Psychopathy: Its Relevance, Nature, Assessment, and Treatment

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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. whereas Factor II encompasses unstable reflects heritable factors, and the other half The first of these higher-order dimensions, lifestyle (irresponsible, impulsive) and reflects nonshared environmental influ- Fearless Dominance, comprises the Social antisocial behavior (early behavior prob- ences—nongenetic factors that make sib- Influence, Fearlessness, and Stress Immu- lems, criminal versatility). Subsequent nity scales and is associated with assertive- lings dissimilar from one another, such as three-factor (Cooke & Michie, 2001) and ness, poise, stress resilience, and thrill- birth order, differential parenting, stressors four-factor (Hare, 2003) models further seeking; although it is largely unassociated (e.g., injuries, illness, trauma), having dif- parse Factor I into separable but correlated with PCL-R total scores, it is modestly ferent peers, and microbiomes (the com- affective and interpersonal features. The associated with its interpersonal facet. The munity of microorganisms that inhabit our PCL-R has been extended downward to second, Self-Centered Impulsivity, com- bodies; Peterson et al., 2009). Environmen- adolescents as the Psychopathy Checklist: prises Machiavellian Egocentricity, Rebel- tal variables also appear to influence the Youth Version (PCL: YV; Forth, Kosson, & lious Nonconformity, Blame Externaliza- expression of genetic risk for psychopathy. Hare, 2003). tion, and Carefree Nonplanfulness scales Particular evidence for the impact of the The time and expertise required to con- and is associated with impulsivity, ruthless environment comes from the apparent duct the PCL-R interview has led to the narcissism, manipulativeness, and hostile response of psychopathic traits and associ- development of briefer self-report ques- attribution bias; it correlates highly with ated behaviors to parenting styles (Viding tionnaires, particularly in research settings PCL-R Factor II. The Coldheartedness & McCrory) and to treatment, as discussed (Lilienfeld & Fowler, 2006). Such measures scale does not load highly on either PPI-R later. include the Levenson Self-Report Psy- higher-order factor, and is associated with chopathy Scale (LSRP; Levenson, Kiehl, & lack of deep social emotions including What Is Psychopathy? Fitzpatrick, 1995), Self-Report Psychopa- empathy and guilt; it correlates moderately Cleckley’s (1941) modern characteriza- thy Scale (SRP-III; Paulhus, Hemphill, & with PCL-R Factor I (Marcus, Fulton, & Edens, 2013). The PPI-R is standardized tion of psychopathy emphasized the confi- Hare, 2012), the Psychopathic Personality for community samples in the United dent, well-adjusted, personable presenta- Inventory–Revised (PPI-R; Lilienfeld & States, offers norms for male offenders, and tion (hence, the reference to the word Widows, 2005), and the Triarchic Psy- can detect positive and negative impression “mask” in his title) of a subset of psychiatric chopathy Measure (TriPM; Patrick, 2010). management and careless responding. inpatients he was seeing. As with other Influenced by the classic writings of More recently, Patrick, Fowles, and forms of personality pathology, these indi- Karpman (1941), Levenson and colleagues Krueger (2009) introduced an increasingly viduals revealed their severe underlying (1995) developed the LSRP, a now well-val- popular triarchic model of psychopathy, deficits over time, which included shallow idated self-report measure to differentiate which attempts to reconcile competing his- affect, egocentricity, and irresponsibility, psychopathy subtypes. They conceptual- torical models by conceptualizing psy- rather than emotionally dysregulated, ized primary psychopathy as encompassing chopathy as encompassing three interre- explosive, violent, or cruel tendencies. interpersonal characteristics such as self- lated phenotypic dispositions of boldness, Others working with incarcerated individ- ishness, uncaring, and manipulativeness, meanness, and disinihibtion. Each domain uals have similarly conceptualized psy- combined with general intelligence, emo- is captured in a 58-item self-report ques- chopathy as marked by superficial emotional stability, and seemingly adequate tionnaire (TriPM; Patrick, 2010). Boldness tions, but they placed greater emphasis on outward adjustment. In contrast, secondary comprises emotional resiliency, confi- callousness, lovelessness, impulsivity, as psychopathy encompasses impulsivity, dence, social assertiveness, and venture- well as hostile alienation from and emotional dysregulation, anxiety, self- someness. It is based largely on the Fearless exploitation of others (McCord & McCord, defeating tendencies, and general psy- Dominance factor of the PPI-R and 1964). chopathology. intended to capture the “mask” features of

June • 2016 155 WHITE ET AL .

Cleckley’s (1941) conceptualization of psy- diction of future violence beyond preexist- An alternative approach by Frick and chopathy, as well as a lack of behavioral ing history of violence (e.g., Hare & Neu- colleagues emphasizes callous/unemo- inhibition. Meanness comprises lack of mann, 2010; Skeem & Cooke, 2010a, b). tional (CU) traits, such as shallow emo- empathy and affiliative capacity, contempt Notably, the construct of psychopathy tions, lack of guilt or remorse, disregard for toward others, predatory exploitativeness, has also been deconstructed in terms of Big others’ feelings, and lack of concern and empowerment through cruelty or Five (or Big Three) normal-range person- regarding one’s own performance in destructiveness, thus overlapping with Cal- ality traits, with the aforementioned psy- important activities. CU traits tend to be lous Unemotional traits in youth (see dis- chopathy measures typically reflecting low associated with relatively high levels of cussion below, “Psychopathy in Chil- Agreeableness (i.e., high antagonism, antisocial behavior (Christian, Frick, Hill, dren?”), as well as the Coldheartedness including suspiciousness and deceptive- & Tyler, 1997), including early onset and scale of the PPI-R. Disinhibition entails ness) and low Conscientiousness (i.e., low persistence of serious conduct problems impulsiveness, weak restraint, hostility and constraint, including impulsivity and non- (Moffitt, 2006; Patterson, 1996), repetitive mistrust, and difficulties in regulating emo- traditional values). Some measures also deceitfulness, rule violations, physical cru- tion, and relates strongly to the Self-Cen- reflect the more psychologically adaptive elty, and property destruction (Frick, Ray, tered Impulsivity factor of the PPI-R. An traits of low Neuroticism, high agentic Thornton, & Kahn, 2014), as well as fear- important distinction between the PPI-R Extraversion, and high Openness, depend- lessness (e.g., Pardini, Lochman, & Powell, and TriPM, on the one hand, and many ing upon how psychopathy is conceptual- 2007). Youth with elevated conduct prob- other psychopathy measures, on the other, ized and operationalized (Lilienfeld, Watts, lems and CU traits are less responsive to is their inclusion of the Fearless Domi- Smith, Berg, & Latzman, 2015). others’ distress (Kimonis, Frick, Fazekas, & nance/Boldness dimension, which is less Loney, 2006), show deficits in fear recogni- well represented within such measures as Psychopathy in Children? tion (Dadds et al., 2006), and are more the LSRP and SRP-III, as well as the youth- prone to proactive aggression (Marsee & based APSD described later (Patrick & Certain psychopathic features appear to Frick, 2007), compared with other youth. Drislane, 2015). emerge early in development and have Such findings have led to expansion of the been measured in children as young as 2 to six items originally forming the CU sub- Definitional Controversies 3 years of age (Kimonis, Frick, Boris, et al., scale on the APSD to form a separate 24- There is still ongoing debate on the role 2006). The most widely used measures of item Inventory of Callous-Unemotional and relevance of certain psychopathy fea- psychopathic features in youth have been Traits (Frick, 2004; Kimonis et al., 2008). tures in defining the personality syndrome. the PCL:YV (Forth et al., 2003) and the Others researchers (Willoughby, For example, although Cleckley (1941) Antisocial Process Screening Device Waschbusch, Moore, & Propper, 2011) noted a lack of extreme meanness in proto- (APSD; Frick, O’Brien, Wooton, & McBur- have constructed CU scales by combining typical psychopaths, the triarchic model nett, 1994). Both are 20-item adaptations of selected items from commonly used symp- accords a central role to meanness. Hence, the adult PCL-R, although the PCL:YV fol- tom inventories, such as the Child Behav- the place of meanness within the psychopa- lows the PCL-R format of requiring a semi- ior Checklist (Achenbach & Rescorla, thy construct requires clarification. structured interview and review of records, 2000). Similarly, although some scholars have whereas the APSD is based upon parent or To acknowledge that youth with ele- argued that adaptive features, such as bold- teacher report or adolescent self-report. vated CU traits comprise a unique sub- ness (as assessed largely by the PPI-R Fear- Factor structures of these measures largely group among those with serious conduct less Dominance dimension), are largely or mirror those of the PCL-R (Kotler & problems, while attempting to minimize entirely irrelevant to psychopathy (e.g., McMahon, 2010), although these factors potential harm in labeling such youth, the Miller & Lynam, 2012), others have argued tend to be more positively correlated with latest edition of the American Psychiatric that they play a key role, accounting in negative emotionality (e.g., depression, Association’s (APA) Diagnostic and Statis- large measure for Cleckley’s (1941) “mask” anxiety) in youth than in adults (Sevecke & tical Manual of Mental Disorders (DSM-5; of superficially healthy functioning (Lilien- Kosson, 2010). APA, 2013) added the specifier “With Lim- feld et al., 2012; Venables, Hall, & Patrick, Other instruments have been devel- ited Prosocial Emotions” to the diagnosis 2014). Adding to the confusion, boldness oped, such as the 50-item Youth Psycho- of conduct disorder to designate those with measures tend to be moderately to highly pathic Traits Inventory (YPI; Andershed, CU traits. A clinician-rated Clinical Assess- correlated with total scores on some psy- Kerr, Stattin, & Levander, 2002), a self- ment of Prosocial Emotions (Frick, 2013) is chopathy measures, but not with total report measure that contains items currently under development to facilitate scores on measures derived from the PCL- designed to tap each of 10 core psycho- determination of the corresponding DSM- R, probably reflecting the PCL-R’s empha- pathic traits identified in nonincarcerated 5 CD specifier. sis on maladaptive (e.g., antisocial and adolescent samples in a manner similar to criminal) behavior (Lilienfeld et al., in the PCL, without requiring the administra- Ethical Implications press). tion training and time of the PCL:YV. A Important ethical concerns remain Others have argued that disinhibition is modified version of the YPI, the Child regarding the potential negative impact, merely a secondary correlate or conse- Problematic Traits Inventory (CPTI; including stigma and negative juror quence of psychopathy rather than a core Colins et al., 2014), developed for children impressions, of labeling children and ado- component (Cooke, Michie, Hart, & ages 3 to 12, excludes the YPI and PCL lescents with a term that implies the pres- Clarke, 2004). Because the PCL-R includes behavioral dimension (e.g., rule-breaking, ence of pre-psychopathic features (Edens, items assessing prior antisocial behavior, antisociality, impulsivity) to avoid con- Mowle, Clark, & Magyar, 2016). Moreover, there is also ongoing debate regarding how founding measurement of traits with the downward extension of psychopathic much psychopathy per se adds to the pre- behavioral symptoms of conduct disorder. traits to children has been controversial on

156 the Behavior Therapist PSYCHOPATHY scientific grounds. Although rank-order behavior problems. However, there is 2002) have been limited by methodological estimates suggest moderate stability of CU ongoing debate concerning whether CU concerns, including a lack of well-designed traits across later childhood into adult- traits attenuate treatment effectiveness studies (D’Silva, Duggan, & McCarthy, hood, there is significant individual vari- (Hawes, Price, & Dadds, 2014), or merely 2004; Harris & Rice, 2006), more recent ability in trajectories over time (Pardini & reflect the fact that such youth start with reviews (Caldwell, McCormick, Umstead, Loeber, 2008), and some children with CU higher levels of conduct problems but & Van Rybroek, 2007; Polaschek, 2014; traits appear to “grow out” of this pattern improve at the same rate in treatment as Salekin, Worley, & Grimes, 2010) at least (Edens, Skeem, Cruise, & Cauffman, 2001). those without CU traits (Waller, Gardner, partially support the treatability of psy- Those examining CU tendencies in early & Hyde, 2013). A recent comprehensive chopathy. childhood sometimes use the term “behav- review (Hawes et al., 2014) of parenting ior” rather than “traits” to emphasize their interventions for youth with CU traits sug- Recent Treatment Advances temporal instability during this develop- gests that parent training is effective in Some new experimental intervention mental period (Waller et al., 2015). reducing behavioral problems in these approaches feature the application of com- youth, particularly when emphasis is Etiology puterized cognitive/affective remediation placed on positive reinforcement and pro- paradigms in attempts to target hypothe- A review of the etiology of psychopathic motion of parental warmth. Other research sized psychopathy-specific deficits (e.g., traits is beyond the scope of this article. suggests that a warm and responsive Baskin-Sommers, Curtin, & Newman, Nevertheless, research suggests that callous parent-child relationship may enhance 2015; Schönenberg et al., 2014). These behaviors can develop early (e.g., Waller et conscience development (Somech & approaches are intended to alter specific al, 2015), with some evidence for moderate Elizur, 2012). Furthermore, there is prelim- cognitive-affective dysfunctions, such as to high heritability (Viding & McCrory, inary evidence that emotion recognition perceptual insensitivity to others’ emotions 2012). There appear to be at least two alter- training may serve as a useful adjunct to (Schönenberg et al.), failure to utilize con- native pathways that reflect either largely parent training for youth with CU traits textual information (for psychopathic, innate (“primary psychopathy”) or envi- (Dadds, Cauchi, Wimalaweera, Hawes, & high-Factor I individuals), or the inability ronmental (“secondary psychopathy”) Brennan, 2012). influences (Karpman, 1941; Kimonis, to regulate affective reactions (for externalizing, or high Factor II/low Factor I indi- Frick, Cauffman, Goldweber, & Skeem, Are Adult Psychopaths Untreatable? 2012). Some prominent etiological models viduals; Baskin-Sommers et al., 2015). Pre- of psychopathy are primarily “bottom up,” Turning to adults, there is surprisingly liminary support has been obtained, for emphasizing the role of emotional distur- little evidence to support the common instance, for deficit-matched cognitive bances in shaping psychopathic deficits. skepticism regarding the treatability of psy- training based on offender subtype. Specif- For example, some posit that deficits in the chopathy or the presumption that psy- ically, Baskin-Sommers and colleagues capacity to process fear and closely related chopathy adversely moderates the effec- found improved attention to context emotions give rise to the core features of tiveness of treatments for adult antisocial among psychopathic men, and improved the condition, such as guiltlessness, cal- behavior (Skeem et al., 2002). The roots of affect regulation among externalizing men. lousness, and superficial charm (e.g., Blair, doubt appear to stem largely from an ear- The results underscore the importance of 2008; Kiehl, 2006; Lykken, 1957). In con- lier intervention study that reported cognitive factors and the potential incre- trast, other major etiological models are increased criminal recidivism among psy- mental value of novel computerized inter- primarily “top down,” emphasizing the chopathic individuals who had partici- ventions in developing specific cognitive role of higher cortical processes, such as pated in a radical “therapeutic community” and affective information processing skills insufficient attentional allocation to extra- (Rice, Harris, & Cormier, 1992). In this that might, in turn, curb antisocial behav- neous cues, in shaping the core features of program, devised by Canadian psychiatrist ior. Nevertheless, it is too early to tell the condition (Moul, Killcross, & Dadds, Elliot Barker and authorized by the Cana- whether these computerized interventions 2012; Patterson & Newman, 1993). Still dian government (Barker & Buck, 1977), will translate into long-term gains in real- other recent models posit a mix of bottom- patients in a maximum security hospital world settings. up and top-down etiological influences were mandated to participate without vol- A larger body of research from high- (e.g., impaired integration model; Hamil- untary consent. They were stripped of their intensity violence-reduction programs, ton, Racer, & Newman, 2015). clothing, locked in “total encounter cap- broadly adhering to risk-need-responsivity sule” rooms for days on end, administered (RNR) principles (discussed further by Do Psychopathic Traits Worsen Treat- psychedelic drugs, fed through tubes in the Mitchell, Wormith, & Tafrate, 2016, this ment Outcomes for Youth? wall, offered minimal contact with profes- issue), offers some clarity regarding what Behavioral interventions for conduct sional staff, and received no attempts to potentially works with psychopathic problems in children, particularly parent alter criminal attitudes or teach social or offenders. Emerging evidence suggests that management training, are well-established problem solving skills—certainly a far cry effective programs must provide high- (Michelson, Davenport, Dretzke, Barlow, from modern-day ethical evidence-based intensity services for high-risk offenders & Day, 2013), yet about 40% to 50% of approaches. (risk principle), prioritize criminogenic youth do not show substantial benefit Countering the pessimism regarding needs to be targeted for risk-reduction ser- (Ollendick et al., 2015). There is reason to treatability, growing evidence suggests that vices (need principle), deliver services in a be concerned about treatment outcomes individuals with elevated psychopathy are flexible and clinically engaging manner for youth with elevated CU traits in partic- best seen as high-risk cases that are in need (general responsivity), and be attentive to ular, as such youth appear to be at greatest of intensive treatment (Skeem et al., 2011). the unique needs of each client (specific risk for chronic and severe disruptive Although early optimistic reviews (Salekin, responsivity). When these core compo-

June • 2016 157 WHITE ET AL . nents can be harnessed, positive risk-rele- they tend to be more severe and probably Andershed, H., Kerr, M., Stattin, H., & vant changes have been linked to reduc- larger in number (Wong & Gordon). Com- Levander, S. (2002). Psychopathic traits tions in sexual (Olver & Wong, 2009) and prehensive and integrated cognitive- in non-referred youths: a new assessment violent (Olver, Lewis, & Wong, 2013; behavioral programs targeting general and tool. In E Blaauw & L Sheridan (Eds.), Wong, Gordon, Gu, Lewis, & Olver, 2012) specific criminogenic need domains are Psychopaths: Current international per- spectives (pp. 131–58). Den Hagg: Else- recidivism after controlling for baseline likely to yield larger net gains and potential vier. risk and individual differences in psy- for recidivism reduction (Wong & Hare, Barker, E. T., & Buck, M. F. (1977). LSD in chopathy. 2005; Wong et al., 2012). For possible gains a coercive milieu therapy program. Wong proposed a two-component to be realized, of course, psychopathic Canadian Psychiatric Association Jour- model for the treatment of psychopathy clientele need to be retained and engaged in nal, 22 , 311-314. that prioritizes services, in part based on treatment. In summary, service providers Baskin-Sommers, A. R., Curtin, J. J., & the structure of psychopathic traits (see are advised to manage, rather than to try to Newman, J. P. (2015). Altering the cogni- Wong et al., 2012; Wong & Hare, 2005). alter, the characteristics associated with tive-affective dysfunctions of psycho- Component 1 is essentially a responsivity Factor I, and to actively target the crimino- pathic and externalizing offender sub- prong, in which service providers manage genic features associated with Factor II (see types with cognitive remediation. the interpersonal and affective features of also Harkness & Lilienfeld, 1997). Clinical Psychological Science, 3(1), 45- psychopathy (i.e., Factor I traits). For 57. instance, psychopathic offenders tend to Conclusions Berg, J. M., Smith, S. F., Watts, A. L., engage in disruptive behavior within Ammirati, R., Green, S. E., & Lilienfeld, Behavioral and cognitive-behavioral groups, pit staff against one another and S. O. (2013). Misconceptions regarding therapists have long focused on internaliz- push boundaries, intimidate co-patients, psychopathic personality: Implications ing problems, particularly anxiety-related for clinical practice and research. Neu- fail to accept responsibility, and show a lack disorders. We believe that the time has ropsychiatry, 3(1), 63-74. of empathy or emotional connectedness come to examine further the opposite end Blair, R. J. R. (2008). The amygdala and toward others. Since Factor I features of the spectrum, which may be just as mal- ventromedial prefrontal cortex: Func- appear to be linked to decreased therapeu- adaptive, albeit in ways that differently tional contributions and dysfunction in tic progress (Olver et al., 2013), increased impact individuals and those around them. psychopathy. Philosophical Transactions dropout (Olver & Wong, 2011), and Countering the prevailing pessimism about of the Royal Society of London Series B, weaker working alliances, particularly the Biological Sciences, 363 (1503), 2557– this client group, a growing literature sug- therapeutic bond (DeSorcy, Olver, & 2565. gests that, although psychopathic traits Wormith, 2016), Wong and colleagues rec- Caldwell, M. F., McCormick, D., Umstead, may increase risk for chronic and severe ommended managing Factor I through D., & Van Rybroek, G. (2007). Evidence conduct problems, the affective, interper- containing treatment-interfering behaviors of treatment progress and therapeutic sonal, and behavioral patterns that com- rather than trying to treat and change outcomes among adolescents with psy- prise psychopathy may prove to be Factor I per se. For example, service chopathic features. Criminal Justice and amenable to cognitive-behavioral providers can maintain open lines of com- Behavior, 34 (5), 573-587. approaches. An analogy to borderline per- munication, present a united front, main- Christian, R. E., Frick, P. J., Hill, N. L., & sonality disorder may be helpful in this tain clear boundaries, avoid power and Tyler, L. (1997). Psychopathy and con- context. Borderline was once viewed duct problems in children: II. Implica- control battles with challenging clients, and widely as an untreatable condition, but tions for subtyping children with con- engage in routine consultation and sup- such views have receded in the wake of duct problems. Journal of the American port. Such strategies are essential in main- major therapeutic advances (Linehan, Academy of Child & Adolescent Psychia- taining psychopathic client engagement in 1993). Similarly, the treatability of psy- try, 36 (2), 233–241. treatment and avoiding program dropout. chopathy, once assumed to be a quixotic or Cleckley, H. (1941). The mask of sanity: An Component 2 (criminogenic compo- even pointless venture, is increasingly attempt to reinterpret the so-called psy- nent) essentially corresponds to the risk chopath. St. Louis: C.V. Mosby. coming to be regarded as a promising new and need principles, and entails delivering frontier. At the same time, important con- Colins, O. F., Andershed, H., Frogner, L., high-intensity risk-reduction services tar- Lopez-Romero, L., Veen, V., & Ander- ceptual and practical questions await fur- geting criminogenic needs (i.e., dynamic shed, A. K. (2014). A new measure to ther investigation with regard to the nature risk factors) associated with PCL-R Factor assess psychopathic personality in chil- and development of interventions for psy- II. The criminal lifestyle features of psy- dren: The Child Problematic Traits chopathy, creating exciting opportunities chopathy correlate highly with measures of Inventory. Journal of Psychopathology for future research. criminogenic needs (Olver & Wong, 2009; and Behavioral Assessment, 36 (1), 4-21. Simourd & Hoge, 2000; Wong & Gordon, Cooke, D. J., & Michie, C. (2001). Refining 2006), and Factor II bears particularly References the construct of psychopathy: Towards a hierarchical model. Psychological Assess- Achenbach, T. M., & Rescorla, L. A. strong links to recidivism. Many of the fea- ment, 13 (2), 171-188. tures of Factor II are dynamic in principle (2000). CBCL/1 1/2-5: Empirically Based Scales for Boys and Girls; DSM-oriented Cooke, D. J., Michie, C., Hart, S. D., & (e.g., impulsivity, irresponsibility, lack of Clark, D. A. (2004). Reconstructing psy- goals, poor behavior controls, parasitic Scales for Boys and Girls. University of Vermont, ASEBA. chopathy: Clarifying the significance of lifestyle), and conceptually share much in antisocial and socially deviant behavior American Psychiatric Association. (2013). common with treatment foci of correc- in the diagnosis of psychopathic person- Diagnostic and statistical manual of tional programs. The criminogenic needs ality disorder. Journal of Personality Dis- mental disorders (5th ed.). Washington, of psychopathic offenders are not different orders, 18 (4), 337-357. DC: Author. than those of nonpsychopathic individuals;

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Callous–unemotional traits and Williams Hall (0436), Virginia Tech, Blacks- entific evidence and public policy. Psy- empathy in proactive and reactive rela- burg, VA 24061; [email protected] > Election Results Sabine Wilhelm, Ph.D. President-Elect, 2016–2017

The membership also passed Simon Rego , Ph.D. two bylaws proposals: Representative-at-Large, 2016–2019 1. Article III: Membership 2. Article V: Voting

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