Psychopathy: Construct, Assessment, and Implications PDF

Psychopathy Construct, Assessment, and Implications 1  Activity Think of a real person or a fictional character that you would characterize as a “psychopath”. What are some of the traits and behaviours that this person/character poss...

Psychopathy Construct, Assessment, and Implications 1  Activity Think of a real person or a fictional character that you would characterize as a “psychopath”. What are some of the traits and behaviours that this person/character possesses?  Outline & What is psychopathy & How is it measured &Does the assessment of psychopathy provide any practical information & What makes them tick 3  History 19th century Philippe Pinel Father of psychiatry Insane without delirium Is the psychopath mad or just bad? –Hervey Cleckley, 1941 Bob Hare, 1960 4 “I believe that these curious people referred to as psychopaths … offer a field of study in personality disorder more baffling and more fascinating than any other” H. Cleckley (1964) 5  Key References www.hare.org 6  Psychopaths in The General Population Population (100%) 1% 7  Psychopaths in Prison Populations Population (100%) 10-25% 8  Psychopaths as Persistent Spouse Abusers Population (100%) 25%  Psychopaths as Killers of Police Officers Population (100%) 44% 10  Psychopathy and Serial Killers Mostserial killers are psychopaths, but most psychopaths are not serial killers Most killers are not psychopaths 11  Psychopaths as Serial Killers Population (100%) 90% 12  What is psychopathy? A personality disorder characterized by a cluster of symptoms An arrogant, deceitful interpersonal style Deficient affective experiences Impulsive and irresponsible behaviors Early onset & diverse antisocial behaviors 13 Key to understanding psychopaths and their nature is: Measurement  Reliable and valid assessment tools  Common metric  Everyone on same diagnostic page 14  Psychopathy: Assessment Issues Psychopathic Traits “In my clinical Self-Report Observer Structured opinion” Inventories Rating Clinical DSM-5 PCL-R PCL:YV 15  Hare Psychopathy Checklist- Revised (PCL-R) 20 items scored using semi-structured interview file information 3-point scale Total ranges from 0 to 40 Scores  30 = typical psychopath 16  Mean PCL-R Scores 40 Psychopaths 30 22 Male Criminals 19 Female Criminals 4 General 0 Population 17 What are some of the defining features of psychopathy? 18 2nd Edition Psychopathy Facet 1 Facet 2 Facet 3 Facet 4 Interpersonal Affective Lifestyle Antisocial Glib/superficial Lack of remorse Needs stimulation Poor beh. controls Grandiose Shallow affect Parasitic lifestyle Early beh. problems Lying Lack of empathy Lack of goals Delinquency Manipulative Not responsible Impulsivity Conditional release Irresponsibility Criminal versatility Other traits in PCL-R: Promiscuous; Many marital relationships 19  Psychopaths Only an abstract, intellectual awareness of feelings of others 20 "There are emotions - a whole spectrum of them - that I know only through words, through reading and in my immature imagination. I can imagine I feel these emotions (know, therefore, what they are), but I do not.” 21  DSM-V Criteria for APD Current age at least 18 Conduct disorder by age 15 Adult criteria (3 out of 7) – repeated criminal acts – deceitfulness – impulsivity – irritability – recklessness – irresponsibility – lack of remorse 22 Overlap Between APD and Psychopathy 60 - 80% 10 - 25% APD Psychopathy 23  PCL-R and APD Forensicpopulations – 90% of psychopaths are APD – 10-25% of APD are psychopathic Most APD do not have the interpersonal and affective characteristics (Factor 1) 24  PCL-R and Co-morbidity Substance abuse Dramatic-erratic-emotional PD Anxious-fearful PD Narcissistic PD Borderline PD 25  R. Condo History Age 10 - foster homes due to disruptive behaviour Age 12 – reform school for criminal behaviour Age 16 – robbing stores and homes Age 18 – homosexual prostitute, addicted cocaine, mugging 26  R. Condo History Age 27 – marries chiropractor (3 children) Age 31 – dating lawyer (1 child) Age 34 – Self-published autobiography “Be strong and let your heart take courage” (1999) Age 35 – assaults, abducts wife 27  R. Condo History Totalof 84 convictions Age 37 – DO hearing  7 year sentence + 10 years probation (LTO) March, 2002 - Condo’s family lawyer pleads guilty for smuggling cocaine into remand facility Married lawyer, released in 2006 Owned, produced, and starred in his own movie about his life ``Section 753.2`` 28  Crown Attorney “Mr. Condo is a danger to anyone who has the misfortune to meet him on a personal level and get involved with him. He is a psychopath who is clearly resistant to change or treatment.” 29  Defence Lawyer “My client is a bad boy but not a monster …He has led a parasitic lifestyle, living off women and pursuing women of some affluence. But that is not criminal behaviour” 30 31  Distribution in Male Prisoners Mean = 22 Base Rate = 20% N = 5200 0 10 20 30 40 Condo 32  Distribution in Female Prisoners Mean = 19 Base rate = 14% N = 1200 0 5 10 15 20 25 30 35 40 33  Impact of Psychopathic Traits: Juvenile Death Penalty (Edens, Guy, & Fernandez, 2003) Does the presence or absence of psychopathic traits impact layperson perceptions of what is an appropriate legal sanction?  Juvenile capital defendant – Psychopathic traits (lacking remorse, callous, arrogant, deceptive) –Non-psychopathic traits (remorseful, accepting responsibility, respects others) 34  Results 40 Psychopath condition 35 30 1. More likely to select 25 death penalty 20 2. Less likely to support 15 rehabilitation 10 5 0 Nonpsychopath Psychopath 35  Conclusion “…it seems that one would be particularly hard pressed to justify the use of any of the psychopathy measures in a juvenile death penalty case.” Edens et al. (2003, p. 825) 36  Link with Crime and Violence PCL-R designed to measure the construct of psychopathy Not designed to measure risk for recidivism or violence Good empirical evidence that the PCL-R is moderately related to recidivism, particularly violence 37  Psychopathy: Motives for Murder (Woodworth & Porter, 2002) 125 Canadian murderers  Classified murders as: 1. Reactive (unplanned, crimes of passion, extreme provocation) 2. Instrumental (planned, settle a score, cold-blooded) 38  Woodworth & Porter, 2002 Reactive Instrumental 100 93 80 72 60 % 40 28 20 7 0 Low PCL-R High PCL-R Facet 1 more associated with Instrumental violence and facet 4 more associated with Reactive 39  Psychopathy and Violence Commit more violence in and out of prison Show more persistence in violence across lifespan 40  Why is psychopathy linked to violence? Impulsivity  fail to consider alternatives to violence Unemotionality  inability to consider or appreciate consequences of violence Arrogance  desire to exert control or power over others Suspiciousness  perception of hostile intent in others 41 Psychopathy and General Reoffending (Hart, Kropp, & Hare, 1988)  Assessed 231 male adult offenders  Release decision blind to PCL-R – Parole – Mandatory supervision  Follow-up period = 3.5 years  Outcome: revocation or new offense 42  Psychopathy and Recidivism: Percent Revoked/Convicted Parole M.S. 100 78 80 % 60 55 41 36 40 24 18 20 0 Low Medium High 43  Psychopathy (PCL-R) and Recidivism: Failure on Conditional Release 100 80 Low Revoked/Convicted Percentage Not 60 Medium 40 20 N = 231 High 0 0 200 400 600 800 1000 1200 Days After Release 44 Hart et al., 1988  Psychopathy and Sexual Deviance (Rice & Harris, 1997)  340 sex offenders  PCL-R score of > 25 = psychopath  All others = nonpsychopath  Deviant sexual arousal  Follow-up = 10 years  Outcome = violent and sexual recidivism 45  Violent Recidivism in Sex Offenders 1 Rice & Harris (1997) 0.8 Deviant Nonpsychopaths % Surviving 0.6 0.4 Not Deviant Not Deviant 0.2 Psychopaths Deviant 0 0 1 2 3 4 5 6 7 8 9 10 Years of Opportunity 46  Sexual Recidivism in Sex Offenders 1 Rice & Harris (1997) 0.8 Nonpsychopaths Deviant % Surviving 0.6 Not Deviant Not Deviant 0.4 0.2 Deviant Psychopaths 0 0 1 2 3 4 5 6 7 8 9 10 Years of Opportunity 47  Psychopathy and Age Psychopath Nonpsychopath 3000 Mean # successful days 2500 2000 1500 1000 500 0 18-24 25-29 30-34 35-39 40-44 45-49 Age 48 Porter et al., 2001  Psychopathy and Age (Harpur & Hare, 1994) 14 12 10 8 Factor 1 6 Factor 2 4 2 0 Age Period 49  Treatment of Psychopaths  What do we treat?  Personality traits or behaviors? Clinicians believe psychopaths are difficult to treat Why would you want to change if you don’t think there is anything wrong with you or the way you live your life? 50  Psychopathy and Treatment (Rice, Harris, & Cormier, 1992) 176 treated patients/146 untreated patients Follow-up period = 10 years Social Therapy Unit – Minimum 2 year treatment program – Foster responsibility and empathy – Limited professional contact – Entry to program nonvoluntary 51  Failure Following Treatment: Violent Offences Untreated Treated 100 77 80 % Failure 60 55 39 40 22 20 0 Nonpsychopaths Psychopaths Treatment Group 52  Psychopathy & Treatment: Sex offenders (Seto & Barbaree, 1999) –283 sex offenders at Warkworth –5 month treatment program Relapse prevention Victim empathy, responsibility Behavioral reconditioning –Treatment behaviors (good vs. poor) –PCL-R (Low vs. high) –2.5 year follow-up 53  Psychopathy & Treatment Outcome Any Violent 40 35 30 % Failure 25 20 15 10 5 0 Low-Good Low-poor High-poor High-Good Group 54 English Prison Service (Hare et al., 2000) –268 English offenders 55 high Factor 1 group 213 low Factor 1 group –Anger management, social skills, and educational/vocational treatment/training –2 year follow up for general reconvictions 55  Psychopathy & Anger Management Outcome Untreated Treated 100 90 80 % Failure 70 60 50 40 30 20 10 0 Low F1 High F1 Group 56  Psychopathy & Education/Vocational Training Outcome Untreated Treated 100 90 80 % Failure 70 60 50 40 30 20 10 0 Low F1 High F1 Group 57  Explanation for Poor Treatment Outcomes –Treatment ratings identified a subset of offenders skilled at manipulating others –Taught them new skills –Used skills at manipulating to obtain access to new victims –Anger is an emotion that does not motivate violence as psychopaths engage in instrumental violence 58  Conclusion: Treatment Psychopaths are resistant to traditional treatment modalities More likely to drop-out of treatment Are more disruptive in group therapy Empirical literature is limited – Premature to conclude that “psychopaths are untreatable” – More recent attempts with youth are more promising 59  Conclusion: Treatment Central element of treatment should be: – To reduce substance use – Remove negative associates – Alter behavior – Make prosocial behavior pay and antisocial behavior not pay – Focus research on the Brain: cognitions and emotional explanations from brain based research to form the basis of interventions. – Remember that not all psycopaths are homogeneous (4 facets) 60  Nature vs Nurture Made: Family background, longitudinal Born: Twin, adoption studies Strong genetic contribution  Heritability of psychopathic traits Traits MZ twin DZ twin CU traits.73.39 AB traits.64.49 “CU traits at 7 years, as assessed by teachers at the end of the first year of school, is under strong genetic influence.” Viding et al., 2004, p. 4  What makes them tick?  We don’t know – Not the sole result of poor parenting or abusive experiences  Some clues from neuroscience 63  Theories of Psychopathy Brain damage, structural anomalies Frontal lobe dysfunction Cognitive processing deficits Response modulation deficits (Newman) Difficulty adjusting behavior in face of a dominant response Emotional deficits (Cleckley, Hare, Blair)  PSYCHOPATHY & AFFECT Language They know the words but not the music Theyknow only the dictionary meaning of words They can learn to use ordinary words...and to reproduce the pantomime of feeling...but the feeling itself does not come to pass 65  The Lexical Decision Task Words have both denotative (explicit, literal) and connotative (implicit, implied) meanings Evaluate words by using: Lexical decision times Brain activity associated with the decisions 66  The Lexical Decision Task Neutral & emotional words, and pronounceable nonwords, briefly presented in random order on a computer screen “Was what you saw a word?” 67  Reaction Time and Word Type msec 950 Nonpsychopaths Psychopaths 900 850 800 750 700 Neutral Positive Negative Emotionality of Words 68 Williamson, Harpur, & Hare (1991)  IDEALIZED ERP WAVEFORM DURING A LEXICAL DECISION TASK Attention ERP is extracted from EEG by averaging - N100 brain potentials over many trials 0 1000 msec stimulus onset LPC + P300 Further cognitive processing; “It’s a word” extraction of more information Stimulus displayed on computer screen: either a word (e.g. cat) or a nonword (e.g. atc) 69  Lexical Decision Neutral Words ------------ “Is it a word?” Emotional Words Pz - 5uv Nonpsychopaths + P670 P300 0 500 1000 msec Williamson, Harper, and Hare (1991) 70  Lexical Decision Neutral Words ------------ “Is it a word?” Emotional Words Psychopaths Pz - 5uv Nonpsychopaths + P670 P300 0 500 1000 msec Williamson, Harper, and Hare (1991) 71  Startle Blink Startle reflex reflex occurs when something unexpected occurs Magnified if person is in negative emotional state or feeling threatened Reduced if person is in positive emotional state Mediated by circuits in amygdala 72  Psychopathy and Startle Reflex (Patrick et al., 1993) Incarcerated offenders Psychopaths vs. nonpsychopaths Affective pictures Pleasant (babies, pets, erotic) Unpleasant (snake, weapons, mutilations) Neutral (objects) Present startle probes 74 75 76 77 78  Eye Blink Magnitude Nonpsychopaths Psychopaths 55 50 45 40 Pleasant Neutral Unpleasant 79  Eye Blink Magnitude Nonpsychopaths Psychopaths 55 50 45 40 Pleasant Neutral Unpleasant 80  Conclusions Emotions play little role in their thinking, language, and behaviours Their approach to the world is predatory They do not play by our rules, nor do they care about our feelings and welfare They put on a good show It is hard not to get sucked in! 81  Affective Mimicry (Jones, 2014) To be successful at manipulating others, one must be able to a) read cues of vulnerability in others, b) avoid detection by appearing to be socially trustworthy, and c) display a range of emotions even if not felt “I can tell a victim by the way she walked down the street, the tilt of her head, the manner in which she carried herself etc...” Ted Bundy, 1985  Perceptions of Victim Vulnerability Gait identified as a cue for vulnerability (Grayson & Stein, 1981) –Victims and non victims vary across movement categories Are there certain traits associated with greater accuracy in perceiving these nonverbal cues? 84  Psychopathy and Perceptions of Victim Vulnerability Students and offenders  psychopathy scores associated with greater accuracy in perceiving walkers’ vulnerability (Book et al., 2013; Ritchie et al., 2018; Wheeler et al., 2009) Offenders with higher factor 1 scores more likely to report using gait cues (Book et al., 2013) 85 Toxic Love: Survivors of Psychopaths (Forth & Sezlik, in prep) What are the experiences and effects of being romantically involved with a psychopath?  Victim’s Perspective “People think of the word ‘psychopath’ & think of someone who murders with a kitchen knife. […] I have learned they could be just a normal person, & they could be the life of the party, & do all of these wonderful, great things but behind a closed door they are a monster.” “No matter how you try to explain it, psychopathy is a disorder that poisons everyone in the path of the psychopath and devastates the woman who tries to love him.” (Brown & Leedom, 2008, p. 5) 88  Method (Forth & Sezlik, 2021) 474 survivors (421 females, 51 males) –21% current intimate –79% ex-intimate –33% completed university; 22% completed graduate school –Age range: 18 – 71 yrs (M = 45 yrs) Recruited and completed study online primarily from support websites Open-ended questions about experiences  How did you meet? Method/Location Percent Online dating site 22 Work 20 Community/Vacation/Church 18 Bar/party/club 11 Friend 9 On line (chat room, gaming) 8 High school/university 6 Relative 4 Prison/AA 2 90 Did you notice anything unusual about him/her when you first met?  “After several dates he wanted to get married.”  “The first thing I noticed is that he wanted to keep track of where I was at all times, he wanted to know every detail of my day, and he wanted to keep track of my friends and he also found a way of hacking into my computer to keep track of my activity.”  “The whole relationship was one major deception. She lies the way normal people breathe.”  “His pathetic look as he told me his miserable life 91  Notice any red flags? Impressions % None; Nothing; Positive 21 Evasive; Elusive; Far-fletched stories 13 Arrogant; Self-centered; Grandiose 11 Too attentive; Excessive flattery 10 Hot-tempered; Aggressive; Controlling 10 Unemotional; Intense stare; Empty eyes 6 Rapid progression of relationship 5 Evoked sympathy; Pity me attitude 4 Other (drinking, reckless) 22  Physical and Mental Health Effects Physical Health Mental Health 90 80 80 70 60 50 % 40 37 30 27 21 20 18 15 10 1 2 0 None Mild Moderate Extreme Female Case 94 The Case of Cherrylle Dell Cherrylle Dell KILLS Scott Dell Ottawa Citizen January 6, 2001 95 The Case of Cherrylle Dell Cherrylle Dell HIRES Brent Crawford 96 Ottawa Citizen, Jan 6, 2001  The Case of Cherrylle Dell (Ottawa Citizen, December 2000 - January 2001) “Mrs. Dell has appeared sullen in court, and occasionally even bored… she at times sat at the edge of her seat to watch the scene from her past” “Mrs. Dell was animated , talking at length and sounding much younger than her age” “While Mrs. Dell spoke hatefully of her husband behind his back, she was sweetness and honey to him when they met” “Mrs. Dell was told that her husband was dead. She seemed to have no reaction at all. She asked what he looked like”. Mrs. Dell addressed the mourners (and) said what about me? I need some sympathy”.’ “Mrs. Dell had a rough time in jail. Mrs. Dell once drove a pencil into her own leg”. 97  What Are the Gender Differences? Less frequent Lower prevalence of Antisocial Personality Disorder (therefore lower recidivism) and lower scores on the criminal component of the PCL-R 11% of violent females compared to 31% of violent males 16-17% in general female prison populations 98  What Are the Gender Differences? Manipulation: – Females flirt – Males run scams and commit fraud Criminal behavior: – females [primarly theft and fraud – Males primarily violence Aggression: – Females relational (e.g., manipulation of social networks), threats of self-injurious behavior, and verbal – Males physical 99  What Are the Gender Differences? Interpersonal symptoms: – Females promiscuity related to obtaining financial and social gains – Males promiscuity related to grandiose self-image and charm Trajectory: – Young females characterized by jealousy, self-harm, manipulation, and verbal aggression – Young boys characterized by rule violations, physical aggression, and violence 100