The Complexity of Psychopathy (Dangerous Behavior in Clinical and Forensic Psychology)

This book provides a nuanced view of psychopathy by linking this syndrome to acknowledged DSM categories and exploring diverse theoretical perspectives for the conceptualization of this condition. While other volumes focus on the uniqueness of the disorder, this book highlights the heterogeneity of psychopathy and the implications of that heterogeneity for research and treatment. Directed to both clinicians and researchers, this volume aims to improve understanding and treatment for this complex condition. The Complexity of Psychopathy Biographies of the Series Editors Biography of the Volume Editor Preface Contents Contributors Chapter 1: Introduction to Psychopathy References Chapter 2: Profile and Assessment of Psychopathy 2.1 Introduction and Clinical Description 2.1.1 The Mask of Sanity 2.2 Epidemiology 2.2.1 North American Samples Versus European Samples 2.2.2 Male Samples Versus Female Samples 2.2.3 African American Samples Versus European American Samples 2.3 Assessment of Psychopathy 2.3.1 The PCL and Related Measures 2.3.1.1 The Structure of the PCL-R 2.3.1.2 Factors, Facets, and Psychopathy “Subtypes” 2.3.1.3 Criminal Behavior and the PCL-R 2.3.1.4 Generalizability Across Groups 2.3.2 Other Measures of Psychopathy 2.3.2.1 Self-Report and Other Alternative Measures 2.3.2.2 Measures for Use with Juvenile Samples 2.4 Conclusions and Recommendations References Chapter 3: Developmental Considerations in Psychopathy 3.1 Introduction 3.2 Measurement of Psychopathic Traits 3.2.1 Evidence of a Multidimensional Construct 3.3 The Etiology of Psychopathic Traits 3.3.1 Environmental Factors 3.3.2 Genetic Factors 3.3.3 Neurobiological Factors 3.4 Emergent Issues in Treatment & Interventions 3.5 Conclusions References Chapter 4: Psychopathy and Gender: How Relevant Is the Construct of Psychopathy in Females? 4.1 How Relevant Is the Construct of Psychopathy in Females? 4.1.1 Gender and Theoretical Considerations in Psychopathy 4.1.2 Development of the Psychopathy Checklist (PCL): When the Construct Starts to Become Synonymous with the Measure 4.1.2.1 PCL-R Factor Structure 4.1.2.2 Prevalence and Gender Differences in PCL-R Scores 4.1.3 The Role of Gender in Expressions of Psychopathy 4.1.4 Primary and Secondary Psychopathy in Females 4.1.5 Use of the PCL Youth Version with Adolescent Girls 4.2 Etiology: Is It Psychopathy or Is It Trauma? 4.2.1 Survival Strategies 4.3 Assessment Considerations 4.4 Psychological Formulation 4.5 Treatment Considerations 4.6 Conclusion and Recommendations References Chapter 5: Psychopathy and Violence 5.1 An Introduction to Psychopathy and Violence 5.1.1 The Importance of Psychopathy for Preventing Violence 5.1.2 The Construct of Psychopathy 5.2 Forms of Aggression 5.2.1 Subtypes of Aggression 5.2.2 Summary of Psychopathy Factor and Facet Model Predictors of Aggression 5.3 Violent Crimes 5.3.1 Homicide 5.3.2 Assault 5.3.3 Intimate Partner Violence 5.3.4 Sexual Offending 5.3.5 Robbery 5.3.6 Violent Recidivism 5.3.7 Prison and Inpatient Violence 5.3.8 Summary 5.4 Chapter Summary and Recommendations for Future Investigation 5.5 Conclusion References Chapter 6: Psychopathy and Neurodevelopmental Disorders 6.1 Introduction 6.2 Overview of Psychopathy 6.3 Overview of Neurodevelopmental Disorders 6.4 Intellectual Disability 6.4.1 Clinical Assessment of Intellectual Disability 6.4.1.1 Assessment of Intellectual Functioning 6.4.1.2 Assessment of Adaptive Functioning 6.4.1.3 Assessment of the Onset of Intellectual Disability 6.4.1.4 Clinical Assessment of Comorbid Psychopathology in Individuals with Intellectual Disability 6.4.2 Diagnostic Comorbidity 6.4.3 Intellectual Disability and Psychopathy 6.4.4 Intellectual Disability and Criminal Offending 6.4.5 Clinical Intervention for Intellectual Disability 6.4.5.1 Applied Behavior Analysis Person-Centered Active Support 6.4.5.2 Cognitive-Behavioral Therapies 6.5 Autism Spectrum Disorder 6.5.1 Clinical Assessment of Autism Spectrum Disorder 6.5.1.1 Clinical Assessment of Comorbid Psychopathology in Individuals with Autism Spectrum Disorder 6.5.2 Diagnostic Comorbidity 6.5.3 Autism Spectrum Disorder and Psychopathy 6.5.4 Autism Spectrum Disorder and Criminal Offending 6.5.5 Clinical Intervention for Autism Spectrum Disorder 6.5.5.1 Applied Behavior Analysis and Person Centered Active Support 6.5.5.2 Verbal Behavior and Clinical Communication Training 6.5.5.3 Cognitive-Behavioral Therapies 6.6 The Impact of Psychopathy on Clinical Interventions for ID or ASD 6.7 Conclusion References Chapter 7: Psychopathy and Psychotic Disorders 7.1 Introduction 7.2 Psychopathy 7.3 Psychosis 7.3.1 Schizophrenia 7.4 Psychopathy in Forensic Psychiatric Settings 7.5 Psychopathy and Schizophrenia 7.6 Psychopathy and Personality Disorders Related to Psychosis 7.7 Schizotypy 7.7.1 Associations Between Psychopathy and Schizotypy 7.8 Conclusion and Recommendations References Chapter 8: Psychopathy and Mood Disorders 8.1 Introduction to Psychopathy 8.2 Measurement of Psychopathy in Incarcerated Samples 8.3 Heterogeneity in Psychopathy 8.4 Introduction to Mood Disorders 8.4.1 Bipolar I Disorder 8.4.2 Bipolar II Disorder 8.4.3 Cyclothymic Disorder 8.4.4 Disruptive Mood Dysregulation Disorder (DMDD) 8.4.5 Major Depressive Disorder 8.4.6 Persistent Depressive Disorder 8.4.7 Premenstrual Dysphoric Disorder 8.5 Psychopathy and Mood Disorders 8.5.1 Psychopathy and Depressive Disorders 8.5.2 Psychopathy and Bipolar Disorder 8.5.3 Psychopathy and Suicidality 8.6 Clinical Assessment Considerations 8.7 Clinical Intervention Considerations 8.7.1 Treatment of Mood Disorders 8.7.2 Treatment of Psychopathy 8.7.3 Treating Comorbidity 8.8 Summary 8.9 Recommendations References Chapter 9: Psychopathy, Trauma, and PTSD Symptoms: Theory and Evidence 9.1 Introduction 9.2 Definitions and Distinctions 9.2.1 Prevalence and Overlap 9.3 Multidimensional Nature of Psychopathy and Relationships to Trauma 9.4 Proposed Models Relating Trauma and Psychopathy 9.4.1 Gene-Environment Correlations 9.4.2 Gene-Environment Interactions 9.4.3 Modeling and Learning Explanations 9.4.4 Emotional Blunting Theories 9.4.5 Emotional Instability Models 9.4.6 Traumatic Brain Injury (TBI) as an Explanatory Variable 9.5 Treatment Outcomes in Psychopathy and Trauma 9.6 Summary and Conclusions 9.6.1 Explanatory Models Linking Psychopathy and Trauma 9.6.2 Integration of TBI 9.7 Clinical Implications References Chapter 10: Psychopathy and Conduct Disorder: Do We Need Additional Specifiers for Adequate Representation? 10.1 Introduction 10.2 Inclusion of Psychopathic Traits and Conduct Problems in the DSM 10.2.1 DSM – I 10.2.2 DSM- II 10.2.3 DSM–III and DSM–III–R 10.2.4 DSM–IV and DSM–IV–TR 10.2.5 DSM-5 10.2.6 Summary and Integration 10.3 Psychopathy and DSM Comorbidity: Is there a Need for the Addition of Psychopathy Criteria if we already have ADHD, CD, and ODD? 10.3.1 Fledgling Psychopath Model 10.3.2 Conduct Problem Mediation Model 10.3.3 ADHD Mediation Model 10.3.4 ODD Temperament Model 10.3.5 Summary and Integration 10.4 Psychopathic Traits and the Etiology of Conduct Disorder 10.5 Conclusion References Chapter 11: Psychopathy and Substance Use Disorders 11.1 Links Between Psychopathy and Substance Use Disorders 11.1.1 Patterns of Associations Between Psychopathy and SUDs 11.1.2 Patterns of Associations Between Psychopathy Factors/Facets and SUDs 11.1.3 Patterns of Associations Between Psychopathy Subtype and SUDs 11.1.4 Patterns of Associations Between Psychopathy Across Developmental Stages and SUDs 11.1.5 Patterns of Associations Between Gender Expressions of Psychopathy and SUDs 11.2 Mechanisms That Increase Risk for SUDs in Psychopathy 11.3 Assessment Considerations 11.3.1 Assessing Psychopathy 11.3.2 Assessing SUDs 11.4 Clinical Interventions 11.5 Conclusions References Chapter 12: Psychopathy and Personality Disorders 12.1 Introduction 12.2 Diagnostic Criteria for Personality Disorder 12.3 The DSM-5 Personality Disorder Proposals 12.4 Five-Factor Model of Personality Disorder 12.5 Personality Disorder Clinical Assessment Considerations and Techniques 12.5.1 Interviews: Unstructured 12.5.2 Interviews: Semi-structured 12.5.3 Self-Reports 12.5.4 Assessment of DSM-5 Section III Personality Disorders: Level of Personality Functioning 12.5.5 Assessment of DSM-5 Section III Personality Disorders: Personality Trait Profile 12.6 Comorbidity 12.6.1 Psychopathy, Antisocial Personality Disorder, and Externalizing Problems 12.6.2 Psychopathy, ASPD, and Narcissistic Personality Disorder 12.6.3 Psychopathy, ASPD, and Borderline Personality Disorder 12.6.4 Psychopathy, ASPD, and Substance Use Disorders 12.7 Criminal Behavior 12.8 Clinical Interventions 12.8.1 Antisocial Personality Disorder 12.8.2 Narcissistic Personality Disorder 12.8.3 Borderline Personality Disorder 12.9 Conclusions References Chapter 13: Forensic Rehabilitation Perspectives: Applying a Two-Component Framework to Interventions for Adults with Psychopathy 13.1 Introduction 13.2 A Treatment Target with Distinct, Interrelated Features 13.3 No Reliable Means to Change the Core Psychopathy Traits (Factor 1) 13.4 Offender Rehabilitation 13.4.1 The Risk, Need, and Responsivity (RNR) Model 13.4.2 The RNR Model and Psychopathy 13.5 Re-thinking the RNR Model: Two-Component Model 13.5.1 Evidence for the Two-Component Model 13.6 The Good Lives Model 13.6.1 Psychopathy and the GLM 13.7 Desistance Frameworks 13.7.1 Psychopathy and Desistance 13.8 Gender Considerations 13.9 Conclusion References Chapter 14: Therapeutic Considerations and Interventions for Psychopathy 14.1 Psychopathy and Therapeutic Pessimism 14.2 Early Treatment Approaches (1990–2006): Therapeutic Communities 14.3 Cognitive-Behavioral Treatment Approaches 14.4 Salekin’s Meta-Analytic Reviews of Research on the Treatment of Psychopathy 14.5 More Recent Treatment Studies 14.6 Treatments Designed for Psychopathic Offenders 14.6.1 Risk-Reduction Approaches: Wong & Hare (2005) Psychopathy Treatment Program (PTP) 14.6.2 Personality Disorder Approaches: Galietta & Rosenfeld (2012) Dialectical Behavior Therapy (DBT) for Psychopathy 14.6.3 Schema Therapy for Forensic PD Patients, Including Those with Psychopathy 14.7 The Future of Psychopathy Treatment 14.8 Lessons Learned 14.9 Pointers to the Future 14.10 Conclusion References Chapter 15: Psychoanalytic Perspectives on Psychopathy 15.1 Introduction 15.2 Historical Psychoanalytic Perspectives of Psychopathy 15.2.1 Criminals from a Sense of Guilt 15.2.2 Developmental Deficits 15.2.3 Psychopathy as a Defence Against Trauma 15.2.4 The Mask of Sanity 15.2.5 Object Relations Theory 15.2.6 Personality Organisations 15.3 Aetiology: Genetics, Neurobiology, and Environment 15.3.1 Primary Versus Secondary Psychopathy, the Role of Anxiety and Diagnostic Confusion 15.3.2 Gene-Environmental Interactions 15.4 Attachment 15.5 A Contemporary Psychoanalytic Understanding of the Mind of the Psychopath 15.5.1 Failures of Internalisation 15.5.2 Primitive Internalised Object Relations and the Grandiose Self 15.5.3 The Psychopathic Superego 15.5.4 Imitation and Simulation 15.5.5 Psychopathic Aggression 15.6 Psychoanalytically-Informed Management and Treatment of Psychopathy 15.7 Personality Characteristics and Treatment Prognosis 15.8 General Treatment Considerations 15.9 Specific Treatment Approaches 15.9.1 Individual Psychodynamic Psychotherapy 15.9.2 Group-Analytic Therapy 15.9.3 Therapeutic Communities 15.9.4 Mentalization-Based Treatment 15.10 Conclusion References Chapter 16: Existential Perspectives of Psychopathy 16.1 Introduction 16.2 What Is Psychopathy? 16.2.1 Psychopathy as an Anger Disorder 16.2.2 Psychopathic Narcissism: A New Diagnosis? 16.3 What Is Existential Therapy? 16.3.1 Existential Therapy and Psychiatric Diagnosis 16.3.2 Existential Analysis 16.3.3 Existential Therapy 16.3.4 Existential Depth Psychology 16.4 Some Existential Perspectives on Psychopathy: Confronting Life’s Ultimate Concerns 16.4.1 Freedom and Responsibility 16.4.2 Fate and Destiny 16.4.3 Anxiety and Guilt 16.4.4 Suffering and Death 16.4.5 Depression and Despair 16.4.6 Nihilism and Meaninglessness 16.4.7 Alienation and Aloneness 16.4.8 Power and Impotence 16.4.9 Existential Frustration, Anger, and Rage 16.4.10 Evil, Creativity, and the Daimonic 16.4.11 Mindfulness, Spirituality and Religiosity 16.5 Finitude, Limitation, and Existential Termination 16.6 Conclusion References Chapter 17: A Gestalt Therapy Perspective on Psychopathy: Bearing the Unbearable 17.1 Statement of Intent 17.2 Psychopathy and Gestalt Therapy 17.3 Psychopathic Experience 17.4 Conditions that Foster Psychopathy 17.4.1 Individual Factors 17.4.2 Situational Factors 17.4.3 Anthropological Factors 17.5 Searching for Meaning in What Has No Meaning: Psychopathy in the Light of Field Theory 17.5.1 Some Definitions in limine 17.5.2 The Psychopathic Field: The Urge to Reify 17.5.3 The Psychopathic Field in the Therapeutic Encounter: Violence Circulates and Is Circulated Even by the Therapist 17.5.4 The Psychopathic Field in the Therapeutic Encounter: Compassion Springs from the Ground 17.6 A Possibility That Is Often Neglected: The Psychopathic Field Is Actualized When It Is the Victim Who Comes to Therapy 17.7 Some Final Clinical Considerations 17.8 A Brief Clinical Example 17.9 The Role of Judas: A Provocative Conclusion References Chapter 18: Group Therapy Interventions for Psychopathy: An Interpersonal Perspective 18.1 Is Psychopathy Responsive to Treatment? 18.2 The Operational Definition of Psychopathy and the “Psychopathic Sexuality Taxon” 18.3 Why the Sex Offense-Specific Treatment Field Is Important to the Study of Psychopathy 18.4 What Is the Nature of the Treatment Given to Men with Psychopathy? 18.4.1 Differences Found When Outcome Is Measured as Recidivism vs. Treatment Responsivity 18.4.2 Selected Studies That Speak Specifically to Treatment Responsiveness in Group Therapy 18.5 New Pilot Study of Interpersonal Group Treatment of Psychopathy 18.5.1 Measures and Procedure 18.5.2 Results and Discussion 18.6 Conclusion and Recommendations References Chapter 19: Family Therapy Interventions for Psychopathy 19.1 Introduction 19.2 Existing Interventions for Youth Conduct Problems 19.3 The Importance of Family-Based Interventions for Youth with Psychopathic Traits 19.4 Conceptualizing Therapeutic Targets for Youth with Psychopathic Traits 19.5 Progress in Adapting Family Interventions for Youth with Psychopathic Traits 19.6 Conclusions and Future Directions References Chapter 20: Neuropsychological Considerations in Psychopathy 20.1 Introduction 20.1.1 Neuropsychological Assessments 20.1.2 Psychopathy: Definition 20.1.3 Understanding Neurodevelopment 20.2 Neurodevelopmental Aspects of Psychopathy 20.2.1 Neuroscience and Psychopathy 20.2.2 Structural and Functional Brain Abnormalities 20.3 Psychopathy: Attentional Deficits 20.4 Psychopathy: Emotional Deficits 20.5 Diagnostic Considerations 20.5.1 Antisocial Personality Disorder, Psychopathy, and the DSM-5 20.5.2 Neuropsychological Profiles of Psychopathy Versus Antisocial Personality Disorder 20.6 Neuropsychological Assessment 20.6.1 The Psychopathy Checklist-Revised (PCL-R) 20.6.2 Error Reduction and Rater Bias 20.6.3 Derivatives of the PCL-R 20.6.4 Self-report Instruments 20.7 Successful Versus Unsuccessful Psychopathy 20.8 Legal Considerations in Neuropsychological Assessment of Psychopathy 20.9 Neuropsychological Research: Frontiers References Chapter 21: Criminal Justice Responses to Psychopathy 21.1 Introduction 21.2 Defining Psychopathy 21.3 PCL-Psychopathy as a Predictor of Risk of Recidivism 21.4 Does Psychopathy Explain Crime and Violence? 21.5 Psychopathy and Treatability 21.6 Reducing Recidivism Risk Through Treatment 21.6.1 Risk-Reducing Interventions for Offenders 21.6.2 Treatment, PCL-Psychopathy and Recidivism Outcomes 21.6.3 PCL-Psychopathy and Change in Treatment 21.7 Treatability of Psychopathy 21.8 Specific Psycho-Legal Uses of the PCL-Psychopathy Measures 21.8.1 Transfer of Young People to Adult Court for Trial 21.8.2 Death-Penalty-Related Sentencing 21.8.3 Civil Detention Through Designation as a Sexually Violent Predator 21.8.4 Assessment of Treatment Amenability 21.8.5 Other Uses in Other Jurisdictions 21.9 Field Reliability and Validity 21.10 Generalizability Across Nations and Ethnicities 21.10.1 Comparability Across Nations in Mean Scores, Factor Structures, and Recidivism Prediction 21.10.2 Comparisons Across Ethnicities Within Nations 21.11 Potential for Stigmatization and Prejudiced Decision Making 21.12 Ethical and Practical Issues and Implications 21.13 Conclusions References Chapter 22: Public Health Considerations in Psychopathy 22.1 Introduction 22.2 Overview of the Public Health Model 22.3 Conceptual Definitions of Psychopathy 22.4 Burden of “Disease” 22.5 Epidemiology 22.6 Etiology, Risk, & Protective Factors 22.7 Community Response and Prevention 22.8 Conclusions References Index