Antisocial PD and .

1. Antisocial PD and�. Psychopathy

2. DSM - Criteria 1) fails to conform to social norms 2) deceitful 3) impulsivity 4) irritable and aggressive 5) reckless 6) irresponsible 7) lacks remorse 3/7 criteria required for diagnosis

3. ICD-10 Criteria 1) callous unconcern 2) irresponsibility 3) incapacity to maintain relationships 4) low frustration tolerance 5) incapacity for guilt 6) blames others

4. Impact on the life-course begins around 8, peaks 20s and 30s Job and marital problems minority in jail Male Substance abuse issues of some sort do not seek treatment treatment does not work

5. ASPD in Media �sex and violence� characters Silence of the Lambs Anthony Hopkins Dr. Hannibal Lecter Youtube link � �Fava beans�

6. ASPD in Media Pulp Fiction

7. ASPD in Media Wall Street Michael Douglas Gordon Gekko Youtube link � �Greed is Good�

8. ASPD in Media Cape Fear Robert DeNiro Max Cady

9. Traits to Disorder

10. ASPD and Normality Glib Grandiosity Lying Lack of remorse Shallow affect Callousness Talk-show host Stage performer Spy Infantryman Undertaker Wartime General

11. History of ASPD

12. ASPD - History Lombroso (1800s) � physiognomy �ASPD� identified by �look� Atavistic individuals = long arms, acute eyesight, heavy jaws, jug ears

13. ASPD History Pinel (1801) � manie sans delire (insanity without delirium) Why? � due to impairment of affect Benjamin Rush (1812) � moral weakness deceptive, manipulative Why? � can�t experience shame/guilt

14. ASPD History Prichard (1835) � moral insanity Despite understanding, their conduct was swayed by overwhelming compulsions Broad conceptualization Included: drug addiction, alcohol problems, sexual deviations, homosexuality, mood disorders

15. ASPD History J. L. Koch (1891) Psychopathic inferiority Why? � brain based cause Broad conceptualization

16. Emil Kraepelin (1904) psychopathy personality chronic and constitutional in nature Psychopathic = mentally ill 1) liars and swindlers 2) criminals by impulse 3) professional criminals 4) morbid vegabonds

17. Emil Kraepelin (1915) Revised typology Dropped professional criminal Added � excitable, eccentric, *antisocial, *quarrelsome

18. ASPD History Adolf Meyer (1904) Constitutional Inferiority Karl Birnbaum (1909) Sociopathic Why? � due to environment

19. ASPD Comes by different names Psychopath (late 1800s) Sociopath (20th century) Dyssocial Personality (ICD-10) Antisocial PD (DSM-IV)

20. Cleckley �� The Mask of Sanity (1941) VA Hospital Augusta Georgia Rejected broad conceptualizations Highly distinct clinical syndrome Why? � deficit in emotional reactivity

21. Cleckley �� The Mask of Sanity (1941) Look good on the outside Mask of mental health Pathological state inside Severe behavioral maladjustment

22. Cleckley � 16 criteria �� 1. superficial charm, good intelligence 2. absence of delusions 3. not nervous 4. unreliability 5. untruthfulness and insincerity 6. lack of remorse or shame 7. inadequately motivated 8. poor judgment, failure to learn

23. Cleckley � 16 criteria �� 09. pathological egocentricity 10. poverty in major affective reactions 11. loss of insight 12. unresponsive interpersonally 13. fantastic behavior with drink 14. suicide rarely carried out 15. sex life is impersonal 16. failure to follow any life plan

24. Cleckley Positive adjustment - 1, 2, 3, 14 Behavioral deviance - 4, 7, 8, 13, 15, 16 *Emotional-interpersonal deficits - 5, 6, 10, 9, 11, 12 * - important in distinguishing from behavior deviance* - important in distinguishing from behavior deviance

25. DSM History of ASPD DSM I (1952) � ICD 6th (1948) Sociopathic disturbance Broad range of disorders �sociopathic personality disturbance: antisocial reaction� Aggressive criminal deviant, violates the norms of society

26. DSM-II (1968) Aligned with ICD-8 term �Antisocial PD� now used inspired by Cleckley Selfish, callous, lack of guilt Limitation � not reliably diagnosed

27. DSM-III Behavioral oriented criteria used Feighner et al. (1972) Lee Robins (1966) Spitzer et al. (1978) Diagnosis highly reliable Millon, Hare � argue, description incomplete

28. DSM-IV Specialized field trials conducted 1) criteria that included the psychopathy features *2) simplification of existing criteria 10 (DSM-III) to 7 criteria (DSM-IV) Core affective-interpersonal features not included

29. DSM-IV A. 3/7 criteria before age 15 B. at least 18 C. 3/15 conduct disorder criteria Aggression toward people/animals Destruction of property Deceptiveness or Stealing Serious Rule Violation D. Not during schizophrenia or mania

30. DSM-IV Prevalence 3% of men, 1% of women Prison � 50 to 80%

31. Co-morbidity

32. Etiology

34. Etiology Biological

35. Cleckley Psychopaths are deficient in their capacity for affective experience emotional experience is a pseudoexperience mimic the emotional displays of others �emotionally retarded�

36. Cause - biology Semantic aphasia Psychopathy do not understand language the same way as others

37. Cause - Biology Large heritability component Temperament aggressive, higher activity and reactivity levels Higher than average need for excitement Lower Nervous system activity Lower levels of 5-HIAA (impulsivity, aggression) EEG abnormalities (excessive theta waves) Alcoholism, ADHD Brain Damage Genetics

38. Cloninger Scan page 21

39. Cause - biological An evolutionary adaptive life strategy �cheating� promotes sexual contact and yields larger numbers of offspring aggressive/antisocial tendencies are an evolutionary �throw forward�

40. Etiology Psychosocial

41. Cause - Psychosocial Frequent moves, family breakups, large families Poverty, urban setting Emotional deprivation Physical/sexual abuse Substance-abusing caregiver

42. Cause - Psychosocial Mother: depressive, weak, masochistic, somatizing, personality disordered Father: explosive, inconsistent, sadistic, alcoholic, criminal history

43. Trait Perspectives

44. MMPI

45. MMPI � Two Point Codes 4/9, 9/4 � high energy psychopath 4/2, 2/4 � depressed psychopath 4/8, 8/4 - schizoid psychopath Psychopathic deviate (4) Hypomania (9) Marital problems, child abuse, drug issues, sex offenses Easily bored, hostile Poor judgment, acts out Rationalizes Good first impression, problems with authority Does not tire easily 2/4, 4/2 Why is scale 2 high? Internal or External (being caught) Good insight Claim to change, but does not Hostility, resentment, remorse Depressed with no acting out Alcohol problems Cynical 4/8, 8/4 Schizoid, not schizophrenic Unpredictable, nonconforming Social problems History of criminal activity Crimes poorly planned Numerous arrests Child molesters, rapists, exposers Psychopathic deviate (4) Hypomania (9) Marital problems, child abuse, drug issues, sex offenses Easily bored, hostile Poor judgment, acts out Rationalizes Good first impression, problems with authority Does not tire easily 2/4, 4/2 Why is scale 2 high? Internal or External (being caught) Good insight Claim to change, but does not Hostility, resentment, remorse Depressed with no acting out Alcohol problems Cynical 4/8, 8/4 Schizoid, not schizophrenic Unpredictable, nonconforming Social problems History of criminal activity Crimes poorly planned Numerous arrests Child molesters, rapists, exposers

46. Jeffrey Dahmer 1960-1994 Milwaukee/Ohio area Sentenced to 957 years 17 male murder victims Serial killer

47. Dahmer�s MMPI Profile

48. Psychoticism aggressive, cold, egocentric, impersonal antisocial, unempathic, creative Extraversion social, lively, active, assertive, carefree, dominant, surgent Neuroticism anxious, depressed, guilt-prone irrational, shy, moody emotional PEN - Eysenck

49. Primary and Secondary Psychopaths Primary �higher P relative to N Secondary � higher N relative to P Psychopathy

50. Other self-report measures Psychopathic Deviate scale Socialization scale (CPI) Self-report Psychopathy scale Pri and Sec Psychopathy scales All tend to tap F2 of PCL-R

51. Psychopathy Personality Inventory PPI 187 self-report items 4 point scale psychometrically sound 8 subscales

56. N =Neuroticism, E = Extraversion, O = Openness to Experience, A = Agreeableness, C = Conscientiousness N, E, O, A and C represent the Big Five, or the fundamental dimensions of personality Along the vertical, we have various personality disorders. The numbers inside the grid represent effect sizes. Number gather by analyzing patterns across 15 studies. Positive numbers represent positive associations with a given factors, where as negative numbers represent the opposite. The stronger the number (either positive or negative), the greater the association between The personality factor and a given PD. N =Neuroticism, E = Extraversion, O = Openness to Experience, A = Agreeableness, C = Conscientiousness N, E, O, A and C represent the Big Five, or the fundamental dimensions of personality Along the vertical, we have various personality disorders. The numbers inside the grid represent effect sizes. Number gather by analyzing patterns across 15 studies. Positive numbers represent positive associations with a given factors, where as negative numbers represent the opposite. The stronger the number (either positive or negative), the greater the association between The personality factor and a given PD.

59. Modern Models of ASPD Turkat, Millon, Hare

60. Turkat � types 1) The Clear sociopath DSM criteria are easily applied usually due to court referral

61. Manson Interview Synder interview Link 1 Link 2 Link 3 Link 4 Link 5 Link 6 Rose Interview Link 1 Link 2 Link 3 Link 4 Link 5 Link 6 Link 7

62. Edmund Kemper Victims� August 27, 1964 Maude Kemper Ed Emil Kemper He was once quoted as saying, "When I see a pretty girl walking down the street, I think two things: One part of me wants to take her home, be real nice and treat her right; the other part wonders what her head would look like on a stick." He was once quoted as saying, "When I see a pretty girl walking down the street, I think two things: One part of me wants to take her home, be real nice and treat her right; the other part wonders what her head would look like on a stick."

63. Kemper

64. Turkat 2) Clever Sociopath individuals present as having some sort of psychological problem hidden agenda and tries to mask the agenda

65. Kenneth Bianchi Hillside Strangler Faked DID Raped and murdered 10 women (with Angelo Buono) Found guilty

66. Primal Fear Edward Norton Aaron Stampler Fakes DID to get out of responsibility for his murder

67. Turkat 3) The Hurting Sociopath individuals who meet the criteria for ANT but want to change More reckless than callous Probably depressed/anxious

68. Millon�s Model Millon's Model three polarity model enhancing/preserving accommodating/modifying nurturing/individuating antisocial types are: modifying-individuating types

69. Millon Subtypes Nomadic � avd, szd Malevolent � sad, par Covetous � pure aspd Risk-taking - his Reputation-defending - nar

70. Robert Hare PCL-R Psychopathy Check List Revised Premised on Cleckley�s Mask of Sanity Two empirical primary factors Youtube link � Robert Hare

71. Hare�s Model 1. glibness / superficial charm 2. grandiose sense of self-worth 3. need for stimulation / proneness to boredom 4. pathological lying 5. conning / manipulative 6. lack of remorse 7. shallow affect 8. callous / lack of empathy 9. parasitic lifestyle 10. poor behavior controls 11. promiscuous sexual behavior 12. early behavior problems 13. lack of realistic long-term goals 14. impulsivity 15. irresponsibility 16. failure to accept responsibility 17. many short-term marital relationships 18. juvenile delinquency 19. revocation of conditional [e.g., from prison] 20. criminal versatility

72. PCL-R 3 point scale 0 = does not apply 1= applies to some extent 2 = applies to individual Cutoffs Normal � Score of 5 Psychopath � Score of 30 or greater Hit Rate � 85% A good predictor of recidivism

75. Hare�s Model 1. glibness / superficial charm 2. grandiose sense of self-worth 3. need for stimulation / proneness to boredom 4. pathological lying (2) 5. conning / manipulative 6. lack of remorse (7) 7. shallow affect 8. callous / lack of empathy 9. parasitic lifestyle (1) 10. poor behavior controls (1, 4, 5) 11. promiscuous sexual behavior (5) 12. early behavior problems (4) 13. lack of realistic long-term goals (1) 14. impulsivity (3) 15. irresponsibility (6) 16. failure to accept responsibility (6) 17. many short-term marital relationships (1) 18. juvenile delinquency (4) 19. revocation of conditional [e.g., from prison] 20. criminal versatility

77. Correlates of PCL-R Factor 1 + dominance + positive affect + achievement + adjustment - empathy + self-centered + Narcissistic PD + Machiavellianism Factor 2 -/+ anxiety + criminality -/+ drug/alcohol + reactive aggression -/+ suicides + impulsivity + sensation seeking + Borderline PD

78. Psychopathy Prevalence Using PCL-R cutoff of 30 15 to 25% (prison), 1%? (population) DSM criteria 50 to 80% (prison), 2% (population)

79. Why do they come for treatment? ego-syntonic condition 1) in trouble with law 2) marital issue 3) occupational problems

80. Treatment High F1 � callousness � poor outcome High F2 � reckless � possible (particularly if depressed) Treatment is a game, pervasive lying Fear induction in therapist Don�t come to therapy for �bad character� Nothing is known to work

81. Homework Assignment � Cape Fear Link 1 Link 2 Link 3 Link 4 Link 5 Link 6 Link 7 Link 8 (missing) Link 9 Link 10 Link 11 Link 12 Link 13 Link 14