Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

The association between psychopathy and other mental disorders was investigated in 80 male forensic patients. Psychopathy was assessed with the Psychopathy Checklist (PCL; R. D. Hare [see PA, Vol 67:2477]). Diagnoses of other mental disorders were based on Axis I and Axis II criteria listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and on two standardized psychiatric rating scales. PCL diagnoses were significantly related only to antisocial and histrionic personality disorder (PD) and to nonalcohol substance abuse disorders. PCL ratings were also positively correlated with prototypicality ratings of antisocial, histrionic, and narcissistic PD and negatively correlated with ratings of avoidant PD. The results provide evidence for the convergent and discriminant validity of the PCL and are consistent with the view that psychopathy is a distinct clinical syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and the DSM-IV criteria for antisocial personality disorder.

The Axis II Work Group of the Task Force on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. R. D. Hare et al describe an alternative to the approach taken in the DSM-III—Revised (DSM-III—R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. The authors also discuss the multisite APD field trials designed to evaluate and compare 4 criteria sets: the DSM-III—R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th edition of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new method for assessing the interpersonal behavior of psychopathic individuals: Preliminary validation studies.

Two studies examined whether increased attention to interpersonal behaviors would improve assessments of the personality core underlying psychopathy. After item analysis, 21 items measuring interpersonal interactions and nonverbal behaviors associated with psychopathy were retained as the Interpersonal Measure of Psychopathy (IM-P). Federal prison inmates (Study 1, N?=?98) and undergraduates (Study 2, N?=?92) were rated on occurrence of these behaviors during an interview conducted to complete either Hare's Psychopathy Checklist—Revised (PCL-R) or Psychopathy Checklist: Screening Version (PCL: SV). In both studies, IM-P scores correlated more highly with PCL Factor 1 than with PCL Factor 2 scores. Regression analyses indicated that, after controlling for demographic variables and PCL factor scores, IM-P scores predicted interviewer emotional responses and participants' adult fighting (Study 1) and ratings of participants' interpersonal dominance (Study 2). Thus, measurement of interpersonal behavior appears to permit improved prediction of several criteria linked to the personality core of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Refining the construct of psychopathy: Towards a hierarchical model.

Psychopathy is characterized by diverse indicators. Clinical accounts have emphasized 3 distinct facets: interpersonal, affective, and behavioral. Research using the Psychopathy Checklist–Revised (PCL–R), however, has emphasized a 2-factor model. A review of the literature on the PCL–R and related measures of psychopathy, together with confirmatory factor analysis of PCL–R data from North American participants, indicates that the 2-factor model cannot be sustained. A 3-factor hierarchical model was developed in which a coherent superordinate factor, Psychopathy, is underpinned by 3 factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience, and Impulsive and Irresponsible Behavioral Style. The model was cross-validated on North American and Scottish PCL–R data, Psychopathy Screening Version data, and data derived from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) antisocial personality disorder field trial. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria.

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical study of the relation of borderline personality disorder to Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders

OBJECTIVE: The criteria for borderline personality disorder seem to select patients with very high rates of Briquet's syndrome (hysteria), somatization disorder, antisocial personality disorder, and substance abuse disorders. This study was undertaken to determine whether systematic assessment of patients with borderline personality disorder would reveal characteristic features of that condition which would distinguish it from these other disorders. METHOD: Eighty-seven white female patients (75 in St. Louis and 12 in Milan, Italy) who had borderline personality disorder according to both the DSM-III-R criteria and the Revised Diagnostic Interview for Borderlines were further examined with the DSM-III-R Checklist and the Perley-Guze Hysteria Checklist to determine their patterns of psychiatric comorbidity. RESULTS: Every patient had at least one additional DSM diagnosis. Patients in St. Louis and Milan averaged five and four additional diagnoses, respectively. Eighty-four percent of the patients in St. Louis met criteria for either somatization disorder, Briquet's syndrome, antisocial personality disorder, or substance abuse disorders. Patterns of comorbidity for panic (51%), generalized anxiety disorder (55%), and major depression (87%) in St. Louis were consistent with those in other studies. CONCLUSIONS: The data indicate that the boundaries for the borderline condition are not specific and identify a high percentage of patients with these other disorders. Furthermore, the comorbidity profiles closely resemble the psychiatric profiles of patients with these disorders. If the borderline syndrome is meant to include all of these disorders, its usefulness as a diagnosis is limited. Until the fundamental features of borderline personality disorder that distinguish it from the others are identified, it is recommended that clinicians carefully assess patients for these other diagnoses. Efforts should be made to change the borderline personality disorder criteria by shifting away from overlap with the criteria for the other disorders.     

Psychopathy and Suicidality in Female Offenders: Mediating Influences of Personality and Abuse.

The influence of personality and childhood abuse on suicidal behaviors and psychopathy was examined among female prisoners. Scores on the affective/interpersonal component (Factor 1; F1) and the antisocial deviance (Factor 2; F2) component of psychopathy were obtained from the Psychopathy Checklist-Revised (R. D. Hare, 1991). Suicide attempt and childhood physical and sexual abuse history were coded from interviews and prison files, and personality was assessed using the Multidimensional Personality Questionnaire (A. Tellegen, in press). Suicide attempts were positively associated with F2 and negatively associated with F1, and each factor accounted for unique variance in suicidality. Path analyses demonstrated that personality mediated the effects of physical abuse on F2, but sexual abuse accounted for unique variance in both suicide attempts and F2. Abuse and personality accounted for minimal variance in F1. These results are discussed in relation to the identification of individuals at risk for both self- and other-harm behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of psychopathy as a function of age.

The assessment of psychopathy was examined as a function of age in 889 male prison inmates between the ages of 16 and 69. Ratings of psychopathy were made with the Psychopathy Checklist (PCL), which measures 2 correlated factors. Factor 1 describes a cluster of affective-interpersonal traits central to psychopathy. Factor 2 describes traits and behaviors associated with an unstable, unsocialized lifestyle, or social deviance. Cross-sectional analyses revealed that mean scores on Factor 1 were stable across the age-span; mean scores on Factor 2 declined with age. The prevalence of antisocial personality disorder, and, to a lesser extent of PCL-defined psychopathy, also declined with age. The results are consistent with a conceptualization of psychopathy as encompassing 2 correlated but distinct constructs. They also suggest that age-related differences in traits related to impulsivity, social deviance, and antisocial behavior are not necessarily paralleled by differences in the egocentric, manipulative, and callous traits fundamental to psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy in female inmates: The SCID-II Personality Questionnaire and the PCL-R.

The authors examined the relationship between personality disorders, as measured by a self-report screening instrument, and psychopathy as measured by the Psychopathy Checklist (PCL-R; R. D. Hare, 1991) in female inmates. Participants included 136 women from a maximum security state prison. There was a positive relationship between the Antisocial Personality Disorder (APD) scale, which measures conduct disorder before age 15, and the Factor 2 scale of the PCL-R; no other significant relationships with other personality scales were obtained, and there were no evident relationships between any of the personality scales and the Factor 1 scale of the PCL-R. A discriminant function analysis and follow-up receiver operating characteristics analysis indicated that the use of a criterion of 3 endorsed conduct disorder items from the 15-item APD scale was sufficient to correctly identify 71.9% of the women who had been identified as meeting the criterion for psychopathy using the PCL-R interview. However, the scale evidenced poor prediction of nonpsychopaths (specificity = 52.8%). Results indicate the value of using the self-report of conduct disorder items as part of a screening procedure in concert with other measures to select inmates who require further assessment of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding psychopathy through an evaluation of interpersonal behavior: Testing the factor structure of the interpersonal measure of psychopathy in a large sample of jail detainees.

Interpersonal characteristics are core features of the psychopathy construct which have a unique pattern of correlations with a variety of external correlates. To improve the assessment of interpersonal traits, the current study evaluated the internal structure of the Interpersonal Measure of Psychopathy (IM–P) through exploratory and confirmatory factor analyses (CFA) in a large sample of jail inmates. A 17-item, 3-factor (Dominance, Grandiosity, and Boundary Violations) structure evidenced good fit in European American inmates. A second CFA demonstrated good fit for this structure in a sample of African American inmates. Moreover, a multigroup CFA indicated structural invariance between European and African American inmates. External validity was tested and demonstrated through positive correlations between IM–P factor scores and Psychopathy Checklist—Revised total and facet scores (R. D. Hare, 2003) and antisocial personality disorder symptoms and diagnoses. Modest correlations between Grandiosity scores and scores on the Shipley Institute of Living Scale—Revised (R. A. Zachary, 1994) were also observed. Finally, a step-down hierarchical regression was conducted to test for racial bias of the IM–P factor scores in relation to external correlates. Little evidence was found for slope bias, but there was evidence of intercept bias for some analyses. Implications and advantages of assessing psychopathy through a comprehensive evaluation of interpersonal traits are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance of criminal psychopaths on selected neuropsychological tests.

Screening batteries of standard neuropsychological tests were administered to 2 different samples (Ns?=?90 and 167) of male prison inmates. Scores on the Psychopathy Checklist—Revised (R. D. Hare, 1990) were used to divide inmates in each sample into high, moderate, and low psychopathy groups. There were no group differences in test performance in either of the samples, even when the effects of self-reported psychopathology and substance abuse were taken into account. The overall prevalence of both test-specific and global neuropsychological impairment was low and did not vary significantly across the 3 groups. The results provide no support for traditional brain-damage explanations of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and sexual assault: Static risk factors, emotional precursors, and rapist subtypes.

This study compared psychopathic and nonpsychopathic rapists on static risk factors and on emotional and motivational precursors. Sixty incarcerated rapists were assessed for psychopathy with the Psychopathy Checklist—Revised (R. D. Hare, 1991), and they were classified according to the Massachusetts Treatment Center: Revised Rapist Typology, Version 3 (R. A. Knight & R. A. Prentky, l990b). Psychopathy was positively associated with past nonsexual offenses and negatively associated with age onset for criminal offending, number of sexual victims, and the intensity of negative emotions experienced before sexual offending. However, psychopathy was not related to sexual offense history, age of onset for sexual offending, or victim harm. Last, psychopaths were most likely to be classified as opportunistic and pervasively angry rapists. The findings indicate that psychopathy should be considered when developing intervention strategies for rapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Criterion-related validity of the Psychopathic Personality Inventory in a prison sample.

The Psychopathic Personality Inventory (PPI; S. 0. Lilienfeld & B. P. Andrews, 1996), a self-report measure of psychopathic personality features, and R. D. Hare's (1991) Psychopathy Checklist–Revised (PCL–R) were administered to adult youthful offender prison inmates (N?=?50). As hypothesized, PPI scores were significantly correlated with scores on the PCL–R, providing evidence of concurrent validity for the PPI. Moreover, unlike existing self-report psychopathy measures, the PPI showed a moderate and positive correlation with PCL–R Factor 1 (i.e., the core personality traits of psychopathy). Discriminant function analysis using the optimal PPI total score value to predict PCL–R classifications of psychopath (n?=?10) and nonpsychopath (n?=?40) resulted in accurate classification of 86% of the cases (sensitivity?=?.50, specificity?=?.95). Results are discussed in terms of the relative merits of these 2 measures of psychopathy and the validation of the PPI for clinical use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder.

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factor Structure of the Psychopathic Personality Inventory: Validity and Implications for Clinical Assessment.

Psychopathy is a personality disorder characterized by impulsive antisocial deviance in the context of emotional and interpersonal detachment. A factor analysis of the subscales of the Psychopathic Personality Inventory (PPI) yielded evidence for 2 factors. One factor showed relations with external criteria mirroring those of the emotional-interpersonal facet of psychopathy, including high dominance, low anxiety, and venruresomeness. The other factor showed relations paralleling those of the social deviance facet of psychopathy, including positive correlations with antisocial behavior and substance abuse, negative correlations with socioeconomic status and verbal ability, and personality characteristics including high negative emotionally and low behavioral constraint. Findings support using the PPI to assess these facets of psychopathy in community samples and to explore their behavioral correlates and genetic-neurobiological underpinnings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A typology of antisociality in methadone patients

Multistage cluster analyses with replications were used to sort score profiles of 252 methadone maintained men on 4 continuous measures of antisociality--childhood conduct disorder and adult antisocial personality disorder symptoms, the revised Psychopathy Checklist, and the Socialization scale of the California Psychological Inventory. The analysis yielded 6 replicable and temporally stable cluster groups varying in degree and pattern of antisociality. The groups were statistically compared on sets of external criterion variables--Addiction Severity Index measures of past and recent substance abuse and functioning and lifetime criminal history. Axis I and II symptomatology, anxiety and depression, object relations and reality testing, hostility, guilt, and machiavellianism. The expression of antisociality in the 6 groups and differences found among them on the external variables supported the validity of a more complex conceptualization of antisociality than is provided by antisocial personality disorder.     

Is criminal behavior a central component of psychopathy? Conceptual directions for resolving the debate.

The development of the Psychopathy Checklist—Revised (PCL–R; R. D. Hare, 2003) has fueled intense clinical interest in the construct of psychopathy. Unfortunately, a side effect of this interest has been conceptual confusion and, in particular, the conflating of measures with constructs. Indeed, the field is in danger of equating the PCL–R with the theoretical construct of psychopathy. A key point in the debate is whether criminal behavior is a central component, or mere downstream correlate, of psychopathy. In this article, the authors present conceptual directions for resolving this debate. First, factor analysis of PCL–R items in a theoretical vacuum cannot reveal the essence of psychopathy. Second, a myth about the PCL–R and its relation to violence must be examined to avoid the view that psychopathy is merely a violent variant of antisocial personality disorder. Third, a formal, iterative process between theory development and empirical validation must be adopted. Fundamentally, constructs and measures must be recognized as separate entities, and neither reified. Applying such principles to the current state of the field, the authors believe the evidence favors viewing criminal behavior as a correlate, not a component, of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy, antisocial personality, and suicide risk.

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist—Revised (PCL—R). Male prison inmates (N?=?313) were assessed using the PCL—R and DSM-III R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL—R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)