Task 6. Antisocial PD and psychopathy
1. What is the clinical picture (phenomenology) of antisocial PD?
DSM-V criteria antisociale persoonlijkheidsstoornis
A. Een diepgaand patroon van gebrek aan achting voor en schending van de rechten van
anderen, vanaf het 15de jaar aanwezig en tot uiting komend in diverse situaties, zoals
blijkt uit drie (of meer) van de volgende kenmerken:
1. niet in staat zich te conformeren aan de maatschappelijke norm dat men zich aan de
wet moet houden, zoals blijkt uit het bij herhaling tot handelingen komen die een
reden voor arrestatie kunnen zijn
2. oneerlijkheid, zoals blijkt uit herhaaldelijk liegen, het gebruik van valse namen of
anderen bezwendelen ten behoeve van eigen voordeel of plezier
3. impulsiviteit of onvermogen ‘vooruit te plannen’
4. prikkelbaarheid en agressiviteit, zoals blijkt uit bij herhaling komen tot vechtpartijen
of geweldpleging
5. roekeloze onverschilligheid voor de veiligheid van zichzelf of anderen
6. constante onverantwoordelijkheid, zoals blijkt uit het herhaaldelijk niet in staat zijn
geregeld werk te behouden of financiële verplichtingen na te komen
7. ontbreken van spijtgevoelens, zoals blijkt uit de ongevoeligheid voor of het
rationaliseren van het feit anderen gekwetst, mishandeld of bestolen te hebben
B. De leeftijd is ten minste 18 jaar
C. Er zijn aanwijzingen voor een gedragsstoornis beginnend vóór het 15de jaar.
D. Het antisociale gedrag komt niet uitsluitend voor in het beloop van schizofrenie of
manische episodes.
Davey, G. (2014). Personality disorders, in: Psychopathology: research, assessment and
treatment in clinical psychology. Chichester: BPS Blackwell.
Note: You read part of this chapter already in the first week, but some parts are also relevant
for the objectives of this week.
2. What is the difference between Antisocial PD and Psychopathy?
People with antisocial personality disorder act in ways that go against socially acceptable
norms. They tend to break laws and feel little or no guilt when they do something wrong.
This condition usually develops in childhood, but you can’t get a diagnosis until you’re 18 or
older.
Psychopaths are people who demonstrate psychopathy. That’s not an official
diagnosis but a set of traits. Some of these traits are: insincere charm, easily bored,
compulsive lying, manipulative, no remorse or guilt, little emotional reaction, no empathy,
take advantage of others, don’t accept responsibility and/or many sexual relationships. The
criteria for psychopathy include psychological symptoms and certain specific behaviors. The
measures of antisocial personality disorder, on the other hand, focus mostly on behaviors
you can see.
Around 25%-30% of people with antisocial personality disorder also have psychopathy.
But you can’t know if someone has psychopathy just by testing them for antisocial disorder.
Instead, a trained clinician will commonly use something called the Hare Psychopathy
,Checklist-Revised. That’s a list of 20 characteristics. The clinician will consider someone,
usually a criminal, a psychopath if they “score” high on the checklist.
Antisociale is volledig gericht op gedrag, psychopathie is meer gericht op persoonlijkheid
(hier staat meer het gebrek aan schuld en empathie centraal). De DSM-V stelt de twee gelijk
aan elkaar (want alleen antisociale persoonlijkheidsstoornis staat in de DSM-V), maar dat is
dus niet zo. Daarnaast zie je bij psychopathie meer geweld en meer verschillende soorten
van delicten.
Twee factoren die centraal staan bij psychopathie: (2) persoonlijkheidsgerelateerd en (2)
gerelateerd aan criminaliteit
Antisociale persoonlijkheidsstoornis: vergelijkend aan factor 2 van psychopathie
3. How is psychopathy usually diagnosed?
Hare, R.D. (2016). Psychopathy, the PCL-R, and criminal justice: Some new findings and
current issues. Canadian Psychology, 57, 21-34. Note: Tot The PCL-R and Criminal Justice
Focus on the characteristics of the PCL- R.
Abstract
Theory and research on the psychopathy construct have increased dramatically over the past
few decades. The international instrument of choice for the clinical and forensic assessment
of this construct in basic neuroscience research and in the criminal justice system is the
Psychopathy Checklist-Revised (PCL-R). Its psychometric properties, structure, and correlates
are well-known. In this article new findings are presented in which the 4 first-order factors of
the PCL-R (Interpersonal, Affective, Lifestyle, Antisocial) can be used to good effect in
understanding the nature of psychopathy and in predicting variables of interest to the
criminal justice system. We used a variable-centered approach (structural equation
modelling) to show how each of the factors make unique contributions to the prediction of
violence, treatment outcome, institutional behaviour, etc. We used a person-oriented
approach (latent profile analysis; LPA) to identify factor profiles among offenders with high
PCL-R scores: manipulative psychopaths (LC1), aggressive psychopaths (LC2), and sociopaths
(LC3). We view LC1 and LC2 as variants of psychopathy and LC3 as a subtype of offender. We
also conducted LPAs on entire samples of offenders (not just those with high scores). Across
several large and diverse samples, we consistently identified 4 profiles of factor scores,
which we identified as Psychopath (C1), Callous-conning Offender (C2), Sociopath (C3), and
General Offender (C4). Finally, we briefly addressed 2 issues related to the potential for
misuse of the PCL-R in the legal context: field reliability of the PCL-R, and
adversarial/ allegiance effects associated with its use.
The PCL-R
The Psychopathy Checklist-Revised (PCL-R) has become the international
standard for the clinical assessment of psychopathy. It is based on a widely
accepted clinical and empirical tradition and serves as the nexus of a
“nomological network” of psychopathy. The early development of the PCL-R
drew, in part, from the theoretical writings of clinicians about their patients
often from a psychodynamic perspective. At the same time, the empirical
development of the PCL-R, in terms of content and format, was shaped by
, training as an experimental psychologist, years of research with offenders, and lengthy
discussions with my colleagues and students. The items are scored on the basis of
observable behaviours rather than on inferences and speculations about psychodynamic or
other reasons for the behaviours. The PCL-R was designed to measure a clinical construct in
accordance with empirical and psychometric theory and principles.
Because of its prominence, and in recognition of the important role it plays in the
criminal justice system, the PCL-R has been subjected to unusually intense scrutiny and
critical analyses.
The PCL-R is a revision of a scale described by Hare and later referred to as the PCL.
The PCL-R is a 20-item construct rating scale for the assessment of psychopathy in adults.
The rater scores each item on a 3-point ordinal scale (0, 1, or 2) according to the extent to
which the item description applies to a given individual. The PCL-R yields dimensional scores
that vary from 0 to 40. For research purposes a score of 30 has proven useful as a threshold
for psychopathy. The standard procedure uses a semi-structured interview, file and
collateral information to score each item. In some cases it is not possible to conduct
interviews, in which case the PCL-R may be scored from collateral, file information only, but
at the risk of losing information about the individual’s interpersonal “style.” The PCL-R yields
dimensional scores but also is used to classify individuals for research and clinical purposes.
The items of the PCL-R fall conceptually and statistically into four correlated first-
order dimensions or factors. The pattern of intercorrelations among these first-order factors
underlies a super-ordinate factor of psychopathy. In addition, it is possible to use these four
factors to model a higher order two-factor model, consistent with the original two-factor
model of the PCL, and the two-factor model of the PCL-R. These are labelled Factor 1 (F1;
Interpersonal/Affective) and Factor 2 (F2; Lifestyle/ Antisocial) in the table.
Some commentators have argued that the Antisocial factor is merely a consequence of
the so-called core features of psychopathy, namely the Interpersonal, Affective, and
Lifestyle factors. Such an argument certainly is not in line with a range of behaviour genetic,
longitudinal, and structural equation modelling (SEM) studies, which indicate that overt
antisocial behavior is tightly linked to the more covert interpersonal, affective, and lifestyle
features of psychopathy. We have shown through discussion of the traditional clinical
literature, as well as with empirical data, that antisociality is a fundamental component of
the psychopathy construct. The most ubiquitous characteristic in the descriptions of
psychopathy is a history of severe, longstanding ASB [antisocial behaviour]. Further, any
description of psychopathy is incomplete without ASB. More recently, Miller and Lynam
listed the recognition of the role of ASB as one of the five important advances in theory and
research. In the absence of antisociality, psychopathy becomes a configuration of traits that
is interesting to look at but that has little real world consequence, reducing psychopathy to a
sort of boutique personality disorder. Along these lines, Rice and Harris noted that early
aggressive and ASB are as fundamental of the underlying selfish and cheating psychopathic
life strategy as are the observable behaviours that indicate impulsivity, irresponsibility,
interpersonal exploitation, callousness, remorselessness, sensation-seeking, etc.
Empirical evidence that antisociality is an integral part of the psychopathy construct is
extensive; it is clear that it properly belongs in the four-factor model of the PCL scales. In a
very large sample of 52,957 of individuals with a variety of PCL-based scales from different
samples and countries, Neumann and colleagues obtained good average fit for the four-
factor model.
