Reconstructing Psychopathy: Clarifying the Significance of Antisocial and Socially Deviant Behavior in the Diagnosis of Psychopathic Personality Disorder

Abstract

A survey of clinical views suggests that the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder is unclear. To investigate this issue, we evaluated Psychopathy Checklist-Revised ratings (PCL-R; Hare, 1991) using structural equation modeling. One model, referred to as the measurement model, included PCL-R ratings related to antisocial behavior as primary symptoms of psychopathy; a second, referred to as the causal model, included the same PCL-R ratings as secondary symptoms or consequences. Compared to the measurement models, the causal model included more PCL-R items, was more parsimonious, and had equal or superior fit indices. These findings suggest that antisocial behavior is best viewed as a secondary symptom or consequence of psychopathy, In addition, the findings have important implications for future research and clinical-forensic practice, especially concerning the assessment of risk for criminality and violence.

A New Understanding of Psychopathy: The Contribution of Phenomenological Psychopathology

“…We will now discuss Cooke et al's [30,31,32,33] criticism of the PCL-R's factor structure, and particularly the presence of antisocial characteristics in the diagnosis of psychopathy.…”

“…The Comprehensive Assessment of Psychopathic Personality (CAPP) [30,31,32,33] defends a different basis for defining the psychopathic entity. This conception, which is also deeply influenced by Cleckley's work, is a multidimensional model of personality that consists of six dimensions, including each of the dysfunctional traits observed in psychopathic personality disorder (table 1), excluding the antisocial factor (and those related to sexual promiscuity and short-term cohabitation relationships in the PCL-R).…”

“…Now let us reconsider the 20 items of the PCL-R. Based on the recommendations of the CAPP [30,31,32,33], we will eliminate the so-called ‘secondary items', which are less relevant to our psychopathological approach. The remaining 13 items are as follows: (1) glibness and/or superficial charm, (2) grandiose sense of self-worth, (3) need for stimulation and/or proneness to boredom, (4) pathological lying, (5) conning and/or manipulative, (6) lack of remorse or guilt, (7) shallow affect, (8) callous and/or lack of empathy, (9) parasitic lifestyle, (13) lack of realistic, long-term goals, (14) impulsivity, (15) irresponsibility, and (16) failure to accept responsibility for own actions.…”

“…The other is American: Cleckley's The Mask of Sanity [28]. We will then summarize the well-known work of Hare [29] including the so-called ‘Hare Psychopathy Checklist' (PCL-R), as well as the critique made by Cooke et al [30,31,32,33]. …”

Aggression and Impulsitivity: Two of a kind ?

“…PCL-R total scores in general ranging from 0-40, ranged in the current sample from 12 to 28 (M = 21.2, SD = 6.2, showing that this is a sample CHAPTER 5 | Anger provocation increases limbic and decreases medial prefrontal cortex displaying psychopathy characteristics). However, using the PCL-R as a diagnostic tool for the assessment of psychopathy (Acheson, 2005;Lynam & Gudonis, 2005, p 383), with scoring 30 or above indicating the diagnosis of psychopathy (Cooke, Michie, Hart, & Clark, 2004) indicates no diagnostic psychopathic individuals within the tested sample of violent offenders. Note.…”