Nonplanfulness, Fearlessness, Impulsive Nonconformity, Blame Externalization, and Stress Immunity • Psychopathy Resemblance Index (PRI) • Index of a Five Factor Model (FFM) based psychopathy prototype (Lynam & Widiger, 2001; Miller & Lynam, 2003).

  9. Prevalence of Psychopathy • North American Male Offenders • 15%–49% (e.g., Herve, Mitchell, & Cooper, 2004; Salekin, Rogers, Ustad, & Sewell, 1998) • North American Female Offenders • 9%–20% (Lehman & Ittel, 2012; Salekin et al., 1997; Vitale et al., 2002)

  10. Psychological Models and Somatic Factors • Fearlessness/Fear-Conditioning Abnormalities • Fowles (1980) • Psychopathy associated with deficits in functioning of the behavioral inhibition system (BIS; e.g., Gray & McNaughten, 2000) and normal behavioral activation system (BAS) functioning • Psychopathic individuals should show poor punishment learning and weak behavioral inhibition • Evidence: Low levels of neurotic anxiety and punishment sensitivity (e.g., Newman, MacCoon, Vaugn, & Saden, 2005),increased levels of passive avoidance errors (e.g., Lykken, 1957), decreased electrodermalresponsivity in anticipation of aversive events (e.g., Arnett, Howland, Smith, & Newman, 1993), abnormalities in eye-blink responses (e.g., Anderson, Standford, Wan, & Young, 2011),reduced startle potentiation (Vaidyanathanet al., 2011).

  11. Psychological Models and Somatic Factors • Fearlessness/Fear-Conditioning Abnormalities • Lykken (1955) • Focus on fearlessness as a trait, which impedes normal socialization and results in the cluster of symptoms associated with psychopathy • Evidence: Lower scores on self-report measures of fearfulness, poor electrodermal conditioning, deficits in passive avoidance performance (Lykken, 1957)

  12. Psychological Models and Somatic Factors • Amygdala Abnormalities • Blair (2006) • Focuses on role of amygdala in psychopathy • Psychopaths should show abnormalities in tasks that involve the formation of associations between a conditioned stimulus and unconditioned stimulus, between a conditioned stimulus and affect representation, and between a conditioned stimulus and valenced sensory properties of the unconditioned stimulus associations • Evidence: Impairment in aversive conditioning tasks, which involve amygdala-specific learning (e.g., Flor et al., 2002), reduced amygdala activation during such aversive conditioning tasks (e.g., Veit et al., 2002), reductions in amygdala volume (e.g., Ermer, Cope, Nyalakanti, Calhoun, & Kiehl, 2012), abnormalities in amygdala structure (Boccardi et al., 2011)

  13. Psychological Models and Somatic Factors • Response Modulation and Attention • Response Modulation Hypothesis (RMH; e.g., Gorenstein & Newman, 1980) • Abnormalities in selective attention undermine ability of psychopaths to consider contextual information that modulates goal-directed behavior of healthy individuals • “Attention bottleneck” hampers simultaneous processing of multiple channels of information (Newman & Baskin-Sommer, 2011) • Psychopathic individuals less able to process full range of affective and nonaffective stimuli and their associated meanings • Evidence: Psychopathic individuals commit more passive avoidance errors when focused on responding to a reward (e.g., Newman & Kosson, 1986) and fear potentiated startle is only impaired when attention is directed away from threat relevant information (Baskin-Sommerset al., 2011)

  14. Psychological Models and Somatic Factors • Genetics • Nonshared environmental factors appear to account for the majority of variance in psychopathy (e.g., Blonigen, Hicks, Kreuger, Patrick, & Iacono, 2006; Larsson, Andershed, & Lichtenstein, 2006) • Additive genetic factors account for a portion of the variance in psychopathy (e.g., Bezdijan, Raine, Baker, & Lynam, 2011; Blonigenet al., 2006) • Negligible influence of shared environmental factors (e.g., Larsson et al., 2006) • Peer relationships may account for the potent influence of nonshared environmental factors (Manke, McGuire, Reiss, Hetherington, & Plomin, 1995)

  15. Treatment of Psychopathy • Treatment prognosis for psychopathy has historically been considered to be poor (e.g., Hare, Clark, Grann, & Thorton, 2000) • Some studies have found increased rates of early discharge from therapeutic programs, less motivation, and overall improvement in psychopaths (Olgoff, Wong, & Greenwood, 1990) • A program geared toward increasing empathy and responsibility for peers was associated with higher recidivism in psychopathic individuals in prison (Rice, Harris, & Cormier, 1992) • Other studies show psychopaths demonstrate poor program adjustment and higher attrition (e.g., Berger, Rotermund, Vieth, & Hohnhorst, 2012), and lower levels of therapeutic gain (Chakhssi, deRuiter, & Berstein, 2010)

  16. Treatment of Psychopathy • Some recent studies point to potential therapeutic gain, particularly for adolescent individuals with psychopathic traits • A program aimed at increasing motivation, positive emotion, and decreasing callousness in youth led to significant decreases in psychopathy scores (Salekin, Tippey, & Allen, 2012) • Another intervention aimed at altering harsh and inconsistent parenting led to decreases in psychopathy scores (McDonald, Dodson, Rosenfield, & Jouriles, 2011)

  17. Treatment of Psychopathy • Future Directions • De-emphasis on treatments geared at building social skills or empathy • Creation of behavior modification programs with goals of reducing harm caused by psychopaths (Harris & Rice, 2006) • Expansion of interventions for children and adolescents with psychopathic traits • Turn to research on the etiology of psychopathy to create better treatment strategies suited to specific deficits seen in the disorder (Wallace, Schmitt, Vitale, & Newman, 2000)

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