Week 21 Reading 2

Psychopathy
Key terms:
 Psychopathy: Synonymous with psychopathic personality, the term used by Cleckley
(1941/1976), and adapted from the term psychopathic introduced by German psychiatrist
Julius Koch (1888) to designate mental disorders presumed to be heritable.
 Antisocial personality disorder: Counterpart diagnosis to psychopathy included in the third
through fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM;
APA, 2000). Defined by specific symptoms of behavioral deviancy in childhood (e.g., fighting,
lying, stealing, truancy) continuing into adulthood (manifested as repeated rule-breaking,
impulsiveness, irresponsibility, aggressiveness, etc.).
 Triarchic model: Model formulated to reconcile alternative historic conceptions of
psychopathy and differing methods for assessing it. Conceives of psychopathy as
encompassing three symptomatic components: boldness, involving social efficacy, emotional
resiliency, and venturesomeness; meanness, entailing lack of empathy/emotional-sensitivity
and exploitative behavior toward others; and disinhibition, entailing deficient behavioral
restraint and lack of control over urges/emotional reactions.

Learn about Cleckley’s classic account of psychopathy, presented in his book The Mask of
Sanity, along with other historic conceptions:
 For many in the public at large, the term “psychopath” conjures up images of ruthless
homicidal maniacs and criminal masterminds.
 However, the concept of psychopathy (“psychopathic personality”) held by experts in the
mental health field differs sharply from this common public perception
 Early writers characterized psychopathy as an atypical form of mental illness in which
rational faculties appeared normal but everyday behavior and social relationships are
markedly disrupted.
 French physician Philippe Pinel (1806/1862) documented cases of what he called manie
sans delire (“insanity without delirium”), in which dramatic episodes of recklessness and
aggression occurred in individuals not suffering from obvious clouding of the mind.
 German psychiatrist Julius Koch (1888) introduced the disease-oriented term psychopathic
to convey the idea that conditions of this type had a strong constitutional-heritable basis.
 In his book The Mask of Sanity, American psychiatrist Hervey Cleckley (1941/1976)
described psychopathy as a deep-rooted emotional pathology concealed by an outward
appearance of good mental health:
o In contrast with other psychiatric patients, psychopathic individuals present as
confident, sociable, and well adjusted.
o However, their underlying disorder reveals itself over time through their actions
and attitudes.
o To facilitate identification of psychopathic individuals in clinical settings, Cleckley
provided 16 diagnostic criteria encompassing:
 indicators of apparent psychological stability (e.g., charm and intelligence,
absence of nervousness)
 along with symptoms of behavioral deviancy (e.g., irresponsibility, failure to
plan)
 and impaired affect and social connectedness (e.g., absence of remorse,
deceptiveness, inability to love).
o Cleckley did not characterize psychopathic patients as inherently cruel, violent, or
dangerous. Although some engaged in repetitive violent acts, more often the harm
they caused was nonphysical and the product of impulsive self-centeredness as
opposed to viciousness.
o Cleckley’s case histories included examples of “successful psychopaths” who
ascended to careers as professors, medical doctors, or businessmen, along with
examples of more aimless dysfunctional types.
 Cleckley’s conception served as a referent for the diagnosis of psychopathy in the first two
editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
 However, a dramatic shift occurred in the third edition of the DSM. The Cleckley-oriented
conception of psychopathy in prior editions was replaced by antisocial personality disorder
(ASPD), defined by specific indicants of behavioral deviancy:
o in childhood (e.g., fighting, lying, stealing, truancy)
o continuing into adulthood (manifested as repeated rulebreaking, impulsiveness,
irresponsibility, aggressiveness, etc.).

Compare and contrast differing inventories currently in use for assessing psychopathy in
differing samples (e.g., adults and younger individuals, within clinical-forensic and
community settings):
 Psychopathy in adult criminal offenders:
o Psychopathy Checklist-Revised (PCL-R) is the most widely used instrument for
diagnosing psychopathy in correctional and forensic settings
o It comprises 20 items rated on the basis of interview and file-record information.
 o Cutoff score of 30 out of 40 for assigning a diagnosis of psychopathy.
o High overall PCL-R scores are correlated with impulsive and aggressive tendencies,
low empathy, Machiavellianism, lack of social connectedness, and persistent
violent offending.
o Structural analyses of its items reveal distinct interpersonal-affective and antisocial
deviance subdimensions (factors)

 Psychopathy in noncriminal adults:

o Psychopathy has most typically been assessed in noncriminal adult samples using
self-report-based measures.
o One example is the now widely used Psychopathic Personality Inventory (PPI). Its
current revised form (PPI-R) contains 154 items, organized into eight facet scales.
o The subscales of the PPI cohere around two distinguishable factors:
 a fearless dominance (FD) factor reflecting:
 social potency (ability to charm and influence others)
 stress immunity (don’t get phased by negative events)
 fearlessness (risk taking, not afraid of consequences)
 a self-centered impulsivity (SCI) factor reflecting:
 Carefree non-planfullness
 Impulsive nonconformity (not conforming to social norms)
 Machiavellian egocentricity (using others towards your own goals)
 Blame externalization
 Psychopathy in child and adolescent clinical samples:
o Different inventories exist for assessing psychopathic tendencies in children and
adolescents. Especially among youth convicted of crimes or referred for treatment of
conduct problems.
o The emphasis in work of this type has been on the importance of psychopathic
features for predicting greater severity and persistence of conduct problems.
o Termed “callous-unemotional” traits, these features encompass:
 low empathy
 deficient remorse or guilt
  shallow affect
 lack of concern about performance in school and other contexts
o One extensively researched measure for assessing psychopathic tendencies in youth
is the Antisocial Process Screening Device (APSD):
 used with clinic-referred children ages 6 through 13.
 includes 20 items completed by parents or teachers.
 As with the PCL-R and PPI, the items of the APSD tap two distinct factors:
 a Callous-Unemotional (CU) traits factor, reflecting emotional
insensitivity and disregard for others
 an Impulsive/Conduct Problems (I/CP) factor, reflecting impulsivity,
behavioral deviancy, and inflated self-importance.

Become familiar with the Triarchic model of psychopathy and its constituent constructs of
boldness, meanness, and disinhibition:
 A theoretic conceptualization formulated recently to reconcile alternative perspectives is the
Triarchic model
 This model conceives of psychopathy as encompassing three separable symptomatic
components—disinhibition, boldness, and meanness—that can be viewed as thematic
building blocks for differing conceptions of psychopathy:
o Disinhibition: encompasses difficulty regulating emotions, weak behavioral
constraint (e.g., I jump into things without thinking)
o Meanness: entailing lack of empathy, exploitative behavior toward others, cruel,
predatory, destructive (e.g., I don’t mind if someone I dislike gets hurt)
o Boldness: encompasses social efficacy, dominance, emotional resiliency, and
adventurous/risk taking (e.g., I am a born leader)
 According to the model:
o Individuals high in disinhibitory tendencies would warrant a diagnosis of
psychopathy if also high in boldness or meanness (or both),
o Individuals high on only one of these tendencies would not warrant a diagnosis of
psychopathy.
o Individuals with differing relative elevations on these three symptomatic
components would account for contrasting variants (subtypes) of psychopathy as
described in the literature
 An inventory designed specifically to operationalize this model is the Triarchic Psychopathy
Measure (TriPM): contains 58 items comprising three subscales that correspond to the
constructs of the model (see Table 1).
Learn about alternative theories regarding the causal origins of psychopathy:
 Existing theories are of two types:
o Emotionally-focused theories: emphasizing impaired emotional experience and
processing. In support of this individuals with psychopathy show:
 lack of normal enhancement of the startle blink reflex to abrupt noises
occurring during viewing of scary or disturbing images as compared with
neutral or pleasant images
 Reduced Amygdala activity in response to seeing fearful faces
 Impaired recognition of emotional facial expressions
 Deficits in fear-based conditioning
 Reduced connectivity between ventromedial Prefrontal Cortex and Amygdala
o Cognitive-attentional theories: emphasizing basic impairments in cognitive-
attentional processing. In support of this individuals with psychopathy show:
 Reduced amplitude of brain potential responses in cognitive tasks. This is
indicative of reduced cortical-attentional processing
 Potential causes:
o Genetics:
 Moderately to highly heritable
 Not one gene, but many candidates
 Twin study: up to 70% of the variance explained by genetic factors
o Environmental factors: but, potential role of gene-environment correlation
 Having a convicted parent
 Physical neglect
 Low paternal involvement and warmth
 Maternal depression
 Abuse
 Harsh discipline
o Brain injury: (pseudopsychopathy or acquired sociopathy)
 Traumatic injury to prefrontal cortex or amygdala
 Earlier age of trauma may result in worse outcomes
Treatment:
 No generally accepted treatement
 Higher levels of psychopathy associated with reduced treatment adherence
 Some evidence suggests that reoffending is higher among individuals with psychopathic
traits after therapy-based treatments

Consider how longstanding matters of debate regarding the nature, definition, and origins of
psychopathy can be addressed from the perspective of the Triarchic model:
 One key issue is whether psychological/emotional stability is characteristic or not of
psychopathy:
o Cleckley view was that:
 psychopathy entails good mental health
 his diagnostic criteria included indicators of positive adjustment.
o By contrast, the dominant clinical assessment devices for psychopathy, the PCL-R and
ASPD:
 are heavily oriented toward deviancy
 include no items that are purely indicative of adjustment.
o From a Triarchic model standpoint:
 the more adaptive elements of psychopathy are embodied in its boldness
facet, which entails social poise, emotional stability, and enjoyment of
novelty and adventure.
 Another issue is whether lack of anxiety is central to psychopathy:
o Cleckley has emphasized this concept.
o This perspective is challenged by research showing somewhat positive associations
of psychopathy measures with anxiety.
o The Triarchic model helps to address this inconsistency by separating the disorder
into subcomponents or facets, which relate differently to measures of anxiety:
 Boldness is correlated negatively with anxiousness
 Disinhibition and Meanness are correlated negatively and negligibly,
respectively, with anxiety
 A further key question is whether violent/aggressive tendencies are typical of
psychopathic individuals and should be included in the definition of the disorder:
o Cleckley’s view was that “such tendencies should be regarded as the exception
rather than as the rule”.
o However, aggressiveness is central to criminally oriented conceptions of
psychopathy, and the PCL-R includes an item reflecting hot-temperedness and
aggression
o In the Triarchic model, tendencies toward aggression are represented in both the
disinhibition and meanness constructs, and a “mean-disinhibited” type of
psychopath clearly exists
 Another question is whether criminal or antisocial behavior more broadly represents a
defining feature of psychopathy, or a secondary manifestation:
 o From the standpoint of the Triarchic model, antisocial behavior arises from the
complex interplay of different “deviance-promoting” influences—including
dispositional boldness, meanness, and disinhibition.
 Another key question is whether differing subtypes of psychopathy exist:
o From the perspective of the Triarchic model
 alternative variants of psychopathy reflect differing configurations of
boldness, meanness, and disinhibition.
 Viewed this way, designations such as “bold-disinhibited” and “mean-
disinhibited” may prove more useful for research and clinical purposes
 An issue from this perspective is whether individuals who are high in
boldness and/or meanness but low in disinhibition would qualify for a
diagnosis of psychopathy.
 Yet another question is whether psychopathy differs in women as compared to men:
o Cleckley’s view was that psychopathy clearly exists in women and reflects the same
core deficit as in men.
o However, men exhibit criminal deviance and ASPD at much higher rates than women
and men in the population at large score higher in general on measures of
psychopathy than women
o From a Triarchic model perspective these differences in prevalence may be
attributable largely to differences between women and men in average levels of
boldness, meanness, and disinhibition.
 A final intriguing question is whether “successful” psychopaths exist:
o Some authors proposed that the presence of dispositional fearlessness (boldness)
may be conducive to success when not accompanied by high externalizing proneness
(disinhibition).
o For example, high-bold/low-disinhibited individuals could be expected to achieve
higher success in occupations calling for leadership and/or courage