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3Psychopathy

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Learning Outcomes

After reading this chapter, you should be able to

• Summarize the historical background of psychopathy and its relation to antisocial personality disorder.

• Discuss the contributions of Robert Hare and the factors in the PCL-R.

• Explain the relationship between psychopathy and criminal behavior.

• Distinguish between juvenile and adult psychopathy.

• Analyze why the study of psychopathy in relation to crime has been so controversial.

• Examine how psychopathy is studied worldwide.

• Describe the treatment outcomes for psychopathic offenders.

Introductory Case Study: Scott Peterson

Introductory Case Study: Scott Peterson Laci Peterson was 8 months pregnant when she went missing from her Modesto, California, home on Christmas Eve morning in 2002. That day, a neighbor found Laci’s dog wandering the neighborhood, which was unusual because Laci either walked the dog on the leash or left it in the backyard. Scott Peterson, her husband, claimed that he was out fishing that day and arrived home later that evening to find that Laci was not there. Scott contacted Laci’s mother, Sharon, asking if Laci was at her house. Sharon, who had not seen or heard from Laci that day, knew immediately that something must be wrong and contacted police. When Laci did not show up for Christmas celebrations with her family, a massive search ensued. However, the mystery of what happened to Laci Peterson would go on for several months.

Scott Peterson’s behavior was suspicious to police because he seemed entirely too calm and unconcerned, despite the fact that his very pregnant wife was missing. Laci’s family and friends vehemently denied that Scott could have had anything to do with Laci’s disappearance because he always seemed so loving and kind. By all accounts, Scott appeared to be a devoted husband and father-to-be. He was also charming, well liked, and had a good job—and Laci adored him. The family was convinced that Scott was heartbroken over Laci’s disappearance. However, it wasn’t long before it was discovered that Scott was not who he appeared to be.

During the course of the investigation, it was discovered that Scott had had numerous extramar- ital affairs. Amber Frey, one of the women he was involved with, recognized Scott from the news coverage of Laci’s disappearance. Scott, who traveled frequently for work, met Amber not too long before Laci’s disappearance and claimed that he was a single man looking for a romantic life partner. The story he told Amber was that he had been married, his wife had died, and this would be his first Christmas as a widower. Laci was alive and well at the time, preparing for the birth of her and Scott’s first child. When Amber saw the news coverage, she realized that she had been duped and contacted Modesto police.

Several months after Laci’s disappearance, police finally recovered her body. When police found Scott, it appeared that he was attempting to flee. Scott had dyed his dark hair blonde. In his car he had $15,000, Viagra pills, camping equipment, four different cell phones, and his brother’s driver’s license. Scott was arrested, put on trial, and ultimately found guilty of first-degree mur- der. He was sentenced to death for the murder of Laci and her unborn baby. He continues to maintain his innocence despite overwhelming evidence that he was the killer.

One of the more fascinating things about Scott Peterson is that he was able to fool so many into believing that he was a doting and caring husband who was excited about the upcoming birth of a new baby. He also successfully convinced women that he was single or widowed and broken- hearted over the loss of his wife. He easily manipulated their emotions and made them believe he was the perfect romantic partner. He was living a double life.

As you read this chapter, consider the following questions regarding this case:

1. Why do you think Scott perpetrated such an elaborate scheme? 2. How can we make sense of a crime such as this? What might explain Scott’s behavior? 3. How can someone capable of planning and executing such a sinister crime appear so

normal and likable?

Section 3.2 Identifying and Defining Psychopathy

3.1 Introduction Of all the psychological theories of crime, none has the controversy, intrigue, empirical inter- est, or panache of psychopathy (pronounced sai-kah-path-ee). It is among the most studied, misunderstood, and fascinating constructs—especially to the general public—as well as the most directly related to antisocial behavior.

More than any other scholarly area in criminol- ogy, psychopathy has a sensationalistic tradition that focuses on the overwhelmingly negative traits. Because psychopathy presents an individual who is without conscience, guilt, or remorse and is seemingly without “normal” emotional responses to others, it closely matches the personality pro- file of extremely violent offenders, such as sexual homicide offenders who receive extensive news and media coverage. Many of the most violent and troubled criminal offenders portrayed on television programs (such as Criminal Minds and The Assassi- nation of Gianni Versace: American Crime Story) and in films (such as American Psycho and Gone Girl) exhibit clear psychopathic traits. A historical exam- ple is Edward Theodore “Ed” Gein, whose crimes were considered so heinous that they have been replicated in Psycho, The Texas Chainsaw Massacre, and The Silence of the Lambs.

This chapter will demonstrate, however, that psychopathy’s reputation is not simply media driven. The empirical evidence that links psychopathy and psychopathic personality fea- tures to various forms of antisocial behavior is extraordinary. Across a range of popula- tions, samples, and study groups selected from multiple nations, communities, and clinical contexts, psychopathy has been shown to predict delinquency, crime, violence, institutional misconduct, recidivism, and predatory behavior. This chapter examines the essential char- acteristics of psychopathy, the biological and environmental factors that contribute to it, the interesting scholarly history of studies of the construct, and its relation to maladaptive behavior and crime.

3.2 Identifying and Defining Psychopathy Psychopathy is a personality disorder that is characterized by a coherent set of affective deficits, lifestyle factors, interpersonal deficits, and behaviors that strongly correlate with antisocial behavior. The prevalence—or proportion (represented as a percentage) of a popu- lation or sample that has or presents a particular condition—of psychopathy in the general population is quite low, at approximately 1% (Neumann & Hare, 2008). The prevalence of psychopathy among prisoners, however, is substantively higher, falling in the range of 25% to 40%. Among the most violent criminal offenders, its prevalence is even higher (DeLisi, 2005; Hare, 1993, 1996; Hare & Neumann, 2008).

Everett Collection/SuperStock

Ed Gein’s crimes inspired the films Psycho, The Texas Chainsaw Massacre, and The Silence of the Lambs.

Section 3.2 Identifying and Defining Psychopathy

Throughout human history, there have been countless examples of individuals who not only engage in severe forms of violent behav- ior but also appear to lack the normal emo- tional responses to committing such acts. Unlike psychotic individuals—who lack the cognitive understanding of right from wrong due to psychiatric disturbance or disordered thought, as in the case of schizophrenia— psychopathic individuals know right from wrong and commit antisocial behavior none- theless (Meloy & Gacono, 1998). In this way, the deficits of psychopathy are not based on sanity or cognition but on morality.

The unique moral deficits of psychopathic individuals and the subsequent challenges of classifying such individuals are seen

throughout the scholarly development of the study of psychopathic personality. For instance, Philippe Pinel (1801) is commonly identified as the first social scientist to clinically describe psychopathy; he used the label insanity without delirium. Other social scientists of the 19th century described psychopathy as “moral alienation of the mind” (Rush, 1812, p. 358) and “moral insanity” (Maudsley, 1898, p. 170). Because psychopaths appeared to understand what they were doing but not care about the harm produced from their conduct, a moral con- notation surrounded psychopathy that set it apart from other psychological conditions.

Psychological Constructs For many years, psychopathy was conceptualized by psychiatrists as a discrete diagnostic category. This meant that an individual either was or was not a psychopath. This is known as a categorical construct, in which an individual does or does not have a particular condition.

However, all personality disorders can be understood as extreme manifestations of normal personality traits. Furthermore, everyone is likely to display some of the traits of psychopa- thy, albeit at low levels. In isolation, having one of these traits does not mean that one is a psy- chopath. For example, many people are impulsive or at least display impulsive behaviors in their daily lives. This can be seen when we eat foods that we know are unhealthy, unthinkingly buy an item at a department store that we do not need, or reactively say something to a friend or coworker that we immediately regret. In other words, nonpsychopaths nevertheless often display some traits of psychopathy. Because of this, clinicians and researchers today concep- tualize psychopathy as a continuous construct, one that is distributed from low to high. Moreover, psychopathy is commonly described as “psychopathic personality” to reflect this continuous nature, in which individuals can have some or many of the traits of the disorder.

Psychopathy Versus Antisocial Personality Disorder The psychopathy construct was once formally included in the DSM. However, the most recent versions of the DSM have replaced the term psychopathy with antisocial personality disorder (APD). Recall from Chapter 2 that APD is a behavioral disorder that involves the pervasive

Nigel Norrington/Associated Press

Actor Matt Smith plays killer Patrick Bateman in a theatrical adaptation of American Psycho. A major marker of psychopathy is an absence of empathy and ability to understand the emotions of others.

Section 3.2 Identifying and Defining Psychopathy

pattern of disregard for and violation of the rights of others occurring from around age 15 onward. It is essentially the adult culmination of adolescent conduct disorder (a repetitive and persistent pattern of behavior in children in which the basic rights of others or basic social rules are violated) and childhood oppositional defiant disorder.

Although similar and correlated, APD and psychopathy are not the same construct. While the former focuses on antisocial behaviors, psychopathy is broader, encompassing antiso- cial behaviors along with affective, lifestyle, and interpersonal deficits, which we’ll discuss later. Although they are different constructs, psychopathy is a specifier in the DSM-5. APD is a diagnosis, whereas psychopathy is not. That is, a psychologist cannot diagnose someone with psychopathy. However, for the first time in DSM history, psychopathy now appears in the DSM under the umbrella of APD. If someone meets the criteria for APD and exhibits additional features of psychopathy such as those undesirable interpersonal, lifestyle, and/or affective factors, the person can be diagnosed with APD with psychopathic personality features. The universe of antisocial behavior is very large (see Figure 3.1), but many behaviors that are potentially antisocial, such as impulsivity, are not criminal and might not ever cause problems for an individual.

Figure 3.1: The universe of antisocial traits

Although psychopaths attract much attention from the criminal justice system, it is important to recognize that only a fraction of antisocial individuals are actually psychopathic.

Antisocial behavior

Criminal offenders

Antisocial Personality Disorder

Psychopathy

Section 3.3 Diagnosing Psychopathic Individuals

Criminal behavior is under the umbrella of antisocial behavior, but even here it is important to acknowledge that many criminal offenders are not necessarily dangerous or severe in their criminal conduct. A segment of criminal offenders has APD, and within this population, a still smaller segment is psychopathic. Approximately 90% of psychopaths meet the diagnostic criteria for APD, while only about 25% to 30% of those with APD are also psychopathic (Mar- tens, 2000; Shipley & Arrigo, 2001). This means that psychopaths are statistically the rarest in terms of their numbers but also the most severe in terms of their conduct (DeLisi, 2009).

3.3 Diagnosing Psychopathic Individuals Hervey Cleckley, a Rhodes scholar and psychia- trist, became interested in studying psychopaths and criminality to bridge a gap between the dis- cipline of psychology and the criminal justice sys- tem. Cleckley wrote extensively about psychopathy throughout his career, becoming such a well-known expert in the field that he was called on by the state of Florida to perform a psychiatric evaluation of Ted Bundy, the infamous serial killer and quintessen- tial psychopath. Through his years of research and practice, Cleckley found that psychopaths exhibited certain behaviors and traits that will be discussed in this section.

Cleckley’s work was expanded by psychologist Rob- ert Hare, who had discovered Cleckley’s work when he was completing his doctoral degree in Canada. Hare worked in the Canadian prison system as a master’s-level psychologist and began to notice that the inmates consistently tried to manipulate him. This interested him in further research and, building on Cleckley’s psychopathy criteria, Hare developed the Psychopathy Checklist (PCL) assess- ment tool for clinicians to use in evaluating for psy- chopathy. The measure was revised in 1991 and is now known as the Psychopathy Checklist- Revised (PCL-R). Many other psychologists have researched psychopathy, but Cleckley’s and Hare’s criteria are the foundation of all the research on psychopathy. Let’s take a closer look at their research and diagnostic criteria.

Mark Forey/Associated Press

Handsome, bright, and articulate, Ted Bundy appeared to have everything going for him. Of course, these positive traits were a facade for the true Ted Bundy, who lacked normal emotional responses following the horrific acts he committed.

Section 3.3 Diagnosing Psychopathic Individuals

Cleckley’s Diagnostic Criteria for Psychopathy Hervey Cleckley, in many respects considered the patriarch of the study of psychopathy, pub- lished The Mask of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality in 1941 based on his clinical observations of psychopathic individuals in a psychiatric facility. Interestingly, Cleckley’s title embodies the uneven development of the study of psychopathic personality because it suggests that the appearance of sanity or normal psychological func- tioning is merely a facade. From his observations, Cleckley developed a list of 16 diagnostic criteria that have served as the basis for the modern scientific study of psychopathy. Cleck- ley’s criteria included traits such as intelligence and superficial charm, absence of nervous- ness, lack of remorse and shame, and poor judgment, among others.

During this era, contemporaries of Cleckley similarly studied individuals who presented with a generalized set of problem behaviors, emotional and interpersonal deficits, and general antisociality (see Gough, 1948; McCord & McCord, 1956, 1964). The researchers all found, at least in the case of primary psychopaths, the presence of externalizing symptoms (i.e., when an individual acts out toward others, such as with aggression) in the absence of internalizing symptoms (i.e., when an individual acts inward, such as the case of negative emotions). That is, psychopaths are far more likely to exhibit callousness toward others (externalizing symp- toms) without any guilt or remorse (internalizing symptoms).

Robert Hare and the Psychopathy Checklist-Revised Cleckley’s conceptualization guided the study of psychopathy for several decades and served as the inspiration for Robert Hare and the current gold standard for measuring psychopathy that he developed: the Psychopathy Checklist-Revised. The Psychopathy Checklist-Revised (PCL-R) is a clinical construct rating scale that uses information from a semistructured inter- view, case history information, and scoring on a 3-point scale (0, 1, or 2) on 20 items that relate to affective, lifestyle, interpersonal, and behavioral factors associated with the disorder (see Figure 3.2). Because the four factors make up the same construct, they are significantly correlated. The highest score on the measure is 40; the higher an individual scores, the more psychopathic traits he or she exhibits.

The PCL-R has been widely tested, and its validity and reliability are strong. Validity means that the PCL-R measures what it sets out to measure—specifically, the existence of psychopa- thy in an individual. Reliability refers to the PCL-R yielding the same result over and over each time it is administered to an individual. To be high in reliability, the results should be the same even if other practitioners administer the measure to the individual. The PCL-R has performed so well that it has engendered a family of measures, including the Psychopathy Checklist Screening Version (PCL: SV), the Psychopathy Checklist Youth Version (PCL: YV), and the Antisocial Process Screening Device (APSD).

Section 3.3 Diagnosing Psychopathic Individuals

It should be noted that Hare (1993, 1996) has been instrumental in introducing the construct of psychopathy to both criminology and the general public. In fact, Hare has been the central figure in the study of psychopathy since the late 1960s and is currently the most cited psy- chopathy researcher in the world. (You can explore the following website for more informa- tion: http://www.hare.org.)

Let’s explore the PCL-R factors here.

Figure 3.2: The Psychopathy Checklist-Revised

Robert Hare’s PCL-R is the most widely used assessment of psychopathy in clinical and correctional populations.

Affective

factor

Antisocial

factor

Lifestyle

factor

Interpersonal

factor

Psychopathy

http://www.hare.org

Section 3.3 Diagnosing Psychopathic Individuals

The Affective Factor Of all the characteristics of psychopathy, the affective dimension—particularly callousness, coldness, and lack of empathy—is arguably the most important and unique. Indeed, in recent years, a separate area of inquiry has focused on callous-unemotional traits, temperamen- tal characteristics that indicate fearlessness and lack of guilt and can be seen in childhood, adolescence, and adulthood. Callous-unemotional traits seem to facilitate the ability of psy- chopathic individuals to victimize others because these individuals do not process or are unaffected by their victims’ distress, pain, and suffering. Indeed, callous-unemotional traits are even associated with a preference for getting into trouble and being punished, which reflects the depth of psychopathic individuals’ emotional deficits (Lorber, Hughes, Miller, Crothers, & Martin, 2011).

The unique, cardinal feature of psychopathy is a deficit in affect (the experiencing of feelings or emotions). Callousness and lack of empathy are the absence of compassion and understand- ing of the feelings and emotional suffering of another person. Failure to accept responsibil- ity is the unwillingness to take part in the responsible investment in another person that is required for normal social interaction. Shallow emotion is the absence of genuine emotion. Lack of guilt or remorselessness is the incapacity to feel negative emotional states, such as guilt, shame, or regret for one’s conduct.

The Lifestyle Factor In terms of the lifestyle factor, psychopaths display a distinct set of features. They may have a lack of realistic life goals, an unreasonable, unfeasible sense of one’s life achievements rela- tive to the investment one makes. In other words, individuals may brag about what they are going to accomplish despite the fact that they have not done the necessary things to make those accomplishments possible (such as earning more than $200,000 per year despite not successfully completing high school, let alone college or graduate school). A psychopath may also have a parasitic orientation, or the desire to exploit or live off the material support of another person. For example, people who live with relatives or a significant other without helping pay the household bills (i.e., freeloading) demonstrate a parasitic orientation. Irre- sponsibility is a global lack of follow-through in the basic requirements and expectations of functional adult roles. Impulsivity occurs when immediate gratification of desires is preferred to the prolonged delay of rewards. Stimulation seeking refers to the need for novel, exciting experiences. See Case Study: Andrew Cunanan for a look at what drove the man to murder fashion designer Gianni Versace.

Section 3.3 Diagnosing Psychopathic Individuals

Case Study: Andrew Cunanan Andrew Cunanan was obsessed with the life- styles of celebrities and other wealthy individu- als. In the 1990s, while living in San Diego, Cali- fornia, he associated himself with the circles of the rich and famous and typically lived off the wealth of others with whom he was in relation- ships. People who knew him described him as charming and focused on the finer things in life, wanting to be admired and famous. He typically lied about his origins, family, and personal his- tory, always making things seem more sensa- tional than they really were.

Cunanan allegedly mentioned the fashion designer Gianni Versace often to friends and seemed resentful of the designer’s wealth and status yet also obsessed with him. Cunanan murdered Versace in 1997, after killing four other men.

Cunanan displayed traits of the lifestyle factor, according to the PCL-R. His psychopathic ten- dencies contributed to the murders of five peo- ple and ultimately to his own death. His crimes inspired the television show The Assassination of Gianni Versace: American Crime Story.

To read more about Cunanan’s case, visit the fol- lowing link: https://www.vanityfair.com/maga zine/1997/09/cunanan199709.

Jeffrey Boan/FBI/Associated Press

Serial killer Andrew Cunanan murdered five victims, including fashion mogul Gianni Versace. Cunanan was a pathological liar who was cold and calculating and who enjoyed living off other people’s money. His criminal behaviors were featured in the 2018 television series The Assassination of Gianni Versace: American Crime Story.

The Interpersonal Factor The interpersonal dimension refers to the psychopathic individual’s ability to exploit and manipulate other people and potential victims. Glib or superficial charm is the ability to strike up a conversation and appear to be charming and engaging in social settings. It is important to note that this charm is superficial; the emotional deficits that psychopathic individuals present generally reduce their capacity to have true, deep engagement with others. Narcis- sism or grandiose self-worth is an extreme love for oneself. Narcissism is doubly important in that it contributes to the blind pursuit of selfish needs at the expense of others. Pathological lying is the repeated use of lying and deception to explain, defend, and justify one’s conduct. Conning or manipulation is the desire to use or exploit others for one’s satisfaction.

https://www.vanityfair.com/magazine/1997/09/cunanan199709

Section 3.4 Psychopathy and Criminal Behavior

The Behavioral Factor Behaviorally, psychopathic individuals display a set of behaviors that are compatible with and in some cases examples of antisocial conduct. Antisocial tendencies can often lead to crimi- nal behavior due to poor behavioral control, low self-regulation, or inability to manage one’s conduct in the face of rules and regulations.

Antisocial tendencies also affect early behavior problems and juvenile delinquency—criminal behavior occurring prior to adulthood that results in police contacts or juvenile court refer- ral. The psychopathic individual may also have criminal versatility, or involvement in a range of crime types, such as violence, property damage, drug offending, and nuisance behaviors. They also may have noncompliance and revocation of conditional release, or a failure to comply with court orders and the conditions of correctional sentences.

Correlations Between PCL-R Factors Individuals who are extremely psychopathic tend to score highly on each factor of the con- struct. This means that the factors are positively correlated; when there is strong evidence of one factor of psychopathy, there tends to be evidence of the others as well. In a study based on data from nearly 7,000 participants, the affective factor is most strongly correlated with the interpersonal factor, and the interpersonal factor is most strongly correlated with the affec- tive factor (Hare & Neumann, 2008).

As mentioned earlier, narcissism embodies the preference for the self over others, and there is evidence that much of the variance in self-control in the general population is attributable to narcissism (Vaughn, DeLisi, Beaver, Wright, & Howard, 2007). Taken together, the facets of the interpersonal factor relate to the method and motivation that a psychopath employs when interacting with others, and the goal of that interaction is exploitative gain.

There are other important connections between the factors of psychopathy as measured by the PCL-R. The same study conducted by Hare and Neumann (2008) found that the lifestyle factor is most strongly correlated with the antisocial factor. In many respects, the lifestyle factor of the PCL-R is consistent with the general personality approach to studying crimi- nal behavior, especially given the importance of impulsivity and stimulation seeking. Among active criminal offenders, it is common to see the parasitic, unsuccessful lifestyle manifest in psychopathic and nonpsychopathic individuals alike.

3.4 Psychopathy and Criminal Behavior It is difficult to overestimate the salience of psychopathy to antisocial and criminal behavior. In a way, the constellation of traits that constitute psychopathy can be viewed as a recipe for criminal behavior. Serious and violent offenders commit crimes for very selfish reasons and frequently display little to no concern or compassion for their victims. Upon capture, severe offenders frequently refuse to acknowledge their crimes or claim responsibility for them; in court, they commonly plead not guilty. From a lay criminal justice perspective, this seems rou- tine. But from a psychological perspective, these behaviors are evidence for the narcissistic, callous, coldhearted, and manipulative behavioral repertoire of the psychopathic offender.

Section 3.4 Psychopathy and Criminal Behavior

As touched on at the beginning of this chapter, the prevalence of psychopathy in prison sam- ples is 10 to 40 times higher than in the gen- eral population, and among the worst of the worst of criminal offenders—such as those who commit sexual homicide—psychopathy is pervasive. For example, a study of sexually violent predators found that for each point above the mean score on the PCL-R, offenders were 49% more likely to be civilly commit- ted because of their level of risk. In addition, those who scored above 30 on the PCL-R were nearly 500% more likely to be civilly commit- ted (Levenson & Morin, 2006). Even when compared to other nonpsychopathic prison-

ers who have been convicted of violent felonies—such as murder, rape, armed robbery, and kidnapping—psychopathic prisoners stand out for their more extensive criminal histories, more entrenched criminal lifestyles, more antisocial attitudes and thought patterns, more challenging correctional needs, and greater dangerousness (DeLisi, 2009; DeLisi & Vaughn, 2008; Hare, 1993, 1996; Simourd & Hoge, 2000).

A meta-analysis of 18 studies found that psychopathy is a strong predictor of violent and nonviolent recidivism and is a useful construct for identifying dangerousness in the criminal population (Salekin, Rogers, & Sewell, 1996). Prior research has utilized correctional samples of prisoners to empirically assess the predictive validity of psychopathy to recidivism and other correctional outcomes. Harris, Rice, and Cormier (1991) conducted a 1-year follow-up study of male offenders released from a psychiatric hospital and found that not only did 80% recidivate within 1 year, they recidivated with a violent offense. Even more importantly, the study showed that predictive effects of psychopathy were stronger on these offenders than the combined effects of 16 other variables relating to criminal history and other covariates.

Additional evidence for the generalized relation of psychopathy to antisocial behavior (and thus criminal behavior) stems from the large number of study groups and populations that researchers have used. A study based on data from psychiatric patients from the MacArthur Violence Risk Assessment Study found that patients with psychopathic personality traits engaged in more self-directed, other-directed, and codirected violence than their peers with fewer psychopathic traits (Swogger, Walsh, Homaifar, Caine, & Conner, 2012). Persons with psychiatric disorders and psychopathy are more likely to hurt themselves and others once released from the hospital or other psychiatric facility. Substantively similar findings have been shown among forensic psychiatric patients in Sweden. Those with more psychopathic personalities were characterized by higher levels of recidivism up to 8 years after their release from treatment (Stalenheim, 2004).

In a statewide survey of institutionalized delinquents, Vaughn, Howard, and DeLisi (2008) reported extensive linkages between psychopathic personality and the severity of delinquent careers. Higher scores on psychopathy measures were associated with higher levels of gen- eral delinquency, more violent delinquency, greater hostile aggression, and earlier onsets of antisocial conduct, police contact, and juvenile court referral. In fact, the most psychopathic

Nicola Patterson/iStock/Getty Images Plus

Psychopathy is much more prevalent in prisons and is a strong indicator of recidivism.

Section 3.5 Psychopathy Across the Life Span

youths were over 200% more likely to have an early onset delinquent career than their peers with less psychopathic features. Vaughn and DeLisi (2008) examined the interplay between psychopathy and career criminality in a large cohort of institutionalized delinquent youths. They found that career criminal youths had significantly higher psychopathy scores; pre- sented with more narcissism, unemotionality, fearlessness, and impulsivity; and had greater involvement in violent and nonviolent delinquency. Moreover, various psychopathic traits were associated with diverse forms of delinquent conduct, such as violent offending, theft, and drug use (Vaughn, Newhill, DeLisi, Beaver, & Howard, 2008).

3.5 Psychopathy Across the Life Span For many years, the study of psychopathy mostly focused on adults and more specifically on adult prisoners and psychiatric patients. However, an empirical issue was that psychopathy— like most personality constructs—is relatively stable and enduring. This means that psychop- athy is not limited to adult offenders but is also present among adolescents and even children.

A noteworthy feature of psychopathy is the lifelong developmental course of psychopathic traits. For instance, Robins and O’Neal (1958) conducted a 30-year follow-up study of behav- iorally disordered children and concluded:

A relatively circumscribed segment of the population [is] distinguished by a life-long failure to conform to the social mores . . . [and] it seems probable that criminal activities are more frequently only one expression of a grossly disturbed life pattern of which transiency, violence, and unstable family rela- tions, as well as crime, are typical. Even as children, these boys engaged in antisocial behavior in most contexts, were thoroughly irresponsible, and showed neither concern for their actions nor remorse for the persons whom they affected. (p. 170)

Like other psychological conditions discussed in this text (e.g., personality, temperament, and neuropsychological deficits), psychopathy is relatively stable and manifests across the life span. For example, Gao, Raine, Chan, Venables, and Mednick (2010) found that early parenting trauma was associated with psychopathic personality 25 years later, especially among chil- dren with low maternal care and high child abuse victimization. That early life environments affect brain functioning vis-à-vis psychopathic personality is chilling, given the longitudinal stability of psychopathy. Similarly, Lynam, Charnigo, et al. (2009) found no evidence of change in psychopathy across childhood and adolescence among boys in the Pittsburgh Youth Study.

Another study of more than 400 youths who became emancipated (reached age 18 and there- fore left foster care as adults) and thus transitioned from foster care is illustrative of psycho- pathic traits carrying over to adulthood (Vaughn, Litschge, DeLisi, Beaver, & McMillen, 2008). Those with higher psychopathic traits, particularly high levels of narcissism and fearless non- conformity, were more likely to commit a range of criminal acts during adulthood, such as drug selling, illegal money making, and assault with a weapon. They were also significantly more likely to accumulate arrests and be subsequently diagnosed with antisocial personality disorder.

Section 3.5 Psychopathy Across the Life Span

Fledgling Psychopathy A major event in the psychological study of psychopathy as it relates to its life-course develop- ment occurred when Donald Lynam (1996, 1997, 1998) presented his fledgling psychopathy thesis. Fledgling psychopathy is a childhood-onset behavioral style characterized by severe conduct problems, attention and hyperactivity deficits suggestive of combined-type attention- deficit/hyperactivity disorder (ADHD), and other features that are consistent with the adult conceptualization of psychopathy. In other words, fledgling psychopathy typifies children who concurrently have oppositional defiant disorder, conduct disorder, and combined-type ADHD—along with psychopathic features relating to callous and unemotional traits. Lynam (1997) devised the Childhood Psychopathy Scale to measure psychopathy among children and found that fledgling psychopathy was associated with severe behavioral problems and delin- quency even when considering the effects of other robust predictors of conduct problems.

Other researchers reported similar findings. Based on a sample of more than 400 middle school students, DeLisi and colleagues (2011) found that about 10% of the sample was char- acterized by fledgling psychopathic traits, including callousness, uncaring, lack of emotion, interpersonal deficits, self-regulation problems, and poor academic performance. Those in this group are most at risk for developing continued behavioral problems because of their various psychopathic traits.

Research has also demonstrated that fledgling psychopathic traits as characterized by Lynam and his colleagues predict psychopathy in later adolescence and adulthood and are

associated with criminal careers (Lynam, Derefinko, Caspi, Loeber, & Stouthamer- Loeber, 2007). Based on data from boys in the Pittsburgh Youth Study, those with more psychopathic personality traits were approximately 500% to 600% more likely than their nonpsychopathic peers to dis- play externalizing symptoms, delinquency, and violence. Psychopathic youths also had the most sustained, serious, violent, and aggressive delinquent careers (Loeber et al., 2002). Lynam, Miller, Vachon, Loeber, and Stouthamer-Loeber (2009) later stud- ied the construct in the Pittsburgh Youth Study and found that childhood psycho- pathic traits were associated with arrests and convictions occurring through age 26.

All of this research is promising in the sense that fledgling psychopathic youths who are the most likely to develop into habitual criminal offenders can be identified and treated much earlier than in prior eras. Moreover, their psychopathic traits can potentially be modified so that their development veers from antisocial to more prosocial behavior. The fact is that juve- niles’ personalities, due to their ongoing growth and development, may be more malleable than adults’ personalities. Therefore, labeling a juvenile a psychopath may be misleading to judges who must sentence juvenile offenders.

Hemera/Thinkstock

Even for juveniles, early evidence of psychopathic personality traits is a strong indicator that a person will later display symptoms of psychopathy or commit violence.

Section 3.6 Considering Gender and Race

Adult Versus Juvenile Psychopathy Researchers from the MacArthur Foundation Research Network (2006) found that adult mark- ers of psychopathy are not directly applicable to juveniles due to the developmental changes from adolescence into adulthood. The study was conducted over a 2-year period on juvenile and adult offenders in secure facilities. The researchers then compared juvenile offenders to adult offenders whose PCL-R test scores showed that they were either psychopathic or non- psychopathic. In the psychopathic groups, juveniles’ scores declined significantly over time, whereas adults’ scores tended to remain relatively stable. Therefore, it is advisable that psy- chologists use discretion when attempting to measure psychopathy in juvenile populations.

3.6 Considering Gender and Race Hare’s PCL-R was developed and validated using a predominantly White, male, criminal psy- chopath test population. Therefore, it is difficult to determine (and there is controversy sur- rounding) whether it is a valid measure of psychopathy in females and minorities.

Psychopathy and Gender As previously mentioned, the overall prevalence of psychopathy in the general population is quite low—somewhere around 1% (Hare, 2003). The vast majority of this group consists of men; research shows that female psychopaths are rare (Nicholls, Ogloff, Brink, & Spidel, 2005). It is estimated that in female jails and prisons, the proportion of the population that has psychopathic traits ranges from 7% to 15% (Hare, 2003; Vitale, Smith, Brinkley, & New- man, 2002). Salekin, Rogers, Ustad, and Sewell (1998) found that recidivism rates of female psychopaths are significantly less than those of male psychopaths and no greater than those of nonpsychopathic females.

As with other psychopathic individuals, the trait that makes psychopathic females perhaps most distinguishable from nonpsychopathic females is significant lack of empathy and high levels of callousness. But researchers have identified other characteristics that may distin- guish some females as distinctly psychopathic (see Douglas, Nikolova, Kelley, & Edens, 2015; Efferson & Glenn, 2018; Grann, 2000; Nicholls & Petrila, 2005, Salekin, Rogers, & Sewell, 1997; Vitale et al., 2002; Warren et al., 2003).

Research shows that females with psychopathic tendencies may rely more on relational aggression than their male counterparts. Relational aggression is more subtle than the direct aggression that is commonly observed in male psychopaths; it is covert, with a focus on dam- aging another’s reputation and social status (Skeem, Patrick, & Lilienfeld, 2011). (We’ll dis- cuss relational aggression in more detail in Chapter 6.) This makes it a challenge to identify the behavior as aggressive. Female psychopaths may also present as sexually promiscuous, exhibit a lack of realistic life goals, engage in a variety of criminal behaviors, and have mul- tiple romantic relationships (Douglas et al., 2015).

Section 3.7 Psychopathy Throughout the World

APD is highly correlated with psychopathy for both male and female psychopaths. Although there are similarities in male and female psychopaths, the psychiatric community frowns on using the PCL-R to predict psychopathy in females (Nicholls et al., 2005). The PCL-R is even less acceptable to use as a measure of psychopathy in female juveniles; research shows that the existence of psychopathy in this particular group is particularly difficult to identify (Sevecke, Pukrop, Kosson, & Krischer, 2009).

Psychopathy and Race Some research suggests that there are no significant clinical differences between male psycho- paths based on race (Douglas et al., 2015); however, other research has shown that differences do exist. Kosson, Smith, and Newman (1990) found that the key difference between Black and White psychopaths appears to be related to impulse control. That is, White male psychopaths exhibit a remarkable lack of impulse control compared to their Black counterparts.

Despite the varying research, it is an ethically sound decision on the part of clinicians to pro- ceed with caution when administering the PCL-R on individuals who are not members of the group in which the measure was validated: White, male psychopaths. This is also true when considering nationality, particularly in individuals who live outside of Canada, where the PCL-R was developed.

3.7 Psychopathy Throughout the World Although Canadian researchers have dominated the study of psychopathy over the past sev- eral decades, it is studied worldwide. Moreover, the evidence for psychopathic offenders and their disproportionate contribution to criminal violence throughout the world is compelling, as shown in the following list.

• England. Drawing on longitudinal data from the Cambridge Study in Delinquent Development, Farrington (2006) compared those who scored in the 90th percentile on the PCL: SV to those scoring below this threshold. The most psychopathic individuals had significantly more criminal convictions, displayed more diagnostic criteria for APD, had greater involvement in the criminal justice system, and were more likely to be habitual offenders.

• Brazil. In a study of male prisoners in Brazil, higher psychopathy scores were associated with more violent crime, more property crime, greater prevalence of carrying weapons, more fraud, and more total crimes. Psychopathic prisoners were also significantly more likely to have been diagnosed with conduct disorder during adolescence and APD during adulthood (Flores-Mendoza, Alvarenga, Herrero, & Abad, 2008).

• Russia. In a study of 175 juvenile delinquents selected from Russia, psychopathic youths were found to be more physically aggressive, violent, and prone to alcohol- related problems than their nonpsychopathic peers. In addition, psychopathic delinquents were significantly more likely to view antisocial behavior as a normal or normative manner of behaving and had more pronounced criminal attitudes (Fritz, Wiklund, Koposov, Klinteberg, & Ruchkin, 2008).

Section 3.7 Psychopathy Throughout the World

• Wales and Scotland. A survey of the household population in Wales and Scotland found that less than 1% of individuals displayed clinical levels of psychopathic traits (Coid, Yang, Ullrich, Roberts, & Hare, 2009). Despite the low prevalence, psychopathic citizens were significantly more likely to have criminal convictions, serve a prison sentence, commit violence (including family violence), become homeless, be admitted to a psychiatric facility, be drug dependent, and attempt suicide.

• The Netherlands. A study of 92 men who were inpatients at a forensic hospital in the Netherlands found that psychopathic personality traits were significantly associated with violating hospital rules and threatening, verbally abusing, and behaving violently toward staff. In addition, those who were clinically psychopathic (those scoring 30 or higher on the PCL-R) were more involved in all forms of disruptive and antisocial behavior than nonpsychopathic patients (Hildebrand, De Ruiter, & Nijman, 2004).

• United States. A meta-analysis of more than 63,000 American college students from 1938 to 2007 and nearly 14,000 American high school students from 1951 to 2002 found that the later generations of young people scored more than one standard deviation higher on a psychopathic personality measure than prior generations. This suggests that American culture has become more conducive to psychopathology (Twenge et al., 2010).

In addition to these studies, Hare and his colleagues have presented workshops to crimi- nal justice practitioners on the administration of the PCL-R and measures derived from it. According to Hare’s website, these workshops have occurred in Argentina, Australia, Canada, England, Finland, Germany, Hong Kong, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Portugal, Scotland, South Korea, Spain, Switzerland, Turkey, the United States, and Wales, among others.

Finally, Sullivan and Kosson (2006) conducted a summary review of 19 studies of psychopa- thy among prisoners, psychiatric patients, and forensic clients referred for evaluation in 10 countries outside North America. They found that “the majority of findings provide com- pelling evidence that the construct of psychopathy as indexed by the PCL-R is valid across cultures” (Sullivan & Kosson, 2006, p. 448). This suggests that psychopathy is a universal phenomenon in terms of its relation to conduct problems, antisocial behavior, crime, and vio- lence. Although the prevalence of psychopathy is quite low, it can have significantly detrimen- tal effects on society, especially at the hands of criminal psychopaths. Therefore, determining how to treat psychopathy is a crucial endeavor.

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Research around the world demonstrates a strong connection between psychopathy and crime.

Section 3.8 The Treatment of Psychopathy

3.8 The Treatment of Psychopathy The tone of this chapter is admittedly not very positive in terms of the likelihood that psy- chopathy can be effectively treated. Because psychopathy is produced by a combination of factors, there is a perception that once established it is essentially impossible to alter. Indeed, in later versions of The Mask of Sanity, Cleckley observed that psychopathy seemed almost immune to modification in terms of the correctional goals of the criminal justice system. Cleckley (1941) asserted that psychopaths lack the ability to form the emotional bonds nec- essary to achieve a successful therapeutic outcome.

To date, research in the area appears to support Cleckley’s position. In fact, Richards, Casey, and Lucente (2003) found that the higher the score on psychopathy measures, the poorer the treatment outcome. Moreover, the essence of neuroscientific theories of psychopathy sug- gests core deficits relating to learning, memory, and emotional processing that are not easily undone by treatment. However, this does not mean that treatment is impossible. Let’s take a look at a few perspectives on psychopathy treatment methods.

There are divergent viewpoints about the evidence for treatment success of psychopathic indi- viduals (see Felthous, 2011). In a meta-analysis of 42 studies that focused on treatment of psy- chopathy, Salekin (2002) provided optimistic evidence for the efficacy of treatment programs in producing positive behavioral outcomes among psychopaths. Overall, Salekin found that 62% of studies in his meta-analysis actually demonstrated successful treatment outcomes. The outcomes varied by the pro- gram modality.

• Among treatments based in psycho- analytic therapy, the success rate was 59%.

• Cognitive behavioral therapies produced a success rate in 62% of studies.

• Eclectic therapies that combined a range of approaches were the most successful at 86%.

• Prison-based treatment programs were the least effective approach, with a success rate in just 25% of programs.

From these findings, Salekin concluded that therapeutic pessimism, the notion that psy- chopathy is untreatable, was unfounded.

Similarly, Skeem, Monahan, and Mulvey (2002) used data from participants in the MacAr- thur Violence Risk Assessment Study and found that psychopathic criminal offenders who received treatment were nearly 5 times less likely to recidivate than psychopathic criminal offenders who did not receive treatment.

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Traditional medicine cannot cure psychopathy, and experts disagree on whether it can be treated at all. Some argue that the experiences and entrenched personality traits that create psychopathy cannot be undone, while other studies have shown that treatment can be effective for certain offenders.

Summary and Conclusion

Salekin and Worley (2010) reviewed treatment outcomes among psychopathic youths and concluded that the treatment effects were generally positive, whereas treatment outcomes among psychopathic adults were generally negative. Thus, part of the reason for divergent views about the treatment prognosis with psychopaths is related to age.

Another view is that treatment protocols are largely ineffective at reducing the problem behaviors associated with psychopathy. Moreover, there is evidence that treatment may even produce worse behavioral outcomes when utilized with psychopathic offenders. Rice, Harris, and Cormier’s (1992) comparative study of 146 treated offenders to a matched group of 146 untreated offenders produced several important findings. Over a follow-up period of more than 10 years, Rice et al. found that treatment was associated with reduced recidivism among offenders who were not psychopathic. Among offenders who were psychopathic and received treatment, there were poorer adjustments to treatment and greater violent recidivism. It is believed that the poorer recidivism outcomes are explained by the psychopaths learning new ways to manipulate and exploit victims from the treatment. In a more recent review, Harris and Rice (2006) argued forcefully that treatment is ineffective with psychopathic offenders, given the uniqueness of their pathology. Indeed, they concluded:

We believe there is no evidence that any treatments yet applied to psycho- paths have been shown to be effective in reducing violence or crime. In fact, some treatments that are effective for other offenders are actually harmful for psychopaths in that they appear to promote recidivism. We believe that the reason for these findings is that psychopaths are fundamentally different from other offenders and that there is nothing “wrong” with them in the man- ner of a deficit or impairment that therapy can “fix.” Instead, they exhibit an evolutionarily viable life strategy that involves lying, cheating, and manipulat- ing others. (Harris & Rice, 2006, p. 568)

That is, psychopaths are adept at predatory manipulation of others, including an uncanny abil- ity to feign normal human emotion such as empathy. As a result, it may be virtually impossible to determine whether any treatment modality can successfully extinguish psychopathic ten- dencies. While treatment can be effective, working with and treating this population requires a significant amount of specialized training and clinical supervision, since psychopaths are notoriously adept at manipulating unsuspecting therapists.

Summary and Conclusion

As you have learned in this chapter, psychopathy is a personality disorder that throughout its history has been highly correlated with antisocial behavior and criminality. Psychopathy encompasses a range of deficits in interpersonal skills, affective style, lifestyle factors, and behaviors.

Although modern psychopathy was first identified by Hervey Cleckley, it has been studied extensively by Robert Hare, who developed the Psychopathy Checklist-Revised (PCL-R)— the gold standard for measuring psychopathy. Though the PCL-R is highly regarded among relevant forensic mental health professionals, it should be used with caution with juveniles, females, racial minorities, and populations outside of Canada and the United States.

Summary and Conclusion

Key Terms affect The experiencing of feelings or emotions.

callous-unemotional traits Temperamen- tal characteristics that indicate fearlessness and lack of guilt; seen in childhood, adoles- cence, and adulthood.

categorical construct A concept or phe- nomenon that is discrete, in which an individual either does or does not have a particular condition.

conduct disorder A repetitive and persis- tent pattern of behavior in children in which the basic rights of others or basic social rules are violated.

continuous construct A concept or phe- nomenon that is dimensional and that ranges from low to high scores on a particu- lar condition.

fledgling psychopathy Lynam’s notion that psychopathy is usually seen in children who concurrently present with severe conduct problems and combined-type ADHD.

prevalence The proportion of a population or sample that has or presents a particular condition; it is represented as a percentage.

psychopathy A personality disorder char- acterized by a set of affective, lifestyle, inter- personal, and behavioral characteristics that are associated with antisocial and criminal behavior.

Psychopathy Checklist-Revised (PCL- R) A clinical construct rating scale that uses a semistructured interview, case history information, and scoring on a 3-point scale (0, 1, or 2) on 20 items that relate to affec- tive, lifestyle, interpersonal, and behavioral factors. Developed by Robert Hare.

therapeutic pessimism The notion that psychopathy is untreatable.

Last, and perhaps most important, there is significant controversy in the relevant scientific community as to whether psychopathy is treatable, based on the characteristics and traits of psychopaths. Adding to the controversy is the discrepancy in research findings; some stud- ies claim successful treatment, while others appear to disconfirm those findings.

Critical Thinking Questions

1. What is unique about psychopathy that has intrigued scholars throughout its history?

2. Can you think of times when people might be labeled “psychopathic” (even though they are not)? What other psychiatric disorders are similar to psychopathy and can lead to diagnostic confusion?

3. Should juveniles ever be labeled as psychopaths? What is the most compelling evidence to suggest that this may be an ill-advised practice?

4. Based on the extant literature, what treatment approaches are most effective at treating psychopathy? What modalities should be used? What modalities should be avoided? Should fledgling psychopaths receive treatment priority over psychopathic adults?