Psychopathy

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  • Psychopathy or sociopathy is a personality trait or disorder that’s characterized by enduring anti-social behaviour, a diminished capacity for empathy or remorse and poor behavioural control the word “psychopathy” comes from the Greek words ‘psyche’ meaning spirit and ‘pathos’ meaning suffering or feeling the term psychopathy initially was a general meaning referring to all sorts of mental disorders or societal abnormalities but became popular since 1891 in Germany Psychopaths can mimic emotions almost perfectly to further their own personal agendas, are very skilled in the arts of deception Sociopathy was introduced from 1901 as an alternative to psychopathy but it reflects the belief that the condition is caused by society or experiences that a person has undergone rather than genetic psychopathic traits They aren’t as capable of feigning emotions, unable to maintain social relationships and hold down a steady job sociopaths also differ from psychopaths in the sense that the former can’t plan ahead while the latter is a master
  • The DSM has no specific classification for psychopathy or sociopathy but the traits are found in the diagnosis of antisocial personality disorder or ASPD The DSM has a diagnosis of Antisocial (Dissocial) Personality Disorder (ASPD) which states: “The essential feature of of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
  • DSM defines ASPD (Axis 2, Cluster B): A) there’s a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence (15 years) and continues into adulthood as indicated by three or more of the following: failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest deception as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure impulsivity or failure to plan ahead irritability and aggressiveness as indicated by repeated physical fights or assaults reckless disregard for safety of self or others consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another B) the individual is at least 18 years old C) there’s evidence of conduct disorder with onset before age 15 years D) the occurrence of antisocial behavior isn’t exclusively during the course of schizophrenia or a manic episode
  • American psychiatrist Hervey Cleckley’s work on psychopathy influenced the initial diagnostic criteria for sociopathic or antisocial personality in the DSM however it was the work of Canadian psychologist Robert D. Hare who strengthened the construct with the Psychopathy Checklist
  • The Hare Psychopathy Checklist-Revised (PCL-R) is the psychological assessment most commonly used to rate psychopathy Developed in the 1970s by Dr. Hare for use in psychology experiments based partly on his work with male offenders and forensic inmates in Vancouver and partly on the work of Dr. Cleckley 20 item inventory of perceived personality traits and recorded behaviors intended to be completed on the basis of a semi structured interview along with a review of other information such as official records Since the individual’s score may have important consequences for their future, it has the potential to cause harm if the test is administered incorrectly thus leading Hare to argue that the test should be considered valid if administered by a suitably qualified and experienced clinician under scientifically controlled and licensed standardized conditions
  • Each of the item in the PCL-R is scored on a three point scale according to a specific criteria along with an interview. In addition to lifestyle and criminal behavior, the checklist assesses glib, superficial charm, grandiosity, need for stimulation, pathological lying, cunning, manipulation, lack of remorse, callousness, poor behavioural controls, impulsiveness, irresponsibility, denial, failure to accept responsibility for one’s own actions and etc. the scores are used to predict risk for criminal recidivism and probability of rehabilitation
  • There are 2 factors which summarizes the 20 assessed areas via factor analysis Factor 1 is labelled is the interpersonal/affective traits ‘selfish, callous and remorseless use of others’ and this is the glibness/superficial charm grandiose sense of self-worth pathological lying cunning/manipulative lack or remorse or guilt shallow affect (genuine emotion is short-lived) callousness; lack of empathy failure to accept responsibility for their actions so-called core personality traits of psychopathy and has a strong correlation to narcissistic personality disorder Factor 2 refers to their lifestyle habits and is labelled as ‘chronically unstable, antisocial and socially deviant lifestyle’ need for stimulation/proneness to boredom parasitic lifestyle poor behavioral control lack of realistic long-term goals impulsiveness irresponsibility juvenile delinquency early behavioral problems criminal versatility strongly correlated to antisocial and borderline personality disorder and associated with reactive anger, criminality and impulsive violence
  • there is a youth version of the PCL used for 13-18 year old as well an adaption called the ‘Antisocial Process Screening Device’ used for 6-13 year olds when administered by parents or teachers or can be self-administered by 13-18 year olds juvenile psychopathy is more strongly associated with more negative emotionality such as anger, hostility, anxiety, depression The Macdonald Triad are the three classic behaviors of bedwetting past the age of five, cruelty to animals and firestarting are possible indicators if occurring together over time during childhood of future episodic aggressive behavior however studies have shown no statistically significant links between the triad and violent offenders but a majority of serial killers exhibited at least some of these behaviors during childhood; further studies show that these behaviors are often the product of parental neglect, cruelty or trauma and that such events in a person’s childhood can result in a tendency for violence
  • The PCL-R is widely used to assess individuals in high secure psychiatric units, prisons and other settings to see who should be detained or released Also widely used as a risk assessment tool that attempts to predict who will offend or reoffend Out of a maximum score of 40, the cut-off for the label of psychopathy is 30 in the US and 25 in the UK
  • Another assessment tool is the Psychopathic Personality Inventory (PPI) developed by Dr. Scott Lilienfeld (Emory University) and Dr. Brian Andrews to comprehensively index the personality traits without assuming particular links to anti-social or criminal behaviors There are 2 main factors plus a third factor which is mainly dependent on scores on the other two
  • Factor 1: Fearless dominance. Involving social influence, fearlessness, stress immunity. Higher scores are associated with emotional stability and social efficacy as well as reduced empathy Factor 2: Impulsive antisociality/selfishness. Involving Machiavellian egocentricity, rebellious nonconformity, externalizing blame, carefree lack of planning. Associated with maladaptive tendencies including aggressiveness, substance abuse, suicidal ideation Factor 3: Coldheartedness
  • A person may score at different levels on the different factors but the overall score reveals the extent of the psychopathic personality Psychopathy is highly adaptive in a highly competitive environment because it gets results for both the individual and the corporations or often the small political sects they represent Seen in leadership roles, executive positions, politicians Psychologists Fritzon and Board in their study comparing the incidence of personality disorders in business executive against criminals detained in mental hospitals found that some personality disorders were more common in the executives They called these executives ‘successful psychopaths’ whereas the criminals were ‘unsuccessful psychopaths’
  • There are numerous causes for psychopathy and one such factor is neurobiological and the role of neurotransmitters One such neurotransmitter with a strong association with individuals with ASPD is serotonin J.F.W. Deakin of University of Manchester Neuroscience and Psychiatry Unit found evidence that low CSF concentration of 5-HIAA (a serotonin metabolite) and hormone responses to 5HT has show that the 2 main ascending 5HT pathways mediate adaptive responses to past and current conditions He states that impairments in the posterior 5HT cells can lead to low mood functioning, impulsiveness and aggression Another hormone influencing psychopathic behaviour includes high levels of testosterone and low levels cortisol Testosterone is associated with approach related behaviour, reward sensitivity and fear reduction Cortisol increases the state of fear, sensitivity to punishment and withdrawal behaviour Injecting testosterone shifts the balance from punishment to reward sensitivity, decreases fearfulness High testosterone levels combined with low serotonin levels may increase violent aggression as testosterone also doesn’t cause aggression but increases dominance seeking behaviour Low serotonin is associated with impulsive and highly negative reactions when combined with high testosterone may cause aggression if an individual becomes frustrated Another neurotransmitter that has been implicated is MAO-A A variant of MAO-A (called the warrior gene) in which the allele associated with behavioural traits consists of 30 bases and produces comparatively less MAO-A enzyme
  • Researchers have linked physical head injuries to antisocial behaviour Traumatic brain injuries including damage to the prefrontal cortex has caused an inability to make morally and socially acceptable decisions Kids with early damage in the prefrontal cortex may never fully develop social or moral reasoning thereby becoming psychopathic individuals In a study done by neuroscientists at the University of Chicago and the University of New Mexico where they tested 80 prisoners b/w ages 18-50 at a correctional facility the men volunteered for the test and were tested for levels of psychopathy they were then studied with functional MRI technology to determine their responses to a series of scenarios showing people being intentionally hurt they were also tested on their responses on seeing short videos of facial expressions showing pain the results showed that participants in the high psychopathy group exhibited significantly less activation in the ventromedial prefrontal cortex, lateral orbitofrontal cortex (key to evaluating consequences and weighing decisions respectively), amygdala and periaqueductal gray parts of brain but more activity in the striatum and the insula this high response in the insula is surprising as this region is critically involved in emotional awareness The results suggest that psychopaths are emotionally ‘aware’ of the pain of others but this signal doesn’t register in other regions of the brain and this contributes to their insensitivity and lack of empathy The diminished response in the ventromedial prefrontal cortex and amygdala is consistent with psychopathic behaviour as the amygdala is important for monitoring ongoing behaviour, estimating consequences and incorporating emotional learning into moral decision making and playing a fundamental role in empathic concern
  • Another factor that may influence psychopathic behaviour is genetics/environment Genetic factors may generally influence the development of psychopathy while environmental factors affect the specific traits that predominate A study by Farrington of London males between age 8 and 48 included studying which factors predicted scoring 10 or more on the PCL-R The strongest factors were ‘having a convicted father or mother, physical neglect, low involvement of the father with the child, low family income, and coming from a disrupted family.’ Other significant factors included poor supervision, harsh discipline, large family size, delinquent sibling, young mother, depressed mother, low social class and poor housing There has also been an association with psychopathy and bullying with hatred towards people due to mass social rejection
  • ASPD is seen in 3% to 30% of psychiatric outpatients The prevalence of the disorder is even higher in selected populations like prisons The prevalence of ASPD is higher among patients in alcohol or other drug abuse treatment programs than in the general population It may coexist with the following conditions such as anxiety, depression, impulse control disorders, substance abuse, somatization disorder, ADHD, BPD, histrionic personality disorder, narcissistic personality disorder, sadistic personality disorder
  • ASPD is considered to be among the most difficult personality disorders to treat due to the individuals having low or absent capacity for remorse They often lack sufficient motivation and fail to see the repercussions associated with violent and criminal behaviour Some examples of psychopaths in pop culture include Norman Bates from Psycho, Dexter, Hannibal Lecter from Silence of the Lambs Real life psychopaths include Ted Bundy, Charles Manson, Jeffrey Dahmer
  • Psychopathy

    1. 1. The Mind of a Psychopath Elakya Balachandran CMU September 2013
    2. 2. Definition • Psychopathy or sociopathy is a personality trait or disorder that’s characterized by enduring anti-social behaviour, a diminished capacity for empathy or remorse and poor behavioural control
    3. 3. DSM Classification • The DSM diagnosis of ASPD (Dissocial) states:“the essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”
    4. 4. DSM Classification • ASPD falls under Axis 2, Cluster B of personality disorders • pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.” • the individual is at least 18 years old • there’s evidence of conduct disorder with onset before age 15 • the occurrence of antisocial behaviour isn’t exclusively during the course of a schizophrenic or manic episode
    5. 5. History of Psychopathy • American psychiatrist Hervey Cleckley’s work on psychopathy influenced the initial diagnostic criteria for sociopathic or antisocial personality in the DSM • Canadian psychologist Robert D. Hare who strengthened the construct with the Psychopathy Checklist
    6. 6. Hare Psychopathy Checklist Revised (PCL-R) • PCL-R is the psychological assessment most commonly used to rate psychopathy • 20 item inventory of perceived personality traits and recorded behaviours along with an interview and a review of official records
    7. 7. PCL-R • each of the item in the PCL-R is scored on a 3 point scale along with the interview • in addition to lifestyle and criminal behaviour the checklist assesses personality traits • the scores are used to predict risk for criminal recidivism and probability of rehabilitation
    8. 8. PCL-R Factors • There are 2 factors which summarizes the 20 assessed areas • Factor 1 is labeled as the interpersonal/affective traits and is ‘selfish, callous, remorseless use of others’ • Factor 2 refers to their lifestyle habits and labeled ‘chronically unstable, antisocial, and socially deviant lifestyle’
    9. 9. Juvenile Psychopathy• youth version of PCL-R used for 13-18 year olds • Antisocial Process Screening Device used for 6-13 year olds or 13-18 year olds if self-administered • more strongly associated with negative emotions such as anger, hostility, anxiety, depression • Macdonald Triad: bedwetting, cruelty to animals, and firestarting are possible indicators of future violence
    10. 10. PCL-R Assessment • widely used to assess individuals in high secured psychiatric units, prisons to see who should be released or detained • also used as a risk assessment tool to predict reoffending • the cut-off for the label of psychopathy is 30 in US and 25 in UK
    11. 11. Psychopathic Personality Inventory • PPI comprehensively indexes the personality traits without assuming particular links to anti-social or criminal behaviours • 2 main factors plus a third factor which is mainly dependent on the scores of the other 2
    12. 12. PPI Factors• Factor 1: Fearless Dominance • higher scores are associated with emotional stability and reduced empathy • Factor 2: Impulsive anti-sociality/selfishness • associated with maladaptive tendencies including aggression, substance abuse, suicidal ideation • Factor 3: Coldheartedness
    13. 13. PPI Assessment • Psychopathy is highly adaptive in a highly competitive environment because it gets results for both the individual and the corporations or often the small political sects they represent • Executives are known as ‘successful psychopaths’ and criminals were ‘unsuccessful psychopaths’ according to Fritzon and Board
    14. 14. Causes for Psychopathy • Neurobiological Factors • Serotonin levels play a crucial role in impulsivity and aggression • High testosterone and low cortisol • High testosterone and low serotonin • MAO-AVariant
    15. 15. Causes for Psychopathy • Physical Head Trauma • Damage to the prefrontal cortex leads to inability to make morally correct decisions • Neuroanatomy • University of Chicago and University of New Mexico study showed that the high psychopathy group exhibited significantly less activation in the ventromedial prefrontal cortex, lateral orbitofrontal cortex, amygdala and periaqueductal grey parts of brain but more activity in the striatum and the insula
    16. 16. Causes of Psychopathy • Genetic/Environmental Factors • Poor family background, abuse, bullying
    17. 17. Epidemiology & Comorbidity • ASPD is seen in 3%-30% of psychiatric outpatients • the prevalence is even higher in populations such as prisons • prevalence is higher among patients with history of substance abuse • coexists with other mental conditions
    18. 18. Treatment • ASPD is considered to be among the most difficult personality disorders to treat due to the individuals having low or absent capacity for remorse • Some examples of psychopaths in pop culture include Norman Bates, Dexter, Hannibal Lecter • Real life psychopaths include Ted Bundy, Charles Manson, Jeffrey Dahmer
    19. 19. Citations • http://en.wikipedia.org/wiki/Psychopathy • Caspi, A.; McClay, J; Moffitt, TE; Mill, J; Martin, J; Craig, IW; Taylor, A; Poulton, R (2002). "Role of Genotype in the Cycle of Violence in Maltreated Children". Science • Frazzetto, Giovanni; Di Lorenzo, Giorgio; Carola, Valeria; Proietti, Luca; Sokolowska, Ewa; Siracusano, Alberto; Gross, Cornelius; Troisi, Alfonso (2007). "Early Trauma and Increased Risk for Physical Aggression during Adulthood: The Moderating Role of MAOA Genotype" • "Hare Psychopathy Checklist". Encyclopedia of Mental Disorders • Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems. • Nedopil, Norbert; Hollweg, Matthias; Hartmann, Julia; Jaser, Robert (1998). "Comorbidity of Psychopathy with Major Mental Disorders". Psychopathy: Theory, Research and Implications for Society. pp. 257–68. • MacDonald, John M. (1963). "The Threat to Kill". American Journal of Psychiatry 120 (2): 125–30. • http://news.uchicago.edu/article/2013/04/24/psychopaths-are-not-neurally-equipped-have-concern-others

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