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Psychopathy: Its Relevance, Nature, Assessment, and Treatment See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/308699806 Psychopathy: Its Relevance, Nature, Assessment, and Treatment Article · June 2016 CITATIONS READS 6 995 3 authors, including: Bradley A White University of Alabama 29 PUBLICATIONS 534 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: View full-text article at: https://rdcu.be/b44iB View project All content following this page was uploaded by Bradley A White on 28 September 2016. The user has requested enhancement of the downloaded file. Psychopathy: Its Relevance, Nature, Assessment, psychopathy” (Gao & Raine, 2010). In addition, it is unclear whether successful and Treatment psychopathy reflects a more mild version of unsuccessful psychopathy, a distinct configuration of psychopathic traits, or an Bradley A. White, Virginia Tech attenuated expression of core psychopathic traits tempered by protective factors Mark E. Olver, University of Saskatchewan (Ishikawa, Raine, Lencz, Bihrle, & Lacasse; 2001; Lilienfeld et al., 2015). Scott O. Lilienfeld, Emory University What Psychopathy Is Not Why Care About Psychopathy? vary dimensionally in youth and adults in Beyond the obvious confusion stem- the general population (e.g., Guay, Ruscio, ming from the unfortunate prefix “psycho” Fascination with individuals who Knight, & Hare, 2007; Murrie et al., 2007). (psychopathy is just one form of personal- chronically violate the rules and demon- Some authors have argued that psycho- ity psychopath ology , and most psychopaths strate reckless disregard for others dates pathic traits are one of the strongest dispo- are not psychotic or otherwise irrational or back to antiquity. In the Book of Deuteron- sitional risk factors for antisocial behavior, disoriented), many erroneous beliefs exist omy, Moses (c. 600 B.C.) described “a way- including physical and sexual aggression, about psychopathy (Berg et al., 2013; ward and defiant son, who does not heed behavioral problems during incarceration, Skeem, Polaschek, Patrick, & Lilienfeld, father or mother and does not obey them and criminal recidivism across age ranges 2011). We will cover a few of the most even after they disciplined him.” In his por- and contexts (e.g., Forsman, Lichtenstein, common misconceptions. trayal of personality types, the Greek Andershed, & Larsson, 2010; Guy, Edens, philosopher and student of Aristotle, Psychopathy Is Not Synonymous Anthony, & Douglas; 2005; Lynam, 1997; With Violence Theophrastus (c. 300 B.C.), described The Reidy et al., 2015; Yang, Wong, & Coid, Unscrupulous Man as “a cheat, rascal, a 2010); although as we describe later, the It is true that psychopathic individuals borrower who never repays, thief, incorri- nature of this association is somewhat con- commit some of the most heinous crimes, gible.” French physician Philippe Pinel troversial. Psychopathy has also been and that certain notorious serial killers, like (1745-1826) later used the terms la folie found to be associated with poorer Ted Bundy and John Wayne Gacy, mani- raisonnante (moral insanity) and manie response to treatment in some studies, but fested marked psychopathic traits. But sans délire (insanity without delirium) to not in others (e.g., Skeem, Monahan, & others, like Charles Manson, displayed describe patients who behaved in irrespon- Mulvey, 2002). more symptoms of psychosis than psy- sible and immoral ways despite intact As a result of its potential impact on chopathy. And of course, violence is influ- rationality and intellect. Other historical individual functioning and criminological enced by a host of factors (e.g., historical, conceptualizations include American psy- risk, as well as questions about its mal- economic, and ideological). Although the chiatrist Benjamin Rush’s (1746-1845) leability, psychopathy has received consid- most widely used measure of psychopathy notion of innate preternatural moral erable attention in both clinical and foren- (Psychopathy Checklist-Revised; Hare, depravity, British psychiatrist Henry sic contexts. Beyond mental health and 2003) emphasizes antisocial features (e.g., Maudsley’s (1835-1918) description of legal settings, there has been growing inter- juvenile delinquency, recidivism, criminal “some few who are congenitally deprived est in, and controversy concerning, success- versatility), not all psychopathic individu- of moral sense,” German psychiatrist Emil ful psychopathy in the general population als exhibit violent or other antisocial ten- Kraepelin’s (1893-1915) proposition that (Widom, 1977), including whether certain dencies, or end up in prison (Lilienfeld, congenital defects lead to moral degenera- levels or features of psychopathy facilitate 1994), even though they may show other tion, and German-American psychiatrist success in certain vocations or avocations, socially undesirable characteristics, such as Karl Birnbaum’s (1878-1950) introduction such as politics, business, and high-risk being superficial, smug, and unempathic. of the label “sociopathic ” to emphasize soci- sports (Lilienfeld, Watts, & Smith, 2015). Psychopathy Is Not Equivalent to etal influences on the development of anti- Even in community contexts, psychopathic social traits (although the term “sociopath” traits may be associated with elevated but Antisocial Personality Disorder has since been confused with “psy- more subtle forms of antisocial behavior Psychopathy is not synonymous with chopath”). (Czar, Dahlen, Bullock, & Nicholson, 2011) antisocial personality disorder (ASPD; Contemporary conceptualizations of such as proactive relational aggression, in APA, 2013), a heterogeneous DSM diagno- psychopathic personality, often known which others’ relationships or social status sis characterized by a chronic history of simply as psychopathy , derive largely from are intentionally harmed by means such as antisocial, criminal, and in some cases vio- the vivid case studies provided by Ameri- gossip or humiliation without provocation, lent behavior (Cox et al., 2013). Despite can psychiatrist Hervey Cleckley in his for sake of instrumental gain (White, earlier editions of the DSM suggesting psy- classic 1941 monograph, The Mask of Gordon, & Guerra, 2015). Psychopathic chopathy and ASPD are synonymous, Sanity . Psychopathy is now seen as a con- traits in such contexts are also associated ASPD measures and diagnostic criteria stellation of affective (e.g., callousness, with more prosocial acts when an audience focus on antisocial behaviors seen in guiltlessness), interpersonal (dishonesty, is present, but lower levels of anonymous approximately half of incarcerated sam- grandiosity), and behavioral traits (impul- and altruistically motivated prosocial acts ples, whereas psychopathy occurs less sivity, irresponsibility) that exist not only in (White, 2014). Yet important questions often, and measures of psychopathy forensic and clinical settings, but that also remain regarding how to define “successful emphasize distinct personality traits 154 the Behavior Therapist PSYCHOPATHY (described later) that are not observed in Measuring Psychopathy The SRP-III (Paulhus et al., 2012) is the most individuals with ASPD (Skeem et al., In forensic settings, the most frequently second revision of a scale developed by 2011). used measure for the assessment and diag- Hare and colleagues as a self-report coun- nosis of psychopathy is the Hare Psychopa- terpart to the PCL-R for use in community Psychopathy is not unalterable. The thy Checklist–Revised (PCL-R; Hare, samples. The current version was revised to conventional belief that psychopathy is 2003), which relies on a semistructured fit the four-facet structure of the PCL-R. It innate and inalterable is increasingly chal- clinical interview and corroborative infor- contains 64 items and produces a global lenged by evidence of the interplay of con- mation (e.g., criminal records) to assign psychopathy score, as well as four sub- stitutional and environmental influences in scales, with Callous Affect and Interper- values on a 20-item symptom-based rating this condition (e.g., Waldman & Rhee, sonal Manipulation subscales reflecting scale. Scores range from 0–40 with a 2006). Genes appear to play a significant PCL-R Factor 1, and Erratic Lifestyle and research-based diagnostic cutoff for psy- role in the development of psychopathy, Antisocial Behavior subscales reflecting chopathy of ≥ 30 (or 25 when rated via file probably by influencing children’s infor- Factor II. only; Wong, 1988). Two broad dimensions mation, or affective-processing styles (e.g., The PPI-R (Lilienfeld & Widows, 2005) have been derived via factor analysis that difficulty learning from punishment, low is an adult 154-item self-report measure account for much of the covariation among emotional reactivity), but there are unlikely usable for community, clinical, and foren- the items on the PCL-R and its variants to be any specific genes for psychopathy sic settings that offers a total score as well (Harpur, Hare, & Hakstian, 1989). Factor I (Viding & McCrory, 2012). Furthermore, as eight factor-analytically derived content encompasses core affective (callousness, twin studies (e.g., Larsson, Andershed, & scales, most of which often, although not lack of remorse) and interpersonal Lichtenstein, 2006) suggest that only about always (Neumann, Malterer, & Newman, (grandiosity, superficiality) features; half of the variability in psychopathic traits 2008), load onto two higher-order factors.
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