More Information on Psychopathy Mavis Humes Baird, Sharon O Hara, Debora Wardlow,

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1 More Information on Psychopathy Mavis Humes Baird, Sharon O Hara, Debora Wardlow, Table of Contents: History pg. 1-2 Up-to-Date Definitions pg. 3-5 Rationale for DSM 5 Changes pg. 6 Co-occuring Traits pg. 7 A.S.P.D. & Psychopathy pg. 8 Corporate Psychopaths pg. 9 Statistics pg. 10 Treatment pg. 11 Psychopathy & Addiction pg. 12 Sexism & Culture pg. 13 Booklist pg PCL Certification pg. 19 Websites pg. 20 Extra Sources pg. 21 History Conceptions of Psychopathy Across Time: 1801 manie sans delire Philippe Pinel 1835 moral insanity J.C. Prichard 1891 psychopathic inferiority J.L.Koch 1952 Sociopathic Personality Disturbance 1980 Antisocial Personality Disorder DSM 2012 Antisocial/Dyssocial Personality Disorder DSM-IV Diagnostic Criteria for Antisocial Personality Disorder A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following: 1.failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest; 2.deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; 3.impulsiveness or failure to plan ahead; 4.irritability and aggressiveness, as indicated by repeated physical fights or assaults; 5.reckless disregard for safety of self or others; 6.consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; 7.lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another; B) The individual is at least age 18 years. C) There is evidence of conduct disorder with onset before age 15 years. Page 1

2 D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode. ICD-10 Criteria for Dissocial (Antisocial) Personality Disorder Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by at least 3 of the following: (a) callous unconcern for the feelings of others; (b) gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations; (c) incapacity to maintain enduring relationships, though having no difficulty in establishing them; (d) very low tolerance to frustration and a low threshold for discharge of aggression, including violence; (e) incapacity to experience guilt and to profit from experience, particularly punishment; (f) marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society. There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis. Includes: * amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder) Excludes: * conduct disorders * emotionally unstable personality disorder Page 2

3 DSM-5 Facts Up-to-Date Definitions Set to be published in May 2013 Dissocial Personality Disorder criteria are very consistent with Hare s definition and could substitute Diagnosis on a spectrum basis Now includes rule-outs for acute substance impairment, gen l medical conditions, developmental stages and socio-cultural environment DSM 5 Diagnostic Criteria for Antisocial or Dyssocial Personality Disorder The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met: A. Significant impairments in personality functioning manifest by: 1. Impairments in self functioning (a or b): a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure. b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior. AND 2. Impairments in interpersonal functioning (a or b): a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another. b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others. B. Pathological personality traits in the following domains: 1. Antagonism, characterized by: a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one s ends. b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events. c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one s actions on others; aggression; sadism. d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior. 2. Disinhibition, characterized by: a. Irresponsibility: Disregard for and failure to honor financial and other obligations or commitments; lack of respect for and lack of follow through on agreements and promises. Page 3

4 b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans. c. Risk taking: Engagement in dangerous, risky, and potentially selfdamaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one s limitations and denial of the reality of personal danger. C. The impairments in personality functioning and the individual s personality trait expression are relatively stable across time and consistent across situations. D. The impairments in personality functioning and the individual s personality trait expression are not better understood as normative for the individual s developmental stage or socio-cultural environment. E. The impairments in personality functioning and the individual s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). F. The individual is at least age 18 years. According to Hare s PCL-R Page 4

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6 Rationale for DSM-5 Changes Extensive co-occurrence among PDs Extreme heterogeneity among patients receiving the same diagnosis Lack of synchrony with modern medical approaches to diagnostics thresholds Temporal instability Poor coverage of personality psychopathology Poor convergent validity The importance of these findings cannot be overemphasized. These data mean that the entire PD literature is built upon shifting sands: had each of the thousands of PD studies been conducted with a different PD assessment, the study participants would have been a largely different set of individuals, thus yielding study results that would be different to an unknown degree. In contrast, the proposed DSM-5 personality trait set is based on an extensive research literature whose origins are more than half a century old, culminating in recent years in a consensual, highly robust, personality traits hierarchical structure that has a high degree of convergent and discriminant validity across a wide rage of measures, primarily questionnaires, but also encompassing structured interviews. Further, this structure has been shown to be invariant across clinical and nonclinical populations, including being influenced by overlapping genetic and environmental factors, and to be sufficiently comprehensive as to capture the variance in and thus to provide coverage for personality disorders Page 6

7 Co-Occuring Traits Manipulative Hypersexual, deviant sexuality Substance abuse Gambling, spending, stealing others $ Rule-breaking Lack trust or respect of authorities Dominant or aggressive personality Page 7

8 A.S.P.D. & Psychopathy The DSM IV-R did not include psychopathy - other than to say that Antisocial Personality Disorder is sometimes called psychopathy. The ICD-10 has changed from ICD-9 and uses Dissocial Personality Disorder instead. DSM definition of ASPD and psychopathy definitions agree up to a point. Hare and Neumann wrote that ASPD was used as a way to better define psychopathy, but got lost along the way; When [ASPD was] introduced by DSM- III in 1980 the intention was to provide a reliable means of measuring the traditional construct of psychopathy by focusing on easily measured antisocial behaviors, albeit at the expense of inferred personality traits fundamental to psychopathy, which were considered too difficult to measure reliably (Hare & Neumann, 2009, p 795). Identifying someone as having [ASPD] is about as nonspecific and scientifically unhelpful as diagnosing a sick patient as having a fever or an infectious or a neurological disorder (Hare & Neumann, 2009, pg. 796). APD diagnoses are strongly coordinated with social deviance (factor 2) components of psychopathy as measured by PCL-R, but only weakly correlated with its interpersonal and affective (factor 1) components (Hare, 2003, pg 6) APD place[s] more emphasis on antisocial and criminal behaviors and less emphasis on personality traits [than PCL-R and other psychopathy definitions (Hare, 2003, pg 5) Many argue that there are differences between ASPD and Psychopathy o Engaging in violence o Functioning within or without of societal constraints o Frustration tolerance o Concern for punishment/learning from punishment Page 8

9 The Corporate Psychopath Taken from Snakes in Suits by Babiak & Hare People generally assume that new hires are honest people with personal integrity (pg. 117) The Halo Effect Interviewers sometimes generalize one good trait or one first impression, to assume that they have the personality of a good leader The need to embrace change [led to] hiring individuals who could shake the trees, rattle cages, and get things done quickly (pg. XII) Their traits allow them to easily blend o Ability to lie/mimicry; a talented psychopath can easily feign leadership or mimic [those] perceived to be good performers (pg. 194, pg. 120) o Charm & grandiosity can be mistaken for charismatic leadership and selfconfidence (pg. 194) o Lack of real affect fulfills leader s responsibility to suspend their own emotional reaction to events in order to be effective (pg. 198) o Risk-taking is impressive to current climate of change Three types of corporate psychopaths o The classic style has a high score on interpersonal, affective, lifestyle and antisocial measures. o The macho style has a low score on interpersonal and affective lifestyle and a high score antisocial measures. o The manipulative style has a low score on interpersonal and affective lifestyle and a high score antisocial measures. Page 9

10 Statistics 1% of general male population 15-20% of prison population 4% of corporate professionals Higher concentration in places of power, where there is easy prey: politics, corporations, even helping professions such as ours These high scores were positively associated with charisma and presentation style These were negatively associated with responsibility and performance. Page 10

11 Treatment Many believe that empathy can be taught to psychopaths o Oxytocin creates empathy o Omega-3s create empathy o Limbic system, hippocampus, amygdala are abnormal in psychopaths o Mirror neurons defective Arousal patterns/threshold may contribute to psychopathic behaviors o CBT o Psychopathy as an arousal-addiction Further clarifying the connection between the addictive disease paradigm and traits of personality disorders Managing its symptoms, traits similarly to, or as part of, addictions Therapy may strengthen the illness by teaching psychopaths new tools for deception A.A. comments on psychopathy: Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot and will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they are born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest. (The Big Book, pg. 58) Page 11

12 Psychopathy & Addiction Active and recovering addicts may display traits of personality disorders. o Diagnosis of PD often on hold for first six months of sobriety. Before this time, diagnosis is usually provisional. o Common wisdom in 12 Step tradition is to wait for substantial step work to be completed. o Certain kinds of reactive character armoring may be diagnosed as PD, but more amenable to treatment. Get to know and use a full range of assessment tools so you are making a thorough diagnosis. Reliable measures include: SDI-R MMPI, PTSI, PCL-R Do you tend to ascribe PD traits to addiction? Or are you more likely to look for personality but not grasp applicability of addiction? Conceptualize each case as whether personality problem is secondary to addiction, addiction is secondary to personality problem, or both are equally dominant. Do both run the motor? Page 12

13 Sexism & Culture Considerations Possible misdiagnosis because of socio-cultural differences: role definition, sexism, etc. o Ex: Men are more likely to be diagnosed as Narcissistic and women as Borderline when they have similar presenting symptoms. Page 13

14 Booklist Informative for the Professional (*Contains elements of self-help) Blair, J., Blair, K., & Mitchell, D. (2005). The psychopath: Emotion and the brain. Blackwell. The Psychopath: Emotion and the Brain by James Blair, Katrina Blair, and Derek Mitchell This book teaches readers to identify psychopaths and explains why they are the way they are, and how they can be treated. Blair, Blair & Mitchell use neuroscience to explain the origins of psychopathy. Brown, S. L. (2010). Women who love psychopaths: Inside the relationships of inevitable harm with psychopaths, sociopaths & narcissists (2nd ed.). Mask. Women Who Love Psychopaths* by Sandra L. Brown This book is a revision of the previous book on women who love psychopaths. Brown utilizes new information on psychopaths to broaden her conception including more neurobiological information. She includes information on treatment and recovery from relationships with psychopaths. Brown has a unique view on the relationship between woman and psychopath including a postulate about the relationships hypnotic quality, and what the existence of the relationship does to reflect on the character traits of the women within them. Cunningham, T. (1987). King baby [Pamphlet]. Hazelden. Hermes, S. (2006). Queen baby [Pamphlet]. Hazelden. King/Queen Baby by Tom Cunningham/Sheila Hermes These pamphlets are used in the addictions recovery fields to explore the childish or immature traits in men/women that may surface during addiction and recovery processes that may hinder recovery and the achievement of a healthy and positive lifestyle. Hare, Robert D., et al. "Psychopathy and the Predictive Validity of the PCL-R: An International Perspective." Behavioral sciences & the law 18.5 (2000): PsycINFO. Web. 30 Aug This academic article discusses the validity and usefulness of Hare s Psychopathy Checklist and also discusses psychopathy as disorder. It also discusses the ability of the Checklist to predict recidivism and treatment outcome. Nuckols, C. C. (1994). Personality issues: Uncovering the hidden barriers to clean and sober living [Pamphlet]. Center, MN: Hazelden. Page 14

15 Personality Issues: Unconvering the Hidden Barriers to Clean and Sober Living by Cardwell C. Nuckols Ph.D. This pamphlet is used in the addictions recovery fields to reveal roadblocks to recovery that might be invisible or hard to parse out. There is a specific regard to the personality and how flaws or coping mechanisms that addicts have developed can actually hinder recovery and fulfillment. Patrick, C. J. (2006). The handbook of psychopathy. Guilford. The Handbook of Psychopathy by Christopher J. Patrick Ph.D. This handbook functions as an encyclopedic overview of psychopathy that includes a myriad of theoretical models, assessment approaches, neurobiological conceptions, cultural conceptions and genetic relations of psychopathy. Clinical and legal affects of this information are also discussed. This handbook does a very thorough job of observing the psychopath as a unique person embedded in a social network. Stone, M. H. (2009). The anatomy of evil. Amherst, NY: Prometheus Books. The Anatomy of Evil by Michael H. Stone Stone utilizes a wide berth of research on violent criminals to delineate a hierarchy of traits that lead to the evil behavior we identify as psychopathy. They meditate on narcissism and aggression and how a new understanding of psychopathy can change how the judicial system views criminals, and offers hope of rehabilitation. Informative for the Laymen (*Also contains elements of self-help) Babiak, P., & Hare, R. D. (2007). Snakes in suits. New York, USA: Harper. Snakes in Suits: When Psychopaths Go to Work by Paul Babiak Babiak examines psychopaths within the context of a corporate environment. He explains how and why psychopaths can have success in the corporate environment based on their innate traits and dispositions. Hare, R. D. (1999). Without conscience: The disturbing world of the psychopaths among us. Guilford. Without Conscience: the Disturbing World of the Psychopaths Among Us by Robert D. Hare, Ph.D. Hare uses the population of con artists, hustlers, rapists and aggressors as a basis to analyze the psychopathy that is prevalent in society. Page 15

16 Lerner, R. (2009). The object of my affection is in my reflection. Deerfield Beach, FL: Health Communications. The Object of My Affection is in My Reflection* by Rokelle Lerner Written from the standpoint that narcissists suffer from a personality disorder that began in the early stages of childhood. Lerner writes from a developmental perspective in which she conceived of the narcissist is stuck in a early developmental phase, which accounts for their childlike traits. She explains their behavior as a consequence of early childhood trauma. Pike, A. (2011). Danger has a face. Outskirts. Danger Has A Face by Anne Pike Pike defines psychopaths as those who harass, manipulate and otherwise abuse innocent bystanders. She explains how to spot a psychopath. Ronson, J. (2011).The psychopath test. Penguin. The Psychopath Test by Jon Ronson This book, though a bit sensationalized, takes a look at different forms of psychopathy. It characterizes the criminally insane, and those who are high functioning psychopaths. Stout, M. (2006). The sociopath next door. Three Rivers. The Sociopath Next Door by Martha Stout Stout educates the reader about traits of common sociopaths, that aren t easily identified by violent crimes. Describes personalities and identifying factors of sociopaths and how to avoid being negatively affected by them. Vaknin, S. (2001). Malignant self love: Narcissism revisited. Narcissus. Malignant Self Love* by Sam Vaknin Vaknin relays a number of personal tesimonials from narcissists themselves and those who have had personal relationships with narcissists. The book answers a number of FAQs posed by those who have encountered narcissits. Self-help For Narcissists & Friends and Families of Narcissists Behary, W. T. (2008). Disarming the narcissist: Surviving and thriving with the selfabsorbed. New Harbinger. Page 16

17 Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed by Wendy T. Behary Behary shows the reader how to incorporate the narcissist into a healthy lifestyle or relationship. The book teaches the reader to bypass typical narcissistic defenses through methods of compassionate, empathetic communication. Behary writes in such a way to show the reader life through the eyes of the narcissist. Lowen, A. (2004). Narcissism: Denial of the true self. Touchstone. Narcissism by Alexander Lowen M.D. Lowen pulls from clinical experience to explain how narcissists are capable of recovering empathy and humanity. This is through a psychoanalytic lens, and uses concepts from bioenergetic analysis. **Dated, but foundational and therefore worth the read. Meier, P., Charlebois, L., & Munz, C. (2010). You might be a narcissist if. Langdon Street. You Might Be A Narcissist If by Paul Meier, M.D. Lisa Charlebois, L.C.S.W., Cynthia Munz, L.M.F.T. This book contains a number of personal testemonials from the authors and their clients about coping with narcissists. It includes a questionnaire about narcissism to determine if someone is a narcissist and offers coping mechanisms for dealing with narcissism. Payson, E. D. (2002). The wizard of oz and other narcissists: Coping with the one-way relationship in work, love, and family. Julian Day. The Wizard of Oz and Other Narcissists by Eleanor D. Payson, M.S.W. Payson uses the movie The Wizard of Oz as an extended metaphor to examine the laymen s experience of a narcissist. The book introduces the reader to traits of narcissists and equips them with tools to identify narcissists and protect themselves from the negative ramifications of interactions with narcissists. Simon, G. K. (2010). In sheep's clothing: Understanding and dealing with manipulative people. Parkhurst Brothers. In Sheep s Clothing by George K. Simon, Jr. Ph.D. This book is a popular and thorough explication of characteristics of psychopaths and how they operate for the layman Additional Readings Page 17

18 Evans, P. (2006). The verbally abusive man, can he change?: A woman's guide to deciding whether to stay or go (2nd ed.). Adams Media. The Verbally Abusive Man: Can He Change? by Patricia Evans Evans explores research on verbal abuse, and educates victims of verbal abuse within a romantic relationship on personal empowerment and how to make these relationships constructive. Nakken, C. M. (1996). The addictive personality: Understanding the addictive process and compulsive behavior (2nd ed.). Hazelden. The Addictive Personality by Craig Nakken This book gives insight into the mechanism of addiction beyond general knowledge about chemical dependency. Nakken describes the progression of addiction and includes a discussion of genetics, cultural influences and what recovery success requires of the addict. Pennebaker, J. W. (2011). The secret life of pronouns: What our words say about us. New York, NY: Bloomsbury. The Secret Life of Pronouns by J.W. Pennebaker This book discusses linguistics research and what diction and syntax can imply about personality and emotional states. This information is relevant to implement when trying to determine if someone is a psychopath, or where they fall on the empathy spectrum. Page 18

19 Getting PCL-R Certified Page 19

20 Important Websites DSM 5 Changes DSM 5 Levels of Personality Functioning Scale Use the PCL-SV for Screening cc-sv&id=pricing&rptgrpid=pcs Become PCL-R Certified Websites for Those Coping with Psychopaths* *Yahoo Groups & Google Groups are also options Products for Women/Men Coping with Psychopaths Page 20

21 Sources Aftermath: Surviving Psychopathy Foundation site by Linda S. Hartoonian-almas, Dec 2011 Babiak, P., & Hare, R. D. (2007). Snakes in Suits. New York, USA: Harper. (Babiak, Neumann and Hare) Center for Building a Culture of Empathy. (n.d.). Retrieved from Center for Building a Culture of Empathy website: The mind of a psychopath. (2010, August 26). Retrieved from ABC news website: Nightline/Prime/secrets-mind-omega-fatty-acidsbrain/story?id= #.UClXFzGXTdI Payson, E. D. (2002). The wizard of oz and other narcissists: Coping with the one-way relationship in work, love, and family. Julian Day. Hare, R. D. (2003). Hare psychopathy checklist-revised: (PCL-R) 2nd edition (2nd ed.). Page 21