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Characterizing Psychopathy Using DSM-5 Personality Traits

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Characterizing Psychopathy Using DSM-5 Personality Traits ASMXXX10.1177/1073191113486691Assessment 20(3)Strickland et al. 486691research-article2013 Article Assessment 20(3) 327 –338 Characterizing Psychopathy Using DSM-5 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav Personality Traits DOI: 10.1177/1073191113486691 asm.sagepub.com Casey M. Strickland1, Laura E. Drislane1, Megan Lucy1, Robert F. Krueger2 and Christopher J. Patrick1 Abstract Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets. Keywords psychopathy, DSM-5, personality disorders, antisocial personality disorder, PID-5 The diagnosis of antisocial personality disorder (ASPD) has PDs (Clark, 2007; Trull & Durrett, 2005; Widiger & Clark, been intensely debated since release of the third and fourth 2000). For these reasons, many researchers favor a dimen- editions of the Diagnostic and Statistical Manual of Mental sional approach to characterizing personality pathology, Disorders (DSM-III/IV; American Psychiatric Association, arguing that PDs represent extremes along trait-disposi- 1980, 2000). In particular, critics have argued that ASPD is tional continua, accompanied by diminished social/occu- a weak facsimile of the classic clinical construct of psychop- pational functioning (Frances & Widiger, 2012; Livesley & athy, omitting core affective-interpersonal features central to Jang, 2000; Widiger & Mullins-Sweatt, 2009). With the the condition. A supplemental approach to diagnosing per- aim of addressing these challenges, the PD section of the sonality pathology that conceptualizes ASPD and other per- upcoming fifth edition of the DSM (DSM-5) will include an sonality disorders (PDs) in terms of dimensional traits will important extension of the existing DSM-IV framework. be included in the upcoming fifth edition of the DSM (DSM- Along with inclusion of PDs as currently defined in 5) as an emerging model. The current study evaluated how DSM-IV, the DSM-5 will include, in Section III, a new effectively this new trait-based approach captures essential trait-based system for characterizing personality pathol- symptomatic facets of psychopathy specified by an integra- ogy, developed by the Personality and Personality Disorders tive theoretic perspective, the Triarchic model (Patrick, (PPD) Work Group for DSM-5, as an emerging model for Fowles, & Krueger, 2009), and in particular whether traits use in clinical research. This addition provides the founda- aside from those specified for the diagnosis of ASPD might tion for moving from the existing categorical system for be needed to capture psychopathy as defined in classic his- PDs toward an alternative dimensional framework in suc- toric writings (e.g., Cleckley, 1976; Lykken, 1957, 1995). cessive revisions of the DSM. Diagnosis of Personality Pathology in DSM-5 1Florida State University, Tallahassee, FL, USA 2University of Minnesota, Minneapolis, MN, USA The categorical system for diagnosing PDs in DSM-IV has Corresponding Author: been widely criticized on a number of grounds, including Christopher J. Patrick, Department of Psychology, Florida State arbitrary symptom thresholds for diagnoses, low reliabili- University, 1107 West Call Street, Tallahassee, FL 32306, USA. ties for a number of the PDs, and high comorbidity among Email: [email protected] Downloaded from asm.sagepub.com at FLORIDA STATE UNIV LIBRARY on August 29, 2013 328 Assessment 20(3) Table 1. Diagnostic Criteria for Antisocial Personality Disorder in DSM-IV, with (in parentheses) Corresponding Personality Trait Criteria within DSM-5 Emerging Model. 1. Failure to conform to social norms with respect to lawful behaviors 2. Deceitfulness (1b, ANT—Deceitfulness) 3. Impulsivity or failure to plan ahead (2b, DIS—Impulsivity) 4. Irritability and aggressiveness (1d, NEGAFF—Hostility) 5. Reckless disregard for safety of self or others (2c, DIS—Risk Taking) 6. Consistent irresponsibility (2a, DIS—Irresponsibility) 7. Lack of remorse (1c, ANT—Callousness) Note. Number/letter entries in parentheses reflect ordering of traits specified under Criterion B (personality trait indicators) for this diagnosis in DSM-5. Capitalized abbreviations in parentheses refer to broad domains in which specified traits are located (ANT = domain of Antagonism; DIS = Disinhibition; NEGAFF = Negative Affect); although identified conceptually with the domain of Antagonism in the PD trait model for DSM-5, the trait of Hostility is identified instead with the domain of Negative Affect in the Personality Inventory for DSM-5 (PID-5; Krueger et al., 2012), based on preferential empirical convergence with this domain. The DSM-5 trait-based definition omits DSM-IV Criterion 1 (not considered a personality disposi- tion; R. F. Krueger, personal communication, July 25, 2012) and adds Criterion 1a, Manipulativeness, from the domain of Antagonism. In addition to these specified traits, the diagnosis of antisocial personality disorder in DSM-5 requires characteristic impairments in self-functioning and interpersonal functioning (Criterion A). This alternative trait-based model calls for PDs to be Beyond this, it is important to evaluate how effectively diagnosed on the basis of impairments in identity, self- the DSM-5 trait-based model can capture features of psy- direction, empathy, and/or intimacy, together with the pres- chopathy not well represented in DSM-IV ASPD (Drislane, ence of pathological personality traits. As a basis for Arsal, & Patrick, 2013; Lynam & Vachon, 2012). The operationalizing these dimensions, members of the DSM-5 Disinhibition and Antagonism domains of the PID-5 appear Work Group and their collaborators developed an instru- to cover much of the same thematic terrain as the disinhibi- ment, the Personality Inventory for DSM-5 (PID-5; Krueger, tion and meanness components of the Triarchic model. Derringer, Markon, Watson, & Skodol, 2012), for assessing However, ASPD as defined in the PD trait model for DSM-5 lower-order facet traits that empirically delineate broad (consistent with its characterization in DSM-IV) does not domains of personality pathology (Negative Affect, include elements of interpersonal efficacy, emotional resil- Detachment, Antagonism, Disinhibition, Psychoticism). iency, and fearless temperament (i.e., prototypical elements Recent studies have linked the PID-5 domains to the exist- of boldness), which are considered by many to be defining ing Personality Psychology–Five (PSY-5) dimensions mea- features of psychopathy (for contrasting views on this issue, sured in the Minnesota Multiphasic Personality Inventory–2 see: Lilienfeld et al., 2012; Marcus, Fulton, & Edens, 2012; Restructured Form (Anderson et al., 2013). Miller & Lynam, 2012; Patrick, Venables, & Drislane, 2013). Indeed, features such as glibness/superficial charm Antisocial Personality Disorder Versus and grandiose sense of self-worth, reflecting high levels of Psychopathy boldness, appear to be crucial for distinguishing psychopa- thy from ASPD (Patrick et al., 2013; Patrick, Hicks, Nichol, One key variant of personality pathology represented in the & Krueger, 2007; Skeem, Polaschek, Patrick, & Lilienfeld, emerging dimensional model for DSM-5 is ASPD. As a 2011). An important question, therefore, is whether the counterpart to the criterion-based definition that exists cur- boldness component of psychopathy can be effectively cap- rently in DSM-IV, the PPD Work Group proposed a trait- tured by PD traits included in the trait model for DSM-5— based definition encompassing traits from PD-relevant as a basis for defining a classically psychopathic variant of domains of Disinhibition and Antagonism. Specifically, as ASPD marked by social efficacy, emotional stability, and shown in Table 1, DSM-IV ASPD criteria of impulsivity, fearlessness. reckless disregard, and irresponsibility are represented by The ability to distinguish psychopathy from ASPD traits of Impulsivity, Risk Taking, and Irresponsibility would be valuable in both clinical and research contexts, as (Disihibition domain), and criteria of deceitfulness, aggres- substantial evidence indicates that antisocial individuals siveness, and lack of remorse are represented by traits of who exhibit the core affective-interpersonal features of Deceitfulness, Manipulativeness, Hostility, and Callousness psychopathy differ in important ways from those who lack (domain of Antagonism). Thus, the dimensional PD frame- these traits.
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