DSM-IV antisocial personality disorder field trial

Offender Subtypes Based on Psychopathic Traits

Abstract. Psychopathy is a primary risk factor of re-offending in sexual offenders. Conceptually, both variable-centered (e.g., factor analysis) and clustering methods (e.g., latent profile analysis) have been used in previous research. Variable-centered and clustering methods were merged in a simultaneous modeling strategy for two purposes: First, to test assumptions on the emergence of psychopathic versus sociopathic (antisocial) sub-groups. And second to compare the predictive validity of clusters with that afforded by a dimensional cut-score. Using mixture modeling, two types of models were estimated: Latent class factor-analytic (LCFA) and factor-mixture models (FMM). The four-factor model of psychopathy as assessed with the Psychopathy Checklist-Revised (PCL-R) was estimated for up to 12 latent classes in a sample of adult male sexual offenders from Austria ( N = 1,266). Solutions with five (LCFA) and two latent classes (FMM) provided a good and parsimonious fit for the data. The two-latent-class FMM solution yielded higher predictive validity than a cut-score but only for general offense recidivism. Theoretically, this solution goes against etiological models that distinguish psychopathic from sociopathic (antisocial) individuals. Official data on offense recidivism (at a fixed 7-year-interval post-release) corroborate the importance of psychopathic offender subtypes. The rates of recidivism varied considerably between the subgroups.

Executive function, attention, and memory deficits in antisocial personality disorder and psychopathy

Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogeneity in operationalizations has led to diverse findings without clear understanding of what characterizes this broader population. This study sought to clarify the neuropsychological profiles of ASPD and psychopathy. The Cambridge Neuropsychological Test Assessment Battery was administered to 85 adult male offenders in a personality disorder secure service and to 20 healthy controls. Of patients with ASPD, 46% met criteria for psychopathy. Of those with psychopathy, 89% met criteria for ASPD. There were two sets of comparisons: ASPD versus other personality disorders versus controls and psychopathy versus other personality disorders versus controls. ASPD showed deficits across executive functions, visual short-term and working memory, and attention (compared with controls). Psychopathy showed deficits limited to attention, complex planning, inhibitory control, and response reversal. Response reversal and visual search deficits appeared specific to ASPD and psychopathy versus other personality disorders and may underpin antisocial traits. Additional deficits in inhibitory control and working memory appeared to distinguish ASPD from other personality disorders.

Machiavellianism and early neural responses to others' facial expressions caused by one's own decisions

The processing of social stimuli generated by one's own voluntary behavior is an element of social adaptation. It is known that self-generated stimuli induce attenuated sensory experiences compared with externally generated stimuli. The present study aimed to examine this self-specific attenuation effect on early stimulus processing in the case of others' facial expressions during interpersonal interactions. In addition, this study explored the possibility that the self-specific attenuation effect on social cognition is modulated by antisocial personality traits such as Machiavellianism. We analyzed early components of the event-related brain potential in participants elicited by happy and sad facial expressions of others when the participant's decision was responsible for the others' emotions and when the others' facial expressions were independent of the participant's decision. Compared to the non-responsible condition, the responsible condition showed an attenuated amplitude of the N170 component in response to sad faces. Moreover, Machiavellianism explained individual differences in the self-specific attenuation effect depending on the affective valence of social signals. The present findings support the possibility that the self-specific attenuation effect extends to interpersonal interactions and imply that distorted cognition of others' emotions caused by one's own behavior is associated with personality disorders that promote antisocial behaviors.

A Psychometric Evaluation of the DSM-IV Criteria for Antisocial Personality Disorder: Dimensionality, Local Reliability, and Differential Item Functioning Across Gender

This study aims at evaluating the psychometric properties of the antisocial personality disorder (ASPD) criteria in a large sample of patients, most of whom had one or more personality disorders (PD). PD diagnoses were assessed by experienced clinicians using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Axis II PDs. Analyses were performed within an item response theory framework. Results of the analyses indicated that ASPD is a unidimensional construct that can be measured reliably at the upper range of the latent trait scale. Differential item functioning across gender was restricted to two criteria and had little impact on the latent ASPD trait level. Patients fulfilling both the adult ASPD criteria and the conduct disorder criteria had similar latent trait distributions as patients fulfilling only the adult ASPD criteria. Overall, the ASPD items fit the purpose of a diagnostic instrument well, that is, distinguishing patients with moderate from those with high antisocial personality scores.

Experiential avoidance, empathy, and anger-related attitudesin antisocial personality disorder

BACKGROUND/AIM

In prevailing opinion, a strong relation exists between lack of empathy and antisocial personality disorder (ASPD). However, recent data fail to wholly clarify this relation, especially in consideration of empathy dimensions. In this study our aim was to address ASPD and social functionality from a contextual behavioral science viewpoint.

MATERIALS AND METHODS

The present study was conducted with a sample of 34 individuals with ASPD and 32 healthy individuals as the control group. The participants were assessed with a sociodemographic form, Structured Clinical Interviews for DSM I and II (SCID-I and SCID-II), Social Functioning Scale (SFS), Acceptance and Action Questionnaire-II for measuring experiential avoidance, Interpersonal Reactivity Index for measuring empathy dimensions, and the State-Trait Anger Scale for anger-related attitudes.

RESULTS

Experiential avoidance, dysfunctional anger regulation patterns, and lack of perspective-taking levels were higher in the ASPD group than in the control group. Experiential avoidance and perspective-taking processes were related with social functioning in ASPD.

CONCLUSION

These findings may provide initial data for understanding ASPD clinical features and related social interaction problems. Further relations between scales and social functionality also analyzed and discussed.

Further Evidence for Reliability and Validity of the Triarchic Psychopathy Measure in a Forensic Sample and a Community Sample

Psychopathy is often described as a constellation of personality characteristics encompassing features such as impulsivity and antisociality, and a lack of empathy and guilt. Although the use of self-reports to assess psychopathy is still debated, there are distinct advantages to such measures and recent research suggests that they may not be as problematic as previously thought. This study further examined the reliability and validity of the Triarchic Psychopathy Measure (TriPM) in a community sample (N = 496) and forensic psychiatric patient sample (N = 217). Results indicated excellent internal consistencies. Additionally, the TriPM total and subscale scores related as expected to different subscales of the Psychopathic Personality Inventory -Revised (PPI-R) and to the Reactive and Proactive Aggression Questionnaire, reflecting good construct validity. Most importantly, ROC curve analyses showed that the TriPM evidenced better discrimination between the community sample and forensic psychiatric patients than the PPI-R. The current study extends the existent evidence demonstrating that the TriPM can be used as an efficient self-report instrument.

The importance of developmental field trials in the revision of psychiatric classifications

Field trials of diagnostic classification systems can be divided into two types: developmental field trials, which are designed to collect performance data from users during the revision process, and summative field trials, which aim to assess what users can expect in terms of the classification's psychometric properties after the classification has been completed. A crucial component of an empirically guided diagnostic revision process is the use of developmental field trials in which data are collected from users regarding the feasibility, reliability, validity, and clinical utility of proposed changes that can assist in refining the proposals before they are finalised. The DSM-III and ICD-10 reliability field trials are best considered summative as they were done primarily to establish whether clinicians using operationalised definitions could achieve adequate diagnostic reliability. The DSM-III-R and DSM-IV field trials, which collected performance data targeting specific diagnostic categories, heralded the use of developmental field trial data as an important component in the construction of diagnostic criteria sets, a process being continued in the ICD-11 revision process. Although initially presented as developmental in nature, the DSM-5 field trials ended up being essentially summative. Although reliability estimates with highly sophisticated methodology were provided for 23 mental disorders, the absence of information regarding the reliability of specific diagnostic items and the reasons for diagnostic disagreement prevented this information from being used to address identified reliability issues. Developmental field trials enhance the empirical basis for stating that psychiatric classifications are evidence based and they ultimately contribute to the improvement of clinical care for patients.

Reliability and Validity of Prototype Diagnosis for Adolescent Psychopathology

The current study investigated the interrater reliability and validity of prototype ratings of 5 common adolescent psychiatric disorders: attention-deficit/hyperactivity disorder, conduct disorder, major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder. One hundred fifty-seven adolescent inpatient participants consented to participate in this study. We compared ratings from 2 inpatient clinicians, blinded to each other's ratings and patient measures, after their separate initial diagnostic interview to assess interrater reliability. Prototype ratings completed by clinicians after their initial diagnostic interview with adolescent inpatients and outpatients were compared with patient-reported behavior problems and parents' report of their child's behavioral problems. Prototype ratings demonstrated good interrater reliability. Clinicians' prototype ratings showed predicted relationships with patient-reported behavior problems and parent-reported behavior problems. Prototype matching seems to be a possible alternative for psychiatric diagnosis. Prototype ratings showed good interrater reliability based on clinicians unique experiences with the patient (as opposed to video-/audio-recorded material) with no training.

Clinical validity of prototype personality disorder ratings in adolescents

A growing body of research shows that personality pathology in adolescents is clinically distinctive and frequently stable into adulthood. A reliable and useful method for rating personality pathology in adolescent patients has the potential to enhance conceptualization, dissemination, and treatment effectiveness. The aim of this study is to examine the clinical validity of a prototype matching approach (derived from the Shedler Westen Assessment Procedure-Adolescent Version) for quantifying personality pathology in an adolescent inpatient sample. Sixty-six adolescent inpatients and their parents or legal guardians completed forms of the Child Behavior Checklist (CBCL) assessing emotional and behavioral problems. Clinical criterion variables including suicide history, substance use, and fights with peers were also assessed. Patients' individual and group therapists on the inpatient unit completed personality prototype ratings. Prototype diagnoses demonstrated substantial reliability (median intraclass correlation coefficient =.75) across independent ratings from individual and group therapists. Personality prototype ratings correlated with the CBCL scales and clinical criterion variables in anticipated and meaningful ways. As seen in prior research with adult samples, prototype personality ratings show clinical validity across independent clinician raters previously unfamiliar with the approach, and they are meaningfully related to clinical symptoms, behavioral problems, and adaptive functioning.

Psychopathy and the DSM

Psychopathy is one of the more well-established personality disorders. However, its relationship with the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has been controversial. The purpose of this article is to trace and discuss the history of this relationship from the very first edition of the DSM to the current fifth edition. Emphasized in particular is the problematic relationship of DSM antisocial personality disorder with the diagnosis of psychopathy by Cleckley (1941, 1976) and the Psychopathy Checklist- Revised (Hare, 2003), as well as with the more recently developed models of psychopathy by Lilienfeld and Widows (2005), Lynam et al. (2011), and Patrick, Fowles, and Krueger (2009).

Psychopathy and Violent Reoffending in German-Speaking Countries

The Psychopathy Checklist-Revised (PCL-R) and its screening version, the PCL:SV, are clinical assessment instruments for the observer rating of psychopathic personality in offenders. Given the link between PCL-R/SV total scores and violent offending, these instruments have been incorporated into various risk assessment protocols in forensic psychology. The purpose of the present study was to examine the predictive validity of the PCL-R/SV instruments in German-speaking countries. We collated data from 11 published studies (total-N = 2,412 offenders). Based on suitable diagnostic cutscores for prototypical psychopathy, the proportions of true-positive and false-positive cases with respect to violent reoffending were compared. Overall, sensitivity was estimated at 27% and specificity at 88% for the PCL-R (or at 28% and 90% for the PCL:SV, respectively). At critical score levels, the odds for violent offense recidivism were more than two times higher than at subcritical levels for both instruments. A decision-theory analysis suggested that the implicit utility of false-positive risk assessments was about halfway between the minimal utility of false-negative assessments and the maximal utility of correct assessments. Both the PCL-R and its screening version are viable instruments for the prediction of violent offense recidivism in German-speaking countries.

The use of a screening device to assess psychopathy in young offenders

The aim of this research was to determine to what extent a psychopath screening device (the APSD) is useful in forensic assessments to predict general and violent offending. For this purpose, a cross-sectional study was done and 238 young people serving a sentence were assessed. The gold standard instrument used to measure psychopathy was the Psychopathy Checklist: Youth Version (PCL:YV; Forth, Kosson & Hare, 2003). The results indicate that the association found between the screening device scores and several indicators of risk is low if compared with those obtained with the PCL:YV, suggesting that it is less useful as a tool in order to predict offending or violent offences. However, an Area Under the Curve of .784 and a validity index of 62.5 support its use as a screening device or as a preliminary approach to assess psychopathy in this population. The usefulness of this instrument to make assessments with young people in the forensic setting is discussed.

Personality disorder diagnostic thresholds correspond to different levels of latent pathology

To meet a diagnosis for a particular personality disorder (PD), among other requirements, a person must exhibit a specified minimum number of the features outlined for that PD, otherwise referred to as the diagnostic threshold. Despite many years of research on the DSM PDs, there is little empirical basis for the chosen thresholds. The present study used mechanisms of item response theory (IRT) to link the diagnostic thresholds of six PDs to their corresponding level of latent PD pathology. Consistent with our hypothesis, analyses of the data from 41,227 participants revealed that PD diagnostic thresholds corresponded to a wide range of latent pathology. For example, the diagnostic threshold for schizoid PD corresponded to 1.54 SDs of pathology whereas the threshold for dependent PD corresponded to 2.72 SDs of pathology. The current analyses have demonstrated for the first time that the latent pathology associated with each PD threshold varies widely, and thus has quantified what others accurately have speculated. Implications and considerations for the future directions of PD classification are discussed.

Assessing measurement invariance of PCL-R assessments from file reviews of North American and German offenders

Cross-cultural research on psychopathy necessitates assessment methods that are generalizable across linguistic and cultural differences. Multiple-group confirmatory factor analysis was used to compare the factorial structure of Psychopathy Checklist-Revised (PCL-R) assessments obtained from file reviews of North-American (N=2622) and German (N=443) male offenders. The analyses indicated that the 18 item, 4-factor model of the PCL-R obtained with the standard PCL-R protocol (interview and file review) also holds for file review data. On a factor-by-factor level, the data are commensurate with strong factorial invariance of factor loadings and item thresholds for the Interpersonal and Lifestyle factors, and with likely metric invariance for the Affective factor. The Antisocial factor showed structural differences between the two samples. The results imply that cultural or environmental factors more strongly influence the judgment and/or expression of antisociality. Based on the results, cross-cultural comparisons between North-American and German offenders in terms of PCL-R psychopathy should be limited to the Interpersonal and Lifestyle factors. Further research using data obtained through the standard protocol (i.e., interview plus file information) is encouraged.

What should be done with antisocial personality disorder in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)?

Antisocial personality disorder, psychopathy, dissocial personality disorder and sociopathy are constructs that have generally been used to predict recidivism and dangerousness, alongside being used to exclude patients from treatment services. However, 'antisocial personality disorder' has recently begun to emerge as a treatment diagnosis, a development reflected within cognitive behaviour therapy and mentalisation-based psychotherapy. Many of the behaviour characteristics of antisocial personality disorder are, at the same time, being targeted by interventions at criminal justice settings. A significantly higher proportion of published articles focusing on antisocial personality concern treatment when compared to articles on psychopathy. Currently, the proposal for antisocial personality disorder for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, suggests a major change in the criteria for this disorder. While the present definition focuses mainly on observable behaviours, the proposed revision stresses interpersonal and emotional aspects of the disorder drawing on the concept of psychopathy. The present commentary suggests that developments leading to improvement in the diagnosis of this type of disorder should, rather than focusing exclusively on elements such as dangerousness and risk assessment, point us to ways in which patients can be treated for their problems.

Intra- and extra-familial child molestation as pathways building on parental and relational deficits and personality disorders

This article addresses the intra- and extra-familial pathways of child molestation. The data presented show preliminary evidence that the difference between the intra- and extra-familial routes can be explained by schizoid and avoidant (intra-familial) and antisocial and passive-aggressive (extra-familial) personality structures. This study also reveals that the amount of warmth and autonomy received during childhood is associated with both intra- and extra-familial child-molesting behaviour. These findings contribute to a further explanation of this deviant sexual conduct and to the development and differentiation of the treatment of child molesters.

Psychopathy: assessment and forensic implications

Psychopathy is commonly viewed as a personality disorder defined by a cluster of interpersonal, affective, lifestyle, and antisocial traits and behaviours, including grandiosity, egocentricity, deceptiveness, shallow emotions, lack of empathy or remorse, irresponsibility, impulsivity, and a tendency to violate social norms. In our article, we outline standard methods for the assessment of psychopathy, its association with antisocial personality disorder (ASPD), and its implications for clinical and forensic issues, including crime and violence, risk assessment, and treatment options.

Triarchic conceptualization of psychopathy: Developmental origins of disinhibition, boldness, and meanness

The clinical concept of psychopathy (“psychopathic personality”) is generally considered to entail persistent behavioral deviancy in the company of emotional–interpersonal detachment. However, longstanding debates continue regarding the appropriate scope and boundaries of the concept. Here, we review alternative historic descriptions of the disorder together with empirical findings for the best-established assessment instruments in use with adolescents and youth as a basis for formulating an integrative, triarchic model of psychopathy. The essence of the triarchic model is that psychopathy encompasses three distinct phenotypic constructs: disinhibition, which reflects a general propensity toward problems of impulse control; boldness, which is defined as the nexus of social dominance, emotional resiliency, and venturesomeness; and meanness, which is defined as aggressive resource seeking without regard for others (“dysaffliated agency”). These differing phenotypic components are considered in terms of relevant etiologic and developmental pathways. The triarchic conceptualization provides a basis for reconciling and accommodating alternative descriptive accounts of psychopathy, and a framework for coordinating research on neurobiological and developmental processes contributing to varying manifestations of the disorder.

Continuity of aggressive antisocial behavior from childhood to adulthood: The question of phenotype definition

Aiming to clarify the adult phenotype of antisocial personality disorder (ASPD), the empirical literature on its childhood background among the disruptive behaviour disorders, such as attention deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder (ODD), conduct disorder (CD), or hyperkinetic conduct disorder (HKCD), was reviewed according to the Robins and Guze criteria for nosological validity. At least half of hyperactive children develop ODD and about a third CD (i.e. AD/HD+CD or HKCD) before puberty. About half of children with this combined problem constellation develop antisocial personality disorder (ASPD) in adulthood. Family and adoption/twin studies indicate that AD/HD and CD share a high heritability and that, in addition, there may be specific environmental effects for criminal behaviours. "Zones of rarity" delineating the disorders from each other, or from the normal variation, have not been identified. Neurophysiology, brain imaging, neurochemistry, neurocognition, or molecular genetics have not provided "external validity" for any of the diagnostic categories used today. Deficient mental functions, such as inattention, poor executive functions, poor verbal learning, and impaired social interaction (empathy), seem to form unspecific susceptibility factors. As none of today's proposed syndromes (e.g. AD/HD or psychopathy) seems to describe a natural category, a dimensional behavioural phenotype reflecting aggressive antisocial behaviours assessed by numbers of behaviours, the severity of their consequences and how early is their age at onset, which will be closely related to childhood hyperactivity, would bring conceptual clarity, and may form the basis for further probing into mental, cognitive, biological and treatment-related co-varying features.

The Upside of Being Socially Anxious: Psychopathic Attributes and Social Anxiety are Negatively Associated

Psychopathy is characterized by a lack of concern for other people and social norms. In contrast, individuals with high social anxiety are overly concerned about the approval of others and violating social norms. Therefore, we hypothesized that social anxiety is negatively associated with psychopathic attributes, with males being more psychopathic than females. In order to test this hypothesis, we administered self-report measures of social anxiety, psychopathic attributes, and academic misconduct as an index of adherence to social norms to a sample of 349 undergraduate college students (244 females and 105 males). Males had more psychopathic attributes than females. Social anxiety and psychopathic attributes showed a weak but significant negative correlation in the total sample and also in the subgroup of males and females. Psychopathic attributes were further positively associated with academic misconduct behaviors among females, but not among males. These findings are consistent with the notion that social anxiety and psychopathic attributes are negatively associated.

Psychopathy as a clinical and empirical construct

In this review, we focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes. Some investigators assert that the PCL-R, ostensibly based on Cleckley's work, has "drifted" from the construct described in his Clinical Profile. We evaluate this profile, note its basis in an unrepresentative sample of patients, and suggest that its literal and uncritical acceptance by the research community has become problematical. We also argue that the idea of construct "drift" is irrelevant to current conceptualizations of psychopathy, which are better informed by the extensive empirical research on the integration of structural, genetic, developmental, personality, and neurobiological research findings than by rigid adherence to early clinical formulations. We offer some suggestions for future research on psychopathy.

The Dutch HEXACO Personality Inventory: psychometric properties, self-other agreement, and relations with psychopathy among low and high acquaintanceship dyads

The HEXACO model (Lee & Ashton, 2004, 2006) of personality structure is based on 6 dimensions that have been recovered in lexical studies of personality in various languages. In this study, we examined a Dutch version of the HEXACO Personality Inventory (HEXACO-PI; Lee & Ashton, 2004) and found it to have satisfactory psychometric properties. Additionally, we examined the level of self-other agreement for the HEXACO-PI variables and the relation of HEXACO-PI Honesty-Humility with the Self-Report Psychopathy Scale (Williams, Paulhus, & Hare, 2007) at varying levels of self-other acquaintanceship. Self-other agreement was found to be high, especially among dyads with high levels of acquaintanceship. Self-reported and other-reported Honesty-Humility and Emotionality were the strongest predictors of psychopathy. The relation between other-reported Honesty-Humility and self-reported psychopathy was near zero for dyads with low levels of acquaintanceship but was moderately strong for dyads with high levels of acquaintanceship.

Effects of diagnostic comorbidity and dimensional symptoms of attention-deficit–hyperactivity disorder in men with antisocial personality disorder

OBJECTIVE

Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHD(c)) or dimensional symptoms (ADHD(d)) in predicting behaviour and substance use problems in APD subjects has not been examined.

METHOD

A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist-Revised (PCL-R); (ii) ADHD(c) diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHD(d) dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005-May 2006).

RESULTS

Sixty five per cent of APD subjects met criteria for ADHD(c) diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHD(d) symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems.

CONCLUSION

Both ADHD(c) diagnostic comorbidity and ADHD(d) symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.

Brain abnormalities in antisocial individuals: implications for the law

With the increasing popularity in the use of brain imaging on antisocial individuals, an increasing number of brain imaging studies have revealed structural and functional impairments in antisocial, psychopathic, and violent individuals. This review summarizes key findings from brain imaging studies on antisocial/aggressive behavior. Key regions commonly found to be impaired in antisocial populations include the prefrontal cortex (particularly orbitofrontal and dorsolateral prefrontal cortex), superior temporal gyrus, amygdala-hippocampal complex, and anterior cingulate cortex. Key functions of these regions are reviewed to provide a better understanding on how deficits in these regions may predispose to antisocial behavior. Objections to the use of imaging findings in a legal context are outlined, and alternative perspectives raised. It is argued that brain dysfunction is a risk factor for antisocial behavior and that it is likely that imaging will play an increasing (albeit limited) role in legal decision-making.

Capturing the four-factor structure of psychopathy in college students via self-report

A number of self-report psychopathy scales have been used successfully in both clinical and nonclinical settings. However, their factor structure does not adequately capture the four factors (Interpersonal, Affective, Lifestyle, and Antisocial) recently identified in the Psychopathy Checklist-Revised (PCL-R; Hare, 2003) and related measures. This deficit was addressed by upgrading the Self Report Psychopathy Scale (SRP-II; Hare, Hemphill, & Harpur, 1989). In Study 1 (N = 249), an exploratory factor analysis of this experimental version revealed oblique factors similar to those outlined by Hare (2003). In Study 2 (N = 274), confirmatory factor analysis (CFA) confirmed this structure, that is, four distinct but intercorrelated factors. The factors exhibited appropriate construct validity in a nomological network of related personality measures. Links with self-reports of offensive activities (including entertainment preferences and behavior) also supported the construct validity of the oblique four-factor model.

The relationship between DSM-IV cluster B personality disorders and psychopathy according to Hare's criteria: clarification and resolution of previous contradictions

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders. To clarify some contradictions among several previous studies on this issue, individual cluster B PDs were looked at alone, excluding any cases of comorbidity with other PDs of this cluster. We found highly significant relationships between antisocial and borderline PD and Factor II of the PCL and a highly significant correlation between narcissistic PD and Factor I of the PCL. These results were to be expected from the theoretical basis of the development of the PCL and provide a contribution to the construct validity of the PCL, which until now has not been validated on such a large sample in Germany.

Creating and field-testing diagnostic criteria for partner and child maltreatment

An integrated set of diagnostic criteria for partner abuse and child abuse and neglect were developed and tested in 4 studies conducted with a branch of America's largest family maltreatment protection agency (i.e., the U.S. military's Family Advocacy Program). Maltreatment criteria then in force were found to have adequate levels of content validity, but experts' and users' feedback indicated ambiguities and poorly specified criteria that undermined reliable application. Criteria incorporating elements of the best existing civilian and military operationalizations were developed and evaluated in two field trials. The final definitions were found to support very high levels of agreement (92%) between base adjudicating committees and master reviewers.

Psychopathy: a clinical and forensic overview

There is a substantial amount of empirical evidence that psychopathy, as measured by the PCL-R and its derivatives, is a predictor of recidivism and violence in prison, forensic psychiatric, and civil psychiatric populations. The PCL-R is one of the most generalizable of the risk factors identified thus far, and for this reason it is included in various actuarial and structured clinical risk assessment procedures. Although psychopathy is not the only risk factor for recidivism and violence, it is too important to ignore, particularly with respect to violence. Treatment and management are difficult, time-consuming, and expensive, but new initiatives based on current theory and research on psychopathy and the most effective correctional philosophies may help to reduce the harm done by psychopaths.

Lack of remorse in antisocial personality disorder: sociodemographic correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders in the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

The purpose of this study was to compare sociodemographic and family history correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders, in an epidemiologic sample of adults with DSM-IV antisocial personality disorder (ASPD) who lacked, vs those who did not lack, remorse.

METHODS

This study is based on a nationally representative sample of adults. Lifetime prevalences of each ASPD diagnostic criterion and each comorbid mood, anxiety, substance use, and personality disorder were estimated. Logistic regression was used to examine associations of lack of remorse with ASPD symptom patterns and comorbid disorders. Diagnoses were made using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version.

RESULTS

Among the 1422 respondents with ASPD, 728 (51%) lacked remorse. Respondents who lacked remorse were younger and more often reported a family history of drug problems than those who did not. More often than remorse-positive respondents, those who were remorse-negative met diagnostic criteria involving violence against persons and less often met criteria involving offenses against property. Remorse was not associated with cruelty to animals, nor with most nonviolent antisocial behaviors. Remorse-negative respondents endorsed more total lifetime violent behaviors than those who were remorse-positive. Lack of remorse was not associated with any lifetime comorbid Axis I or Axis II disorder. Patterns of findings were generally similar between men and women.

CONCLUSIONS

Lack of remorse appears to identify at best a modestly more symptomatically severe and violent form of ASPD in nonclinical populations.

A cognitive neuroscience perspective on psychopathy: evidence for paralimbic system dysfunction

Psychopathy is a complex personality disorder that includes interpersonal and affective traits such as glibness, lack of empathy, guilt or remorse, shallow affect, and irresponsibility, and behavioral characteristics such as impulsivity, poor behavioral control, and promiscuity. Much is known about the assessment of psychopathy; however, relatively little is understood about the relevant brain disturbances. The present review integrates data from studies of behavioral and cognitive changes associated with focal brain lesions or insults and results from psychophysiology, cognitive psychology and cognitive and affective neuroscience in health and psychopathy. The review illustrates that the brain regions implicated in psychopathy include the orbital frontal cortex, insula, anterior and posterior cingulate, amygdala, parahippocampal gyrus, and anterior superior temporal gyrus. The relevant functional neuroanatomy of psychopathy thus includes limbic and paralimbic structures that may be collectively termed 'the paralimbic system'. The paralimbic system dysfunction model of psychopathy is discussed as it relates to the extant literature on psychopathy.

Psychopathy factors and risk for aggressive behavior: a test of the "threatened egotism" hypothesis

The primary purpose of this study was to examine psychopathy within a model of aggressive behavior that encompasses narcissism and "threatened egoism." This model was advanced by Baumeister and his colleagues (e.g., R. F. Baumeister, L. Smart, & J. M. Boden, 1996; B. J. Bushman & R. F. Baumeister, 1998). We examined whether the threatened egotism model extends to the construct of psychopathy and whether the two factors underlying psychopathy exhibit different associations with aggression within this model. Self-report data, correctional officer and counselor reports, and disciplinary report information obtained for 98 male inmates provided partial evidence that psychopathic individuals tend to respond aggressively when confronted with an ego threat. Moreover, psychopathic individuals exhibited this pattern of aggression more strongly than did narcissistic individuals. These findings bear potentially useful implications for the understanding and treatment of aggression in forensic populations.

Construct validity of the Balloon Analog Risk Task (BART): associations with psychopathy and impulsivity

To continue research assessing the validity of the Balloon Analog Risk Task (BART) as a measure of risk taking, the BART was administered to a nonforensic sample of individuals with varying levels of psychopathic characteristics. Construct validity of the BART was evaluated by measuring risk-taking behavior in relation to self-reported psychopathy, anxiety, psychophysiological data, and demographic variables. Supporting the construct validity of the BART, while controlling for variance accounted for by interrelated variables in the context of hierarchical regression analyses, higher self-reported psychopathy was significantly predictive of increased risk taking on the BART. Findings also revealed interesting gender differences in self-reported psychopathy and a trend for men to engage in riskier behavior. Limitations and research directions are presented.

The natural history of conduct disorder symptoms in female inmates: on the predictive utility of the syndrome in severely antisocial women

This study examined the utility of the conduct disorder (CD) diagnosis in predicting antisocial personality disorder (ASPD) among incarcerated women. It was surprising that most female inmates did not meet standard criteria for ASPD. This was due to a low occurrence of CD symptoms reported before age 15. Cluster analysis of CD symptoms revealed 4 types that characterized women with criminal histories. One type, which was characterized by a history of CD with interpersonal and physical aggression, was more predictive of ASPD than the traditional CD diagnosis. Yet another type, characterized by destruction of property, also represented an improvement over the traditional CD diagnosis. Overall, the results suggest that the types of CD behaviors, rather than their number, may be a more important indicator for identifying women at risk for future antisocial personality pathology.

Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: screening version

Recently, psychopathy has become virtually synonymous with the Psychopathy Checklist (PCL) measures. However, the "gold standard" 2-factor model that underlines these measures has been questioned for its uncertain empirical support and emphasis on antisocial behavior that is not specific to psychopathic personality deviation. This study (N = 870 civil psychiatric patients) compares the fit of the traditional 2-factor model with that of a revised 3-factor model of psychopathy. The revised model better describes the structure of the Screening Version of the PCL (PCL:SV) than the traditional model. Although the revised model's exclusion of some items that assess antisocial behavior reduces the PCL:SV's power in predicting patient violence, this model arguably assesses psychopathy in a more specific, theoretically coherent fashion that may reduce misapplications of the construct. Implications for future research are discussed.

The prediction of violent and nonviolent criminal behavior in a methadone maintenance population

The utility of traits associated with Antisocial Personality Disorder in making risk assessments of violent and nonviolent crimes was examined in 254 subjects sampled from a methadone maintenance population. A factor analysis of a number of baseline measures resulted in five factors measuring hostility, insecure attachment, impaired reality testing, antisocial personality, and empathy. These factors were used in logistic regression analysis to predict charges for violent and nonviolent crimes over a 2-year period. Individuals with high scores on the antisocial personality factor had an increased risk of both violent and nonviolent criminal charges. Individuals with low scores on the empathy factor were at high risk for violent crimes. In an analysis using the factor components rather than the factors, the measures of perspective-taking and a socialization were associated with violent criminal charges, and the measure of psychopathy, but not antisocial behavior, was associated with nonviolent criminal charges. The results support the use of measures of personality traits in addition to measures of a history of antisocial behavior in making violence risk assessments in substance-dependent patients. The DSM construct and diagnosis of Antisocial Personality Disorder may be enhanced by greater emphasis on personality traits associated with antisocial behavior.

The classification of personality disorders: critical review and need for rethinking

An overview is presented of the historical background to the current classification of personality disorders in ICD-10 and DSM-IV. Although the precursors of the present diagnostic concepts were originally developed as dimensional or prototype typologies, both ICD-10 and DSM-IV have adopted a quasi-nosological, categorical model of personality disorders on Axis II. It is argued that the model is fundamentally flawed and restricts the capacity to collect and communicate relevant data on the impact of personality characteristics on the manifestations, course and outcome of Axis I disorders. Dimensional models originating in recent psychological research offer an alternative, but considerable theoretical and field research work will be required before a meaningful and generally acceptable restructuring of Axis II becomes feasible.