Change during forensic treatment in psychopathic versus nonpsychopathic offenders (original) (raw)
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Psychopathy (PCL-R) in a forensic psychiatric sample of homicide offenders: Some reliability issues
International Journal of Law and Psychiatry, 2007
Several studies have shown that psychopathy is overrepresented among homicide offenders. There is a consensus that Hare's Psychopathy Checklist-Revised PCL-R is currently the most valid and useful tool for rating psychopathy (e.g., [Fulero, S. M. (1995). Review of the Hare Psychopathy Checklist-Revised. In J. C. Conoley & J. C. Impara (Eds.), Twelfth Mental Measurements Yearbook (pp. 453-454). Lincoln, NE: Buros Institute]). Usually, when making a rating of psychopathy, both an interview and an examination of the subject's files are used. However, it has been discussed what is really required to be able to rate psychopathy in a reliable manner. The aim of the present study was to retrospectively rate the degree of psychopathy in 35 homicide offenders being subjected to forensic psychiatric assessment. These ratings of psychopathy were carried out using forensic psychiatric files and courts'; verdicts only. Another aim was to examine the reliability of PCL-R in this specific Swedish sample of homicide offenders. There was a good agreement between the two raters with respect to the categorical diagnosis of psychopathy (Cohen's kappa = .81, p b .001), which indicates that retrospective ratings of psychopathy are well suited for research purposes. The prevalence of psychopathy among the homicide offenders was 31.4% (using a cutoff score of 30), which means that the construct of psychopathy may contribute to the understanding of the phenomenon of homicide. In the planning of treatment for homicide offenders, a consideration of possible psychopathy is necessary. As criminal psychopaths are known to relapse into violent criminality, it is very important that they are given efficient treatment, placement and management.
Psychiatry Research, 2012
The complexity and consequences of psychopathy are still debated, and its relation to other mental disorders, pathological personality traits, and criminality needs to be further investigated by clinical, longitudinal studies using structured diagnostic instruments. The present study used two groups of mentally disordered offenders (N = 153) investigated with in-depth clinical assessments and prospective long-term follow-up to identify the convergence between 1) the four facets of psychopathy defined by the Psychopathy Checklist-Revised (PCL-R; Interpersonal, Affective, Lifestyle, and Antisocial), 2) mental disorders according to SCID I and II interviews, 3) personality traits as measured by the Karolinska Scales of Personality, and 4) criminal recidivism. The Interpersonal facet differed substantially from the other three facets by not being significantly associated with substance use disorders, antisocial personality disorder (the other facets at P ≤ 0.001 level), or personality traits involving impulsive and aggressive antisocial behaviors (the other facets at P b 0.01 level). Furthermore, the interpersonal facet could not predict violent recidivism better than random. The Antisocial facet outperformed not only the other facets but also the total PCL-R score in the prediction of violent recidivism, P b 0.001.The findings confirm psychopathy as a heterogeneous phenomenon and have clinical implications for assessments of psychopathy and violence risk assessments in clinical and forensic contexts.
Psychopathy and the dimensions of personality disorder in violent offenders
Personality and Individual Differences, 1998
The relationship of factors of personality disorder to psychopathy was investigated to determine whether psychopathy is more appropriately construed as a dimension of personality disorder rather than as one of several discrete categories of personality disorder. Comparisons were also made of the associations of personality disorders and psychopathy with measures of established personality dimensions, criminality and lifetime psychopathology. Male violent offenders detained in English prisons and a maximum security psychiatric hospital (N= 167) were assessed with the Structured Clinical Interview for DSM-III Axis II disorders (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). Factor analysis of personality disorder measures yielded four factors identified as impulsivity, detachment, sensitivity and compulsivity. The first three factors were related to measures of the personality dimensions of agreeableness, extraversion and neuroticism, respectively. The PCL-R correlated highly with the impulsivity factor. Both had significant associations with violent and nonviolent criminality, but relationships to psychopathology were limited to substance abuse history. The results replicate previous findings on the dimensional structure of personality disorders and support a dimensional conception of psychopathy.
The concept of psychopathy is unlike most other mental disorders in the lack of observations of vulnerability and pain in those affected. Rather, the psychopath’s callous and self-centered ways are known to evoke suffering in others. Measures are developed to identify these characteristics in a reliable way. However, increased accuracy has not led to better treatment. As a consequence, this study aimed to investigate whether the current understanding of psychopathy is changing, or should be changed, and if central changes in the concept and measurement of psychopathy require a modification of the way we handle the problem today? Hallmarks of the current paradigm were challenged through 3 research questions: 1. Are psychopathy and suffering mutually exclusive constructs? 2. Is the psychopath more than the persistent callous, grandiose and ruthless characteristics that we usually see? 3. Is the psychopath deprived of a capacity to change? The first article of the thesis reviews previously published (1980-2009) cases of offenders with severely psychopathic traits (n=11). Vulnerability and pain in psychopaths were consistent with empirical evidence and concepts associated with object relations theory, Reid (1986) and Martens’ (2002) clinical experience of suffering in psychopaths, and comorbid symptom- and personality pathology, as indicated by the authors’ assessment and the selfreport of individual offenders. Articles two and three draw from an in-depth investigation of Norwegian high-security and detention prisoners with possible and strong indications of psychopathy (n=16) and controls (n=35). Results indicate important nuances in psychopathic offenders’ affective and interpersonal functioning in terms of relational uncertainties and pain, and a greater emotional range than what is previously reported. Results further indicate a link between empirical findings and clinical theory describing structural affective, relational and defensive nuances in pathologically extreme self-states, which should be considered in future treatment of psychopathy. Results are incongruent with Cleckley’s (1941; 1988) recognized description, and the wellestablished primary-secondary psychopathy distinction (Karpman, 1941), and in agreement with the dimensional model of self- and interpersonal functioning advised in APA’s (2010) proposed revision of personality diagnoses. Future work should focus on the vulnerability and suffering, nuances and adjacent treatment of psychopathy. Such an approach would represent a paradigm shift in this field.
Clarifying associations between psychopathy facets and personality disorders among offenders
Journal of Criminal Justice, 2017
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2001
is a relatively new self-report measure that has shown considerable promise as an index of psychopathic traits in both nonoffender and offender samples. The present study examined the construct validity and predictive utility of the PPI by examining its association with theoretically relevant scales of the Personality Assessment Inventory (PAI; Morey, 1991) among 60 male prison inmates, and its ability to predict institutional misbehavior in an expanded sample (n = 89). As expected, correlations with the PAI scales were highest for the Antisocial Features (ANT) and Aggression (AGG) scales (rs = .68 and .57, respectively). The PPI also predicted various forms of nonviolent and physically aggressive disciplinary infractions significantly better than chance (point biserial correlations ranging from .26 to .37).
Concurrent Validity of the Psychopathic Personality Inventory With Offender and Community Samples
Assessment, 2010
The Psychopathy Checklist -Revised (PCL-R; Hare, 2003) is a frequently used and well-validated measure of psychopathy, but is relatively time-intensive and expensive to administer. The Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) is a self-report measure that provides a less time-intensive and less expensive method for identifying psychopathic individuals. Using three independent samples and two different versions of the PCL (i.e., PCL-R, PCL:SV), we evaluated the extent to which the PPI and PCL overlap in their measurement of the psychopathy construct. Across three studies, PPI total and Factor 2 scores correlated moderately to strongly with PCL total and Factor 2 scores. Results for PPI and PCL Factor 1 scores were less positive. These findings raise important questions concerning the integration of results obtained using alternative psychopathy assessments.