Topic 9: Psychopathy and Antisocial Personality Disorder

Question 1

What are the conclusions from the Homer Simpson assignment?

Answer 1

his score was 15

yes he has antisocial personality disorder but he is not a psychopath

psychopaths make up 10% of prisons

average score is 2 or 3 for women

Question 2

What is the historical development of psychopathy?

Answer 2

psychopathy is a construct that describes an element of personality predisposing one to criminal and other antisocial behaviors

psychopaths are among the worst criminals

the construct is not appropriately applied to generally law-abiding, but self-serving individuals

there are very few “successful” psychopaths: they seldom have the drive and determination to undergo the rigors of education or hard work

diagnosis of this attribute has progressed from a purely theoretical and attributional definition to one based primarily on observable behaviors

more recently, there has been a recognition of the need to include both dimensions

Question 3

What was Pinel’s (1801) thinking on psychopathy?

Answer 3

mania sans delire

a condition in which one demonstrates high levels of social irresponsibility despite apparently intact intellectual functioning

Question 4

What was Benjamin Rush’s (1812) thinking on psychopathy?

Answer 4

amongst the first to hypothesize a physiological basis for antisocial behavior as characterized by his description of “a congenital defect of moral derangement”

therefore, the domain of medicine

Question 5

What was the term “moral insanity” coined by Pritchard?

Answer 5

survived until quite recently

the intellectual faculties appear to have sustained little or no injury, while the disorder is manifested principally or alone in the state of the feelings, temper, or habits

Question 6

What was Kraepelin’s (1909) thinking on psychopathy?

Answer 6

created a list of seven subtypes

it included the excitable, the unstable/impulsive, the eccentric, the liar, the swindler, the antisocial, and the quarrelsome

these ideas survive in the current conceptualization of psychopathy, though not as discreet subtypes

Question 7

What was Kahn’s (1931) thinking on psychopathy?

Answer 7

expanded the list to fourteen types including the nervous, anxious, sensitive, compulsive, excitable, hyperthymic, depressive, moody, affectively cold, weak willed, sexual perverse, hysterical, eccentric, and fantastically cranky

Question 8

What is the term semantic dementia coined by Cleckley (1976)?

Answer 8

underscores the apparent rift between words and deeds that figures prominently into the many vignettes characterizing the behavior of psychopaths

this idea is well represented in the often quoted phrase, “they know the words but not the music”

Question 9

What are the problems with the diversity of explanations for psychopathy?

Answer 9

the diversity of explanations, labels, and definitions noted above underscores the lack of consistency that has plagued researchers

problem: it became virtually impossible to generalize findings from one group to the next

Question 10

What was the impact of The Mask of Sanity (1976) by Cleckley?

Answer 10

provided many of the diagnostic criteria in use to the present day

16 characteristics

Cleckley’s criteria left researchers and clinicians to rely heavily upon inference concerning the presence or absence of essential characteristics

Question 11

What are Cleckley’s Big 16 characteristics of psychopaths?

Answer 11

1. superficial charm and good intelligence
2. absence of delusions and other signs of irrational thinking
3. absence of nervousness or psychoneurotic manifestations
4. unreliability
5. untruthfulness and insincerity
6. lack of remorse or shame
7. inadequately motivated antisocial behavior
8. poor judgment and failure to learn by experience
   9.pathological egocentricity and incapacity to love
9. general poverty in major affective reactions
10. specific loss of insight
11. unresponsiveness in general interpersonal relations
12. fantastic and uninviting behavior with drink, and sometimes without
13. suicide rarely carried out
14. sex life impersonal, trivial, and poorly integrated
15. failure to follow any life plan

Question 12

What are the characteristics of Antisocial Personality Disorder in the DSM?

Answer 12

A. there is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Question 13

In what way was the DSM-5 supposed to take a different (hybrid) approach?

Answer 13

only 6 of the personality disorders, not 10

from Cluster B this includes Antisocial/Psychopathic and Borderline (and maybe Narcissistic)

definition based on different criteria each rated on a 4 point scale

total PD severity is rated on a 5 point scale

Question 14

What is the proposed criteria for DSM-6 categories of antisocial/psychopathic?

Answer 14

antagonism: callousness, aggression, manipulativeness, hostility, deceitfulness, narcissism

disinhibition: irresponsibility, recklessness, impulsivity

each scored on a scale of 0 to 3

clinicians could use this information to make a global severity rating from 1 to 5

Question 15

Why would the changes proposed for the DSM-6 be helpful to diagnosing antisocial personality disorder?

Answer 15

reduction in diagnostic overlap

less arbitrary diagnostic threshold

movement from a categorical to dimensional conceptualization

recognition that symptom severity can fluctuate over time

Question 16

What is conduct disorder?

Answer 16

A. a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months

B. the disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

C. if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder

Question 17

What is the aggression to people and animals characteristic of conduct disorder?

Answer 17

1. often bullies, threatens, or intimidates others
2. often initiates physical fights
3. has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
4. has been physically cruel to people
5. has been physically cruel to animals
6. has stolen while confronting a victim
7. has forced someone into sexual activity

Question 18

What is the destruction of property characteristic of conduct disorder?

Answer 18

8. has deliberately engaged in fire setting with the intention of causing serious damage
9. has deliberately destroyed others’ property (other than by fire setting)

Question 19

What is the deceitfulness or theft characteristic of conduct disorder?

Answer 19

10. has broken into someone else’s house, building or car
11. often lies to obtain goods or favors or to avoid obligations (i.e., “con” others)
12. has stolen items of nontrivial value without confronting a victims

Question 20

What is the serious violations of rules characteristic of conduct disorder?

Answer 20

13. often stays out at night despite parental prohibitions, beginning before age 13 years
14. has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
15. is often truant from school, beginning before age 13 years

Question 21

What are the DSM-5 changes to conduct disorder criteria?

Answer 21

allows for addition of Callous-Unemotional Presentation qualifier, based on…

1. lack of remorse or guilt
2. callous-lack of empathy
3. unconcerned about performance
4. shallow or deficient affect

Question 22

Who is Robert Hare?

Answer 22

has advocated for, and standardized a diagnostic scheme based on behavioral criteria but which also operationalizes characteristics of the sort described by Cleckley

result: PCL-R

Question 23

What is the reliability of the `PCL-R?

Answer 23

good interrater reliability for the individual items, ranging from 0.42 to 0.82

total score interrater reliabilities of 0.78 when single rater administer the PCL-R, and 0,87 when the averaged scores of two-rater teams were used

Question 24

What is the relationship between PCL-R scores and ASPD?

Answer 24

Hart, Forth and Hare (1991) reported a correlation of 0.48 between PCL-R scores and ASPD diagnoses

correlation between PCL-R scores and number of APD criteria met was 0.72

79.2% of their subjects who met the PCL-R criteria for classification as psychopaths (i.e., total score of thirty or higher) also met the DSM-III-R criteria for ASPD

only 30.2% of the ASPD group were defined as psychopaths

Question 25

What were the methods of the Lykken (1957) study on the fact that psychopaths show deficient passive avoidance learning compared to controls?

Answer 25

sequencing (or "mental maze") task 20 decision points requiring the depression of one of four switches pressing the correct switch moved the subject to the next set of choices, as signaled by a green light two of the three remaining switches activated red lights, indicating the need to make another choice, and pressing the remaining switch resulted in a shock

Question 26

What were the results of the Lykken (1957) study on the fact that psychopaths show deficient passive avoidance learning compared to controls?

Answer 26

the threat of a painful shock should engender anxiety; the successful learning of the task would result in fewer shocks (therefore negative reinforcement) Lykken used the number of shocks delivered as an index of how effectively anxiety reduction would reinforce correct responding consistent with Cleckley's position that psychopaths do not develop emotional responses (i.e. fear) as readily as normals, Lykken found that the psychopaths received significantly more shocks

Question 27

What were the methods of the Chesno and Kilmann (1975) study that found extraneous stimulation assists psychopaths in learning?

Answer 27

90 subjects comprising two groups (high psychopathy and low psychopathy) subjects from both groups were further divided into three groups according to their level of anxiety, on the basis of self-reports testing occurred under three experimental conditions defined by the level of background white noise in the testing environment; the noise levels were 36, 65, and 95 dB respectively the task involved viewing a series of numbers for a brief period and either pressing, or not pressing, a button; certain numbers signaled that button pressing would prevent electric shock, whereas pressing when those numbers were absent would result in the delivery of an otherwise unscheduled shock (both active and passive avoidance learning)

Question 28

What were the results of the Chesno and Kilmann (1975) study that found extraneous stimulation assists psychopaths in learning?

Answer 28

low anxious psychopaths made significantly more active errors (those resulting from pressing the button when numbers signaling shock were not presented) than the other groups in the 35 dB condition, but they made no more errors when the background noise was higher given that loud noise and electric shock both constitute forms of stimulation, Chesno and Kilmann (1975) hypothesized that receiving shocks in the low noise condition was "beneficial" to the low anxious psychopaths in terms of increasing their level of central stimulation

Question 29

What was the method of the Schmauk (1970) study that resembled Lykken's?

Answer 29

employed three different types of punishment in a design which closely resembled Lykken's electric shock being verbally informed when an error was committed 25 cent fine for each error; subjects in the latter condition were told they could earn as much as eight dollars if their performance was perfect

Question 30

What were the results of the Schmauk (1970) study that resembled Lykken's?

Answer 30

psychopaths performed more poorly only when punished by shock or verbal feedback; not when financial punishments were used this is consistent with the hypothesis that electric shock may improve central arousal in psychopaths it also suggests that negative punishment (i.e., taking away something they like) is more effective with psychopaths than positive punishment (i.e., delivering something nasty)

Question 31

What was the Siegal (1978) study?

Answer 31

allowed his subjects to turn over as many cards from each of 11 decks as they wished; for each numbered card they turned over they were paid one cent, whereas they were fined one cent for each face card they turned over decks were prearranged to contain a fixed number of punishments; in the first deck, no face cards were includes, and hence no fines were imposed; in the final deck, all cards were face cards; the percentage of face cards increased progressively in 10 percent increments from the first to the last deck as subjects could abandon a deck, and move to the next whenever they wished, it was possible to derive a measure of response suppression

Question 32

What was the prediction of the Schmauk (1970) study that resembled Lykken's?

Answer 32

response suppression would be poorest among psychopaths when probability of punishment was most uncertain

Question 33

What were the results of the Schmauk (1970) study that resembled Lykken's?

Answer 33

in fact, psychopaths' responses were significantly less suppressed than those of controls, and most of the between-group difference originated in the fifth to ninth (40% to 90% punishment) decks i.e. responding was comparable when the probability of punishment was very low or very high; they differed mainly in the middle probability range psychopaths could estimate prior playoff rates about as accurately as controls failure to suppress was not explainable on the basis of deficient appreciation of the risks difference not present when forced to delay responding

Question 34

What are evoked potential studies on psychopathy?

Answer 34

multi-channel EEG recordings processed by computer examine changes in cortical potentials following presentation of visual, auditory, or stimulus changes can be either positive (P) or negative (N), and are classified according to latency e.g., P300 changes occur in a positive (increased voltage) direction, 300 msec or more after stimulus presentation P300s are best recorded over the parietal area thought to reflect changes in attention, and underlying cortical activity that corresponds to decision making

Question 35

What was the method of the Kiehl et al. (1999) study on EEG recording during a visual oddball task?

Answer 35

requires subjects to attend and react differentially to common and low probability events both were 50 ms presentation of a white square; subjects were to press a key only after common event, oddball task is tedious, long, and boring; hard to concentrate on even for normally attentive subjects

Question 36

What was the results of the Kiehl et al. (1999) study on EEG recording during a visual oddball task?

Answer 36

two difference emerged between psychopathic and non-psychopathic groups: 1. smaller common/oddball P300 differences among psychopaths compared to non-psychopaths 2. P300's were less lateralized psychopaths but no differences in P300 to common stimuli

Question 37

What are the implications evoked potential studies on psychopathy?

Answer 37

supports the conclusion that psychopaths have trouble properly (re) allocating attention, and in sustaining attention what other group would you expect to show similar results? --> ADHD

Question 38

What was the Gorenstein (1982) study on evoked potentials?

Answer 38

noted similarity to frontal lobe injured patients; hypothesized that psychopaths suffer FL impairment found significant differences on a number of neuropsychological tests between psychopaths and non-psychopaths

Question 39

What was the Hare (1984) study on evoked potentials?

Answer 39

was unable to replicate those findings different definitions of psychopathy seem to have accounted for the different findings

Question 40

What are the general research findings regarding psychopaths?

Answer 40

psychopaths are more likely to show punishment effects when monetary penalties (negative punishment) are used, than when aversive stimuli (positive punishment) are applied they will show these punishment effects in the form of response suppression as long as competing reinforcement contingencies are not in place third, they appear to integrate new information poorly unless forced to delay responding for even a brief period they cannot be differentiated from controls on tests of intellectual ability or neuropsychological impairment psychophysiological studies suggest fundamental differences in some cognitive processes

Question 41

What are some additional areas of research for psychopaths?

Answer 41

semantic decision making dichotic listening tasks fMRI / PET scanning

Question 42

What is the still dissent about regarding psychopathy?

Answer 42

there is still some dissent around the "true" manifestation of psychopathy (e.g., Thomas-Peter, 1992) Blackburn (e.g., 1971) and other European researchers include subjects with an element of neurotic conflict

Question 43

What is the PCL-R?

Answer 43

20 item checklist each item is scored 0, 1, or 2 maximum score is 40, 30 generally considered the cut-off for research purposes Hare advocates for a polythetic approach (i.e., the degree to which a ratee matches the prototype) factor analysis yielded two factors: Interpersonal/Affective ad Antisocial behavior items can be pro-rated when some information is absent both interview and file review contribute important information