of the Comprehensive Assessment of Psychopathic Personality (CAPP) Model Spanish Version

Transcription

1 Journal of Personality Disorders, 28, 2014, The Guilford Press A Prototypicality Validation of the Comprehensive Assessment of Psychopathic Personality (CAPP) Model Spanish Version Gerardo Flórez, MD, PhD, Alfonso Casas, MD, Mette K. F. Kreis, PhD, Leonello Forti, MD, Joaquín Martínez, MD, Juan Fernández, MD, Manuel Conde, MD, Raúl Vázquez-Noguerol, MD, Tania Blanco, MD, Helge A. Hoff, PsyD, and David J. Cooke, PhD, DUniv, FBPsS, FRSE The Comprehensive Assessment of Psychopathic Personality (CAPP) is a newly developed, lexically based, conceptual model of psychopathy. The content validity of the Spanish language CAPP model was evaluated using prototypicality analysis. Prototypicality ratings were collected from 187 mental health experts and from samples of 143 health professionals and 282 community residents. Across the samples the majority of CAPP items were rated as highly prototypical of psychopathy. The Self, Dominance, and Attachment domains were evaluated as being more prototypical than the Behavioral and Cognitive domains. These findings are consistent with findings from similar studies in other languages and provide further support for the content validation of the CAPP model across languages and the lexical approach. A new conceptual model of psychopathic personality disorder (PPD) has recently been proposed by Cooke and colleagues and focuses on personality traits rather than on antisocial and criminal behavior; the Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2004, 2012). The lexical hypothesis, the idea that the important dimensions of personality variation will be richly represented within natural language, was used to provide a comprehensive and differentiated de- This article was accepted under the editorship of Robert F. Krueger and John Livesley. From Galician Forum for the Study of Personality, Vigo, Spain (G. F., A. C., L. F., J. M., J. F., M. C., R. V.-N.); Section of Clinical and Health Psychology, University of Edinburgh & NHS Forth Valley (M. K. F. K.); Psychiatry Service, Pontevedra University Hospital, Pontevedra, Spain (T. B.); Haukeland University Hospital, Centre for Research and Education in Forensic Psychiatry, Bergen, Norway (H. A. H.); and Section of Forensic Psychology, Glasgow Caledonian University (D. J. C.). Address correspondence to Gerardo Flórez, Unidad de Conductas Adictivas, Hospital Santa María Nai, CHUO, Ramón Puga 52-56, Ourense, Spain; gerardof@mundo-r. com 1

2 2 FLÓREZ ET AL. scription of PPD (Ashton & Lee, 2005; Mollaret, 2009; Saucier, Goldberg, & Institute, 2001). The CAPP contains 33 items; each item is specified more precisely using three closely related trait-descriptive adjectives. The 33 items were grouped into six domains of personality functioning: Affective, Behavioral, Cognitive, Dominance, Emotional, and Self (Cooke et al., 2012). A range of validation studies are currently being carried out (e.g., Hoff, Rypdalm, Mykletun, & Cooke, 2012; Kreis & Cooke, 2011; Kreis, Cooke, Michie, Hoff, & Logan, 2012). Some of these have used prototypicality analysis to test the relevance and robustness of the CAPP model to the construct of psychopathy in a number of languages: English (Hoff et al., 2012), Norwegian (Heinzen, Fittkau, Kreis, & Huchzermeier, 2011), German (Kreis et al., 2012), and Persian (S. V. Shariat, personal communication, August 28, 2012). Prototypicality analysis is a method derived from cognitive psychology (Rosch, 1978). Several studies have previously employed prototypicality analysis in the evaluation of personality disorders, including psychopathy (Cruise, Colwell, Lyons, & Baker, 2003; Livesley, Reiffer, Sheldon, & West, 1987; Samuel & Widiger, 2004). Prototypicality analysis is particularly useful in the content validation of a new conceptual model of psychopathy such as the CAPP model because it makes it possible to clarify which symptoms are relevant or irrelevant to the PPD construct (Hoff et al., 2012). The approach has previously been successfully used to evaluate the content validity of the original English language CAPP (Kreis et al., 2012) and the translated Norwegian version (Hoff et al., 2012). Support for the content validity of the CAPP model was found across language versions, expert and lay samples (Hoff et al., 2012; Kreis et al., 2012), and gender (Kreis & Cooke, 2011). OBJECTIVES The current study was designed to evaluate the content validity of the CAPP Spanish version using prototypically analysis, and secondly to compare the Spanish results with the findings of previous studies of the English and Norwegian language versions. To reduce method variance, we adopted the same methodology as in the aforementioned studies (Hoff et al., 2012; Kreis et al., 2012), particularly that used by Hoff et al. using both expert and lay samples. The prototypicality of the CAPP items was compared with a set of foil items considered not to be part of the concept of psychopathy. Following the lexical hypothesis, our a priori hypothesis was that there would be no significant prototypicality differences in the Spanish version of the CAPP relative to previously published work in the UK and Norway, knowing that Spain and these countries are European cultures that share some common ground but also have significant cultural and linguistic differences. Norwegian is, like English, a member of a West Germanic subgroup of the Indo-European language group; by contrast, Spanish is a Romance language, derived from Vulgar Latin, although part of the Indo-European language family.

3 PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 3 METHOD PARTICIPANTS Three samples of participants were selected on the basis of their knowledge of, and experience in dealing with, psychopathy. Participation in the study was completely voluntary. Sample 1 was an expert sample, consisting of 187 mental health, forensic, and penitentiary staff (i.e., forensic medical officers, forensic psychologists, psychiatrists, clinical psychologists, prison medical officers, and prison psychologists) recruited at their workplaces or at national conferences and workshops across Spain. All were highly trained in diagnosing and interacting with patients suffering from many types of mental illness, including psychopathy and other personality disorders. Only 10 experts refused to participate. Sample 2 consisted of 143 other health professionals (i.e., general practitioners and nurses) with limited experience of mental disorders in general, and psychopathy in particular. Their recruitment took place at their workplace or at local workshops. Only 13 health professionals refused to participate. In Sample 3 were 282 community residents (i.e., lay people) from diverse backgrounds (74 university students, 102 clerical staff from general hospitals, and 106 visitors to general hospitals) with no formal training in, or professional experience of, psychopathy. Their recruitment took place at various locations, including workplaces, training courses, universities, and public places. Only 61 community residents refused to participate. Table 1 provides a summary of the demographic characteristics of the three samples. TABLE 1. Sample Characteristics of Raters Community Residents Health Professionals Expert Group Total Men 68 (24.11%) 31 (21.68%) 78 (41.71%) Age 25 or below 127 (45.04%) 4 (2.80%) 0 (0%) (18.79%) 69 (48.25%) 35 (18.7%2) (23.76%) 47 (32.87%) 88 (47.06%) Above (12.41%) 23 (16.08%) 64 (34.22%) Background Expert group Clinical psychologist 49 (26.21%) Forensic medical officer 26 (13.90%) Forensic psychologist 5 (2.67%) Prison medical officer 14 (7.49%) Prison psychologist 4 (2.14%) Psychiatrist 89 (47.59%) Years of experience (M) Contact with psychopathy Expert group Daily 35 (18.72%) Weekly 42 (22.46%) Monthly 43 (22.99%) Quarterly 32 (17.11%) Rarely 35 (18.72%)

4 4 FLÓREZ ET AL. PROCEDURE The Spanish version of the CAPP was used to design a two-part questionnaire based on the one developed by Kreis et al. (2012) and Hoff et al. (2012).The questionnaire included the 33 CAPP items plus nine foil items (see the first column of Table 2). The format of our questionnaire was the same as that used by Hoff et al. in the Norwegian language study. Part 1 of the questionnaire was constructed as follows: (a) experts were asked to rate the 42 items according to how relevant they were to a specific patient or inmate they had met during their practice and whom they thought was a typical psychopath; (b) the other two samples were asked to rate the 42 items according to how typical they thought these were of psychopathy in general. They were asked to think of someone who from their point of view was clearly psychopathic. In Part 2 of the questionnaire, participants from all samples had to rate the typicality of the 42 items to a specific patient or inmate (experts sample) or person (other samples) they definitely did not consider to be psychopathic. All ratings were on a 7-point Likert-type scale anchored at 1 (low typicality) and 7 (high typicality). Demographic participant information was also collected, including the experts professional experience with, and frequency of assessment of, psychopathic patients or inmates. ANALYSES After conducting descriptive statistics for all symptoms, the CAPP items and domains were analyzed in relation to typicality of psychopathy. Like Hoff et al. (2012), a mean typicality rating of psychopathy between 4 and 5 was labeled as moderately typical and above 5 as highly typical (Rogers, Duncan, Lynett, & Sewell, 1994). We also analyzed the domains and items in relation to distinctiveness; the higher the difference in typicality ratings, psychopathic versus nonpsychopathic person, the more distinctive the item. A prototypical analysis was then conducted with these two analyses. As mentioned before, a prototype is a model created to test a concept. Analyzing the prototype is a way to evaluate and, if necessary, modify the design based on the concept, in this case the Spanish version of the CAPP. RESULTS PROTOTYPICALITY OF THE INDIVIDUAL CAPP SYMPTOMS Variability in typicality ratings across items was found (see Table 2). Across samples, the majority of the 33 CAPP items were rated as moderately to highly typical of psychopathy. For the Attachment domain, four items (Detached, Unempathic, Uncommitted, and Uncaring) were considered as highly prototypical by the three groups (community residents,

5 Domain/Item TABLE 2. Prototypicality Evaluations of CAPP Items and Foils Community Residents Versus Community Residents Health Professional Versus Prison Experts Versus Forensic Psychiatry Psychopath Nonpsychopath Psychopath Nonpsychopath Psychopath Nonpsychopath M SD M SD M SD M SD M SD M SD Attachment 5.43/5.25 (1.11/1.13) 1.89/1.63 (0.95/0.94) 5.48/5.24 (1.02/1.12) 2.11/2.48 (1.00/1.43) 5.74/5.75 (0.85/0.98) 2.07/2.73 (0.95/1.24) Detached 5.54/4.98 (1.55/1.68) 2.03/1.69 (1.21/1.12) 5.64/4.75 (1.40/193) 2.01/2.78 (1.09/2.08) 5.47/5.25 (1.43/1.58) 2.46/3.01 (1.28/1.72) Unempathic 5.84/6.06 (1.53/1.38) 1.57/1.56 (1.02/1.09) 5.79/6.06 (1.54/1.39) 1.60/2.47 (1.00/1.76) 5.86/6.27 (1.50/1.07) 1.85/2.37 (1.11/1.44) Uncommitted 5.14/4.92 (1.64/1.58) 2.04/1.70 (1.26/1.18) 5.42/5.19 (1.55/1.38) 1.87/2.38 (1.15/1.41) 5.78/5.87 (1.21/1.23) 2.51/2.95 (1.47/1.61) Uncaring 5.19/5.07 (1.64/1.61) 1.93/1.59 (1.25/1.10) 5.48/4.97 (1.51/1.40) 1.69/2.28 (0.96/1.46) 5.85/5.59 (1.19/1.44) 2.44/2.58 (1.32/1.53) Behavioral 4.24/4.00 (0.74/1.04) 2.32/2.32 (0.89/1.04) 4.59/4.07 (1.30/1.13) 2.53/2.69 (1.08/1.34) 4.74/4.97 (0.87/0.95) 2.43/3.33 (1.20/1.26) Disruptive 4.44/4.03 (1.84/1.69) 2.39/2.35 (1.27/1.44) 4.86/4.41 (1.78/1.93) 1.99/2.56 (1.07/1.83) 4.98/5.33 (1.64/1.44) 2.63/3.04 (1.56/1.67) Restless 4.31/3.81 (1.79/1.75) 2.92/3.08 (1.36/1.56) 4.09/4.00 (1.85/1.48) 2.85/3.25 (1.42/1.85) 4.18/4.55 (1.64/1.59) 3.27/3.88 (1.62/1.95) Unreliable 4.57/4.62 (1.83/1.76) 2.07/1.93 (1.22/1.30) 4.79/4.41 (1.90/1.72) 1.99/2.56 (1.18/1.48) 5.21/5.57 (1.53/1.52) 2.55/2.91 (1.56/1.62) Reckless 3.49/3.49 (1.84/1.77) 2.63/2.46 (1.37/1.46) 4.09/4.00 (2.07/1.76) 2.14/2.69 (1.21/1.89) 4.50/4.54 (1.77/1.69) 2.87/2.97 (1.60/1.90) Lacks perseverance 3.35/2.71 (1.90/1.60) 2.32/2.44 (1.24/1.43) 4.07/2.72 (1.92/1.73) 2.18/2.88 (1.24/2.00) 4.27/4.20 (1.66/1.87) 2.95/3.33 (1.64/1.26) Aggressive 5.29/5.33 (1.58/1.49) 1.61/1.64 (1.04/1.16) 5.64/4.88 (1.46/2.00) 1.47/2.22 (0.73/1.56) 5.52/5.65 (1.23/1.30) 2.25/3.01 (1.29/1.69) Cognitive 4.49/4.36 (0.90/0.91) 2.37/2.48 (0.96/1.10) 4.48/4.26 (0.87/1.01) 2.73/2.99 (1.06/1.50) 4.43/5.01 (0.87/0.95) 2.73/3.66 (1.09/1.09) Inflexible 5.22/5.27 (1.44/1.47) 2.75/2.41 (1.37/1.40) 5.35/5.19 (1.51/1.51) 2.43/2.56 (1.23/1.83) 5.11/5.53 (1.48/1.43) 3.23/3.31 (1.44/1.70) Lacks planfulness 3.09/2.75 (1.96/1.67) 2.55/2.60 (1.52/1.64) 3.15/2.91 (1.86/1.80) 2.32/3.41 (1.35/2.11) 3.83/4.39 (1.79/1.84) 3.17/4.22 (1.60/1.90) Suspicious 5.76/5.39 (1.27/1.47) 2.45/2.21 (1.36/1.44) 5.62/5.25 (1.36/1.44) 2.16/3.06 (1.24/1.81) 4.83/5.50 (1.46/1.45) 3.09/3.66 (1.52/1.81) Lacks concentration 3.14/3.21 (1.87/1.74) 2.84/2.85 (1.38/1.49) 3.13/3.03 (1.86/1.51) 2.52/3.34 (1.29/2.06) 3.17/4.04 (1.49/1.67) 3.29/4.52 (1.63/1.74) Intolerant 5.25/5.17 (1.48/1.50) 2.00/2.31 (1.25/1.46) 5.13/4.91 (1.65/1.75) 1.97/2.56 (1.02/1.76) 5.20/5.59 (1.42/1.44) 2.58/2.62 (1.36/1.52) continued 5

6 Domain/Item TABLE 2. Continued Community Residents Versus Community Residents Health Professional Versus Prison Experts Versus Forensic Psychiatry Psychopath Nonpsychopath Psychopath Nonpsychopath Psychopath Nonpsychopath M SD M SD M SD M SD M SD M SD Dominance 5.02/5.40 (0.93/0.88) 2.37/2.11 (0.87/0.95) 5.40/5.62 (0.90/0.87) 2.48/2.08 (0.99/0.98) 5.50/5.71 (0.80/0.84) 2.38/2.46 (1.05/1.04) Garrulous 3.35/4.74 (1.99/1.74) 3.83/3.22 (1.44/1.56) 3.93/5.63 (1.93/1.58) 3.13/2.25 (1.50/1.24) 4.45/5.42 (1.62/1.53) 3.24/2.93 (1.41/1.80) Domineering 5.50/5.95 (1.59/1.33) 2.43/2.31 (1.26/1.37) 5.87/6.22 (1.32/1.26) 2.26/2.28 (1.22/1.44) 5.89/5.99 (0.99/1.24) 2.59/2.29 (1.28/1.39) Antagonistic 4.65/4.78 (1.68/1.59) 2.05/1.79 (1.20/1.22) 5.20/4.59 (1.64/1.83) 1.87/1.78 (1.03/1.21) 5.26/5.32 (1.28/1.50) 2.53/2.48 (1.43/1.49) Insincere 5.15/4.99 (1.53/1.67) 2.18/1.91 (1.27/1.30) 5.52/5.09 (1.47/1.38) 2.14/2.31 (1.26/1.49) 5.51/5.57 (1.30/1.39) 2.59/2.22 (1.50/1.38) Manipulative 5.94/6.37 (1.36/1.11) 1.93/1.73 (1.15/1.20) 6.27/6.50 (1.08/0.84) 1.97/1.94 (1.25/1.24) 6.21/6.34 (0.95/0.89) 2.42/2.59 (1.37/1.74) Deceitful 5.54/5.58 (1.58/1.41) 1.81/1.71 (1.13/1.22) 5.64/5.69 (1.55/1.33) 1.77/1.91 (1.05/1.09) 5.70/5.62 (1.35/145) 2.25/2.24 (1.31/1.36) Emotional 4.96/4.99 (0.94/0.88) 2.29/2.16 (0.86/0.99) 5.11/5.06 (0.87/1.04) 2.48/2.99 (0.95/1.46) 5.03/5.27 (0.74/0.79) 2.48/3.25 (0.98/1.01) Lacks pleasure 4.20/3.31 (1.98/1.73) 2.07/2.35 (1.44/1.62) 4.67/4.03 (1.94/1.53) 2.03/2.97 (1.45/1.88) 3.98/4.00 (1.87/1.74) 2.83/3.64 (1.74/1.79) Lacks emotional depth 5.37/5.43 (1.76/1.72) 2.03/1.75 (1.36/1.19) 5.52/5.78 (1.69/1.34) 1.83/2.75 (1.26/2.08) 5.55/5.54 (1.41/1.63) 2.42/3.13 (1.54/1.78) Lacks emotional stability 5.52/5.73 (1.65/1.38) 2.44/2.70 (1.32/1.57) 5.19/5.22 (1.78/1.91) 2.48/3.28 (1.48/1.80) 4.80/5.85 (1.63/1.30) 3.46/4.34 (1.78/1.88) Lacks anxiety 3.89/4.46 (1.90/1.77) 2.85/2.23 (1.37/1.33) 4.07/4.53 (1.89/1.80) 2.78/2.91 (1.54/1.67) 4.44/4.75 (1.59/1.60) 2.82/2.50 (1.45/1.55) Lacks remorse 5.84/6.02 (1.67/1.37) 2.09/1.75 (1.38/1.24) 6.09/5.72 (1.47/1.44) 1.78/3.06 (1.17/2.08) 6.41/6.19 (0.85/1.14) 2.04/2.64 (1.20/1.66) Self 5.10/5.38 (0.91/0.87) 2.21/2.31 (0.90/1.00) 5.35/5.46 (0.89/0.58) 2.71/2.58 (0.99/1.24) 5.32/5.72 (0.71/0.77) 2.55/3.11 (1.03/1.12) Self-justifying 5.28/5.66 (1.60/1.52) 2.36/2.35 (1.41/1.42) 5.56/5.91 (1.71/1.40) 2.68/2.97 (1.45/1.96) 5.88/6.39 (1.27/0.90) 3.04/3.27 (1.51/1.75) Sense of uniqueness 5.51/5.55 (1.60/1.55) 2.48/2.78 (1.36/1.63) 5.92/5.84 (1.38/1.32) 2.78/2.13 (1.69/1.48) 5.56/5.91 (1.18/1.32) 2.62/2.78 (1.28/1.79) Self-aggrandizing 4.54/5.22 (1.75/1.59) 2.21/2.08 (1.19/1.30) 5.27/5.50 (1.63/1.32) 2.18/2.06 (1.18/1.65) 5.24/5.82 (1.21/1.37) 2.51/2.28 (1.32/1.50) Sense of invulnerability 5.31/5.19 (1.68/1.57) 1.99/2.03 (1.25/1.29) 5.53/5.53 (1.36/1.41) 1.90/2.41 (1.02/1.60) 5.25/5.47 (1.35/1.49) 2.20/2.14 (1.22/1.42) Unstable self-concept 3.88/4.66 (1.80/1.79) 2.05/2.49 (1.17/1.49) 3.38/2.87 (1.88/1.91) 2.22/3.13 (1.30/1.76) 3.14/4.07 (1.69/1.93) 3.42/4.82 (1.68/1.80) Sense of entitlement 5.40/5.34 (1.47/1.53) 2.22/2.02 (1.30/1.30) 5.71/5.91 (1.30/1.15) 2.34/2.56 (1.45/1.76) 5.89/5.98 (1.06/1.15) 2.82/2.81 (1.47/1.75) Self-centred 5.80/6.07 (1.35/1.25) 2.19/2.40 (1.30/1.42) 6.11/6.53 (1.18/0.67) 2.62/2.90 (1.63/1.72) 6.14/6.36 (0.91/0.88) 2.95/3.65 (1.48/1.77) Foils Dependent 3.28/2.81 (1.95/1.76) 3.05/3.11 (1.46/1.71) 3.05/2.09 (1.96/1.38) 2.94/3.25 (1.44/1.85) 2.43/3.47 (1.72/1.86) 4.09/4.83 (1.79/1.67) Perfectionist 4.84/4.92 (1.86/1.64) 3.65/3.46 (1.37/1.50) 4.39/4.94 (1.93/1.78) 3.73/2.84 (1.41/1.73) 3.27/4.30 (1.57/1.88) 3.82/2.80 (1.36/1.69) Conscientious 3.81/2.31 (2.00/1.55) 4.38/5.64 (1.47/1.43) 3.68/3.34 (1.95/1.83) 4.53/4.44 (1.61/2.06) 2.90/2.10 (1.62/1.33) 4.17/4.20 (1.51/1.68) Considerate 2.82/2.31 (1.70/1.54) 5.29/5.80 (1.40/1.42) 2.99/2.87 (1.80/1.43) 5.18/4.97 (1.62/1.69) 2.13/2.37 (1.47/1.57) 4.75/4.45 (1.67/1.53) Strange 4.59/4.04 (1.90/1.84) 2.02/2.28 (1.23/1.41) 4.10/3.35 (1.92/1.68) 1.96/2.22 (1.16/1.77) 2.91/4.22 (1.53/1.76) 2.82/3.48 (1.73/1.94) Restrained 3.70/3.69 (1.86/1.82) 3.97/4.33 (1.56/1.56) 3.11/3.75 (1.91/1.72) 4.10/4.13 (1.53/1.79) 2.50/3.19 (1.54/1.70) 4.34/3.66 (1.48/1.77) Shy 4.50/2.69 (1.83/1.64) 2.54/3.14 (1.35/1.54) 3.52/1.97 (1.84/1.51) 2.64/3.10 (1.27/1.68) 2.50/2.12 (1.56/1.38) 3.47/3.85 (1.66/1.72) Cautious 3.31/2.32 (1.83/1.52) 3.12/3.18 (1.48/1.52) 2.79/1.88 (1.65/1.13) 3.25/3.16 (1.55/1.90) 2.54/2.26 (1.58/1.43) 4.00/4.35 (1.56/1.80) Self-conscious 3.30/2.73 (1.81/1.66) 2.64/2.90 (1.36/1.48) 2.88/2.25 (1.77/1.69) 2.60/2.97 (1.35/1.75) 2.09/2.60 (1.32/1.69) 3.70/4.38 (1.76/1.74) Note. The same data from Hoff et al. (2012) are given in italics for direct comparison. 6

7 PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 7 health professionals, and experts). For the Behavioral domain, only one item (Aggressive) was considered as highly typical by the three groups, while three items (Disruptive, Restless, and Unreliable) were considered as either moderately or highly typical by all the groups. Another two items rated below 4 by the community residents (Reckless and Lacks Perseverance) were rated as moderately typical by both health professionals and experts. For the Cognitive domain, two items were rated as highly typical by the three groups (Inflexible and Intolerant), one item considered as moderate or highly typical (Suspicious), and two were rated below 4 by all groups (Lacks Planfulness and Lacks Concentration). For the Dominance domain, four items were rated as highly typical by the three groups (Domineering, Insincere, Manipulative, and Deceitful), one was considered as moderate or highly typical (Antagonistic), and one was rated below 4 by the community residents and health professionals but rated as moderately typical by the experts (Garrulous). In the Emotional domain, two items were rated as highly typical (Lacks Emotional Depth and Lacks Remorse), one was considered as highly typical by the community residents and health professionals but only moderately typical by the experts (Lacks Emotional Stability), and one item was rated below 4 by the experts (Lacks Pleasure) but was rated as moderately typical by the community residents and the health professionals. Lacks Anxiety was rated as moderately typical by the health professionals and the experts but below 4 by the community residents. Finally, five Self domain items (Self-justifying, Sense of uniqueness, Self-aggrandizing, Sense of invulnerability, Sense of entitlement, and Self-centered) were rated as highly typical by all three groups, Self-aggrandizing was rated as moderately typical by the community residents, and Unstable self-concept was rated below 4 by all three groups. None of the foils were perceived as at least moderately typical of psychopathy for the three groups (Table 2). However, Perfectionist was perceived as moderately typical by the community residents and health professionals groups, as was Strange. Shy was perceived as moderately typical only by the community residents. In order to check if the mean psychopath and nonpsychopath ratings of CAPP items differed across groups, a one-way analysis of variance (ANOVA) and Tukey s multiple range test were applied at a significance level of.05. No significant difference in the mean of nonpsychopaths ratings was found in health professionals to community residents (p =.59), while significant differences were found in experts to community residents (p <.001) and health professionals to experts (p <.001). In the case of the psychopaths, no significant differences were found in the mean values of experts to community residents (p =.61) and health professionals to community residents (p =.26). Finally, in the case of health professionals to experts, the p value is not significant either, although considerably lower (p =.07) and close to the significance level. Paired-sample t tests were conducted to examine whether the foils and CAPP items were rated differently with respect to psychopathy. Because

8 8 FLÓREZ ET AL. an overall significance level of.05 was required and 123 comparisons were to be made (41 individual symptoms and 3 different comparisons: experts vs. health professionals, experts vs. community residents, and health professionals vs. community residents), a level of.0004 was needed in order to reject the null hypothesis and conclude that there is a difference between the two means. In the community residents sample, most of the CAPP items were rated higher in the psychopaths than in the nonpsychopaths with statistically significant p values, with only three exceptions: Lacks planfulness, t(282) = 3.32, p >.0004, Lacks concentration, t(282) = 2.13, p >.0004, and Garrulous, t(282) = 3.14, p > The same occurred with the foils, except Dependent, t(282) = 1.56, p >.0004, Restrained, t(282) = 1.83, p >.0004, and Cautious, (t(282) = 1.36, p > For the health professionals, all the CAPP and foil items were rated higher in the psychopaths with the exception of Lacks planfulness, t(143) = 2.34, p >.0004, Lacks concentration, t(143) = 0.50, p >.0004, Garrulous, t(143) = 3.41, p >.0004, Perfectionist, t(143) = 1.76, p >.0004, Dependent, t(143) = 0.55, p >.0004, Shy, t(143) = 0.033, p >.0004, and Self-Conscious, t(143) = 1.49, p > Finally, in the expert subsample, all the CAPP and foil items were rated higher in psychopaths with the exception of Lacks concentration, t(187) = 0.72, p >.0004, Unstable self-concept, t(187) = 1.59, p >.0004, Strange, t(187) = 0.57, p >.0004, Perfectionist, t(187) = 1.86, p >.0004, and Shy, t(187) = 1.62, p > PROTOTYPICALITY OF THE CAPP DOMAINS The result of the ANOVA test, applied to the average value of the marks of the three categories of participants in the study without foils, showed that there are statistically significant differences in the mean values between at least two of the categories (p =.0009). Also, the use of the Tukey test with a confidence interval of the 95% for the three pairs of categories (community residents vs. health professionals, health professionals vs. experts, and experts vs. community residents) leads us to the result that the average value of the mark of community residents was lower than the average of experts and health professionals, the average difference in whose marks cannot be considered as statistically significant. As presented in Table 2, the means and standard deviations show that all domains were rated as moderately to highly typical of psychopathy. Considering the average value of each domain, the most prototypical domain across the groups was the Attachment domain, followed by the domains of Dominance, Self, Emotional, Behavioral, and Cognitive. Finally, paired-sample t tests were conducted in order to verify that for the three groups of raters, the values of the domains Attachment, Dominance, and Self were larger than Emotional, Behavioral, and Cognitive. The results, taking into account that an overall significance level of.05 is required and 54 comparisons were made (3 raters groups, psychopaths and general population, and a total of 3 domains compared with another 3)

9 PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 9 mean that a level of.0009 is needed in order to reject the null hypothesis. All the comparisons performed are under the aforementioned level with the exception of the Self domain compared with Emotional evaluated by health professionals, t(143) = 2.57, p >.0009, and in the community residents for Dominance compared with Emotional, t(282) = 0.91, p >.0009, and Self compared also with Emotional, t(282) = 2.33, p >.0009, all three in psychopaths. DISCUSSION The aim of this study was to measure the content validity of the Spanish version of the CAPP using prototypical analysis, and to compare the results with the previous studies of the English and Norwegian language versions. The primary findings were these: (1) CAPP items: The large majority of these were evaluated as prototypical of psychopathy, and on average more prototypical than the foils. (2) CAPP domains: The descriptive analysis showed that certain aspects related to Attachment, Dominance, and Self were judged as relatively more central (typical) and distinctive (prototypical) of psychopathy than Emotional, Behavioral, and Cognitive. (3) Community residents sample: The way the CAPP was rated in this case was only slightly different from the two other samples, which adds support to the lexical hypothesis. It is important to point out that the overall pattern of prototypicality was highly consistent with those of the similar prototypicality studies previously mentioned; the English one (Kreis et al., 2012) and specially the one in Norwegian (Hoff et al., 2012) were the samples most similar to those in our study. The findings suggest that the CAPP model in the Spanish translation has good overall content validity. This lends further support to the hypothesis that the model can be generalized from the English version. What can our findings add to the debate on what is and what is not prototypical of psychopathy? Since Cleckley (1988), many authors have insisted that the core of psychopathy is better structured around superficial charm, lack of remorse, pathological egocentrism, and emotional poverty than around antisocial and criminal behavior (Blackburn, 2007; Lilienfeld, 1994; Skeem & Cooke, 2010). Our study lends some support to this idea because the Attachment, Dominance, and Self domains were perceived by all samples as a better way to conceptualize psychopathy than the Behavioral domain. What can we learn by examining the items that appeared systematically weak in the prototypicality evaluation? Two out of the six items in the Behavioral domain were found to be among the least prototypical (Lacks perseverance, Reckless). From the Cognitive domain, Lacks concentration and Lacks planfulness were considered as not prototypical, and the same was the case with Garrulous from the Dominance domain.

10 10 FLÓREZ ET AL. These five items share common ground; they have a robust association with the construct of impulsivity (Patton, Stanford, & Barratt, 1995); the weakness shown by impulsivity-related items in our prototypicality evaluation also suggests that impulsivity might not be the cardinal feature of psychopathy that it has previously always been seen as (Hart & Dempster, 1997; Poythress & Hall, 2001). Across lay and expert samples, Unstable self-concept was judged as the least prototypical item from the Self domain. Moreover, unstable selfconcept is within the current International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD) and Diagnostic and Statistical Manual of of Mental Disorders (DSM ) diagnostic criteria for borderline personality disorder. Lacks pleasure was one of the items from the Emotional domain that was perceived as not prototypical. The first CAPP prototype study in English (Kreis et al., 2012) also described Lacks pleasure as one of the least prototypical items, something that was also replicated in the Norwegian study (Hoff et al., 2012). The other item in our sample from the Emotional domain that was also perceived not to be prototypical was Lacks anxiety. Taken together, the lack of prototypicality of these two items might indicate that the participants in our study do not see psychopaths as people without any emotions at all, but simply as people without the correct emotional repertoire toward others (e.g., K. S. Blair et al, 2006; R. J. R. Blair, 2008; R. J. R. Blair & Mitchell, 2009; Lorenz & Newman, 2002; Reidy, Zeichner, & Seibert, 2011). LIMITATIONS Translation is a difficult process; a degree of linguistic bias in the findings cannot be ruled out. Nonetheless, the high degree of similarity between our results and the ones obtained in the Norwegian study (Hoff et al., 2012), a language that is totally dissimilar linguistically to Spanish, seemed to confirm that the lexical approach to personality used by the CAPP authors was the correct one. Another possible limitation is that professional training and experience biased the expert sample. Did PCL-R training (Hare, 2003) condition the answers given by the expert sample? However, PCL-R training has not been as systematic in Spain as in other countries, and the most prototypical symptoms found in our study are poorly operationalized in the PCL-R, and thus bias is unlikely. The great similarity between the professional and lay ratings the latter not having been contaminated by PCL-R training also tends to rule out that explanation. Another limitation might be the influence on the community residents sample of psychopaths who appear in movies and television series (e.g., Dexter Morgan). This might explain why items such as Perfectionist, Strange, and Shy were rated by community residents as more typical of psychopaths than of nonpsychopaths. A similar result was also obtained

11 PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 11 for Perfectionist with the health professionals sample. It should be kept in mind that these psychopaths are presented as highly intelligent serial killers who play mind games with the police officers who try to arrest them. They are thus portrayed to the public as extremely perfectionist. Further research into this topic is needed to test this hypothesis properly. Another limitation is that psychopathy is, as current evidence points out, a dimensional construct rather than a categorical one, and although the CAPP model follows this line of evidence, the way of conducting prototypicality analysis is fundamentally categorical. Sampling can be another limitation. The sampling approach used in this research may be considered as consecutive because in the case of the three samples, all available people located in certain places at certain times were reached. We cannot fully guarantee that our sample is totally representative. Despite these limitations, we conclude, as in previous research, that the current study clearly suggests that the CAPP model has good overall content validity. The correspondence in ratings between the community residents, the health professionals, and the expert samples lends support to the lexical hypothesis. Important psychopathic attributes have been encoded and can be retrieved from natural language, not only in the source language (English) but also across languages (Norwegian and Spanish). Finally, we would like to remark that from our point of view, the validation of a construct is never complete. As has also been discussed in previous research, validation is important not only for theoretical reasons, but also in practice (Cooke, Michie & Skeem, 2007). REFERENCES Ashton, M. C., & Lee, K. (2005). A defence of the lexical approach to the study of personality structure. European Journal of Personality, 19, Blackburn, R. (2007). Personality disorder and antisocial deviance: Comments on the debate on the structure of the Psychopathy Checklist-Revised. Journal of Personality Disorders, 21, Blair, K. S., Richell, R. A., Mitchell, D. G. V., Leonard, A., Morton, J., & Blair, R. J. R. (2006). They know the words, but not the music: Affective and semantic priming in individuals with psychopathy. Biological Psychology, 73, Blair, R. J. R. (2008). The amygdala and ventromedial prefrontal cortex: Functional contributions and dysfunction in psychopathy. Philosophical Transactions of the Royal Society of London, 363, Blair, R. J. R., & Mitchell, D. G. V. (2009). Psychopathy, attention and emotion. Psychological Medicine, 39, Cleckley, H. (1988). The mask of sanity: An attempt to clarify some issues about the so-called psychopathic personality. St. Louis, MO: C.V. Mosby Co. Cooke, D. J., Hart, S. D., Logan, C., & Michie, C. (2004). Comprehensive Assessment of Psychopathic Personality-Institutional Rating Scale (CAPP-IRS). Unpublished manuscript, Department of Psychology, Glasgow Caledonian University. Cooke, D. J., Hart, S. D., Logan, C., & Michie, C. (2012). Explicating the construct of psychopathy: Development and validation of a conceptual model, the Comprehensive Assessment of Psychopathic Personality (CAPP). International Journal of Forensic Mental Health, 11,

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