Antisocial PD and.

Psychopathy

Are you a psychopath?

DSM - Criteria
1) 2) 3) 4) 5) 6) 7)

fails to conform to social norms deceitful impulsivity irritable and aggressive reckless irresponsible lacks remorse 3/7 criteria required for diagnosis

ICD-10 Criteria
1) 2) 3) 4) 5) 6) callous unconcern irresponsibility incapacity to maintain relationships low frustration tolerance incapacity for guilt blames others

Impact on the life-course

begins around 8, peaks 20s and 30s Job and marital problems minority in jail Male Substance abuse issues of some sort do not seek treatment treatment does not work

ASPD in Media

sex and violence characters Silence of the Lambs Anthony Hopkins Dr. Hannibal Lecter Youtube link Fava beans

ASPD in Media

Pulp Fiction

Youtube link Dont do drugs

ASPD in Media

Wall Street Michael Douglas

Gordon Gekko

Youtube link Greed is Good

ASPD in Media

Cape Fear Robert DeNiro

Max Cady

Traits to Disorder

Adverturers Dissenting

ASPD

Style

Disorder

ASPD and Normality

Glib Grandiosity Lying Lack of remorse Shallow affect Callousness

Talk-show host Stage performer Spy Infantryman Undertaker Wartime General

History of ASPD

ASPD - History

Lombroso (1800s) physiognomy

ASPD identified by look

Atavistic individuals = long arms, acute eyesight, heavy jaws, jug ears

ASPD History

Pinel (1801) manie sans delire

(insanity without delirium)

Why? due to impairment of affect Benjamin Rush (1812) moral weakness deceptive, manipulative Why? cant experience shame/guilt

ASPD History

Prichard (1835) moral insanity

Despite understanding, their conduct was swayed by overwhelming compulsions

Broad conceptualization
Included: drug addiction, alcohol problems, sexual deviations, homosexuality, mood disorders

ASPD History

J. L. Koch (1891)

Psychopathic inferiority

Why? brain based cause

Broad conceptualization

Emil Kraepelin

(1904)

psychopathy personality chronic and constitutional in nature

Psychopathic = mentally ill

1) 2) 3) 4) liars and swindlers criminals by impulse professional criminals morbid vegabonds

Emil Kraepelin

(1915)

Revised typology Dropped professional criminal Added excitable, eccentric, *antisocial, *quarrelsome

ASPD History

Adolf Meyer (1904)

Constitutional Inferiority

Karl Birnbaum (1909)

Sociopathic Why? due to environment

ASPD

Comes by different names

Psychopath (late 1800s) Sociopath (20th century) Dyssocial Personality (ICD-10) Antisocial PD (DSM-IV)

Cleckley

The Mask of Sanity (1941)

VA Hospital Augusta Georgia
Rejected broad conceptualizations Highly distinct clinical syndrome Why? deficit in emotional reactivity

Cleckley

The Mask of Sanity (1941)

Look good on the outside

Mask of mental health

Pathological state inside

Severe behavioral maladjustment

Cleckley 16 criteria

1. 2. 3. 4. 5. 6. 7. 8.

superficial charm, good intelligence absence of delusions not nervous unreliability untruthfulness and insincerity lack of remorse or shame inadequately motivated poor judgment, failure to learn

Cleckley 16 criteria

09. 10. 11. 12. 13. 14. 15. 16.

pathological egocentricity poverty in major affective reactions loss of insight unresponsive interpersonally fantastic behavior with drink suicide rarely carried out sex life is impersonal failure to follow any life plan

Cleckley

Positive adjustment - 1, 2, 3, 14 Behavioral deviance - 4, 7, 8, 13, 15, 16 *Emotional-interpersonal deficits - 5, 6, 10, 9, 11, 12

DSM History of ASPD

DSM I (1952) ICD 6th (1948) Sociopathic disturbance

Broad range of disorders

sociopathic personality disturbance: antisocial reaction Aggressive criminal deviant, violates the norms of society

DSM-II (1968)

Aligned with ICD-8 term Antisocial PD now used inspired by Cleckley

Selfish, callous, lack of guilt

Limitation not reliably diagnosed

DSM-III

Behavioral oriented criteria used Feighner et al. (1972) Lee Robins (1966) Spitzer et al. (1978) Diagnosis highly reliable Millon, Hare argue, description incomplete

DSM-IV

Specialized field trials conducted 1) criteria that included the psychopathy features *2) simplification of existing criteria 10 (DSM-III) to 7 criteria (DSM-IV) Core affective-interpersonal features not included

DSM-IV

A. 3/7 criteria before age 15 B. at least 18

C. 3/15 conduct disorder criteria

Aggression toward people/animals Destruction of property Deceptiveness or Stealing Serious Rule Violation

D. Not during schizophrenia or mania

DSM-IV

Prevalence 3% of men, 1% of women

Prison 50 to 80%

Co-morbidity
Substance Abuse

Over 80%

ASPD

Etiology

Etiology
Biological

Cleckley

Psychopaths are deficient in their capacity for affective experience emotional experience is a pseudoexperience mimic the emotional displays of others emotionally retarded

Cause - biology

Semantic aphasia Psychopathy do not understand language the same way as others

Cause - Biology

Large heritability component Temperament

aggressive, higher activity and reactivity levels

Higher than average need for excitement

Lower Nervous system activity Lower levels of 5-HIAA (impulsivity, aggression) EEG abnormalities (excessive theta waves) Alcoholism, ADHD Brain Damage Genetics

Cloninger

Scan page 21

Cause - biological

An evolutionary adaptive life strategy cheating promotes sexual contact and yields larger numbers of offspring aggressive/antisocial tendencies are an evolutionary throw forward

Etiology
Psychosocial

Cause - Psychosocial

Frequent moves, family breakups, large families Poverty, urban setting Emotional deprivation Physical/sexual abuse Substance-abusing caregiver

Cause - Psychosocial

Mother: depressive, weak, masochistic, somatizing, personality disordered Father: explosive, inconsistent, sadistic, alcoholic, criminal history

Trait Perspectives

Primary psychopath = 4/9 9/4

MMPI

Secondary psychopathy = 4/2 2/4

MMPI Two Point Codes

4/9, 9/4 high energy psychopath

4/2, 2/4 depressed psychopath

4/8, 8/4 - schizoid psychopath

Jeffrey Dahmer

1960-1994 Milwaukee/Ohio area

Sentenced to 957 years

17 male murder victims

Serial killer

Dahmers MMPI Profile

PEN - Eysenck

Psychoticism

aggressive, cold, egocentric, impersonal antisocial, unempathic, creative

Extraversion

social, lively, active, assertive, carefree, dominant, surgent

Neuroticism

anxious, depressed, guilt-prone irrational, shy, moody emotional

Psychopathy

Primary and Secondary Psychopaths

Primary higher P relative to N Secondary higher N relative to P

Other self-report measures

Psychopathic Deviate scale Socialization scale (CPI) Self-report Psychopathy scale Pri and Sec Psychopathy scales All tend to tap F2 of PCL-R

Psychopathy Personality Inventory

PPI 187 self-report items 4 point scale psychometrically sound 8 subscales

Stress Immunity Fearlessness

Social Potency Impulsivity

Coldheartedness

PPI

Externalization

Nonplanfulness
Egocentricity

DSM ASPD r = .15

Stress Immunity Fearlessness

Social Potency Impulsivity

Coldheartedness

PPI

Externalization

Nonplanfulness
DSM ASPD r = .27 Egocentricity

Assured- Dominance 90 Arrogant Calculating 150 120 60 GregariousExtrav erted 30

NAR ANT HIS

Cold180 Heart ed

PAR

SDF

W armAgreeable

SZD 210 Aloof Int rov ert ed 240 270 Unassured- Subm issiv e AVD

DEP 330 UnassumingIngenuous 300

Assured- Dominance 90 ArrogantCalculating 150 120 60 GregariousExtrav erted NAR ANT SAD ColdHeart ed W armAgreeable HIS 30

180

0.6

0.4 PAR

0.2

0.2

0.4

0.6

BDL 210 AloofInt rov ert ed 240 270 Unassured- Subm issiv e SZD DEP DPR AVD 300 UnassumingIngenuous 330

SDF

N
SZD AVD DEP HST NAR ANT COM SZT BDL PAR H H

E L L
H H

H L L h L

H N H

L L L

Modern Models of ASPD

Turkat, Millon, Hare

Youtube link Manson Interview

Turkat types

1) The Clear sociopath DSM criteria are easily applied usually due to court referral

Manson Interview

Synder interview Link 1 Link 2 Link 3 Link 4 Link 5 Link 6

Rose Interview Link 1 Link 2 Link 3 Link 4 Link 5 Link 6 Link 7

Edmund Kemper

Victims August 27, 1964 Maude Kemper Ed Emil Kemper

Crime Library

Kemper
Victims Mary Anne Pisce May 5, 1972 Anita Luchese May 5, 1972 Aiko Koo September 14, 1972 Cindy Schall January 8, 1973 Rosalind Thorpe February 5, 1973 Alice Lui February 5, 1973

Clarnell Strandberg April 21, 1973 Sally Hallett April 21, 1973

Youtube - Kemper Interview

Turkat

2) Clever Sociopath individuals present as having some sort of psychological problem hidden agenda and tries to mask the agenda

Kenneth Bianchi

Hillside Strangler Faked DID Raped and murdered 10 women

(with Angelo Buono)

Found guilty

Primal Fear

Edward Norton Aaron Stampler Fakes DID to get out of responsibility for his murder

Turkat

3) The Hurting Sociopath individuals who meet the criteria for ANT but want to change More reckless than callous Probably depressed/anxious

Millons Model

Millon's Model

three polarity model

enhancing/preserving accommodating/modifying nurturing/individuating

antisocial types are:

modifying-individuating types

Millon Subtypes

Nomadic avd, szd Malevolent sad, par Covetous pure aspd Risk-taking - his Reputation-defending - nar

Robert Hare

PCL-R Psychopathy Check List Revised

Premised on Cleckleys Mask of Sanity Two empirical primary factors

Youtube link Robert Hare

F1 = Callousness, selfish, remoreless F2 = Antisocial Behavior, socially deviant

PCL-R

Hares Model

1. glibness / superficial charm

11. promiscuous sexual behavior

2. grandiose sense of self-worth

3. need for stimulation / proneness to boredom 4. pathological lying 5. conning / manipulative

12. early behavior problems

13. lack of realistic long-term goals 14. impulsivity 15. irresponsibility 16. failure to accept responsibility 17. many short-term marital relationships 18. juvenile delinquency 19. revocation of conditional [e.g., from prison] 20. criminal versatility

6. lack of remorse 7. shallow affect 8. callous / lack of empathy 9. parasitic lifestyle

10. poor behavior controls

PCL-R

3 point scale

0 = does not apply 1= applies to some extent 2 = applies to individual

Cutoffs

Normal Score of 5 Psychopath Score of 30 or greater

Hit Rate 85% A good predictor of recidivism

F1 = charm, grandiosity, deceitful, lack of remorse and empathy, blame externalization

F2 = antisocial lifestyle, child behavior problems, impulsivity, irresponsibility, lack of long-term goals

F1

F2

r = .5

F1 = charm, grandiosity, deceitful, lack of remorse and empathy, blame externalization

F2 = antisocial lifestyle, child behavior problems, impulsivity, irresponsibility, lack of long-term goals

F1

F2

The DSM ASPD assesses F2

F1 = Callousness, selfish, remoreless F2 = Antisocial Behavior, socially deviant

PCL-R

Hares Model

1. glibness / superficial charm

11. promiscuous sexual behavior

(5)

2. grandiose sense of self-worth

3. need for stimulation / proneness to boredom 4. pathological lying (2) 5. conning / manipulative

12. early behavior problems (4)

13. lack of realistic long-term goals (1) 14. impulsivity (3) 15. irresponsibility (6) 16. failure to accept responsibility (6) 17. many short-term marital relationships (1) 18. juvenile delinquency (4) 19. revocation of conditional [e.g., from prison] 20. criminal versatility

6. lack of remorse (7) 7. shallow affect 8. callous / lack of empathy 9. parasitic lifestyle (1)

10. poor behavior controls (1, 4, 5)

PCL-R F1 r = .28
Stress Immunity Fearlessness

Social Potency Impulsivity

Coldheartedness

PPI

Externalization

Nonplanfulness
PCL-R F2 Egocentricity r = .31

Correlates of PCL-R

Factor 1 + dominance + positive affect + achievement + adjustment - empathy + self-centered + Narcissistic PD + Machiavellianism

Factor 2 -/+ anxiety + criminality -/+ drug/alcohol + reactive aggression -/+ suicides + impulsivity + sensation seeking + Borderline PD

Psychopathy Prevalence

Using PCL-R cutoff of 30

15 to 25% (prison), 1%? (population)

DSM criteria

50 to 80% (prison), 2% (population)

Why do they come for treatment?

ego-syntonic condition

1) in trouble with law 2) marital issue 3) occupational problems

Treatment

High F1 callousness poor outcome High F2 reckless possible (particularly if depressed) Treatment is a game, pervasive lying Fear induction in therapist Dont come to therapy for bad character Nothing is known to work

Warning very violent

Homework Assignment Cape Fear

Link Link Link Link Link Link Link

1 2 3 4 5 6 7

Link Link Link Link Link Link Link

8 (missing) 9 10 11 12 13 14