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.

The reliability and validity of traditional taxonomies are limited by arbitrary boundaries between psychopathology and normality, often unclear boundaries between disorders, frequent disorder co-occurrence, heterogeneity within disorders, and diagnostic instability. These taxonomies went beyond evidence available on the structure of psychopathology and were shaped by a variety of other considerations, which may explain the aforementioned shortcomings. The Hierarchical Taxonomy Of Psychopathology (HiTOP) model has emerged as a research effort to address these problems. It constructs psychopathological syndromes and their components/subtypes based on the observed covariation of symptoms, grouping related symptoms together and thus reducing heterogeneity. It also combines co-occurring syndromes into spectra, thereby mapping out comorbidity. Moreover, it characterizes these phenomena dimensionally, which addresses boundary problems and diagnostic instability. Here, we review the development of the HiTOP and the relevant evidence. The new classification already covers most forms of psychopathology. Dimensional measures have been developed to assess many of the identified components, syndromes, and spectra. Several domains of this model are ready for clinical and research applications. The HiTOP promises to improve research and clinical practice by addressing the aforementioned shortcomings of traditional nosologies. It also provides an effective way to summarize and convey information on risk factors, etiology, pathophysiology, phenomenology, illness course, and treatment response. This can greatly improve the utility of the diagnosis of mental disorders. The new classification remains a work in progress. However, it is developing rapidly and is poised to advance mental health research and care significantly as the relevant science matures.

A hierarchical biometric model is presented of the origins of comorbidity among substance dependence, antisocial behavior, and a disinhibited personality style. The model posits a spectrum of personality and psychopathology, united by an externalizing factor linked to each phenotype within the spectrum, as well as specific factors that account for distinctions among phenotypes within the spectrum. This model fit self-report and mother-report data from 1,048 male and female 17-year-old twins. The variance of the externalizing factor was mostly genetic, but both genetic and environmental factors accounted for distinctions among phenotypes within the spectrum. These results reconcile evidence for general and specific causal factors within the externalizing spectrum and offer the externalizing factor as a novel target for future research.

Antisocial behavior, substance use, and impulsive and aggressive personality traits often co-occur, forming a coherent spectrum of personality and psychopathology. In the current research, the authors developed a novel quantitative model of this spectrum. Over 3 waves of iterative data collection, 1,787 adult participants selected to represent a range across the externalizing spectrum provided extensive data about specific externalizing behaviors. Statistical methods such as item response theory and semiparametric factor analysis were used to model these data. The model and assessment instrument that emerged from the research shows how externalizing phenomena are organized hierarchically and cover a wide range of individual differences. The authors discuss the utility of this model for framing research on the correlates and the etiology of externalizing phenomena. Keywords drug; alcohol; impulsivity; aggression; classificationThe existence of individual differences in the tendency to contain versus express impulses has been recognized in academic psychology since its inception as a discipline (James, 1890(James, /1983. In more recent times, this domain has been instantiated in psychological constructs ranging from disinhibition (Clark & Watson, 1999;Gorenstein & Newman, 1980) to impulsivity (Barratt, 1994;Dickman, 1990;Gray, 1981;Whiteside & Lynam, 2001), ego control (J. Block, 1965; J. H. Block & Block, 1980), constraint (Tellegen, 1985), the problem behavior syndrome (Jessor & Jessor, 1977), sensation seeking (Zuckerman & Kuhlman, 2000), and novelty seeking (Cloninger, Svrakic, & Przybeck, 1993). In addition, a dimension of effortful control is a salient feature of childhood temperament that likely relates to these disinhibitory personality characteristics in adulthood (Rothbart, Ahadi, & Evans, 2000). Robust correlations have also been observed between these disinhibitory personality constructs and mental disorders involving substance problems and antisocial behavior (for a review, see Sher & Trull, 1994).In spite of these rich interrelations, many of these constructs continue to be studied and conceptualized as separate entities, in separate literatures. A major reason for this fragmentation is the lack of an integrative model of this domain (Widiger & Clark, 2000). The purpose of the current research is to further the development of an empirically based model of NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript this broad domain of personality and psychopathology, which we term the externalizing spectrum (Krueger, Markon, Patrick, & Iacono, 2005). Origins of the Externalizing Spectrum ConceptualizationAs applied to adult psychopathology, the externalizing spectrum conceptualization emerged initially from research on mental disorders defined within current nosologies. In the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text. rev.; DSM-IV-TR; American Psychiatric Association, 2000), various forms of substance problems are conceptualized as discrete disorder...

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 venturesomeness. 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.

Startle-elicited blinks were measured during presentation of affective slides to test hypotheses concerning emotional responding in psychopaths. Subjects were 54 incarcerated sexual offenders divided into nonpsychopathic, psychopathic, and mixed groups based on file and interview data. Consistent with findings for normal college students, nonpsychopaths and mixed subjects showed a significant linear relationship between slide valence and startle magnitude, with startle responses largest during unpleasant slides and smallest during pleasant slides. This effect was absent in psychopaths. Group differences in startle modulation were related to affective features of psychopathy, but not to antisocial behavior per se. Psychopathy had no effect on autonomic or self-report responses to slides. These results suggest an abnormality in the processing of emotional stimuli by psychopaths that manifests itself independently of affective report. Abnormal or deficient emotional responding is considered to be a hallmark of psychopathy. Cleckley's (1955) classic diagnostic criteria for psychopathy include absence of nervousness, lack of remorse or shame, egocentricity and incapacity for love, and general poverty in major affective reactions. He believed that a discordance between linguistic and experiential components of emotion, a condition he termed semantic dementia, defined the essence of psychopathy. From this standpoint, the psychopath knows the "words" of emotion, but not the "music" (cf. Johns & Quay, 1962). Lykken (1957) provided empirical evidence that psychopaths defined by Cleckley's criteria are deficient in their capacity to develop anxiety responses. Subsequent empirical studies of emotion in psychopaths have focused largely on the responses of these individuals in punishing or threatening situations. The most consistent findings have been that psychopaths show reduced electrodermal response during anticipation of a noxious event and poor passive avoidance learning, that is, a failure to

The Multidimensional Personality Questionnaire (MPQ; A. Tellegen, 1982, in press) provides for a comprehensive analysis of personality at both the lower order trait and broader structural levels. Its higher order dimensions of Positive Emotionality, Negative Emotionality, and Constraint embody affect and temperament constructs, which have been conceptualized in psychobiological terms. The MPQ thus holds considerable potential as a structural framework for investigating personality across varying levels of analysis, and this potential would be enhanced by the availability of an abbreviated version. This article describes efforts to develop and validate a brief (155-item) form, the MPQ-BF. Success was evidenced by uniformly high correlations between the brief-and full-form trait scales and consistency of higher order structures. The MPQ-BF is recommended as a tool for investigating the genetic, neurobiological, and psychological substrates of personality.

Abnormal affective response in psychopaths is conceptualized within a broad theory of emotion that emphasizes reciprocal appetitive and defensive motivational systems. The startle response is proposed as a specific measure of the directional component of emotional activation. I review the literature that indicates that criminal psychopaths do not show the expected potentiation of the startle reflex that normally occurs during processing of aversive stimuli such as unpleasant photographs or punishment cues. Evidence is presented to demonstrate that this deviant response pattern is specific to individuals who display the classic affective symptoms of psychopathy. The core emotional deviation in psychopathy could be a deficit in fear response, which is defined as a failure of aversive cues to prime normal defensive actions. This emotional deficit may represent an extreme variant of normal temperament.