Running Head: the PSYCHOPATH NEXT DOOR 1

Running head: THE PSYCHOPATH NEXT DOOR 1

The Psychopath Next Door: How Similar Are They to Those Behind Bars? Criminality,

Executive Functioning, and Emotion Processing in ‘Noncriminal’ Psychopathy.

Emily Louise Adam

Bachelor of Arts (Psychology)

Bachelor of Psychological Science (Honours)

Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy (IF49)

The School of Psychology and Counselling

Faculty of Health

Institute of Health and Biomedical Innovation

Queensland University of Technology

2017 THE PSYCHOPATH NEXT DOOR 2

Keywords

Criminality, psychopathy, noncriminal psychopathy, primary psychopathy, secondary psychopathy, executive function, emotion, emotion-processing, gender differences, lexical decision task.

Running head: THE PSYCHOPATH NEXT DOOR 3

“Though not deeply vicious, he carries disaster lightly in each hand”

Hervey Cleckley, The Mask of Sanity (1955)

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List of Abbreviations

ASD Antisocial Personality Disorder (in quoted material)

ASPD Antisocial Personality Disorder

ASPD+P Antisocial Personality Disorder with Psychopathy

ASPD-P Antisocial Personality Disorder without Psychopathy

AX-CPT A/X Continuous Performance Test

BAS Behaviour Activation System

BE Blame Externalisation

BIS Behavioural Inhibition System

C Coldheartedness

calCAP-SPM2 California Computerised Assessment Package Serial Pattern Matching 2

CAT Categories Achieved

CFA Confirmatory factor analysis

CH Coldheartedness

CN Carefree Nonplanfulness

CSS-M Criminal Sentiments Scale-Modified

CSS-R Criminal Sentiments Scale-Revised

DLPFC Dorsolateral prefrontal cortex

DSM Diagnostic and statistical manual of mental disorders

DSM-II Diagnostic and statistical manual of mental disorders second edition

DSM-III Diagnostic and statistical manual of mental disorders third edition

DSM-III-R Diagnostic and statistical manual of mental disorders third revised edition

DSM-IV Diagnostic and statistical manual of mental disorders fourth edition

DSM-IV-TR Diagnostic and statistical manual of mental disorders fourth revised edition

DSM-V Diagnostic and statistical manual of mental disorders fifth edition

EF Executive Function THE PSYCHOPATH NEXT DOOR 5

ERN Error-related negativity

ERP Event-related potential

F Fearlessness

F1 Factor one

F2 Factor two

FD Fearless Dominance

FFFS Fight-Flight-Freeze System

FFM Five-Factor Model of personality

HH High Factor 1 and Factor 2 Scores

HL High Factor 1 Scores and Low Factor 2 Scores

HR Heart Rate

IA Impulsive Antisociality

ICO Identification with criminal others

ID/ED Intradimensional/Extradimensional

IES Integrated Emotions Systems

IGT Iowa Gambling Task

IMC’s Instructional manipulation checks

IQ Intelligence Quotient

LCP Law-Court-Police

LDT lexical decision task

LH Low Factor 1 Scores and High Factor 2 Scores

LL Low Factor 1 and Factor 2 Scores

LSRP Levenson Self-Report Psychopathy

ME Machiavellian Egocentricity

MI Mental Illness

MPQ Multidimensional Personality Questionnaire – Brief form

NART National Adult Reading Tests THE PSYCHOPATH NEXT DOOR 6

NPE Nonperseverative errors

NTV Number of Traffic Violations

OFC Orbitofrontal cortex

OLD20 Orthographic Levenshtein distance

PAS Personality Assessment Screener

PCL Psychopathy Checklist

PCL:SV Psychopathy Checklist: Screening Version

PCL-R Psychopathy Checklist-Revised

PCL-R Psychopathy Checklist Revised

PCL-SV Psychopathy Checklist Screening Version

PCL-YV Psychopathy Checklist Youth Version

PE Preservative errors

PEBL Psychology Experiment Building Language

PET Positron Emission Tomography

PPI Psychopathic Personality Inventory

PPI:SF Psychopathic Personality Inventory: Short Form

PPI-C Psychopathic Personality Inventory

PPI-FD Psychopathic Personality Inventory-Fearless Dominance

PPI-I Psychopathic Personality Inventory

PPI-II Psychopathic Personality Inventory

PPI-R Psychopathic Personality Inventory-Revised

PPI-SCI Psychopathic Personality Inventory- Self-Centred Impulsivity rCBF Cerebral blood flow

RMH Response Modulation Hypothesis

RN Rebellious Nonconformity

RST Reinforcement Sensitivity Theory

RT Reaction times THE PSYCHOPATH NEXT DOOR 7

SCI Self-Centred Impulsivity

SES Socioeconomic status

SI STOP-IT

SOI Social Influence

SPM-P Standard Progressive Matrices Plus

SRCS Self-reported criminal offending

SRCS Self-Report Criminality Scale

SRDS Self-Report Delinquency Scale

SRP-III Self-Report Psychopathy Scale – Version Three

SSDs Stop-signal delays

SSRT Stop-signal reaction time

STI Stress Immunity

TLV Tolerance for law violations

TMT-B Trail-Making Test Part B

TOL Tower of London

TOL-DX Tower of London Drexal University

WAIS Weschler Abbreviated Scale for Intelligence

WAIS-III Weschler Adult Intelligence Scale – Third Edition

WAS Welsh Anxiety Scale

WCST Wisconsin Card Sorting Test

WCST:CV4 Wisconsin Card Sorting Test: Computer Version Four

WISC-III Wechsler Intelligence Scale for Children Third Edition;

WMC Working memory capacity

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Table of Contents

List of Abbreviations ...... 4 List of Figures ...... 14 List of Tables ...... 15 Abstract ...... 18 Acknowledgements ...... 19 Chapter One - Thesis Overview ...... 21 Chapter Overview ...... 21 Background and Context ...... 21 Purpose of Research Program ...... 22 Thesis Structure ...... 23 Chapter Two - General Literature Review ...... 24 Chapter Overview ...... 24 Psychopathy Defined ...... 24 Assessment of Criminal Psychopathy ...... 26 Assessment of Noncriminal Psychopathy ...... 27 Review of Psychopathy Assessments ...... 28 Psychopathy Variants ...... 29 Psychopathy and Antisocial Personality Disorder ...... 31 Psychopathy and Affective Deficits ...... 34 Psychopathy and Cognitive Deficits ...... 40 Executive Functioning ...... 41 Summary of Affective and Cognitive Deficits ...... 45 Theories of Psychopathy ...... 46 Lykken’s Low Fear Hypothesis ...... 46 Gray’s Reinforcement Sensitivity Theory ...... 48 The Somatic Marker Hypothesis ...... 50 The Integrated Emotions Systems Model ...... 52 The Response Modulation Hypothesis ...... 54 Review of Current Theories of Psychopathy ...... 55 What is Noncriminal Psychopathy? ...... 56 Theoretical Perspectives of Noncriminal Psychopathy ...... 57 THE PSYCHOPATH NEXT DOOR 9

Subclinical psychopathy...... 58 Successful psychopathy...... 58 A dual process model of psychopathy...... 59 Triarchic Model of Psychopathy ...... 60 Review of Theories of ‘Noncriminal’ Psychopathy ...... 61 The Current Research ...... 62 Original Contribution to Knowledge ...... 62 Psychopathy and Criminality ...... 62 Executive Function ...... 63 Emotion Processing ...... 63 Research Questions ...... 65 Research Question One: How central is criminal behaviour to the construct of psychopathy? ...... 66 Research Question Two: Is the relationship between criminality and psychopathy the same for males and females? ...... 66 Research Question Three: What is the relationship between psychopathy variants and executive function in a community sample? ...... 66 Research Question Four: Is the pattern of relationships between psychopathy variants and executive function the same for males and females? ...... 67 Research Question Five: What is the relationship between psychopathy variants and emotion processing in a community sample? ...... 67 Research Question Six: Is the relationship between psychopathy variants and emotion processing abnormalities the same for males and females? ...... 67 Chapter Three...... 68 Chapter Overview ...... 68 Background to Research ...... 68 Examination of the PCL-R...... 70 Noncriminal Measures of Psychopathy...... 73 Theories of noncriminal psychopathy...... 76 Crime and Criminality...... 79 Gender...... 82 The Current Study ...... 84 Method ...... 86 Participants ...... 86 Materials ...... 88 THE PSYCHOPATH NEXT DOOR 10

Demographic questionnaire...... 88 Levenson Self-Report Psychopathy Scale (LSRP) (Levenson et al., 1995)...... 88 The Criminal Sentiments Scale Modified (CSS-M) (Simourd, 1997)...... 89 Self-Report Criminal Activity Scale...... 90 Instructional manipulation checks (IMC’s) (Oppenheimer, Meyvis, & Davidenko, 2009)...... 90 Procedure ...... 90 Design ...... 91 Results ...... 92 Data Screening ...... 92 Descriptive Statistics ...... 92 Inferential Statistics ...... 94 Criminal Attitudes...... 95 Attitudes Toward Law, Courts and Police...... 97 Tolerance for Law Violations...... 99 Identification with Criminal Others...... 101 Self-Reported Criminal Behaviour...... 103 Follow-up Mediation Analyses ...... 105 Discussion ...... 108 Overview of Research ...... 108 Key Findings ...... 108 Gender...... 108 Criminal convictions and traffic violations...... 109 Criminal attitudes...... 109 Self-Reported Criminal Behaviour...... 112 Implications, Limitations, and Future Directions ...... 115 Chapter Summary ...... 116 Chapter Four ...... 117 Chapter Overview ...... 117 Background to Research ...... 119 Executive Function ...... 120 Hot and Cool Executive Function ...... 122 Cool Executive Functions in Psychopathy ...... 126 Cool Executive Function in Unsuccessful Psychopathy ...... 128 THE PSYCHOPATH NEXT DOOR 11

Cool Executive Function in Successful Psychopathy ...... 136 Summary of Cool Executive Functioning in Successful and Unsuccessful Psychopathy . 143 The Current Study ...... 157 Aims and Hypotheses ...... 160 Method ...... 161 Participants ...... 161 Materials ...... 162 The Psychopathic Personality Inventory-Revised (PPI-R) (Lilienfeld & Widows, 2005)...... 162 The Wisconsin Card Sorting Task (WCST)...... 163 The N-Back Task...... 164 The Tower of London...... 164 The Stop-Signal Task...... 165 The Raven’s Standard Progressive Matrices Plus (SPM-P)...... 165 Procedure ...... 166 The computerised executive function tasks...... 166 The WCST:CV4...... 166 The N-Back...... 167 STOP-IT (Verbruggen et al., 2008)...... 167 TOL-DX (Culbertson & Zillmer, 1998; Mueller, 2010)...... 168 Design ...... 168 Results ...... 169 Data Screening ...... 169 Descriptive Statistics ...... 170 Inferential Statistics ...... 173 Psychopathic Personality Inventory – Revised ...... 175 Raven’s Standard Progressive Matrices-Plus ...... 175 Tower of London ...... 176 Tower of London -Total Score...... 176 Tower of London – Planning and Execution Time...... 179 Stop-Signal Reaction Time ...... 181 Wisconsin Card Sorting Task ...... 182 Categories Achieved...... 182 Percentage of Perseverative Errors...... 182 THE PSYCHOPATH NEXT DOOR 12

N-Back Task ...... 184 Self-Report Criminality Scale (SRCS) ...... 185 Discussion ...... 186 Overview of Research ...... 186 Key Findings ...... 187 Males...... 188 Females...... 190 Psychopathy, Executive Function, and Self-Report Criminality ...... 193 Limitations and Directions for Future Research ...... 194 Chapter Summary ...... 195 Chapter Five ...... 196 Chapter Overview ...... 196 Emotion Deficits in Psychopathy ...... 197 Emotion Deficits in Primary and Secondary Psychopathy ...... 200 Affective and Semantic Language Processing ...... 202 Lexical Decision Task Research in Psychopathy ...... 204 Summary of Implicit Language Tasks in Psychopathy ...... 210 Study 3 ...... 212 Method ...... 213 Participants ...... 213 Materials ...... 214 Demographic questionnaire...... 214 The Psychopathic Personality Inventory-Revised (PPI-R) (Lilienfeld & Widows, 2005)...... 214 Word Stimuli...... 215 Pseudoword stimuli...... 215 Procedure ...... 216 The Lexical Decision Task...... 216 Word rating task...... 217 Design...... 218 Results ...... 218 Data Screening ...... 218 Lexical Decision Data ...... 219 Psychopathy and Priming Effects ...... 220 THE PSYCHOPATH NEXT DOOR 13

Word Rating Task ...... 222 Discussion ...... 224 Overview of Research ...... 224 Key Findings ...... 225 Psychopathy and priming...... 225 Psychopathy and word ratings...... 226 Summary of Findings ...... 227 Limitations, Implications and Directions for Future Research ...... 228 Chapter Six...... 229 Psychopathy and Criminality ...... 230 Executive Function ...... 231 Emotion Processing ...... 233 Theoretical Implications, Practical Applications, and Directions for Future Research ..... 234 References ...... 236 Appendix 1 ...... 277 Appendix 2 ...... 278 Appendix 3 ...... 280 Appendix 4 ...... 282 Appendix 5 ...... 283 Appendix 6 ...... 284 Appendix 7 ...... 292 Appendix 8 ...... 294 Appendix 9 ...... 300 Appendix 10 ...... 301

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List of Figures

Figure 1 Conceptual diagram of the Direct and Indirect Effects of Secondary

Psychopathy on Self-Reported Criminal Behaviour for Males. …………………….Page 106

Figure 2 Conceptual diagram of the Direct and Indirect Effects of Secondary

Psychopathy on Self-Reported Criminal Behaviour for Females. …………………….Page 107

Figure 3a. Conceptual diagram of the Direct and Indirect Effects of Self-Centred

Impulsivity on Tower of London Performance for Males. ……………………………. Page 178

Figure 3b. Conceptual Diagram of the Direct and Indirect effects of Self-Centred

Impulsivity on Tower of London Execution Times for Males. …………………………Page 178

Figure 4. Example trial sequences: (a) congruent emotion word trial (b) incongruent concrete word trial. ………………………………………………………………………….Page 217

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List of Tables

Table 1 Participant Demographics (N = 523)……………………………………….Page 87

Table 2 Descriptive Statistics for Psychopathy and Criminal Attitudes for Males and

Females…………………………………………………………………………………………...Page 94

Table 3 Bivariate Correlations between Psychopathy and Criminal Attitudes

(Correlations Below the Diagonal Are for Males, Above the Diagonal for Females). Page 95

Table 4 Hierarchical Multiple Regression Predicting Criminal Attitudes from Primary and Secondary Psychopathy Separately for Males and Females…………………………Page 97

Table 5 Hierarchical Multiple Regression Predicting Attitudes Toward Law, Courts, and Police from Primary and Secondary Psychopathy Separately for Males and

Females…………………………………………………………………………………………..Page 99

Table 6 Hierarchical Multiple Regression Predicting Tolerance for Law Violations from Primary and Secondary Psychopathy Presented Separately for Males and

Females……………………………………………………………………………………… Page 101

Table 7 Hierarchical Multiple Regression Predicting Identification with Criminal

Others from Primary and Secondary Psychopathy for Males and Females…………Page 103

Table 8 Hierarchical Multiple Regression Predicting Criminal Behaviour from

Primary and Secondary Psychopathy for Males and Females…………………………Page 105

Table 9 Studies Examining Behavioural Performance on Measures of Cool Executive

Function in Psychopathy……………………………………………………………………Page 146

Table 10 Descriptive Statistics for Psychopathy and Executive Function for Males and

Females………………………………………………………………………………………..Page 162

Table 11 Bivariate Correlations between Psychopathy and Executive Function for

Males and Females (Males are below the diagonal, females above) .Page 172 THE PSYCHOPATH NEXT DOOR 16

Table 12 Mediated Regression Predicting Tower of London Execution Times from Self-

Centred Impulsivity and Cognitive Ability for Females. ……………………………….Page 174

Table 13 Mediated Regression Predicting Tower of London Execution Times from Self- Centred Impulsivity and Cognitive Ability for Females…….…………………………..Page 181 Table 14 Priming effects, presented separately for each gender, for concrete, abstract and emotion words (in milliseconds)………………………………………………………Page 220

Table 15 Correlations between Psychopathy Factors and Priming Effects for Males and

Females…………………………………………………………………………………………Page 220

Table 16 Mean word ratings for positive, negative, abstract and concrete words on

concreteness, imageability, context availability, arousal, and valence………………...Page 221

Table 17 Correlations between Psychopathy Factors and Word Ratings for Males and

Females………………………………………………………………………………………….Page 222

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Abstract

The current thesis provides an original contribution to knowledge through the examination of

psychopathy in a mixed gender community sample with a noncriminal measure of

psychopathy. Most research on psychopathy, a personality disorder characterised by

callousness, manipulativeness, deceitfulness, and a lack of emotion, has used predominately

male criminal samples and criminal measures of psychopathy. This monofocal approach

conflates psychopathy with criminality and has resulted in a dearth of knowledge regarding

the nature and presentation of psychopathy in females and in the general population. This

research tested prominent theories of psychopathy by examining criminality, executive

functioning, and emotion-processing in psychopathy in a community sample. Gender

differences were also examined. Study 1 examined the relationship between psychopathy and

criminality using a comprehensive survey; Study 2 explored executive function in

psychopathy using a series of computer-based executive function tests, and Study 3 focused

on emotion-processing in psychopathy using a lexical decision task. The results from Study 1 showed that psychopathy was a poor predictor of criminal behaviour and attitudes, for both genders. In Study 2, while psychopathy predicted executive dysfunction in males, for females, psychopathy predicted superior executive function. In Study 3, there were no

significant relationships between psychopathy and emotion-processing in either males or

females. However, gender differences were also observed for emotion-processing. These

findings suggest that while current theories of psychopathy explain male, criminal

psychopathy well (as would be expected given the tautology with sampling and

measurements), they do not adequately explain noncriminal psychopathy nor female

psychopathy.

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Acknowledgements

First and foremost, I would like to express my deep gratitude for the support and mentoring provided by my primary supervisor, Renata Meuter. Renata, you have finessed the art of postgraduate student supervision by providing me with enough support and advice to get me through, but enough space to be an independent researcher. In addition to sharing your exceptional content knowledge on language processing, E-prime, and virtually all aspects of cognitive psychology, you have been a consistent advocate for me throughout the PhD journey. I would never have finished this PhD had it not been for your support, encouragement, and advice – thank you, thank you, thank you! I would also like to thank my associate supervisor, Nigar Khawaja, who joined the PhD supervision team late in the program. Nigar, thank you for reviewing drafts of my thesis and for setting expectations of me that kept me motivated and on task.

To my husband Troy, thank you for listening to me whine about the PhD program and for encouraging me out of my ‘imposter syndrome’ episodes. You have supported and loved me not just through the PhD journey, but through all the wonderful and horrible life circumstances throughout the past 8 years. A wife could not ask for a more loyal, supportive, patient, or loving husband.

To my parents, Rick and Janine, thank you for your unwavering support for me. You have loved me, encouraged me, nurtured me, and raised me to be the woman I am today.

Mum, you taught me to be a kind and empathetic person and you inspire me to be a better person through the example that you set every day. Papa, thank you for raising me to be a strong, determined, and confident woman. Your love, support, and belief in me has enabled me to pursue my dreams and aspirations. To my siblings, Rachael and Kieran, thank you for being my lifelong best friends and confidantes. THE PSYCHOPATH NEXT DOOR 20

Thank you to my PhD peers, Louise Starfelt, Sherrie-Ann Kaye, Shannon Edmed,

Alicia Allen, Jim Oxtoby, Vincent Tam, Ivan Chang, Cassandra Pattinson, Daniel Joyce,

Sophie Miller, and Rachel and Stuart Leske. I couldn’t have asked for a better group of people to go to work with every day. You all made the PhD journey so much more enjoyable and I will never forget the good times we had navigating the academic world.

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Chapter One - Thesis Overview

Chapter Overview

This chapter of the thesis provides an overview of the current program of research. In

an attempt to increase understanding on the nature and presentation of psychopathy, the

relationships between criminality, executive functioning, and emotion processing in

psychopathy were examined using a community sample. Although interest in female

psychopathy and noncriminal psychopathy has increased in recent times, the current body of

literature on psychopathy primarily reflects male, criminal psychopathy. Very little is known

about the presentation of psychopathy in females, and it is unclear whether research findings

in male psychopaths generalize to female psychopaths. Furthermore, the focus on criminal

offenders and the use of criminal scales to assess psychopathy has resulted in the conflation

of psychopathy and criminality. Thus, the primary goal was to extend psychopathy research to female and noncriminal psychopathy using a community sample. To do this, current theoretical models of noncriminal psychopathy were examined and their applicability to noncriminal psychopathy and female psychopathy were assessed in the three studies presented throughout this thesis. A brief background to the research is outlined in this chapter, along with the presentation of the rationale and aims of the research program, the

chapter concludes with the presentation of the structure of the thesis.

Background and Context

The psychopathic personality produces considerable personal, financial and societal burdens, including, an increased risk for domestic violence (Coid & Yang, 2011), an

increased incidence of workplace bullying (Boddy, 2011), negative impacts of corporate

psychopaths on employee well-being and productivity (Boddy, 2014), and an increased

incidence of general, violent, and sexual recidivism in criminal psychopathy (Hemphill, Hare

&Wong, 1998). Given the negative impact of psychopathy on families and society more THE PSYCHOPATH NEXT DOOR 22 broadly it is not surprising that a considerable amount of research has focused on elucidating the etiological mechanisms that give rise to this personality, along with attempts to treat and reform individuals with psychopathy. However, because psychopathy has long been associated with both serious and recidivist criminal behaviour (Hemphill, Hare & Wong,

1998), the majority of research on psychopathy has focused on criminal manifestations of psychopathy. This program of research aims to extend the research literature on psychopathy by highlighting the limitations of previous research that have focused exclusively on criminal offender samples. Specifically, it will be argued that the use of predominately male, criminal offender samples and the use of measures of psychopathy that explicitly tap criminality are problematic and interfere with the interpretation of research on psychopathy. It will be argued that the majority of previous research on psychopathy is confounded by criminality and the prevalent belief that criminal behaviour is central to psychopathy cannot be justified by the existing research literature.

Purpose of Research Program

The current research program addresses a significant gap in the psychopathy literature which has primarily focused on male, criminal psychopathy. Because previous literature has focused on criminal psychopathy, and emphasises criminality as a key feature, the goals of the current program of research were to (a) extend psychopathy research to a community sample; (b) examine the relationship between psychopathy and criminality using a community sample and noncriminal measure of psychopathy; (c) examine executive functioning in psychopathy as a way to test current theoretical models of psychopathy and to establish whether previous findings in criminal psychopathy also extend to noncriminal psychopathy; (d) examine emotion processing in psychopathy and establish whether findings of affective abnormalities in criminal psychopathy extend to noncriminal psychopathy; (e) examine possible gender differences in psychopathy and the manifestation of criminal THE PSYCHOPATH NEXT DOOR 23

behaviour, executive functioning, and emotion processing. These research aims were

addressed by three broad studies that are described in chapters three, four, and five of this

thesis.

Thesis Structure

This thesis contains six chapters. Chapter one provides an overview of the research

program and thesis. The second chapter provides a general introduction to the current body of

literature on psychopathy, highlights potential problems with current findings, and provides a

brief rationale for the program of research presented in chapters three, four, and five.

Chapters three to five outline the background, aims, method, results and discussion of the

three studies designed to address the aforementioned aims of the current program of research.

Chapter three provides a more detailed review of the psychopathy assessment literature, describes theories of noncriminal psychopathy, and outlines the method and results of Study 1. Chapter four describes the background, methods and findings of the second study, which examines whether findings of executive dysfunction in criminal psychopathy also extend to noncriminal and female psychopathy, and whether there are differential relationships between executive function and primary and secondary psychopathy. Chapter five describes the background, methods and findings of the third study, which examines the relationship between primary and secondary psychopathy and emotion processing in a noncriminal sample, including an examination of possible gender differences. Chapter six summarises the findings of the current program of research in the context of the current literature, and provides some direction for future research.

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Chapter Two - General Literature Review

Chapter Overview

This chapter provides the general background of the psychopathy literature. It begins by defining the psychopathy construct, including coverage of the controversies in the conceptualization and assessment of psychopathy. The current theoretical perspectives on the etiology of psychopathy are set-out, followed by discussion of the notion of noncriminal psychopathy. Through discussion of the current theories, measures, and approaches to the study of psychopathy, gaps in the literature between theoretical conceptualisations and the modern approach to the study of psychopathy become apparent. Specifically, it will be argued that the over-use of criminal samples and the mono-operationalisation of psychopathy have resulted in the conflation of psychopathy and criminality. Furthermore, it will be argued that the male bias in the scientific study of psychopathy hinders understanding and may result in less effective treatments for psychopathic females. The global objective here is to empirically test two theories of psychopathy: the successful psychopathy model and the dual process model. There is an additional focus on examining gender differences in the manifestation of psychopathy. The chapter concludes with a presentation of the aims and research questions of the current program of research.

Psychopathy Defined

The psychopathic individual is characterized by an excessive sense of self-worth, a propensity towards deception, impulsivity, and a failure to learn from previous experience.

(Cleckley, 1951; Hare, 1991; Lilienfeld & Widows, 2005). Interpersonally, they are known for their superficial charm, manipulativeness, and exploitation of others for personal gain.

Emotionally, they lack the capacity for genuine love, fear, empathy, and remorse.

Behaviourally, psychopathic individuals have a reputation for being impulsive and irresponsible, and controversially, some theorists claim that antisocial behaviour is a defining THE PSYCHOPATH NEXT DOOR 25

attribute (Hare, 1991). Although the early psychiatric literature describes individuals

displaying ‘manie sans délire’ (Pinel, 1801) ‘innate, preternatural moral depravity’ (Rush,

1812, p. 360), and ‘moral insanity’ (Pritchard, 1835), it was Hervey Cleckley (1941, 1948,

1951) who offered one of the first clear descriptions of the psychopathy construct with his

16-item checklist of interpersonal, affective, and behavioural symptoms. The criteria include:

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 behaviour

8. Poor judgment and failure to learn by experience

9. Pathologic egocentricity and incapacity for love

10. General poverty in major affective reactions

11. Specific loss of insight

12. Unresponsiveness in general interpersonal relations

13. Fantastic and uninviting behaviour with drink and sometimes without

14. Suicide rarely carried out

15. Sex life impersonal, trivial, and poorly integrated

16. Failure to follow any life plan (Cleckley, 1941, pp. 338-339)

Cleckley’s clinical accounts have been hugely influential in the modern conceptualisation and measurement of psychopathy. The most commonly used and empirically validated measure of psychopathy, the Psychopathy Checklist Revised (PCL-R)

(Hare, 1991), was developed specifically from Clecklian criteria. THE PSYCHOPATH NEXT DOOR 26

Assessment of Criminal Psychopathy

Although reports of the psychopathic personality appear consistently throughout the psychological literature (Herve & Yuille, 2007), the development of a valid empirical measurement of psychopathy is a relatively recent addition. Hare (1980) was the first to develop a standardised and reliable measurement of psychopathy with the Psychopathy

Checklist (PCL) (now Psychopathy Checklist-Revised [PCL-R]) (Hare, 1991). The construction of the Psychopathy Checklist was based on Cleckley’s clinical description of interpersonal, affective, and behavioural abnormalities. Research on the factor structure of the

PCL-R has produced varying factor structures, including two-factor (Hare, 1991), three- factor (Cooke & Michie, 2001), and four-factor models (Hare & Neumann, 2005). Although there is relatively little consensus amongst researchers on which factor structure best captures

PCL-R psychopathy, the two-factor structure is consistent with historical conceptualisations of psychopathy as consisting of two distinct yet related variants (Blackburn, 1975; Karpman,

1941; Lykken, 1995). PCL-R Factor one (F1) reflects the interpersonal and affective characteristics of psychopathy, such as superficial charm, egocentricity, deceitfulness, blunted affect and a lack of inhibitory emotions (i.e., fear, guilt and remorse). PCL-R Factor two (F2) reflects the behavioural and lifestyle features of psychopathy, such as impulsivity, irresponsibility and a lack of long-term goals, and is associated with the experience of negative affect (i.e., fear, anxiety and hostility).

The PCL-R has contributed enormously to the scientific study of psychopathy and is considered by many to be the ‘gold standard’ of psychopathy measurement (e.g., Fulero,

1995). However, the PCL-R is not without limitations. The PCL-R consists of a 20-item clinical rating scale completed by a trained clinician on the basis of extensive interviews and information gathered from institutional files. As a result, the administration of the PCL-R is a lengthy and involved process, and the reliance on institutional files makes it unsuitable for THE PSYCHOPATH NEXT DOOR 27

nonclinical populations. Furthermore, the PCL-R was developed and standardised on criminal

offender samples, and includes assessment items that specifically capture previous criminal

behaviour. This focus on criminal samples and the antisocial behavioural aspects of

psychopathy has been a topic of recent debate (Skeem & Cooke, 2010a, 2010b). Specifically,

some researchers point out that the focus on criminal behaviour in the PCL-R measurement of psychopathy is inconsistent with the theoretical foundations on which it was originally constructed (Blackburn, 2005; Skeem & Cooke, 2010a). Given the heavy focus on criminal

samples and criminal behaviour in the development and standardisation of the PCL-R, it

follows that the PCL-R is best viewed as a measurement of criminal psychopathy, not the

broad theoretical construct of psychopathy.

Assessment of Noncriminal Psychopathy

The study of psychopathy outside of forensic samples was hindered by the absence of suitable assessment techniques. However, the advent of self-report measurements of psychopathy has provided researchers with an avenue to study noncriminal psychopathy. The two most promising self-report measures of noncriminal psychopathy are the Levenson Self-

Report Psychopathy Scale (LSRP) (Levenson, et al., 1995) and the Psychopathic Personality

Inventory-Revised (PPI-R) (Lilienfeld & Widows, 2005). The Levenson Self-Report

Psychopathy Scale (Levenson, et al., 1995) is a self-report measure of psychopathy. The

LSRP consists of two related subscales: the LSRP Primary Scale and the LSRP Secondary

Scale. Similar to the two-factor model of the PCL-R, primary psychopathy reflects the interpersonal and affective features of psychopathy and secondary psychopathy reflects the behavioural and lifestyle features of psychopathy. The LSRP possesses good psychometric properties (Levenson, et al., 1995; Lynam, Whiteside, & Jones, 1999) and has been shown to capture the same two-factor structure as the PCL-R (Levenson, et al., 1995). More THE PSYCHOPATH NEXT DOOR 28

importantly, the LSRP does not contain items that tap criminality, making it a useful measure

of noncriminal psychopathy.

The Psychopathic Personality Inventory-Revised (Lilienfeld & Widows, 2005) is another promising self-report measure of psychopathy. The PPI-R was developed for use in non-institutionalised samples and does not contain items that assess criminality. The PPI-R is psychometrically reliable and captures the same two factor structure as the PCL-R (Lilienfeld

& Widows, 2005). Validity research on the PPI-R has shown that the two factors are strongly correlated with composite scores from the Multidimensional Personality Questionnaire

(MPQ; Patrick, Curtin and Tellegen, 2002), and the factors display significant correlations with internalising and externalising behaviours that are consistent with theoretical accounts of psychopathy (Witt, Donnellan, Blonigen, Krueger & Conger, 2009). With the advent of psychometrically reliable measures of noncriminal psychopathy, researchers now have the opportunity to investigate the mechanisms underlying the range of affective and cognitive dysfunction observed in psychopathy, without the confounding effect of criminality.

Review of Psychopathy Assessments

The measure of psychopathy utilised often reflects the researcher’s theoretical position regarding the role of severe anti-sociality in psychopathy and/or the research sample of interest. Typically, those who endorse the view of criminality as central to psychopathy utilise the PCL-R measures (i.e., PCL-R, PCL-SV, PCL-YV, and P-SCAN), and those who view criminality as an epiphenomenon utilise the LSRP or the PPI-R. Additionally, researchers interested in criminal samples often utilise the PCL-R, whereas the LSRP and

PPI-R are more commonly used when investigating psychopathy in noncriminal populations.

However, a consistent finding across all measures of psychopathy is the emergence of two separate, yet related aspects of psychopathy, an interpersonal and affective facet, and an THE PSYCHOPATH NEXT DOOR 29

antisocial-lifestyle facet. This finding aligns with theoretical conceptualisations of

psychopathy as consisting of two related, yet separate, variants (e.g., Karpman, 1941).

Psychopathy Variants

Karpman (1941) was the first to suggest the existence of two variants of psychopathy that appeared phenotypically similar but were distinct in the underlying core deficits and etiology. Karpman (1941, 1948) suggested that primary psychopathy or “idiopathic” psychopathy was associated with a heritable deficit in affective experience, whereas secondary psychopathy or “symptomatic” psychopathy was associated with affective dysfunction resulting from negative environmental experiences. According to Karpman

(1941) primary psychopathy is characterized by an innate inability to experience negative emotional states, including fear and anxiety, which interferes with socialisation. In contrast,

Karpman suggested that secondary psychopathic individuals experience increased levels of negative affect, and have the capacity for empathy. Differentiating psychopathy variants has important clinical implications. Although both primary and secondary variants are phenotypically similar, if different etiological processes give rise primary and secondary psychopathy, then it is plausible that interventions that may be effective for secondary psychopathy may not be effective for primary psychopathy, and vice versa.

Research focused on disaggregating psychopathy variants has shown that primary psychopathy and secondary psychopathy display distinct etiological markers and divergent patterns of relationships with external variables (e.g., socioeconomic status (SES) variables)

(Benning, Patrick, Hicks, Blonigen, & Krueger, 2003; Morrison & Gilbert, 2001). A key distinguishing feature of primary and secondary psychopathy is the experience of negative affect (i.e., fear, anxiety and remorse) (Frick, Lilienfeld, Ellis, Loney, & Silverthorn, 1999;

Patrick, 1994). Numerous studies have shown that primary psychopathy is associated with a paucity of negative emotions (K. S. Blair, Morton, Leonard, & Blair, 2006; Frick et al., 1999; THE PSYCHOPATH NEXT DOOR 30

Lykken, 1957). Specifically, primary psychopathy is associated with a lack of fear and anxiety (Lykken, 1957; Ogloff & Wong, 1990), poor passive avoidance to punishment when the task involves competing goals (Newman & Kosson, 1986), and decreased electrodermal responsivity to punishment cues (Lykken, 1957). In contrast, secondary psychopathy is associated with elevated levels of negative affect, specifically, anxiety, fear and hostility

(Hicks, Markon, Patrick, Krueger, & Newman, 2004; Vassileva, Kosson, Abramowitz, &

Conrod, 2005). The experience of negative affect is often used to distinguish between primary and secondary psychopathy.

In addition to the affective differences between primary and secondary psychopathy, a range of socioeconomic and behavioural differences have also been observed. Secondary psychopathy is positively associated with lower SES factors, lower educational levels and lower verbal intelligence (Benning et al., 2003). In contrast, primary psychopathy is negatively associated with these factors (Benning et al., 2003). Additionally, secondary psychopathy and primary psychopathy differ in respect to aggressive behaviour. Empirical findings demonstrate that primary psychopathy is associated with increased rates of both instrumental and reactive aggression (Reidy, Zeichner, Miller, & Martinez, 2007).

Conversely, secondary psychopathy is only associated with increased rates of reactive aggression (Reidy et al., 2007).

These differences in affective, socioeconomic and behavioural functioning suggest that although primary and secondary psychopathy share some similar behavioural features, they are actually two separate variants in terms of dysfunction and etiology. Research using twins has demonstrated a distinct genetic architecture for primary psychopathy and secondary psychopathy (Blonigen, Carlson, Krueger, & Patrick, 2003; Blonigen, Hicks, Krueger,

Patrick, & Iacono, 2005). According to the dual process model, primary and secondary psychopathy arise from distinct neurobiological deficits (Patrick & Bernat, 2009). According THE PSYCHOPATH NEXT DOOR 31

to this theory, primary psychopathy stems from dysfunctional neurobiological systems

responsible for motivation and emotion. On the other hand, secondary psychopathy is thought

to result from deficits in brain regions responsible for higher order cognitive functioning.

Taken together, the observed differences between the two variants highlights the need to

distinguish between primary and secondary psychopathy and the phenomenon of interest

when conducting psychopathy research.

It is evident that a complex pattern of both affective and behavioural anomalies have

been observed in primary and secondary psychopathy. However, the majority of previous

research has utilised criminal offender samples. The estimated prevalence of psychopathy in

prison populations (approximately 30%) (Hare, 1991) versus the estimated prevalence of

psychopathy in the general population using PCL measures (approximately 1-6%) (Coid,

Yang, Ullrich, Roberts, & Hare, 2009) makes criminal offender samples a convenient recruitment option. However, the exclusive use of criminal offender samples provides a relatively narrow perspective of psychopathy. The etiological mechanisms that lead to criminal psychopathy (both primary and secondary variants) may not be the same as those in psychopathy more broadly. Therefore, in order to gain a clearer understanding of the biological and environmental processes that produce psychopathy, both criminal and otherwise, research utilising more diverse populations is necessary. In addition to the lack of generalisability of previous research to the wider population, the traditional use of criminal offender samples has contributed to the coalescing of psychopathy with criminality and antisocial personality disorder.

Psychopathy and Antisocial Personality Disorder

An important distinction in the psychopathy literature is that of psychopathy and

Antisocial Personality Disorder (ASPD). The original conception of psychopathy (Cleckley,

1941, 1948) emphasised interpersonal and affective abnormalities concealed by a ‘mask of THE PSYCHOPATH NEXT DOOR 32

sanity’. Cleckley’s research strongly influenced the criteria for ‘antisocial personality’ in an

early version of the diagnostic and statistical manual of mental disorders (DSM-II)

(American Psychiatric Association, 1968). However, recent editions of the DSM (e.g. DSM-

III; DSM-III-R; DSM-IV; DSM-IV-TR, DSM-V) (American Psychiatric Association, 1980,

1987, 1994, 2000) have shifted towards behaviour-based criteria instead of personality traits and affective characteristics, because the latter are considered difficult to assess objectively and reliably. Antisocial Personality Disorder as described in the current version of the DSM

(DSM-V) (American Psychiatric Association, 2013) emphasises “a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years” (section

301.7 [F60.2]) demonstrated by evidence of at least three of the following criteria:

1. Failure to conform to social norms with respect to lawful behaviours, 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 behaviour or honour financial obligations.

7. Lack of remorse, as indicated by being indifferent to or rationalizing having

hurt, mistreated, or stolen from another. (American Psychiatric Association,

2013, section 301.7 [F60.2]) THE PSYCHOPATH NEXT DOOR 33

Although ‘associated features supporting diagnosis’ describe some of the

interpersonal and affective features characteristic of psychopathy (American Psychiatric

Association, 2013), the current diagnostic criteria primarily focus on antisocial behaviour

rather than interpersonal and affective features. The emphasis in the DSM on antisocial

behaviour has drawn criticism from psychopathy researchers, who disagree with claims that

psychopathy and ASPD are synonymous constructs. This particular claim is not supported for

several reasons. Firstly, psychopathy is a personality construct that consists not only of

behavioural components, but also cognitive, interpersonal, and affective components. These

other central and perhaps more crucial aspects of psychopathy are not adequately captured in

DSM-V descriptions of ASPD which focus heavily on behavioural features. Furthermore,

there is a robust debate occurring in the psychopathy literature about the role of antisocial

behaviour, with some strong arguments against antisocial behaviour as a diagnostic feature of

psychopathy (Skeem & Cooke, 2010a). Secondly, research on the prevalence of ASPD in

forensic settings estimate that 50-80% of prisoners meet the criteria, while estimates of

psychopathy are only 15-30% (Hare, 1991). The high prevalence of ASPD in criminal

samples may be attributed to the focus on antisocial behaviour rather than personality

characteristics in the diagnosis of ASPD. Alternatively, research in a non-forensic sample suggests that disparate cut-offs for psychopathy (stricter cut-offs) versus ASPD (lower cut- offs) may explain the differences in prevalence rates (Rogers & Rogstad, 2010). However, given the differences in sample characteristics in the Rogers and Rogstad study, further research is needed before conclusions can be drawn regarding disparate cut-offs and differences in prevalence rates for PCL-R measures of psychopathy and ASPD. Thirdly, the predictive utility of psychopathy in forensic settings is higher than that of ASPD. Research has shown that psychopathy is a good predictor of general recidivism, violent recidivism and sexual recidivism (Hemphill, Hare, & Wong, 1998). Criminal psychopaths are three times THE PSYCHOPATH NEXT DOOR 34 more likely to recidivate than criminal non-psychopaths and four times more likely to recidivate violently than criminal non-psychopaths (Hemphill et al., 1998). Therefore, the classification of psychopathy demonstrates a predictive utility above and beyond a diagnosis of ASPD. Lastly, ASPD diagnoses in criminal offenders capture a highly heterogeneous population grouped together based on antisocial behaviour rather than the various etiological factors that lead to the behaviour. Lykken (2006) emphasised this latter point:

APD is plainly a heterogeneous category in respect to etiology and also in respect to

the psychological characteristics that give rise to the varied patterns of socially

deviant behaviour that serve to meet the criteria. Identifying someone as ‘having’

APD is about as nonspecific and scientifically unhelpful as diagnosing a sick patient

as having a fever or an infectious or a neurological disorder (Lykken, 2006, p. 4).

It is commonly accepted that the causes of antisocial behaviour are multifarious, with biological, psychological, sociological, geographic, and economic factors all implicated in crime causation (Brown, Esbensen, & Geis, 2010). In contrast, the diagnosis of psychopathy captures a more homogenous group of individuals who share a common pattern of personality dysfunction. This personality dysfunction separates psychopathic individuals from individuals with antisocial personality disorder, and there is a wealth of evidence that demonstrates that psychopathic criminals show unique emotional and cognitive impairments not found in nonpsychopathic criminals.

Psychopathy and Affective Deficits

Clinical accounts of psychopathy emphasized emotional impairment as a central feature of the disorder. This position is supported by a vast body of literature that demonstrates that psychopathy is characterized by abnormal emotion processing. Lykken

(1957) conducted one of the earliest investigations of affective dysfunction in psychopathy THE PSYCHOPATH NEXT DOOR 35

when he examined the performance of primary and secondary psychopaths (categorized using

Cleckian criteria) on a passive avoidance test. Using a sample of male and female participants

from a correctional facility, Lykken found that primary psychopaths generated lower galvanic

skin response to stimuli associated with punishment, and less avoidance of punished

responses compared to criminal controls (Lykken, 1957). Research using a startle reflex

paradigm has also revealed abnormal emotion processing in psychopathic individuals. In the

startle reflex paradigm, the startle reflex (aversive reflex) can be augmented by the

presentation of a visual prime before the startle probe (a loud noise) (Lang, Bradley, &

Cuthbert, 1990). In conditions where a positive prime (e.g., pictures of romantic couples or babies) is presented before the startle probe, healthy participants display reduced startle response compared to conditions using neutral primes (e.g., a book or a pair of shoes), as measured by eye blinks using electrodes attached to the face (Lang et al., 1990). In contrast,

when negative primes (e.g., images of victims of violent death) are displayed prior to the

presentation of the startle probe, healthy participants display an increased startle response

compared to neutral primes (Lang et al., 1990). Research using the startle response paradigm

in psychopathic offenders has shown that whilst some reduction in startle reflex is observed

after the presentation of positive primes, there is significantly less augmentation of the startle

reflex following the presentation of negative primes (Patrick, 1994). These findings suggest a

reduced response to negative emotional information in psychopathic individuals compared to

controls.

Subsequent studies on emotion processing in psychopathy have produced consistent

evidence of pervasive emotional impairment in psychopathic individuals. For example, Blair

and colleagues examined skin conductance responses to visual distress cues, threat cues, and

neutral stimuli in a sample of male, psychopathic criminals and nonpsychopathic criminals

and found that psychopathic individuals compared to controls displayed hyporesponsivity to THE PSYCHOPATH NEXT DOOR 36 the distress cues but intact responsivity to the threat cues and neutral stimuli (R. J. R Blair,

Jones, Clark, & Smith, 1997). Further support for the emotional impairment of psychopathic individuals is provided by research that demonstrates that psychopathic individuals are selectively impaired in recognizing the fearful facial expressions of others (R. J. R Blair et al., 2004). Furthermore, this deficit appears to extend across sensory modality. Using a male, criminal offender sample Blair and Colleagues (2002) examined the recognition of vocal affect (happiness, disgust, anger, fear, and sadness) in psychopathic and nonpsychopathic participants. They found that psychopathic participants were selectively impaired in recognizing fearful and sad vocal affect, committing significantly more recognition errors than nonpsychopathic controls (R. J. R. Blair et al., 2002).

The accumulated evidence on emotion and psychopathy strongly supports the claims of affective dysfunction as a core feature of psychopathy. However, like many of the modern studies on psychopathy, the vast majority of these studies employed predominately criminal and predominately male participants. With the exception of a few studies (e.g., Eisenbarth et al., 2013; Iria & Barbosa, 2009; Reidy, Zeichner, & Foster, 2009), the examination of emotion deficits in noncriminal and female psychopathic samples remains an understudied area. Iria and Barbosa (2009) examined the ability to recognize fearful facial expressions amongst male noncriminal psychopaths. The authors found that the deficit in recognizing fearful facial expressions commonly reported in criminal psychopaths also occurred in noncriminal psychopaths. Preliminary research on emotional facial recognition in female criminal psychopaths suggests that this deficit also extends to female, criminal psychopathy

(Eisenbarth, Alpers, Segrè, Calogero, & Angrilli, 2008; Eisenbarth et al., 2013). However, this difficulty in recognizing facial expressions may not extend to female, noncriminal psychopathy. For example, Justus & Finn (2007) found that the abnormal startle response to aversive images found in male criminal psychopaths also occurred for male noncriminal THE PSYCHOPATH NEXT DOOR 37

psychopaths, but that this did not extend to noncriminal female psychopaths. In fact,

noncriminal females high on psychopathy (global and primary psychopathy) demonstrated a larger startle amplitude for negative images compared to those low on psychopathy.

Clearly, further research is needed to determine whether the findings of broad

emotional dysfunction in male, criminal psychopaths also extend to female psychopaths and

noncriminal psychopaths. Further, given that primary and secondary psychopathy display

divergent relationships with a range of external variables, it would be interesting to consider

whether similar emotion processing deficits are found in both primary and secondary

psychopathy. One task that has been used in previous research to examine implicit emotion

processing in psychopathy is the lexical decision task (LDT). The LDT is a well-known cognitive task for studying the nature of language processing. In this task, participants are presented with a string of letters and asked to decide as quickly as possible whether the letter string forms a word or a nonword. The letter strings are typically presented in quick succession on a computer screen with the response (often a key press) triggering the presentation of the next letter string. Previous research has found that this task is useful in tapping implicit cognitive and emotional processes related to psychological abnormality. For example, research examining responses to appearance-related words (e.g., beautiful, ugly) after viewing pictures of emaciated-looking women or thin women, found that participants with Anorexia Nervosa responded faster to appearance-related words after looking at emaciated pictures than did healthy females.

In relation to psychopathy, previous research using the LDT has shown that healthy individuals show a speed advantage for emotion words (e.g., love, hate) relative to neutral words (grass, candle) (Graves, Landis, & Goodglass, 1981; Landis, 2006; Strauss, 1983).

However, this speed advantage has not been observed in psychopathic individuals (Kiehl,

1999; Williamson et al., 1991). Further evidence for affective language dysfunction comes THE PSYCHOPATH NEXT DOOR 38 from research which shows that psychopathic individuals do not display the same event- related potential (ERP) responses to emotion words that are observed in healthy individuals

(Williamson et al., 1991). Collectively, these findings suggest that different processes may be involved in the processing of affective language in psychopathic individuals (S. Williamson,

Harpur, & Hare, 1991). However, the majority of previous research on affective language processing in psychopathy has been conducted using male participants. There is only one known study that has examined language processing in female psychopathy (Vitale,

Maccoon, & Newman, 2011). The lack of consideration for gender differences in affective language processing in psychopathy is problematic. Research has consistently demonstrated differences in emotional processing as a function of gender. For example, previous research has demonstrated gender differences in the judgment of facial affect (Thayer & Johnsen,

2000), including increased physiological reactivity to facial affect for females over males

(Dimberg & Lundquist, 1990); gender differences in the experience of emotion (Fischer,

Rodriguez Mosquera, van Vianen, & Manstead, 2004); gender differences demonstrating increased emotional expressiveness for females (Kring & Gordon, 1998); and gender differences in affective priming (Gohier et al., 2011). Therefore, it stands to reason that the findings of affective dysfunction in language processing may only be true for male psychopaths. This is likely given that Vitale et al. (2001) failed to replicate the findings of affective language dysfunction with a female sample. However, because this study employed only female participants, a direct examination of gender differences was not possible.

Clearly, further research on affective language processing in female psychopathy and an examination of possible gender differences is needed in order to address this gap in the psychopathy literature.

In addition to the lack of research on gender differences in affective language processing in psychopathy, there is also a lack of research examining the separate THE PSYCHOPATH NEXT DOOR 39 relationships between primary and secondary psychopathy and affective language processing.

As previously stated, research has shown that primary and secondary psychopathy are associated with differential experiences of emotion, with primary psychopathy associated with a paucity of negative emotion and secondary psychopathy associated with elevated levels of negative emotion (Del Gaizo & Falkenbach, 2008). Affective priming studies have consistently demonstrated a facilitation in response to negative stimuli amongst individuals with elevated levels of negative affect (e.g., anxiety and depression) (B. P. Bradley, Mogg, &

Millar, 1996; B. P. Bradley, Mogg, & Williams, 1995; Ruiz-Caballero & González, 1997).

Thus, given that secondary psychopathy is associated with elevated levels of negative emotionality (e.g., anxiety), it stands to reason that an attentional bias to negative words may be observed. This attentional bias would result in a facilitation to negative words amongst secondary psychopaths. However, given the paucity of emotion in primary psychopathy, it would be expected that a lack of facilitation to both positive and negative words would be observed. Consequently, the current findings of language processing deficits in psychopathy may only be true for primary psychopathy and not secondary psychopathy.

There is only one known study that has investigated language processing separately for primary and secondary psychopathy (Reidy, Zeichner, Hunnicutt-Ferguson, & Lilienfeld,

2008). Reidy and colleagues (2008) investigated response latencies to discrete affect word categories (anger, sadness, happiness, and fear) and abstract words as a function of primary and secondary psychopathy. Their findings provided partial evidence of a differential pattern of response latencies to sadness and anger words between primary and secondary psychopathy. Primary psychopathy was associated with slower responses to sadness words and secondary psychopathy was associated with faster responses to anger words (Reidy et al.,

2008). However, a number of methodological limitations were present. An undergraduate sample was used, but consisted of only male participants, thus affecting the generalisability THE PSYCHOPATH NEXT DOOR 40

of the findings. Furthermore, the authors did not obtain word ratings on the discrete affect

dimensions from participants. Consequently, words that healthy, normal adults rate as

‘angry’, ‘sad’ or ‘happy’, may not be rated in the same fashion by psychopathic individuals.

Reidy, et al., (2008) suggested that cognitive biases based on individual differences may have

been present. For example, words that normal, healthy adults view as fearful (e.g. murder),

may actually activate anger nodes in individuals with high levels of hostile emotion (Reidy et

al., 2008). This highlights the importance of including a word rating task when conducting

language studies in psychopathy, especially considering the elevated rates of hostility and

aggression in secondary psychopathy (Reidy et al., 2007). Reidy, et al., (2008) concluded that

future studies should incorporate a wider participant sample, including female participants,

and the inclusion of a word rating task when conducting emotional priming studies in

psychopathy.

Psychopathy and Cognitive Deficits

In addition to the impairments in affective functioning, there is now a large body of

research that suggests that psychopathy is associated with abnormal cognitive processing

(Bagshaw, Gray, & Snowden, 2014; Baskin–Sommers, Curtin, Li, & Newman, 2012; Hiatt,

Schmitt, & Newman, 2004; Jutai, Hare, & Connolly, 1987; Kosson, 1996; Newman,

Patterson, & Kosson, 1987). Studies have shown that psychopathic individuals display

attentional deficits, such as reduced interference on Stroop-like tasks (Hiatt, et al., 2004) and reduced physiological reactivity to irrelevant auditory stimuli (Jutai, et al., 1987). There is also some evidence of executive dysfunction in criminal psychopathic individuals, such as poor behavioural inhibition (Newman & Brinkley, 1997) and set-shifting (Bagshaw et al.,

2014), with research suggesting this is primarily associated with elevated levels of secondary psychopathy. Conversely, there is some research that suggests that noncriminal psychopathy

(Ishikawa, Raine, Lencz, Bihrle, & Lacasse, 2001) and/or higher levels of primary THE PSYCHOPATH NEXT DOOR 41

psychopathy are actually associated with superior executive functioning (Hansen, Johnsen,

Thornton, Waage, & Thayer, 2007; Sellbom & Verona, 2007).

Executive Functioning

The term ‘executive function’ refers to a constellation of higher order, self-regulatory cognitive abilities, including attention, memory, planning, decision-making, response inhibition, and cognitive flexibility (Royall et al., 2002). These self-regulatory processes are essential for socially appropriate behaviour, prompting researchers to suggest that executive dysfunction may underlie the range of socially inappropriate and self-defeating behaviours observed in individuals with psychopathy. This hypothesis is bolstered by evidence of

‘acquired sociopathy’ or ‘pseudo-psychopathy’, a condition characterised by pervasive changes in personality and socially appropriate behaviour, such as callousness, a paucity of emotion, irresponsibility, impulsivity, and a lack of empathy, following damage to the ventromedial prefrontal cortex, an area implicated as important for intact executive functioning (Tranel, 2002). Individuals with acquired psychopathy display profound deficits regulating socially inappropriate behaviour, and like psychopathic individuals, they generally display intact intelligence, memory, and language ability.

Whilst the prefrontal cortex plays a crucial role in the ability to perform a range of executive functions, different regions are purported to be responsible for different kinds of executive function. A common distinction in the executive function literature is that of ‘hot’ and ‘cool’ executive functions (Zelazo & Cunningham, 2007; Zelazo & Muller, 2002). Hot executive functions refer to cognitive functions that are recruited in situations that are emotionally or motivationally significant because they involve reward/punishment. These executive functions are subserved by the ventromedial prefrontal cortex and its associated pathways (Zelazo & Muller, 2002; Zelazo, Qu, & Kesek, 2010). On the other hand, cool executive functions are purely cognitive in nature, such as working memory, planning, set- THE PSYCHOPATH NEXT DOOR 42 shifting and attentional processes, and rely on the lateral prefrontal cortex (Zelazo & Carlson,

2012; Zelazo & Cunningham, 2007; Zelazo & Muller, 2002; Zelazo et al., 2010). Researchers claim that similar to the individuals with ‘acquired sociopathy’, the psychopathic individuals’ executive dysfunction is characterised by ventromedial prefrontal cortex deficits, with largely intact lateral prefrontal cortex functioning (K. S. Blair, Newman, et al., 2006; Gao, Glenn,

Schug, Yang, & Raine, 2009).

The intuitive appeal of the executive dysfunction hypothesis has led to a flurry of research examining executive function processes in psychopathic individuals (e.g., Bagshaw et al., 2014; De Brito, Viding, Kumari, Blackwood, & Hodgins, 2013; Dolan, 2012; Ishikawa et al., 2001; Mahmut, Homewood, & Stevenson, 2008; Mol, Van Den Bos, Derks, & Egger,

2009; Pham, Vanderstukken, Philippot, & Vanderlinden, 2003; Ross, Benning, & Adams,

2007; Sellbom & Verona, 2007; Snowden, Gray, Pugh, & Atkinson, 2013). However, research findings to date are contradictory and clouded by methodological inconsistencies in the measurement of psychopathy, the types of executive function studied (e.g., cool executive functions or hot executive functions), the measurement of executive function utilised, and demographic differences between samples (e.g., male criminal offender samples, male community samples, or mixed gender community samples).

Generally speaking, two streams of research on the psychopathy-executive function relationship have emerged, a stream examining executive function in criminal psychopaths

(often referred to as unsuccessful psychopaths), and a stream examining executive function in noncriminal psychopaths (often referred to as successful psychopaths). The common suggestion in the psychopathy literature is that criminal psychopathy is associated with poorer executive functioning, whilst noncriminal psychopathy is associated with superior executive functioning (Gao & Raine, 2010). This hypothesis was generated in part by

Ishikawa et al. (2001), who examined performance on the Wisconsin Card Sorting Test THE PSYCHOPATH NEXT DOOR 43

(WCST: a common neuropsychological measure of executive function) in successful

psychopaths, unsuccessful psychopaths, and non-psychopathic controls. They found that

successful psychopaths solved more categories, and displayed less perseverative and non-

perseverative errors than the unsuccessful psychopaths and non-psychopathic controls. There

were no differences in WCST performance for the unsuccessful psychopaths and non-

psychopathic controls. This study has been consistently referred to in the literature as

evidence of superior executive functioning in successful psychopaths. However, the literature

on executive functioning in psychopathy is considerably more complex, with differential

patterns of association with executive function observed for primary (F1) versus secondary

psychopathy (F2), both within the criminal and noncriminal psychopathy literatures, and

inconsistent results across different measures of executive function (for a full review of the

executive function literature on psychopathy, see Chapter Four). For example, Sellbom and

Verona (2007) used a mixed gender undergraduate sample to examine WCST performance as

a function of PPI-R assessed psychopathy and found that whilst Factor 1 was associated with

better performance, Factor 2 was associated with worse performance. These findings suggest

a more nuanced relationship between psychopathy and executive function.

Another possible explanation for the finding of executive dysfunction in criminal

psychopathy, primarily factor 2 (which captures the antisocial features), could be due to

factors related to criminality rather than psychopathy. Dolan (2012) examined planning

ability, set-shifting, and response inhibition in a large sample of offenders with Antisocial

Personality Disorder (ASPD) with and without PCL:SV assessed psychopathy (ASPD+P and

ASPD-P) against nonpsychopathic participants from the general population. The author found that individuals with ASPD-P performed worse on tasks of planning ability, set-

shifting, and response inhibition than controls but that the performance of ASPD+P was not

significantly different to controls (Dolan, 2012). This finding suggests that antisociality, THE PSYCHOPATH NEXT DOOR 44

rather than psychopathy, is associated with executive dysfunction on tasks reliant on the

DLPFC. When taken together with the findings by Ishikawa et al. (2001), one could infer that

successful psychopaths could well have superior executive functioning.

However, De Brito et al. (2013) conducted a similar study which examined

performance on a range of hot and cool executive functions (verbal working memory,

reversal learning, decision-making under risk, and stimulus-reinforcement-based decision

making) in a group of violent offenders diagnosed with ASPD with and without PCL-R assessed psychopathy. The results revealed that the violent offenders (both ASPD-P and

ASPD+P) displayed poorer performance on measures of hot executive function than a noncriminal control group but similar performance to each other. Specifically, the offenders

(ASPD-P and ASPD+P) failed to change their behaviour in response to changing task requirements, failed to learn from punishment cues, and despite taking longer to make decisions than the controls, they displayed more decision-making errors. However, unlike the findings of Dolan (2012), the offenders (ASPD-P and ASPD+P) performed worse on a measure of cool EF (working memory tasks) than controls. These findings suggest that poor performance of psychopathic individuals recruited from forensic samples on tasks of hot executive function may be explained by factors related to criminality (antisocial behaviour), rather than psychopathy per se. However, the finding of poorer performance on tasks of cool executive dysfunction in ASPD+P is in contrast to the results of Dolan (2012). Given that these studies have not examined the unique relationships between primary psychopathy, secondary psychopathy and executive function; it could be that differences in the levels of primary versus secondary psychopathy between the samples is responsible for the inconsistent findings.

The inconsistency in findings of different studies of psychopathy and executive function may suggest different patterns of relationships for unsuccessful versus successful THE PSYCHOPATH NEXT DOOR 45

psychopathy, or superior performance for primary psychopathy and worse performance for

secondary psychopathy, or they could be an artefact of methodological differences between

studies. Specifically, research in criminal offender samples typically utilise male participants,

whereas research in community samples has utilised either male participants or mixed gender

samples without any consideration of gender as a moderating factor (e.g., Snowden et al.,

2013). The a priori assumption that the pattern of relationships between psychopathy and

measures of executive function are the same for males and females is problematic. There is

evidence of differential patterns of disease susceptibility and symptomatology in males and

females for a range of physical and psychological conditions (For a review see Beery &

Zucker, 2011). However, a male bias in health research is prolific (Beery & Zucker, 2011),

and is prevalent in psychopathy research.

In addition to this problem, the previous research on psychopathy and executive

function is difficult to interpret because gender differences between criminal and noncriminal

samples obfuscate the relationship. This problem is exacerbated by research that

demonstrates gender differences in a range of cognitive functions (Astur, Ortiz, &

Sutherland, 1998; D. W. Collins & Kimura, 1997; Herlitz & Rehnman, 2008; Thakkar et al.,

2014; Tlauka, Brolese, Pomeroy, & Hobbs, 2005). Therefore, discrepancies between studies

that employ primarily male criminal offender samples and those that employ mixed gender

community samples could be because of the impact of criminality on the psychopathy-

executive function relationship, or they could be due to gender differences. One of the aims

of this thesis is to examine executive functioning in psychopathic individuals from the

community, including an examination of possible gender differences.

Summary of Affective and Cognitive Deficits

There is evidence of both affective and cognitive processing abnormalities in psychopathic individuals. However, theorists are divided on the etiological and explanatory THE PSYCHOPATH NEXT DOOR 46 mechanisms that underlie these abnormalities. These abnormalities are interpreted as being either primarily affective or primarily cognitive in nature depending on the theoretical lens of the researcher.

Theories of Psychopathy

The interaction of affective, behavioural, interpersonal, and cognitive traits of psychopathy produce a complex personality, and whilst numerous studies have examined the pattern of dysfunction associated with psychopathy, the underlying etiology remains unclear.

Early reports of affective dysfunction in psychopathy led to the development of theoretical models that attempted to explain psychopathy primarily as a disorder of emotion (e.g., absence of fear). However, evidence of abnormalities in processing neutral stimuli (Kiehl,

1999; Newman, Schmitt, & Voss, 1997) combined with evidence of general information processing dysfunction (Lorenz & Newman, 2002a) resulted in revisions to the ‘emotion dysfunction’ hypotheses. Whilst there is relatively little consensus on the etiology of psychopathy, the most prominent theories of psychopathy are Lykken’s Low Fear Hypothesis

(Lykken, 1957, 1995), Gray’s Reinforcement Sensitivity Theory (revised) (Gray, 1975; Gray

& McNaughton, 2003), The Somatic Marker Hypothesis (Bechara, Damasio, Damasio, &

Anderson, 1994; Bechara, Damasio, & Damasio, 2000; Damasio, 1994, 1995a), The

Integrated Emotions System Hypothesis (R J R. Blair, Mitchell, & Blair, 2005), and the

Response Modulation Hypothesis (Gorenstein & Newman, 1980; Lorenz & Newman, 2002a;

Newman & Lorenz, 2003).

Lykken’s Low Fear Hypothesis

In his book ‘The Antisocial Personalities’, David T. Lykken (1995) outlined his theory on the etiological mechanisms that give rise to the various personalities that appear in forensic institutions, including, sociopathy and psychopathy. His theory of psychopathy demarcated the personality into two main subtypes: a primary subtype and a secondary THE PSYCHOPATH NEXT DOOR 47

subtype. Lykken (1995) proposed a ‘low-fear hypothesis’ of primary psychopathy that argues that primary psychopathy is associated with an absence of fear to conditions or situations that would normally elicit a fear response. He suggested that all the characteristics on Cleckley’s

(1941) checklist can be accommodated for by an innate fearlessness. For example,

‘untruthfulness and insincerity’ is accounted for by the low-fear hypothesis with the claim that fear of being caught in a lie prevents most people from telling serious lies, and that

‘white-lies’ are told because of fear of hurting other’s feelings (Lykken, 1995). Lykken proposed that the innate fearlessness of primary psychopaths made it difficult to socialise them away from antisocial behaviour, because they were impervious to the fear of punishment. Lykken (1995) borrowed from Gray’s (1987) model of affective behaviour to differentiate the secondary psychopath from the primary psychopath. Lykken suggests that secondary psychopathy is associated with intact or normal reactivity to fear and anxiety, but a strong sensitivity to reward. He claims that the strong sensitivity to reward may lead the secondary psychopath to disregard the fear or anxiety that may normally curtail his psychopathic behaviour.

The low fear hypothesis has garnered a range of empirical support, with studies showing that psychopathic individuals display poor fear conditioning (Lykken, 1957), impairments in response to threat cues (Ogloff & Wong, 1990), and poor startle response to threat scenes (Levenston, Patrick, Bradley, & Lang, 2000). Lykken’s low-fear hypothesis set the foundation for subsequent studies on the psychopathology of psychopathy and contributed to a greater understanding of the affective dysfunction observed in psychopathic individuals. However, whilst the low-fear hypothesis explains some the affective deficits observed in psychopathy, it does not explain findings which suggest that emotional impairment is present for both negative and positive emotional stimuli (K. S. Blair, Morton, et al., 2006). K.S. Blair et al., (2006) used the Differential Reward/Punishment task to THE PSYCHOPATH NEXT DOOR 48

demonstrate that psychopathic individuals were impaired on both punishment (as predicted

by the low-fear hypothesis) and reward trials. These findings cannot be easily accommodated within the low-fear hypothesis, which argues that it is fearlessness, not general affective

dysfunction that characterizes the psychopathic individual. An extension of the low-fear

hypothesis that attempts to explain the broader emotion dysfunction observed in psychopathic

individuals is Gray’s Reinforcement Sensitivity Theory (now revised [RST]).

Gray’s Reinforcement Sensitivity Theory

Lykken (1995) considered aspects of the RST (Gray, 1987; Gray & McNaughton,

2003) to be consistent with his low-fear hypothesis and both theories share an emphasis on dysfunction of fear and anxiety in psychopathic individuals. The RST is a sophisticated neurobiological theory of individual differences in motivation and affective behaviour that proposes three major systems of emotion: The Fight-Flight-Freeze System (FFFS), The

Behavioural Inhibition System (BIS) and, The Behavioural Approach System (BAS). The

FFFS is reactive to both conditioned and unconditioned aversive stimuli, such as innately unpleasant or painful stimuli and mediates emotional and behavioural responses to these stimuli (e.g., fear and subsequent escape behaviours, respectively) (Corr, 2004; Gray &

McNaughton, 2003). The BAS is reactive to both unconditioned and conditioned reward cues and is associated with the initiation of goal-directed behaviour (e.g., approach behaviour), the anticipation of reward, and hope (Corr, 2004). The BIS is responsible for detecting and resolving goal conflict by acting as a mediator between the FFFS and the BAS; it is activated when FFFS and BAS conflict and is responsible for resolving conflict between approach and avoidance behaviours. It performs this function by momentarily suspending behaviour and shifting attention to the environment, performing a risk assessment of the environment, and scanning memory (Gray & McNaughton, 2003). Because the BIS is sensitive to goal conflict THE PSYCHOPATH NEXT DOOR 49 it is postulated to be responsible for the experience of anxiety, worry, and rumination (Gray

& McNaughton, 2003).

The RST model applied to psychopathy suggests that: (a) both primary and secondary psychopathy are associated with a dysfunctional BIS, (b) primary psychopathy is associated with an underactive FFFS, and (c) secondary psychopathy is associated with an overactive

BAS (Corr, 2010). Hughes, Moore, Morris and Corr (2012) recently tested the RST model of psychopathy in an university sample using Carver and White’s (1994) BIS/BAS scales and the Levenson Self-Report Psychopathy Scale (Levenson, Kiehl, & Fitzpatrick, 1995). In this study, the BIS scale was separated into a FFFS subscale and a BIS subscale, whilst the BAS produced scores on three subscales: Drive, Fun-seeking, and Reward Responsiveness. The

Drive subscale captured goal-directed behaviour, the Fun-seeking subscale reflected impulsive behaviour motivated by immediate reward, and the Reward Responsiveness scale captured motivation in anticipation of future reward. In support of Corr’s (2010) hypothesis,

Hughes et al., (2012) found that both primary and secondary psychopathy were associated with low BIS activity. Primary psychopathy was associated with low FFFS activity, negatively related to the Fun-seeking scale of the BAS, and positively associated with the

Drive and Reward Responsiveness subscales of the BAS. In contrast, secondary psychopathy was not associated with the FFFS or the Drive and Reward Responsiveness subscales of the

BAS, but it was positively associated with the Fun-seeking subscale of the BAS. Whilst these findings are consistent with characterisations of low fear, low anxiety and predatory behaviour in primary psychopathy, the finding of a negative relationship between BIS and secondary psychopathy is in direct contrast with both theory and research on the relationship between anxiety and secondary psychopathy. In an attempt to clarify the relationship between primary and secondary psychopathy and measures of FFFS, BIS and BAS, Broerman, Ross and Corr (2014) replicated Hughes et al.,’s (2012) study with a larger university sample THE PSYCHOPATH NEXT DOOR 50 whilst controlling for shared psychopathy variance. Using partial correlations they found that secondary psychopathy was positively associated with BIS and FFFS activity and BAS Fun- seeking. Primary psychopathy was unrelated to BAS Reward Responsiveness, positively associate with BAS Drive, and negatively associated with BIS and FFFS. These findings are consistent with historical conceptualisations of a fearless, constrained primary psychopath and an impulsive, hostile secondary psychopath. Furthermore, these findings conflict less with research on psychopaths insensitivity to reward stimuli, a finding making the low-fear hypothesis untenable (K. S. Blair, Morton, et al., 2006). Although research on the revised

RST model of psychopathy is in its infancy, the preliminary findings suggest that the revised model can accommodate many of the emotion and information-processing abnormalities observed in psychopathic individuals. Another popular theory of psychopathy with neurobiological origins is Damasio’s (1994, 1995a) Somatic Marker Hypothesis, similar to the RST, this model is concerned with the role of emotion in decision-making.

The Somatic Marker Hypothesis

Compared to the RST, which is focuses on individual differences in emotion behaviour, the Somatic Marker Hypothesis is a more general theory of the role of emotion in decision-making (Damasio, 1994, 1995a). The theory is based on observations of emotional processing abnormalities in the documentation of the famous neuropsychological patient,

Phineas Gage, and other patients who suffered similar injuries to the ventromedial prefrontal cortex (Damasio, 1994). Challenging the commonly held belief that decision-making is best performed in the absence of emotion (e.g., with a ‘cool-head’), Damasio (1994, 1995a) argued that effective decision-making involves the use of emotions and emotional information. The Somatic Marker Hypothesis proposes that the ventromedial prefrontal cortex is involved in storing information about past situations and the physiological (somatic) reactions (e.g., heart rate, facial expression, blood flow, posture, hormones, and muscle THE PSYCHOPATH NEXT DOOR 51 contractions) to these situations and the emotions that are subsequently processed in the brain. These ‘somatic’ markers then elicit the emotional reaction that was previous associated with that situation and influence approach or avoidance behaviour. According to Damasio

(1994, 1995) somatic markers can influence decision making in two ways: (a) via the ‘body loop’, in which bodily changes in response to a situation activate the emotional response, and

(b) via the ‘as-if body loop’ in which representations or simulations of the bodily changes are processed and elicit the emotional response.

The majority of research testing the Somatic Marker Hypothesis has been conducted using the Iowa Gambling Task (Bechara et al., 1994), a card game that consists of four decks of cards. Participants are given an imaginary loan and play the card game to win money. Two decks of cards produce small gains but also unexpected small loses and result in an overall net gain of $250 per 10 cards. The other two decks produce large gains but also unexpected large losses and result in an overall net loss of $250 per 10 cards. The game begins with trial and error until participants begin choosing the advantageous card decks, with participants either consciously or unconsciously aware of the advantageous strategy (Bechara, Damasio,

Tranel, & Damasio, 1997). Thus, the Iowa Gambling Task simulates real life decision making by creating circumstances which produce uncertainty, reward, and punishment. The

Somatic Marker Hypothesis predicts that individuals with intact ventromedial prefrontal cortex functioning will begin to establish somatic markers eliciting positive and negative emotions to the four decks of cards following the gains and losses associated with each deck.

These somatic markers bias decision-making away from the risky decks to the advantageous decks. Damasio and colleagues found that following a trial and error process, neurologically- intact participants were initially drawn to the risky decks before switching to the advantageous decks. However, participants with damage to the ventromedial prefrontal cortex, unlike controls, were unable to establish the advantageous response strategy and THE PSYCHOPATH NEXT DOOR 52

continued to sample from the risky decks (Bechara et al., 1994; Bechara , Damasio , Damasio

, & Lee 1999; Bechara et al., 1997). Observing the deficits of individuals with ‘acquired

sociopathy’ following damage to the ventromedial prefrontal cortex, Damasio (1994)

suggested that abnormal ventromedial prefrontal cortex functioning might also explain the

behaviour of individuals with developmental psychopathy.

Initial research testing the Somatic Marker Hypothesis in psychopathic individuals

failed to discriminate the performance of psychopaths compared to controls (Schmitt,

Brinkley, & Newman, 1999). However, methodological inconsistencies between Schmitt,

Brinkley and Newman’s (1999) study and that of Bechara, Damasio & Damasio’s (2000)

investigation likely explained the findings, given that subsequent research using the same

methodology as Bechara, Damasio & Damasio showed that psychopathic individuals were

impaired on the Iowa Gambling Task (Mitchell, Colledge, Leonard, & Blair, 2002). Using a

sample of psychopathic offenders assessed with the PCL-R, Mitchell, Colledge, Leonard and

Blair (2002) found that psychopaths performed worse on the Iowa Gambling Task compared to controls, with psychopaths preferring the risky decks despite the long-term negative consequences. However, Mitchell, Colledge, Leonard and Blair suggest that the Somatic

Marker Hypothesis cannot adequately explain the selective impairment for sad and fearful stimuli, but intact processing of threat cues found in previous research (e.g., R. J. R Blair et al., 1997; Patrick, Bradley, & Lang, 1993). Instead, R J R Blair and colleagues propose a more specific model of neurobiological dysfunction in psychopathic individuals, the

Integrated Emotions System Model (R J R. Blair et al., 2005).

The Integrated Emotions Systems Model

The Integrated Emotions Systems (IES) model proposed by R J R Blair and colleagues (2005) suggests that the deficits associated with psychopathy are a result of genetic anomalies that lead to amygdala dysfunction. The amygdala dysfunction disrupts THE PSYCHOPATH NEXT DOOR 53

emotional learning, and as a result the normal affect representations are not made in

psychopathic individuals (R J R. Blair et al., 2005). More specifically, because the integrity of the amygdala is crucial in the recognition of fearful and sad facial expressions, children with psychopathic tendencies do not experience the same reaction to distress of others as healthy children. Blair (1995) claims that the distress of others acts as an unconditioned stimulus that results in aversive conditioning towards the behaviour that elicited the distress.

It is the inability to process sad and fearful facial expressions in children with psychopathy that interferes with moral socialisation and the failure to inhibit antisocial behaviours that cause harm to others. Blair and colleagues (2005) point out that whilst negative affect representations are more severely impacted in psychopathy, these abnormalities also occur to a lesser extent to positive affect representations. Thus explaining the findings of positive and negative emotional dysfunction in psychopathy. Whilst amygdala dysfunction is the basic tenet of the IES model, the model also suggests that functional interactions between the amygdala and associated neural systems (e.g., orbitofrontal and ventrolateral prefrontal cortex, and insula) are disrupted in psychopathic individuals (R J R. Blair et al., 2005). The pattern of dysfunction predicted by the IES is consistent with research findings that demonstrate that psychopathic individuals display deficits in tasks that rely on these neural systems, for example, goal-directed behaviour (K. S. Blair, Morton, et al., 2006); the ability to recognize fearful and sad facial expressions (R. J. R Blair et al., 2004); the ability to recognize vocal affect (R. J. R. Blair et al., 2002); attention to emotional stimuli (Lorenz &

Newman, 2002a; Mitchell, Richell, Leonard, & Blair, 2006); and response control (Kiehl et al., 2001).

While the IES model can accommodate the findings of emotional impairment, it cannot account for findings that demonstrate that redirection of attention to emotional information ameliorates the emotion impairment (Dadds, El Masry, Wimalaweera, & THE PSYCHOPATH NEXT DOOR 54

Guastella, 2008; Larson et al., 2013; Newman, Curtin, Bertsch, & Baskin-Sommers, 2010).

For example, Newman, Curtin, Bertsch and Baskin-Sommers (2010) found that deficits in fear-potentiated startle in criminal psychopaths were ameliorated under conditions in which the threat was the primary focus of attention. They argue that the IES model cannot explain these findings and suggest an alternative model, the Response Modulation Hypothesis

(Newman & Lorenz, 2003; Patterson & Newman, 1993).

The Response Modulation Hypothesis

The Response Modulation Hypothesis proposed by Newman and colleagues (Lorenz

& Newman, 2002; Newman & Brinkley, 1997; Newman & Lorenz, 2003; Patterson &

Newman, 1993) suggests that the behavioural and affective impairments currently observed in psychopathy can be attributed to dysfunctional information processing. More specifically, they suggest that psychopathy is associated with a deficit in shifting response set to accommodate peripheral information. This results in an over-focus of attention to the primary or salient features of a task, to the detriment of overall task performance. The Response

Modulation Hypothesis claims that the emotional deficits observed in psychopathy are simply a secondary symptom of a broader problem of dysfunctional information processing. Several studies provide support for the Response Modulation Hypothesis, for example, results from a lexical decision task revealed deficits in processing non-salient neutral information (e.g., word frequency cues) (Lorenz & Newman, 2002a), indicating that deficits in psychopathy are not exclusively affective in nature; less interference to neutral, incongruent information in a flanker-type task when the target was the prepotent focus of attention, but normal interference when the target was no longer the prepotent focus of attention (Zeier, Maxwell, & Newman,

2009); and less interference to incongruent information on modified Stroop tasks (Hiatt et al.,

2004). Altogether, these findings suggest that the affective and cognitive deficits observed in psychopathy are specific to situations in which important information is peripheral to the THE PSYCHOPATH NEXT DOOR 55

primary task. This ‘situation-specific’ position is in direct contrast with theories that posit

general emotional dysfunction in psychopathic individuals, such as the IES model.

Subsequent research on the Response Modulation Hypothesis suggests that an early

attentional bottleneck may underlie the attentional abnormalities observed in psychopathic

individuals (Baskin-Sommers, Curtin, & Newman, 2011). Providing further support for the

Response Modulation Hypothesis, recent research by Baskin-Sommers, Curtin, and Newman

(2015) found that cognitive remediation focused on addressing the attentional deficits in

psychopathy resulted in better performance on response modulation tasks for psychopathic

individuals.

However, the Response Modulation Hypothesis is not without criticism. Although a

recent meta-analytic and narrative analysis revealed small to medium effect sizes between psychopathy and response modulation deficits, the results also revealed some evidence of publication bias, with the effect sizes reported in the published literature higher than those reported in unpublished studies (Smith & Lilienfeld, 2015).

Review of Current Theories of Psychopathy

Whilst these theories differ with respect to the specific mechanisms that underlie psychopathy dysfunction, a common theme of many theories to posit dysfunction of one or more regions of the brain associated with emotion processing. The point of contention amongst theorists is whether the emotion dysfunction is exclusively affective in nature, or whether it is an artefact of a more general information processing abnormality. However, with the exception of the Low-Fear Hypothesis and the Revised RST model, these theories predominately view psychopathy as a categorical construct, even in light of evidence that suggests that psychopathy is best viewed as a dimensional construct (Edens, Marcus,

Lilienfeld, & Poythress, 2006). In fact, the majority of previous research and theory on psychopathy has viewed psychopathy as a unitary, categorical construct. However, given THE PSYCHOPATH NEXT DOOR 56 evidence that suggests psychopathy is dimensional, and that different etiological markers and patterns of dysfunction are observed between primary and secondary psychopathy (e.g.,

Benning et al., 2003), an updated theoretical framework of psychopathy that accommodates these findings is important for an accurate account of the nature of psychopathy.

The arguments surrounding psychopathy subtypes and the dimensional nature of psychopathy tie in closely with the notion of ‘noncriminal psychopathy’. Given the empirical evidence that psychopathic individuals differ in degree, rather than kind (Edens et al., 2006;

Lilienfeld & Widows, 2005; Murrie et al., 2007; Walters et al., 2007), it stands to reason that psychopathic traits and behaviours may not be limited to the extremes seen in criminal offenders, and that these traits may be found in the general population. Whilst the majority of previous research has utilized forensic or clinical samples, there is now some research emerging on the notion of ‘noncriminal psychopathy’ (e.g., Lilienfeld & Widows, 2005).

What is Noncriminal Psychopathy?

The vast majority of research on psychopathy has been conducted using criminal offender samples. Consequently, comparatively little is known about psychopathy outside of forensic settings. This is problematic because theoretical conceptualization by theorists such as Cleckley (1941) did not emphasise criminality as a central feature of the disorder. On the contrary, there is no a priori reason for assuming that the core interpersonal and affective features should result in increased antisocial behaviour. Whilst it is acknowledged that a lack fear, empathy, and regard for the welfare of others might place some psychopathic individuals at risk for antisocial behaviour, situational factors such as socioeconomic status, peer group, level of education, and family environment likely play a role in the manifestation THE PSYCHOPATH NEXT DOOR 57

of psychopathy. Providing theoretical support for the notion of noncriminal psychopathy,

Hare remarked that:

Many psychopaths never go to prison or any other facility. They appear to function

reasonably well – as lawyers, doctors, psychiatrists, academics, mercenaries, police

officers, cult leaders, military personnel, businesspeople, writers, artists, entertainers,

and so forth – without breaking the law or at least without being caught and

convicted. These individuals are every bit as egocentric, callous, and manipulative as

the average criminal psychopath (Hare, 2011, pp. 202-203).

Recent studies of noncriminal psychopathy provide empirical support for the existence of psychopathy in the general population (Levenson et al., 1995; Lilienfeld &

Widows, 2005). Thus, the criminal psychopathy literature must be interpreted cautiously as it may only be reflective of a specific sub-population of psychopathy and not representative of the construct as a whole. Studies examining psychopathy in the general population are theoretically important because they provide insight into the nature of the disorder without the confounding effect of criminality. Furthermore, research on psychopathy in the general population is clinically relevant as it may identify protective factors and compensatory mechanisms that buffer against severe antisociality and criminality (Lilienfeld, 1994).

Theoretical Perspectives of Noncriminal Psychopathy

Hall and Benning (2006) suggest that there are three common theoretical perspectives of noncriminal psychopathy: psychopathy as a subclinical or less severe version of the full- blown disorder; a moderated expression of psychopathy where psychopathic traits are manifested in a positive, rather than negative way (i.e., successful psychopathy); and a dual

perspective of psychopathy that distinguishes the interpersonal features of the disorder from

the behavioural features. However, a more recent model of noncriminal psychopathy, the

Triarchic Model of Psychopathy, suggests that the varying conceptualisations of psychopathy THE PSYCHOPATH NEXT DOOR 58

can be explained by differing emphasis on the three phenotypic constructs of psychopathy by

psychopathy researchers (Patrick, Fowles, & Krueger, 2009).

Subclinical psychopathy. Proponents of the subclinical psychopathy perspective

claim that noncriminal psychopaths possess the same affective and interpersonal

characteristics as criminal psychopaths, but to a lesser degree (Ali, Amorim, & Chamorro-

Premuzic, 2009; Gustafson & Ritzer, 1995; Mahmut et al., 2008; Paulhus & Williams, 2002).

A central feature of the subclinical perspective is that it holds the interpersonal and affective

characteristics of psychopathy as the cause of anti-social behaviour. Consequently, individuals who possess the interpersonal and affective characteristics of psychopathy at a reduced level, will also exhibit less extreme examples of anti-social behaviour. However, the term ‘subclinical’ implies that there is a clinical cut-off that determines whether a person is a psychopath or a nonpsychopath (Lilienfeld, 1998). Therefore, the notion of subclinical psychopathy cannot be sustained given research on the nature of psychopathy demonstrates that psychopathy is dimensional not taxonic (Edens et al., 2006).

Successful psychopathy. According to proponents of the ‘successful psychopathy’ perspective, noncriminal psychopathy is viewed as an adaptive expression of psychopathy

(Hall & Benning, 2006; Hare, 2011; Widom, 1977). The central tenet of this model is the claim that noncriminal psychopaths possess the same core characteristics, at the same level of severity, but that compensatory factors moderate the expression of the disorder.

Compensatory factors such as high intelligence, high SES factors, level of education and educational opportunities, parental style, and adequate vs. poor socialisation are said to result in a successful adaption of psychopathy (Hall & Benning, 2006). Although successful psychopaths possess the core affective and interpersonal features of the disorder, they are expressed in noncriminal or socially accepted avenues, such as business environments, and politics (Hall & Benning, 2006). In these environments, the core interpersonal and affective THE PSYCHOPATH NEXT DOOR 59

features of psychopathy (e.g. fearlessness and paucity of emotion) are considered

advantageous. However, critics of the successful psychopathy model claim that the notion of

‘successful’ psychopathy is an oxymoron, because a personality disorder is inherently

pathological and maladaptive (Kiehl & Lushing, 2014). Yet, as S. F. Smith, Watts, and

Lilienfeld (2014) point out psychopathology is sometimes associated with creative temperament and achievement. For example, numerous studies have demonstrated a link between mood disorders and creativity and achievement (Kyaga et al., 2011; MacCabe et al.,

2010; Santosa et al., 2007). Therefore, although psychological conditions are characterised by pathological traits, they can also have adaptive manifestations.

A dual process model of psychopathy. The dual process model of psychopathy mirrors historical conceptualisations of psychopathy as consisting of two separate components: the interpersonal and affective component (viz. primary psychopathy), and the anti-social behaviour component (viz. secondary psychopathy) (Patrick, 2007). According to the dual process model, the presence of the interpersonal and affective component can occur in absence of the anti-social behaviour component, and vice versa, as it is thought that the two components result from distinct etiological pathways. According to the dual process model, primary psychopathy results from a deficiency in the brain’s defensive motivational system resulting in trait fearlessness. In contrast, secondary psychopathy is thought to stem from impairments in brain regions responsible for higher-order processes such as planning, behavioural inhibition, and cognitive flexibility, resulting in a vulnerability to externalising psychopathology (e.g., behavioural deviance, substance abuse) (Patrick & Bernat, 2009).

Therefore, individuals can present with elevations on primary psychopathy or secondary psychopathy, or both. There is empirical support for the dual processing perspective, with studies demonstrating that the two factors show divergent patterns of relationships with external variables (e.g. personality, temperament, anti-social behaviour, and social THE PSYCHOPATH NEXT DOOR 60

functioning) (Benning et al., 2003; Harpur, Hare, & Hakstian, 1989; Hicks et al., 2004). A

recent study also found differences between primary and secondary psychopathy in feedback-

related negativity (FRN) for positive and negative faces on a time estimation task, with

primary, but not secondary psychopathy, related to reduced FRN (Schulreich, Pfabigan,

Derntl, & Sailer, 2013). A further extension of the dual process model is the Triarchic Model of Psychopathy, which seeks to address the discrepancies in the conceptualization of psychopathy between criminal and noncriminal classifications (Patrick et al., 2009).

Triarchic Model of Psychopathy

The Triarchic Model of Psychopathy proposed by Patrick et al., (2009) suggests that

the reoccurring themes in the conceptualization of psychopathy can be characterized as

generally fitting into three phenotypic constructs: disinhibition, boldness, and meanness.

Disinhibition reflects issues of impulsivity, behavioural disinhibition, an inability to delay

gratification, and a lack of forethought or planning (Patrick et al., 2009). Boldness reflects a

propensity towards thrill-seeking combined with low stress reactivity, emotional resiliency,

and social dominance (Patrick et al., 2009). Meanness reflects a lack of empathetic concern,

exploitativeness, callousness, and a disregard for close interpersonal relationships (Patrick et

al., 2009). Patrick and colleagues (2009) suggest that individuals may not possess all three

components of psychopathy and that conceptualisations of noncriminal and criminal

psychopathy can be explained by differences in how the three components are emphasized.

They suggest that psychopathy can be characterized as disinhibition combined with either

meanness or boldness, or both. They suggest that the Cleckian approach (Cleckley, 1941) emphasizes disinhibition and boldness, whilst the criminal approach that dominates the contemporary psychopathy literature emphasizes disinhibition and meanness. However, there is a current debate on the usefulness and appropriateness of boldness in the psychopathy construct, with some research suggesting that boldness is not a central component of THE PSYCHOPATH NEXT DOOR 61

psychopathy (Gatner, Douglas, & Hart, 2016; Miller, Lamkin, Maples-Keller, & Lynam,

2016).

Review of Theories of ‘Noncriminal’ Psychopathy

A common theme in all theories of noncriminal psychopathy is the view that criminality and severe anti-sociality are not central to psychopathy. Whilst this view has recently been subject to enthusiastic debate (Hare & Neumann, 2010; Skeem & Cooke,

2010a, 2010b), very little empirical investigation has been conducted on the link between

criminality and psychopathy in the general population. This is an area of research that

warrants empirical attention as the current psychopathy literature may only apply to a small

subpopulation of psychopathy. There are two reasons for the overall lack of research on

psychopathy in the general population. Firstly, estimates of the prevalence of psychopathy in

criminal offender samples are higher (Hare, 1991) than estimates of the prevalence of

psychopathy in the general population (Coid et al., 2009). Thus, criminal offender samples

provide a convenient and easily recruited psychopathic sample. Secondly, until recently, there

were no suitable or established measures of psychopathy that could be used on noncriminal

samples.

The relative absence of research on noncriminal psychopathy can be partially

attributed to measurement limitations. The PCL-R has been hailed as the ‘gold standard’ of psychopathy measurement (e.g. (Fulero, 1995; Paulhus & Williams, 2002; Williams &

Paulhus, 2004), generating concern that researchers may be equating PCL-R psychopathy with the theoretical construct of psychopathy (Blackburn, 2007; Skeem & Cooke, 2010a,

2010b). Furthermore, as previously discussed, the PCL-R was designed for use in criminal offender samples, requires access to case histories, and contains items that specifically tap criminal behaviours. Therefore, the PCL-R should be considered a measure of criminal psychopathy rather than the broad construct of psychopathy. The recent advent of measures THE PSYCHOPATH NEXT DOOR 62

of noncriminal psychopathy (Levenson, et al., 1995; Lilienfeld & Widows, 2005) have

provided researchers with an avenue to study the theoretical concept of psychopathy more

broadly.

The Current Research

Original Contribution to Knowledge

This program of research contributes to the existing body of literature on psychopathy by addressing three main gaps in the current literature, each discussed in the following sections: psychopathy and criminality; psychopathy and executive function; and psychopathy and emotion-processing.

Psychopathy and Criminality

Because of the paucity of studies on the relationship between psychopathy and criminality in the general population, it is not known whether criminality is a key feature of psychopathy or simply one manifestation. Research investigating the relationship between psychopathy and criminality in the general population may assist with answering this question. In addition, the exclusive use of male participants means that we have a limited understanding of the nature and presentation of female psychopathy. The first aim of the current research project is to conduct a population study of psychopathy with the aim of disentangling the relationship between psychopathy and criminality. Whilst several theories of ‘noncriminal’ psychopathy have been proposed, a common perspective is that criminality and anti-sociality are not central to psychopathy. The current theoretical models of noncriminal psychopathy will be tested by examining the relationships between criminality, criminal attitudes, and psychopathy in a general population sample. Additionally, an examination of possible gender differences in the psychopathy-criminality nexus will be included to address the male bias in previous psychopathy research. THE PSYCHOPATH NEXT DOOR 63

Executive Function

The psychopathy literature on executive function has produced confusing and

contradictory findings. This may be attributed to methodological inconsistences between

studies, including criminal versus noncriminal samples; male versus mixed gender samples;

differences in the types of executive function studied; differences in the tests used to

operationalize the different types of executive function; differences in the measurement of

psychopathy; and whether psychopathy was examined as a unitary, categorical construct, or a

continuous, dimensional construct. Therefore, one of the aims of this program of research is

to provide some clarification on the relationship between psychopathy and executive function

by examining the separate relationships between primary and secondary psychopathy and

performance on several popular measures of executive function in a community sample. An

additional aim of this program of research is to examine the relationship between

psychopathy and executive function separately for males and females. This should assist with

comparison of the findings from this program of research with previous studies and also

reveal whether gender differences exist in the psychopathy-executive function relationship.

These findings may also provide support for one or more theories of psychopathy, for example, by revealing whether a moderated expression of psychopathy is characterised by intact executive functioning (i.e., the successful psychopathy model).

Emotion Processing

Most previous research on emotion processing abnormalities in psychopathy has been conducted using male, criminal offender samples. Consequently, the patterns of emotion dysfunction currently observed in psychopathy may not generalise to other psychopathic populations. Specifically, the current psychopathy literature may only be applicable to male psychopathy, and not female psychopathy. In fact, given that a range of cognitive and emotion processing differences are observed between males and females, some differences in THE PSYCHOPATH NEXT DOOR 64

cognitive and emotional processing between male and female psychopaths may be expected.

Therefore, the inclusion of gender in studies of affective dysfunction in psychopathy

(including affective language dysfunction) is warranted.

The current research project will examine emotion processing in psychopathy and will

include an examination of gender differences. The emotion literature has consistently

demonstrated differences in emotional processing as a function of gender, including

differences in the ratings of affective stimuli and affective priming. Research on psychopathy

and emotion using male participants has revealed a range of affective deficits, including

abnormal responding to affective words and affective priming abnormalities. However, it not

currently clear whether these deficits will be seen in female psychopathy.

Lastly, this program of research considers the separate contributions of primary and secondary psychopathy on the processing of affective and semantic language and executive function. Previous research suggests that psychopathy is a superordinate construct consisting of two separate yet related subtypes; primary psychopathy and secondary psychopathy. As mentioned earlier, primary and secondary psychopathy display differential patterns of affective experience (Del Gaizo & Falkenbach, 2008). Primary psychopathy is associated

with a paucity of positive and negative emotionality, whilst secondary psychopathy is

associated with elevated levels of negative emotionality (e.g., anxiety and hostility).

Cognitive bias studies have demonstrated a facilitation to negative stimuli in individuals with

elevated levels of negative emotion (e.g., anxiety). Given the differences in emotional

experience between primary and secondary psychopathy, differences in processing affective

language may also be observed. There is only one known study that has investigated primary

and secondary psychopathy and affective language abnormalities, and a number of

methodological limitations were present (Reidy et al., 2008). Specifically, this study did not consider differences in word ratings for psychopathic samples, or differences in word ratings THE PSYCHOPATH NEXT DOOR 65

for primary and secondary psychopathy (Reidy et al., 2008). The current research project will

examine emotion processing in primary and secondary psychopathy using a LDT and will

extend upon previous research by addressing methodological limitations found in previous

research.

Findings from previous research suggests that psychopathy consists of two subtypes

(Hare, 1991). Primary psychopathy reflects the core interpersonal and affective features of

psychopathy and is thought to be associated with emotion deficits (Karpman, 1941, 1948),

whilst secondary psychopathy reflects the anti-social and impulsive features of psychopathy and is thought to be associated with affective dysfunction (Karpman, 1941, 1948). More specifically, research has shown that primary psychopathy is associated with a lack of negative affect, whilst secondary psychopathy is positively associated with elevated levels of negative affect (Del Gaizo & Falkenbach, 2008). A consideration of these differences in emotional experience from a cognitive bias perspective suggests that in comparison to both non-psychopathic individuals and primary psychopaths a facilitation to negative emotion stimuli may be observed in secondary psychopathy. Furthermore, given that primary psychopathy is associated with a paucity of emotion, it is expected that there will be no differences in response to emotion words in primary psychopathy.

Research Questions

Six main research questions were developed to address the aforementioned aims of this program of research. These research questions were designed to address the gaps in the psychopathy literature regarding the underrepresentation of female participants in the study of psychopathy, the a priori assumption of criminality as a core feature of psychopathy, and the tendency to consider psychopathy as a unitary construct despite evidence that it is subsumed by two separate yet related variants.

THE PSYCHOPATH NEXT DOOR 66

Research Question One: How central is criminal behaviour to the construct of psychopathy?

This research question addresses the controversial dispute between psychopathy researchers regarding the centrality of criminality to the psychopathy construct. This research question is addressed by a thorough coverage of the current debate about the role of antisocial behaviour in relation to psychopathy and empirically tested in study 1 in this program of research. The relevant literature, the methodology and findings are discussed in chapter three of this thesis.

Research Question Two: Is the relationship between criminality and psychopathy the same for males and females?

This research question addresses the underrepresentation of female participants in psychopathy research. This research question is concerned with possible gender differences in the relationship between psychopathy and criminality and is empirically tested in study one of this program of research. The relevant literature, the methodology and findings are discussed in chapter three of this thesis.

Research Question Three: What is the relationship between psychopathy variants and executive function in a community sample?

This research question empirically tests the dual process model of psychopathy and also addresses the current confusion in the psychopathy literature regarding the relationship between psychopathy and performance on measures of executive function. This is achieved in study two of this program of research, which examines the relationship between primary and secondary psychopathy and several popular measures of executive function in a community sample. The relevant literature, methodology and findings are discussed in chapter four of this thesis. THE PSYCHOPATH NEXT DOOR 67

Research Question Four: Is the pattern of relationships between psychopathy variants and executive function the same for males and females?

This research question addresses the limitations of previous research on executive functioning in noncriminal samples by including an examination of possible gender differences. Whilst a couple of previous studies using noncriminal samples have included female participants, they have not included an examination of possible gender differences in the relationship between primary and secondary psychopathy and performance on measures of executive function. This limitation is addressed in study two of this program of research and the relevant literature and study details are set out in chapter four.

Research Question Five: What is the relationship between psychopathy variants and emotion processing in a community sample?

This research question addresses the gap in the psychopathy literature regarding the unique relationships between primary and secondary psychopathy and emotion processing abnormalities. Specifically, it considers whether a differential relationship between primary and secondary psychopathy will be observed on a task of implicit emotion processing. The majority of previous studies have used a criminal offender sample and/or criminal measure of psychopathy, thus inhibiting interpretation. The only study that has examined whether differences exist used a male only sample and did not examine explicit ratings of the emotional stimuli. This limitation is addressed in study three of this program of research, which is outlined in chapter five of this thesis.

Research Question Six: Is the relationship between psychopathy variants and emotion processing abnormalities the same for males and females?

Several differences in emotion processing have been observed between males and females. However, the research on emotion processing abnormalities in psychopathy research has failed to include an examination of possible gender differences. This limitation is THE PSYCHOPATH NEXT DOOR 68 addressed in study 3 of this program of research. The relevant literature and study details are presented in chapter five of this thesis.

Chapter Three

Chapter Overview

This chapter of the thesis presents theoretical arguments and empirical evidence for extending research on psychopathy to noncriminal populations. The chapter begins by covering the ongoing debate in the psychopathy literature on the centrality of criminal and anti-social behaviour to the psychopathy construct, and presents a rationale for extending psychopathy research to a community sample. It was hypothesised that the relationship between psychopathy and criminality would more nuanced than suggested by previous research that has used criminal offender samples and criminal measures of psychopathy. As the bulk of previous research on psychopathy has examined male participants, possible gender differences in the relationship between psychopathy and criminality were also examined.

Background to Research

The psychopathic personality is typified by interpersonal, affective, and behavioural characteristics such as, manipulativeness, deceitfulness, egocentricity, superficial charm, irresponsibility, impulsivity, a disregard for conventional norms, and reduced emotional and empathic capacity. Whilst considerable progress has been made in regards to the conceptualization and measurement of psychopathy in criminal offenders (Hare, 1980, 1991,

1996), relatively little is known about psychopathy in the general population. The scarcity of research on psychopathy in noncriminal samples can be attributed to measurement limitations and a lack of consensus on how psychopathy should be conceptualised and defined

(Lilienfeld, 1994), specifically the role of severe anti-sociality (Hare & Neumann, 2010; THE PSYCHOPATH NEXT DOOR 69

Neumann, Hare, & Newman, 2007; Skeem & Cooke, 2010a, 2010b; Skeem, Polaschek,

Patrick, & Lilienfeld, 2011).

Whilst the majority of modern research on psychopathy has focused on criminal

manifestations, earlier accounts of the psychopathic personality included both theoretical and

clinical reports of noncriminal psychopaths. In fact, the generally accepted conceptualization

of the clinical construct of psychopathy originated from Cleckley’s (1948) ‘The Mask of

Sanity’. In this collection of case studies, Cleckley highlighted various accounts of

psychopathic individuals who possessed the central features of psychopathy observed in

criminal psychopaths (e.g., egocentricity, manipulativeness, and a lack of concern for others),

but who did not commit serious anti-social or criminal acts (e.g., the business man; scientist;

psychiatrist; and the psychopath as man of the world) (Cleckley, 1948). This classic

Clecklian conceptualization is what forms the basis of modern psychopathy theory, research,

and measurement. At present, the Psychopathy Checklist Revised (PCL-R) is the most widely

used measure of psychopathy, and it was constructed specifically from Clecklian criteria.

(Hare, 1980, 1991). However, the PCL-R was developed and normed on criminal offender samples, contains items specifically related to criminality, and requires the use of institutional files, making it unsuitable for the assessment of psychopathy in the general population. Even

PCL-R variants designed for use in noncriminal samples are similarly constrained by the inclusion of items that specifically assess criminality (e.g., SRP-III). This modern approach to psychopathy measurement does not align with the theoretical and clinical accounts from which it was originally constructed. This is problematic because a basic tenet of personality research states that the development of psychometric assessments should be guided by a coherent theory of the construct of interest. Without a coherent theoretical foundation for including criminality as a key feature of the psychopathy construct, the PCL-R unjustifiably amalgamates psychopathy and criminality. This has resulted in claims of ‘conceptual drift’ THE PSYCHOPATH NEXT DOOR 70

(Blackburn, 2005) and ‘construct drift’(Skeem & Cooke, 2010a). However, this disaccord

between theoretical conceptualizations of psychopathy and the measurement of psychopathy

has been largely overlooked by researchers. As highlighted by Skeem and Cooke (2010a), the

psychopathy literature is bordering on equating the PCL-R measurement of psychopathy with the construct itself. This mono-operationalisation is problematic not only because of the departure from a coherent theoretical foundation, but also because previous findings using

PCL-R measures may not generalize to other psychopathic populations. The criticisms regarding PCL-R measurement are not recent (e.g., Lilienfeld, 1994), yet the PCL-R and its derivatives continue to be used almost exclusively in psychopathy research. Recent theoretical discussions on the nature of psychopathy (e.g., Hare & Neumann, 2005; Hare &

Neumann, 2010; Lilienfeld, Watts, & Smith, 2015; Skeem & Cooke, 2010a, 2010b; Skeem et al., 2011) have resulted in a renewed focus on examining alternative measures of psychopathy and utilising noncriminal samples.

Examination of the PCL-R. As mentioned, the PCL-R is the most widely used measure of psychopathy. Research on the factor structure of the PCL-R and its derivatives has produced two-factor (Hare, 1991; Harpur et al., 1989), three-factor (Cooke & Michie,

2001), and four-factor models (Hare & Neumann, 2005; Hare & Neumann, 2006; Vitacco,

Neumann, Caldwell, Leistico, & Van Rybroek, 2006; Vitacco, Neumann, & Jackson, 2005;

Vitacco, Rogers, Neumann, Harrison, & Vincent, 2005). The once widely-accepted two- factor model of the PCL-R produces two moderately correlated factors (Harpur et al., 1989).

Factor 1 reflects the interpersonal and affective features of psychopathy, including deceitfulness, callousness, manipulativeness, superficial charm, and a lack of inhibitory emotions. Factor 2 reflects the behavioural features of psychopathy, including criminal antisociality, hostility, and impulsivity. Of particular relevance, criminal behaviour is encompassed under Factor 2 of the two-factor model. THE PSYCHOPATH NEXT DOOR 71

Unsatisfied with the methodological techniques used in previous factor analyses of

the PCL-R, and the conclusions drawn from these methods, Cooke and Michie (2001)

conducted factor analysis of the PCL-R using confirmatory factor analysis (CFA) on data

obtained from large forensic samples. Their research did not support the commonly accepted

two-factor model of PCL-R psychopathy. Instead Cooke & Michie’s research indicated that a

three-factor model best described PCL-R psychopathy. The first factor, named Arrogant and

Deceitful Interpersonal Style, consists of the interpersonal features commonly identified in

the psychopathy literature, including, superficial charm, grandiosity, manipulativeness, and

deceitfulness. The second factor, named Deficient Affective Experience, reflects the affective

characteristics, including shallow affect, a lack of inhibitory emotions (i.e., guilt, empathy &

remorse), and a failure to accept responsibility for one’s own actions. The third factor, named

Impulsive and Irresponsible Behavioural style, reflects the lifestyle features of psychopathy,

including boredom proneness, impulsivity, irresponsibility, a parasitic lifestyle, and a lack of

realistic long-term goals. Notably, the severe antisocial behavioural features that appear in the

two-factor model were excluded from Cooke & Michie’s model because they were

considered to be poor indicators of psychopathy.

The four-factor model is the most recent factor-analytic model proposed of PCL-R

psychopathy (Hare, 2003; Hare & Neumann, 2005; Hare & Neumann, 2008; Neumann et al.,

2007). Because of differing theoretical positions on the centrality of severe antisocial

behaviour in psychopathy, Hare and Colleagues (Hare & Neumann, 2005; Neumann et al.,

2007) conducted CFA on the PCL-R and its progeny (e.g., Psychopathy Checklist: Screening

Version [PCL-SV], Psychopathy Checklist: Youth Version [PCL-YV], etc.) using large forensic adult and youth samples and community samples. The authors proposed a four-factor model which consisted of the three factors identified in Cooke & Michie’s (2001) factor analysis and an additional factor labelled ‘antisocial’. The antisocial factor reflects poor THE PSYCHOPATH NEXT DOOR 72

behavioural controls, early behavioural problems, juvenile delinquency, revocation of

conditional release, and criminal versatility (Hare & Neumann, 2005). Hare (2003) has

suggested that the four factors can easily be converted to the two factor model with Factor 1

consisting of the interpersonal and affective factors and Factor 2 consisting of the lifestyle

and antisocial factors. However, other variations of the four-factor model exist. Cooke,

Michie & Skeem (2007) describe the many variations of the four-factor models as fitting into

three general perspectives: a two factor, four facet model (Hare, 2003), a four factor

hierarchical model (Hare, 2003), and a four-factor correlated model (Hare & Neumann,

2005).

There is currently no consensus amongst researchers on a model of PCL-R psychopathy. Proponents of the three-factor model criticise the methodology used in previous factor analytic studies, and the a priori assumption that criminality is a key feature of psychopathy (Cooke et al., 2007). In turn, proponents of the four-factor models criticise the techniques used to derive the three-factor model, and argue that early and persistent antisocial behaviours are central to psychopathy. Whilst there is no consensus on which model of PCL-

R psychopathy is best, it is important to consider that the results of factor analyses are reliant on the scale items entered. As such, understanding of the criminality-psychopathy nexus cannot progress by repeatedly conducting factor analyses on the same scale items. In order to increase understanding, future research should examine the relationship between a measure of psychopathy that does not explicitly tap criminality, with indicators of criminality, using a noncriminal and non-psychiatric sample. This has been consistently highlighted by researchers (Blackburn, 1988; Cooke et al., 2007; Lilienfeld, 1994), including Skeem and

Cooke (2010a, 2010b) who emphasised the tautological nature of predicting criminality from measures of psychopathy that consist of items and subscales that directly tap criminality. This problem is further magnified by research which uses the PCL-R as measure of psychopathy, THE PSYCHOPATH NEXT DOOR 73

then examines the relationship between PCL-R scores and a range of indicators of criminality

(e.g., Harris, Rice, & Cormier, 1991), and then uses these findings to support the notion that criminality is a central feature of psychopathy (e.g., Hare, 1996). In order to examine the true relationship between psychopathy and criminality, noncriminal measures of psychopathy need to be utilised. A few measures of psychopathy suitable for assessment in both forensic and non-forensic populations now exist for researchers, and research suggests that these measures possess good psychometric properties. (Levenson et al., 1995; Lilienfeld &

Widows, 2005).

Noncriminal Measures of Psychopathy. Perhaps two of the most promising self-

report measures of psychopathy are the Levenson Self-Report Psychopathy Scale (LSRP)

(Levenson et al., 1995), and the Psychopathic Personality Inventory (Now the Psychopathic

Personality Inventory- Revised) (Lilienfeld & Widows, 2005). The LSRP is a 26-item self- report inventory designed to extend research on psychopathy to a noncriminal sample and does not contain items that explicitly assess criminal behaviour. The scale produces a total score and scores on two subscales that parallel the two factors consistently highlighted in the literature: primary psychopathy and secondary psychopathy. Validation studies of the LSRP have produced two-factor (Levenson et al., 1995; Lynam, Whiteside, & Jones, 1999) and

three factor structures (C. Brinkley, Schmitt, Smith, & Newman, 2001; Sellbom, 2011) that

display similar relations with external correlates as the PCL-R. Additionally, the LSRP has

demonstrated good concurrent validity with the PCL-R (C. Brinkley, Schmitt, Smith, &

Newman, 2001). Lynam, Whiteside and Jones (1999) found significant, yet weak correlations

(r between .15 and .32) between LSRP scores and antisocial behaviour in a large university sample (n = 1219), they concluded that the LSRP scale was a promising self-report measure of psychopathy. THE PSYCHOPATH NEXT DOOR 74

Another promising measure of psychopathy is the PPI, which is the most widely used measure of psychopathy in college and community samples. Unlike the PCL-R, the PPI does not explicitly tap criminal or anti-social behaviours. Rather, the PPI was developed to measure the core personality traits considered by many theorists to be central to psychopathy

(Lilienfeld & Widows, 2005). The PPI produces a global psychopathy score and eight content scale scores derived from factor analyses: Stress Immunity, Social Potency, Fearlessness,

Coldheartedness, Impulsive Nonconformity, Blame Externalisation, Machiavellian

Egocentricity, and Carefree Nonplanfulness. Factor analytic studies of the PPI have generally produced two dominant factors (Although see, Neumann, Malterer, & Newman, 2008, who did not replicate the two-factor structure) labelled Fearless Dominance (FD) and Self-Centred

Impulsivity (SCI). (Benning et al., 2003; Patrick, Edens, Poythress, Lilienfeld, & Benning,

2006). A third factor labelled Coldheartedness (CH) also emerged from the aforementioned studies, but comprised mostly of items from the Coldheartedness content scale. The FD factor reflects aspects of positive adjustment such as low anxiety and worry, and social adeptness, combined with high levels of interpersonal dominance (Lilienfeld et al., 2012; Lilienfeld &

Widows, 2005; Patrick et al., 2006). The SCI factor reflects the more deviant personality traits of psychopathy, including, impulsivity, manipulativeness, egocentricity, a tendency to blame others for one’s own mistakes, and lack of concern for convention (Benning et al.,

2003; Lilienfeld & Widows, 2005). The CH factor reflects the callous and unemotional traits of psychopathy. Research by Witt et al. (2009) has demonstrated that the FD and SCI factors display good convergent and criterion validity. Importantly, because the PPI-R was designed using a personality-based approach, it does not contain items that assess criminal and/or antisocial behaviour.

It clear at this point that the measure of psychopathy utilised often reflects the theoretical position of the researcher regarding the role of severe anti-sociality in THE PSYCHOPATH NEXT DOOR 75

psychopathy. Typically, researchers who endorse the view of criminality as central to psychopathy utilise the PCL-R or similar measures (e.g., PCL-SV), and researchers who view criminality as an epiphenomenon utilise the PPI or similar measures (e.g., LSRP). However, a consistent finding across all measures of psychopathy is the emergence of two separate, yet related aspects of psychopathy, an interpersonal and affective facet, and an antisocial-lifestyle facet. The difference between the measures is the degree to which antisocial behaviour loads on the antisocial-lifestyle facet, and this is a point of contention amongst psychopathy researchers. However, in order to establish the true relationship between psychopathy and criminality, and resolve the question of the centrality of criminality to psychopathy, it is necessary to utilise a noncriminal measure of psychopathy.

It has been argued that it is tautological to predict criminality from measures of psychopathy that assess criminality (e.g., Cooke et al., 2007; Skeem & Cooke, 2010a,

2010b). This logic also extends to research on the relationship between psychopathy and criminality in criminal offender samples. It is currently difficult to assess the degree to which criminality is central to the construct of psychopathy as previous research has been confounded by both measurement and sample biases. In this regard, even if alternative, noncriminal measures of psychopathy are used, understanding of the nature and presentation of psychopathy will not evolve unless research is extended to include other populations.

Attempts to examine psychopathy using general population samples have been hindered by measurement limitations, but also previous estimates of the prevalence of psychopaths in the general population (e.g., estimates between 1-3%, Coid et al., 2009). With such small estimates, large samples would be required - a task that is both timely and expensive. However, these estimates were established using criminal measures of psychopathy, which as pointed out earlier, are unsuitable for assessing psychopathy in the general population. True estimates of the prevalence of psychopathy in the general population THE PSYCHOPATH NEXT DOOR 76 would require the use of noncriminal measures. In addition, the research that does exist on the relationship between psychopathy and criminality in general population samples has employed measures of psychopathy that directly assess criminality, thus making it difficult to interpret findings (Coid & Yang, 2011; Coid et al., 2009; Watt & Brooks, 2011). It is likely that the range of interpersonal and affective features (e.g., callousness, manipulativeness, superficial charm, deceitfulness, glibness) described by Cleckley (1948, 1951) do exist in the general population, as severe anti-sociality is not a necessary consequence of possessing these traits. Furthermore, even within criminal offender samples, the key interpersonal and affective features are not good predictors of criminal behaviour (Hemphill et al., 1998). In a review paper on psychopathy measures, Lilienfeld (1998) drew upon McCrae & Costa’s

(1995) distinction between basic tendencies and characteristic adaptations to highlight that the basic tendencies of psychopathy may be manifested in antisocial ways when psychopathy traits interact with adverse environmental factors. Given a different set of environmental factors the basic tendencies of psychopathy may manifest in different characteristic adaptations (Lilienfeld, 1998). This line of reasoning has led to the development of several theories of noncriminal psychopathy.

Theories of noncriminal psychopathy. Whilst relatively little empirical research has been conducted on noncriminal psychopathy, a few theoretical perspectives of noncriminal psychopathy exist in the literature. These theoretical perspectives have been identified as reflecting three distinct models: a subclinical psychopathy model, a successful psychopathy model, and a dual process model (Hall & Benning, 2006). According to the subclinical account, noncriminal psychopathy and criminal psychopathy share the same etiological processes and the same psychopathic traits and features, however, noncriminal psychopaths possess these characteristics to a lesser degree than criminal psychopaths (Ali et al., 2009;

Gustafson & Ritzer, 1995; Mahmut et al., 2008; Paulhus & Williams, 2002). According to the THE PSYCHOPATH NEXT DOOR 77 subclinical account, criminal behaviour is a product of the core personality characteristics of psychopathy. However, some researchers (e.g., Lilienfeld, 1994) have suggested that the term

‘subclinical’ implies a clinical cut-off and research demonstrates that psychopathy is a dimensional construct, not a taxonic construct (Edens et al., 2006; Walters, Brinkley,

Magaletta, & Diamond, 2008). Thus the assumptions of the ‘subclinical’ account are not supported by research on the nature of psychopathy. In contrast, the model of successful psychopathy claims that noncriminal psychopaths possess the same traits and features as criminal psychopaths, and to the same degree, however, compensatory mechanisms moderate the expression of these traits (Hall & Benning, 2006; Hare, 2011; Lilienfeld, 1998; Widom,

1977). From this perspective, a criminal manifestation of psychopathy would occur in the presence of other known criminogenic factors, such as pro-criminal attitudes, criminal associates, substance abuse, familial history of criminal conduct, and lower educational and financial achievement (Gendreau, Little, & Goggin, 1996). However, in the absence of these criminogenic factors and/or the presence of compensatory mechanisms, the traits of psychopathy may be expressed in an advantageous fashion (e.g., rational, successful business leaders, etc.). This position is in line with the aforementioned distinction between basic tendencies and characteristic adaptations in personality, which is widely accepted within the domain of personality theory (McCrae & Costa Jr, 1995). Furthermore, a recent study found that intelligence was a compensatory factor in the psychopathy-criminality relationship

(Wall, Sellbom, & Goodwin, 2013). Wall, Sellbom & Goodwin (2013) examined intelligence as a moderating variable between PPI-R assessed psychopathy and self-reported criminal activity in a university sample and found that individuals who scored highly on psychopathy, and who were of higher intelligence, reported engaging in less criminal behaviour. This study provides some support for Hall & Benning’s (2006) successful psychopathy theory and suggests that psychopathic individuals who are intelligent may be less likely to engage in THE PSYCHOPATH NEXT DOOR 78

criminal conduct. This finding is in line with research on criminality and intelligence, which

has shown that criminal offenders possess lower levels of intelligence than non-offenders,

particularly verbal intelligence (Kratzer & Hodgins, 1999; Moffitt, 1990). Lastly, the dual

process model of psychopathy suggests that distinct etiological factors give rise to the

development of the interpersonal and affective characteristics, and the development of the

anti-social behavioural features (Hall & Benning, 2006). According to this model,

psychopathic individuals can possess the interpersonal and affective features (primary

psychopathy) in absence of the anti-social behavioural features (secondary psychopathy)

(Patrick, 2007). This position is consistent with suggestions that antisocial behaviour is a

correlate of psychopathy, rather than a core feature. Furthermore, it is possible for individuals

to score highly on one facet whilst scoring low on the other, and there is consistent evidence

of divergent relationships with external variables for individuals high on primary vs.

secondary psychopathy (Benning et al., 2003; Benning, Patrick, & Iacono, 2005; Blonigen et

al., 2003; Morrison & Gilbert, 2001) . Although these theories offer divergent explanations of

the underlying mechanisms of noncriminal psychopathy, the explanations are not mutually

exclusive and a shared feature of all models is the reduced emphasis on criminality as a

central aspect of psychopathy. As previously highlighted, the view of criminality as central to

psychopathy resulted from the popular use of a criminal measure of psychopathy (PCL-R), and the ease of access to psychopathic individuals in forensic institutions. This modern conceptualisation of psychopathy is at odds with the theoretical foundation from which it has originated (e.g., Cleckley).

Whilst the need to study noncriminal samples has been recognized, and new noncriminal scales have enabled such research, attempts to examine the relationship between psychopathy and criminality in the general population have continued to use criminal measures (e.g., Coid et al., 2009; DeMatteo, Heilbrun, & Marczyk, 2006; Ishikawa et al., THE PSYCHOPATH NEXT DOOR 79

2001; Watt & Brooks, 2011). Therefore, although general population samples were utilised, the scales used may only be capturing criminal psychopathy in a noncriminal sample. Very few studies have examined psychopathy in noncriminal and nonclinical samples using noncriminal measures (e.g., Lynam et al., 1999; Sellbom & Verona, 2007; Wall et al., 2013).

This is an area of research that warrants empirical attention as the current psychopathy literature, both forensic and non-forensic, may not generalise to other psychopathic populations. For example, Skeem & Cooke (2010a) have suggested that the current psychopathy literature is one of ‘unsuccessful psychopathy’. Therefore, the aim of the current study was to examine the relationship between LSRP assessed psychopathy and criminality in a general population sample.

Crime and Criminality. Criminality is a socially constructed concept that can be defined in various ways. Behaviour can be antisocial but not necessarily criminal and criminal law is sometimes at odds with what is considered antisocial. For example, public displays of affection are heavily penalised in some countries (e.g., United Arab Emirates), yet spousal rape is not a criminal offence in many countries, although such behaviour would be considered by many to be antisocial. Thus, it is acknowledged that criminal behaviour is relative to the social, cultural, and political contexts in which it is performed; what is considered ‘criminal’ varies across time and space. A recent debate on the distinction between criminal and antisocial behaviour in regards to psychopathy (Hare & Neumann,

2010; Skeem & Cooke, 2010a, 2010b) highlights the need to provide a clear definition of criminal behaviour for the context of the current discussion. Debates on how best to define

‘crime’ can be found in great detail within the criminology literature, with little agreement amongst criminologists (see Brown et al., 2010 for a review). For the purposes of this discussion, crime is defined as an act that is socially harmful, prohibited by the legal system in the relevant state or country, and results in punishment (Sutherland, 1934). Implied in this THE PSYCHOPATH NEXT DOOR 80

definition is the view that behaviours are still deemed ‘criminal’ even if they are not officially

documented and prosecuted. Criminologists have long acknowledged the limitations of

official convictions and official records in estimating criminal activity (Erickson & Empey,

1963; Sellin, 1931; Sutherland, 1934), with research showing that criminal activity is more

prevalent than indicated by official conviction records (Erickson & Empey, 1963; Porterfield,

1943). To overcome these limitations researchers have implemented self-report delinquency scales to estimate the prevalence of criminal activity in the general community (Krohn,

Thornberry, Gibson, & Baldwin, 2010). Therefore, the use of a self-report criminal behaviour inventory, together with the assessment of official convictions, may provide a more comprehensive picture of the relationship between psychopathy and criminality than measuring official convictions alone. In this discussion the term ‘criminality’ is used as a more general term to refer to criminal behaviour and attitudes towards criminal behaviour.

Attitudes are encompassed in this definition because research in forensic samples shows that the endorsement of pro-criminal attitudes correlates with future criminal behaviour for both men and women (Andrews & Bonta, 2014; Gendreau et al., 1996; Holsinger, 1999). Thus, the assessment of criminal attitudes may provide an additional indicator of criminality in noncriminal samples.

Attitudes. Attitudes are favourable or unfavourable evaluations of something or someone and consist of three components: affective, cognitive and behavioural (Maio, Olson,

Bernard, & Luke, 2006). The affective component refers to feelings about the object, the cognitive component refers to beliefs and ideas about the object, and the behavioural component refers to past behaviours regarding the object. Although personality traits and attitudes are both used to explain and predict behaviour, there are also distinguishing features that separate personality traits and attitudes (Ajzen, 2005). Personality traits are viewed as behavioural dispositions or response tendencies of an individual that occur in a range of THE PSYCHOPATH NEXT DOOR 81

circumstances, and are relatively stable over time (i.e., manipulativeness). Attitudes are

evaluations of a particular object (e.g., person, event, idea, or institution), and are more

flexible, and susceptible to change than personality traits (i.e., negative attitudes towards law

enforcement) (Ajzen, 2005). Azjen’s (1991) influential theory of planned behaviour suggests

that attitudes towards a particular behaviour, combined with subjective norms and perceived

control, can be used to predict behavioural intentions with a high degree of accuracy. It is

conceivable then that attitudes towards crime and criminal behaviour may provide an implicit

indicator of criminality in psychopathy, even in absence of actual criminal behaviour.

The Criminal Sentiments Scale- Revised (CSS-R) (Simourd, 1997) is a scale used to

assess attitudes towards criminal behaviour. The scale produces a global score and scores on

three subscales: attitudes towards the law-courts-police, identification with criminal others,

and tolerance for law violations. Thus, the CSS-M can be used to assess attitudes towards a

particular behaviour/s (criminal behaviours), which as suggested by Ajzen (1991) is one

component of predicting behavioural outcomes. Research by Simourd and Olver (2002) using

the CSS-M in a large, male offender sample found that the endorsement of criminal attitudes

was significantly related to rearrest, violent rearrest, and re-incarceration. Previous research

on the CSS-M and psychopathy in criminal offender samples has shown that secondary

psychopathy, but not primary psychopathy is moderately correlated with pro-criminal

attitudes (Simourd, 1997). Therefore, the use of the CSS-M to assess attitudes towards criminal behaviour may be a good indicator of latent criminality in psychopathy in a community sample. This study will examine the relationship between LSRP global psychopathy, primary psychopathy, secondary psychopathy and criminal attitudes.

As mentioned earlier, the common theme shared by theories of noncriminal psychopathy is the reduced role of criminality. However, these theories lead to differential hypotheses regarding the relationship between psychopathy and criminal attitudes. According THE PSYCHOPATH NEXT DOOR 82

to the dual-model, the interpersonal and affective features can appear in absence of the antisocial features. Thus, it might be expected that only secondary psychopathy would be associated with pro-criminal attitudes in a general population. However, according to the successful psychopathy model, psychopathic individuals in the community possess the same traits and to the same degree, but moderating factors influence the expression of these traits.

From this perspective, it might be expected that both primary and secondary psychopathy would be associated with pro-criminal attitudes. However, the influence of these attitudes on criminal behaviour would be moderated by social influences or other criminogenic factors known to contribute to criminal behaviour. For example, it is acknowledged that subjective norms influence the strength of attitudes, and the attitude-behaviour relationship. Research in support of the effect of subjective norms on the attitude-behaviour relationship has shown

that group norms influence the strength of attitudes (Visser & Mirabile, 2004), and the

relationship between attitudes and behavioural intentions, particularly when the individual

identifies strongly with the social group (Terry & Hogg, 1996; Terry, Hogg, & White, 1999).

Therefore, it is reasonable to suggest that individuals with increased levels of psychopathy in

criminal social contexts, where criminality is normalised, may display stronger criminal

attitudes and increased criminal behaviour. However, in contexts where criminal behaviour is

not acceptable and is heavily penalised, both formally and informally, the behavioural

expression of pro-criminal attitudes may be supressed. Therefore, some individuals with

psychopathy in the community may possess stronger pro-criminal attitudes, but the influence

of social context may supress the behavioural expression of these attitudes.

Gender. As previously discussed, the majority of previous research on psychopathy

has utilised male, criminal offender samples. Thus, in addition to criminal samples

dominating the psychopathy literature, research on psychopathy predominately reflects male

psychopathy. There is comparatively little research on psychopathy in females, and few THE PSYCHOPATH NEXT DOOR 83

studies have explored possible differences in the manifestation of psychopathy traits as a

function of gender. The current literature on psychopathy and gender has demonstrated that

males are more likely to possess psychopathic characteristics than females (Rogstad &

Rogers, 2008), and mean differences in psychopathy scores are consistently reported (Miller,

Watts, & Jones, 2011). Furthermore, there is some evidence that psychopathy is expressed

differently in males and females. For example, Forouzan (2003) found that the interpersonal

characteristics of male and female psychopaths varied, deceitful males were more likely to be

conning, whilst females were more likely to act flirtatiously. Behavioural differences were

also observed, while male psychopaths displayed problems with impulsivity and violent

criminal conduct, female psychopaths displayed self-harming behaviours, manipulation and non-violent criminal conduct, such as theft or fraud (Forouzan, 2003). However, these findings are consistent with gender differences in offending more broadly, with crime statistics showing that males are more likely to engage in violent criminal behaviour than females, and that when females offend it is generally theft and property crimes (Australian

Institute of Criminology, 2013; United States Department of Justice, 2014). Therefore, female and male criminal psychopaths are engaging in gender-consistent criminal behaviours and the gender differences observed may not be related to psychopathy per se. Forouzan &

Cooke (2005) suggest that clinicians find the interpersonal features such as superficial charm and grandiosity to be less observable in females and suggest that this may be an artefact of socialisation. In addition, whilst psychopathy is considered a good predictor of recidivism in males, the predictive utility of psychopathy in females is questionable. Using the PCL-R in a female inmate sample, Salekin, Rogers, Ustad & Sewell (1998) found that the PCL-R performed poorly as a predictor of recidivism in females, with only 11% of the recidivists scoring highly on psychopathy. This study also found that unlike males, Factor 1 of the PCL-

R was a better predictor of recidivism in females than factor 2 (Salekin et al., 1998). Research THE PSYCHOPATH NEXT DOOR 84

using male, criminal offender samples has consistently shown that Factor 2 of the PCL-R is a

better predictor of recidivism than Factor 1 (Hemphill et al., 1998). These findings suggest that psychopathy factors may differentially predict criminal behaviour in males and females.

In contrast, Miller, Watts & Jones (2011) examined possible gender differences in the relationships between psychopathy, etiological factors (e.g., parental relationships), the Five-

Factor Model of personality (FFM), measures of Gray’s (1970) behavioural inhibition and activation systems, and a range of externalising behaviours (e.g., gambling, substance abuse, and self-harm) in an undergraduate sample and found that the relationships between psychopathy and these factors were similar across gender. Furthermore, research examining the factor structure of psychopathy measures suggests that the factor structure is consistent for both genders (Cale & Lilienfeld, 2002; Skeem, Mulvey, & Grisso, 2003; Kennealy,

Hicks, & Patrick, 2007). Whilst there appears to be similarities in the underlying structure of psychopathy for males and females the scarcity of research on psychopathy in females, together with some evidence of differences between males and females in the behavioural expression of psychopathy, warrants an examination of possible gender differences in the psychopathy-criminality nexus.

The Current Study

The aim of this study was to examine the relationship between criminality and psychopathy in the community using a noncriminal measure of psychopathy. It was expected that some individuals recruited from the community would score highly on the LSRP scale.

Given the theories of noncriminal psychopathy previously discussed, it was hypothesised that individuals who scored highly on primary and secondary psychopathy would not possess the same level of criminality as psychopaths in criminal samples. Alternatively, the dual-model approach may suggest elevated levels of criminality only in secondary psychopathy. Given the scarcity of research on psychopathy using female participants, and some evidence of THE PSYCHOPATH NEXT DOOR 85

gender differences in both crime (Australian Institute of Criminology, 2013; United States

Department of Justice, 2014) and the relationship between psychopathy and criminality

(Salekin et al., 1998), an additional aim of this study was to examine the psychopathy-

criminality relationship separately for males and females with the aim of elucidating any

gender differences. The examination of male and female findings separately will also aid in

the comparison of findings from the current study with previous research which has

predominately used male, criminal offender samples.

To achieve these aims, this study examined the relationship between primary and

secondary psychopathy (measured by the LSRP) and self-reported criminal convictions, criminal behaviour, and traffic violations. To obtain a comprehensive assessment of the relationship between psychopathy and criminality, criminal attitudes were also assessed as an additional indicator of criminality. According to the theory of planned behaviour, attitudes can influence behaviour, and there is some empirical support for the association between criminal attitudes and criminal conduct (Gendreau, Andrews, Goggin & Chanteloupe, 1992;

Simourd & Andrews, 1994).

In line with theoretical accounts of noncriminal psychopathy, which emphasise the reduced role of anti-sociality, it was hypothesised that the relationship between psychopathy and criminality would be more nuanced than that found in previous research using criminal offender samples. The successful psychopathy model suggests that compensatory mechanisms (e.g., favourable environmental factors) influence the expression of psychopathy towards adaptive rather than maladaptive expressions. Following this theory, it would be expected that neither primary nor secondary psychopathy would be associated with criminal convictions, self-report criminal behaviour, or traffic violations. However, because attitudes are implicit and their expression influenced by social context, primary and secondary psychopathy may be associated with pro-criminal attitudes, but not necessarily criminal THE PSYCHOPATH NEXT DOOR 86

conduct. An examination of possible mediating effects of group norms on the relationship

between psychopathy and criminality may provide additional support for the successful psychopathy model. Therefore, if a significant relationship is found between psychopathy and criminal behaviour, it could be because of a stronger identification with criminal social groups.

In contrast, the dual process model suggests that the interpersonal and affective features are distinct from the antisocial behaviour features. In this regard, it might be expected that only secondary psychopathy (the antisocial-lifestyle facet) would be significantly related to criminal attitudes, criminal convictions, self-report criminal behaviour, and traffic violations. This hypothesis is further supported by research in forensic samples which demonstrates that only secondary psychopathy (Factor 2) is related to pro- criminal attitudes (Simourd, 1997), and that secondary psychopathy is better predictor of criminal behaviour (Hemphill et al., 1998). In regards to gender differences, it is hypothesised that if a relationship exists between psychopathy and criminality in the current study, primary psychopathy will be a better predictor than secondary psychopathy in the female sample only, because previous research has shown that unlike males, Factor 1 of the

PCL-R is a better predictor of criminality in female criminal offenders (Hemphill et al., 1998;

Salekin et al., 1998).

Method

Participants

The sample consisted of 523 participants (68% female) recruited from the general population of South East Queensland via social networking sites, online news websites, classified advertisements, and advertising flyers posted at shopping centres and university campuses. The average age of participants was 29 years (males M = 29 years, SD = 10 years; females M = 30 years, SD = 12 years). The sample consisted of participants who were THE PSYCHOPATH NEXT DOOR 87

students (45%), and participants who were employed full-time (35.4%), part-time (11.1%), or on a casual basis (4.2%); self-employed (1.7%); unemployed (1%) and other (1.5%) (e.g., volunteers/full-time parents/retirees). The complete demographic data for participants is presented in Table 1.

Table 1 Participant Demographics (N = 523)

Demographic Variable % Male % Female Highest Level of Education Did Not Complete Year - .60 10 Year 10 Certificate 1.80 2.50 Year 12 Certificate 44.40 41.20 Trade/Diploma 14.20 13.30 Undergraduate Degree 29.60 26.30 Postgraduate Degree 10.10 16.10 Country of Birth Australia 78.10 74.90 England 4.10 5.40 New Zealand 4.10 4.50 China 3.0 1.10 Other (all < 2% 10.70 14.10 frequency) Cultural Background Australian 86.20 89.70 British 3.80 6.90 Chinese 4.40 2.20 Other (all < 1% 5.60 1.20 frequency) Traffic Violation Yes 58.60 50.90 No 41.40 49.10 Criminal Conviction Yes 5.30 2.0 No 94.70 98.0 Prison Sentence Yes - .30 No 100 99.70

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Materials

Demographic questionnaire. A brief demographic questionnaire was used to

measure individual difference variables, such as age, gender, ethnicity, level of education and

employment status. In addition, there were items regarding previous criminal conduct and

lawful behaviour. Participation was anonymous, no personally identifying information was

requested from participants.

Levenson Self-Report Psychopathy Scale (LSRP) (Levenson et al., 1995). The

LSRP is a 26-item self-report questionnaire designed for use in non-institutionalised samples

(Levenson, et al., 1995). Each item consists of a statement that participants endorse on a four-

point Likert scale (the anchors are 1 = disagree strongly and 4 = agree strongly). The primary

psychopathy subscale contains 16 items that assess the core personality traits of psychopathy

described by Cleckley (1941, 1948, 1951), including manipulativeness, callousness, and lack

of empathy, guilt or remorse. A sample item is “I tell other people what they want to hear so

that they will do what I want them to do”. Scores range from 16 to 64 with higher scores

reflect higher levels of primary psychopathy. The secondary psychopathy subscale contains

10 items that assess impulsivity, anti-social behaviour and a self-defeating lifestyle. A sample item is “I don’t plan anything very far in advance”. Scores range from 10 to 40 with higher scores reflect higher levels of secondary psychopathy. Some items are scored in reverse order to control for response sets. The scale has good internal reliability for the primary psychopathy subscale with Cronbach’s alpha .84 and adequate internal reliability for the secondary psychopathy subscale with Cronbach’s alpha .72 (Ali, et al., 2009). The scale possesses good temporal reliability at eight weeks’ test-retest (.83) (Lynam, et al., 1999). In a male, predominately Caucasian, undergraduate sample the mean level of primary psychopathy (M = 32.22, SD = 6.80) and secondary psychopathy (M = 18.60, SD = 3.60)

(Reidy et al., 2008) is similar to that found in male, Caucasian, criminal offender samples for THE PSYCHOPATH NEXT DOOR 89

primary (M = 31.86, SD = 8.22) and secondary (M = 22.20, SD = 5.18) psychopathy

(Brinkley et al., 2001).

The Criminal Sentiments Scale Modified (CSS-M) (Simourd, 1997). The CSS-M is a 41-item self-report questionnaire designed to measure attitudes, values and beliefs towards criminality and lawful behaviour. Each item consists of a statement with which participants agree, disagree or remain undecided (anchors are A = agree, D = disagree, U = undecided). Endorsement of pro-criminal statements (or the rejection of pro-social statements) attracts two points whilst the rejection of pro-criminal statements (or the endorsement of pro-social statements) yields a point of zero. Undecided responses attract one point. Thus, higher scores indicate greater pro-criminal attitudes. Some items are scored in reverse to control for response sets. The CSS-M yields a total score and three subscale scores: law-court-police (LCP), identification with criminal others (ICO), and tolerance for law violations (TLV). The LCP subscale contains 25 items that assess attitudes towards the law and criminal justice system. Sample items are “The police are as crooked as the people they arrest” (police), “Almost any jury can be fixed” (courts), and “It’s our duty to obey all laws”

(law). The ICO subscale contains 6 items designed to assess personal evaluative judgments that individuals hold toward law violators. A sample item is “People who have broken the law have the same sorts of ideas about life as me”. The TLV subscale contains 10 items that assess justification for criminal behaviour and law violation. Sample items are “Most people would commit crimes if they wouldn’t get caught” and “There is never a good reason to break the law”. The CSS-M possesses good internal reliability for the total scale (alpha = .91)

(Simourd & Olver, 2002) and LCP subscale (alpha = .87) (Simourd & Olver, 2002), and adequate internal reliability for the TLV (alpha = .76) (Simourd & Olver, 2002) and ICO

(alpha = .73) (Simourd, 1997) subscales. THE PSYCHOPATH NEXT DOOR 90

Self-Report Criminal Activity Scale. A self-report criminal activity scale was included to capture acts of criminal behaviour that may not have resulted in an official conviction. The Self-Report Delinquency Scale (SRDS) (Mak, 1993) was modified so that items relating to delinquent behaviours (such as truancy from school) were excluded or reworded so that they were applicable to an adult population. The SRDS was designed by

Mak (1993) to capture actual delinquent behaviour rather than official convictions in young people, and the scale demonstrates good internal consistency (Cronbach’s alpha = .88).

Unlike the SRDS, the modified scale used in the current study employed a Likert-scale response format that assessed the frequency of a particular criminal act across the lifespan, rather than in the previous 12-month period (the anchors are 1 = never, 2 = a couple of time,

3 = a few times, 4 = many times, 5 = all the time). The modified scale contains 28 items: 22 items that assess the frequency of a range of criminal behaviours, and six items to detect socially desirable responding (See Appendix 1). The possible scores range from 22 to 110, with higher scores indicating higher levels of criminal activity. The modified scale possesses good internal consistency (Cronbach’s alpha = .85).

Instructional manipulation checks (IMC’s) (Oppenheimer, Meyvis, &

Davidenko, 2009). The two IMC’s were designed to capture satisfice responding. The IMC’s instructed participants to select a particular response on the Likert-scale or to refrain from responding. A sample item is “Please select ‘agree strongly’ as your answer for this question”.

Procedure

Ethical approval for this study was obtained from the Human Research Ethics

Committee of the Queensland University of Technology and is presented in appendix 2

(approval number 1100001490). Participants were given an information letter which detailed the nature of the research and participation requirements. The participant information letter THE PSYCHOPATH NEXT DOOR 91

contained a web link to an online survey tool (Surveymonkey.com) and participants

completed the questionnaire set electronically. Participation was anonymous and participants

were given the choice to participate in future studies by providing a unique identifier code.

The identifier code consisted of the first three letters of the participants’ mothers’ maiden

name and the last three digits of the participants’ mobile telephone number. The identifier

code was designed to link participant responses from this study with participation in

subsequent studies of this research program. Participation in this study was voluntary.

Participants first completed the demographic questionnaire and then the Levenson

Self-Report Psychopathy Scale. The Criminal Sentiments Scale-Modified and Self-Report

Criminal Activity Scale were presented last in a counterbalanced order to avoid value-laden items from influencing responses on the other questionnaires. The IMC’s were presented randomly throughout the questionnaire set. Participants were thanked for their participation at the conclusion of the questionnaire set. The complete questionnaire set for this study is presented in Appendix 1.

Design

A cross-sectional, correlational design was used to examine the relationship between psychopathy and criminality. The predictor variables were primary psychopathy and secondary psychopathy as measured by the Levenson Self-Report Psychopathy Scale (LSRP)

(1995). The LSRP was chosen as the measure of primary and secondary psychopathy for this study, as this scale is a psychometrically sound, public domain test and could therefore be used in the online questionnaire set. The outcome variables were previous criminal convictions; traffic violations; the three criminal attitude factors (attitudes towards law- courts-police, tolerance for law violations, and identification with criminal others) (measured using the CSS-M); and self-reported criminal offending (measured using the SRCS). THE PSYCHOPATH NEXT DOOR 92

To prevent potential satisfice responding, a progress bar was displayed at the top of the page to provide participants with information on their progress through the study. In addition, four instructional manipulation checks (IMC’s) (Oppenheimer, Meyvis &

Davidenko, 2009) were used to capture satisfice responding and were randomly presented throughout the questionnaire set. Participants who did not respond appropriately were excluded from the sample (N = 32).

Results

Data Screening

Data was screened prior to analyses for accuracy of input, missing values, and outliers. There were no missing data points or out of range values. All means and standard deviations were plausible. Values that were more than 3.29 standard deviations from the mean were considered extreme values (Tabachnick & Fidell, 2007). These cases were addressed by replacing the original score with a value equal to the mean plus three standard deviations. The modified data was used in all inferential analyses.

Descriptive Statistics

Descriptive statistics are displayed separately for males and females in Table 2. An examination of the means indicated possible gender differences in global psychopathy, primary psychopathy, tolerance for law violations, identification with criminal others, and self-report criminality. T-tests confirmed that these differences were significant. Males reported significantly higher levels of global psychopathy, t(521) = 2.80, p = .005, d = .26, primary psychopathy, t(521) = 3.28, p = .001, d = .26, tolerance for law violations, t(521) =

2.96, p = .003, d = .27, possessed a stronger identification with other criminals, t(521) = 3.53, p < .001, = .31, and reported engaging in more criminal behaviour, t(521) = 5.70, p <

.001, = 𝑑𝑑.56. The small effect sizes observed for psychopathy and criminal attitudes suggest that no𝑑𝑑 meaningful differences exist between males and females. However, a medium effect THE PSYCHOPATH NEXT DOOR 93

size was observed for criminal behaviour, suggesting that there is a noticeable difference in

criminal offending as a function of gender. This finding is consistent with crime data on

gender differences in offense rates (Australian Institute of Criminology, 2013; United States

Department of Justice, 2014). Of the 523 participants only 16 reported having a criminal

conviction (< 3% of the sample), thus no further analyses were conducted in relation to

criminal offenses. The means and standard deviations for primary psychopathy and secondary

psychopathy were similar to those found in previous research using an undergraduate sample

(Reidy et al., 2008), and criminal offender sample (C. Brinkley et al., 2001) (Cohen’s d = .38, a small-moderate effect, for the difference between the current sample and Brinkley et al.

2001). Interestingly, the means and standard deviations for the criminal sentiments subscales were also similar to those found in previous research using male, criminal offender samples

(CSS-M Total, M = 27.10, SD = 14.80; LCP, M = 18.10, SD = 10.70; TLV, M = 6.50, SD =

3.80, ICO, M = 2.50, SD = 2.30) (Simourd, 1997). The internal reliabilities for the scales were calculated using the whole sample and are displayed in Table 2. The internal reliabilities of the scales ranged from good to adequate, with the exception of the ICO subscale. The poor

internal reliability of the ICO subscale could be because it contains only 6 items and

Cronbach’s alpha is sensitive to the number of items included. All inter-item correlations for

the ICO subscale were positive.

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Table 2 Descriptive Statistics for Psychopathy and Criminal Attitudes for Males and Females Male Female Cronbach’s a Measure M SD M SD Global Psychopathy 48.49 9.48 46.05 9.14 .85 Primary psychopathy 28.48 9.14 26.37 6.28 .84 Secondary 19.98 3.93 19.69 4.33 .70 psychopathy Criminal Sentiments 25.81 12.11 24.15 9.73 .88 Scale total Law-Courts-Police 15.43 8.23 15.30 6.74 .85 Tolerance for law 7.15 3.69 6.17 3.42 .70 violations Identification with 3.18 1.68 2.67 1.51 .54 criminal others Self-report 29.89 7.38 26.32 4.97 .85 criminality

Inferential Statistics

Hierarchical multiple regression analyses were conducted to predict self-report

criminal behaviour and criminal attitudes as a function of primary and secondary

psychopathy. All assumptions were met (i.e., additivity and linearity, independent errors, homoscedasticity, and normally distributed residuals). Bivariate correlations are displayed separately for males and females in Table 2. The pattern of relationships between psychopathy and the criminal attitudes factors are similar for both males and females.

However, the relationship between primary psychopathy and self-report criminality is different for males and females. Higher levels of primary psychopathy show a weak, positive, and significant relationship with criminal behaviour in females. However, for males a weak, negative and nonsignificant relationship is observed. The difference between these correlations was statistically significant, Z = 2.82, p = .005. These findings are consistent with previous research in criminal offender samples (Hemphill et al., 1998; Salekin et al.,

1998). Secondary psychopathy was significantly related to self-report criminal conduct in THE PSYCHOPATH NEXT DOOR 95 both males and females. Given the low bivariate correlations between the number of traffic violations and primary and secondary psychopathy no further analyses were conducted.

Table 3 Bivariate Correlations between Psychopathy and Criminal Attitudes (Correlations Below the Diagonal Are for Males, Above the Diagonal for Females) Psych Prim Secon CSS LCP ICO TLV SRCS NTV Total Psych Psych Total

Psych .90** .79** .39** .27** .26** .46** .25** .04 Total

Prim .92** .46** .31** .19** .20** .42** .18** .01 Psych

Secon .71** .38** .37** .29** .25** .35** .27** .07 Psych

CSS .42** .33** .38** .92** .52** .77** .32** .07 Total

LCP .31** .23** .30** .95** .32** .52** .22** .06

ICO .34** .27** .31** .62** .45** .41** .22** .04

TLV .48** .40** .41** .82** .63** .53** .36** .08

SRCS .06 -.01 .16* .33** .25** .37** .32** .18*

NTV -.15 -.17 -.04 -.22* -.19* -.11 -.21* .29**

Note. CSS Total = Criminal Sentiments Scale Total; LCP = Law Courts Police; ICO = Identification with Criminal Others; TLV = Tolerance for Law Violations; Psych Total = Psychopathy Total Score; Prim Psych = Primary Psychopathy; Secon Psych = Secondary Psychopathy; SRCS = Self-report Criminality Scale NTV = Number of Traffic Violations. * p < .05, **p < .01. two-tailed.

Criminal Attitudes. Hierarchical multiple regression was conducted to predict criminal attitudes from the linear combination of primary and secondary psychopathy.

Because the literature on psychopathy suggests that secondary psychopathy is more strongly related with antisocial behaviour, secondary psychopathy was entered in the first step, and primary psychopathy was entered in the second step. THE PSYCHOPATH NEXT DOOR 96

Males. The results at the first step revealed that higher levels of secondary

psychopathy significantly explained 14.3% (adjusted R square) of the variance in criminal

attitudes, a moderate effect (R = .38, F [1, 167] = 29.06, p < .001). Adding primary psychopathy to the regression model explained an additional 4% of the variation in criminal attitudes and this change in was significant, F(1, 167) = 8.10, p = .005. The linear 2 combination of primary and𝑅𝑅 secondary psychopathy significantly predicted criminal attitudes,

R= .43, accounting for 17.8% of the variance, F(2, 166) = 19.20, p<.001. Within the

regression model higher levels of secondary psychopathy, and to a lesser extent, higher levels

of primary psychopathy significantly predicted pro-criminal attitudes. Details of the

regression are presented in Table 4.

Females. In the first step when secondary psychopathy was entered, R = .37,

accounting for 13.6% of the variation in criminal attitudes (adjusted R square), F(1, 352) =

56.59, p < .001. The addition of primary psychopathy to the regression model explained an

additional 2.5%, and this change was significant, F(1, 351) = 10.70, p < .001. The linear

combination of primary and secondary psychopathy significantly predicted criminal attitudes

in females, accounting for 15.9% of the variability in pro-criminal attitudes, R = .40, F(2,

351) = 34.42, p < .001. Within the regression model both higher levels of primary and

secondary psychopathy significantly predicted pro-criminal attitudes, with secondary

psychopathy being a better predictor. Details of the regression are presented in Table 4.

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Table 4 Hierarchical Multiple Regression Predicting Criminal Attitudes from Primary and Secondary Psychopathy Separately for Males and Females B SE B β t

Males

Step 1

Constant 2.09 4.48

Secondary Psychopathy 1.18 .22 .38 5.39***

Step 2

Constant -3.25 4.77

Secondary Psychopathy .76 .13 .34 5.90***

Primary Psychopathy .26 .08 .18 3.18**

Females

Step 1

Constant 7.67 2.24

Secondary Psychopathy .83 .11 .37 7.52**

Step 2

Constant 4.03 2.47

Secondary Psychopathy .64 .12 .28 5.21***

Primary Psychopathy .27 .08 .18 3.27**

Note. **p<.01 ***p<.001.

Attitudes Toward Law, Courts and Police. To further elucidate the relationship between criminal attitudes and primary and secondary psychopathy, hierarchical multiple regression was conducted on the criminal sentiments subscale: law, courts and police. Using the previously mentioned rationale, secondary psychopathy was entered in the first step and primary psychopathy was entered in the second step. THE PSYCHOPATH NEXT DOOR 98

Males. The results at the first step revealed that higher levels of secondary

psychopathy significantly explained 8.9% of the variance in negative attitudes toward the

law, courts, and police, a small effect (R = .30, F [1, 167] = 17.40, p < .001). The addition of

primary psychopathy to the regression model did not produce a significant change in , F(1, 2 166) = 3.08, p = .08. The linear combination of primary and secondary psychopathy 𝑅𝑅

explained 10% of the variance, R = .33, F(2, 166) = 10.35, p<.001. However, within the

regression model only higher levels secondary psychopathy significantly predicted negative

attitudes towards the law, courts, and police. Details of the regression are presented in Table

Females. In the first step, higher levels of secondary psychopathy significantly

predicted negative attitudes towards the law, courts and police, R = .29, F(1, 352) = 34.64, p

< .001, accounting for 8.7% of the variability in negative attitudes towards the law, courts

and police. The addition of primary psychopathy to the regression model did not produce a

significant change in , F(1, 351) = 1.24, p =.26. The linear combination of primary and 2 secondary psychopathy𝑅𝑅 significantly predicted negative attitudes towards the law, courts and

police, explaining 9.3% of the variance, R = .30, F(2, 351) = 17.95, p<.001. However, only higher levels of secondary psychopathy significantly predicted negative attitudes towards the law, courts and police. The regression model is presented in Table 5.

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Table 5 Hierarchical Multiple Regression Predicting Attitudes Toward Law, Courts, and Police from Primary and Secondary Psychopathy Separately for Males and Females B SE B β t

Males

Step 1

Constant 2.55 3.14

Secondary Psychopathy .64 .15 .30 4.17**

Step 2

Constant .20 3.39

Secondary Psychopathy .53 .16 .25 3.20**

Primary Psychopathy .16 .09 .13 1.75

Females

Step 1

Constant 6.11 1.59

Secondary Psychopathy .46 .07 .29 5.88***

Step 2

Constant 5.22 1.78

Secondary Psychopathy .42 .09 .26 4.68***

Primary Psychopathy .06 .06 .06 1.11

Note. **p<.01 ***p<.001.

Tolerance for Law Violations. Hierarchical multiple regression was used to assess if primary and secondary psychopathy significantly predicted a higher tolerance for law violation. Secondary psychopathy was again entered in the first step and primary psychopathy was entered in the second step.

Males. At the first step higher levels of secondary psychopathy significantly explained 16.7% of the variance in tolerance for law violations, R = .41, F (1, 167) = 34.70, p THE PSYCHOPATH NEXT DOOR 100

< .001. The addition of primary psychopathy to the regression model explained an additional

7.2% of the variance in tolerance for violations of the law and this change in was 2 significant, F(1, 166) = 15.85, p <.001. The linear combination of primary and𝑅𝑅 secondary psychopathy significantly predicted tolerance for law violations, R = .49, accounting for

23.5% of the variance, F(2, 166) = 26.82, p<.001. A higher tolerance for law violations was significantly predicted by higher levels of primary and secondary psychopathy, with secondary psychopathy being a better predictor. The full regression model is presented in

Table 6.

Females. The results at the first step showed that higher levels of secondary psychopathy significantly explained 12.3% of the variation in tolerance for law violations, R

= .35, F(1, 352) = 50.46, p < .001. With primary psychopathy added to the model, an additional 8.9% of variability was explained and this change was significant, F(1, 351) = 2 39.81, p <.001. The linear combination of primary and𝑅𝑅 secondary psychopathy significantly predicted a tolerance for law violations, explaining 21% of the variability (R = .46, F[2, 351]

= 47.92, p <.001). Higher levels of both primary and secondary psychopathy significantly predicted a higher tolerance for law violations. However, unlike the findings for males, higher levels of primary psychopathy better predicted a tolerance for law violations. Details of the regression are presented in Table 6.

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Table 6 Hierarchical Multiple Regression Predicting Tolerance for Law Violations from Primary and Secondary Psychopathy Presented Separately for Males and Females B SE B β t

Males

Step 1

Constant -.63 1.34

Secondary Psychopathy .39 .06 .41 5.89***

Step 2

Constant -2.83 1.40

Secondary Psychopathy .28 .06 .30 4.15***

Primary Psychopathy .15 .03 .29 3.98***

Females

Step 1

Constant .65 .79

Secondary Psychopathy .28 .03 .35 7.10***

Step 2

Constant -1.73 .84

Secondary Psychopathy .15 .04 .19 3.67***

Primary Psychopathy .18 .02 .33 6.31***

Note. ***p <.001.

Identification with Criminal Others. Primary and secondary psychopathy were used in a hierarchical regression analysis to predict identification with criminal others. Secondary psychopathy was entered in the first step and primary psychopathy was entered in the second step.

Males. The results at the first step revealed that secondary psychopathy significantly explained 9.1% of the variance in identification with other criminals, R = .31, F (1, 167) = THE PSYCHOPATH NEXT DOOR 102

17.81, p < .001. The addition of primary psychopathy to the regression model explained an

additional 2.8% of the variance in identification with criminal others, and this change in 2 was significant, F(1, 166) = 5.30, p =.02. The overall prediction model was statistically 𝑅𝑅

significant, R = .35, accounting for 11.4% of the variance, F (2, 166) = 11.78, p < .001.

Within the regression model higher levels of both primary and secondary psychopathy

predicted a stronger identification with criminal others, with secondary psychopathy being a

better predictor. Details of the regression are presented in Table 7.

Females. The results after the first step showed that higher levels of secondary

psychopathy significantly explained 6.1% of the variation in identification with other

criminals, R = .25, F (1, 352) = 23.76, p < .001. The addition of primary psychopathy to the

regression model did not produce a significant change in , F(1, 351) = 3.8, ns. The linear 2 combination of primary and secondary psychopathy significantly𝑅𝑅 predicted a stronger sense of identification with other criminals, explaining 6.8% of the variability (R=.27, F[2, 351] =

13.91, p < .001. Unlike the male results, only secondary psychopathy was a significant predictor within the regression model. The full details of the prediction model are presented in Table 7.

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Table 7 Hierarchical Multiple Regression Predicting Identification with Criminal Others from Primary and Secondary Psychopathy for Males and Females B SE B β t

Males

Step 1

Constant .53 .64

Secondary Psychopathy .13 .03 .31 4.22***

Step 2

Constant -.09 .68

Secondary Psychopathy .10 .03 .24 3.06**

Primary Psychopathy .04 .01 .18 2.30*

Females

Step 1

Constant .94 .36

Secondary Psychopathy .08 .01 .25 4.8***

Step 2

Constant .58 .40

Secondary Psychopathy .06 .02 .19 5.41**

Primary Psychopathy .02 .01 .14 1.96

Note. *p<.05 **p<.01 ***p<.001.

Self-Reported Criminal Behaviour. Primary and secondary psychopathy were used in a hierarchical regression analysis to predict criminal behaviour. Secondary psychopathy was entered in the first step and primary psychopathy was entered in the second step.

Males. After the first step when secondary psychopathy was entered, the model significantly explained 2.2% of the variability in criminal behaviour, R = .16, F (1, 167) =

4.85, p = .02. The addition of primary psychopathy to the regression model did not result in a THE PSYCHOPATH NEXT DOOR 104

significant change to , F(1, 166) = 1.35, ns. The linear combination of primary and 2 secondary psychopathy𝑅𝑅 significantly explained 2.4% of the variability in criminal behaviour

(R=.19, F[2, 166] = 3.10, p = .04). Within the regression model higher levels of secondary, but not primary, psychopathy significantly predicted criminal behaviour. The full details of the model are displayed in Table 8.

Females. The results at the first step revealed that higher levels of secondary psychopathy significantly predicted higher levels of criminal behaviour, explaining 7% of the variability, R = .27, F (1, 352) = 27.63, p < .001. The addition of primary psychopathy to the model did not explain any additional variability in criminal behaviour, with a nonsignificant

change, F(1, 351) = 1.69, ns. The linear combination of primary and secondary 2 𝑅𝑅psychopathy significantly explained 7.2% of the variability in criminal behaviour, R = .27, F

(2, 351) = 14.69, p < .001. However, within the regression model only secondary

psychopathy was a significant predictor of criminal behaviour. Details of the regression

model are presented in Table 8.

THE PSYCHOPATH NEXT DOOR 105

Table 8 Hierarchical Multiple Regression Predicting Criminal Behaviour from Primary and Secondary Psychopathy for Males and Females B SE B β t

Males

Step 1

Constant 23.58 2.91

Secondary Psychopathy .31 .14 .16 2.20*

Step 2

Constant 25.03 3.17

Secondary Psychopathy .38 .15 .20 2.48*

Primary Psychopathy -.09 .08 -.09 1.16

Females

Step 1

Constant 20.21 1.18

Secondary Psychopathy .31 .05 .27 5.25***

Step 2

Constant 19.43 1.32

Secondary Psychopathy .26 .06 .23 4.04***

Primary Psychopathy .06 .04 .07 1.30

Note. *p<.05 **p<.01 ***p<.001.

Follow-up Mediation Analyses

Mediated regression analyses were used to follow-up the significant effect of secondary psychopathy on self-reported criminal behaviour to determine whether this effect was mediated by a stronger identification with other criminals.

Males. A mediated regression analysis was conducted to predict self-reported criminal behaviour from secondary psychopathy whilst examining the possible mediating role THE PSYCHOPATH NEXT DOOR 106 of ICO. All assumptions of the analysis were met. The linear combination of secondary psychopathy and ICO significantly predicted self-reported criminal behaviour, explaining

14.2% of the variance, R = .37, F(2, 166) = 13.73, p <.001. Within the regression model a stronger identification with criminal others significantly predicted criminal behaviour (b

=1.55, p < .001), secondary psychopathy was not a significant predictor (b =.10, p = .44). The results of the mediation analysis revealed a significant indirect effect of secondary psychopathy on self-reported criminal behaviour through ICO, b = .20, BCa CI [.06, .43].

This represents a small effect, = .10, 95% BCa CI [.03, .19]. There was no significant 2 direct effect of secondary psychopathy𝜅𝜅 on self-reported criminal behaviour, b = .10, p = .44,

The results suggest that the effect of secondary psychopathy on self-reported criminal behaviour is entirely mediated by a stronger identification with other criminals. The mediation effect is displayed graphically in Figure 1.

Figure 1 Conceptual diagram of the Direct and Indirect Effects of Secondary Psychopathy on Self-

Reported Criminal Behaviour for Males.

Females. A mediated regression analysis was conducted to predict self-reported criminal behaviour from secondary psychopathy whilst examining the possible mediating role THE PSYCHOPATH NEXT DOOR 107

of ICO. All assumptions were met. The linear combination of secondary psychopathy and

ICO significantly predicted self-reported criminal behaviour, explaining 10% of the variance,

R = .31, F(2, 351) = 19.62, p <.001. Within the regression model a stronger identification with criminal others significantly predicted criminal behaviour (b =.56, p = .001), as did

higher levels of secondary psychopathy (b =.26, p <.001). The results of the mediation

analysis revealed a significant indirect effect of secondary psychopathy on self-reported

criminal behaviour through ICO, b = .04, BCa CI [.01, .09]. This represents a very small

effect, = .04, 95% BCa CI [.01, .07]. Unlike males, there was also a significant direct 2 effect of𝜅𝜅 secondary psychopathy on self-reported criminal behaviour, b = .26, p < .001. The

results suggest that the effect of secondary psychopathy on self-reported criminal behaviour

is only partially mediated by a stronger identification with other criminals, and that an effect

of secondary psychopathy on criminal behaviour exists even when controlling the effects of identification with criminal others The conceptual model is displayed in Figure 2.

Figure 2 Conceptual diagram of the Direct and Indirect Effects of Secondary Psychopathy on Self-

Reported Criminal Behaviour for Females.

THE PSYCHOPATH NEXT DOOR 108

Discussion

Overview of Research

Previous research on the relationship between psychopathy and criminality has typically utilised male, criminal offender samples, or criminal measures of psychopathy.

Consequently, it has been difficult to interpret previous research on the relationship between psychopathy and criminality because of sample and measurement biases. The current study aimed to provide clarification on the relationship between psychopathy and criminality by using a community sample and a noncriminal measure of psychopathy. An examination of possible gender differences was also included, as research on female psychopathy is scant.

Two current theories of noncriminal psychopathy were explored, the successful psychopathy model and the dual process model. This was achieved by examining the relationship between primary and secondary psychopathy and indices of criminality (criminal convictions, criminal behaviour and traffic violations, and criminal attitudes).

Key Findings

Gender. Research on psychopathy has almost exclusively examined the personality construct in male participants. Because of this, very little is known about psychopathy in women. The few studies that have examined psychopathy in women have found that males generally score higher on measures of psychopathy. Consistent with previous research on psychopathy and gender, the current study found that males possessed higher levels of primary psychopathy than females, but that secondary psychopathy did not differ between genders (Miller, Gaughan, & Pryor, 2008). Although the gender difference in primary psychopathy found in the current study produced a small effect, this finding provides some support for claims by clinicians that the interpersonal and affective features of psychopathy are muted in women (Forouzan & Cooke, 2005). However, alternative explanations for this difference have been proposed in detail by Forouzan and Cooke (2005), including, effects of THE PSYCHOPATH NEXT DOOR 109

gender socialisation on both the behavioural expression of psychopathy in females, and the

clinicians’ assessment of psychopathy in females; the failure of current psychopathy

assessments, designed for males, to capture female psychopathy; and genuine differences in

symptomatology for females. In addition to gender differences in mean psychopathy scores,

the current study also found a range of gender differences in the relationships between

psychopathy and criminal attitudes, and psychopathy and self-reported criminal behaviour.

These findings are discussed in detail in the proceeding sections.

Criminal convictions and traffic violations. It was hypothesised that the degree of criminality reported in psychopathy using a community sample would be lower than that found in criminal offender samples. The current study found no relationship between primary and secondary psychopathy and traffic violations for males or females. Whilst the small proportion of participants in the current sample with a criminal conviction (< 3%) prevented analysis of the relationship between psychopathy and self-reported criminal conduct, the means and standard deviations for global psychopathy, primary psychopathy and secondary psychopathy were similar to those found in criminal offender samples (e.g., C. Brinkley et al.,

2001). This suggests that although psychopathic characteristics can be found equally in criminal offender and community samples, individuals in the community with psychopathic characteristics are far less likely to have a criminal conviction. Interpreted in isolation, this finding would suggest that individuals with psychopathy in general community are engaging in less criminal behaviour that individuals with psychopathy in forensic populations.

However, not all crimes are detected and even when they are detected, they do not always lead to an official conviction. To overcome this limitation, the current study also examined self-reported criminal behaviour, and pro-criminal attitudes.

Criminal attitudes. Following the dual process model it was hypothesised that higher levels of secondary psychopathy, which reflect the antisocial, impulsive and interpersonally THE PSYCHOPATH NEXT DOOR 110 parasitic features, would predict pro-criminal attitudes. However, because the interpersonal and affective features are considered distinct from the antisocial features it was hypothesised that primary psychopathy would not be related to pro-criminal attitudes.

In contrast, the predictions following the successful psychopathy model were that primary or secondary psychopathy could be associated with pro-criminal attitudes. However, because attitudes are implicit and subjective norms influence their behavioural expression, it was suggested that the behavioural expression of these attitudes may be mediated by social factors.

The results showed that for both males and females higher levels of primary and secondary psychopathy predicted the endorsement of pro-criminal attitudes. However, it was higher levels of secondary psychopathy that explained most of the variance, with primary psychopathy not contributing much to the explanation of pro-criminal attitudes. These findings are consistent with research in male criminal offender samples which show that elevated levels of secondary psychopathy are more strongly associated with pro-criminal attitudes than higher levels of primary psychopathy (Simourd, 1997). The results provide partial support both models of noncriminal psychopathy. The dual process model suggests that primary psychopathy and secondary psychopathy arise from distinct etiological mechanisms, and suggest that secondary psychopathy may be more strongly related with criminality. The results provide partial support for this claim as secondary psychopathy was a stronger predictor of pro-criminal attitudes than primary psychopathy. However, the results also provide support for the successful psychopathy model in that both primary and secondary psychopathy were associated with pro-criminal attitudes, but not an increase in official convictions or traffic violations. This suggests that perhaps moderating factors are influencing the expression of psychopathy away from criminal manifestations. This finding was consistent for both male and female participants. However, some gender differences THE PSYCHOPATH NEXT DOOR 111 were evident in the pattern of relationships between primary and secondary psychopathy and the criminal attitudes subscales.

For both males and females only secondary psychopathy significantly predicted negative attitudes towards the justice system. However, gender differences were observed for tolerance for law violations and identification with criminal others. For males, both primary and secondary psychopathy significantly predicted a higher tolerance for law violations, with secondary psychopathy being a better predictor. In contrast, both primary and secondary psychopathy predicted a higher tolerance for law violations, but primary psychopathy was a better predictor in the female sample. This suggests that the relationship between psychopathy and beliefs about criminal behaviour are different for males and females. This finding is consistent with previous research on gender differences in the relationship between psychopathy and criminal recidivism, which show that factor 1 is a better predictor in females samples only (Salekin et al., 1998).

A possible explanation for this difference is the influence of gender norms on attitudes toward antisocial behaviour. In general, antisocial behaviour is more frowned upon, especially violent antisocial behaviour, in females than in males because the behaviour is inconsistent with expected female traits of passivity, empathy and sensitivity. Females with elevated levels of primary psychopathy may have a higher tolerance for law violations because their personality makes them less susceptible to the guilt and shame associated with violating female stereotypes of acceptable behaviour. This is consistent with Cleckley’s

(1941) description of ‘Anna’, a female client with psychopathy who engaged in a range of sexual behaviours considered inappropriate for the era, with an apparent lack of concern for social opinion. However, this explanation warrants further research to establish the possible mediating effects of gender role on the relationship between primary psychopathy and THE PSYCHOPATH NEXT DOOR 112

criminality, particularly because secondary psychopathy was generally a better predictor of

pro-criminal attitudes for both males and females in the current sample.

Self-Reported Criminal Behaviour. An examination of self-reported criminal behaviour was included in the current study to overcome the discrepancies between estimates of crime and official conviction records. According to the dual process model, it was hypothesised that only secondary psychopathy would be associated with self-reported criminal behaviour. The results supported this prediction revealing that secondary psychopathy, but not primary psychopathy, significantly predicted self-report criminal conduct. The results were consistent for males and females, although secondary psychopathy explained more variance in criminal conduct in the female sample compared to the male sample.

The successful psychopathy model proposes that external factors influence the expression of psychopathic traits. According to this model, it was hypothesised that neither primary nor secondary psychopathy would be associated with elevated engagement in criminal behaviour. The results of this study did not support this hypothesis, with secondary psychopathy a significant predictor of criminal behaviour. However, secondary psychopathy did not explain much variance in criminal behaviour, particularly for males, suggesting that other factors are more important than psychopathy in predicting criminal behaviour in this sample. An alternative explanation for this finding could be that social group mediates the relationship between psychopathy and criminal behaviour. The results of the follow-up mediation analysis revealed that the relationship between secondary psychopathy and criminal conduct was entirely mediated by identification with criminal peers for males, and partially mediated by identification with criminals for females. These results suggest that normative effects influence the relationship between psychopathy and criminality. Therefore, it could be that criminal attitudes and behaviours are normalised in circumstances where a THE PSYCHOPATH NEXT DOOR 113

psychopathic individual identifies with a criminal group, resulting in a criminal manifestation

of psychopathy. This interpretation is consistent with the successful psychopathy model,

which suggests that other factors influence the expression of psychopathy towards adaptive and maladaptive manifestations. This claim is bolstered by the results of the current study which demonstrated that whilst primary psychopathy was a significant predictor of pro- criminal attitudes, it was not a significant predictor of criminal behaviour. This suggests that other factors are mediating and/or moderating the relationship between primary psychopathy and criminal behaviour. Gao & Raine (2010) have proposed a neurobiological model to explain differences between noncriminal and criminal psychopaths. The authors suggest that the neurobiological abnormalities found in criminal psychopaths are absent in noncriminal psychopaths, and that these abnormalities may contribute to a criminal manifestation of psychopathy (Gao & Raine, 2010). They suggest that noncriminal psychopathy may be characterised by superior executive function.

Research examining executive functioning in psychopathy has shown that criminal and noncriminal psychopaths display differential patterns of performance on measures of executive function. A study by Ishikawa and colleagues (2001) examined executive functioning in psychopathic individuals and found that whilst criminal psychopaths displayed dysfunctional executive processing, noncriminal psychopaths displayed superior executive functioning compared to both criminal psychopaths and controls (Ishikawa et al., 2001).

Given the differential patterns of executive dysfunction between criminal and noncriminal psychopaths, it is plausible that intact or superior executive functioning could be moderating the influence of pro-criminal attitudes on the behaviour of individuals with elevated levels of psychopathy. Processes such as response inhibition, decision-making ability, cognitive flexibility, and planning may prevent individuals with elevated levels of psychopathy, and pro-criminal attitudes from engaging in risky, criminal behaviours. Superior executive THE PSYCHOPATH NEXT DOOR 114 functioning could moderate the expression of criminal behaviour in individuals with psychopathy because they are better able foresee the consequences of criminal behaviour, are better equipped to inhibit inappropriate behaviour, and have increased cognitive flexibility to determine superior courses of action.

However, these findings may also be explained by the dual process model, which suggests that primary psychopathy results from deficits in the brain’s motivational systems, whilst secondary psychopathy results from deficits in brain regions responsible for higher order cognitive functions (Patrick & Bernat, 2009). According to this model, only secondary psychopathy would be associated with executive dysfunction. The findings of executive dysfunction in criminal, but not noncriminal, psychopathy may be explained by higher levels of secondary psychopathy in the criminal sample. Support for this hypothesis comes from research conducted by Sellbom and Verona (2007) who examined the relationships between general executive control and response inhibition and found that whilst secondary psychopathy was associated with deficits in response inhibition and general executive control, primary psychopathy was related to superior general executive control, but not associated with response inhibition. These findings may explain the results from the current study which found that only secondary psychopathy predicted criminal behaviour, it could be that executive dysfunction in secondary psychopathy may be related to criminal offending.

However, a recent review of the psychopathy and executive function literature found that studies of executive function in psychopathy are obscured by methodological inconsistencies, including differences in samples, measures of executive function, and statistical approaches

(Maes & Brazil, 2013). Therefore, further research is needed to establish whether individuals with secondary psychopathy are at a heightened risk for criminal offending because of executive dysfunction (dual process model), or alternatively whether executive dysfunction THE PSYCHOPATH NEXT DOOR 115

plays a role in moderating the expression of psychopathic traits (successful psychopathy

model).

Implications, Limitations, and Future Directions

Although the current study provides an important contribution to the literature on

psychopathy and criminality, a number of limitations need to be considered when interpreting

the findings. The first limitation is the use of self-report measures to capture primary and

secondary psychopathy, criminal attitudes, and criminal behaviour. The use of self-report

measures can lead to socially desirable responding and other kinds of response biases (e.g.,

conservative or liberal responding). In order to counter social desirability, the current study

was conducted anonymously online. However, online studies can be problematic as

participants can adopt satisficing response strategies, and the ability to participate multiple

times can lead to duplicate data. In order to counter these potential issues, instructional manipulation checks were randomly presented throughout the questions to detect satisfice responding, and the use of a unique identifier was used to prevent duplicate data.

Nevertheless, these techniques may only have reduced the abovementioned issues, rather than eliminated them. Future research could consider the use of scale to measure socially desirable responding and other responses biases (e.g., the Marlowe-Crowne Social Desirability Scale

[MCSDS; Reynolds, 1982]) to identify and address these issues.

Although the study possesses some methodological limitations, the current study

contributes important empirical evidence to the debate on whether criminality is a key feature

of psychopathy. The results obtained challenge the common assumption of both laypeople

and researchers that psychopathy equals criminality, and provides some support for Skeem &

Cooke’s (2010a) assertion that the current body of literature on psychopathy reflects

primarily unsuccessful psychopathy. The findings highlight the need to extend psychopathy

research to noncriminal samples, as such research may lead to the identification of protective THE PSYCHOPATH NEXT DOOR 116

factors for individuals with psychopathy who are at risk of criminal offending. One such

direction for future research could be to examine the role of social group on the relationship

between psychopathy and criminality. Although the findings of the current study suggest that

the relationship between psychopathy and criminal behaviour is mediated by identification

with criminal peers, there was no direct assessment of peer group in the current study, which

limits the conclusions that can be drawn. Another avenue for future research could be to

examine neurobiological differences in psychopathy for criminal and noncriminal samples. In

particular, research examining executive functioning and noncriminal psychopathy may shed

light on the link between psychopathy, criminal attitudes, and criminal behaviour. The

current study also found some evidence of gender differences in the relationships between

psychopathy and criminal attitudes, however, future research is needed to determine the

mechanisms underlying gender differences in psychopathy. One such direction could be to

examine the extent to which psychopathic females identify with the feminine gender role

(e.g., Bem, 1974), and the extent to which gender stereotypes influence criminal and

noncriminal female psychopaths.

Chapter Summary

Controversy around the conceptualisation and measurement of psychopathy has led to an increased interest in noncriminal psychopathy (Hare & Neumann, 2010; Skeem & Cooke,

2010a, 2010b). Current theories of noncriminal psychopathy generally fit into the subclinical model, the successful psychopathy model, or the dual process model. The findings from this study provided support for both the successful and dual process models, with secondary psychopathy being the only significant predictor of criminal behaviour, yet this was entirely mediated by identification with criminals for males, and partially mediated for females.

Interestingly, both primary and secondary psychopathy were predictive of pro-criminal attitudes, suggesting that other compensatory mechanisms may be moderating the expression THE PSYCHOPATH NEXT DOOR 117 of primary psychopathy in noncriminal samples. One explanation of these findings may be that dysfunctional executive processes in secondary psychopathy leads to an increased risk for criminal offending and that intact processes in primary psychopathy act as a protective mechanism against criminal offending. However, this suggestion requires future research to examine the potential role of executive function in the psychopathy-criminality nexus.

Chapter Four

Chapter Overview

The results from the previous study provided support for both the dual process and successful models of psychopathy. Primary psychopathy did not significantly predict criminal behaviour, however, secondary psychopathy did. Whilst secondary psychopathy was related to criminality, the results suggest that the severe antisocial features often associated with psychopathy are muted in psychopathic individuals living in the community. It has been previously suggested that neurobiological differences may explain the differential manifestation of antisocial behaviour in criminal versus noncriminal psychopaths (Gao &

Raine, 2010). For example, Gao and Raine suggest that neurobiological deficits associated with criminal psychopathy, such as executive dysfunction, reduced grey volume, and decreased autonomic reactivity, may be absent in noncriminal psychopathy. This hypothesis aligns with theoretical accounts of ‘successful psychopathy’, in which compensatory mechanisms, such as superior intelligence, are thought to moderate the expression of psychopathy towards prosocial or socially acceptable manifestations (Hall & Benning, 2006).

Given the important role of executive processes in regulating socially acceptable behaviour, it seems plausible that executive functioning may be differentially impaired in criminal versus noncriminal psychopathy. From this perspective, executive function may moderate the expression of criminal behaviour in individuals with psychopathy. THE PSYCHOPATH NEXT DOOR 118

In contrast, proponents of the dual process model claim that psychopathy is not a

unitary disorder. Instead, they suggest that deficits in two neurobiological systems produce

two distinct patterns of personality dysfunction (Patrick & Bernat, 2009). According to this

model, primary psychopathy results from a deficiency in the brain’s defensive motivational

system resulting in trait fearlessness. In contrast, secondary psychopathy is thought to stem

from impairments in brain regions responsible for higher-order processes such as planning,

behavioural inhibition, and cognitive flexibility, resulting in a vulnerability to externalising

psychopathology (e.g., behavioural deviance, substance abuse) (Patrick & Bernat, 2009).

According to the dual process model, individuals can present with elevations on both primary

and secondary psychopathy, or either primary or secondary psychopathy. From this

perspective, only individuals with elevated levels of secondary psychopathy are at risk of

behavioural deviance because of difficulties with higher order processes, vis a vis executive

dysfunction.

This chapter of the thesis describes a study that empirically tests these two theories of psychopathy by examining relationship between noncriminal psychopathy and executive function. The review of the literature on executive function in psychopathy will highlight that research on executive function in both criminal and noncriminal psychopathy has produced

mixed findings. These contradictory findings may result from methodological inconsistencies

across studies of executive function in psychopathy, including differences in the

conceptualisation of psychopathy (unitary syndrome or dual process); the measurement of

both psychopathy and executive function; and demographic differences between criminal and

noncriminal samples (e.g., sex, age, level of education, and drug use).

In the current study executive function in primary and secondary psychopathy is

examined using a noncriminal sample and several commonly used measures of executive

function, whilst also controlling for the possible mediating role of intelligence. An additional THE PSYCHOPATH NEXT DOOR 119

focus was the examination of sex differences in the psychopathy-executive function

relationship. In doing so, this addresses a significant gap in the psychopathy literature on

executive function which hitherto has focused almost exclusively on males. Considering

gender differences is particularly important given that research, including the findings Study

1 of this program of research, suggest some gender differences exist in the manifestation of

psychopathy (Forouzan & Cooke, 2005; Justus & Finn, 2007). The chapter begins with a critical review of the literature on psychopathy and executive function and highlights the discrepancies and inconsistencies in previous research. The aims of the current study are then described along with the methodology. The chapter concludes with a discussion of the findings in relation to current models of psychopathy.

Background to Research

Intact self-regulatory processes are essential for socially appropriate behaviour, leading researchers to suggest that executive dysfunction may underlie the range of socially inappropriate and self-defeating behaviours observed in individuals with psychopathy. This hypothesis is bolstered by evidence of ‘acquired sociopathy’ or ‘pseudo-psychopathy’, a condition characterised by pervasive changes in personality and socially appropriate behaviour, such as callousness, a paucity of emotion, irresponsibility, impulsivity, and a lack of empathy, following damage to the ventromedial prefrontal cortex, an area implicated as important for executive functioning (Tranel, 2002). Whilst these patients display profound deficits regulating socially inappropriate behaviour, like psychopathic individuals they generally display intact intelligence, memory, and language ability.

There is now a wealth of evidence to suggest that psychopathy is characterised by a range of cognitive deficits. Studies have shown that psychopathic individuals display attentional abnormalities, such as reduced interference on Stroop-like tasks (Hiatt et al.,

2004) and reduced physiological reactivity to irrelevant auditory stimuli (Jutai et al., 1987). THE PSYCHOPATH NEXT DOOR 120

In addition to the attentional abnormalities, there is also accumulating evidence of executive dysfunction in criminal psychopathic individuals, such as poor behavioural inhibition

(Newman & Brinkley, 1997), difficulties planning a sequence of events (Lapierre, Braun, &

Hodgins, 1995; Pham et al., 2003), difficulties changing response strategies to changing environmental contingencies (Ishikawa et al., 2001), and poor decision-making (Mitchell et al., 2002).

Executive Function

Executive function is an umbrella term that refers to a range of cognitive functions

including: working memory, attention, response inhibition, planning, and cognitive

flexibility, all of which are necessary for the regulation of socially acceptable behaviour

(Chan, Shum, Toulopoulou, & Chen, 2008; Damasio, 1995b; Jurado & Rosselli, 2007; Royall

et al., 2002). Research suggests that the broad range of executive functions can be organised

into three correlated yet separate processes: set shifting or task-switching, inhibition, and

working memory functions such as monitoring and updating (Miyake et al., 2000). Collette et

al’s (2005) research using Positron Emission Tomography (PET) provided further support for

both the unity and diversity of executive functioning by demonstrating that whilst all three

executive processes share common neural substrates, there are also specific neural substrates

for each executive function (updating, shifting and inhibition). Although executive functions

can generally be categorised into three separate processes, research on executive function

also includes an examination of planning ability, which reflects the ability to plan a sequence

of events in order to achieve a goal. However, the planning function may fall under the

banner of ‘inhibition’, as it involves suspending behaviour and evaluating several potential

options before proceeding with a course of action.

Hofmann, Schmeichel and Baddeley (2012) suggest that all three basic executive functions play a role in the self-regulation of behaviour. Working memory capacity (WMC) THE PSYCHOPATH NEXT DOOR 121

(monitoring and updating) is linked to self-regulation through executive attention and goal-

shielding. Executive attention and goal-shielding refer to the ability to ignore distracting

stimuli and maintain goal-directed focus. WMC is considered to be a passive form of

inhibition in self-regulation because inhibition of distracting stimuli/thoughts results from the

selective activation of goal-directed processing. Inhibition is a key component of self-

regulation and refers to the ability to inhibit impulsive responses that conflict with an

individual’s goals. Finally, task-switching or set shifting refers to cognitive flexibility and

involves overriding prepotent responses that are no longer advantageous, and adopting

alternative strategies and methods (Hofmann et al., 2012; see also Miyake et al., 2000).

Given that intact executive function processes are essential for self-regulation and socially acceptable behaviour, it seems plausible that psychopathy may be associated with executive dysfunction. The intuitive appeal of the executive dysfunction hypothesis has resulted in active research on psychopathy and executive dysfunction, however results are contradictory and clouded by methodological inconsistencies. These methodological inconsistencies include heterogeneous samples, different measures of psychopathy, and different measures of executive function. Generally speaking, two streams of research on the psychopathy-executive function relationship have emerged, a stream examining executive function in criminal psychopaths (often referred to as unsuccessful psychopaths), and a stream examining executive function in noncriminal psychopaths (often referred to as successful psychopaths).

Some researchers claim that unsuccessful psychopathy is associated with poorer executive functioning, whilst successful psychopathy is associated with superior executive functioning (Gao et al., 2009; Gao & Raine, 2010). This hypothesis was generated in part by a study by Ishikawa, Raine, Lencz, Bihrle and Lacasse (2001). They examined performance on the Wisconsin Card Sorting Test (WCST), a common neuropsychological measure of THE PSYCHOPATH NEXT DOOR 122 executive function, in male participants classified as successful psychopaths, unsuccessful psychopaths, and non-psychopathic controls. The results showed that successful psychopaths solved more categories, and displayed less perseverative and non-perseverative errors than the unsuccessful psychopaths and non-psychopathic controls. There were no differences in

WCST performance for the unsuccessful psychopaths and non-psychopathic controls. This study has been consistently referred to in the literature as evidence of superior executive functioning in successful psychopaths. However, the literature on executive functioning in psychopathy is considerably more complex, with differential patterns of association between executive function observed for primary (F1) versus secondary psychopathy (F2), both within the criminal and noncriminal psychopathy literatures, and inconsistent results across different measures of executive function. This has led some researchers to propose that the inconsistent findings may be attributed to the different types of executive function tasks tapping two kinds of executive processes: hot executive function processes, and cool executive function processes (e.g., Lapierre et al., 1995; Snowden et al., 2013). These two types of executive function are discussed in the proceeding section.

Hot and Cool Executive Function

Previous research on executive function in psychopathy has often produced inconsistent findings, with some research showing no evidence of executive dysfunction

(e.g., Hare, 1984; Hart, Forth, & Hare, 1990). This has led some researchers to suggest that psychopathy may be marked by specific executive dysfunction, namely dysfunction on measures of hot executive function and intact performance on measures of cool executive function (Lapierre et al., 1995; Snowden et al., 2013). Hot executive functions refer to cognitive functions that are recruited in situations that are emotionally or motivationally significant because they involve reward/punishment, and are believed to be subserved by the orbital-ventromedial prefrontal cortex and its associated pathways (Zelazo & Muller, 2002; THE PSYCHOPATH NEXT DOOR 123

Zelazo et al., 2010). In contrast, cool executive functions are purely cognitive in nature, such as working memory, planning, set-shifting and attentional processes, and are believed to rely on the lateral prefrontal cortex (Zelazo & Carlson, 2012; Zelazo & Cunningham, 2007;

Zelazo & Muller, 2002; Zelazo et al., 2010). Researchers claim that similar to the individuals with ‘acquired sociopathy’, the psychopathic individuals’ executive dysfunction is underscored by orbital-ventromedial prefrontal cortex deficits, with largely intact lateral prefrontal cortex functioning (K. S. Blair, Newman, et al., 2006; Gao et al., 2009; Lapierre et al., 1995; Snowden et al., 2013). However, evidence for compromised orbital-ventromedial prefrontal cortex functioning and intact lateral frontal cortex functioning in psychopathy is equivocal.

Snowden et al. (2013) examined performance on measures of hot and cool executive function as a function of PPI-R assessed psychopathy in 150 undergraduate students. They used the Porteus Maze and Object and Spatial Alternation Tasks1 to measure orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC) functioning, respectively. Snowden et al. (2013) found no significant relationship between global psychopathy, fearless dominance, or self-centred impulsivity and performance on the Spatial Alternation Task.

However, fearless dominance was weakly negatively correlated with performance on the

Object Alternation Task, and both fearless dominance and self-centred impulsivity were associated with poorer performance on the Porteus Maze. The authors concluded that the poor performance on the Porteus Maze reflected OFC dysfunction. However, the claim that the Porteus Maze selectively taps orbitofrontal cortex functioning is spurious, with some research showing that the dorsolateral cortex is also involved (Roberts & Wallis, 2000).

Furthermore, the finding of poor performance on the Porteus Maze contrasts with an earlier study of psychopaths recruited from the general population (Widom, 1977). Here

1 In the Porteus Maze THE PSYCHOPATH NEXT DOOR 124

performance of psychopaths on the Porteus Maze was similar to that found in normal, healthy

adults.

Using a criminal sample, Pham, Vanderstrukken, Philippot and Vanderlinden (2003)

examined executive function in 36 male inmates assigned to psychopathic and non-

psychopathic groups on the basis of PCL-R classification. They found some evidence to

support selective attention abnormalities, specifically impaired maintenance of attention on

the D-II Cancellation Test (a measure of cool executive function). Psychopathic individuals

made significantly more qualitative errors on the Porteus Maze (crossed more walls), they performed significantly more movements on misleading trials of the Tower of London, and took longer to solve the problem after the first move. Importantly, performance on the Tower

of London has been demonstrated to rely upon the dorsolateral prefrontal cortex (Cazalis et

al., 2003), which is believed to play a role in cool executive functions.

Smith, Arnett and Newman (1992) also found deficits in cool executive function in

psychopaths. They examined performance on several measures of executive function in male

prisoners classified as low anxious psychopaths (n=18), low-anxious non-psychopaths

(n=18), high anxious psychopaths (n=19) and high anxious non-psychopaths (n=14) using the

PCL-R and the Welsh Anxiety Scale. They found that performance on two measures of cool executive function, the Trail-Making Part B (TMT-B) and Block Design test, was impaired in the low anxious psychopaths only, reflecting an impairment in their ability to plan a sequence of events (TMT-B), and their ability to form and maintain a cognitive set, cognitive flexibility, and attention (Block design). These findings and those from Pham et al. (2003) suggest that there is some dysfunction in psychopathic individuals on tasks of cool executive function.

Additionally, there is limited evidence of an OFC deficit even on tasks that are known to rely upon intact OFC functioning, such as the Iowa Gambling Task (IGT), the IGT is THE PSYCHOPATH NEXT DOOR 125 purported to be sensitive to ventromedial deficits and has been widely used in testing the

Somatic Marker Hypothesis (Bechara & Damasio, 2005). For example, Hughes, Dolan,

Trueblood and Stout (2014) examined performance on this task in male offenders with varying degrees of PCL-SV psychopathy and controls and found no difference in performance on the IGT. In fact, higher levels of the antisocial facet of the PCL-SV predicted better performance on the IGT. This finding is in contrast to previous research indicating either poorer performance in psychopathic individuals (R. J. R. Blair, Colledge, & Mitchell,

2001; Mitchell et al., 2002) or intact performance in psychopathic individuals (Schmitt et al.,

1999).

Given the mixed findings on the role of the OFC in psychopathy, it is difficult to draw any firm conclusions regarding the relationship between psychopathy and hot executive functions, or the hypothesis that psychopathy is characterised by a specific OFC dysfunction.

The inconsistencies in results across different studies of hot executive function, may be because different methodologies, samples and statistical analyses were used, or because the relationship between brain pathology and psychological and behavioural functioning is complex. E Miller (1972) in Lezak (2004) made the following insightful analogy:

“It is tempting to conclude that if by removing a particular part of the brain we can

produce a deficit in behaviour, e.g., a difficulty in verbal learning following removal

of the left temporal lobe in man, then that part of the brain must be responsible for the

impaired function…..[T]his conclusion does not necessarily follow from the evidence

as can be seen from the following analogy. If we were to remove the fuel tank from a

car we would not be surprised to find that the car was incapable of moving itself

forward. Nevertheless, it would be very misleading to infer that the function of the

fuel tank is to propel the car forward.” (pp. 19-20) THE PSYCHOPATH NEXT DOOR 126

Thus, whilst specific deficits may be associated with damage to dorsolateral prefrontal

cortical regions or orbitolateral prefrontal cortical regions, it may be misleading to assume

that these regions are solely responsible for the pattern of dysfunction observed in individuals

with psychopathy. Indeed, the variable findings in relation to the role of anxiety (S. S. Smith

et al., 1992) and degree of antisocial markers (M. A. Hughes et al., 2014) suggest greater complexity. It is likely that complex interactions between various prefrontal and other neuroanatomical regions underlie normal executive processing and that damage to any one of these (or combination of) prefrontal or related neuroanatomical regions may result in deficits on a task that relied on the complex interaction. Furthermore, the use of hot executive function tasks to assess executive function in psychopathy may be not be suitable because they also rely on other non-executive processes, such as feedback processing and sensitivity to reward and punishment cues (Maes & Brazil, 2013). In contrast, the use of cool or ‘pure’ executive function tasks allow the examination of cognitive processing in the absence of emotional processing. This distinction is important in psychopathy research because of evidence of emotional dysfunction in psychopathy. However, the research literature on cool executive functioning in psychopathy is also plagued by contradictory and confusing findings.

Cool Executive Functions in Psychopathy

Gorenstein (1982) conducted one of the earliest studies on executive function in psychopathy using a male psychiatric inpatient sample classified as psychopathic (n=20) and nonpsychopathic (n=23) using the Socialization Scale of the California Psychological

Inventory. Psychopathic individuals displayed more perseverative errors on the Wisconsin

Card Sorting Test (a task known to rely on the dorsolateral prefrontal cortex), poorer performance on the Sequential Matching Memory Task, and significantly more reversals on the Necker Cube (a phenomenon observed in bilateral frontal lobe lesion patients). THE PSYCHOPATH NEXT DOOR 127

Gorenstein concluded that psychopathy was marked by frontal lobe deficits. However, the study possessed a number of methodological weaknesses (e.g., differences in substance abuse between the psychopathic and non-psychopathic groups, as well as the scale used to measure psychopathy), and subsequent studies failed to replicate these findings (Hare, 1984; Sutker &

Allain, 1987; Sutker, Moan, & Allain, 1983). For example, Hare (1984) failed to find any group differences in performance on the Wisconsin Card Sorting Test, Sequential Matching

Memory Task, or Necker Cube in a sample of male criminal offenders classified as high

(n=14), medium (n=16) or low (n=16) on psychopathy. However, more recently several studies have reported evidence of poorer performance on measures of cool executive function in psychopathic individuals (Bagshaw et al., 2014; Heritage & Benning, 2013;

Hoppenbrouwers et al., 2013; Kiehl, Smith, Hare, & Liddle, 2000; Kim & Jung, 2014;

Mahmut et al., 2008; Sellbom & Verona, 2007). For example, Hoppenbrouwers et al. (2013) examined dorsolateral prefrontal cortex and working memory functioning in male psychopathic offenders. They found that compared to controls, psychopathic offenders displayed poorer performance on the letter-number sequencing test, a measure of working memory, that was accompanied by inhibition deficits in the DLPFC. These findings suggest that psychopathy is associated with DLPFC dysfunction and this dysfunction may explain the impulse control problems that are characteristic of psychopathy. Whilst these findings provide some evidence of executive dysfunction, studies on cool executive function in psychopathy have also produced inconsistent findings, likely due to methodological differences between studies of executive function in psychopathy. These demographic and measurement differences make it difficult to determine whether executive dysfunction is present in psychopathic individuals. Given the evidence that these differences in findings may be attributed to the use of criminal versus noncriminal samples (Ishikawa et al., 2001), THE PSYCHOPATH NEXT DOOR 128

the extant literature on executive function in criminal and noncriminal psychopathy is

considered separately in the proceeding sections.

Cool Executive Function in Unsuccessful Psychopathy

In addition to the interpersonal, affective and lifestyle features of psychopathy, unsuccessful psychopaths also display problematic antisocial behaviours and a failure to learn from mistakes. This pattern of self-defeating behaviour has led some to propose that criminal psychopathy is characterised by executive dysfunction (e.g., Gao & Raine, 2010; Gorenstein,

1982). However, evidence supporting the executive dysfunction hypothesis has been equivocal, with different results across different executive functions (working memory, planning, set-shifting, and response inhibition) and factors of psychopathy (Factor 1 and

Factor 2 vis a vis primary and secondary psychopathy).

Working Memory. There are only a handful of studies that have examined working memory function in criminal psychopathy, with most research focusing on set-shifting and response inhibition because of their putative link with problematic behaviours. However,

Hansen et al. (2007) examined working memory function in male offenders (n=53) using the

California Computerised Assessment Package Serial Pattern Matching 2 (calCAP-SPM2) and the N-back task (2-back). Using the PCL-R to delineate psychopathy into four facets

(interpersonal, affective, lifestyle and antisocial facets) they found that only Facet 1

(interpersonal) was related to superior performance on the calCAP and the N-back, indicating superior working memory function. No other relationships found with working memory function. In contrast, Hoppenbrouwers et al. (2013) in a small sample of male offenders classified as psychopathic using the PCL-R (n=13) and a small sample of age-matched, healthy, community controls (n=15) found that psychopathic offenders performed worse than healthy controls on the Letter-Number Sequencing test from the Weschler Adult Intelligence

Scale – Third Edition (WAIS-III), indicating deficits in working memory function. These THE PSYCHOPATH NEXT DOOR 129

contrasting findings are difficult to interpret and could be affected by a number of other

factors. For example, Hoppenbrouwers et al. (2013) noted that whilst no participants reported

drug use in the past six months, 87% of the psychopathic participants had a history of drug

use and substance use disorder. Therefore, it is plausible that their findings may be

attributable, at least in part, to neuropsychological changes caused by substance abuse, rather

than psychopathy. Another explanation for the discrepancy between these two studies is that

Hansen et al. (2007) examined working memory function and the PCL-R factors separately, whilst Hoppenbrouwers et al. (2013) only examined the total PCL-R score. Thus, it could be that only the interpersonal facet of the PCL-R is characterised by superior working memory function, whilst the other factors are characterised by impairment in working memory.

Clearly further research is needed on working memory function in criminal psychopathy before any conclusions can be drawn regarding this particular executive function.

Planning. Despite the intuitive appeal of a planning deficit in criminal psychopathy, there is scant research in this area, with only four studies identified as having examined planning in criminal psychopathy. Lapierre et al. (1995) was one of the first to examine planning deficits in criminal psychopathy using the Porteus Maze in a sample of male offenders classified using the PCL-R as psychopathic (n=30) or nonpsychopathic (n=30), and matched on a range of demographic variables (e.g., age, education, socioeconomic status, etc). The Porteus Maze requires participants to trace a path through a series of mazes avoiding dead ends or ‘blind alleys’ and without back-tracking or crossing maze walls. The test is scored for two types of errors: quantitative errors (i.e., the number of wrong entries or blind alleys) and qualitative errors (i.e., rule-breaking errors such as back-tracking and crossing maze walls). Lapierre et al. (1995) found no differences for the number of quantitative errors, but a greater number of qualitative errors. These findings provide initial support for a planning deficit in criminal psychopathy and are consistent with the findings THE PSYCHOPATH NEXT DOOR 130

Pham et al. (2003), who examined planning ability using the Porteus Maze, Trail Making

Test Part B (TMT-B), and a TOL task with three different types of problems: neutral problems, facilitating problems and misleading problems. They found no differences in PCL-

R psychopathic or nonpsychopathic offenders for the number of quantitative errors on the

Porteus Maze, but found significant differences for the number of qualitative errors. They also found that psychopaths displayed excessive movements on misleading trials of the TOL, broke more rules, and displayed longer subsequent completion times than nonpsychopathic offenders, regardless of problem type. These findings suggest that planning deficits in psychopathy may be subtle and dependent upon task complexity. The longer subsequent completion times may be attributed to impulsively moving the first disc without thoughtful consideration of the sequence of moves required to complete the problem. Bagshaw et al.

(2014) found similar results when they examined planning ability using an adapted Tower of

London (TOL) task in a small sample of male offenders. They found that PCL-R psychopathy was related to more moves on misleading trials of the TOL and that Factor 1

(interpersonal and affective) and Factor 2 (impulsive and antisocial) were negatively related to planning times. The shorter planning times and higher number of moves on misleading problems indicate difficulties with planning a sequence of events, possibly because of impulsive decision-making. Altogether, the findings from these studies suggest that criminal psychopathy is characterised by planning deficits.

Response Inhibition. Similar to research on working memory function, research on response inhibition in psychopathy has produced mixed findings, Kiehl et al. (2000) examined response inhibition in psychopathy using a Go/No-Go task in male offenders classified as psychopathic (n = 13) and nonpsychopathic (n = 11) using the PCL-R. They found no difference in performance between the two groups. However, other studies using the same paradigm did observe difficulties in response inhibition (Lapierre et al., 1995; THE PSYCHOPATH NEXT DOOR 131

Varlamov, Khalifa, Liddle, Duggan, & Howard, 2011). For example, Varlamov et al. (2011) compared performance in personality-disordered male forensic patients classified as psychopathic (n = 22) or nonpsychopathic (n= 27) using the PCL-R, and a group of healthy controls matched on age, intelligence, and parental occupation. They found that the psychopathic patients made significantly more errors of commission than the nonpsychopathic patients and controls. However, psychopathic patients made a similar number of errors of omission to the healthy controls, indicating a problem with response inhibition on No-Go trials but intact performance on Go trials.

As with working memory and planning performance, these inconsistent findings may be explained by differential patterns of relationship with response inhibition deficits for

Factor 1 (interpersonal and affective) and Factor 2 (impulsive and antisocial). Support for this hypothesis is provided by a recent study that examined the relationship between PCL-R psychopathy factors and response inhibition using the Hayling Sentence Completion Test in a sample of 29 male offenders (Bagshaw et al., 2014). The authors found that Factor 2 was moderately associated with poorer response inhibition on the Hayling Sentence Completion

Test. However, there was no relationship between performance and Factor 1, indicating intact response inhibition.

Set-shifting. The ability to shift between tasks is another key executive function.

Lapierre et al. (1995) examined set-shifting in a male offender sample using the WCST. They found that psychopaths (n = 30), classified using the PCL-R, made more perseverative errors and achieved fewer categories than the nonpsychopathic offenders (n =30), with a trend towards significance (p = .07, p = .06, respectively). In contrast, Pham et al. (2003) found that performance on the WCST in psychopaths (n =18) and offender controls (n = 18) was similar, with psychopathic offenders actually making fewer perseverative errors. However, these inconsistent findings may result from differential relationships between PCL-R THE PSYCHOPATH NEXT DOOR 132

psychopathy factors and performance on the WCST, similar to what was observed by

Bagshaw et al. (2014)

For example, Mol, Van Der Bos, Derks and Egger (2009) examined possible differential associations between PCL-R Factor 1 and Factor 2, and performance on the

WCST in a male forensic sample (n = 53). There were no differences in performance between psychopathic (n = 17) and nonpsychopathic individuals (n = 36) in the number of categories achieved, or in the number of perseverative and nonperseverative errors. However, when they examined the relationships between WCST performance and the PCL-R factors separately they found that Factor 1 was related to better performance on the WCST, with more categories achieved and fewer perseverative and nonperseverative errors. In contrast, Factor 2 was largely unrelated to performance, with a weak relationship with nonperseverative errors observed. Furthermore, when they examined performance in four psychopathy subgroups

(low F1 and F2 [low-low, n = 16), high F1 and low F2 [high-low, n = 6], high F2 and low F1

[low-high, n = 8], and high F1 and high F2 [high-high, n = 16) they found no significant

differences in performance between the four groups. However, this may be because of a lack

of statistical power from the small sample sizes, as the pattern of results showed that the

high-low group had fewer perseverative and nonperseverative errors and achieved more

categories than the other groups. The low-high group performed the worst, with a greater number of perseverative and nonperseverative errors and fewer categories achieved (See

Table 9). This pattern of results suggest that Factor 1 may be related to superior performance and Factor 2 related to worse performance. However, given the weak correlations found, further research is needed before strong conclusions can be drawn regarding set-shifting in criminal psychopathy.

To recap, the lack of consistency in findings across different studies of executive function in criminal psychopathy may be a function of the different measures of executive THE PSYCHOPATH NEXT DOOR 133 function utilized and may reflect differences task complexity. Alternatively, given that some studies have shown a differential pattern of relationships between Factor 1 and Factor 2 psychopathy and executive dysfunction, the inconsistency in previous findings could be a result of failing to parse psychopathy into primary and secondary factors. Based on the preliminary evidence examining primary and secondary psychopathy and executive function, it appears that primary psychopathy may be related to intact or superior executive functioning, whilst secondary psychopathy may be associated with executive dysfunction.

Interestingly, secondary psychopathy reflects the antisocial features of psychopathy and there is considerable debate about whether antisociality is a central feature of psychopathy or simply one behavioural manifestation of the central personality characteristics. Given that

Morgan and Lilienfeld (2000) concluded from their meta-analytic review that there was a robust and significant relationship between antisocial behaviour and executive dysfunction, the degree to which executive dysfunction is attributable to psychopathy, or just antisociality more broadly, is debatable.

For example, Dolan (2012) examined DLPFC dysfunction using a planning, set- shifting and response inhibition task in male offenders with ASPD and varying degrees of psychopathy (Low, Medium, High) with healthy controls. Results on the planning task showed that offenders with Anti-Social Personality Disorder (ASPD) performed worse than healthy controls but that psychopathy score was not related to performance: participants who scored higher on psychopathy performed as well as healthy controls. This suggests that previous research showing planning deficits in criminal samples may reflect the DLPFC dysfunction associated with ASPD rather than psychopathy. In regards to set-shifting, Dolan found that offenders with ASPD performed worse on the set-shifting task than healthy controls, but again, performance did not vary with psychopathy scores. It is reasonable to suggest that previous research that found set-shifting deficits in offenders with psychopathy THE PSYCHOPATH NEXT DOOR 134

may be due to antisocial behaviour features related to psychopathy, rather than psychopathy

per se. In regards to the response inhibition task (Go/No-Go), Dolan found that ASPD

participants with moderate levels of psychopathy performed worse than healthy controls but

that ASPD participants with high levels of psychopathy displayed intact performance on the

Go/No-Go and actually displayed longer mean reaction times than healthy controls,

suggesting a response style marked by lower levels of impulsivity.

Similarly, Zeier, Baskin–Sommers, Hiatt Racer, and Newman (2012) recently concluded from the results of their study that response inhibition deficits are not unique to psychopathy, but related to antisociality more broadly. Using a male offender sample they examined the relationship between response inhibition using a flanker task, psychopathy using the PCL-R, and antisocial personality disorder. They found that when they examined the global psychopathy scores and performance on the flanker task that high psychopathic, low anxious individuals performed worse. However, they further elucidated the relationship between psychopathy and response inhibition by examining Factor 1 and Factor 2 separately, they found that only Factor 2 was related to worse performance. Interestingly, when they examined the data for overlapping effects of antisocial personality disorder and psychopathy, antisocial personality disorder remained a significant predictor of response disinhibition, but none of the PCL-R scores approached significance. This suggests that it is the antisocial behaviour associated with, but not unique to, secondary psychopathy that is related to poor response inhibition.

Extending this research, De Brito et al. (2013) examined performance on a range of

hot and cool executive functions (verbal working memory, reversal learning, decision-making under risk, and stimulus-reinforcement-based decision making) in a group of violent offenders diagnosed with ASPD with and without PCL-R assessed psychopathy. The results revealed that the violent offenders (both ASPD-P and ASPD+P) displayed poorer THE PSYCHOPATH NEXT DOOR 135

performance on measures of hot executive function than a noncriminal control group but

similar performance to each other. Specifically, the offenders failed to change their behaviour

in response to changing task requirements, failed to learn from punishment cues, and despite

taking longer to make decisions than the controls, they displayed more decision-making

errors (De Brito et al., 2013). Furthermore, the offenders (both ASPD-P and ASPD+P)

performed worse on a measure of cool EF (working memory tasks) than controls, but similar

to each other. These findings suggest that poor performance of psychopathic individuals

recruited from forensic samples on tasks of hot and cool executive function may be explained

by factors related to criminality (antisocial behaviour) rather than psychopathy per se.

Taken together, the findings from these three studies suggest that the executive dysfunction found in criminal psychopathy may not be unique to psychopathy, but rather shared by other externalising disorders (e.g., ASPD), all of which place an individual at risk for behavioural deviance. This aligns with claims of the dual process model of psychopathy, which suggests that primary and secondary psychopathy result from distinct etiological processes. Secondary psychopathy is considered to result from deficits in brain regions important for higher order processes, placing these individuals at risk for externalising problems. Interestingly, in criminal offender samples psychopathy is measured using the

PCL-R, which is oversaturated with items tapping externalising symptomatology (e.g., criminal versatility). Therefore, the findings of executive dysfunction in criminal offender samples could be because PCL-R psychopathy reflects elevated levels of primary

psychopathy, but also an emphasis on externalising psychopathology in the assessment of

secondary psychopathy. From this perspective, criminal psychopathy may be related to

executive dysfunction because individuals in forensic institutions have elevated levels of

secondary psychopathy. THE PSYCHOPATH NEXT DOOR 136

However, Gao and Raine (2010) propose an alternative explanation. They suggest

that intact neurobiological functioning differentiates criminal psychopaths from noncriminal

psychopaths. This hypothesis is bolstered by research on executive function in noncriminal

(successful) psychopathy which suggests that criminal psychopaths display executive

dysfunction, but that successful psychopaths actually display superior executive function

(Ishikawa et al., 2001).

Cool Executive Function in Successful Psychopathy

Gao and Raine’s (2010) recent review on successful and unsuccessful psychopathy

highlighted the lack of research on successful psychopathy. They proposed a neurobiological

model to account for the behavioural differences between successful and unsuccessful

psychopaths in criminal offending. They suggested these differences may reflect underlying

neurobiological differences, including executive functioning, in which successful

psychopaths are hypothesised to possess intact or superior functioning, whilst unsuccessful

psychopaths possess deficits. Given the recent evidence that it is antisocial behaviour in

general, rather psychopathy that is associated with executive dysfunction (e.g., Dolan, 2012), it seems plausible that successful psychopaths may possess intact executive functioning.

Indeed, if individuals with the interpersonal and affective features of psychopathy possess intact or superior executive function then their tendencies towards impulsive antisocial behaviour may be moderated by superior planning ability, response inhibition, set-shifting

and working memory.

Working Memory. Sellbom and Verona (2007) examined working memory function

using the digits backward in a sample of undergraduate university students. They found that

Factor 1 psychopathy (measured using the PPI-R) was associated with superior working memory function, with more digits recalled on the digits backward. In contrast, Factor 2 was unrelated to working memory function. Similarly, Sadeh and Verona (2008) examined THE PSYCHOPATH NEXT DOOR 137

performance on measures of selective attention and cognitive control in a sample of male

university students. Using the PPI to measure psychopathy, they hypothesized that primary

psychopathic traits would be associated with superior selective attention/reduced interference of distracting stimuli on a test of selective attention, and that secondary psychopathic traits would be associated with poorer performance on a measure of cognitive control. The results supported their hypothesis, with primary psychopathic traits associated with faster reaction times on the selective attention task, indicating reduced processing of distracting stimuli.

Secondary psychopathic traits were not associated with performance on the selective attention task. However, secondary psychopathic traits, but not primary psychopathic traits, were associated with cognitive control deficits, specifically, impaired working memory function.

These findings suggest a differential pattern of relationships between primary and secondary psychopathy and executive function deficits, with primary psychopathy characterised by intact executive functioning and secondary psychopathy characterised by poor executive functioning. Sadeh and Verona (2008) suggest that the differential pattern may explain the contradictory findings from previous research that failed to partial psychopathy traits into primary and secondary components.

Planning. Gao and Raine (2010) suggest that successful psychopathy may be characterised by superior neuropsychological functioning and that this may facilitate the achievement of personal goals, whilst avoiding detection. In order to successfully achieve their desired goals, these individuals need the ability to foresee possible consequences of their actions, and thus would need intact or superior planning ability. Salnaitis, Baker, Holland, and Welsh (2011) found evidence for such relationship. They examined performance on a computerised version of the Tower of Hanoi to assess planning ability, but also response style, in a sample of undergraduate university students, assessed for psychopathy using the THE PSYCHOPATH NEXT DOOR 138

PPI. They found that high psychopathy scorers displayed better performance, with a response

style marked by slow and accurate responses, compared to low and medium psychopathy

scorers.

In contrast, Snowden et al. (2013) when examining planning ability in an

undergraduate university sample with the Porteus Maze test, found that PPI-R total score,

PPI-I and PPI-II were all related to qualitative errors, suggesting difficulties in planning a sequence of events. However, Sellbom and Verona (2007) used the WISC-III Mazes to assess planning and found no significant relationships between PPI-I and PPI-II and performance.

However, the pattern of relationships showed that PPI-I was associated with better performance, whilst PPI-II was associated with worse performance. Further analysis revealed that the differences in performance for the two PPI-R factors were statistically significant, suggesting that the relationship between psychopathy and executive function is different for the primary and secondary components. Importantly, Sellbom and Verona (2007), unlike

Snowden et al. (2013), presented partial correlations thus identifying the unique relationships between PPI-I and PPI-II and planning ability. The pattern of findings across the three studies of planning ability suggest that, like working memory function, primary psychopathy appears to be related to intact or superior planning ability, whilst secondary psychopathy is associated with poor planning ability.

Set-Shifting. In one of the first studies of set-shifting in successful psychopathy,

Ishikawa et al. (2001) examined performance on the WCST in a sample of successful psychopaths, unsuccessful psychopaths and healthy controls. They were no differences between unsuccessful psychopaths and healthy controls. However, they did find that the successful psychopaths displayed superior performance on the WCST, indicating superior set-shifting abilities. Subsequent studies have failed to consistently replicate this finding. For example, Mahmut et al. (2008) found that high psychopathy participants recruited from a THE PSYCHOPATH NEXT DOOR 139

university student population performed similarly to low psychopathy participants on a

computerised version of the TMT-B, suggesting intact but not superior set-shifting abilities.

In contrast, Yang, Raine, Colletti, Toga, and Narr (2011) examined performance on the

WCST as a function of PCL-R psychopathy in a community sample recruited from temporary

employment agencies. They found that psychopathy was positively associated with the

number of perseverative errors, but not nonperseverative errors. Similarly, Kim and Jung

(2014) examined set-shifting using the WCST in a small sample of university students

classified as psychopathic and nonpsychopathic using the PPI-R. They found that the

psychopathic group displayed significantly more perseverative and nonperseverative errors

than the nonpsychopathic group.

The findings from these two studies (Kim & Jung, 2014; Yang et al., 2011) suggest

that noncriminal psychopathic individuals have deficient set-shifting abilities. However, both

Mahmut et al. (2008) and Yang et al. (2011) used criminal measures of psychopathy (SRP-III

and PCL-R, respectively), thus conflating psychopathy with criminality. Given that there is a

robust relationship between antisocial behaviour and executive dysfunction (Morgan &

Lilienfeld, 2000), these findings may simply reflect the relationship between antisocial

behaviour and set-shifting deficits. Although Kim and Jung (2014) found that PPI-R

psychopathy (a measure of noncriminal psychopathy) was related to more perseverative and nonperseverative errors, they failed to parse the PPI-R into its subfactors: Fearless

Dominance (Primary) and Impulsive-Antisociality (Secondary). When Sellbom and Verona

(2007) examined the separate relationship between PPI-R factors and performance on the

WCST, they found that primary psychopathy was associated with significantly fewer perseverative errors and secondary psychopathy was associated with more perseverative errors. These findings suggest that it is the antisocial characteristics that are associated with THE PSYCHOPATH NEXT DOOR 140

set-shifting dysfunction, and this may explain the inconsistent findings in research on

successful psychopathy.

Response Inhibition. Unlike research on set-shifting, planning and working memory, most of the research on response inhibition has examined the separate relationships between primary and secondary psychopathy and response inhibition, the exception being two recent studies conducted using undergraduate samples. Using the Psychopathic Personality

Inventory: Short Form (PPI:SF), Zimak, Suhr, and Bolinger (2014) found no differences in response inhibition on the Stop-Signal Task between psychopathic and nonpsychopathic participants. Similarly, Kim and Jung (2014) examined response inhibition using the Go-No-

Go task, a popular measure of response inhibition. The Go-No-Go task is a computerised task that requires participants to respond, as quickly as possible, to ‘Go’ stimuli and to withhold responses for ‘No-Go’ stimuli. Kim and Jung found no differences in performance between

PPI-R psychopaths and nonpsychopaths on the Go-No-Go task. These findings suggest that successful psychopathy is characterised by normal response inhibition. However, studies that have examined primary and secondary factors separately paint a different picture. For example, Sellbom and Verona (2007) found that PPI-I was unrelated to response inhibition assessed using the Controlled Word Association Test and a Flanker Task. However, PPI-II was significantly related to response inhibition deficits, with higher levels of PPI-II significantly related to greater errors of commission on the Flanker Task.

Providing support for Sellbom and Verona’s research, Heritage and Benning (2013) tested the Response Modulation Hypothesis (RMH)2 in male (n = 39) and female participants

(n = 50) recruited from an emergency department. Psychopathy was assessed with the

multidimensional personality questionnaire, from which scores of Impulsive-Antisociality

2 The Response Modulation Hypothesis is described in detail in Chapter Two of this thesis. THE PSYCHOPATH NEXT DOOR 141

(e.g., SCI, PPI-II) and Fearless Dominance (e.g, PPI-I) were produced. They tested the RMH using a stop-signal lexical decision task with words of different valence (positive, negative, and neutral) and measured the event-related potentials (ERPs) N1 and error-related negativity

(ERN). The N1 is used as an index of attentional processing and the ERN is elicited when an individual responds erroneously, it is used as an indicator of error monitoring. Heritage and

Benning showed that individuals with higher levels of Fearless Dominance had intact performance on the task and normal N1 and ERN responses. However, Impulsive

Antisociality (IA) was associated with poorer performance on the task, with poorer lexical decision accuracy, stop signal accuracy, stop signal delay and stop signal reaction times. This did not change as a function of the valence of the word (positive, negative, or neutral). IA was also correlated with smaller ERN peaks for the lexical decision responses and stop signal inhibition, suggesting problems with error monitoring. Individuals higher on IA also showed smaller N1 peaks after all stop signals, suggesting an issue with processing of the stop signal itself. Follow-up mediation analyses showed that N1 mediated the relationship between IA and ERN, suggesting that problems with inhibiting responses on the task may be a product of deficient attentional processing of the stop signal cues. Altogether, these findings suggest that in noncriminal samples, primary psychopaths possess intact response inhibition, whilst secondary psychopaths display dysfunctional response inhibition that is underscored by abnormal physiological reactivity to response inhibition cues. These findings suggest that the antisocial features of psychopathy are related to response inhibition deficits, rather than the core interpersonal features.

Although the majority of findings on response inhibition have found no relationship between primary psychopathy and negative relationships with secondary psychopathy, there are two studies that have found relationships between psychopathy and response inhibition.

For example, Carlson and Thai (2010) examined response inhibition using a modified version THE PSYCHOPATH NEXT DOOR 142

of the Expectancy AX-CPT in an undergraduate university sample (n = 72; 40 females and 32

males). The Expectancy AX-CPT is a computerised task where a single letter is presented on the screen. Participants are required to respond ‘target’ to the letter ‘X’ if it follows the letter

‘A’ and ‘non-target’ to all other letters. The task is designed to create an expectation for X

following the letter A, and participants must withhold responses to other letters following A.

They found that PPI-I was related to superior response inhibition, with faster responses for

correct trials, but that PPI-II was unrelated to performance. In contrast to the previous studies,

these findings suggest that primary psychopathy is associated with superior response

inhibition, whilst secondary psychopathy is characterised by normal response inhibition.

However, Lynam, Whiteside, and Jones (1999) looked at performance on a Go-No-

Go task and a Q task with 77 male undergraduate participants. The Q task is a computerised task that assesses behavioural inhibition to previously punished stimuli. In the conditioning phase, participants are presented with a string of letters and asked to respond as quickly as possible when the letter-string does not contain the letter ‘Q’. Participants are rewarded when they respond correctly (e.g., given points when the Q is absent) and punished when they respond incorrectly (e.g., points taken when the Q is present). In the test phase, participants are again presented letter strings, this time with a combination of letters and number or letters only. Participants are instructed to respond as quickly as possible to the letter-only strings.

The letter Q is presented in some of the letter-only strings and responses on this task are again rewarded or punished. Longer reaction times to letter trials containing the Q compared non-Q trials indicate greater inhibition to the previously punished stimuli. There were no significant correlations between secondary psychopathy and performance on the Q task or

Go-No-Go task. However, total scores on the Levenson Self-Report Psychopathy Scale

(LSRP) were correlated with Go-No-Go commission errors, and this was primarily because of a significant relationship between primary psychopathy and commission errors on the Go- THE PSYCHOPATH NEXT DOOR 143

No-Go task. On the surface, these findings suggest that the interpersonal features of psychopathy are related to response inhibition. However, in this sample, primary psychopathy was more strongly related to antisocial behaviour, as assessed by the Antisocial Behaviour

Inventory, than secondary psychopathy. Therefore, these findings provide partial support for the link between antisocial behaviour features and response inhibition deficits in psychopathy.

Summary of Cool Executive Functioning in Successful and Unsuccessful Psychopathy

Although results differ across studies of criminal and noncriminal samples, with some evidence of executive dysfunction in criminal samples and superior executive function in noncriminal samples, an emerging pattern across both samples is the divergent relationships between primary and secondary psychopathy and executive function (see Table 9). Given these findings, it is plausible that the differing results across the two samples may be attributed to the different ways in which psychopathy was conceptualised, with studies using criminal samples generally failing to parse psychopathy into its primary and secondary factors. When psychopathy is parsed into primary and secondary factors, the findings across both samples suggest that secondary psychopathy may be characterised by executive dysfunction, whilst primary psychopathy may be characterised by intact or superior executive function. However, this pattern is not consistent across different studies of psychopathy and executive function, perhaps because of other methodological differences.

One such methodological difference relates to sample characteristics. Thus, an alternative explanation for the conflicting findings across criminal and noncriminal studies could be that the two samples differ in a range of demographic and socioeconomic factors

(e.g., age and gender). These factors vary across criminal and noncriminal samples and confound any conclusions regarding the role of executive function in the psychopathy- criminality relationship. Importantly, samples also differ according to gender. It is THE PSYCHOPATH NEXT DOOR 144

noteworthy that all of the studies on executive function in criminal psychopathy have used

male participants, in contrast, the majority of the studies on executive function in noncriminal

psychopathy have used mixed gender samples (see Table 9). Despite this obvious gender

confound and bias, only two studies of executive function in noncriminal psychopathy have

examined possible gender differences. This is problematic because there is evidence that the

manifestation of psychopathy is different for males compared to females (e.g., Forouzan,

2003; Rogstad & Rogers, 2008).

For example, Justus and Finn (2007), using a short-form of the PPI-R to examine the influence of psychopathy on startle response to affective images in a community sample of male and female participants, found that the augmentation of the startle response in psychopathy was moderated by gender. Males with elevated levels of global psychopathy and

PPI-I showed decreased startle amplitude compared to males with low psychopathy for unpleasant images, at 2ms probe. However, the opposite pattern was observed for women, with high levels of psychopathy producing greater startle response amplitudes to unpleasant images compared to women low on psychopathy. These findings suggest that the expression of psychopathy is different for males and females, with different physiological reactivity to emotional stimuli observed. Interestingly, female participants in this study had significantly lower levels of antisocial behaviour than the male participants. This finding is consistent with data on gender differences in antisocial behaviour, with rates of antisocial behaviour generally lower amongst females compared to males (Australian Institute of Criminology,

2013). Importantly, antisociality is known to be related to executive dysfunction (Morgan &

Lilienfeld, 2000). This highlights a significant oversight in the current literature on

psychopathy and executive function, as the majority of previous studies using mixed gender

samples have failed to examine possible gender differences. This is problematic because the

available evidence suggests that the manifestation of psychopathy is different for males and THE PSYCHOPATH NEXT DOOR 145 females, and it is possible that the psychopathy and executive function relationship differs depending on gender.

In addition to gender differences in criminal and noncriminal samples, the age of participants in criminal offender and noncriminal samples also varies systematically, with criminal offenders on average ten years older (average age 34 years) than their undergraduate, noncriminal psychopathic counterparts (average age 23 years) (see Table 9).

This age difference is problematic because research on the developmental trajectory of executive function suggests that executive functions peak around the age of 20, with a gradual cognitive decline observed from the age of 30 (for a review see, De Luca & Leventer,

2010). Thus, criminal and noncriminal samples not only differ with respect to antisociality, which is known to be related to executive dysfunction, but also age, which is also linked to performance on executive function tests. Although samples utilising criminal offenders usually have a matched healthy comparison group, the executive function deficits in criminal offenders could be due to additive effects of a vulnerability to externalising psychopathology combined with the onset of general cognitive decline. These differences in both gender and age make comparison of findings between criminal and noncriminal samples very difficult and cast doubt on the claims of executive dysfunction in criminal psychopathy and superior executive functioning in ‘successful’ psychopathy. One simple solution to the demographic inconsistencies would be to recruit participants from the community and to examine data separately for males and females.

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Table 9 Studies Examining Behavioural Performance on Measures of Cool Executive Function in Psychopathy Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables Bagshaw et al. Male offenders 0 PCL-R Weschler Planning Adapted TOL PCL-R related to more moves (r =.45, s) Factors not (2014) (n = 29, mean parsed into Abbreviated (planning time; examined separately.

age = 35) F1 and F2 Scale for number of moves). FI and F2 negatively related to planning times (F1: r scores Intelligence Brixton Spatial =-.57 to -.68) (F2 r = -.35). (WAIS), Set- Anticipation Test: psychopathy F1 and F2 negatively related to rule detection errors shifting (rule detection was not related (F1:r = -.33, ns) (F2 r = -.39, s) and positively related errors and rule to IQ to rule adherence errors (F1 r = .33, s) (F2 r = .35, s) adherence errors) Drug screening The Hayling test, all screens Sentence F1 not related to reaction time or errors returned Completion Test negative results Response F2 related to more errors (r = -.32, p = .051) Inhibition (RT’s and errors) Carlson and Undergraduates 44 PPI parsed Excluded head Response Expectancy AX- No gender differences. FD was associated with faster Thai (2010) (n = 72, mean into FD, IA injury/neuropsy Inhibition CPT (RT) RTs. FD predicted faster RTs on correct trials (r = - Examin age = 20) and CH chological .28, s). No relationship observed for IA or CH. ation of factors conditions gender differen ces DeBrito et al. Male violent 0 PCL-R Total Matched on age Verbal Digits Backward ASPD groups recalled less digits than healthy controls (2013) offenders with Score and IQ. Working (raw score) but there was no difference between ASPD+P or ASPD with (n = Memory ASPD-P participants. Alcohol and 17, mean age = drug use Nonverbal There was no significant difference between groups on 40) and without Spatial Alternation recorded. Working the spatial alternation task. psychopathy (n Task Healthy controls Memory had less THE PSYCHOPATH NEXT DOOR 147

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables = 28, meange substance use age = 36) but substance use was similar Healthy amongst controls (n = ASPD+P and 21, mean age = ASPD-P 35) groups. Dolan (2012) Male offenders 0 PCL:SV Offenders and Planning Computerised No significant differences in planning time across the with ASPD (n = Total Score controls TOL (planning four groups

96, mean age = divided matched on age time and All ASPD groups completed less problems than the 37) sample into and IQ percentage of healthy controls, but only for the difficult trials. Low (LP) problems Healthy Psychopathy groups performed similarly to each other. Medium completed) controls (n = (MP). and No group differences in ID performance but a 49, mean age = ID/ED set-shifting High (HP) significant group difference on ED performance, with 34) Set- task (the mean scorers. healthy controls completing more stages than shifting number of stage offenders. No differences between any of the completed, and the psychopathy groups. number or errors) There was no significant difference in the number of

errors between the four groups for the ID stages. There Go/No-Go Task were significant differences between the healthy Response (Mean probability controls and the psychopathic groups on ED stages. Inhibition of response There was a significant difference in the probability of inhibition and inhibition between the MP group and the LP group mean RT) and healthy controls. The HP group displayed longer mean reaction times than the healthy controls, indicating less impulsive responding. No other group differences were observed. THE PSYCHOPATH NEXT DOOR 148

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables Hansen et al. Male offenders 0 PCL-R Working calCAP/SPM2 Facet 1 related to better performance on the calCAP (2007) (n = 48, mean parsed into Memory (accuracy and RT) SPM2 (r = .29, s) age = 32) Facets 1- 4. N-back task Facet 1 related to better performance on the N-back (accuracy and RT task (r = .27, s) Heritage and Emergency 50 MPQ-BF to Response Lexical Decision FD was not related to performance Benning (2013) dept. patients (n assess FD Inhibition Stop Signal Task No IA was significantly negatively related to LD and SS = 89, mean age and IA (LD reaction examina accuracy, SS delay (r = -.29, -.30, -.31), and = 36) times, LD and SS tion of significantly positively related to SSRT (r =.32) to . accuracy, and gender These findings indicate increased impulsivity and SSRTs) differen difficulty inhibiting a response. ces Hoppenbrouwer Male offenders 0 PCL-R Total Participants Working Letter-number Psychopathic individuals performed worse than s et al (2013) (n = 13, mean Score screened for MI memory sequencing test healthy controls (t[26] = 3.06, s). age = 34) using PAS or from the WAIS-III

case notes (total score) Healthy male controls (n=15, Participants mean age = 34) with current substance use excluded Ishikawa et al. Males classified 0 PCL-R Total IQ measured Set- WCST (CAT, PE, Successful psychopaths solved more categories and (2001) as successful (n Score using the shifting NPE) made fewer perseverative and nonperseverative errors = 13, mean age WAIS-R and than both unsuccessful psychopaths and controls. = 30) and controlled for in Unsuccessful psychopaths and controls did not differ unsuccessful all analyses in performance. psychopaths (n = 17, mean age = 34), or THE PSYCHOPATH NEXT DOOR 149

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables healthy controls (n = 26, mean age = 28) Kiehl et al. Male offenders 0 PCL-R Total Response Go/No-Go Planned comparisons revealed that schizophrenic (2000) comprised of 12 Score Inhibition (Reaction times, offenders made more errors of commission than non- schizophrenic percentage of psychopaths. There were no other significant offenders (mean correct responses, differences in performance, with psychopathic and age = 33) , 24 and errors of nonpsychopathic offenders performing similarly. nonpsychotic commission) offenders classified as psychopathic (n = 13, mean age = 28)) and nonpsychopathi c (n = 11, mean age = 27) Kim and Jung Undergraduate 20 No PPI-R Total Psychopathic Set- WCST (CAT, PE, T-tests revealed that psychopaths and non-psychopaths (2014) students (n = examina Score used and shifting NPE) completed the same number of categories but 30, mean age = tion of to classify nonpsychopathi psychopaths displayed significantly more Go/No-Go Task 20) gender groups as c groups perseverative and nonperseverative errors. (Accuracy and differen psychopathi matched on age, RTs for Go and There were no significant differences in performance ces c or education, IQ No-Go trials) on any aspect of the Go/No-Go task. nonpsychop (WAIS) and athic gender. Response Inhibition Lapierre et al. Male offenders 0 PCL-R used Matched on age, Planning Porteus Maze No differences for number of quantitative errors, but (1995) (n = 60, mean to classify education, (quantitative and psychopathic individuals displayed significantly more

age = 33) offenders as socioeconomic qualitative errors) qualitative errors. THE PSYCHOPATH NEXT DOOR 150

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables psychoapthi status, and drug A trend towards significance was observed for the c (n = 30) or and alcohol number of perseverative errors (p = .07) and categories Set- WCST (CAT, nonpsychop consumption. achieved (p = .06), with psychopathic individuals Shifting NPE) athic (n = No performing worse. 30) neuropsycholog There were no differences in the number of errors of ical problems. Go/No-Go omission, but psychopathic individuals displayed (commission and Response significantly more errors of commission. omission error) Inhibition Lynam, Male 0 LSRP Response Go/No-Go Task LSRP prim was significantly correlated with errors of Whiteside and undergraduate parsed into Inhibition (errors of omission commission (r = .23, s), but not omission. The same Jones (1999) students (n = prim and sec and commission) pattern of results was observed for LSRP sec but the 70). psyc factors results were only marginally significant (r = .18, ns). Demographic details not provided Mahmut et al. Undergraduate 74 SRP-III total Estimated IQ Set- Computerised There were no gender differences in performance. No (2008) students (n = Examin score used using NART, no shifting TMT-B differences in completion time between psychopathic 101, mean age ation of to classify differences (Completion time) and nonpsychopathic groups for either males or = 23) gender participants between males females. However, the Callous-Affect facet was differen as or females and significantly related to longer completion times. ces psychopathi no differences c and between nonpsychop psychopathic athic and nonpsychopathi c groups. Mol et al. (2009) Male forensic 0 PCL-R Age, education Set- WCST (CAT, PE, T-test revealed that performance did not differ psychiatric parsed into and substance Shifting NPE) between psychopathic and nonpsychopathic THE PSYCHOPATH NEXT DOOR 151

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables patients (n = 53, F1 and F2 abuse were participants. However, partial correlations revealed mean age = 39) scores and included as that F1 was positively associated with the number of four covariates categories achieved and negatively associated with subgroups, both perseverative and nonperseverative errors (r = LH, HH, .22, -.15, -.22, respectively). F2 was unrelated to the LL,and HL. number of categories achieved or perseverative errors but was related to nonperseverative errors (r = .17). However, these correlations were not significant at p <.01. Performance on the task also varied across the four subgroups, LH (PE = 23.25, NPE = 26.63, CAT = 4), HH (PE = 20.81, NPE = 23.13, CAT = 4.38), LL (PE = 18.87, NPE = 19, CAT = 4.57) and HL (PE = 13.17, NPE = 12.33, CAT = 5.17), all ns. Munro et al., Male violent 0 PCL-R total Psychotropic Response Go/No-Go Offenders made more errors than controls but that this (2007) offenders (n = score to medications Inhibition (number of was only for errors of commission, with the number of 15, mean age = classify unrelated to omission and errors of omission the same between groups. However, 46) offenders as variables of commission errors the level of psychopathy within the offender group psychopathi interest. and RTs) was negatively related to the number of commission Healthy c (n = 9) and errors (r = -.46). controls (n = nonpsychop 15, mean age = Similarly, offenders displayed longer reaction times athic (n = 6) 47) for Go and No-Go trials. However, the level of psychopathy within the offender group was unrelated to performance (r = -.19). Pham et al. Male inmates (n 0 PCL-R total Matched on age Planning TOL with three Factorial ANOVA’s revealed that psychopaths (2003) = 36, mean age scores used and WAIS IQ. different types of displayed excessive movements but only in misleading

= 30) to classify problems, neutral, trials, and broke more rules and displayed longer participants facilitating, or subsequent completion times than nonpsychopathic THE PSYCHOPATH NEXT DOOR 152

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables as misleading. individuals, regardless of problem type. There was no psychopathi (number of difference between groups for reaction time.

c (n = 18) movements,

and number of broken

nonpsychop rules, initiation athic (n = time and 18) subsequent

completion time)

Psychopaths displayed more qualitative errors than Porteus Maze (Quantitative and nonpsychopaths but a similar number or quantitative qualitative errors) errors. Set- Shifting TMT-A and B There were no differences in performance between (completion time psychopathic and nonpsychopathic participants. and number of errors)

There were no differences in performance between Modified WCST psychopathic and nonpsychopathic participants. (CAT, PE, NPE, and percentage of perseverative errors) Salnaitis et al. Undergraduate 60 PPI total Working Planning Computerised High psychopathy scorers were faster and more (2011) university score used memory Tower of Hanoi- accurate than medium and low psychopathy scorers. No students (n = to classify capacity revised (RT and The results indicate superior planning abilities examina participants assessed using accuracy) amongst noncriminal psychopaths. tion of THE PSYCHOPATH NEXT DOOR 153

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables 82, mean age = gender as low, the Spatial Span 21) differen medium and Task was used ces in high as a covariate psychop psychopathy athy- executiv e function Sellbom and Undergraduate 45 PPI parsed Estimated IQ Composite Digits Backward PPI-I was positively correlated with ECF (r =.28, s). Verona (2007) university into PPI-I measured using scores for (total score) This was primarily due to a negative relationship with No students (n = and PPI-2 the Shipley General the number of perseverative errors on the WCST (r = - examina WCST (PE) 95, mean age = factors Institute of executive .23, s) and better performance on the Digits Backward tion of 20) Living Scale cognitive TMT-B (r = .23, s). gender functions (Completion time) differen PPI-II was negatively correlated with ECF (r = -.22, (ECF) and ces WISC-III mazes s). This was primarily because of longer completion response (Completion time) times on the TMT-B and WISC-III mazes, and more inhibition Controlled Word perseverative errors on the WCST (r = .20, .17, .12, Association Test respectively, ns). (number of words There was no relationship between PPI-I and the retrieved and response inhibition composite or individual tasks (all number of rule ns). breaks) PPI-II was negatively related to response inhibition (- Flanker task .21, s) and this was because of greater commission (errors) errors on the Flanker task (r = .25, s)

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Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables Snowden et al. Undergraduate Experim PPI-R Working Spatial and Object FD was related to more errors on the Object (2013) students. ent 1 (n parsed into Memory Alternation Tasks Alternation Task (r =.22). No other relationships were Experiment 1 (n = 46). FD, IA, and (number of errors) found.

= 90) and Experim CH factors

Experiment 2 (n ent 2 (n Planning = 60). No age = 48). Porteus Maze FD and IA were related to more qualitative errors on or demographic (Qualitative the Porteus maze (r = .24 and .23, respectively). CH No details errors) was unrelated to performance. examina provided. tion of gender differen ces Varlamov et al. Male 0 PCL-R Healthy controls Response Go/No-Go (errors Psychopathic patients made significantly more errors (2011) personality- classified as screened for Inhibition of omission and of commission. Nonpsychopathic patients made more disordered psychopathi psychopathy commission) errors of omission than psychopathic patients and forensic c and using PCL-SV controls, with a trend observed (p = .055). patients with (n nonpsychop = 22, mean age athic = 32) and without psychopathy (n = 27, mean age = 34).

Healthy controls (n = 19, mean age = 33) THE PSYCHOPATH NEXT DOOR 155

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables Yang et al. Community ? PCL-R total Age and IQ Set- Computerised Partial correlations revealed a significant relationship (Yang et al., sample score controlled in shifting WCST (PE and between PCL-R scores and perseverative errors (r = 2011) recruited from analyses NPE) .20, s). No relationship with nonperseverative errors. temp employment agency (n= 86) demographic details not provided. Zeier et al. Male offenders 0 PCL-R Total IQ Response Flanker Task No effect of ASPD on RT. However, ASPD resulted (2012) (n = 98, mean score and Inhibition (accuracy and RT) in significantly more errors on incongruent trials. ASPD age = 28) WAS used No effect of psychopathy, anxiety or their interaction to classify on RT. Psychopathic participants displayed more offenders as errors on congruent and incongruent trials. High low anxious anxious individuals displayed more errors. However, a psychopathi significant interaction was found where high c (n = 29), psychopathic, low anxious individuals displayed more high anxious errors. psychopathi c (n = 25), Analyses of individual PCL-R factors revealed that for low anxious the two-factor model, Factor 2 was related to more nonpsychop errors on incongruent trials. In the three factor model, athic (n = only facet 3 was associated with more errors on 23) or high incongruent trials. anxious When the overlapping effects of ASPD and nonpsychop psychopathy were examined together, ASPD was still athic (n = related to lower accuracy, but psychopathy was no 29). longer related to lower accuracy. THE PSYCHOPATH NEXT DOOR 156

Author/s Sample Females Psychopathy Control Executive EF measure and Results (n) Measure measures Function dependant variables Zimak (Zimak et Male 0 PPI-SF IQ. No head Response Stop-Signal Task T-tests revealed no difference between psychopathic al., 2014) undergraduate participants injury, Inhibition (SSRT) and nonpsychopathic participants on SSRT. students (n = caterogised neuropsycholog 79, mean age = into high ical or 19) and low psychological psychopathy conditions, no substance abuse. Word memory test to detect faking.

Note: PCL-R = Psychopathy Checklist Revised; MPQ = Multidimensional Personality Questionnaire – Brief form; FD = Fearless Dominance; IA = Impulsive Antisociality; CH = Coldheartedness; MI – Mental Illness;

PAS = Personality Assessment Screener; WAIS-III = Wechsler Adult Intelligence Scale Third Edition; WCST = Wisconsin Card Sorting Test; CAT = Categories Achieved; PE = Perseverative errors, NPE =

Nonperseverative Errors; ASPD = Antisocial Personality Disorder; ASPD+P = Antisocial Personality Disorder with Psychopathy; ASPD-P = Antisocial Personality Disorder without Psychopathy; PCL:SV =

Psychopathy Checklist: Screening Version; ID/ED = Intradimensional/Extradimensional; WISC-III = Wechsler Intelligence Scale for Children Third Edition; TMT-B = Trail Making Test Part B; PPI = Psychopathic

Personality Inventory; PPI-R = Psychopathic Personality Inventory-Revised; SRP-III = Self-Report Psychopathy Scale – Version Three; NART = National Adult Reading Test; RT = Reaction times; LSRP = Levenson

Self-Report Psychopathy Scale; WAS = Welsh Anxiety Scale; LH = Low Factor 1 Scores and High Factor 2 Scores; HH = High Factor 1 and Factor 2 Scores; LL = Low Factor 1 and Factor 2 Scores; HL = High Factor

1 Scores and Low Factor 2 Scores; PPI-SF = Psychopathic Personality Inventory – Short Form; THE PSYCHOPATH NEXT DOOR 157

The Current Study

The literature on executive function in psychopathy has produced inconsistent findings in both criminal and noncriminal samples. These inconsistent findings may be attributed to differences in the conceptualisation and measurement of psychopathy, with some

studies examining psychopathy as a unitary construct and others examining primary and

secondary factors separately. According to the dual process model, psychopathy is

conceptualised as two distinct syndromes with distinct neurobiological origins. Primary

psychopathy is thought to arise from a deficiency of the brain’s defensive motivational

system, resulting in the lack of fear and anxiety that is characteristic of the primary

psychopath (Patrick & Bernat, 2009). Secondary psychopathy is considered to result from an

impairment in brain regions that are responsible for higher order cognitive processes.

Although the pattern is somewhat inconsistent across studies, when the unique relationships

are examined between executive function and primary and secondary psychopathy, a

divergent relationship emerges. Primary psychopathy appears to be related to superior, or at

least intact, executive function, whilst secondary psychopathy appears to be related to

executive dysfunction. These findings are consistent with the claims of the dual process

model of psychopathy, which suggest that the interpersonal and affective features (primary

psychopathy [PCL-R Factor 1, PPI-FD]) are etiologically distinct from the socially deviant

and lifestyle features of psychopathy (secondary psychopathy [PCL-R Factor 2, PPI-SCI]).

Further support for the dual process model is found in research which demonstrates unique

and divergent relationship between primary and secondary psychopathy and a range of

external variables.

For example, Heinzen, Köhler, Godt, Geiger, and Huchzermeier (2011) used a large,

male forensic sample to examine the unique relationships between PCL:SV psychopathy

factors, intelligence, and conviction history. The authors found no association between Factor THE PSYCHOPATH NEXT DOOR 158

1 (primary psychopathy) and intelligence or number of convictions. However, they did find that Factor 1 was associated with the length of conviction, perhaps indicating a relationship between primary psychopathy and seriousness of offence. In contrast, Factor 2 (secondary psychopathy) was negatively related with intelligence and the length of conviction, but positively related to the number of prior convictions. These findings indicate that primary and secondary psychopathy share opposite relationships with intelligence and conviction history.

Similar studies have found that primary psychopathy and secondary psychopathy display distinct etiological markers and divergent patterns of relationships with external variables (i.e., socioeconomic status variables) (Benning et al., 2003; Morrison & Gilbert,

2001). Most notably, primary and secondary psychopathy differ in the experience of negative affect (i.e. fear, anxiety and remorse) (Frick et al., 1999; Patrick, 1994). Numerous studies have shown that primary psychopathy is associated with a paucity of negative emotions (K.

S. Blair, Morton, et al., 2006; Frick et al., 1999; Lykken, 1957). Specifically, primary psychopathy is associated with a lack of fear and anxiety (Lykken, 1957; Ogloff & Wong,

1990), poor passive avoidance to punishment when the task involves competing goals

(Newman & Kosson, 1986), and decreased electrodermal responsivity to punishment cues

(Lykken, 1957). In contrast, secondary psychopathy is associated with elevated levels of negative affect, specifically, anxiety, fear and hostility (Hicks et al., 2004; Vassileva et al.,

2005).

Taken together, there is some evidence that psychopathy arises from a two distinct processes, each resulting in different, yet sometimes related, syndromes. From this perspective, primary psychopathy would not be related to executive dysfunction. In contrast, a deficit in brain regions responsible for executive processes places an individual with secondary psychopathy at risk of externalising psychopathology (e.g., behavioural deviance).

Although offering different explanations of psychopathy, the dual process and successful THE PSYCHOPATH NEXT DOOR 159

models of psychopathy are not mutually incompatible. For example, the results from study 1

provided support for both models by showing that the relationship between secondary

psychopathy and criminal behaviour was explained by identification with criminal peers. This

finding is consistent with the successful model of noncriminal psychopathy (Hall & Benning,

2006), which suggests the manifestation of psychopathy is influenced by other internal (e.g.,

intelligence, executive dysfunction) and external factors (e.g., peer group, family

environment).

Further evidence for the successful psychopathy model comes from a recent study by

Wall et al. (2013) which suggests that intelligence moderates the relationship between

psychopathy and criminal behaviour. Using a large undergraduate sample the authors

examined whether intelligence, as measured by the Shipley-2, moderated the relationship between PPI-R psychopathy and scores on the Antisocial Behaviour Questionnaire. The results indicated that individuals with high psychopathy scores (PPI-R and PPI-FD) were less likely to have engaged in criminal behaviour if they had higher scores on both the verbal and non-verbal scales of the Shipley-2. For individuals with higher levels of Self-Centred

Impulsivity, higher scores on the verbal scale of the Shipley-2 predicted a decreased likelihood of having engaged in criminal behaviour (Wall et al., 2013). Therefore, the increased risk for behavioural deviance in secondary psychopathy predicted by the dual process model may be affected by other environmental factors, such as general intelligence, education, socioeconomic status, and peer group, a finding that is consistent with the successful psychopathy model. Following this line of reasoning, it may be that secondary psychopathy is related to an increased risk of behavioural deviance because of executive dysfunction, but that the degree of executive dysfunction moderates the relationship between secondary psychopathy and antisocial behaviour. However, there are no known studies that have explicitly tested these two neurobiological theories of noncriminal psychopathy. THE PSYCHOPATH NEXT DOOR 160

Aims and Hypotheses

The primary aim of this study is to empirically test two contemporary neurobiological theories of psychopathy; the successful psychopathy model (Gao & Raine, 2010; Hall &

Benning, 2006) and the dual process model. Given the pattern observed in previous research on executive function in psychopathy and the findings of Study 1, it is hypothesised that there will be intact or superior performance on measures of executive function in primary psychopathy. Because there is accumulating evidence that supports the dual process model, it is hypothesised that secondary psychopathy will be related to poorer performance on measures of executive function. However, in line with the claims of the successful psychopathy model, it is hypothesised that the relationship between secondary psychopathy and antisocial behaviour will be moderated by the degree of executive dysfunction.

A secondary aim of this study is to address the demographic inconsistencies between criminal and noncriminal studies. This will be achieved by recruiting participants from the community, as opposed to an undergraduate university sample. Furthermore, this study will examine possible gender differences in the relationship between psychopathy and executive function. Given that previous research has demonstrated gender differences in the expression of psychopathy, it is hypothesised that there would be some gender differences in the relationship between psychopathy, executive function, and criminal behaviour. Given that there is limited research on psychopathy in women, and that the current study is exploratory, no specific hypotheses were made in regards to gender differences.

In addition to the examination of gender, this study will also control for possible effects of intelligence on the relationship between primary and secondary psychopathy and executive function. There is some evidence that performance on tests of executive function are related to performance on intelligence tests (e.g., Salthouse, 2005), and that tests of executive function and tests of intelligence both measure general intelligence (e.g., THE PSYCHOPATH NEXT DOOR 161

Obonsawin et al., 2002). However, more in-depth analysis of the relationship between

intelligence and executive function shows that inhibition and task switching are not related to

general intelligence, and that updating may be the only executive function that is related to

general intelligence (Miyake et al., 2000). Nevertheless, given the differential relationship

between primary psychopathy and secondary psychopathy and intelligence (Heinzen et al.,

2011; Vitacco, Neumann, et al., 2005), and preliminary evidence that intelligence moderates

the psychopathy-antisocial behaviour relationship (Wall et al., 2013), the current study will

examine possible mediating effects of intelligence on the psychopathy-executive function

relationship.

Method

Participants

Forty participants were recruited from the participant pool of Study 1 (19 males, 21 females) by contacting all participants who expressed interest in participating in future

studies.The average age of participants was 28 years (males M = 28 years, SD = 7.6 years;

females M = 27 years, SD = 10 years). The sample consisted of participants who were

students (55%), and participants who were employed full-time (25%), part-time (2.5%), or on

a casual basis (10%); self-employed (5%), or unemployed (5%). Table 10 displays the

breakdown of employment status and education level by gender. Participants with a previous

history of psychiatric or neurological illness, and/or regular use of psychiatric or neurological

medication were excluded from participating. Additionally, participants who did not speak

English as their first language were excluded from participation.

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Table 10 Employment status and education presented separately for males and females (N = 40)

Demographic Variable % Male (n = 19) % Female (n = 21)

Highest Level of Education

Year 12 Certificate 31.60 50.00

Trade/Diploma 26.30 25.00

Undergraduate Degree 36.80 20.00

Postgraduate Degree 5.30 5.00

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Materials

The Psychopathic Personality Inventory-Revised (PPI-R) (Lilienfeld & Widows,

2005). The Psychopathic Personality Inventory-Revised (PPI-R) is a 154-item self-report questionnaire commonly used to assess psychopathy in noncriminal populations (Lilienfeld &

Widows, 2005). Each item consists of a statement that participants endorse on a four-point

Likert scale (anchors are 1= false, 2= mostly false, 3= mostly true, 4= true). The PPI-R yields a global psychopathy score, as well as eight content scale scores: Machiavellian Egocentricity

(ME), Rebellious Nonconformity (RN), Blame Externalisation (BE), Carefree

Nonplanfulness (CN), Social Influence (SOI), Fearlessness (F), Stress Immunity (STI), and

Coldheartedness (C). Factor analysis of the scale reveals a two factor solution that is THE PSYCHOPATH NEXT DOOR 163 consistent with other well-validated measures of psychopathy (Benning, et al., 2003;

Lilienfeld & Widows, 2005).

The PPI-FD factor labeled “fearless dominance” consists of scores from the SOI, STI and F content scales and reflects higher levels of wellbeing (e.g., lower social and physical anxiety, and lower levels of worry and tension), interpersonal dominance, narcissism, and thrill-seeking (Benning et al., 2003; Benning et al., 2005; Lilienfeld & Widows, 2005). The

PPI-SCI factor labeled “self-centered impulsivity” consists of scores from the ME, RN, BE and CN content scales and reflects higher levels of manipulativeness, impulsivity, a propensity to blame others for one’s shortcomings, and a defiance of societal norms and values (Benning et al., 2003; Benning et al., 2005; Lilienfeld & Widows, 2005). Although the

C content scale does not load highly onto either PPI-FD or PPI-SCI, the scale captures a callous disposition, a characteristic that many clinicians consider to be central to psychopathy

(Cleckley, 1951; Lilienfeld & Widows, 2005).

The scale has good internal reliability for the global psychopathy scale with

Cronbach’s alpha .92 (Lilienfeld & Widows, 2005). The temporal reliability of the global psychopathy scale remains high at an average test-retest interval of 19.94 days (Cronbach’s alpha = .93) (Lilienfeld & Widows, 2005).

The Wisconsin Card Sorting Task (WCST). The WSCT is a classic test of executive function that has been used extensively in cognitive, neuropsychological and personality research (Eling, Derckx, & Maes, 2008). The WCST provides an index of abstract reasoning ability, concept formation, the ability to maintain a response strategy, and the ability to change response strategies to changing environmental contingencies (Eling et al., 2008). The test consists of four stimulus cards and 128 response cards that depict varying geometric figures (triangles, stars, crosses, and circles), colours (red, green, yellow, and blue) and number of figures (one, two, three, or four). The task requires the participant to match THE PSYCHOPATH NEXT DOOR 164

each of the 128 response cards to one of the four stimulus cards and the participant is given

feedback about whether the response was correct or incorrect. Once the participant has

achieved ten consecutive correct responses the sorting principle is changed without warning.

The test yields seven different scores: number of categories completed, trials to complete first

category, percent perseverative errors, percent non-perseverative errors, failure to maintain

set, percent conceptual level responses, and learning to learn. The variables of interest for this

study were the number of categories achieved as an index of overall task performance, and

the percentage of perseverative errors as an index of task-switching ability. Computerised

administration of the WCST was used with the Wisconsin Card Sorting Test: Computer

Version Four (WCST:CV4).

The N-Back Task. The n-back task is commonly used to investigate working

memory function and uses a parametric design to vary working memory load whilst

maintaining task consistency across conditions. A single n-back task was utilized across four levels of difficulty (0-3-back). The stimuli consisted of eight phonologically distinct consonants (B, F, H, K, M, Q, R, X). A computerised version of the task was administered using E-prime software.

The Tower of London. The Tower of London (TOL) requires participants to manoeuvre a number of discs across three vertical pegs of differing sizes from a start position to a goal configuration, under the tasks constraints that only one disc is moved at a time, and the number of discs on each vertical peg cannot exceed what the peg can accommodate (The first peg can only accommodate one disc, the second peg can accommodate two discs, and the third peg can accommodate three discs). Successful completion of the task requires a number of execution functions, including planning, response inhibition and goal-oriented

behaviour (Anderson & Douglass, 2001; Goel & Grafman, 1995). A computerised version of

the Tower of London Drexal University (TOL-DX) (Culbertson & Zillmer, 1998) was THE PSYCHOPATH NEXT DOOR 165

administered using the Psychology Experiment Building Language (PEBL) software

(Mueller, 2010). The indices of performance on the TOL-DX were the total number of correct trials, the average planning time (time from presentation of trial to the first problem- solving move), and the average execution time (time from first problem-solving move to completion of trial).

The Stop-Signal Task. The stop-signal task is used to assess response inhibition

(Lappin & Erikson, 1966; Logan & Cowan, 1984; Vince, 1948). Research by Verbruggen and Logan (2008) suggests that in contrast to other measures of response inhibition, such as the go/no-go paradigm, the stop-signal paradigm captures controlled, top-down inhibition, and is therefore a purer measure of executive control processes in response inhibition. A windows executable version of the stop-signal task called ‘STOP-IT’ (SI) was used to administer the task (Verbruggen, Logan, & Stevens, 2008). The primary task requires participants to perform a shape judgement task by discriminating between a square and circle as quickly and accurately as possible. However, on stop-signal trials an auditory stop signal is presented immediately following the presentation of the primary stimulus, which signals that participants must withhold their response. The SI software uses a horse-race model to produce a measure of the latency of the stop process, known as the stop-signal reaction time

(SSRT) (Verbruggen et al., 2008). Greater stop signal reaction times are indicative of poorer response inhibition.

The Raven’s Standard Progressive Matrices Plus (SPM-P). The SPM-P is a nonverbal measure of cognitive reasoning ability that was designed to capture the educative component of Spearman’s g. The SPM-P consists of a series of patterns or designs with a missing section. Participants are required to select the correct missing section from a number of possible alternatives in a multiple choice format. The SPM-P consists of 60 problems divided into five sets with a progressive level of difficulty both among the problems in each THE PSYCHOPATH NEXT DOOR 166 set, and across sets (sets A-E). Each set consists of 12 problems. The test produces total scores ranging from 0-60 with higher scores on the SPM-P indicating higher levels of educative reasoning ability. The SPM-P provides a robust measure of cognitive reasoning ability in a wide range of cultural, socioeconomic and ethnic groups and possesses adequate test-retest reliability (>.85) for periods up to one year (Raven, Raven, & Court, 2000).

Procedure

Participants from Study 1 who indicated that they were interested in participating in future studies were contacted. Testing was conducted individually in a quiet study room at the Queensland University of Technology. Participants were given an information letter which detailed the nature of the research and participation requirements (See Appendix 3 for information letter). The executive function tasks, the SPM-P, and the PPI-R were conducted in a counter-balanced order to control for order effects. The SPM-P and the PPI-R were administered according to the test manual procedures for each test. Computerised versions of the WCST, Stop-Signal, N-Back and Tower of London were used. Participants were encouraged to take regular breaks between testing. The entire testing session lasted approximately 120 minutes, including instructions and practice blocks.

The computerised executive function tasks. The computerised executive function tasks were conducted on a computer connected to a flat screen monitor with a screen resolution set at 1920x1080 pixels and a screen refresh rate of 60 Hertz. Auditory displays were presented using the computer speakers and participants provided confirmation that the sound was audible. A standard qwerty keyboard was used to obtain responses from participants on the n-back and stop-signal tasks. An optical computer mouse was used to obtain responses on the WCST and Tower of London tasks.

The WCST:CV4. The WCST:CV4 was administered to participants according to the test manual instructions for computer mouse administration. The four stimulus cards were THE PSYCHOPATH NEXT DOOR 167

presented across the top of the screen and the response cards were presented on the bottom of

the screen one at a time. Participants were required to match the response cards to the

stimulus cards by using the computer mouse to select the stimulus card they believed

matched the response card (pressing either the left or right mouse key). After each selection

participants were given visual and auditory feedback on whether their selection was correct

or incorrect.

The N-Back. Stimuli were presented in black on a white background for 500ms with a 2,500ms interval which consisted of a blank screen. Participants responded with the ‘target” key which was mapped to the ‘f’ key if the target matched the stimulus presented n-items ago, or the ‘not a target’ key which was mapped to the ‘j’ key if the target did not match the stimulus presented, with a response window of 3,000ms. In the 0-back condition participants

were asked to respond if the stimulus presented matched a pre-specified stimulus (X). In the

1-back condition, the target was any letter that was identical to the letter immediately

preceding it (one trial back). In the 2-back and 3-back conditions, the target was any letter

that was identical to the letter presented two or three trials back, respectively.

Participants performed a practice block at the start of each level so that the task

requirements were clear. This was followed by three experimental blocks of each of the four

levels in a sequential order, resulting in 12 blocks. Each block consisted of 30 trials which

contained 10 targets and 20 non-targets presented in a pseudorandom sequence (random with

reset after complete cycle of stimuli). Full instructions for the n-back task are presented in

Appendix 4.

STOP-IT (Verbruggen et al., 2008). Stimuli consisted of a square and a circle

presented in the centre of the screen in white text on a black background. On stop-signal trials

(25% of the trials) an auditory stop signal (750 Hz for 75 ms at 80dB) was presented

immediately following the presentation of the primary task stimulus. Participants responded THE PSYCHOPATH NEXT DOOR 168

with the ‘square’ key which was mapped to the ‘z’ key if the stimulus presented was a square

and the ‘circle’ key which was mapped to the ‘/’ key if the stimulus presented was a circle.

Participants performed a practice block of 32 trials followed by three experimental

blocks of 64 trials. Each trial consisted of the presentation of a fixation sign (+) presented in

the centre of the screen for 250ms which was immediately replaced by the primary stimulus.

The primary stimulus was presented until a response was obtained or 1250ms (maximum

reaction time), with an ISI of 2,000ms that was independent of reaction time. On stop-signal

trials the stop signal was presented at varying stop-signal delays (SSDs) using a staircase procedure. The initial SSD was 250ms and when the response was correctly inhibited the

SSD increased by 50ms; when the response inhibition failed the SSD decreased by 50ms.

There was a compulsory 10 second break between blocks in which participants were

provided with feedback on their performance on the previous block, including the number of

incorrect responses on no-signal trials, the number of missed responses on no-signal trials,

and the percentage of correctly inhibited responses (Verbruggen et al., 2008).

TOL-DX (Culbertson & Zillmer, 1998; Mueller, 2010). The task consisted of three

pile heights: the first pile could only accommodate one disc, the second pile height could

accommodate two discs and the third pile height could accommodate three discs. Participants

were instructed to move the discs to match the goal configuration within a specified number

of moves using the computer mouse. The next trial commenced once the participant was

successful or the specified number of moves had been exhausted. The task consisted of 15

trials. Full instructions for the TOL-DX task are presented in Appendix 5.

Design

A cross-sectional, correlational design was used to predict executive function from

primary and secondary psychopathy. Primary psychopathy and secondary psychopathy were THE PSYCHOPATH NEXT DOOR 169 the predictors variables and were assessed using the Psychopathic Personality Inventory-

Revised (PPI-R) (Lilienfeld & Widows, 2005). The PPI-R was chosen for this study to allow the comparison of findings with previous reseach on psychopathy and executive function, which has predominately used the PCL-R or PPI-R.

The executive functions of set-shifting, working memory function, planning, and response inhibition were assessed using the Wisconsin Card Sorting Task, the N-back task, the Tower of London task, and the Stop-Signal task, respectively and these were used as the outcome variables. Measures of cool executive function were chosen to allow the examination of cognitive processing in the absence of emotional processing. As previously mentioned, this distinction is important in psychopathy research because of evidence of emotional dysfunction in psychopathy.

Estimates of general cognitive ability were obtained using the Raven’s Standard

Progressive Matrices Plus. This measure of cognitive ability was used to examine possible mediating effects of cognitive ability on the psychopathy-executive function relationship.

Follow-up moderation analyses were conducted to examine the influence of executive function on the relationship between psychopathy and criminal behaviour. Criminal behaviour was measured using the Self-Report Criminality Scale data from Study 1.

Results

Data Screening

Data were screened prior to analyses for accuracy of input and outliers. There were no out-of-range values, and all means and standard deviations were plausible. Missing values were not systematic and were excluded from analyses in a pairwise fashion. The PPI-R was evaluated for inconsistent responding, and socially desirable and/or malingering response sets according to the test manual instructions (Lilienfeld & Widows, 2005). One female THE PSYCHOPATH NEXT DOOR 170 participant scored highly on the ‘Deviant Responding’ subscale. Experimenter notes indicated that this participant had adopted a satisfice response style throughout the experiment despite multiple reminders about task requirements. This participant was excluded from all analyses. One female participant scored highly on both the ‘Virtuous’ and

‘Deviant’ Responding subscales. However, there was no evidence to suggest the participant had adopted an exiguous response style, there was no evidence of inconsistent responding, and the PPI-R scores were within normal ranges. Therefore, in order to increase power this participant was included in all analyses with the caveat that they may have been ‘faking bad’ and ‘faking good’ on the PPI-R.

The data was examined for univariate outliers, and values were considered problematic if they were greater than 3.29 standard deviations from the mean. There was only one participant (male) with extreme scores, which reflected extremely high levels of PPI-

Total, PPI-FD, PPI-SCI and PPI-C. In order to retain the extreme value whilst reducing the impact, the value was replaced with a score that was equal to three standard deviations from the mean. Normality was checked separately for males and females via inspection of histograms. Due to the small samples sizes (male n = 19, females n = 19) the data displayed slightly leptokurtic distributions, but was otherwise normally distributed. Distribution-free tests were used where violations of normality could impact the robustness of the statistical analyses.

Descriptive Statistics

Descriptive statistics are displayed separately for males and females in Table 11.

Because gender differences in psychopathy are often reported, an examination of mean differences was conducted using t-tests (Mann-Whitney U analyses were consistent with the results of the t-tests). There was a significant gender difference in PPI-R Total Scores, t(36) =

2.41, p = .021, = .14, which could be attributed to higher scores for males on the PPI-C, 2 𝜂𝜂 THE PSYCHOPATH NEXT DOOR 171

t=(36) = 2.95, p = .005, = .19, and PPI-FD subscales t(35) = 2.30, p = .027, =.13. There 2 2 were no significant gender𝜂𝜂 differences observed for self-report criminality, PPI𝜂𝜂-SCI, cognitive ability, or any of the executive function measures. The means and standard deviations for the PPI-R were in line with those found in previous research using community samples, for both the male and female samples (Lilienfeld & Widows, 2005). Additionally, the means for the male sample were similar to those found in an Australian male prison sample (PPI-Total M = 310.67, SD = 37.29; PPI-SCI M = 156.96, SD = 29.74; PPI-FD M =

124.69, SD = 18.20; PPI-C M = 42.96, SD = 9.52) (M. A. Hughes, Stout, & Dolan, 2013). THE PSYCHOPATH NEXT DOOR 172

Table 11 Descriptive Statistics for Psychopathy and Executive Function for Males and Females Male (n=19) Female (n=19) Measure M SD SE Min Max M SD SE Min Max Self-Report Criminality Scale 33.00 13.78 3.45 22.00 76.00 29.18 9.27 2.25 22.00 53.00 PPI-R Total 306.89 40.32 9.25 266 424 276.47 37.36 8.57 219 354 PPI-R Self-Centred Impulsivity 148.37 23.90 5.48 118 191 139.58 18.72 4.29 110 194 PPI-R Fearless Dominance 126.00 20.73 4.89 77 177 109.89 21.74 4.98 69 152 PPI-R Coldheartedness 33.95 7.75 1.78 21 56 27.00 6.83 1.56 16 40 SPM-Plus 43.28 8.84 2.08 25 58 39.55 6.79 1.60 27 56 TOL Total 30.00 10.39 2.45 12 45 27.17 8.38 2.03 15 39 TOL Avg Planning Time (sec) 22.65 12.88 3.03 8.26 52.48 15.56 6.58 1.55 9.99 28.87 TOL Avg Execution Time (sec) 8.47 2.78 .65 4.73 15.07 9.85 4.04 .95 9.99 16.21 SSRT(ms) 279.43 39.2 9.24 225.00 365.10 273.46 46.29 10.91 198.70 373.50 WCST Categories Achieved 5.82 .73 .18 3 6 5.72 .82 .19 3 6 WCST Perseverative Errors % 8.82 3.94 .95 5.00 23.00 9.00 4.45 1.05 5.00 20.00 N-Back Zero Back Target Hits 30.00 0.00 0.00 30.00 30.00 30.00 0.00 0.00 30.00 30.00 N-Back One Back Target Hits 25.66 3.41 .80 17.00 30.00 26.39 2.91 .68 18.00 30.00 N-back Two Back Target Hits 23.27 7.22 1.70 0.00 30.00 24.39 3.93 .92 15.00 30.00 N-back Three Back Target Hits 16.06 8.05 2.01 2.00 29.00 16.76 5.72 1.39 3.00 25.00

THE PSYCHOPATH NEXT DOOR 173

Inferential Statistics

The data were examined separately for males and females to elucidate any gender differences in the psychopathy-executive function relationship. Because of breaches to the normality assumption, Kendall’s Tau nonparametric bivariate correlations were conducted and are displayed separately for males and females in Table 12. The results show that the pattern of relationships between the psychopathy subscales, and psychopathy and executive function is different for males and females. Given the differences in the psychopathy- executive function relationship, separate regression analyses were conducted for males and females for the executive function measures. THE PSYCHOPATH NEXT DOOR 174

Table 12 Bivariate Correlations between Psychopathy and Executive Function for Males and Females (Males are below the diagonal, females above) PPI-R PPI-SCI PPI-FD PPI-C SPM SRCS TOL TOL P TOL E SSRT WCST CA WCST PE One-back Two-back Three-back

PPI-R .519** .677** .673** .143 .278 .244 .214 -.155 -.391* .093 -.147 -.298 .127 .163

PPI-SCI .622** .185 .376* .294 .236 .459** .199 -.376* -.229 -.108 -.356* -.080 .149 .194

PPI-FD .695** .362* .505** .091 .400* .044 .148 .030 -.459* .217 -.124 .008 .221 .162

PPI-C .149 -.125 .180 -.031 .079 .004 .149 .-.075 -.209 .266 -.297 -.298 .127 .163

SPM -.133 -.260 -.120 .149 .378* .067 -.355# -.187 .086 -.140 .458* .598** .605**

SRCS .205 .256 .293 .026 -.100 .383# -.020 -.099 -.296 -.162 .159 .250 .125 .104

TOL -.222 -.377* -.030 .137 .430* -.142 .284 -.529* -.253 -.112 .048 .114 .292 .148

TOL P -.033 -.092 .096 .233 .253 -.020 .651** .033 -.137 .211 -.062 .140 .035 -.090

TOL E .281 .472** .214 -.207 -.558** .156 -.477** -.176 .150 -.014 -.034 -.070 -.438* -.209

SSRT .098 .026 .244 .033 .239 -.215 .383* .268 -.124 .099 .062 -.084 -.327 -.045

WCST CA -.343 -.344 -.354 -.349 .306 -.080 .331 .000 -.343 .214 -.487* .150 .210 .125

WCST PE .318# .440* .161 .008 -.462* .183 -.287 -.127 .207 -.096 -.371 .117 -.110 -.295

One-back -.129 -.137 -.054 .035 .132 .051 .280 .238 -.089 -.048 .202 -.042 .424* .254

Two-back .094 -.047 .168 -.027 .226 .281 .305 .243 .067 .121 .355 -.206 .505** .567**

Three-back -.176 -.336 -.221 .239 .281 .160 .266 .126 -.377* -.192 .367 -.104 .487* .421*

Note. *p <.05, **p < .01, # = trend towards significance. Two-tailed. Running head: THE PSYCHOPATH NEXT DOOR 175

Psychopathic Personality Inventory – Revised

The results show that the pattern of relationships between the PPI-R subscales and the total scale is different for males and females. Whilst PPI-C is not related to PPI-Total, PPI-

FD or PPI-SCI in males (all r <.19, ns), PPI-C is positively associated with PPI-total, PPI-FD and PPI-SCI in females. The findings of low mean inter-item correlations for the PPI-R factors in the male sample are consistent with previous research on the PPI-R in an Australian male prison sample (M. A. Hughes et al., 2013). However, the results of the mean inter-item correlations for the female sample are not in line with previous research. Chapman, Gremore, and Farmer (2003) using a female prison sample found that PPI-C only displayed a weak relationship (r=.11) with the PPI overall scale score. However, this study did use an earlier version of the PPI-R (PPI).

Raven’s Standard Progressive Matrices-Plus

The SPM-P was used to examine if there was a relationship between psychopathy and intelligence in the community. The results revealed that PPI-R, PPI-FD, PPI-SCI and PPI-C were not significantly related to the SPM-P for either males or females (all ns). This finding is in line with previous research in general population samples, which shows there is no relationship between psychopathy and intelligence (Bagshaw et al., 2014). With the exception of TOL final score (r = .37, p = .04), TOL execution time (r =-.33, p =.05), and N-back performance (one-back, r = .42, p = .02; two-back, r = .59, p =.001; three-back, r = .60, p

=.001), there were no significant relationships between SPM-P and the executive function measures, for females. As can be seen in Table 11, for males, higher scores on the SPM-P were significantly negatively related to WCST perseverative errors, and TOL execution time; and significantly positively related to TOL total score. There were no significant relationships observed between SPM-P and SSRT, WCST categories achieved, TOL planning time, or performance on the N-back (all ns). Whilst all relationships between the PPI-R scales and THE PSYCHOPATH NEXT DOOR 176

SPM-P were weak and non-significant, preliminary evidence suggests that intelligence may

be a compensatory mechanism in the psychopathy-criminality relationship (Wall et al., 2013).

Therefore, follow up tests were conducted to examine possible mediating effects of cognitive

ability on the psychopathy-executive function relationship for each individual task (i.e., the

TOL, Stop-signal, WCST, and N-back).

Tower of London

Tower of London -Total Score. Increased levels of PPI-SCI in males was

significantly related to poorer performance on the TOL, with a moderate, negative correlation

observed. In contrast, increased levels of PPI-SCI in females was significantly associated

with better performance on the TOL, with a moderate, positive correlation observed (see

Table 11). This difference cannot be explained by mean differences between males and

females on PPI-SCI or performance on the TOL. There were no significant relationships

observed between PPI-Total, PPI-FD, and PPI-C and performance on the TOL for either

males or females (all ns). Although non-significant, it is interesting to observe that the pattern

of relationships between PPI-Total, PPI-FD, and PPI-C and performance on the TOL was

opposite for males and females. For females, increased levels of psychopathy were positively

associated with performance on the TOL. For males, increased levels of psychopathy were

negatively associated with performance on the TOL, with exception of the PPI-C factor

which displayed a weak, positive correlation. Because of differences in the relationship

between PPI-SCI and TOL performance, separate regression analyses were conducted for

males and females.

Males. A mediated regression analysis was conducted to predict performance on the

TOL from PPI-SCI whilst examining the possible mediating role of SPM-P. All assumptions

of the analysis were met. The linear combination of PPI-SCI and SPM-P significantly predicted performance on the TOL, explaining 51.28% of the variance, R = .71, F(2, 15) = THE PSYCHOPATH NEXT DOOR 177

7.89, p =.004. Within the regression model higher scores on the SPM-P significantly predicted better performance on the TOL (b =.53, p = .04), whilst higher scores on the PPI-

SCI scale predicted worse performance, with a trend towards significance observed (b =-.16, p = .07). The results of the mediation analysis revealed a significant indirect effect of PPI-

SCI on TOL through SPM-P, b = -.09, BCa CI [-.25, -.01]. This represents a medium effect,

= .23, 95% BCa CI [.03, .50]. There was also a direct effect of PPI-SCI on TOL 2 𝜅𝜅performance, b = -.17, p = .07, with a trend towards significance observed. These results

suggest a partial mediation effect of SPM-P on the relationship between PPI-SCI and TOL

performance. This indicates that PPI-SCI predicts poorer performance on the TOL through its

relationship with SPM-P, although a direct effect of PPI-SCI still exists beyond the mediating

role of SPM-P. This relationship is displayed graphically in Figure 3a. Running head: THE PSYCHOPATH NEXT DOOR 178

Figure 3a. Figure 3b.

Conceptual Diagram of the Direct and Indirect effects of Self- Conceptual diagram of the Direct and Indirect Effects of Self- Centred Impulsivity on Tower of London Execution Times for Males. Centred Impulsivity on Tower of London Performance for Males.

Running head: THE PSYCHOPATH NEXT DOOR 179

Females. A mediated regression analysis was conducted to predict performance on the TOL

from PPI-SCI whilst examining the possible mediating role of SPM-P. All assumptions were met. Unlike males, there was no mediating role of SPM-P, b = .03, BCa CI [-.01, .23]. The regression analysis revealed that higher levels of PPI-SCI significantly predicted better performance on the TOL, R = .59, with 34.8% of the variance explained, F(1, 14) = 7.48, p =

.01.

Tower of London – Planning and Execution Time. For males and females, there was no relationship observed between the PPI-R scales and planning time (all ns). However, for males higher levels of PPI-SCI were significantly related to longer execution times, with a moderate-strong relationship observed. In contrast, higher levels of PPI-SCI in females was moderately, negatively related to execution time, with a trend towards significance observed

(p = .05). This differential relationship between PPI-SCI and TOL execution time cannot be explained by mean differences between males and females on PPI-SCI or TOL execution time. There were no significant relationships observed between PPI-Total, PPI-FD, or PPI-C and TOL execution time for either males or females (all ns). Although non-significant, the direction of the relationships between the PPI-R scales and TOL execution time was again opposite for males and females. These differences in performance were followed up with separate regression analyses for males and females.

Males. To examine possible mediating effects of SPM-P, a mediated regression analysis was conducted to predict TOL execution times from PPI-SCI scores. All assumptions were met. The results of the regression revealed that PPI-SCI and SPM-P significantly predicted performance on the TOL, explaining 63.57% of the variance, R = .79,

F(2, 15) = 13.08, p <.001. Higher scores on the SPM-P significantly predicted shorter execution times on the TOL (b = -173.43, p = .006). However, higher scores on the PPI-SCI scale significantly predicted longer execution times (b = 44.97, p = .04). The results of the THE PSYCHOPATH NEXT DOOR 180

mediation analysis revealed a significant indirect effect of PPI-SCI on TOL execution times

through SPM-P, b = 30.04, BCa CI [1.46, 82.49]. This represents a medium effect, = .29, 2 95% BCa CI [.03, .56]. There was also a significant direct effect of PPI-SCI on TOL𝜅𝜅 performance, b = 44.97, p = .04. The conceptual diagram is displayed in Figure 3b. These results show a partial mediation effect of SPM-P on the relationship between PPI-SCI and

TOL execution times. However, elevated scores on the PPI-SCI significantly predict longer execution times, even with the effects of SPM-P partialled from the regression. These longer execution times seen for males with elevated levels of PPI-SCI could be due to impulsively moving the first disc without considering the constraints imposed by the move limit.

Females. A mediated regression analysis was conducted to predict execution times on the TOL from PPI-SCI scores, whilst examining any mediating effects of SPM-P. All assumptions were met. The linear combination of SPM-P and PPI-SCI significantly predicted execution times on the TOL, R = .48, accounting for 23.48% of the variance, F(2, 14) = 5.41, p = .01. The details of the regression are displayed in Table 13 and show that only SPM-P was a significant predictor, with higher scores predicting shorter execution times.

Furthermore, unlike males, there was no mediating effect of SPM-Ps on the relationship between PPI-SCI and TOL execution times b = -15.92, BCa CI [-96.53, 4.24].

THE PSYCHOPATH NEXT DOOR 181

Table 13

Mediated Regression Predicting Tower of London Execution Times from Self-Centred Impulsivity and Cognitive Ability for Females.

B SE B β t

Constant 25142.49 5851.12

SPM-P -192.22 78.98 .-.34 2.43*

PPI-SCI -56.96 42.90 -.27 1.34

Note. *p<.05

Stop-Signal Reaction Time

There were no significant relationships observed between any of the PPI-R scales and

SSRT for males (all ns). However, the results for the female sample show that elevated levels of PPI-R Total and PPI-FD were related to shorter SSRT times. These results were followed up with a forced entry multiple regression analysis predicting SSRT from the linear combination of PPI-FD, PPI-SCI and PPI-C. A forced entry multiple regression analysis was chosen because little is known about the relationships between primary and secondary psychopathy and executive function in females. The results revealed that the linear combination of PPI-FD, PPI-SCI, and PPI-C did not significantly predict SSRTs, R = .52,

F(3, 13) = 1.48, p = .26. However, an examination of the individual beta-weights revealed a trend towards significance for higher levels of PPI-FD predicting shorter SSRTs (p = .09).

Accordingly, a follow up mediated regression analysis was conducted to predict SSRT from

PPI-FD, whilst controlling for the effects of SPM-P. All assumptions of the analysis were met. The results revealed that higher levels of PPI-FD predicted shorter SSRT’s, b = -.95, t =

1.81, explaining 19.48% of the variance, R = .44, F(1, 15) = 3.27, with a trend towards THE PSYCHOPATH NEXT DOOR 182

significance observed (p = .07). There was no mediating effect of SPM-Ps on the relationship

between PPI-FD and SSRT, b = -0.07, BCa CI [-.53, .06]. These results suggest that higher

levels of the interpersonal and affective features of psychopathy in females, such as

interpersonal dominance, narcissism, and low levels of anxiety predict superior response

inhibition, with a moderate effect observed.

Wisconsin Card Sorting Task

The bivariate correlations between PPI-R Total, PPI-SCI, PPI-FD, PPI-C and

performance on the WCST show that the pattern of relationships vary according to gender. A

similar pattern of relationships emerged, with psychopathy in males related to poorer

performance on the Wisconsin Card Sorting Test, whilst in females psychopathy was

associated with superior performance on the Wisconsin Card Sorting Test.

Categories Achieved. There were no significant relationships observed between

WCST number of categories achieved and any of the PPI-R scales for males or females (all

ns). However, consistent with the pattern of results for the other executive function measures,

the number of categories achieved was moderately and negatively related to PPI-R total, PPI-

FD, PPI-SCI and PPI-C for males, and moderately and positively related to PPI-FD and PPI-

C for females. There was no relationship between PPI-R Total and PPI-SCI in females (<

.11).

Percentage of Perseverative Errors. For males there was a significant moderate, positive relationship between the number of perseverative errors made and PPI-SCI. There was also a moderate, positive relationship between PPI-R Total and the number of perseverative errors, with a trend towards significance (p = .09). There were no relationships observed between PPI-FD, PPI-C and the number of perseverative errors made. For females, there were no relationships between the number of perseverative errors and PPI-R Total, PPI- THE PSYCHOPATH NEXT DOOR 183

FD or PPI-C. However, there was a significant negative relationship observed between the

number of perseverative errors and PPI-SCI. These significant findings were followed up with separate mediated regression analyses for males and females.

Males. Given that a moderate relationship was observed between PPI-R Total, PPI-

SCI, and the percentage of perseverative errors, a hierarchical multiple regression was conducted to predict the percentage of perseverative errors from the linear combination of

PPI-SCI, PPI-FD, and PPI-C. The assumption of normally distributed residuals was not met, therefore a logarithmic transformation was applied to PPI-SCI, PPI-FD, PPI-C, SPM-P, and

WCST percentage of perseverative errors. This transformation was successful in achieving the assumptions of the test, and the analysis was performed using the transformed data. PPI-

SCI was entered in the first step, and PPI-FD and PPI-C were entered in the second step. At the first step, the results revealed that higher levels of PPI-SCI significantly predicted a higher percentage of perseverative errors, b = 1.27, t = 2.90, explaining 31.80% of the variance, R = .60, F(1, 15) = 8.44, p = .01. The addition of PPI-FD and PPI-C to the regression model did not produce a significant change in , F(2, 13) = 1.36, p = .29. The 2 linear combination of PPI-SCI, PPI-FD, and PPI-C explained𝑅𝑅 34.9% of the variance, R = .68,

F(2, 13) = 3.86, p = .03. However, within the regression model only higher levels PPI-SCI

significantly predicted a higher percentage of perseverative errors. To examine possible

mediating effects of intelligence, the results of the hierarchical regression analysis were

followed up with a mediated regression analysis. There was no mediating effect of SPM-P on

the relationship between PPI-SCI and the number of perseverative errors, b = .02, BCa CI

[.00, .07]. These results suggest that males with elevated levels of secondary psychopathy

have more difficulty switching strategies in response to changing task contingencies, and that

this effect is independent of intelligence. THE PSYCHOPATH NEXT DOOR 184

Females. A mediated regression analysis was used to predict the number of

perseverative errors from PPI-SCI. The assumptions of normally distributed residuals and

homoscedasticity were not met and logarithmic transformations failed to address the

violations. Therefore, PROCESS’s ‘heteroscedasticity consistent standard errors’ tool was

used to control for any deleterious effects of heteroscedasticity (Hayes, 2012). The results of

the regression analysis were not significant, R = .11, F(1, 15) < 1, p = .77. Furthermore, there

was no mediating effect of SPM-P on the relationship between PPI-SCI and the number of perseverative errors, b = .02, BCa CI [-1.67, .09].

N-Back Task

As can be seen in Table 10, there was decrease in the number of targets correctly identified as the task difficulty increased from zero-back to three-back. A repeated measures

ANOVA was conducted on the total sample and confirmed that this difference was significant, F(3, 96) = 72.33, p < .001. Post-hoc pairwise comparisons using a Bonferroni correction revealed that participants identified significantly fewer targets in the two-back condition compared to the one-back condition, t(1, 32) = 3.00, p =.03, and significantly fewer targets in the three-back condition compared to the two-back condition t(1, 32) = 8.1, p <

.001. These findings demonstrate that the N-back task was successfully increasing the working memory load across difficulty level.

The bivariate correlations presented in Table 11 show that there were no significant

relationships observed between performance on the N-Back Task (at any level of difficulty)

and any of the PPI-R scores for either gender. This suggests that psychopathy is not related to

attentional deficits in either males or females. This finding is consistent with previous

research on psychopathy and attention, with studies demonstrating unusual yet superior

selective attention in psychopathic individuals. THE PSYCHOPATH NEXT DOOR 185

Self-Report Criminality Scale (SRCS)

Follow-up moderation analyses were conducted to see whether executive function

moderated the relationship between psychopathy and self-report criminality. Bivariate

correlations revealed that for males, antisocial behaviour was positively related to PPI-R,

PPI-C, PPI-FD, and PPI-SCI but the results did not reach statistical significance because of a

lack of statistical power. A similar pattern of results was found for females, with the

exception that antisocial behaviour was significantly, moderately related to PPI-FD. Because

the pattern of relationships for the male and female samples were the same, the analysis was

rerun using the combined sample. The results revealed that PPI-FD, PPI-SCI, and PPI-R were

significantly, moderately related to scores on the SRCS (r = .304, p = .01; r = .279, p = .02, r

= 295, p = .02, respectively). However, for both genders, the SRCS only displayed nonsignificant, weak to moderate correlations with the executive function measures.

Interestingly, the pattern of relationships between the SRCS and the measures of executive function differed across the two samples, and so the male and female data were analysed separately.

Moderated regression analyses were conducted using the PROCESS tool (Hayes,

2012). Variables were centred prior to analysis and any potential issues with heteroscedasticity were controlled using the heteroscedasticity-consistent standard errors function. For males, there were no significant moderating effects of executive function on the relationship between PPI-SCI and SRCS (all ns). Additionally, there were no significant moderating effects of executive function on the relationship between PPI-FD and SRCS (all ns). For females, the results of the moderation analyses revealed no significant moderation of any of the executive function measures on the relationship between PPI-FD and SRCS (all ns). Furthermore, there were no moderating effects of executive function on the relationship between PPI-SCI and SRCS (all ns). THE PSYCHOPATH NEXT DOOR 186

Discussion

Overview of Research

The primary aim was to empirically test two theories of psychopathy: the dual process model and the successful psychopathy model. Whilst both theories attempt to explain the differential manifestation of psychopathy in criminal versus noncriminal samples, they differ with respect to the neurobiological mechanisms that underlie criminal versus noncriminal psychopathy. In line with the claims of the successful psychopathy model, Gao and Raine

(2010) suggest that criminal and noncriminal psychopaths are differentiated by executive functioning. According to their hypothesis, criminal psychopaths are characterised by executive dysfunction which places them at greater risk for overt criminal offending. In contrast, noncriminal or ‘successful’ psychopaths possess intact or superior executive functioning, which acts as a protective mechanism against criminal offending. From this perspective, executive function is hypothesised to moderate the expression of antisocial behaviour in psychopathy.

On the other hand, the dual process model claims that psychopathy cannot be considered a unitary syndrome, but rather a confluence of two etiologically distinct syndromes. From this perspective, primary psychopathy arises from a deficit in the brain’s defensive motivational system, manifesting as trait fearlessness. Secondary psychopathy is hypothesised to stem from a dysfunction in brain regions responsible for higher order processes, placing an individual at risk for criminal offending. According to the dual process model, individuals can present with elevated levels of primary and secondary psychopathy, or elevated levels on only primary or secondary psychopathy. In this conceptualisation, the criminal psychopath presents with elevated levels of both dimensions. However, the noncriminal psychopath presents with only elevated levels of primary psychopathy, with low or average levels of secondary psychopathy. From this perspective, primary psychopathy THE PSYCHOPATH NEXT DOOR 187 would be associated with intact executive functioning. In contrast, secondary psychopathy would be characterised by executive dysfunction.

This study aims to examine the relationships between primary and secondary psychopathy and executive function, whilst also testing for moderating effects of executive function on the relationship between psychopathy and antisocial behaviour. This was achieved by utilising several commonly used measures of executive function and examining their relationship with psychopathy and criminal behaviour in a community sample.

Following the dual process model, it was hypothesised that primary psychopathy would be associated with intact executive function. In contrast, it was hypothesised that secondary psychopathy would be predictive of executive dysfunction. In line with the successful psychopathy model, it was hypothesised that the degree of executive dysfunction would moderate the relationship between secondary psychopathy and antisocial behaviour.

In addition to theory testing, the secondary aim of this study was to address the demographic inconsistencies between criminal and noncriminal studies, with a particular focus on exploring possible gender differences in the relationship between psychopathy and executive function. Given that previous research has found some gender differences in the expression of psychopathy, it was hypothesised that there would be gender differences in the relationship between psychopathy, executive function, and criminality. Furthermore, because there is some evidence that measures of executive function and measures of intelligence tap the same underlying construct, intelligence was included as a possible mediating factor.

Key Findings

These findings provide partial support for the dual process model of psychopathy. For both males and females, primary psychopathy was associated with intact performance on all measures. Interesting, for females, primary psychopathy was predictive of superior response THE PSYCHOPATH NEXT DOOR 188 inhibition and this effect was independent of intelligence. However, support for the dual process model was dependent on gender. This finding supports the hypothesis regarding gender differences in the manifestation of psychopathy. It is interesting to note that there were no gender differences in intelligence or performance on the measures of executive function that could explain the differential findings for gender on the relationship between psychopathy and executive function. Furthermore, although the majority of participants in the female sample were students, males in current sample had higher levels of education than the females, suggesting that level of education cannot explain the gender differences observed.

Given the gender differences, discussion of the key findings are presented separately for males and females.

Males. For males, the results provide partial support for the dual process model, with secondary psychopathy associated with poorer performance on some, but not all, measures of executive function. Specifically, higher levels of secondary psychopathy were related to, or predictive of, poorer planning ability and cognitive flexibility. However, higher levels of secondary psychopathy were not related to working memory function or response inhibition.

The finding of intact response inhibition in secondary psychopathy is consistent with two previous studies on response inhibition in secondary psychopathy using a noncriminal sample

(Carlson & Thái, 2010; Lynam et al., 1999).

In contrast, two other studies have found that individuals with higher levels of secondary psychopathy displayed greater errors of commission on a Flanker task (Sellbom &

Verona, 2007) and longer stop-signal reaction times (Heritage & Benning, 2013). However, in both these studies, the relationships observed between secondary psychopathy and response disinhibition were weak (r = .25 - .32). Given that the sample sizes used in previous studies were much larger than the sample used in the current study, the lack of replication in the current study may reflect problems with statistical power. Nevertheless, given the weak THE PSYCHOPATH NEXT DOOR 189 relationships observed between secondary psychopathy and response disinhibition across all four studies, response disinhibition may not be a hallmark feature of secondary psychopathy in noncriminal samples.

This appears to the case for working memory function also, with the results showing intact working memory function in secondary psychopathy. This finding is consistent with previous research using undergraduate (Sellbom & Verona, 2007; Snowden et al., 2013) and criminal samples (Hansen et al., 2007). Taken together, these findings suggest that secondary psychopathy is not characterised by global executive function deficits, but rather by specific executive function deficits. The results suggest that males with higher levels of secondary psychopathy have more difficulty planning a sequence of events, with worse overall performance and longer execution times on the Tower of London. Furthermore, intelligence only partially mediated the effects of psychopathy on performance, with a direct effect observed for overall score and execution time. These findings are consistent with previous research in an undergraduate sample, which showed that performance on the WISC-III Mazes was significantly different for primary versus secondary psychopathy (Sellbom & Verona,

2007). In Sellbom and Verona’s study, primary psychopathy was associated with better planning ability, whilst secondary psychopathy was associated with poorer planning ability.

Taken together, these findings highlight the importance of examining primary and secondary variants separately. This is particularly important given that previous research on planning ability using global psychopathy scores has produced inconsistent findings.

Similar to other studies in both criminal and noncriminal populations, global psychopathy was associated perseverative responding on the WCST (Kim & Jung, 2014;

Lapierre et al., 1995; Yang et al., 2011). However, other studies have generally failed to parse psychopathy into primary and secondary variants. The results show that when the relationship between perseverative errors and primary and secondary psychopathy is examined separately, THE PSYCHOPATH NEXT DOOR 190 only secondary psychopathy is significantly related to perseverative responding. Furthermore, this effect is not mediated by intelligence This finding is consistent with Sellbom and Verona

(2007) findings, and highlights the importance of examining the psychopathy variants separately. It also finding provides support for the dual process model, by showing that males with higher levels of primary psychopathy have intact set-shifting abilities, but that those higher on secondary psychopathy have problems with cognitive flexibility.

Taken together, the results provide partial support for the claims of the dual process model, with primary psychopathy not related to performance on any of the measures of executive function. In line with the claims of the dual process model, secondary psychopathy was associated with some deficits in executive functioning. However, the results from this study showed that support for the dual process model was specific to the male sample.

Females with elevated levels of secondary psychopathy did not display the same pattern of executive function deficits predicted by the dual process model.

Females. While for males, secondary psychopathy was related to poorer performance on tasks assessing planning and set-shifting abilities, for females, higher levels of secondary psychopathy significantly predicted better performance, as shown on the Tower of London.

Furthermore, as shown by the finding that secondary psychopathy was negatively related to execution times, higher levels of secondary psychopathy in females was related to faster completion times. There were no mediating effects of intelligence for females. It is interesting to observe that the pattern of relationships between secondary psychopathy and performance on the Tower of London are opposite for males and females. This finding may explain why previous research has produced inconsistent findings. As discussed previously, criminal samples contain only male participants and reveal a deficit in planning for psychopathy. On the other hand, noncriminal samples have a mix of male and female participants and reveal intact performance on planning tasks. For example, Salnaitis et al. THE PSYCHOPATH NEXT DOOR 191

(2011) found that undergraduate participants who scored high on psychopathy performed better on the Tower of Hanoi than low and medium psychopathy scorers. Interestingly, in contrast to criminal offender samples, the sample was predominately female (73%).

Therefore, it is plausible that the inconsistency in findings for a planning deficit in psychopathy across criminal and noncriminal samples is because of gender differences in the manifestation of psychopathy.

This pattern of superior or intact performance for females with elevated levels of secondary psychopathy was observed for all the executive function tasks. Although not significant, secondary psychopathy was negatively related to stop-signal reaction times, and unrelated to performance on the N-back task, indicating intact response inhibition and working memory function. Furthermore, the bivariate correlations revealed that higher levels of secondary psychopathy were significantly negatively related to the percentage of perseverative errors on the WCST. This finding is in contrast to that found for males, and indicates that females with elevated levels of secondary psychopathy have superior set- shifting abilities. Taken together, these findings suggest that current theoretical models of psychopathy do not adequately explain the manifestation of psychopathy in women.

A possible reason for the differences in performance for males and females with secondary psychopathy may have to do with gender stereotypes and the role they play in the performance of females on tests of ability and intelligence. For example, previous research has shown that ‘stereotype threat’ negatively affects performance on tests for females and other minority groups (Nguyen & Ryan, 2008). Stereotype threat refers to the psychological phenomenon where negative group stereotypes negatively impact performance on ability tests

(Steele, 1997). Many social-cognitive theories have been proposed to explain how gender stereotypes are formed and maintained, including the gender schema theory (Bem, 1981), the social-cognitive theory (Bussey & Bandura, 1999), and the cognitive-developmental theory THE PSYCHOPATH NEXT DOOR 192

(Kohlberg, 1966). However, a central tenet of each theory is the role of socio-cultural and cognitive influences in the formation and maintenance of gender roles.

Gender roles are defined as the roles that society assigns to men and women based upon biological sex, and include the types of responsibilities, behaviours, attitudes, personality traits, and skills that are appropriate for each sex. Generally speaking, masculine stereotypes emphasise independence, competitiveness, physical strength and ability, emotional ‘toughness’, and a natural intelligence. On the other hand, feminine stereotypes emphasise social connectedness, empathy, compliance, physical ‘fairness’, and intellectual inferiority. There exists a masculine hegemony where traditionally ‘male’ qualities are superior and the male experience is the normative standard. These stereotypes are reinforced by the media (R. Collins, 2011; Lauzen, Dozier, & Horan, 2008; Ward, 2002), parents

(Tenenbaum & Leaper, 2002; Tomasetto, Alparone, & Cadinu, 2011), teachers (Gunderson,

Ramirez, Levine, & Beilock, 2012), and peers (Kessels, 2005). This perspective of male superiority has negatively impacted women, resulting in negative body image and negative self-evaluations of physical ability (Hively & El-Alayli, 2014; Slater & Tiggemann, 2011); lower participation in traditionally masculine enterprises, such as math and science (Nosek et al., 2009; Schmader, Johns, & Barquissau, 2004); and poorer performance on a range of ability tests (Good, Aronson, & Inzlicht, 2003; Schmader & Johns, 2003; Schmader, Johns, &

Forbes, 2008; Sekaquaptewa & Thompson, 2003).

For example, Schmader (2002) examined the influence of gender roles and stereotype threat on math performance. Using a sample of male and female undergraduates, they examined the moderating effects of gender identity on male and female math performance.

When females strongly identified with the feminine gender role, and their gender identity was manipulated to be relevant to performance, their performance was worse than their male counterparts. This effect was not observed for women with low levels of feminine gender THE PSYCHOPATH NEXT DOOR 193 identification, with these women performing similarly to men. However, when gender identity was not linked to performance women, regardless of gender identity, performed equally as well as the men. There were no effects of gender identity on men’s math performance. These findings show how gender roles and stereotype threat affect women’s performance on ability tests.

Given that the measure of secondary psychopathy used here reflects unconventionality and a defiance of societal norms, it is plausible that a flouting of traditional gender identity roles in females with secondary psychopathy acts as protective mechanism against gender stereotype threat. This hypothesis may also explain the superior performance on the stop-signal reaction task for females with higher levels of primary psychopathy. This is because one of the ways that stereotype threat affects performance is through increased levels of test anxiety (Osborne, 2007). Therefore, it is plausible that females with higher levels of primary psychopathy may identify with gender stereotypes, but that this does not impact performance because of their innate fearlessness and stress immunity. Therefore, it may be that primary and secondary psychopathy confer some advantages for females, particularly in relation to performance on ability tests. However, this hypothesis requires testing in future research on psychopathy in females. One possible avenue for future research could be to employ a measure of gender identity and examine possible moderating effects on the relationship between psychopathy and performance on tests of executive function.

Research has shown that gender identity moderates the performance of women on tests of mathematical ability (Schmader, 2002). It is plausible that this may also be true for performance on tasks of executive function.

Psychopathy, Executive Function, and Self-Report Criminality

In addition to testing the dual process model of psychopathy, this study examined the successful model of psychopathy by examining the possible moderating role of executive THE PSYCHOPATH NEXT DOOR 194 function on the relationship between criminality and self-report criminality. The results do not provide support for the successful psychopathy model, as executive function did not moderate the relationship between primary or secondary psychopathy and self-reported criminal behaviour. Instead, the results suggest that the dual process model of psychopathy may explain the differential relationships between primary and secondary psychopathy and executive function. However, this was only true for the male participants. The results from this study indicate that current theoretical models of psychopathy do not adequately explain female psychopathy, with no support for the dual process or successful psychopathy model.

Limitations and Directions for Future Research

Although the aim was to make comparisons between criminal samples and this study easier by controlling for age and gender differences, there are still other differences (e.g., drug use, socioeconomic status, education level, etcetera) that make comparison between the two samples difficult. Future research may consider examining psychopathy in criminal and noncriminal samples, including an examination of the possible mediating role of substance use, socioeconomic status, and education level in the relationship between psychopathy and executive function. The findings for the male participants support the pattern of relationships observed for both criminal and noncriminal samples, with primary psychopathy related to intact or superior functioning and secondary psychopathy related to some types of executive dysfunction. This finding highlights the importance of examining psychopathy variants separately. Inconsistencies across previous studies of executive dysfunction in psychopathy may be because of the way that psychopathy was conceptualised and measured (e.g., different measures of psychopathy, different samples, and unitary versus variant conceptualisations).

In order to gain a better understanding of the relationship between psychopathy and executive function, future research should ensure that the psychopathy variants are examined separately. THE PSYCHOPATH NEXT DOOR 195

Whilst the findings for males supported the dual process model, the results revealed that this model did not adequately explain female psychopathy. Indeed, neither the dual process nor successful model of psychopathy adequately explained the results for psychopathic women in the current study, indicating that current theoretical models based predominately on male psychopathy do not generalise to female psychopathy. Given that psychopathy presents with less nefarious manifestations in females, future research should examine female psychopathy to determine whether the mechanisms that produce this difference could be utilised in the treatment and management of male psychopathy.

There is one final limitation to note, and that is that the sample size was small and consequently the analyses, particularly the regression analyses, may have been underpowered. Although the sample size here is similar to previous research (see Table 9), future studies using larger sample sizes would be better equipped to examine the possible moderating role of executive function in the psychopathy-criminality nexus, and the possible moderating role of gender.

Chapter Summary

According to the dual process model, primary and secondary variants arise from two distinct processes, with primary psychopathy characterised by emotional dysfunction and secondary psychopathy characterised by executive dysfunction. These findings provided partial support for the dual process model, but only males. Future research could examine the dual process model in relation to emotion deficits, including an examination of possible gender differences. As previously mentioned, research has consistently demonstrated differences in emotional processing as a function of gender. For example, previous research has demonstrated gender differences in the judgment of facial affect (Thayer & Johnsen,

2000), including increased physiological reactivity to facial affect for females over males

(Dimberg & Lundquist, 1990); gender differences in the experience of emotion (Fischer et THE PSYCHOPATH NEXT DOOR 196 al., 2004); gender differences demonstrating increased emotional expressiveness for females

(Kring & Gordon, 1998); and gender differences in affective priming (Gohier et al., 2011).

Given the gender differences observed for executive functioning in psychopathy, and the research on gender differences in emotion processing, it would be interesting to see whether gender differences also exist for emotion processing in psychopathy. According to the dual process model, primary psychopathy arises from dysfunctional motivational systems, resulting in a paucity of fear and anxiety. However, the findings from this study suggest that models of psychopathy based on males do not generalise to females. Therefore, the final study of this thesis tests the dual process model of psychopathy for emotion deficits, with a particular focus on examining gender differences.

Chapter Five

Chapter Overview

The dual process model of psychopathy (Patrick & Bernat, 2009) suggests that secondary psychopathy is the result of dysfunctional higher-order cognitive processing.

Consistent with this model, in Study 2 secondary psychopathy was related to poorer performance on planning and set-shifting executive functions for males. However, females with higher levels of secondary psychopathy displayed superior planning and set-shifting abilities. In contrast, primary psychopathy was characterised by intact executive functioning for both males and females. These findings indicate that current models of psychopathy, developed to explain male psychopathy, do not necessarily extend to female psychopathy. A further claim of the dual process model is that primary psychopathy is characterised by emotional dysfunction (e.g., lack of emotional depth, and a lack of empathy, guilt or remorse for personal transgressions) that is underscored by deficits in the brain’s motivational system.

However, as previously discussed, research to date has largely focused on criminal samples and largely on men. Therefore, it is currently unknown not only whether the claims of the THE PSYCHOPATH NEXT DOOR 197 dual process model regarding primary psychopathy extend to noncriminal psychopathy but also whether they extend to female psychopathy.

Clinical descriptions of psychopathy emphasise a pattern of affective and interpersonal abnormalities, including: a paucity of inhibitory emotions (i.e., empathy, remorse, and guilt), a lack of emotional depth, fearlessness, and interpersonal manipulativeness (Cleckley, 1941, 1948). This pattern of affective functioning led researchers to examine whether deficits in processing emotional information and cues may underlie the emotional symptoms observed in psychopathic individuals. There is now a wealth of evidence that suggests psychopathy is characterised by abnormal affective processing and reactivity.

Implicit emotional functioning is frequently measured using the lexical decision task, previous studies employing this task in psychopathic criminal offenders have found abnormal affective processing (e.g., K. S. Blair, Richell, et al., 2006; S. Williamson et al., 1991).

However, they have largely focused on male criminal offenders and have viewed psychopathy as a unitary construct (i.e., psychopath vs. nonpsychopath). Addressing this gap, this study examines affective and semantic processing in primary and secondary psychopathy using a noncriminal, mixed gender sample to allow the examination of gender differences.

Emotion Deficits in Psychopathy

Lykken (1957) conducted one of the earliest investigations of affective dysfunction in psychopathy when he examined the performance of primary and secondary psychopaths on a passive avoidance test. Using a sample of male and female participants from a correctional facility, Lykken found that primary psychopaths generated lower galvanic skin responses to THE PSYCHOPATH NEXT DOOR 198 stimuli associated with punishment, and less avoidance of punished responses compared to criminal controls (Lykken, 1957).

Research using a startle reflex paradigm has also revealed abnormal emotion processing in psychopathic individuals. In the startle reflex paradigm, the startle reflex

(aversive reflex) can be augmented by the presentation of a visual prime before the startle probe (a loud noise) (Lang et al., 1990). In healthy participants, positive primes (e.g., pictures of romantic couples or babies) result in a reduced startle response compared to neutral primes

(e.g., a book or a pair of shoes), as measured by eye blinks using electrodes attached to the face (Lang et al., 1990). In contrast, negative primes (e.g., images of victims of violent death) result in an increased startle response (Lang et al., 1990). In psychopathic offenders, whilst some reduction in startle reflex is observed after the presentation of positive primes, there is significantly less augmentation of the startle reflex following the presentation of negative primes (Patrick, 1994), suggesting a reduced response to negative emotional information.

Subsequent studies have produced consistent evidence of pervasive emotional impairment in male, criminal psychopathic individuals. For example, Blair and colleagues examined skin conductance responses to visual distress cues, threat cues, and neutral stimuli in a sample of male criminals classified as psychopathic or nonpsychopathic (i.e., psychopathy as a unitary construct). They found that psychopathic individuals compared to controls displayed hyporesponsivity to the distress cues, but intact responsivity to the threat cues and neutral stimuli (R. J. R Blair et al., 1997). Further research suggests that this emotional impairment may be specific to fearful or negative emotions. For example, some research has shown that psychopathic individuals are selectively impaired in recognizing the fearful facial expressions of others (R. J. R Blair et al., 2004), and this deficit appears to extend across sensory modality. Using a male, criminal offender sample Blair and colleagues

(2002) examined the recognition of vocal affect (happiness, disgust, anger, fear, and sadness) THE PSYCHOPATH NEXT DOOR 199 in psychopathic and nonpsychopathic participants. Psychopathic participants were selectively impaired in recognizing fearful and sad vocal affect, committing significantly more recognition errors than nonpsychopathic controls (R. J. R. Blair et al., 2002).

Williamson, Harper and Hare (1991) conducted one of the earliest studies into abnormal processing of emotional information using a lexical decision task (LDT). On the

LDT participants are asked to identify, as quickly as possible, whether a string of letters presented briefly on a screen (e.g., < 150 milliseconds) represents a valid word or a nonword

(e.g., Blerp). The LDT is an appropriate measure of affective function in psychopathic individuals because the task assesses automatic/implicit processes rather than strategic/explicit processes. This distinction is important in research on psychopathy because psychopathic individuals are known for being conning and duplicitous. Previous research using the LDT has shown that healthy adults respond faster to emotion words compared to neutral words (Strauss, 1983). Williamson, Harper and Hare (1991) predicted that this phenomenon would be absent in psychopathic offenders. Using a small sample of male criminal offenders classified as psychopathic (n=8) and nonpsychopathic (n=8) by the PCL-

R, they examined responses to positive, negative and neutral words using a lexical decision task. Whilst nonpsychopathic offenders responded faster to positive and negative emotion words (compared to neutral words), the psychopathic individuals responded slower to positive and negative words. Interestingly, on a post-experimental word rating task both psychopathic and nonpsychopathic offenders rated positive words as good, and negative words as bad. These findings indicate that psychopathic individuals have intact objective appraisal of emotional information, but may process this information differently.

Alternatively, it could be that psychopathic offenders were rating the emotion words according to how they believed other people would rate them. In either case, these and THE PSYCHOPATH NEXT DOOR 200 similar observations support the use of implicit/automatic measures of emotional functioning in psychopathic individuals.

Emotion Deficits in Primary and Secondary Psychopathy

Although most research on emotion processing in psychopathy has viewed psychopathy has a unitary construct, some research has examined emotion processing and the unique relationships between primary and secondary variants, revealing divergent relationships between primary and secondary psychopathy and emotional impairment. For example, Patrick et al. (1993) demonstrated that in criminal psychopaths the deficient startle response was specific to high PCL-R Factor 1 scores (primary psychopathy), and was not observed for high PCL-R Factor 2 scores (secondary psychopathy). These findings suggest that different patterns of emotional reactivity may exist for primary and secondary psychopathy.

Verona, Patrick, Curtin, Bradley, and Lang (2004) examined the relationships between PCL-R assessed primary and secondary psychopathy and physiological reactions to positive (e.g., baby laughing) and negative sounds (e.g., baby crying) sourced from the

International Affective Digitized Sounds system. The physiological measures of emotional reactivity included skin conductance responses, heart rate reactivity, and corrugator (frown) and zygomatic (smile) responses measured using electromyography. A sample of male criminal offenders was classified as nonpsychopathic, high primary psychopathic (high on

F1, but low on F2), high secondary psychopathic (high on F2, but low on F1), and psychopathic (high on both F1 and F2). Participants high in primary psychopathy displayed lower skin conductance responses to all sounds (positive, negative, and neutral). Further, those high in primary psychopathy did not show the expected skin conductance response differentiation between positive, negative and neutral sounds observed in those high in secondary psychopathy. An unusual pattern of HR was observed for the high secondary THE PSYCHOPATH NEXT DOOR 201 psychopathy group across positive, negative and neutral sounds. Participants high on secondary psychopathy displayed a similar decrease in HR for neutral and emotion sounds found for high primary psychopathy, but only on the first block of the experiment. On the second and third blocks they displayed a similar pattern of heart rate reactivity to the other two groups, indicating intact functioning. The authors suggest this may indicate a delay in the processing of the affective significance of sounds for those with secondary psychopathy. No effects in regards to psychopathy were observed for electromyography activity. This study provides some evidence of differential emotion impairment, with abnormal sympathetic reactivity to emotional stimuli in primary psychopathy and generally intact functioning in secondary psychopathy. These findings are consistent with more recent research which has demonstrated reduced physiological reactivity to emotional stimuli in primary, but not secondary, psychopathy (Casey, Rogers, Burns, & Yiend, 2013).

One study, in contrast to those discussed hitherto, found enhanced (rather than reduced) emotion perception capabilities in primary psychopathy. Del Gaizo and Falkenbach

(2008) examined the unique relationships between primary and secondary psychopathy, the ability to identify vocal and facial affect, and the experience of positive and negative emotions in an undergraduate sample (female = 119, male = 56). Using the PPI to assess primary and secondary psychopathy, those scoring highly on primary psychopathy displayed a weak, negative correlation with errors in identifying fearful facial expressions. There were no other relationships observed between primary and secondary psychopathy and the ability to identify facial or vocal affect. In addition, those with primary psychopathy displayed a moderate positive relationship with the experience of positive emotions and a weak, positive relationship with negative emotions. In contrast, those with secondary psychopathy displayed a moderate, positive correlation with the experience of negative emotions, but not positive emotions. This study provides support for the notion of increased experience of negative THE PSYCHOPATH NEXT DOOR 202 affect and lack of positive affect in secondary psychopathy. However, the findings suggest that primary psychopathy is associated with superior ability to identify fearful facial expressions, and intact experience of positive and negative emotions, at least in an undergraduate sample. This may reflect the sample used (i.e., noncriminal) and could suggest that the emotion deficits observed in criminal samples may not extend to noncriminal samples. Alternatively, it could be that primary psychopathic individuals are capable of emotion perception but lack the capacity to experience negative emotions (as indicated by the weak relationship with negative emotionality).

Taken together, there is some evidence to suggest that primary and secondary psychopathy present with different emotion processing capabilities and different experiences of emotion. However, most research to date has utilized male, criminal offender samples.

Research that has used a noncriminal sample, notably Del Gazio and Falkenbach (2008), reported divergent findings. More research is needed to establish whether psychopathy is associated with emotional impairments and whether these impairments are uniquely related to specific psychopathy variants (i.e., primary and secondary psychopathy), specifically outside of a forensic environment. One promising area of emotion research is situated within the language literature on affective and semantic language processing. The use of a language task to assess affective deficits in psychopathy is particularly useful because it provides insight into the emotional experiences of psychopathic individuals and their capacity to use emotional information to make decisions.

Affective and Semantic Language Processing

The ability to use language to directly communicate our ideas and feelings with others is perhaps one of the most fundamental traits of the human experience, and research has shown that differences in how language is processed can provide important insights into our psychological functioning. For example, research has shown that anxious individuals display THE PSYCHOPATH NEXT DOOR 203

an attentional bias for negative word stimuli. Using a Stroop-task, Mogg, Bradley, Williams,

and Mathews (1993) examined subliminal effects of five types of words (anxiety words, depression words, positive words, neutral categorized words [e.g., household items], and neutral uncategorized neutral words) in a sample of anxious individuals, depressed individuals, and healthy controls. Anxious individuals displayed greater interference for negative words (combined anxiety and depression words), supraliminally and subliminally, compared to depressed individuals and healthy controls. This suggests an early attentional bias for negative information in highly anxious individuals. Similarly, Minor et al. (2015) found that an analysis of language use was effective in predicting schizophrenic symptomatology, suggesting that patterns of language use are useful in capturing clinically relevant information. One commonly used language task for assessing implicit processing is the lexical decision task (LDT). In the LDT, participants are asked to identify whether a string of letters represents a valid word or a nonword (e.g., Blerp). The LDT has been widely used to capture implicit and automatic processes, including cognitive bias for eating disorder information (D. A. Williamson, 1996), implicit attitudes and racial prejudice (Wittenbrink,

Judd, & Park, 1997), and as an implicit alcohol expectancy measure (Campos-Melady &

Smith, 2012).

Altogether, there is evidence that the LDT can capture both emotional functioning and psychopathology. A further advantage of using the LDT, is that the activation of affective and semantic networks occurs automatically and subconsciously (see Balota, 1983; Neely, 1977) and this is important because psychopathic individuals have a reputation for being manipulative and deceitful. Thus, the LDT allows the assessment of implicit emotional and semantic processing in psychopathy. Previous research using the LDT has demonstrated that lexical decisions on a standard LDT and go/no-go LDT are faster for both positive (e.g., puppy, love) and negative emotion words (e.g., murder, cancer) compared to neutral words THE PSYCHOPATH NEXT DOOR 204

(e.g., table, tissue) (Yap & Seow, 2014). The facilitation of lexical decisions to emotion

words can be explained by semantic-richness accounts which suggest that emotion words are

responded to faster because they are more familiar and meaningful (Pexman, 2012).

However, an interesting finding within the male, criminal psychopathy literature is the failure

of emotion words to facilitate lexical decisions (S. Williamson et al., 1991). Interestingly,

male criminal psychopaths display intact semantic processing (C. A. Brinkley, Schmitt, &

Newman, 2005).

Lexical Decision Task Research in Psychopathy

S. Williamson et al. (1991) was one of the first to use the LDT to assess affective and semantic processes in psychopathic offenders. Since that time, several studies have utilised the LDT to examine affective and semantic processing in psychopathy, with a pattern of dysfunctional affective processing and intact semantic processing emerging (e.g., C. A.

Brinkley et al., 2005). In addition to examining reaction times for different word types, the lexical decision task is commonly used to examine affective and semantic priming. A consistent finding is that if word pairs are semantically related (e.g. sand/beach), then lexical decisions to the second word (target word) are facilitated (e.g., Meyer & Schvaneveldt,

1971). That is, lexical priming is the facilitation in the detection or recognition of a word

through the use of prior information (McDonough & Trofimovich, 2009). Semantic priming

refers to the phenomenon in which the speed or accuracy in responding to a word is

facilitated when it is preceded by a semantically-related prime (e.g., butter-bread), rather than

a semantically-unrelated prime (e.g., butter-mouse) (McDonough & Trofimovich, 2009).

Affective priming refers to the phenomenon in which the speed or accuracy in responding to

an emotion-word (i.e., love) is facilitated when it is preceded by a prime with the same THE PSYCHOPATH NEXT DOOR 205

affective valence (i.e., happy), rather than a prime with the opposite affective valence (i.e.,

fear) (Klauer & Musch, 2003).

Spreading activation models are the generally accepted model of priming. Although

several spreading activation models have been proposed (e.g., Anderson, 1976, 1983; Collins

& Loftus, 1975; Quillian, 1967) the common hypothesis is that when an item is retrieved

from memory it activates its internal representation, which in turn activates related concepts

and facilitates their retrieval from memory. Spreading activation models are closely linked to

network models of semantic memory. Network models of semantic memory suggest that

memory can be viewed as a network of nodes (concepts) that are interconnected by

associative links. When a word is presented (e.g. dog), the retrieval of the concept from the

semantic network activates related concepts (e.g. cat) and facilitates subsequent response

times to related words because they are already activated in the semantic network. Spreading

activation models provide a straightforward explanation of semantic priming by suggesting

that priming effects occur because a target word has already been partially activated by a

related prime word (A. M. Collins & Loftus, 1975).

Research employing a semantic priming LDT has demonstrated intact semantic

processing in male, psychopathic offenders. C. A. Brinkley et al. (2005) classified participants has low anxious or high anxious using the Welsh Anxiety Scale (Welsh, 1956), and as psychopathic and nonpsychopathic using the PCL-R. All participants performed similarly on the semantic priming LDT, with responses faster to words that were preceded by related words. There were no group differences regarding anxiety or psychopathy. Similarly, they found that performance on a semantic Stroop task was the same for all groups, with significant interference on trials where color-related words (e.g., grass, lemon, fire) were written in incongruent colours. This finding demonstrates that psychopathic offenders, THE PSYCHOPATH NEXT DOOR 206

including those low on anxiety (a hallmark of the Cleckley psychopath) possess intact

semantic processing.

Extending on this research, K. S. Blair, Richell, et al. (2006) demonstrated that male,

psychopathic offenders (n = 52) displayed intact semantic processing, but deficient affective

processing using an affective priming word categorization task and a semantic priming word

categorization task. Participants were classified as psychopathic or nonpsychopathic with the

PCL-R. The affective priming task consisted of negative emotion words, positive emotion

words, and neutral words. In congruent conditions emotion target words were preceded by an

affectively congruent word (e.g., love-song). In incongruent conditions target words were

preceded by a prime word with the opposite affective valence (e.g., hate-song). For the neutral words, a neutral prime was paired with a positive or negative target word. Participants were also asked to complete a word rating task in which they rated the words on a pleasantness scale (seven-point Likert scale). The results revealed that the nonpsychopathic offenders displayed significant facilitation in congruent conditions and significant interference for negative targets that were preceded by positive primes. The psychopathic individuals displayed no facilitation or interference for emotion words. However, consistent with a previous studies (Kiehl, 1999; S. Williamson et al., 1991), psychopathic individuals rated the positive and negative emotion words as similarly pleasant on the word rating task.

Follow-up correlational analyses revealed that both Factor 1 (primary psychopathy) and

Factor 2 (secondary psychopathy) of the PCL-R were related to longer reaction times on the affective priming task. This could suggest that the affective and interpersonal features and the impulsive-antisocial features of the PCL-R are related to deficient emotion processing.

Alternatively, given that partial correlations were not used, it could be that participants in the sample who scored highly on Factor 2 also scored highly on Factor 1 and thus the findings for Factor 2 represent shared variance. THE PSYCHOPATH NEXT DOOR 207

The semantic priming task required participants to categorise words as belonging to

the category of fruit/vegetable or the category of animal. The congruent trials consisted of

congruent animal-animal (e.g., dog-cat) and fruit-fruit (e.g., apple-orange) word pairs. The

incongruent trials consisted of pairing animal words and fruit words (e.g., dog-apple) or vice

versa (e.g., lemon-cat). Both nonpsychopathic and psychopathic participants displayed facilitation for congruent prime-target word pairs compared to incongruent prime-target word

pairs. Correlation analyses revealed that the PCL-R total score, PCL-R Factor 1, PCL-R

Factor 2 were unrelated to semantic processing. These findings indicate that semantic

processing is intact for individuals with psychopathy.

Demonstrating a similar finding of deficient affective processing, Lorenz and

Newman (2002a) found behavioural differences between psychopathic and nonpsychopathic

offenders on an affective priming task. Participants were classified as psychopathic or

nonpsychopathic using the PCL-R and then classified as low-anxiety or high-anxiety using

the Welsh Anxiety Scale (Welsh, 1956). This resulted in four groups: low-anxious

psychopaths, high-anxious psychopaths, low-anxious nonpsychopaths, and high-anxious

nonpsychopaths. Using a LDT, they examined behavioural responses to positive, negative,

and neutral words that were matched on frequency, concreteness, pronounceability, length,

number of letters, and imagery. Additionally, they also examined appraisal of the emotion

and neutral word stimuli using a word rating task where participants were required to rate

words on a 7-point Likert scale (anchors were 0 = bad, 4 = neutral, and 7 = good). They

found no differences between any of the groups in the appraisal of the word stimuli, with all

groups rating positive words highest, followed by neutral words, and then negative words.

However, they did find that nonpsychopathic offenders showed faster responses to emotion

words than neutral words and this facilitation effect was not observed in psychopathic

offenders. THE PSYCHOPATH NEXT DOOR 208

An interesting finding is that the dysfunctional affective processing in psychopathic

offenders captured using the LDT may be underscored by abnormal physiological reactivity.

For example, Intrator et al. (1997) examined affective and semantic processing in a male

sample recruited from a substance abuse program, along with a healthy control group (who

they assumed were nonpsychopathic). The substance abuse users were classified as

psychopathic or nonpsychopathic using the PCL-R and this resulted in three groups; psychopathic substance abuse, nonpsychopathic substance abuse, and healthy control. The authors recorded behavioural responses (speed and accuracy) and cerebral blood flow (rCBF) to neutral and negative emotion words using a LDT. Because this study used long stimulus exposure times this made it unlikely that any group differences in behavioural responses would emerge. However, the main purpose was to examine rCBF. Consistent with their predictions, they failed to find any behavioural differences between psychopathic and nonpsychopathic participants to neutral or negative emotion words, with all groups performing similarly. However, they did find that psychopaths displayed increased rCBF to the negative emotion words compared to both control groups. The authors interpreted this finding as evidence that psychopathic individuals require additional resources to respond to emotional information.

Similarly, Kiehl (1999) examined emotion and semantic processing in a small sample of criminal offenders classified as psychopathic or nonpsychopathic using the PCL-R. They found no differences between psychopathic and nonpsychopathic offenders for word identification of positive and negative words. Furthermore, all participants regardless of psychopathy status, responded faster to concrete words than abstract words in a LDT and word identification task. However, the psychopathic participants displayed large negative event-related potentials (ERPS) (N350) for all word types and this finding was absent in the nonpsychopathic participants who displayed large positive ERPs. Kiehl (1999) interpreted THE PSYCHOPATH NEXT DOOR 209

this finding as evidence that psychopathic individuals require more cognitive resources to

perform affective and semantic language tasks than do nonpsychopathic individuals, an

interpretation that echoes Intrator et al. (1997).

Taken together, there is evidence that male psychopathic offenders display difficulties

processing emotional information but have intact semantic processing. However, these

findings may only generalise to Caucasian, male criminal offenders. For example, some

research has shown that the impairments in affective processing on the LDT do not extend to

African-American offenders, or female offenders. Lorenz and Newman (2002b) replicated

their affective and semantic processing study (Lorenz & Newman, 2002a) with a group of

male, African-American criminal offenders. In contrast to the previous findings, they found

no differences in affective or semantic processing between low-anxious psychopathic, high- anxious psychopathic, low-anxious nonpsychopathic or high-anxious nonpsychopathic

groups. Similarly Vitale et al. (2011) failed to find any differences between low anxious

psychopathic and nonpsychopathic female offenders on an affective lexical decision task.

Female offenders were classified as psychopathic or nonpsychopathic using the PCL-R and

anxiety was scored using the WAS. Additionally, participants were diagnosed with or with

Antisocial Personality Disorder (ASPD) and this was used a covariate in the analyses. The

results revealed that participants with ASPD responded faster to emotion words than non-

ASPD participants, and no effects of regarding psychopathy. These findings suggest that the

emotion processing abnormalities observed in Caucasian, male criminal offenders may not

extend to Caucasian, female criminal offenders. The two aforementioned studies raise the

question of whether emotion processing deficits are limited to Caucasian, male, criminal

offenders.

There is only one known study that has examined lexical decisions in psychopathic

individuals recruited from a noncriminal sample. Using a male, undergraduate university THE PSYCHOPATH NEXT DOOR 210 sample, Reidy et al. (2008) examined whether LSRP primary and secondary psychopathy predicted reaction times to neutral, anger, sadness, fear or happiness words on a LDT. They found that higher levels of secondary psychopathy, but not primary psychopathy, significantly predicted faster reaction times (RTs) to anger words. Furthermore, higher levels of primary psychopathy, but not secondary psychopathy, significantly predicted slower RTs to sadness words. There were no significant findings regarding neutral words, happiness words, or fear words. These findings indicate that the divergent relationships for secondary and primary psychopathy and emotional reactivity may extend to male, noncriminal samples.

Furthermore, it appears as though different categories of negative words evoke different responses depending on psychopathy variants.

Summary of Implicit Language Tasks in Psychopathy

A table summarising the findings from studies of implicit language tasks in both unsuccessful and successful psychopathy is presented in Appendix 6. The pattern observed from the studies suggests that psychopathic offenders display abnormal affective processing

(i.e., lack of responsivity) but intact semantic processing. However, this finding appears to be specific to Caucasian, male, primary psychopaths. There have been no studies to date that have examined affective and semantic processing using an implicit language task with a noncriminal, community sample of mixed gender. Therefore, it is unknown whether noncriminal psychopathic women will display the emotion processing deficits observed in

Caucasian men in criminal and noncriminal samples. Furthermore, there is some evidence that emotion processing deficits on implicit language tasks are specific to primary psychopathy. For example, as mentioned previously, Reidy et al. (2008) found that higher levels of secondary psychopathy were associated with faster responding for anger words, suggesting a facilitated response for certain kinds of emotion words. Additionally, Vitale et al. (2011) found that females with ASPD displayed increased emotional facilitation effects. THE PSYCHOPATH NEXT DOOR 211

Interestingly, ASPD is moderately correlated with Factor 2 (secondary psychopathy) of the

PCL-R (Hare, 1991). Therefore, it is plausible that intact or increased reactivity for emotion words may be observed in females with secondary psychopathy. Furthermore, given that there are no studies have examined the unique relationship between primary psychopathy and affective language processing in females, it may be that the emotion deficits characteristic of primary psychopathy in men, are absent in women. This may be because females are socialized to be more empathetic and nurturing, thus emphasizing emotional intelligence in females.

Another avenue for research would be to examine whether semantic processing is intact for both abstract and concrete stimuli. Kiehl (1999) found that psychopathic individuals

displayed more errors for abstract words than nonpsychopathic individuals. K. S. Blair,

Richell, et al. (2006) suggest that this may indicate that intact semantic processing may only

be present for concrete words. Interestingly, Altarriba and Bauer (2004) conducted a word

rating task with undergraduate students and found that emotion words are considered less

concrete than abstract words. Further, emotion words were considered less imageable, more

difficult to think of a context, and less concrete than concrete words. Therefore, an interesting

extension of Blair’s rationale would be to examine how psychopathic individuals rate

emotion words in terms of characteristics known to facilitate responding, including context

availability, concreteness, and imageability. It may be that emotion processing deficits

captured by implicit language tasks actually reflect difficulties processing abstract stimuli.

The use of word rating task may also aid in the interpretation of any gender differences in

affective and semantic language processing in psychopathy. This is because previous research

has shown that females consider emotion words as having a greater emotional impact than

men and that women display a different pattern of brain activation to emotion words than

men (Bremner et al., 2000). THE PSYCHOPATH NEXT DOOR 212

Study 3

The primary aim of Study 3 is to test the dual process model by examining implicit emotion processing in primary and secondary psychopathy in a noncriminal sample. Given that psychopathic individuals are known for being deceitful and manipulative, lexical decision tasks using emotion words are particularly useful as they provide an implicit measure of emotion processing through the assessment of automatic and subconscious processes (Balota, 1983). Therefore, this study will examine implicit emotion processing using a lexical decision task. Specifically, the study explores whether the impairment on affective tasks seen in Caucasian, male psychopaths extends to noncriminal psychopathic samples, including females.

Given that previous research has suggested that secondary psychopathy is associated with faster responses for anger words (Reidy et al., 2008), and that ASPD is associated with faster responses for both positive and negative emotion words in females (Vitale et al., 2011), it is predicted that higher levels of secondary psychopathy will be related to larger priming effects for negative words on the LDT, reflecting an increased sensitivity to negative emotional information. It is further hypothesized that secondary psychopathy will be unrelated to priming for positive words, reflecting intact emotional processing of positive affective stimuli. Regarding primary psychopathy, for males it is hypothesized that higher levels of primary psychopathy will be negatively related to priming for negative emotion words. This is hypothesized to reflect the emotional impairment that is characteristic of males with high levels of primary psychopathy by demonstrating that those higher on primary psychopathy have difficulty using emotional cues. Previous research has demonstrated differences in emotional processing as a function of gender (e.g., Dimberg & Lundquist,

1990; Fischer et al., 2004; Kring & Gordon, 1998; Thayer & Johnsen, 2000), and in Study 2 it was found that the relationships between psychopathy and executive function were THE PSYCHOPATH NEXT DOOR 213 different for males and females, with higher levels of psychopathy predicting superior executive function in females. Therefore, it is hypothesised that no relationships will be observed between primary psychopathy and affective priming for females.

In regards to semantic priming, it is hypothesized that there will be intact semantic processing for primary and secondary psychopathy in both males and females. However, if semantic processing deficits appear, these are hypothesized to be specific to abstract stimuli because, as previous mentioned, there is some evidence of abnormal processing of abstract information in psychopathic individuals (Kiehl, 1999).

An additional aim of Study 3 is to examine explicit emotion processing in psychopathy by using a word rating task. In male criminal offender samples, there is no difference in word ratings for concrete, abstract or emotion words, indicating that explicit processing of emotional information is intact. Using a word rating task, this study examines whether this finding extends to noncriminal samples. Given that previous research has demonstrated that psychopathic individuals appraise emotion words in the same way as nonpsychopathic individuals, it is hypothesized that there will be no relationship between psychopathy and word ratings. However, given that this is the first study to employ a comprehensive word rating task for abstract, concrete and emotion words, it is unknown what relationships might emerge regarding the ratings of concreteness, context availability, imageability, valence and arousal in psychopathy.

Method

Participants

Thirty-five participants were recruited from the participant pool of Study 2 (18 males,

17 females). The mean age was 28 years (males M = 28 years, SD = 7.8 years; females M =

28 years, SD = 10.6 years). The sample consisted of students (51.4%), and individuals who were employed full-time (28.6%), part-time (2.9%), or on a casual basis (8.6%); self- THE PSYCHOPATH NEXT DOOR 214

employed (2.9%), or unemployed (5.7%). Participants with a previous history of psychiatric

or neurological illness, and/or regular use of psychiatric or neurological medication were

excluded from participating, as were those who did not speak English as their first language.

Materials

Demographic questionnaire. A brief demographic questionnaire was used to

measure individual difference variables, such as age, gender, ethnicity, level of education,

employment status, and handedness (RH/LH).

The Psychopathic Personality Inventory-Revised (PPI-R) (Lilienfeld & Widows,

2005). The Psychopathic Personality Inventory-Revised (PPI-R) is a 154-item self-report questionnaire commonly used to assess psychopathy in noncriminal populations (Lilienfeld &

Widows, 2005). Each item consists of a statement that participants endorse on a four-point

Likert scale (anchors are 1= false, 2= mostly false, 3= mostly true, 4= true). The PPI-R yields a global psychopathy score, as well as eight content scale scores: Machiavellian Egocentricity

(ME), Rebellious Nonconformity (RN), Blame Externalisation (BE), Carefree

Nonplanfulness (CN), Social Influence (SOI), Fearlessness (F), Stress Immunity (STI), and

Coldheartedness (C). Factor analysis of the scale reveals a two factor solution that is consistent with other well-validated measures of psychopathy (Benning, et al., 2003;

Lilienfeld & Widows, 2005). The scale has good internal reliability for the global psychopathy scale with Cronbach’s alpha .92 (Lilienfeld & Widows, 2005). The temporal reliability of the global psychopathy scale remains high at an average test-retest interval of

19.94 days (Cronbach’s alpha = .93) (Lilienfeld & Widows, 2005). A score for the Fearless

Dominance factor akin to primary psychopathy was obtained by combining the Fearlessness,

Social Influence, and Stress Immunity subscales. A score for Self-centered Impulsivity was obtained by combining the Machiavellian Egocentricity, Rebellious Nonconformity, Blame

Externalisation and Carefree Nonplanfulness subscales. This was used as the measure of THE PSYCHOPATH NEXT DOOR 215

secondary psychopathy. Although factor analytic studies have found that the Coldheartedness

factor does not load onto either the FD or SCI factors, this subscale was included in the

analyses as it represents characteristics that many consider to be central to psychopathy.

Word Stimuli. A total of 240 English language words were selected as follows: concrete words (30 primes, 30 targets) whose meaning represented objects, materials or people (e.g., chair) and/or had high concreteness ratings in previous research (Toglia &

Battig, 1978; Wilson, 1988); abstract words (30 primes, 30 targets) whose meaning did not represent objects, materials, or people (e.g., metaphor), were not classified as emotion words, and/or had low concreteness ratings in previous research (Toglia & Battig, 1978; Wilson,

1988); and emotion words (60 primes and 60 targets, with an equal number of positive and negative words that were matched on valence and arousal) selected from the ANEW database

(Bradley & Lang, 1999). This resulted in a total of 120 prime-target pairs. All word stimuli were matched on frequency (Brysbaert & New, 2009), word type (noun/verb), and word length (see Appendix 7). The prime-target pairs were matched on mean strength of association across the concrete, abstract, and emotion word conditions using the University of

South Florida Free Association Norms database (Nelson, McEvoy, & Schreiber, 1998) or the

Edinburgh Associative Thesaurus (Kiss, 1975; Kiss, Armstrong, Milroy, & Piper, 1973). The

complete list of word stimuli can be found in Appendix 8.

Pseudoword stimuli. A total of 120 pronounceable non-words were generated from the target stimuli using the Wuggy pseudoword generator (Keuleers & Brysbaert, 2010). The pseudowords were matched to the target word stimuli on length, subsyllabic segments (2/3), transition frequency, and orthographic Levenshtein distance (OLD20). An additional set of concrete, abstract and emotion words (120 words in total) were used as primes for the pseudowords. This resulted in a total of 120 prime-target pairs. The prime words used in the pseudoword condition were matched to the primes used in the word conditions on frequency THE PSYCHOPATH NEXT DOOR 216

(Brysbaert & New, 2009), word type (noun/verb), and word length. In addition, concrete and abstract primes were matched on concreteness and imageability to the primes used in the word conditions (Toglia & Battig, 1978; Wilson, 1988), and emotion words were matched on valence and arousal (M. M. Bradley & Lang, 1999). The complete list of pseudowords can be found in Appendix 8.

Procedure

Testing was conducted individually in a quiet room. Participants were given an information letter which detailed the nature of the research and participation requirements

(See Appendix 3 for information letter). The LDT was conducted first, followed by the word rating task to avoid repetition priming effects. Participants then completed the demographic questionnaire. Scores from Study 2 for the PPI-R were used in this study. The entire testing session lasted approximately 90 minutes, including instructions and a practice block.

The Lexical Decision Task. A classic LDT (word/nonword) was used to assess response times and error rates for concrete, abstract, and emotion word targets. The LDT was conducted using Eprime software on a computer connected to a flat screen monitor with a screen resolution set at 1920x1080 pixels and a screen refresh rate of 60 Hertz. Participants were seated comfortably in a quiet room. The letter strings were presented in black lowercase letters on a white background. A standard qwerty keyboard was used to obtain responses from participants to the letter strings. The ‘f’ and ‘k’ keys were labelled with either ‘word’ or

‘nonword’ and were counterbalanced across participants. Participants were instructed to identify, as quickly as possible, whether the second letter string formed a valid English word by pressing the relevant key. The full instructions for the LDT are presented in Appendix 9.

A typical trial began with a fixation point (‘+’) presented briefly in the centre of the screen

(500ms). Next, a prime word was presented in the centre of the screen for 125ms, followed by the presentation of a blank screen (1000ms) and then the target word which was presented THE PSYCHOPATH NEXT DOOR 217

for 100ms, participants had 1500ms to respond (see Figure 4). There was a 1900ms inter-trial

interval before the next trial began.

Figure 4. Example trial sequences: (a) congruent emotion word trial (b) incongruent

concrete word trial.

(a) 500ms 125ms 1000ms 100ms

(b) 500ms 125ms 1000ms 100ms

The LDT began with a practice phase of 20 trials, followed by the experimental

phase. In the experimental phase, each participant was given a total of 240 trials: 30 concrete,

abstract, and 60 emotion (30 positive, 30 negative) word-word trials and 30 concrete,

abstract, and 60 emotion (30 positive, 30 negative) word-pseudoword trials. There was an

equal number of word/pseudoword word trials. There was an equal number of congruent and

incongruent prime-target trials for each word type and the trials were presented in random

order. In the concrete and abstract conditions, the prime words were counterbalanced across

participants so that the same prime words were used in both the related and unrelated

conditions (McNamara, 2005). In the emotion word condition, the primes used in the

affectively congruent prime-target pairs were re-paired with a word of the opposite affective

valence to form the incongruent prime-target pair. Participants completed the trials in blocks of 80 (a total of three blocks) and the blocks were presented in random order. Participants were given a 2-minute rest break between blocks. The lexical decision task lasted approximately 25 minutes.

Word rating task. A computerized word rating task was used to obtain ratings for concrete, abstract and emotion words on concreteness, imageability and context availability THE PSYCHOPATH NEXT DOOR 218

using a 7-point Likert scale. Concreteness refers to the degree to which a word represents a

physical or perceivable entity. Imageability refers to the ease with which a word evokes

mental imagery, sound, or experience. Context availability refers to how easy it is to think of

a context for a given word. Emotion words were also rated on valence and arousal. Valence

refers to how positive or negative a word is and arousal refers to how stimulating or alerting a

word is. Concrete, abstract and emotion words were randomly presented throughout the word

rating task to control for fatigue and order effects. Participants were provided with clear

instructions for each word characteristic (e.g., context-availability) on the word rating task

and these instructions were in line with previous research (Paivio, Yuille, & Madigan, 1968)

(See Appendix 10 for complete instructions). The word rating task took approximately 40 minutes to complete.

Design

A cross-sectional, correlational design was used to examine the relationships between primary and secondary psychopathy and priming effects for concrete, abstract, and emotion words. The predictor variables were primary and secondary psychopathy, as measured by the

Psychopathic Personality Inventory-Revised (PPI-R) (Lilienfeld & Widows, 2005). The outcome variables were the word ratings of concrete, abstract and emotion words; and priming effects for concrete, abstract and emotion word targets, assessed using the LDT.

Results

Data Screening

Data for the PPI-R from Study 2 was used for the analyses for Study 3 (see Chapter 4 results for data screening of the PPI-R). The RT data was screened and incorrect responses

(4.3% error rate), or responses less than 250ms (nil) or greater than 1000ms (0.8%) were excluded from the data. Participants whose RTs on the LDT were greater than 2.5 SDs from the mean were excluded from the LDT analyses (n= 1). Normality was checked separately for THE PSYCHOPATH NEXT DOOR 219

males and females for the word rating and LDT data. The data for the word rating task and

LDT were not normally distributed. Therefore, nonparametric tests were used in instances

where violations of normality could affect the robustness of the statistical analyses.

Lexical Decision Data

The descriptive data for the RTs for positive, negative, abstract and emotion words on

congruent trials and incongruent trials are presented separately for males and females in

Table 14. Since analysis of variance (ANOVA) is considered robust to violations of

normality when group sizes are equal (Field, 2007), a 2 (relatedness) x 2 (gender) mixed

ANOVA was conducted for each word type to examine whether responses in congruent

conditions were faster than responses in incongruent conditions and whether this varied by

gender. For abstract words, there was no significant difference between responses for

congruent compared to incongruent conditions (F (1, 32) = 1.32, p = .25, = .04) and no 2 𝑝𝑝 interaction by gender (F (1, 32) = .41, p = .52, = .01). For concrete words,𝜂𝜂 there was no 2 𝑝𝑝 significant difference between responses for congruent𝜂𝜂 compared to incongruent conditions

(F (1, 32) = 2.30, p = .13, = .06) and no interaction by gender (F (1, 32) = .07, p = .78, 2 2 𝑝𝑝 𝑝𝑝 = .002). This indicates that𝜂𝜂 there were no priming effects for abstract or concrete words. For𝜂𝜂

positive emotion words, there was a significant difference between congruent (M = 556.90,

SD = 12.44) and incongruent conditions (M = 581.44, SD = 11.62), F (1, 32) = 19.41, p

<.001, = .38, a large effect. This was the same for males and females, with no significant 2 𝑝𝑝 interaction𝜂𝜂 for word by gender (F (1, 32) = 1.09, p = .30, = .03. This indicates that RTs 2 𝑝𝑝 were faster in congruent conditions (i.e., positive, positive)𝜂𝜂 compared to incongruent conditions (i.e., negative, positive) and that this was the same for males and females. For negative emotion words, there was a significant difference between congruent (M = 578.85,

SD = 10.56) and incongruent conditions (M = 558.85, SD = 11.36), F (1, 32) = 12.29, p =

.001, = .27, a large effect. This was the same for males and females, with no significant 2 𝜂𝜂𝑝𝑝 THE PSYCHOPATH NEXT DOOR 220

interaction for word by gender (F (1, 32) = .71, p = .40, = .02. This indicates that RTs 2 𝑝𝑝 were faster in the incongruent conditions (i.e., positive, negative)𝜂𝜂 compared to congruent conditions (i.e., negative, negative) and this was regardless of gender.

Table 14 Mean RTs for lexical decision responses, presented separately for each gender, on congruent and incongruent trials (Milliseconds) Trial Male (n=17) Female (n=17) M SD M SD Positive Congruent 568 72 546 73 Positive Incongruent 586 58 577 77 Negative Congruent 583 60 575 63 Negative Incongruent 557 62 560 70 Abstract Congruent 606 70 581 66 Abstract Incongruent 609 74 594 71 Concrete Congruent 579 50 566 75 Concrete Incongruent 568 70 558 79

Psychopathy and Priming Effects

Priming effects were obtained for concrete, abstract, and positive and negative

emotion words by subtracting the mean RTs for the congruent trials from the mean RTs for

the incongruent trials. The descriptive data is presented in Table 15, greater values indicate

greater priming effects and smaller values indicate less priming.

Table 15 Priming effects, presented separately for each gender, for concrete, abstract and emotion words (in milliseconds) Male (n=17) Female (n=17) Measure M SD SE M SD SE Priming Effect Positive Word 18.70 38.34 9.29 30.38 25.30 6.13 (RT) Priming Effect Negative Words -25.23 36.57 8.87 -15.44 30.81 7.47 (RT) Priming Effect Abstract Words 3.84 41.43 9.46 13.76 47.70 11.57 (RT) Priming Effect Concrete Words -10.74 43.18 10.04 -7.93 28.01 6.79 (RT) Note: RT = Reaction Time in Milliseconds THE PSYCHOPATH NEXT DOOR 221

Spearman’s Rho nonparametric correlations were conducted to examine the relationships between psychopathy factors and priming effects for positive, negative, abstract, and concrete word types. Table 16 displays the findings for both males and females.

Table 16 Correlations between Psychopathy Factors and Priming Effects for Males and Females Male (n = 18) Females (n = 17)

Measure SCI FD COLD SCI FD COLD

Positive Priming -.324 -.444# -.132 .178 .341 -.059 Effect

Negative Priming -.066 -.140 .199 -.067 .366 .137 Effect

Abstract Priming -.196 .029 .530* .170 -.041 .362 Effect

Concrete Priming .609** .402# .032 .028 .299 .531* Effect

Note: * <.05, **,.01, # <.1 Regardless of gender, there were no significant relationships between the psychopathy factors and affective priming, possibly because of a lack of statistical power given the small sample sizes. However, a moderate negative relationship was observed between FD and priming for positive emotion words, with a trend towards significance (p = .08). This suggests that males with higher levels of primary psychopathy display less priming for positive emotion words. This relationship was not observed for females, with a non- significant positive relationship between FD and priming for positive words.

For males, SCI was strongly positively related to the concrete priming effect, indicating that individuals with higher levels of secondary psychopathy displayed greater priming effects for concrete words. There was also a moderate positive relationship between

FD and concrete priming effects, although this was only a trend (p =.07). These relationships were not observed for females, but Coldheartedness was significantly positively related to the THE PSYCHOPATH NEXT DOOR 222 concrete priming effect in females. In males, Coldheartedness was significantly positively related to the abstract priming effect.

Word Rating Task

Table 17 shows the descriptive statistics for the word rating task separately for males and females. Females and males both considered concrete words to be the most concrete, followed by negative words, positive words, and then abstract words; concrete words to be easier to think of a context, followed by emotion words, and then abstract words; concrete words easier to image, followed by negative words, positive words, and then abstract words; emotion words to be moderately arousing; positive emotion words to be positive and negative emotion words to be negative.

Table 17 Mean word ratings for positive, negative, abstract and concrete words on concreteness, imageability, context availability, arousal, and valence Male (n=18) Female (n=17) Measure M SD SE M SD SE Concreteness Positive words 3.83 1.02 .24 4.06 .92 .21 Negative words 4.82 .90 .21 5.08 .89 .20 Abstract words 2.68 1.01 .23 2.70 1.05 .24 Concrete words 6.85 .14 .03 6.84 .29 .06 Context Availability Positive words 6.48 .51 .12 6.26 .72 .16 Negative words 6.45 .59 .14 6.57 .58 .13 Abstract words 5.91 .86 .20 5.26 1.37 .31 Concrete words 6.63 .58 .13 6.77 .33 .07 Imageability Positive words 5.47 1.03 .24 5.60 .73 .16 Negative words 6.00 .78 .18 6.18 .55 .12 Abstract words 3.69 1.40 .33 3.20 1.11 .25 Concrete words 6.83 .28 .06 6.92 .11 .02 Arousal Positive words 4.60 .86 .20 4.97 1.08 .24 Negative words 3.80 1.25 .29 4.61 1.32 .30 Valence Positive words 5.64 .38 .09 5.81 .55 .12 Negative words 2.45 .80 .18 1.81 .46 .10

THE PSYCHOPATH NEXT DOOR 223

Mann-Whitney U analyses were conducted to determine any gender differences in word ratings (i.e., concreteness, imageability, context availability, arousal, and valence). The only significant difference across the word rating categories was for negative words, which were considered more negative by females (Mdn = 1.73, range = 1.87) compared to males

(Mdn = 2.15, range = 3.50), U = 61 p < .001, r = .54.

Correlations were conducted to examine whether psychopathy was related to the ways in which the words were rated. Because the word rating data was not normally distributed,

Spearman’s Rho non-parametric correlations were conducted. The findings are presented separately for males and females in Table 18.

Table 18. Correlations between Psychopathy Factors and Word Ratings for Males and Females Male (n = 18) Females (n = 17)

Measure SCI FD COLD SCI FD COLD

C-AB .106 .157 -.078 -.094 -.077 -.199

C-CON .186 .011 -.406 .160 .041 .096

C-POS .102 .313 .032 -.142 .026 -.031

C-NEG .110 .174 -.206 .103 -.065 .155

I–AB .142 .083 -.336 -.134 .026 -.305

I-CON -.010 -.016 -.486* -.170 -.015 -.172

I-POS -.044 .016 -.359 -.357 -.059 -.357

I-NEG -.107 .059 -.323 -.274 -.139 -.274

CT-AB -.004 .006 -.205 .128 .143 -.013

CT-CON .121 .322 .131 -.072 -.043 -.106

CT-POS -.229 -.046 -.149 .094 .179 -.018

CT-NEG .056 .212 -.076 .260 .058 .080

VAL-POS -.099 .008 -.601** -.039 -.346 -.173

VAL-NEG .415 .265 .494* .457* .518* .252

AR-POS .611** .775** .159 .063 .110 .010

AR-NEG .273 .385 .359 .380 -.062 .058

Note: *<.05, **<.01 CT = Context availability, C = Concreteness, I = Imageability, VAL = Valence, AR = Arousal, AB = Abstract, CON = concrete, POS = positive, NEG = negative. THE PSYCHOPATH NEXT DOOR 224

For males, Coldheartedness was moderately negatively related to imageability for

concrete words, strongly negatively related to valence for positive words, and strongly

positively related to valence for negative words. These findings indicate that males with

higher levels of Coldheartedness consider concrete words to be harder to image, positive

words to be less positive, and negative words to be less negative. Both Self-Centered

Impulsivity and Fearless Dominance were strongly, positively related to arousal for positive words. This indicates that males higher on SCI and FD consider positive words to be more arousing. For females, a moderate-strong positive correlation was observed between the valence rating for negative words and both SCI and FD. This indicates that females with higher levels of SCI and FD consider negative words to be less negative.

Discussion

Overview of Research

The primary aim of this study was to empirically test the claims of emotional impairment in primary psychopathy proposed by the dual process model of psychopathy in a noncriminal sample. According to the dual process model, psychopathy consists of two etiologically distinct variants: primary psychopathy and secondary psychopathy (Patrick &

Bernat, 2009). Primary psychopathy is thought to result from aberrant neurological functioning in regions of the brain responsible for emotion processes, specifically fear and anxiety. Secondary psychopathy is considered to stem from impairments in brain regions responsible for higher-order cognitive processes, resulting in disorganised and impulsive behaviour. According to the dual process model, individuals can present with elevations on either primary or secondary psychopathy, or elevations on both primary and secondary psychopathy.

Following the claims of the dual process model, it was hypothesized that secondary psychopathy would be characterised by intact or increased responsivity to emotional THE PSYCHOPATH NEXT DOOR 225 information on a lexical decision task. Specifically, it was hypothesized that secondary psychopathy would be positively associated with affective priming for negative words. In contrast, it was hypothesized that the performance of individuals with primary psychopathy would not be influenced by emotional information. Specifically, it was hypothesized that for males, primary psychopathy would be associated with less priming for negative words. Given that the results from the previous study found that the dual process model does not adequately explain secondary psychopathy in females, it was predicted that primary psychopathy in females would not be associated with priming effects for emotion words. A word rating task was also included to examine whether primary and secondary psychopathy might be associated with the ways in which emotion words, concrete words, and abstract words were rated on attributes known to facilitate responding on lexical decision tasks.

Because some previous research has demonstrated that psychopathy may be associated with dysfunctional semantic processing for abstract words, an examination of word ratings and priming effects for abstract and concrete words types was included in the study. It was hypothesized that there would be intact semantic processing for primary and secondary psychopathy in both males and females. However, it was thought that if semantic processing deficits were observed they would be for abstract words only.

Key Findings

Psychopathy and priming. There were gender differences observed in the relationship between psychopathy and priming. For males there was a trend level moderate, negative relationship observed between Fearless Dominance and priming for positive words.

The opposite relationship was observed for females with a non-significant positive relationship found between Fearless Dominance and priming for positive words. No other findings existed for affective stimuli. THE PSYCHOPATH NEXT DOOR 226

With regard to semantic processing, Self-Centered Impulsivity was positively related

to the priming effect for concrete words, and a trend level relationship was observed between

Fearless Dominance and the priming effect for concrete words. This suggests that there does

not appear to be a deficit in semantic processing of abstract or concrete stimuli in a

noncriminal psychopathic sample. For females, there was a positive relationship between

Coldheartedness and priming for concrete words and abstract words. This suggests that

semantic processing is intact for females with high levels of the affective features of

psychopathy.

Psychopathy and word ratings. The results from this study revealed that for males,

Coldheartedness was related to lower ratings of imageability for concrete words, lower

valence ratings for positive words and high valence ratings for negative words. This means

that males high on the affective features of psychopathy consider concrete words as harder to

bring an image to mind, positive words less positive and negative words less negative. These

findings suggest that the affective features of psychopathy, such as callousness and a lack of

empathy, are related to differential appraisal of emotional information. This may indicate that

individuals high on the callous traits of psychopathy do not respond appropriately to

emotional information because of differences in the appraisal of the information rather than a

lack of responsivity. This finding is in contrast with that found in criminal offender samples,

where psychopathic individuals rated emotional words the same as nonpsychopathic

individuals (Kiehl, 1999; S. Williamson et al., 1991). However, the current study differs in methodology, viewing psychopathy as a continuous construct as opposed to taxonomic.

Therefore, methodological differences may account for the discrepancy in the findings between this study and those using criminal offenders. Alternatively, it could be that similarities between offenders in the evaluation of emotion has obfuscated the findings of differential appraisal of the valence of emotional stimuli in psychopathy. THE PSYCHOPATH NEXT DOOR 227

Self-Centered Impulsivity and Fearless Dominance were related to arousal for positive words. This means that males in this study with higher levels of primary and secondary psychopathy considered positive emotion words to be more exciting than individuals lower on primary and secondary psychopathy. These findings suggest appetitive appraisal of positive emotion stimuli for males in both primary and secondary psychopathy.

Whilst previous research has examined valence ratings, this is the first study to examine arousal for emotional words as a function of psychopathy.

For females, both Self-Centered Impulsivity and Fearless Dominance were positively related to valence for negative emotion words. This means that females with higher levels of primary and secondary psychopathy consider negative words to be less negative. This indicates that both the interpersonal and lifestyle features of psychopathy in women are related to differential appraisal of negative emotion information. This finding is in contrast with the hypotheses for emotional appraisal in primary and secondary psychopathy for women. However, given that there are no previous studies that have examined word ratings in primary and secondary psychopathy using female participants these findings offer the first insight into the appraisal of emotional language. The finding of differential appraisal of negative emotion words in primary psychopathy is consistent with clinical accounts of emotional impairment in primary psychopathy. This may suggest that the affective features of primary psychopathy, considered by clinicians and researchers alike to be a key diagnostic feature, are also characteristic of female psychopathy. The findings regarding secondary psychopathy were not expected and suggest that secondary psychopathy in females is related to differential appraisal of negative stimuli.

Summary of Findings

The findings from this study provide partial support for the hypotheses. It was hypothesized that secondary psychopathy would be related to increased priming for negative THE PSYCHOPATH NEXT DOOR 228

words, but no relationship with priming for positive words was expected for both males and

females. Consistent with this hypothesis, secondary psychopathy was not related to priming

for either positive or negative emotion words in either males or females, indicating intact

emotion processing. It was hypothesized that primary psychopathy would be negatively

related to priming effects for negative emotion words. This hypothesis was only partially

supported by the findings of this study with primary psychopathy not related to priming for

negative words. However, primary psychopathy in males was related to less priming for

positive emotion words, indicating that males with primary psychopathy may have

difficulties using positive emotion cues and information. This provides partial support for the

dual process hypothesis, which suggests that primary psychopathy is underscored by dysfunctional neurological processing of emotional information. Interestingly, in some instances, the explicit appraisal of emotional stimuli in this study did not correspond with the

implicit responses. This may be because males higher on primary psychopathy are

responding dishonestly. However, given that participation in this study was anonymous, the

motivation to do so is unclear. An alternative explanation is that males higher on primary

psychopathy have intact appraisal of emotional stimuli but have difficulties processing

emotional information. In contrast to males, it was hypothesized that primary psychopathy in

females would be unrelated to priming for negative emotion words and this hypothesis was

supported. This suggests that the dual process model of psychopathy does not adequately

explain female psychopathy.

Limitations, Implications and Directions for Future Research

This study possessed some limitations that may affect interpretation of the findings.

Firstly, despite the use of methodologically robust lexical decision task, the expected priming

effects for abstract, concrete and negative emotion words that have been found in previous

research were not found in this study. This cannot be explained by the word stimuli, as THE PSYCHOPATH NEXT DOOR 229

participants in the current study rated words similarly to previous research on concreteness,

imageability, valence and arousal. However, this study did not examine the cue to target

strength for each of the prime-target pairs. It could be that the participants in this study did

not consider the prime-target pairs to be highly related. Future research could consider the use of a discrete associate task to examine the prime to target strength of association. The absence of clear priming effects makes interpretation of the relationship between psychopathy and the priming effects difficult, as only one priming effect was found (i.e., for positive words). Future studies may consider the use of an alternative implicit emotion task to

assess emotional processing in noncriminal psychopathy (e.g., affective priming using picture

stimuli). Secondly, this study was also limited by the small sample size, meaning that some of

the correlational analyses may have lacked statistical power. For example, a moderate,

negative correlation was observed between primary psychopathy and positive priming but

this did not reach statistical significance. Furthermore, given that results could change with

greater statistical power, the current findings should be interpreted with caution. The use of

larger sample size will make it easier to elucidate the relationships between psychopathy and

affective and semantic priming

Chapter Six

Chapter Summary

This program of research contributes to the current psychopathy literature by

addressing the scarcity of research on noncriminal psychopathy and female psychopathy,

whilst also examining the unique relationships between primary and secondary psychopathy

and criminality, executive function, and emotion processing. The key findings from each

study have been discussed in their respective chapters. Therefore, this chapter of the thesis

provides a summary of these key findings, along with a discussion of the implications for THE PSYCHOPATH NEXT DOOR 230

current theories of psychopathy and some practical implications. The chapter concludes with

a discussion on future directions in psychopathy research.

Psychopathy and Criminality

Because there are few studies on the relationship between noncriminal psychopathy

and criminality in the general population, it was not known whether criminality was a key feature of psychopathy or simply one manifestation. Some theorists have claimed that antisocial behaviour is a defining feature (e.g., Hare, 1991; Hare & Neumann, 2010).

However, there was little empirical evidence for such a claim, with the majority of research on psychopathy conducted in criminal offender samples and with criminal measures of psychopathy. This obfuscated any clear interpretation of the relationship between psychopathy and criminality. Furthermore, the exclusive use of male participants limits our understanding of the nature and presentation of female psychopathy. Therefore, Study 1 sought to answer two research questions: (1) How central is criminal behaviour to the construct of psychopathy; and (2) Is the relationship between criminality and psychopathy the same for males and females? This was achieved by examining the relationship between psychopathy and criminality in the community using noncriminal measures of psychopathy and a mixed gender sample. Additionally, an examination of possible gender differences in

the psychopathy-criminality nexus was included to address the male bias in previous

psychopathy research. To the best of our knowledge, this was the first study to examine the

relationship between psychopathy and criminality using noncriminal measures in a mixed

gender, general population sample

The findings from Study 1 challenge the common assumption of both laypeople and

researchers that psychopathy equals criminality, and provides some support for Skeem &

Cooke’s (2010a) assertion that the current body of literature on psychopathy reflects

primarily unsuccessful psychopathy. These findings highlight the need to extend psychopathy THE PSYCHOPATH NEXT DOOR 231 research to noncriminal samples, as such research may lead to the identification of protective factors for individuals with psychopathy who are at risk of criminal offending. However, there was evidence of gender differences between psychopathy and criminal attitudes, and future research is needed to determine the mechanisms underlying gender differences in psychopathy. One such direction could be to examine the extent to which psychopathic females identify with the feminine gender role, and the extent to which gender stereotypes influence criminal and noncriminal female psychopaths.

Executive Function

Study 2 extended theory testing of the successful and dual process models of psychopathy by examining the relationships between primary and secondary psychopathy and executive function in a mixed gender community sample. In line with the claims of the successful psychopathy model, Gao and Raine (2010) suggest that criminal and noncriminal psychopaths are differentiated by executive functioning. According to their hypothesis, criminal psychopaths are characterised by executive dysfunction which places them at greater risk for overt criminal offending. In contrast, noncriminal or ‘successful’ psychopaths possess intact or superior executive functioning, which acts as a protective mechanism against criminal offending. From this perspective, executive function is hypothesised to moderate the expression of antisocial behaviour in psychopathy.

elevated levels on only primary or secondary psychopathy. In this conceptualisation, the

criminal psychopath presents with elevated levels of both dimensions. However, the

noncriminal psychopath presents with only elevated levels of primary psychopathy, with low

or average levels of secondary psychopathy. From this perspective, primary psychopathy

would be associated with intact executive functioning. In contrast, secondary psychopathy

would be characterised by executive dysfunction.

In Study 2, two main research questions were addressed: (1) What is the relationship

between psychopathy variants and executive function in a community sample; and (2) Is the

pattern of relationships between psychopathy variants and executive function the same for

males and females? This was achieved by utilising several commonly used measures of

executive function and examining their relationship with psychopathy and criminal behaviour

in a community sample, separately for males and females. Furthermore, because there is

some evidence that measures of executive function and measures of intelligence tap the same

underlying construct, intelligence was included as a possible mediating factor.

The results from Study 2 did not provide support for the successful psychopathy model, but provided partial support for the dual process model of psychopathy. For both males and females, primary psychopathy was associated with intact performance on all measures. Interesting, for females, primary psychopathy was predictive of superior response inhibition and this effect was independent of intelligence. However, support for the dual process model was dependent on gender. For males, secondary psychopathy was predictive of poorer planning ability and a lack of cognitive flexibility and this was not mediated by intelligence. This suggests some deficits in executive function for psychopathic males. In contrast, for females, it was found that secondary psychopathy predicted superior planning ability and cognitive flexibility and this was not mediated by intelligence. These findings suggest that whilst the dual process model of psychopathy explains male psychopathy, it does THE PSYCHOPATH NEXT DOOR 233 not adequately explain female psychopathy. Given these findings, the final study of the thesis set out to examine the claims of the dual process model of psychopathy in relation to emotion processing, with particular attention to gender differences.

Emotion Processing

Most previous research on emotion processing abnormalities in psychopathy has been conducted using male, criminal offender samples. Therefore, it was suggested that the patterns of emotion dysfunction currently observed in psychopathy may not generalise to other psychopathic populations. Specifically, given the findings from Study 2, it was suggested that the current psychopathy literature may not be applicable to female psychopathy. In fact, given that a range of cognitive and emotion processing differences are observed between males and females, it was suggested that some differences in cognitive and emotional processing between male and female psychopaths may be expected. Therefore, the aim of Study 3 was to test the dual process model of psychopathy, with a particular focus on the examination of gender differences in affective dysfunction in psychopathy. Two main research questions were addressed; (1) What is the relationship between psychopathy variants and emotion processing in a community sample; and (2) Is the relationship between psychopathy variants and emotion processing the same for males and females?

The results of Study 3 found some evidence of emotion processing deficits in primary but, not secondary psychopathy, for males but not females. These findings provide partial support for the dual process model of psychopathy for males and again highlight that current theoretical models of psychopathy are unsuitable for female psychopathy. However, the findings from this study should be interpreted with caution as we were unable to obtain priming effects with the LDT, which limited our examination of emotion-processing deficits. THE PSYCHOPATH NEXT DOOR 234

Theoretical Implications, Practical Applications, and Directions for Future Research

The findings from the three studies of this thesis have implications for the current

theories of psychopathy. Firstly, the assumption that criminality is central to psychopathy is

not supported by the evidence from Study 1, which is the only study to examine psychopathy

and criminality in a community sample with a noncriminal measure of psychopathy and a

consideration of gender differences. This finding, taken together with the lack of evidence in

the literature for criminality as a key feature, suggests that accounts of psychopathy that posit

criminality as a central feature need to be revised. Furthermore, these findings bolster the

claims by Skeem and Cooke (2010) that the current body of literature primarily reflects

research on unsuccessful psychopathy. Future research on psychopathy should focus on

examining psychopathy in a range of noncriminal populations (e.g., the general community,

corporate environments, etcetera) as research in these samples may lead to the identification

of protective factors and early indicators that can inform the treatment and management of

psychopathic individuals, both criminal and otherwise.

The second broad theoretical implication from these findings is that a dual process

account of psychopathy, as suggested by Patrick and Bernat (2009), best accommodates the

contradictory and often paradoxical research findings of both emotion deficits and cognitive

deficits in psychopathy. Furthermore, these findings suggest that the IES Model and RMH

may not be mutually incompatible, but complimentary accounts of psychopathy deficits in

primary and secondary psychopathy, respectively. The findings presented here suggest that

primary psychopathy is primarily characterised by emotion deficits, as predicted by the IES

Model and secondary psychopathy is primarily characterised by cognitive deficits, namely

executive dysfunction, as suggested by the RMH. This aligns with Patrick and Bernat’s

(2009) account, which brings together these competing theories and offers a possible explanation for the contradictory findings of emotion deficits and cognitive deficits in THE PSYCHOPATH NEXT DOOR 235

psychopathy when psychopathy is examined as a unitary construct. Taken together, this highlights the importance of examining psychopathy variants separately in future psychopathy research. Given these findings, it stands to reason that a broad treatment approach for psychopathy may not be effective, and this could partially explain the failure of previous approaches to the treatment of psychopathy. Given that primary and secondary psychopathy are characterised by unique deficits (i.e., emotion deficits and executive dysfunction, respectively), it seems reasonable to suggest that treatment approaches to psychopathy should first focus on elucidating whether an individual is high on primary or secondary psychopathy, or both, and tailor treatment approaches to address the primary underlying dysfunction.

The final broad theoretical implication from the studies presented here is that current theoretical models of psychopathy, designed to explain male psychopathy, do not explain female psychopathy. The findings from Study 2, which is the first study to examine gender differences in the executive function-psychopathy relationship, suggest that alternative theories of female psychopathy are needed. Future research should focus on examining female psychopathy, with the goal of elucidating possible gender differences in the manifestation of psychopathy.

THE PSYCHOPATH NEXT DOOR 236

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Appendix 1

See attachment labelled ‘Appendix_Study1_Questionnaire’.

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Appendix 2

Personality and the Law PARTICIPANT INFORMATION FOR QUT

RESEARCH PROJECT

Personality and Language Processing

QUT Ethics Approval Number 1100001490

RESEARCH TEAM Principal Emily Adam, PhD Student, QUT Researcher:

Associate Associate Professor Renata Meuter and Associate Professor Nigar Khawaja, Researcher: QUT

DESCRIPTION This project is being undertaken as part of a PhD research project for Emily Adam. The purpose of this project is to explore the relationship between personality and attitudes towards authority and the law. You are invited to participate in this project in order to gain a better understanding of how personality influences the ways in which individuals think about the law and authority. PARTICIPATION The research team are looking for male and female participants between the ages of 18 and 60 years who reside in South East Queensland. Participants must speak English as their first language. The following exclusion criteria also apply: 1) no past or present history of psychiatric or neurological disorders; 2) no regular use of psychiatric or neurological medication (e.g., antiepileptic medication or antidepressants). Your participation in this project is entirely voluntary. If you do agree to participate, you can withdraw from the project at any time without comment or penalty. Any identifiable information already obtained from you will be destroyed. Your decision to participate, or not participate, will in no way impact upon your current or future relationship with QUT. Participation will involve completing an online survey that includes a brief demographic questionnaire, a personality questionnaire, a questionnaire on attitudes towards the law, and a questionnaire looking at any past anti-social acts. Participation will take approximately 45 minutes of your time and participation is anonymous. The questionnaires are designed to assess your feelings and beliefs, for example, “Before I do anything, I carefully consider the possible consequences” and to gain some background information (e.g. age and gender). EXPECTED BENEFITS It is expected that this project will not directly benefit you. However, it may benefit our understanding of how personality influences the way individuals’ view authority and the law. To recognise your contribution should you choose to participate, the research team is offering participants the chance to win an iPad mini. RISKS There are no risks beyond normal day-to-day living associated with your participation in this project. THE PSYCHOPATH NEXT DOOR 279

PRIVACY AND CONFIDENTIALITY All comments and responses will be treated confidentially and will remain anonymous. You will be asked to provide a unique code at the start of the study to identify your responses on this study with subsequent studies, whilst maintaining your anonymity. The unique code will not identify you an any way and will only be used for the purpose of matching responses. If please provide your contact phone number when prompted at the end of the survey. Please note that non-identifiable data collected in this project may be used as comparative data in future projects. CONSENT TO PARTICIPATE Submitting the completed online questionnaire is accepted as an indication of your consent to participate in this project. QUESTIONS / FURTHER INFORMATION ABOUT THE PROJECT If have any questions or require any further information about the project please contact one of the research team members. A/Prof Renata Meuter, A/Prof Nigar Khawaja, Emily Adam, PhD Student Supervisor Supervisor

School of Psychology and Counselling, Faculty of Health, QUT

+61 7 3138 4625 +61 7 3138 4625 +61 7 3138 4625

[email protected] [email protected] [email protected]

CONCERNS / COMPLAINTS REGARDING THE CONDUCT OF THE PROJECT QUT is committed to research integrity and the ethical conduct of research projects. However, if you do have any concerns or complaints about the ethical conduct of the project you may contact the QUT Research Ethics Unit on +61 7 3138 5123 or email [email protected]. The QUT Research Ethics Unit is not connected with the research project and can facilitate a resolution to your concern in an impartial manner. Thank you for helping with this research project. Please keep this sheet for your information.

THE PSYCHOPATH NEXT DOOR 280

Appendix 3

PARTICIPANT INFORMATION FOR QUT

RESEARCH PROJECT

Personality and Language Processing

QUT Ethics Approval Number 1100001490

RESEARCH TEAM Principal Emily Adam, PhD Student, Queensland University of Technology (QUT) Researcher:

Associate Associate Professor Renata Meuter and Associate Professor Nigar Khawaja, Researcher: QUT

DESCRIPTION This project is being undertaken as part of a PhD research project for Emily Adam. The purpose of this project is to explore the relationship between personality and memory, attention, problem-solving, multi-tasking, planning, and the processing of different types of words: emotion words (i.e. happy, sad), concrete words (i.e. desk), and abstract words (i.e. metaphor). You are invited to participate in this project in order to gain a better understanding of how personality influences the processing of written language, memory, attention, and other tasks such as problem- solving and multi-tasking. PARTICIPATION The research team are looking for male and female participants between the ages of 18 and 60 years who reside in the South East Queensland Region. Participants must speak English as their first language. The following exclusion criteria also apply: 1) no past or present history of psychiatric or neurological disorders; and 2) no regular use of psychiatric or neurological medication (e.g., antiepileptic medication or antidepressants). Your participation in this project is entirely voluntary. If you do agree to participate, you can withdraw from the project at any time without comment or penalty. Any identifiable information already obtained from you will be destroyed. Your decision to participate, or not participate, will in no way impact upon your current or future relationship with QUT. Participation involves attending two testing sessions scheduled on different days. Participation in one testing session will involve completing a brief demographic questionnaire, a personality questionnaire, a word rating task, and a lexical decision task. Participation in this testing session will take approximately 1 and a half hours of your time. The questionnaire is designed to assess your feelings and beliefs, for example, “Some people say that I am a ‘worry wart’” and to gain some background information (e.g. age and gender). The word rating task is designed to gain your opinion on the qualities of English language words. The lexical decision task simply asks you to decide whether a string of letters is a word or not (e.g. apple vs bram) and records your response times in making that decision. Participation in the other testing session will involve completing a brief demographic questionnaire, four computerised problem-solving tasks and one pen-and-paper problem-solving task. Participation in this testing session will take approximately 1 and a half hours of your time. The computerised and pen-and-paper problem-solving tasks are designed to memory, attention, problem-solving, planning and multi-tasking. THE PSYCHOPATH NEXT DOOR 281

EXPECTED BENEFITS It is expected that this project will not directly benefit you. However, it may benefit our understanding of how personality influences the way individuals’ process written language. To recognise your contribution should you choose to participate, the research team is offering participants two adult movie passes for each testing session. RISKS

There are no risks beyond normal day-to-day living associated with your participation in this project. PRIVACY AND CONFIDENTIALITY All comments and responses will be treated confidentially and will remain anonymous. If you are willing to participate in similar follow-up studies for this research project, please provide your contact phone number and your unique code as indicated at the end of the questionnaire. This unique code will not identify you in any way, and will only be used for the purpose of matching responses from this study and any follow-up studies. Please note that non-identifiable data collected in this project may be used as comparative data in future projects. CONSENT TO PARTICIPATE Submitting the completed online questionnaire is accepted as an indication of your consent to participate in this project. QUESTIONS / FURTHER INFORMATION ABOUT THE PROJECT If have any questions or require any further information about the project please contact one of the research team members. A/Prof Renata Meuter – A/Prof Nigar Khawaja – Emily Adam – PhD Student Supervisor Supervisor

School of Psychology and Counselling – Faculty of Health – QUT

07 3138 4625 07 3138 4625 07 3138 4625

[email protected] [email protected] [email protected]

CONCERNS / COMPLAINTS REGARDING THE CONDUCT OF THE PROJECT QUT is committed to research integrity and the ethical conduct of research projects. However, if you do have any concerns or complaints about the ethical conduct of the project you may contact the QUT Research Ethics Unit on 07 3138 5123 or email [email protected]. The QUT Research Ethics Unit is not connected with the research project and can facilitate a resolution to your concern in an impartial manner. Thank you for helping with this research project. Please keep this sheet for your information.

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Appendix 4

Welcome to the n-back test. You will see letters on the screen, one letter at a time. When you see the letter X press TARGET. For all other letters press NOT A TARGET. Press

SPACEBAR to continue.

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Appendix 5

You are about to perform a task called the ‘Tower of London’. Your goal is to move a pile of disks from their original configuration to the configuration shown on the top of the screen.

You can only move one disk at a time, and you cannot move a disk onto a pile that has no more room (as indicated by the size of the grey rectangle). To move a disk, clock on the pile you want to move the disk off of, and it will move up above the piles. Then, click on another pile and the disk will move down to that pile. You will only have a limited number of moves to solve each problem. Before you make your first move, think about the problem to make sure you can solve it within your move limit. If you do not finish the problem within the limit, the turn will end and you will move onto the next problem. Running head: THE PSYCHOPATH NEXT DOOR 284

Appendix 6