Notes on Psychopathy

This is some old work I did for SI. See also Notes on the Psy­chol­ogy of Power.

De­viant but not nec­es­sar­ily dis­eased or dys­func­tional minds can demon­strate re­sis­tance to all treat­ment and at­tempts to change their mind (think No Univer­sally Com­pel­ling Ar­gu­ments; the pre­mier ex­am­ple are prob­a­bly psy­chopaths—no drug treat­ments are at all use­ful nor are there any ther­a­pies with solid ev­i­dence of even marginal effec­tive­ness (one widely cited chap­ter, “Treat­ment of psy­chopa­thy: A re­view of em­piri­cal find­ings”, con­cludes that some at­tempted ther­a­pies merely made them more effec­tive ma­nipu­la­tors! We’ll look at that later.) While some psy­chopath traits bear re­sem­blance to gen­eral char­ac­ter­is­tic of the pow­er­ful, they’re still a pretty unique group and worth look­ing at.

The main fo­cus of my ex­cerpts is on whether they are treat­able, their effec­tive­ness, pos­si­ble evolu­tion­ary bases, and what other is­sues they have or don’t have which might lead one to not sim­ply write them off as “bro­ken” and of no rele­vance to AI.

(For ex­am­ple, if we were to dis­cover that psy­chopaths were healthy hu­man be­ings who were not uni­ver­sally men­tally re­tarded or in­effec­tive in gain­ing wealth/​power and were de­struc­tive and amoral, de­spite be­ing com­pletely hu­man and of­ten so­cial­ized nor­mally, then what does this say about the frag­ility of hu­man val­ues and how likely an AI will just be nice to us?)

As usual in my ‘notes’ ar­ti­cles, the fol­low­ing is a se­ries of ex­cerpts and cita­tions; if any in­ter­est you, leave a com­ment and I will try to jailbreak a copy for you or failing that, post a re­quest on the re­search help page.

1 Psychopathy

The Psy­chopath: Emo­tion and the brain, Blair et al 2005:

There are now a rel­a­tively large num­ber of stud­ies in­di­cat­ing that in­di­vi­d­u­als with psy­chopa­thy re­offend at higher rates than non-psy­cho­pathic in­di­vi­d­u­als. For ex­am­ple, in an early study, the PCL-R was ad­ministered to 231 offen­ders prior to re­lease from pris­ons (Hart et al., 1988). Within 3 years, 25% of non-psy­cho­pathic in­di­vi­d­u­als had been re-in­car­cer­ated. In sharp con­trast, 80% of the in­di­vi­d­u­als with psy­chopa­thy had breached the terms of their re­lease. In an­other study Serin and Amos (1995) fol­lowed 299 offen­ders, and within 3 years, 65% of in­di­vi­d­u­als with psy­chopa­thy ver­sus only 25% of the non-psy­cho­pathic in­di­vi­d­u­als were con­victed of a new offence. Such re­sults have been found in Euro­pean stud­ies also. Thus, in a Swedish sam­ple of foren­sic pa­tients, Grann et al. (1999) found that in­di­vi­d­u­als scor­ing above 25 on the PCL-R vi­o­lently re­offended at a rate of 66% ver­sus only 18% for those with a score less than 26. In Belgium, the re­con­vic­tion rates of psy­cho­pathic, mid­dle scor­ing, and low scor­ing in­di­vi­d­u­als were 44% , 21% , and 11% , re­spec­tively (Hare et al., 2000)…An in­ter­na­tional study of 278 offen­ders is of par­tic­u­lar in­ter­est. This found that 82% of the in­di­vi­d­u­als with psy­chopa­thy but only 40% of non- psy­cho­pathic in­di­vi­d­u­als were re­con­victed of an offence (Hare et al., 2000). In the same group, 38% of the high psy­chopa­thy group com­mit­ted a vi­o­lent offence, but only 2.7% of those with a low PCL-R score did. In­ter­est­ingly, both the in­di­vi­d­u­als with psy­chopa­thy and the non-psy­cho­pathic in­di­vi­d­u­als failed to show at­ten­u­ated re­con­vic­tion rates fol­low­ing treat­ment af­ter con­trol­ling for age and crim­i­nal his­tory. How­ever, the pat­tern of re­sults changes when Fac­tor 1 scores [in­ter­per­sonal/​af­fec­tive: glib charm, grandios­ity, ly­ing, cal­los­ity, cun­ning] are care­fully ex­am­ined. Par­ti­ci­pants with high Fac­tor 1 scores re­offended at higher rates if they had been treated: 86% as op­posed to 59% ! Similarly strik­ing re­sults have been seen when ex­am­in­ing par­ti­ci­pants who en­gage in ed­u­ca­tional and vo­ca­tional train­ing pro­grams. Here offen­ders with low Fac­tor 1 scores show an im­prove­ment in re­ci­di­vism rate fol­low­ing the course. How­ever, offen­ders with high Fac­tor 1 scores are re­con­victed at higher rates if they take part in these pro­grams rather than if they do not. In what is per­haps the most com­pre­hen­sive re­view and meta-anal­y­sis to date, Hem­phill and col­leagues (1998) ex­am­ined nine available pub­lished and un­pub­lished prospec­tive stud­ies of psy­chopa­thy and re­ci­di­vism. The length of fol­lowup for the stud­ies re­viewed ranged from 1 to 10.5 years. The au­thors de­ter­mined that within a year of re­lease, in­di­vi­d­u­als with psy­chopa­thy are three times more likely to re­ci­di­vate, and four times more likely to re­ci­di­vate vi­o­lently. In fact, the rel­a­tive risk for re­offend­ing (the pro­por­tion of psy­cho­pathic in­di­vi­d­u­als who re­offend di­vided by the pro­por­tion of non-psy­cho­pathic offen­ders who re­offend) ranged from 1.7 to as high as 6.5 across stud­ies. Taken to­gether, at a 1-year fol­low-up, the gen­eral re­ci­di­vism rate for in­di­vi­d­u­als with psy­chopa­thy was three times higher than that of non-psy­cho­pathic in­di­vi­d­u­als and the vi­o­lent re­ci­di­vism rate was three to five times higher. Psy­chopa­thy is as­so­ci­ated with both gen­eral and vi­o­lent re­ci­di­vism at fol­low-up lengths of as lit­tle as a year, or as long as more than 10 years.

  • Hart S. D., Kropp P. R., Hare R. D. (1988). Perfor­mance of male psy­chopaths fol­low­ing con­di­tional re­lease from prison. Jour­nal of Con­sult­ing and Clini­cal Psy­chol­ogy, 56, 227-232

  • Serin R. C., Amos N. L. (1995). The role of psy­chopa­thy in the as­sess­ment of dan­ger­ous­ness. In­ter­na­tional Jour­nal of Law and Psy­chi­a­try, 18, 231-238

  • Grann M., Langstrom N., Tengstrom A., Kul­l­gren G. (1999). Psy­chopa­thy (P. C. L-R) pre­dicts vi­o­lent re­ci­di­vism among crim­i­nal offen­ders with per­son­al­ity di­s­or­ders in Swe­den. Law and Hu­man Be­hav­ior, 23, 205-217.

  • Hare R. D., Clark D., Grann M., Thorn­ton D. (2000). Psy­chopa­thy and the pre­dic­tive val­idity of the P. C. L-R: an in­ter­na­tional per­spec­tive. Be­hav­ioral Sciences and the Law, 18, 623-645

  • Hem­phill J. F., Hare R. D., Wong S. (1998). Psy­chopa­thy and re­ci­di­vism: a re­view. Le­gal and Crim­inolog­i­cal Psy­chol­ogy, 3, 139-170

How­ever, pre­limi­nary work con­ducted by Paul Frick us­ing the APSD has ex­am­ined the in­ci­dence rate of psy­cho­pathic ten­den­cies in com­mu­nity sam­ples in­volv­ing chil­dren. As dis­cussed in chap­ter 1, we have used a score of 27 on the APSD as our cut-off point for a clas­sifi­ca­tion of psy­cho­pathic ten­den­cies in many of our stud­ies (Blair et al., 2001a, b). Us­ing this cut-off re­sults in a prevalence rate of psy­cho­pathic ten­den­cies of be­tween 1.23% and 3.46% (Frick, per­sonal com­mu­ni­ca­tion); i.e., ap­prox­i­mately one quar­ter of the in­ci­dence rate of CD in com­mu­nity sam­ples. More­over, epi­demiolog­i­cal stud­ies ex­am­in­ing the prevalence of psy­chopa­thy in foren­sic sam­ples have been con­ducted. Th­ese re­veal that while up to 80% of US in­mates reach di­ag­nos­tic crite­ria for ASPD, only 15-25% of US in­mates meet crite­ria for psy­chopa­thy ac­cord­ing to the crite­ria laid down by the PCL-R (Hare, 1996). In other words, ap­prox­i­mately one quar­ter of those re­ceiv­ing the DSM-IV di­ag­no­sis of ASPD meet the crite­ria for psy­chopa­thy. Based on these find­ings and the 3% com­mu­nity in­ci­dence rate of ASPD sug­gested by the DSM-IV, the prevalence of psy­chopa­thy can be in­ferred. If we as­sume ap­prox­i­mately 25% of those with a di­ag­no­sis of ASPD might meet crite­ria for psy­chopa­thy, we can es­ti­mate an in­ci­dence rate for psy­chopa­thy in males in the com­mu­nity of 0.75%.

  • Blair R. J. R., Col­ledge E., Mitchell D. G. (2001a). So­matic mark­ers and re­sponse re­ver­sal: is there or­bitofrontal cor­tex dys­func­tion in boys with psy­cho­pathic ten­den­cies? Jour­nal of Ab­nor­mal Child Psy­chol­ogy, 29(6), 499-511.

  • Blair R. J. R., Col­ledge E., Mur­ray L., Mitchell D. G. (2001b). A se­lec­tive im­pair­ment in the pro­cess­ing of sad and fear­ful ex­pres­sions in chil­dren with psy­cho­pathic ten­den­cies. Jour­nal of Ab­nor­mal Child Psy­chol­ogy, 29(6), 491-498

  • Hare R. D. (1996). Psy­chopa­thy: a clini­cal con­struct whose time has come. Crim­i­nal Jus­tice and Be­hav­ior, 23, 25-54

Hare and col­leagues, us­ing the Wech­sler Adult In­tel­li­gence Scale, found lit­tle cor­re­la­tion be­tween IQ and both PCL-R to­tal scores and emo­tional dys­func­tion (Fac­tor 1) scores. How­ever, there was a mod­est nega­tive cor­re­la­tion with an­ti­so­cial be­hav­ior (Fac­tor 2 [Im­pul­sive/​an­ti­so­cial lifestyle: delin­quency, par­a­sitism, no long-term goals]) scores (Hare, 1991); i.e., lower IQ was as­so­ci­ated with higher lev­els of an­ti­so­cial be­hav­ior. Similar find­ings have been re­ported with chil­dren with psy­cho­pathic ten­den­cies (Frick et al., 1994). Similarly, Hare, us­ing a bat­tery of tests that mea­sure over 20 men­tal abil­ities, found no cor­re­la­tion be­tween cog­ni­tive func­tion­ing and Fac­tor 1 or to­tal PCL-R scores, but did find a sig­nifi­cant nega­tive cor­re­la­tion (r = −0.46) be­tween Fac­tor 2 and “crys­tal­lized in­tel­li­gence” (Hare, 2003). Crys­tal­lized in­tel­li­gence can be con­sid­ered a mea­sure of ac­cu­mu­lated knowl­edge. It is highly in­fluenced by an in­di­vi­d­ual’s ex­pe­rience (i.e., their school­ing and in­volve­ment in cul­tural ac­tivi­ties). More­over, Hare, in a com­pre­hen­sive re­view, re­ports a con­sis­tent, though mod­est, nega­tive cor­re­la­tion be­tween ed­u­ca­tion and Fac­tor 2, but not Fac­tor 1, scores (Hare, 2003). Over­all, then, there is no ev­i­dence to sug­gest that in­di­vi­d­u­als with psy­chopa­thy have su­pe­rior IQ com­pared to in­di­vi­d­u­als with no psy­chopa­thy. How­ever, an­ti­so­cial be­hav­ior does ap­pear to be linked with lower in­tel­li­gence and lower level of school­ing.

  • Hare R. D. (1991). The Hare Psy­chopa­thy Check­list—Re­vised. Toronto, On­tario: Multi-Health Systems

  • Frick P. J., O’Brien B. S., Woot­ton J. M., McBur­nett K. (1994). Psy­chopa­thy and con­duct prob­lems in chil­dren. Jour­nal of Ab­nor­mal Psy­chol­ogy, 103, 700-707

  • Hare R. D. (2003). The Hare Psy­chopa­thy Check­list—Re­vised (PCL-R), 2nd edn. Toronto, On­tario: Multi-Health Sys­tems.

  • psy­chopa­thy un­cor­re­lated with schizophre­nia; nega­tively cor­re­lated with de­pres­sion & anx­iety/​fear in gen­eral (in­ter­est­ingly, pos­i­tively cor­re­lated with Neu­roti­cism, see “Psy­chopa­thy and Per­son­al­ity” in the Hand­book); pos­i­tively cor­re­lated with sub­stance abuse of var­i­ous sorts, and with ADHD

In this chap­ter, we also re­ported that age, SES, and IQ are all in­versely re­lated to an­ti­so­cial be­hav­ior. The older an in­di­vi­d­ual is (af­ter the age of 20 years), the higher their SES, and the higher their IQ, the less likely they are to en­gage in an­ti­so­cial be­hav­ior. More­over, we also re­ported that all of these vari­ables are in­versely as­so­ci­ated with the an­ti­so­cial be­hav­ior (Fac­tor 2) com­po­nent of psy­chopa­thy. How­ever, it was in­ter­est­ing to note that none of these vari­ables are as­so­ci­ated with the emo­tional dys­func­tion (Fac­tor 1) com­po­nent of psy­chopa­thy…Much an­ti­so­cial be­hav­ior shown by in­di­vi­d­u­als with psy­chopa­thy is in­stru­men­tal in na­ture—it has the goal of gain­ing an­other’s money, sex­ual fa­vors, or “re­spect” (Cor­nell et al., 1996; Willi­am­son et al., 1987). In­di­vi­d­u­als can at­tempt to achieve these goals through a va­ri­ety of means. Hav­ing a higher SES (or for that mat­ter in­tel­li­gence) en­ables a wider choice of available routes for achiev­ing these goals than hav­ing a lower SES (or in­tel­li­gence). We sug­gest that a rea­son for the in­verse re­la­tion­ship be­tween SES and IQ with the an­ti­so­cial be­hav­ior com­po­nent of psy­chopa­thy is that lower SES/​IQ limits the be­hav­ioral op­tions available so that an­ti­so­cial be­hav­ior ap­pears a use­ful route to the goal. A healthy in­di­vi­d­ual of limited SES/​IQ may also have a nar­row range of be­hav­ioral op­tions but will ex­clude an­ti­so­cial be­hav­ior be­cause of aver­sion to this be­hav­ior formed dur­ing so­cial­iza­tion (see chap­ter 8). In con­trast, in­di­vi­d­u­als with psy­chopa­thy may en­ter­tain the an­ti­so­cial op­tion be­cause they do not find the re­quired an­ti­so­cial be­hav­ior aver­sive…In other words, we an­ti­ci­pate that there are in­di­vi­d­u­als of higher SES who do not pre­sent with the full psy­cho­pathic syn­drome even though their emo­tional dys­func­tion is of an equiv­a­lent de­gree to other in­di­vi­d­u­als who pre­sent with both the emo­tional and be­hav­ioral com­po­nents of the di­s­or­der.

  • Cor­nell D. G., War­ren J., Hawk G., Stafford E., Oram G., Pine D. (1996). Psy­chopa­thy in in­stru­men­tal and re­ac­tive vi­o­lent offen­ders. Jour­nal of Con­sult­ing and Clini­cal Psy­chol­ogy, 64, 783-790

  • Willi­am­son S., Hare R. D., Wong S. (1987). Violence: crim­i­nal psy­chopaths and their vic­tims. Cana­dian Jour­nal of Be­hav­ioral Science, 19, 454-462

One ex­tinc­tion task that has been used with in­di­vi­d­u­als with psy­chopa­thy is a card play­ing task origi­nally de­vel­oped by Joe New­man and col­leagues (New­man et al., 1987). In this task, the par­ti­ci­pant has to de­cide whether to play a card. Ini­tially, the par­ti­ci­pant’s choice to play is always re­in­forc­ing; if the par­ti­ci­pant plays the card he or she will win points or money. How­ever, as the par­ti­ci­pant pro­gresses through the pack of cards, the prob­a­bil­ity of re­ward de­creases. Thus, ini­tially ten out of ten cards are re­warded, then nine out of ten, then eight out of ten con­tin­u­ing on un­til zero out of ten cards are re­warded. The par­ti­ci­pant should stop play­ing the cards when play­ing means that more cards are as­so­ci­ated with pun­ish­ment rather than re­ward. That is, they should stop play­ing the cards when only four out of ten cards are as­so­ci­ated with re­ward. Chil­dren with psy­cho­pathic ten­den­cies and adult in­di­vi­d­u­als with psy­chopa­thy have con­sid­er­able difficulty with this task; they con­tinue to play the cards even when they are be­ing re­peat­edly pun­ished and may end up los­ing all the points that they had gained (Fisher and Blair, 1998; New­man et al., 1987; O’Brien and Frick, 1996).

  • Fisher L., Blair R. J. R. (1998). Cog­ni­tive im­pair­ment and its re­la­tion­ship to psy­cho­pathic ten­den­cies in chil­dren with emo­tional and be­havi­oural difficul­ties. Jour­nal of Ab­nor­mal Child Psy­chol­ogy, 26, 511-519

  • New­man J. P., Pat­ter­son C. M., Kos­son D. S. (1987). Re­sponse per­se­ver­a­tion in psy­chopaths. Jour­nal of Ab­nor­mal Psy­chol­ogy, 96, 145-148

  • O’Brien B. S., Frick P. J. (1996). Re­ward dom­i­nance: as­so­ci­a­tions with anx­iety, con­duct prob­lems, and psy­chopa­thy in chil­dren. Jour­nal of Ab­nor­mal Child Psy­chol­ogy, 24, 223-240

There are sev­eral ways in which peo­ple differ­en­ti­ate be­tween moral and con­ven­tional trans­gres­sions. Thus, first of all, peo­ple gen­er­ally judge moral trans­gres­sions to be more se­ri­ous than con­ven­tional trans­gres­sions (Nucci, 1981; Smetana and Braeges, 1990; Turiel, 1983). Se­cond, peo­ple give differ­ent rea­sons for jus­tify­ing why moral and con­ven­tional trans­gres­sions are wrong. Thus, for moral trans­gres­sions, peo­ple re­fer to the dis­tress of the vic­tim (i.e., it is wrong to hit some­one be­cause it will hurt them), but for con­ven­tional trans­gres­sions, peo­ple re­fer to the so­cial di­s­or­der that may en­sue (i.e., it is wrong to talk in class be­cause you are there to learn) (Smetana, 1993; Turiel, 1983). Third, and more im­por­tantly, mod­ify­ing the rule con­di­tions (for ex­am­ple, by an au­thor­ity figure re­mov­ing the pro­hi­bi­tion against the act) only af­fects the per­mis­si­bil­ity of con­ven­tional trans­gres­sions. Thus, even if there is no rule pro­hibit­ing the ac­tion, par­ti­ci­pants gen­er­ally judge moral trans­gres­sions as non-per­mis­si­ble (i.e., they still think it is wrong to hit an­other in­di­vi­d­ual even if there is no rule against it). In con­trast, if there is no rule pro­hibit­ing a con­ven­tional trans­gres­sion, par­ti­ci­pants gen­er­ally judge the act as per­mis­si­ble (i.e., they think it is OK to talk in class if there is no rule against it). While par­ti­ci­pants do not always make the moral/​con­ven­tional dis­tinc­tion in their se­ri­ous­ness judg­ments, they do always make the moral/​con­ven­tional dis­tinc­tion in their mod­ifi­a­bil­ity judg­ments. Thus, chil­dren at cer­tain ages have been found to judge some con­ven­tional and moral trans­gres­sions as equally se­ri­ous (Stod­dart and Turiel, 1985; Turiel, 1983). How­ever, they still iden­tify the moral trans­gres­sions as less rule con­tin­gent and less un­der au­thor­ity ju­ris­dic­tion than the con­ven­tional trans­gres­sions.

  • Nucci L. P. (1981). Con­cep­tions of per­sonal is­sues: a do­main dis­tinct from moral or so­cietal con­cepts. Child Devel­op­ment, 52, 114-121

  • Smetana J. G., Braeges J. L. (1990). The de­vel­op­ment of tod­dlers’ moral and con­ven­tional judg­ments. Mer­rill-Palmer Quar­terly, 36, 329-346

  • Turiel E. (1983). The Devel­op­ment of So­cial Knowl­edge: Mo­ral­ity and con­ven­tion. Cam­bridge: Cam­bridge Univer­sity Press

  • Smetana J. G. (1993). “Un­der­stand­ing of so­cial rules”. In M. Ben­nett (ed.), The Child as Psy­chol­o­gist: An in­tro­duc­tion to the de­vel­op­ment of so­cial cog­ni­tion, pp. 111-141. New York: Har­vester Wheat­sheaf.

  • Stod­dart T., Turiel E. (1985). Chil­dren’s con­cepts of cross-gen­der ac­tivi­ties. Child Devel­op­ment, 56, 1241-1252

Chil­dren with psy­cho­pathic ten­den­cies and adults with psy­chopa­thy have con­sid­er­able difficulty with the moral/​con­ven­tional dis­tinc­tion task (Blair, 1995, 1997; Blair et al., 1995a, 2001c). In ad­di­tion, similar difficul­ties have been ob­served with more gen­eral pop­u­la­tions of chil­dren pre­sent­ing with an­ti­so­cial be­hav­ior (Arse­nio and Fleiss, 1996; Dunn and Hughes, 2001; Hughes and Dunn, 2000; Nucci and Her­man, 1982). Chil­dren with psy­cho­pathic ten­den­cies, adults with psy­chopa­thy, and other an­ti­so­cial pop­u­la­tions do gen­er­ally re­gard moral trans­gres­sions as more se­ri­ous than con­ven­tional trans­gres­sions. How­ever, such pop­u­la­tions are far less likely than com­par­i­son in­di­vi­d­u­als to make refer­ence to the vic­tim of the trans­gres­sion when jus­tify­ing why moral trans­gres­sions are bad (Arse­nio and Fleiss, 1996; Blair, 1995; Blair et al., 2001c; Dunn and Hughes, 2001; Hughes and Dunn, 2000). In ad­di­tion, when the rules pro­hibit­ing the trans­gres­sions are re­moved, such pop­u­la­tions are far less likely to make the dis­tinc­tion be­tween moral and con­ven­tional trans­gres­sions that is seen in healthy in­di­vi­d­u­als (Blair, 1995; Blair et al., 2001c; Nucci and Her­man, 1982)…while it has been re­peat­edly shown that the use of em­pa­thy-in­duc­ing pos­i­tive par­ent­ing strate­gies by care­givers de­creases the prob­a­bil­ity of an­ti­so­cial be­hav­ior in healthy de­vel­op­ing chil­dren, it does not de­crease the prob­a­bil­ity of an­ti­so­cial be­hav­ior in chil­dren who pre­sent with the emo­tional dys­func­tion of psy­chopa­thy (Woot­ton et al., 1997).

  • Blair R. J. R. (1995). A cog­ni­tive de­vel­op­men­tal ap­proach to moral­ity: in­ves­ti­gat­ing the psy­chopath. Cog­ni­tion, 57, 1-29

  • Blair R. J. R. (1997). Mo­ral rea­son­ing in the child with psy­cho­pathic ten­den­cies. Per­son­al­ity and In­di­vi­d­ual Differ­ences, 22, 731-739

  • Blair R. J. R., Jones L., Clark F., Smith M. (1995a). Is the psy­chopath “morally in­sane”? Per­son­al­ity and In­di­vi­d­ual Differ­ences, 19, 741-752

  • Blair R. J. R., Mon­son J., Fred­er­ick­son N. (2001c). Mo­ral rea­son­ing and con­duct prob­lems in chil­dren with emo­tional and be­havi­oural difficul­ties. Per­son­al­ity and In­di­vi­d­ual Differ­ences, 31, 799-811

  • Arse­nio W. F., Fleiss K. (1996). Typ­i­cal and be­havi­ourally dis­rup­tive chil­dren’s un­der­stand­ing of the emo­tion con­se­quences of so­cio-moral events. Bri­tish Jour­nal of Devel­op­men­tal Psy­chol­ogy, 14, 173-186

  • Dunn J., Hughes C. (2001). “I got some swords and you’re dead!”: vi­o­lent fan­tasy, an­ti­so­cial be­hav­ior, friend­ship, and moral sen­si­bil­ity in young chil­dren. Child Devel­op­ment, 72(2), 491-505

  • Hughes C., Dunn J. (2000). He­donism or em­pa­thy? Hard-to-man­age chil­dren’s moral aware­ness and links with cog­ni­tive and ma­ter­nal char­ac­ter­is­tics. Bri­tish Jour­nal of Devel­op­men­tal Psy­chol­ogy, 18, 227-245

  • Nucci L. P., Her­man S. (1982). Be­hav­ioral di­s­or­dered chil­dren’s con­cep­tions of moral, con­ven­tional, and per­sonal is­sues. Jour­nal of Ab­nor­mal Child Psy­chol­ogy, 10, 411-425

  • Woot­ton J. M., Frick P. J., Shel­ton K. K., Silver­thorn P. (1997). Ineffec­tive par­ent­ing and child­hood con­duct prob­lems: the mod­er­at­ing role of cal­lous—un­emo­tional traits. Jour­nal of Con­sult­ing and Clini­cal Psy­chol­ogy, 65, 292-300

Long sec­tion sum­mary:

Data in­di­cat­ing that in­di­vi­d­u­als with psy­chopa­thy pre­sent with rel­a­tively lit­tle or no im­pair­ment for func­tions known to re­quire the in­tegrity of the amyg­dala, such as the for­ma­tion of stim­u­lus-re­ward as­so­ci­a­tions and as­pects of so­cial cog­ni­tion, qual­ify the amyg­dala dys­func­tion po­si­tion. They sug­gest that the ge­netic anoma­lies, which we as­sume are the fun­da­men­tal causes of psy­chopa­thy, do not globally dis­rupt the func­tion­ing of the amyg­dala but rather have a more se­lec­tive effect, per­haps by dis­rupt­ing the func­tion­ing of spe­cific neu­ro­trans­mit­ter(s) in­volved in spe­cific as­pects of amyg­dala func­tion­ing. We sug­gest that the no­ra­dren­er­gic re­sponse to stress/​threat stim­uli may be dis­turbed in in­di­vi­d­u­als with psy­chopa­thy.

More on the ADHD cor­re­la­tion:

ADHD is a co­nun­drum be­cause while there is high co­mor­bidity of ADHD with psy­cho­pathic ten­den­cies (Babin­ski et al., 1999; Barry et al., 2000; Col­ledge and Blair, 2001; Ly­nam, 1996), the neu­rocog­ni­tive im­pair­ments seen in chil­dren with ADHD are, to a large ex­tent, not found in in­di­vi­d­u­als with psy­chopa­thy. …In­di­vi­d­u­als with psy­chopa­thy show no im­pair­ment on clas­sic mea­sures of ex­ec­u­tive func­tion­ing such as the Wis­con­sin Card Sort­ing Task (LaPierre et al., 1995) or the ED-shift com­po­nent of the ID/​ED task (Mitchell et al., 2002). In­di­vi­d­u­als with ADHD show difficulty with both of these tasks (Pen­ning­ton and Ozonoff, 1996; Willi­ams et al., 2000). In­di­vi­d­u­als with psy­chopa­thy show no im­pair­ment, or even re­duced in­terfer­ence (New­man et al., 1997), on Stroop, or Stroop-like, tasks (Blair et al., un­der re­vi­sion; Smith et al., 1992). As de­scribed above, in­di­vi­d­u­als with ADHD show strik­ing difficulty with such tasks.

  • Babin­ski L. M., Hart­sough C. S., Lam­bert N. M. (1999). Child­hood con­duct prob­lems, hy­per­ac­tivity-im­pul­sivity, and inat­ten­tion as pre­dic­tors of adult crim­i­nal ac­tivity. Jour­nal of Child Psy­chol­ogy and Psy­chi­a­try and Allied Dis­ci­plines, 40, 347-355

  • Barry C. T., Frick P. J., DeS­hazo T. M., McCoy M. G., Ellis M., Loney B. R. (2000). The im­por­tance of cal­lous-un­emo­tional traits for ex­tend­ing the con­cept of psy­chopa­thy to chil­dren. Jour­nal of Ab­nor­mal Psy­chol­ogy, 109(2), 335-340

  • Col­ledge E., Blair R. J. R. (2001). Re­la­tion­ship be­tween at­ten­tion-deficit-hy­per­ac­tivity di­s­or­der and psy­cho­pathic ten­den­cies in chil­dren. Per­son­al­ity and In­di­vi­d­ual Differ­ences, 30, 1175-1187

  • Ly­nam D. R. (1996). Early iden­ti­fi­ca­tion of chronic offen­ders: who is the fledgling psy­chopath? Psy­cholog­i­cal Bul­letin, 120(2), 209-224

  • LaPierre D., Braun C. M. J., Hod­gins S. (1995). Ven­tral frontal defic­its in psy­chopa­thy: neu­ropsy­cholog­i­cal test find­ings. Neu­ropsy­cholo­gia, 33, 139-151

  • Mitchell D. G. V., Col­ledge E., Leonard A., Blair R. J. R. (2002). Risky de­ci­sions and re­sponse re­ver­sal: is there ev­i­dence of or­bitofrontal cor­tex dys­func­tion in psy­cho­pathic in­di­vi­d­u­als? Neu­ropsy­cholo­gia, 40, 2013-2022

  • Pen­ning­ton B. F., Ozonoff S. (1996). Ex­ec­u­tive func­tions and de­vel­op­men­tal psy­chopathol­ogy. Jour­nal of Child Psy­chol­ogy and Psy­chi­a­try, 37, 51-87

  • Willi­ams D., Stott C. M., Goodyer I. M., Sa­hakian B. J. (2000). Spe­cific lan­guage im­pair­ment with or with­out hy­per­ac­tivity: neu­ropsy­cholog­i­cal ev­i­dence for fron­tos­tri­atal dys­func­tion. Devel­op­men­tal Medicine and Child Neu­rol­ogy, 42(6), 368-375

  • New­man J. P., Sch­mitt W. A., Voss W. D. (1997). The im­pact of mo­ti­va­tion­ally neu­tral cues on psy­cho­pathic in­di­vi­d­u­als: as­sess­ing the gen­er­al­ity of the re­sponse mod­u­la­tion hy­poth­e­sis. Jour­nal of Ab­nor­mal Psy­chol­ogy, 106, 563-575

  • Blair K. S., New­man C., Mitchell D. G., Richell R. A., Leonard A., Mor­ton J., Blair R. J. R. (un­der re­vi­sion). Differ­en­ti­at­ing among pre­frontal sub­strates in psy­chopa­thy: neu­ropsy­cholog­i­cal test findings

  • Smith S. S., Ar­nett P. A., New­man J. P. (1992). Neu­ropsy­cholog­i­cal differ­en­ti­a­tion of psy­cho­pathic and nonpsy­cho­pathic crim­i­nal offen­ders. Per­son­al­ity and In­di­vi­d­ual Differ­ences, 13(11), 1233-1243

A pos­si­ble over­all pic­ture:

No biolog­i­cally based di­s­or­der other than psy­chopa­thy is as­so­ci­ated with an in­creased risk of in­stru­men­tal ag­gres­sion Cur­rently, there are no rea­sons to be­lieve that there are any biolog­i­cally-based di­s­or­ders as­so­ci­ated with a height­ened risk of in­stru­men­tal an­ti­so­cial be­hav­ior other than psy­chopa­thy. There are other di­s­or­ders as­so­ci­ated with a height­ened risk of in­stru­men­tal an­ti­so­cial be­hav­ior (e.g., ado­les­cent-limited CD) but they are not biolog­i­cally based. In chap­ter 8, we de­vel­oped an ac­count of psy­chopa­thy. In essence, this ac­count sug­gests that ge­netic anoma­lies give rise to a di­s­or­der where there is re­duced re­spon­sive­ness of the amyg­dala to aver­sive stim­uli in par­tic­u­lar. This spe­cific form of re­duced emo­tional re­spon­sive­ness in­terferes with so­cial­iza­tion such that the in­di­vi­d­ual is more likely to learn to use anti-so­cial be­hav­ior to achieve goals.

Snakes in Suits: When Psy­chopaths Go To Work, Babiak & Hare 2006:

Psy­chopa­thy is a per­son­al­ity di­s­or­der de­scribed by the per­son­al­ity traits and be­hav­iors that form the ba­sis of this book. Psy­chopaths are with­out con­science and in­ca­pable of em­pa­thy, guilt, or loy­alty to any­one but them­selves. So­ciopa­thy is not a for­mal psy­chi­a­tric con­di­tion. It refers to pat­terns of at­ti­tudes and be­hav­iors that are con­sid­ered an­ti­so­cial and crim­i­nal by so­ciety at large, but are seen as nor­mal or nec­es­sary by the sub­cul­ture or so­cial en­vi­ron­ment in which they de­vel­oped. So­ciopaths may have a well-de­vel­oped con­science and a nor­mal ca­pac­ity for em­pa­thy, guilt, and loy­alty, but their sense of right and wrong is based on the norms and ex­pec­ta­tions of their sub­cul­ture or group. Many crim­i­nals might be de­scribed as so­ciopaths. An­ti­so­cial per­son­al­ity di­s­or­der (APD) is a broad di­ag­nos­tic cat­e­gory found in the Amer­i­can Psy­chi­a­tric As­so­ci­a­tion’s Di­ag­nos­tic and Statis­ti­cal Man­ual of Men­tal Di­sor­ders, 4th edi­tion (DSM-IV). An­ti­so­cial and crim­i­nal be­hav­iors play a ma­jor role in its defi­ni­tion and, in this sense, APD is similar to so­ciopa­thy. Some of those with APD are psy­chopaths, but many are not. The differ­ence be­tween psy­chopa­thy and an­ti­so­cial per­son­al­ity di­s­or­der is that the former in­cludes per­son­al­ity traits such as lack of em­pa­thy, grandios­ity, and shal­low emo­tion that are not nec­es­sary for a di­ag­no­sis of APD. APD is three or four times more com­mon than psy­chopa­thy in the gen­eral pop­u­la­tion and in pris­ons. The prevalence of those we would de­scribe as so­cio­pathic is un­known but likely is con­sid­er­ably higher than that of APD.

Sev­eral re­cent twin stud­ies provide con­vinc­ing ev­i­dence that ge­netic fac­tors play at least as im­por­tant a role in the de­vel­op­ment of the core fea­tures of psy­chopa­thy as do en­vi­ron­men­tal fac­tors and forces. Re­searchers Bloni­gen, Car­l­son, Krueger & Pa­trick stated that the re­sults of their study of 271 adult twin pairs pro­vided “sub­stan­tial ev­i­dence of ge­netic con­tri­bu­tions to var­i­ance in the per­son­al­ity con­struct of psy­chopa­thy.” Sub­se­quently, re­searchers Larrson, An­der­shed & Lich­sten­stien ar­rived at a similar con­clu­sion in their study of 1090 ado­les­cent twin pairs: “A ge­netic fac­tor ex­plains most of the vari­a­tion in the psy­cho­pathic per­son­al­ity.” Vid­ing, Blair, Moffitt & Plomin stud­ied 3687 seven-year-old twin pairs and also con­cluded that “the core symp­toms of psy­chopa­thy are strongly ge­net­i­cally de­ter­mined.” They re­ported that the ge­netic con­tri­bu­tion was high­est when cal­lous-un­emo­tional traits were com­bined with an­ti­so­cial be­hav­iors.

Un­for­tu­nately, no group is more sur­prised to learn that they have been psy­cholog­i­cally ma­nipu­lated than those who be­lieve they are smarter and stronger than oth­ers, no mat­ter how true this may be. Nar­cis­sis­tic man­agers, in par­tic­u­lar, tend to rise to man­age­ment po­si­tions in or­ga­ni­za­tions in dis­pro­por­tionately large num­bers. Be­ing par­tic­u­larly self-ab­sorbed, they are known to use (and abuse) their sub­or­di­nates and play up to their su­pe­ri­ors to as­sure their own per­sonal ca­reer suc­cess. (See pages 40-41 for similar­i­ties and differ­ences be­tween nar­cis­sists and psy­chopaths.) We have spo­ken with a num­ber of nar­cis­sis­tic man­agers who also felt vic­tim­ized by cor­po­rate cons: much to their own sur­prise-and not easy for them to ad­mit- they were out­classed and out­gunned. Ad­di­tion­ally, and this re­ally plays into the hands of the cor­po­rate con, in­di­vi­d­u­als with strong per­son­al­ities, such as nar­cis­sism, are far less likely than most to seek as­sis­tance, guidance, or even per­sonal feed­back un­til it is too late, mak­ing them at­trac­tive long-term tar­gets.

Price­wa­ter­house­Coop­ers (PWC) re­ported that in 2003, 37 per­cent of 3,600 com­pa­nies in 50 coun­tries had suffered from fraud­u­lent acts, with an av­er­age com­pany loss of more that $2 mil­lion. The ac­tual av­er­age loss likely was much higher be­cause of failures to de­tect or re­port frauds, or a ten­dency to write them off as a com­mer­cial loss. One quar­ter of the frauds were com­mit­ted by se­nior man­agers and ex­ec­u­tives with a so­phis­ti­cated un­der­stand­ing of the com­pany’s in­ter­nal con­trols and risk man­age­ment pro­ce­dures. In spite of the pub­lic out­rage at the re­cent spate of high-pro­file scan­dals in the cor­po­rate world, things are not get­ting any bet­ter. In 2004, the per­centage of com­pa­nies in the PWC global sur­vey that ex­pe­rienced fraud rose from 37 to 44 and then to 45 in 2005.

  • “Cor­po­rate Fraud in the Board­room” Skalak, S., Nestler, C., & Buss­mann, K. Global Eco­nomic Crime Sur­vey, 2005. PricewaterhouseCoopers

In the jour­nal Psy­chol­ogy, Crime, and Law, re­searchers Board and Frit­zon ad­ministered a self-re­port per­son­al­ity in­ven­tory to a sam­ple of Bri­tish se­nior busi­ness man­agers and ex­ec­u­tives. They con­cluded that the prevalence of histri­onic, nar­cis­sis­tic, and com­pul­sive per­son­al­ity di­s­or­ders was rel­a­tively high, and that many of the traits ex­hibited were con­sis­tent with psy­chopa­thy: su­perfi­cial charm, in­sincer­ity, ego­cen­tric­ity, ma­nipu­la­tive­ness, grandios­ity, lack of em­pa­thy, ex­ploita­tive­ness, in­de­pen­dence, rigidity, stub­born­ness, and dic­ta­to­rial ten­den­cies.

  • Board, B. J., & Frit­zon, K. Di­sor­dered per­son­al­ities at work. Psy­chol­ogy, Crime and Law, 11(1), 17-32, 2005.

In our origi­nal re­search work­ing with al­most 200 high-po­ten­tial ex­ec­u­tives, we found about 3.5 per­cent who fit the pro­file of the psy­chopath as mea­sured on the PCL: SV (pages 26-28). [Un­able to find a pa­per about this origi­nal re­search]

We now know that some or­ga­ni­za­tions ac­tively seek out and re­cruit in­di­vi­d­u­als with at least a mod­er­ate dose of psy­cho­pathic fea­tures. Some ex­ec­u­tives have said to us, “Many of the traits you de­scribe to us seem to be val­ued by our com­pany. Why shouldn’t com­pa­nies hire psy­chopaths to fill some jobs?” A proper, sci­en­tific an­swer is that more re­search is needed to de­ter­mine the im­pact of var­i­ous doses of psy­cho­pathic char­ac­ter­is­tics on the perfor­mance of differ­ent types of jobs. The “op­ti­mal” num­ber and sever­ity of such char­ac­ter­is­tics pre­sum­ably is higher for some jobs (such as stock pro­moter, poli­ti­cian, law en­force­ment, used-car sales­peo­ple, mer­ce­nar­ies, and lawyers) than for oth­ers (such as so­cial work­ers, teach­ers, nurses, and ministers). Un­til such re­search is done, we can safely say that those who be­lieve that “psy­chopa­thy is good” clearly have not had much ex­po­sure to the real thing.

Are psy­chopaths par­tic­u­larly well suited for dan­ger­ous pro­fes­sions? David Cox, a psy­chol­ogy pro­fes­sor at Si­mon Fraser Univer­sity, doesn’t think so. He stud­ied Bri­tish bomb-dis­posal op­er­a­tions in North­ern Ire­land, be­gin­ning his re­search with the ex­pec­ta­tion that be­cause psy­chopaths are “cool un­der fire” and have a strong “need for ex­cite­ment” they would ex­cel at the job. But he found that the sol­diers who performed the ex­act­ing and dan­ger­ous task of de­fus­ing or dis­man­tling IRA bombs referred to psy­chopaths as “cow­boys”-un­re­li­able and im­pul­sive in­di­vi­d­u­als who lacked the perfec­tion­ism and at­ten­tion to de­tail needed to stay al­ive on the job. Most were filtered out dur­ing train­ing, and those who slipped through didn’t last long.

We an­a­lyzed the suc­ces­sion plans of a few hun­dred North Amer­i­can ex­ec­u­tives and noted that the similar­i­ties be­tween the de­vel­op­men­tal is­sues for some man­agers iden­ti­fied as “high po­ten­tials” and psy­cho­pathic-like fea­tures were startling. Our list of ques­tion­able char­ac­ter­is­tics-dys­func­tional be­hav­iors, at­ti­tudes, and judg­ments-was re­fined to form the B-Scan, a re­search in­stru­ment for use by com­pa­nies as part of their eval­u­a­tion for suc­ces­sion plan­ning. We ob­tained clear differ­ences be­tween a group of suc­cess­ful, high-perform­ing ex­ec­u­tives and a group of con­victed white-col­lar or eco­nomic crim­i­nals (that is, in­di­vi­d­u­als who defrauded their com­pa­nies and other in­no­cent vic­tims). In a fol­low-up in­ves­ti­ga­tion, we also found pre­dictable differ­ences be­tween the suc­cess­ful high perform­ers and cor­po­rate psy­chopaths. Re­search on the B-Scan con­tinues.

“A Ge­netic Fac­tor Ex­plains Most of the Vari­a­tion in the Psy­cho­pathic Per­son­al­ity”, Lars­son et al 2006:

The au­thors used a self-re­port ques­tion­naire (The Youth Psy­cho­pathic Traits In­ven­tory) to study the im­por­tance of ge­netic and en­vi­ron­men­tal in­fluences on psy­cho­pathic per­son­al­ity traits in a sam­ple of 1,090 monozy­gotic and dizy­gotic twin pairs, aged 16 −17 years. Re­sults showed a strong ge­netic in­fluence be­hind the higher or­der “psy­cho­pathic per­son­al­ity” fac­tor, un­der­pinned by the three psy­cho­pathic per­son­al­ity di­men­sions. Over and above the effects to the higher or­der fac­tor, sig­nifi­cant unique ge­netic in­fluences were also found in the cal­lous/​un­emo­tional and in the im­pul­sive/​ir­re­spon­si­ble di­men­sion, but not in the grandiose/​ma­nipu­la­tive di­men­sion.

…there are only two pub­lished twin stud­ies that have di­rectly in­ves­ti­gated the im­por­tance of ge­netic and en­vi­ron­men­tal in­fluences for psy­cho­pathic traits (Bloni­gen, Car­l­son, Krueger, & Pa­trick, 2003; Tay­lor, Loney, Bobadilla, Ia­cono, & McGue, 2003). One of these used a sam­ple of adult male twins (Bloni­gen et al., 2003) and ex­am­ined the ge­netic and en­vi­ron­men­tal in­fluence on psy­cho­pathic per­son­al­ity traits by us­ing a self-re­port mea­sure, the Psy­cho­pathic Per­son­al­ity In­ven­tory (PPI; Lilien­feld & An­drews, 1996). In­di­vi­d­ual differ­ences in all eight di­men­sions mea­sured by the PPI were as­so­ci­ated with ge­netic and non­shared en­vi­ron­men­tal effects. Ge­netic effects ex­plained 29%-56% of the vari­a­tion of the re­spec­tive di­men­sions of the PPI. Shared en­vi­ron­men­tal effects were not found for any of the PPI facets (Bloni­gen et al., 2003). Another re­cent study on male ado­les­cent twins (Tay­lor et al., 2003) used a self-re­port mea­sure that taps the im­pul­sive/​an­ti­so­cial be­hav­ior and cal­lous/​un­emo­tional in­ter­per­sonal style of the psy­cho­pathic per­son­al­ity con­stel­la­tion (Min­nesota Tem­per­a­ment In­ven­tory; Loney, Tay­lor, But­ler, & Ia­cono, 2002). In this study, ge­netic effects ac­counted for ap­prox­i­mately 40% of the vari­a­tion in both the cal­lous/​un­emo­tional and the im­pul­sive/​an­ti­so­cial fac­tors. Non­shared en­vi­ron­men­tal effects ex­plained all of the re­main­ing var­i­ance, whereas the in­fluences of shared en­vi­ron­ment seemed to be of no im­por­tance (Tay­lor el al., 2003). [em­pha­sis added] …As would be ex­pected, non­shared en­vi­ron­men­tal in­fluences were found [by us] to be sig­nifi­cant in all of the analy­ses con­ducted. Non­shared en­vi­ron­men­tal fac­tors were shown to be im­por­tant for ex­plain­ing 37% of the var­i­ance in the la­tent psy­cho­pathic per­son­al­ity fac­tor.

…The re­sults from the pre­sent study sug­gest that shared en­vi­ron­men­tal fac­tors pro­duce a neg­ligible con­tri­bu­tion to the var­i­ance in the psy­cho­pathic per­son­al­ity con­stel­la­tion. Th­ese re­sults repli­cate those of re­cent twin stud­ies ex­am­in­ing self-re­ported psy­cho­pathic traits in ado­les­cent (Tay­lor et al., 2003) and adult (Bloni­gen et al., 2003) twins in find­ing no ev­i­dence of shared en­vi­ron­men­tal in­fluences in psy­cho­pathic traits. The re­sults are also con­sis­tent with ev­i­dence re­ported from many be­hav­ioral ge­netic stud­ies of psy­chopathol­ogy (Bouchard & McGue, 2003) and per­son­al­ity (Bouchard & Loehlin, 2001; Loehlin, 1992; McGuffin & Tha­par, 1992).

Hand­book of Psy­chopa­thy, ed. Christo­pher Pa­trick 2005

For ex­am­ple, in her im­por­tant study of men­tal ill­ness in prim­i­tive so­cieties, Mur­phy (1976) found that the Yupic-speak­ing Eski­mos in north­west Alaska have a name, kun­langeta, for the

man who, for ex­am­ple, re­peat­edly lies and cheats and steals things and does not go hunt­ing and, when the other men are out of the village, takes sex­ual ad­van­tage of many women-some­one who does not pay at­ten­tion to rep­ri­mands and who is always be­ing brought to the el­ders for pun­ish­ment. One Eskimo among the 499 on their is­land was called kun­langeta. When asked what would have hap­pened to such a per­son tra­di­tion­ally, an Eskimo said that prob­a­bly some­body would have pushed him off the ice when no­body else was look­ing. (p. 1026)

This is in­ter­est­ing since out of 500, the usual Amer­i­can base rates would pre­dict not 1 but >10 psy­chopaths. Is this all due to the tribal and closely knit na­ture of more abo­rigi­nal so­cieties, or could Eskimo so­ciety re­ally have been se­lect­ing against psy­chopaths while big mod­ern so­cieties give scope for their tal­ents & ren­der them more evolu­tion­ar­ily fit? This may be unan­swer­able un­til the rele­vant genes are iden­ti­fied and sam­ples of gene pools ex­am­ined for the fre­quen­cies.

Con­sid­er­ing the pri­mary facets and cit­ing Church (1994), Ben­ning and col­leagues (2003) iden­ti­fied the fol­low­ing as the strongest as­so­ci­a­tions be­tween the MPQ and FFM that are rele­vant to psy­chopa­thy: FFM (low) Agree­able­ness with the MPQ Ag­gres­sion and Alie­na­tion facets of NEM, FFM Neu­roti­cism with the MPQ Stress Re­ac­tion Facet of NEM, and FFM Con­scien­tious­ness with both the MPQ Con­trol com­po­nent of Con­straint and the achieve­ment facet of PEM. Thus, the An­tag­o­nism end of Agree­able­ness in­cludes el­e­ments of MPQ NEM hav­ing less to do with stress re­ac­tivity, and Con­scien­tious­ness in­cludes achieve­ment or agen­tic el­e­ments of MPQ PEM.

“Treat­ment of Psy­chopa­thy: A Re­view of Em­piri­cal Find­ings”, Har­ris & Rice 2006; from Hand­book of Psy­chopa­thy 2005:

The clini­cal liter­a­ture has been quite pes­simistic about the out­come of ther­apy for psy­chopaths. Her­vey Cleck­ley, in his sev­eral edi­tions of The Mask of San­ity (1941, 1982), de­scribed psy­chopaths as nei­ther benefit­ing from treat­ment nor ca­pa­ble of form­ing the emo­tional bonds re­quired for effec­tive ther­apy. In con­trast, some early stud­ies claimed pos­i­tive effects of psy­chother­apy (Beacher, 1962; Corsini, 1958; Rodgers, 1947; Rosow, 1955; Sch­mide­berg, 1949; Show­stack, 1956; Szurek, 1942; Thorne, 1959). How­ever, all these were un­con­trol­led case re­ports. Re­view­ers be­fore 1990 con­cluded, as had Cleck­ley, that there was no ev­i­dence for the effi­cacy of treat­ment with adult psy­chopaths (Hare, 1970; McCord, 1982).

  • Hare, R. D. (1970). Psy­chopa­thy: The­ory and re­search. New York: Wiley.

  • McCord, J. (1982). Parental be­hav­ior in the cy­cle of ag­gres­sion. Psy­chi­a­try, 51, 14-23

Based on these, Rice, Har­ris, and Cormier (1992) eval­u­ated an in­ten­sive ther­a­peu­tic com­mu­nity for men­tally di­s­or­dered offen­ders thought to be es­pe­cially suit­able for psy­chopaths. It op­er­ated for over a decade in a max­i­mum se­cu­rity psy­chi­a­tric hos­pi­tal and drew wor­ld­wide at­ten­tion for its nov­elty. The pro­gram was de­scribed at length by Barker and col­leagues…The re­sults of a fol­low-up con­ducted an av­er­age of 10.5 years af­ter com­ple­tion of treat­ment showed that, com­pared to no pro­gram (in most cases, un­treated offen­ders went to prison), treat­ment was as­so­ci­ated with lower vi­o­lent re­ci­di­vism for non-psy­chopaths but higher vi­o­lent re­ci­di­vism for psy­chopaths. Psy­chopaths showed poorer ad­just­ment in terms of prob­lem be­hav­iors while in the pro­gram, even though they were just as likely as nonpsy­chopaths to achieve po­si­tions of trust and early recom­men­da­tions for re­lease. Why did the ther­a­peu­tic com­mu­nity pro­gram have such differ­ent effects on the two offen­der groups? We spec­u­lated that both the psy­chopaths and nonpsy­chopaths who par­ti­ci­pated in the pro­gram learned more about the feel­ings of oth­ers, tak­ing oth­ers’ per­spec­tive, us­ing emo­tional lan­guage, be­hav­ing in so­cially skil­led ways, and de­lay­ing grat­ifi­ca­tion.

  • Rice, M. E., Har­ris, G. T., & Cormier, C. (1992). A fol­low-up of rapists as­sessed in a max­i­mum se­cu­rity psy­chi­a­tric fa­cil­ity. Jour­nal of In­ter­per­sonal Violence, 5, 435-448

In an­other ther­a­peu­tic com­mu­nity, Ogloff, Wong, and Green­wood (1990) re­ported on the be­hav­ior of psy­chopaths and nonpsy­chopaths defined by crite­ria out­lined in an early ver­sion of the Psy­chopa­thy Check­list (Hare & Frazelle, 1985). Com­pared to nonpsy­chopaths, psy­chopaths showed less mo­ti­va­tion, were discharged ear­lier (usu­ally be­cause of lack of mo­ti­va­tion or se­cu­rity con­cerns), and showed less im­prove­ment. Similar re­sults were re­ported for a ther­a­peu­tic com­mu­nity in England’s Gren­don prison in (Hob­son, Shine, & Roberts, 2000), where poor ad­just­ment to the pro­gram was like­wise as­so­ci­ated with higher PCL-R scores. A re­cent study of a ther­a­peu­tic com­mu­nity for fe­male sub­stance abusers (Richards, Casey, & Lu­cente, 2003) re­ported that, al­though none of the offen­ders scored over 30 on the PCL-R, higher psy­chopa­thy scores were nev­er­the­less as­so­ci­ated with poorer treat­ment re­sponse in­di­cated by failing to re­main in the pro­gram, rule vi­o­la­tions, avoid­ing urine tests, and spo­radic at­ten­dance.

  • Ogloff, J., Wong, S., & Green­wood, A. (1990). Treat­ing crim­i­nal psy­chopaths in a ther­a­peu­tic com­mu­nity pro­gram. Be­hav­ioral Sciences and the Law, 8, 81-90

  • Hob­son, J., Shine, J., & Roberts, R. (2000). How do psy­chopaths be­have in a prison ther­a­peu­tic com­mu­nity? Psy­chol­ogy, Crime and Law, 6, 139-154

  • Richards, H. J., Casey, J. O., & Lu­cente, S. W. (2003). Psy­chopa­thy and treat­ment re­sponse in in­car­cer­ated fe­male sub­stance abusers. Crim­i­nal Jus­tice and Be­hav­ior, 30, 251-276

Be­sides ther­a­peu­tic com­mu­ni­ties, cog­ni­tive-be­hav­ioral ther­apy is of­ten recom­mended for psy­cho­pathic offen­ders. An­drews and Bonta (1994), Brown and Gutsch (1985), Serin and Kurychik (1994), and Wong and Hare (2005) all sug­gested that in­ten­sive cog­ni­tive-be­hav­ioral pro­grams tar­get­ing “crim­ino­genic needs” (i.e., per­sonal char­ac­ter­is­tics cor­re­lated with re­ci­di­vism) might be effec­tive. For ex­am­ple, Wong and Hare recom­mended re­lapse pre­ven­tion in com­bi­na­tion with cog­ni­tive-be­hav­ioral pro­grams. How­ever, doubts as to the effi­cacy of this treat­ment with psy­chopaths arose from an eval­u­a­tion of a cog­ni­tive-be­hav­ioral and re­lapse pre­ven­tion pro­gram for sex offen­ders con­ducted by Seto and Bar­ba­ree (1999). High psy­chopa­thy offen­ders who were rated as hav­ing shown the most im­prove­ment (as mea­sured by con­duct dur­ing the treat­ment ses­sions, qual­ity of home­work, and ther­a­pists’ rat­ings of mo­ti­va­tion and change) were more likely to re­offend than other par­ti­ci­pants, par­tic­u­larly in vi­o­lent ways…It was highly struc­tured and cog­ni­tive-be­hav­ioral, best match­ing the learn­ing style of most offen­ders, in­clud­ing psy­chopaths. More­over, psy­chopaths are high-risk offen­ders with many crim­ino­genic needs (Zinger & Forth, 1998), and thus the pro­gram tar­geted de­viant sex­ual prefer­ences and an­ti­so­cial at­ti­tudes (Bar­ba­ree, Pea­cock, Cor­tini, Mar­shall, & Seto, 1998). In view of these fea­tures, the re­sults per­tain­ing to psy­chopaths are es­pe­cially no­table.

  • An­drews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gen­dreau, P., & Cul­len, F. T. (1990). Does cor­rec­tional treat­ment work? A clini­cally rele­vant and psy­cholog­i­cally in­formed meta-anal­y­sis. Crim­inol­ogy, 28, 369-404

  • Brown, H. J., & Gutsch, K. U. (1985). Cog­ni­tions as­so­ci­ated with a de­lay of grat­ifi­ca­tion task: A study with psy­chopaths and nor­mal pris­on­ers. Crim­i­nal Jus­tice and Be­hav­ior, 12, 453-462

  • Serin, R. C., & Kuriy­chuk, M. (1994). So­cial and cog­ni­tive pro­cess­ing defic­its in vi­o­lent offen­ders: Im­pli­ca­tions for treat­ment. In­ter­na­tional Jour­nal of Law and Psy­chi­a­try, 17, 431-441

  • Wong, S., & Hare, R. D. (2005). Guidelines for a psy­chopa­thy treat­ment pro­gram. Toronto, ON, Canada: Multi-Health Systems

  • Seto, M. C., & Bar­ba­ree, H. (1999). Psy­chopa­thy, treat­ment be­hav­ior, and sex offen­der re­ci­di­vism. Jour­nal of In­ter­per­sonal Violence, 14, 1235-1248

  • Zinger, I., & Forth, A. E. (1998). Psy­chopa­thy and Cana­dian crim­i­nal pro­ceed­ings: The po­ten­tial for hu­man rights abuses. Cana­dian Jour­nal of Crim­inol­ogy, 40, 237-276.

  • Bar­ba­ree, H. E., Pea­cock, E. J., Cor­tini, F., Mar­shall, W. L., & Seto, M. (1998). On­tario pen­i­ten­tiaries’ pro­gram. In W. L. Mar­shall, Y. M. Fer­nan­dez, S. M. Hud­son, & T. Ward (Eds.), Source­book of treat­ment pro­grams for sex­ual offen­ders. New York: Plenum Press

In an­other study, Hare, Clark, Grann, and Thorn­ton (2000) eval­u­ated cog­ni­tive-be­hav­ioral prison pro­grams for psy­cho­pathic and non-psy­cho­pathic offen­ders. After short-term anger man­age­ment and so­cial skills train­ing, 24-month re­con­vic­tion rates for 278 treated and un­treated offen­ders yielded an in­ter­ac­tion be­tween psy­chopa­thy and treat­ment out­come similar to that re­ported by Rice and col­leagues (1992). Whereas the pro­gram had no demon­stra­ble effect on non-psy­chopaths, treated offen­ders who scored high on Fac­tor 1 of the PCL-R had sig­nifi­cantly higher rates of re­ci­di­vism than high-scor­ing but un­treated offen­ders.

  • Hare, R. D., Clark, D., Grann, M., & Thorn­ton, D. (2000). Psy­chopa­thy and the pre­dic­tive val­idity of the PCL-R: An in­ter­na­tional per­spec­tive. Be­hav­ioral Sciences and the Law, 18, 623-645

How can we sum­ma­rize these “con­trol­led” stud­ies of treat­ment out­come? We note that only one study (Rice et al., 1992) used the PCL-R, which is the con­tem­po­rary stan­dard (and most em­piri­cally valid) mea­sure of psy­chopa­thy. Only two em­ployed ob­jec­tive mea­sures of crim­i­nal re­ci­di­vism (Craft et al., 1964; Rice et al., 1992). In­ter­est­ingly, our in­ter­pre­ta­tion of both of these is that the treated group ex­hibited higher rates of re­ci­di­vism than the con­trol group. Our read­ing of the “con­trol­led” stud­ies in the Salekin meta-anal­y­sis is that there is ab­solutely no ba­sis for op­ti­mism re­gard­ing treat­ment to re­duce the risk of crim­i­nal or vi­o­lent re­ci­di­vism. Other prob­le­matic as­pects of the meta-anal­y­sis cast fur­ther doubt on the au­thor’s op­ti­mistic con­clu­sion. As men­tioned ear­lier, most stud­ies in the meta-anal­y­sis re­lied on ther­a­pists’ rat­ings to mea­sure out­come [!]. We con­sider this in­ad­e­quate, es­pe­cially for psy­chopaths. Note that Seto and Bar­ba­ree (1999) ex­am­ined the re­ci­di­vism of sex offen­ders as a func­tion of psy­chopa­thy and progress in treat­ment, with progress as­sessed via eight struc­tured ther­a­pist rat­ings. Based on these rat­ings, which showed good in­ter­rater agree­ment and were un­doubt­edly more re­li­able than un­struc­tured im­pres­sions of ther­a­peu­tic progress, those offen­ders with bet­ter than av­er­age progress were more likely to re­ci­di­vate vi­o­lently, and this was es­pe­cially true for psy­chopaths. In our opinion, ther­a­pists’ im­pres­sions of clini­cal progress can­not be defended as an in­dex of treat­ment effec­tive­ness for offen­ders, es­pe­cially psy­chopaths. In­de­pen­dently mea­sured crim­i­nal con­duct must be at least part of the out­come for an eval­u­a­tion of treat­ment for psy­chopaths. This re­quire­ment elimi­nates all but a hand­ful of the stud­ies in the Salekin meta-anal­y­sis.

The later Hand­book pa­per, “Risk for Crim­i­nal Re­ci­di­vism: The Role of Psy­chopa­thy” (Dou­glas et al), also has use­ful crit­i­cal com­ments on meta-analy­ses in­clud­ing the Salekin meta-anal­y­sis.


We be­lieve there is no ev­i­dence that any treat­ments yet ap­plied to psy­chopaths have been shown to be effec­tive in re­duc­ing vi­o­lence or crime. In fact, some treat­ments that are effec­tive for other offen­ders are ac­tu­ally harm­ful for psy­chopaths in that they ap­pear to pro­mote re­ci­di­vism. We be­lieve that the rea­son for these find­ings is that psy­chopaths are fun­da­men­tally differ­ent from other offen­ders and that there is noth­ing “wrong” with them in the man­ner of a deficit or im­pair­ment that ther­apy can “fix.” In­stead, they ex­hibit an evolu­tion­ar­ily vi­able life strat­egy that in­volves ly­ing, cheat­ing, and ma­nipu­lat­ing oth­ers.

The evolu­tion­ary hy­poth­e­sis of psy­chopa­thy is strik­ing (eg. it’s par­tially hered­itable; or, sex offen­ders who tar­get post-pu­ber­tal women have the high­est PCL-R scores com­pared to any other sub­di­vi­sion of sex offen­ders), but not im­me­di­ately rele­vant. It’s dis­cussed a lit­tle skep­ti­cally in the chap­ter “The­o­ret­i­cal and Em­piri­cal Foun­da­tions” in the Hand­book.

“Psy­chopa­thy and Per­son­al­ity”, Ly­nam & Dere­finko, Hand­book:

In sum­mary, effect sizes for N came from FFM N, Eysenck’s N, and MPQ stress re­ac­tion. Effect sizes for E came from FFM E, Eysenck’s E, and the av­er­age of MPQ well-be­ing and so­cial close­ness. Effect sizes for A came from FFM A, Psy­choti­cism (re­versed), and the av­er­age of MPQ ag­gres­sion (re­versed) and so­cial po­tency (re­versed). Effect sizes for C came from FFM C, Eysenck’s P (re­versed), and Con­straint. Re­sults ap­pear in Table 7.2. The weighted effect size for E is sig­nifi­cantly differ­ent from zero but minus­cule. N bears a small, pos­i­tive re­la­tion to psy­chopa­thy with a weighted effect size of .14 and a 95% con­fi­dence in­ter­val rang­ing from .11 to .17. The effect for C is mod­er­ate to large and nega­tive with weighted effect size of -.36 and a 95% con­fi­dence in­ter­val of -.38 to -.33. Fi­nally, the re­la­tion be­tween A and psy­chopa­thy is large and nega­tive with a weighted av­er­age effect size of -.47 and a 95% con­fi­dence in­ter­val rang­ing from -.49 to -.44.

Based on these de­scrip­tions, the psy­cho­pathic in­di­vi­d­ual is in­ter­per­son­ally an­tag­o­nis­tic (low A). At the facet level, he is sus­pi­cious (low in trust), de­cep­tive (low in straight­for­ward­ness), ex­ploitive, ag­gres­sive, ar­ro­gant, and tough-minded. This in­di­vi­d­ual has trou­ble con­trol­ling his im­pulses and en­dorses non­tra­di­tional val­ues and stan­dards (low C). Run­ning some­what counter to Cleck­ley’s origi­nal de­scrip­tion is a ten­dency for the psy­cho­pathic in­di­vi­d­ual to ex­pe­rience nega­tive emo­tions (e.g., anger and crav­ingsre­lated dis­tress), al­though this re­la­tion is weaker than the re­la­tions to A and C. There is lit­tle ev­i­dence that the psy­cho­pathic in­di­vi­d­ual is high or low in Ex­traver­sion.

…Less con­sis­tent were the re­sults for Neu­roti­cism (N) and Ex­traver­sion (E), per­haps due to facets of these di­men­sions re­lat­ing differ­en­tially to psy­chopa­thy. For ex­am­ple, ex­pert rat­ings and the PCL-R trans­la­tion both sug­gest that the psy­cho­pathic in­di­vi­d­ual can be de­scribed as high in some el­e­ments of N (i.e., an­gry hos­tility and im­pul­sive­ness/​ur­gency) but low in oth­ers (i.e., self-con­scious­ness). Th­ese dis­tinc­tions may get lost when one moves to the do­main or higher-or­der fac­tor level where N demon­strates a small, pos­i­tive cor­re­la­tion with psy­chopa­thy in the meta-analy­ses. The case may be similar for E. Ex­pert raters and the PCL-R trans­la­tion agree that psy­cho­pathic in­di­vi­d­u­als are low in some el­e­ments of E (i.e., warmth and pos­i­tive emo­tions) but high in oth­ers (i.e., ex­cite­ment seek­ing). Again, these dis­tinc­tions are lost at the do­main level where E demon­strates a small, nega­tive re­la­tion with psy­chopa­thy.

“Psy­chopa­thy and DSM-IV Psy­chopathol­ogy”, Hand­book:

The re­la­tion­ship of psy­chopa­thy to anx­iety di­s­or­ders has been con­tro­ver­sial (Frick, Lilien­feld, Elllis, Loney, & Silver­thorn, 1999; Sch­mitt & New­man, 1999). Cleck­ley (1941) in­cluded within his origi­nal crite­ria for psy­chopa­thy an “ab­sence of ‘ner­vous­ness’ or psy­choneu­rotic man­i­fes­ta­tions” (p. 206). Rather than be trou­bled by the pres­ence of anx­iety di­s­or­ders it was sug­gested that “it is highly typ­i­cal for [psy­chopaths] not only to es­cape the ab­nor­mal anx­iety and ten­sion . . . but also to show a rel­a­tive im­mu­nity from such anx­iety and worry as might be judged nor­mal or ap­pro­pri­ate” (Cleck­ley, 1941, p. 206). Miller and col­leagues (2001) sur­veyed 15 psy­chopa­thy re­searchers, ask­ing them to de­scribe the pro­to­typic psy­chopath in terms of the do­mains and facets of the FFM de­scrip­tion of gen­eral per­son­al­ity func­tion­ing. Their de­scrip­tion in­cluded very low lev­els of anx­ious­ness, in­con­sis­tent with the PCL-R as­sess­ment of psy­chopa­thy but con­sis­tent with the ear­lier de­scrip­tion of this di­s­or­der by Cleck­ley (1941). In stark con­trast, it is stated in DSM-IV that “in­di­vi­d­u­als with this di­s­or­der [APD] may also ex­pe­rience dys­pho­ria, in­clud­ing com­plaints of ten­sion, in­abil­ity to tol­er­ate bore­dom, and de­pressed mood” (Amer­i­can Psy­chi­a­tric As­so­ci­a­tion, 2000, p. 702). It is noted more speci­fi­cally that “they may have as­so­ci­ated anx­iety di­s­or­ders [and] de­pres­sive di­s­or­ders” (Amer­i­can Psy­chi­a­tric As­so­ci­a­tion, 2000, p. 702). The sug­ges­tion in DSM-IV that APD is as­so­ci­ated with anx­iety di­s­or­ders can be at­tributed in part to the con­fine­ment of many of the APD stud­ies to clini­cal pop­u­la­tions (Lilien­feld, 1994). Anx­ious­ness is com­mon among per­sons in treat­ment for men­tal di­s­or­ders.

“Neu­roanatom­i­cal Bases of Psy­chopa­thy”, Hand­book; sum­mary:

Ini­tial, pre­limi­nary struc­tural imag­ing re­search on psy­cho­pathic groups has so far in­di­cated (1) en­large­ment of the cor­pus cal­lo­sum (Raine, Lencz, et al., 2003), (2) vol­ume re­duc­tion in the pos­te­rior hip­pocam­pus (Laakso et al., 2001), (3) an ex­ag­ger­ated right > left asym­me­try to the an­te­rior hip­pocam­pus (Raine et al., 2004), and (4) re­duced pre­frontal gray vol­ume (Yang, Raine, Lencz, LaCasse, & Col­letti, 2005). Nev­er­the­less, these lat­ter two find­ings are spe­cific to “un­suc­cess­ful” psy­chopaths and are not found in “suc­cess­ful” psy­chopaths….From a the­o­ret­i­cal stand­point, anatom­i­cal pre­frontal im­pair­ments in psy­cho­pathic and an­ti­so­cial pop­u­la­tions could help ex­plain the dis­in­hibited, im­pul­sive be­hav­ior of psy­chopaths and un­der­pin the clas­sic low arousal/​fear­less­ness/​con­di­tion­ing the­o­ries of psy­cho­pathic be­hav­ior. Cal­losal struc­tural ab­nor­mal­ities give rise to a “faulty wiring” hy­poth­e­sis of psy­chopa­thy and in part ac­count for so­cial, au­to­nomic, and emo­tional im­pair­ments ob­served in psy­chopaths. Hip­pocam­pal im­pair­ments may pre­dis­pose to af­fect dys­reg­u­la­tion and poor con­tex­tual fear con­di­tion­ing in psy­chopaths, in part by dis­rup­tion to pre­frontal-hip­pocam­pal cir­cuits. In this con­text, while re­search on sin­gle brain struc­tures pro­vides a start­ing point for un­der­stand­ing the neu­roanatom­i­cal ba­sis of psy­chopa­thy, fu­ture re­search needs to bet­ter un­der­stand im­pair­ments to more spe­cific neu­ral cir­cuits which give rise to biobe­hav­ioral ab­nor­mal­ities which re­sult in spe­cific psy­cho­pathic symp­toms. As such, the neu­roanatomy of psy­chopa­thy is a re­search field in its infancy

“Un­der­stand­ing Psy­chopa­thy: The Cog­ni­tive Side”

Psy­chopa­thy has not tra­di­tion­ally been as­so­ci­ated with cog­ni­tive dys­func­tion, at least with re­gard to in­tel­li­gence, mem­ory, and ex­ec­u­tive abil­ity (e.g., Cleck­ley, 1982). In­deed, psy­chopaths are no­to­ri­ous for the con­trast be­tween their good ex­plicit knowl­edge and their profound failures when put to the test of daily life. How­ever, it is pos­si­ble that the as­sump­tion of in­tact cog­ni­tive abil­ity is based on an overly sim­plified model of cog­ni­tive and ex­ec­u­tive func­tions.

Thus, both be­hav­ioral and phys­iolog­i­cal in­ves­ti­ga­tions of psy­chopaths’ at­ten­tional func­tion­ing are largely con­sis­tent with rigid task-fo­cused at­ten­tion that is poorly mod­u­lated by sec­ondary or con­tex­tual in­for­ma­tion. In ad­di­tion, these stud­ies sug­gest that psy­chopaths’ at­ten­tional in­sen­si­tivity to sec­ondary or con­tex­tual in­for­ma­tion may be ex­ac­er­bated by left-hemi­sphere ac­ti­va­tion. The pos­si­ble con­tri­bu­tion of left-hemi­sphere ac­ti­va­tion sug­gests a po­ten­tial re­fine­ment of psy­chopaths’ difficulty ac­com­mo­dat­ing unat­tended con­tex­tual in­for­ma­tion. We re­turn to this pos­si­bil­ity in the dis­cus­sion sec­tion.

At­tempts to repli­cate Lykken’s (1957) find­ing have pro­duced mixed re­sults and have re­vealed that psy­chopaths’ pas­sive avoidance defic­its are con­text de­pen­dent. Sch­mauk (1970) used a mod­ified ver­sion of Lykken’s task, and ex­am­ined pas­sive avoidance un­der con­di­tions in­volv­ing ver­bal pun­ish­ment (“wrong”), tan­gible pun­ish­ment (loss of 25 cents), or phys­i­cal pun­ish­ment (elec­tric shocks). In the con­di­tions in­volv­ing ver­bal and phys­i­cal pun­ish­ment, low-anx­ious psy­chopaths dis­played smaller skin con­duc­tance re­sponses, poorer pas­sive avoidance learn­ing, and less aware­ness of the pun­ish­ment con­tin­gen­cies than did non­in­car­cer­ated con­trols. How­ever, the groups did not differ on any of these mea­sures when the pun­ish­ment con­tin­gency in­volved loss of money. Later stud­ies by other re­searchers have found pas­sive avoidance defic­its even with loss of money (New­man & Kos­son, 1986; New­man, Pat­ter­son, & Kos­son, 1987; Siegel, 1978). New­man and col­leagues (1990) ar­gued that, un­like Sch­mauk (1970), each of the stud­ies demon­strat­ing poor pas­sive avoidance un­der con­di­tions of mon­e­tary loss also in­volved a com­pet­ing re­ward con­tin­gency. They ar­gued that a com­pet­ing re­ward con­tin­gency is an im­por­tant com­po­nent of psy­chopaths’ poor pas­sive avoidance.

..New­man and Kos­son (1986) pre­sented par­ti­ci­pants with two ver­sions of a pas­sive avoidance task…Psy­chopaths made more pas­sive avoidance (com­mis­sion) er­rors than con­trols in the ver­sion in­volv­ing com­pet­ing re­ward and pun­ish­ment con­tin­gen­cies but performed com­pa­rably to con­trols in the pun­ish­ment-only con­di­tion. New­man and Kos­son con­cluded that psy­chopaths show poor pas­sive avoidance only in the pres­ence of com­pet­ing re­ward con­tin­gen­cies…Ar­nett, Smith, and New­man (1997) pro­vided fur­ther ev­i­dence that psy­chopaths show nor­mal avoidance of ex­plicit pun­ish­ment con­tin­gen­cies. …As with psy­chopaths’ at­ten­tional and lan­guage-pro­cess­ing ab­nor­mal­ities, psy­chopaths’ be­hav­ioral in­hi­bi­tion defic­its re­veal ev­i­dence of difficulty us­ing in­for­ma­tion that oc­curs out­side the pri­mary fo­cus of at­ten­tion. Thus, poor ac­com­mo­da­tion of sec­ondary or in­ci­den­tal in­for­ma­tion ap­pears to be a con­sis­tent fea­ture of psy­chopaths’ cog­ni­tive func­tion­ing. Although psy­chopaths’ hemi­spheric pro­cess­ing asym­me­tries have not been in­ves­ti­gated within the do­main of be­hav­ioral in­hi­bi­tion, it is worth not­ing that re­ward-seek­ing be­hav­iors may differ­en­tially ac­ti­vate the left hemi­sphere (e.g., David­son 1995; Miller & To­marken, 2001; Sobotka, David­son, & Senulis, 1992). The ex­ac­er­ba­tion of psy­chopaths’ dis­in­hi­bi­tion in the pres­ence of a re­ward-seek­ing re­sponse set may there­fore be con­sis­tent with Kos­son’s (1996, 1998) find­ings of at­ten­tional dys­func­tion un­der left-hemi­sphere ac­ti­vat­ing con­di­tions.

The liter­a­ture on psy­chopaths’ cog­ni­tive func­tion­ing is ex­ten­sive and re­veals a va­ri­ety of con­sis­tent and com­pel­ling defic­its …It is in­trigu­ing that psy­chopaths’ cog­ni­tive defic­its do not fit es­tab­lished mod­els of cog­ni­tive dys­func­tion, such as ex­ec­u­tive defic­its or difficulty with sus­tained at­ten­tion. Psy­chopaths ap­pear to have ad­e­quate cog­ni­tive re­sources and ca­pac­ity but difficulty main­tain­ing an adap­tive bal­ance be­tween top-down and bot­tom-up pro­cess­ing…Psy­chopaths’ defic­its also in­di­cate that con­text-spe­cific failures in the ap­pro­pri­ate, adap­tive al­lo­ca­tion of available re­sources can con­tribute to profound failures of self-reg­u­la­tion, de­spite the ab­sence of tra­di­tional cog­ni­tive or ex­ec­u­tive defic­its.

[Ir­ra­tional, or just higher valu­ing of re­wards/​lower fear­ing of in­jury?]

“The”Suc­cess­ful” Psy­chopath: Adap­tive and Sub­clini­cal Man­i­fes­ta­tions of Psy­chopa­thy in the Gen­eral Pop­u­la­tion”, Hall & Ben­ning, Handbook

Con­sis­tent with prior re­search, un­suc­cess­ful psy­chopaths demon­strated re­duced car­dio­vas­cu­lar re­ac­tivity dur­ing a so­cial stres­sor task, rel­a­tive to con­trols. The non­con­victed psy­chopaths, how­ever, ex­hibited a pat­tern of in­creased car­dio­vas­cu­lar re­sponse dur­ing the stres­sor, which con­sisted of giv­ing a brief speech about one’s faults. Rel­a­tive to both com­par­i­son groups, these psy­chopaths also demon­strated a higher level of ex­ec­u­tive func­tion­ing, as mea­sured by perfor­mance on the Wis­con­sin Card Sort Test (WCST; Heaton, Chelune, Talley, Kay, & Kur­tis, 1993). Ishikawa and col­leagues spec­u­lated that height­ened au­to­nomic re­ac­tivity to stress and rel­a­tively higher lev­els of ex­ec­u­tive func­tion­ing might act as pro­tec­tive fac­tors for “suc­cess­ful” psy­chopaths, en­abling them to avoid the riskiest of crim­i­nal ac­tivi­ties that might re­sult in ar­rest, con­vic­tion, and in­car­cer­a­tion.

…To sum­ma­rize, lab­o­ra­tory stud­ies of psy­chopaths re­cruited from the com­mu­nity have demon­strated that these in­di­vi­d­u­als tend to have higher ar­rest rates than the norm, but a slightly re­duced rate of con­vic­tion rel­a­tive to in­car­cer­ated psy­chopaths; they are psy­cho­me­t­ri­cally similar to in­car­cer­ated psy­chopaths in terms of self-re­ported per­son­al­ity (e.g., em­pa­thy, im­pul­sivity, so­cial­iza­tion, and MMPI pro­files); and, like in­car­cer­ated psy­chopaths, they tend to demon­strate poor re­sponse mod­u­la­tion, care­less mo­tor be­hav­ior, and ab­nor­mal af­fec­tive mod­u­la­tion of star­tle. Taken to­gether, these find­ings point most no­tably to ways in which non­in­car­cer­ated psy­chopaths are phe­no­typ­i­cally (and per­haps etiolog­i­cally) similar to their in­car­cer­ated coun­ter­parts. Fur­ther­more, these data sug­gest that at least a sub­set of non­in­car­cer­ated psy­chopaths man­i­fest psy­chopa­thy at a re­duced or sub­clini­cal level, in­so­far as their con­tinued pres­ence in the com­mu­nity is in­dica­tive of re­duced sever­ity of the pro­cess un­der­ly­ing their an­ti­so­cial de­viance. …Wi­dom (1977) also noted that psy­chopaths from the com­mu­nity tend to come from higher so­cioe­co­nomic back­grounds than in­car­cer­ated psy­chopaths.

“Psy­chopa­thy and Ag­gres­sion”, Porter & Wood­worth; Handbook

For ex­am­ple, in the Willi­am­son and col­leagues (1987) study, the ma­jor­ity of vi­o­lent acts by psy­chopaths in the sam­ple were not in­stru­men­tal. This sup­ports the idea that poor be­hav­ioral con­trols or im­pul­sivity in psy­chopaths con­tributes to their vi­o­lence (also see Demp­ster et al., 1996). Over­all, these data es­tab­lished that psy­chopaths en­gage in both ma­jor forms of ag­gres­sion, whereas vi­o­lent nonpsy­chopaths are un­likely to en­gage in in­stru­men­tal vi­o­lence.

…A po­ten­tial mod­er­a­tor of the re­la­tion­ship be­tween psy­chopa­thy and vi­o­lence is in­tel­li­gence. That is, more in­tel­li­gent psy­chopaths may be less in­clined to use ag­gres­sion be­cause they can they can use their cog­ni­tive re­sources to de­vise non­vi­o­lent means (such as con­ning and ma­nipu­la­tion) to get what they want. Less in­tel­li­gent psy­chopaths may re­sort to vi­o­lence to com­pen­sate for their in­fe­rior abil­ities to ma­nipu­late oth­ers through lan­guage. Heilbrun (1982) found that past vi­o­lent offend­ing in a sam­ple of 168 male in­mates was in­fluenced by the in­ter­ac­tion of in­tel­lec­tual level and psy­chopa­thy. Less in­tel­li­gent psy­chopaths were more likely to have a his­tory of im­pul­sive vi­o­lence than more in­tel­li­gent psy­chopaths (and than less in­tel­li­gent nonpsy­chopaths). Heilbrun (1985) re­ported that the most dan­ger­ous offen­ders in a sam­ple of 225 offen­ders were those with the fol­low­ing char­ac­ter­is­tics: psy­cho­pathic, low IQ, so­cial with­drawal, and his­tory of vi­o­lence.

While these early stud­ies offered some ev­i­dence for in­tel­li­gence as a mod­er­a­tor of psy­chopa­thy and vi­o­lence, lit­tle re­search has ad­dressed the is­sue in re­cent years, largely due to method­olog­i­cal ob­sta­cles. Speci­fi­cally, the most in­tel­li­gent psy­chopaths in so­ciety may suc­ceed in cor­po­rate or poli­ti­cal cir­cles and/​or use vi­o­lence less fre­quently and thus may be less likely to wind up in prison. As such, they would be less likely to be stud­ied by psy­cholog­i­cal re­searchers, whereas less in­tel­li­gent psy­chopaths are available in dis­pro­por­tionate num­bers for re­search.

Another po­ten­tial is­sue in this area is that psy­chopaths with higher cog­ni­tive func­tion­ing may be as likely to com­mit vi­o­lence as other psy­chopaths but be much less likely to be ap­pre­hended for such acts. Ishikawa and col­leagues (2001) tested a com­mu­nity sam­ple of 16 “un­suc­cess­ful” and 13 “suc­cess­ful” psy­chopaths (clas­sified based on their PCL-R scores and whether they had re­ceived crim­i­nal con­vic­tions) on mea­sures of au­to­nomic stress re­ac­tivity and ex­ec­u­tive func­tion­ing (refer­ring to the ca­pac­ity for ini­ti­a­tion, plan­ning, ab­strac­tion, de­ci­sion mak­ing). The two groups had en­gaged in a sub­stan­tial and similar amount of self-re­ported crim­i­nal be­hav­ior, in­clud­ing vi­o­lence. The re­sults in­di­cated that the suc­cess­ful psy­chopaths ex­hibited greater au­to­nomic re­ac­tivity to emo­tional stres­sors and stronger ex­ec­u­tive func­tion­ing than un­suc­cess­ful psy­chopaths. This sug­gested that psy­chopaths who are less likely to be caught and con­victed for their vi­o­lent acts have the ca­pac­ity for bet­ter plan­ning and de­ci­sion mak­ing than their un­suc­cess­ful coun­ter­parts.

“Toward the Fu­ture: Trans­lat­ing Ba­sic Re­search into Preven­tion and Treat­ment Strate­gies”, Seto & Quinsey:

Meta-an­a­lytic stud­ies demon­strat­ing rel­a­tively few or no differ­ences in the suc­cess of var­i­ous psy­chother­a­peu­tic ap­proaches have stim­u­lated re­search on the non­spe­cific fac­tors that af­fect treat­ment out­come. There is good ev­i­dence that as­pects of the ther­a­peu­tic al­li­ance are par­tic­u­larly im­por­tant, with a re­cent meta-anal­y­sis of 79 stud­ies find­ing a re­li­able, mod­er­ate re­la­tion­ship be­tween mea­sures of ther­a­peu­tic al­li­ance and out­come (Martin, Garske, & Davis, 2000). Ac­cord­ing to Martin and col­leagues, the com­mon el­e­ments across differ­ent defi­ni­tions of ther­a­peu­tic al­li­ance are the col­lab­o­ra­tive na­ture of the ther­a­peu­tic re­la­tion­ship, the af­fec­tive bond be­tween ther­a­pist and client, and the ther­a­pist’s and client’s agree­ment on treat­ment goals and tasks. Devel­op­ing a ther­a­peu­tic al­li­ance with psy­cho­pathic clients could be quite challeng­ing be­cause of their defin­ing char­ac­ter­is­tics and be­cause of ther­a­pists’ re­ac­tion to non­com­pli­ance; dis­rup­tive be­hav­ior; the na­ture of psy­chopaths’ offenses; and con­cerns about pos­si­ble ex­ploita­tion, ma­nipu­la­tion, and de­cep­tion. One could imag­ine that there is a great deal of po­ten­tial for ther­a­pist mis­trust, sus­pi­cion, and more con­fronta­tional or hos­tile in­ter­ac­tions with psy­cho­pathic clients (these ther­a­pist be­hav­iors are some­times referred to as coun­ter­trans­fer­ence in the clini­cal liter­a­ture). Con­sis­tent with this hy­poth­e­sis, Taft, Mur­phy, Musser, and Rem­ing­ton (2004) found that self-re­ported psy­cho­pathic char­ac­ter­is­tics were sig­nifi­cantly and nega­tively as­so­ci­ated with ther­a­peu­tic al­li­ance in a sam­ple of men in treat­ment for part­ner abuse. Psy­cho­pathic char­ac­ter­is­tics were also nega­tively as­so­ci­ated with mo­ti­va­tion for change, and mo­ti­va­tion for change me­di­ated the re­la­tion­ship be­tween psy­cho­pathic char­ac­ter­is­tics and ther­a­peu­tic al­li­ance.

Fur­ther­more, al­though psy­chopaths have been de­scribed as af­fec­tively im­pov­er­ished- for ex­am­ple, be­ing less re­spon­sive to dis­tress cues than nonpsy­chopaths (Blair, Jones, Clark, & Smith, 1997)-they do not ap­pear to have defic­its in the recog­ni­tion of emo­tional states in oth­ers. Book, Quinsey, Cooper, and Langford (2004) stud­ied the re­la­tion­ship be­tween psy­chopa­thy and ac­cu­racy in per­ceiv­ing the emo­tional mean­ing of fa­cial ex­pres­sions and body lan­guage in a sam­ple of 59 male prison in­mates and 60 men re­cruited from the com­mu­nity. Psy­chopa­thy was mea­sured by the Self-Re­port Psy­chopa­thy Scale (Leven­son, Kiehl, & Fitz­patrick, 1995) for all par­ti­ci­pants, and by the PCL-R for the in­mates. The in­mates’ PCL-R scores were not cor­re­lated with the num­ber of er­rors in cat­e­go­riz­ing posed fa­cial ex­pres­sions and were pos­i­tively but not sig­nifi­cantly cor­re­lated with the in­mates’ ac­cu­racy in rat­ing emo­tional in­ten­sity of posed fa­cial pho­tographs. All par­ti­ci­pants rated the as­sertive­ness of con­fed­er­ates from a brief, spon­ta­neous video­taped so­cial in­ter­ac­tion be­tween the con­fed­er­ate and one of the con­fed­er­ate’s friends. The Self-Re­port Psy­chopa­thy Scale was pos­i­tively cor­re­lated with the ac­cu­racy of par­ti­ci­pants’ rat­ings of the friend’s level of as­sertive­ness, as mea­sured by both the con­fed­er­ate’s rat­ing and the friend’s self-rat­ing. In a com­pan­ion study in­volv­ing a sub­set of the same sam­ple, Book, Quinsey, and Langford (2004) ex­am­ined the re­la­tion­ship be­tween psy­chopa­thy and the ac­cu­racy of posed fa­cial ex­pres­sions of emo­tion. Thir­ty­one in­mates and 50 com­mu­nity vol­un­teers agreed to be video­taped while at­tempt­ing to mimic pro­to­typ­i­cal fa­cial ex­pres­sions (happy, sad, fear­ful, dis­gusted, and an­gry). PCL-R scores were pos­i­tively as­so­ci­ated with in­creased in­ten­sity of fear in the posed fear­ful faces, as mea­sured by Ek­man and Friesen’s (1978) Fa­cial Ac­tion Cod­ing Sys­tem. Un­der­grad­u­ate stu­dents gave higher be­liev­abil­ity and in­ten­sity rat­ings to fear­ful faces posed by par­ti­ci­pants who had higher scores on the Pri­mary Psy­chopa­thy sub­scale of the Self-Re­port Psy­chopa­thy Scale. A similar trend was ob­served for Fac­tor 1 of the PCL-R. Taken to­gether with other re­search show­ing that psy­chopa­thy is as­so­ci­ated with de­cep­tive­ness (Seto, Khat­tar, Lalu­mière, & Quinsey, 1997), lack of re­sponse to dis­tress cues (Blair et al., 1997), and an ad­e­quate the­ory of mind (Richell et al., 2003), these re­sults in­di­cate that psy­chopaths lack feel­ings for oth­ers but do un­der­stand their men­tal states; in other words, they know but they do not care. This does not seem to be much of a deficit if part of a so­cially ma­nipu­la­tive and ex­ploita­tive life his­tory strat­egy.

…Although schizophre­nia is a ge­net­i­cally caused brain dis­ease, the most effec­tive treat­ment dis­cov­ered to date for its most se­vere man­i­fes­ta­tions is a rigor­ously im­ple­mented and very care­fully planned be­hav­ioral pro­gram (Paul & Lentz, 1977). The thor­ough­ness and in­tegrity of im­ple­men­ta­tion of this pro­gram seem to be the keys to its suc­cess. The im­pli­ca­tions for treat­ments of psy­cho­pathic offen­ders are clear (see also Har­ris & Rice, Chap­ter 28, this vol­ume). In­ter­ven­tions to re­duce re­ci­di­vism among psy­cho­pathic offen­ders will need to be pro­vided on an on­go­ing ba­sis, al­though the in­ten­sity of ser­vice may vary over time with chang­ing cir­cum­stances. Th­ese in­ter­ven­tions will likely in­volve high staff-to-client ra­tios in or­der to provide suffi­cient su­per­vi­sion, to pro­tect ther­a­pists from be­ing de­ceived or ma­nipu­lated, and to help them re­frain from nega­tive re­ac­tions to psy­chopaths that might in­terfere with in­ter­ven­tion effi­cacy. More­over, the in­ter­ven­tions will fo­cus on shap­ing be­hav­ior in de­sired di­rec­tions, rather than more ab­stract con­cepts such as re­spon­si­bil­ity, em­pa­thy, and re­lapse pre­ven­tion, with sub­stan­tial at­ten­tion de­voted to pro­gram fidelity and a re­li­ance on mea­sures other than self-re­port. Given the ev­i­dence for psy­chopaths’ dom­i­nant re­sponse styles and differ­ing re­sponse thresh­olds, in­creas­ing the salience and con­sis­tency of pun­ish­ments would be im­por­tant el­e­ments in these in­ter­ven­tions. Other im­por­tant in­ter­ven­tion tar­gets would in­clude in­creas­ing de­lay of grat­ifi­ca­tion and com­pli­ance with pro­gram rules and re­duc­ing ag­gres­sion and as­so­ci­a­tions with an­ti­so­cial peers.