psychopathy and women

Transcription

1 and or, the trouble with definitions presentation good practice recommendations definitions definitions presentation presentation good practice recommendations good practice recommendations 1

2 DEFINITIONS e.g., Hare, 2003; Lynam, 2011 Robert Hare (1981, 1991, 2003) psychoanalytic cognition & emotion low fear hypothesis interpersonal style biological theories evolutionary perspectives Karpman Newman, Beck Lykken Blackburn, Leary Gray, Eysenck Mealey largely descriptive account based on Cleckley s The Mask of Sanity (1941) but little attention to positive adjustment attention focused instead on outward signs of pathology, as indicators of its presence model defined by the PCL measures 2

3 the PCL R model arrogant and deceitful interpersonal style antisocial lifestyle deficient affective experience impulsive and irresponsible behavioural style Chris Patrick (2010) triarchic model is characterised in terms of three distinguishable phenotypic facets or building blocks linked to under reactivity of the brain s defensive motivational system (affectiveinterpersonal features) and impairment in fronto cortical regulatory circuitry (impulsive antisocial features) social assertiveness, selfconfidence, charm, shallow affect persuasiveness, attention seeking, e.g., Kraepelin, Schneider, Cleckley meanness brutality, emotional coldness, lack of affection, predatory exploitativeness eg. Pinel, Rush, Schneider boldness disinhibition disinhibiting or externalising components of e.g., Prichard Cooke, Hart, Logan & Michie (2004, 2012) a conceptual model defined in terms of pathology Comprehensive Assessment of Psychopathic Personality (CAPP) dimensional not categorical hierarchical & bottom up lexical natural language captures important differences in human transactions the model lead to measures not the reverse 3

4 Psychopathic Personality 4

5 are not funny shaped men are not funny shaped men Cooke & Logan, in press but you would be forgiven for thinking they were on the basis of the extant literature on in men assertive independent interpersonal agency personal responsibility identification with peers competitive, dominant externalising Adshead, 2011; Paris 2007; Rosenfield 2000 are not funny shaped men expressive limited power identification with others harm potential neutralised victimised, exploited nurturing, sensitive internalising Adshead, 2011; Paris 2007; Rosenfield 2000 are not funny shaped men it appears self evident that the power one holds in the domain in which one holds it will influence the method used to abuse that power mento the detriment of others Logan & Weizmann Henelius,

6 domineering, antagonistic reckless, aggressive, disruptive, reckless cognition interpersonal functioning (non intimate) lacks anxiety behaviour emotional expression PRESENTATION OF PSYCHOPATHY IN MEN AND WOMEN attachments (intimate) unempathic, uncommitted, uncaring e.g., Cunliffe et al, 2015 self concept self aggrandizing, sense of invulnerability reckless, aggressive = seen in severely impaired behaviour cognition manipulative, deceitful interpersonal functioning (non intimate) & differently domineering (sex) lacks emotional stability emotional expression we cannot remove the cultural frame of reference of gender from our understanding of the deficits created by the effects of this on is potentially profound given how generally are attachments (intimate) in self concept unempathic, uncaring, detached = profound deficits in Kreis, 2009; Kreis & Cooke, 2012 self justifying, self centred, unstable self concept = more visible 6

7 we cannot remove the cultural frame of reference of gender from our understanding of the deficits created by the effects of this on is potentially profound given how generally are we cannot remove the cultural frame of reference of gender from our understanding of the deficits created by the effects of this on is potentially profound given how generally are we are distracted by the prospect of physical violence (by men) and severely at risk of being seduced by the mask of maternalism, as if domestic cruelty and neglect (by ) were somehow less important Kreis & Cooke, 2011 contd/ the severity of the may be underestimated because (a) its presentation is traditionally measured using a metric (PCLs) developed on the expected behaviour of men, which is insensitive to the nature and scale of the deficits the typically creates in, and (b) many are able to superficially conceal the symptoms of the by competently mimicking other GOOD PRACTICE RECOMMENDATIONS 7

8 assess with care! use PCL with caution attend to interview craft management treatment assess in order to formulate i.e., explain, don t just describe connect dysfunction to the behaviour of interest the must reference gender and inform interventions Cooke & Logan, 2015 avoid interventions focusing on vulnerability integrated model of care, with focus on DBT combine with good clinical management treatment management treatment 8

9 definitions presentation and the trouble with good practice recommendations 9