Psychopathy and Treatment

L’évaluation de la psychopathie reste incontournable tant dans le domaine de l’expertise, de l’orientation, du traitement, que de l’évaluation et la gestion du risque. Le profil psychopathique et le niveau de risque de récidive associé constituent des indicateurs pertinents pour les professionnels de terrain. Cet article se propose de compléter le premier datant de 2011 en apportant des connaissances supplémentaires relatives aux modèles d’évaluation de la psychopathie ainsi qu’un éclairage optimiste sur l’efficacité des traitements auprès d’adultes délinquants. Il décrit, d’une (...) part, les instruments d’évaluation de la psychopathie avec une attention particulière portée aux applications et propositions d’implémentation. D’autre part, il décrit l’importance de spécifier les profils psychopathiques dans l’évaluation des traitements psychologiques auprès de personnes présentant un trouble de la personnalité psychopathique. Enfin, il aborde l’évaluation neuropsychologique auprès de ce type de population. (shrink)

In order to assess the potential of psychopathy to increase evolutionary fitness, we examined the relations between psychopathy and fitness indicators (number of children and grandchildren, problems in physical health both in parents and offspring) in a sample of post-reproductive individuals (N = 187; Mage = 66.52). Specifically, we explored the possibility that psychopathy traits are involved in evolutionary trade-offs: both positive and negative relations with different fitness components. Psychopathy was measured via three traits—interpersonal, affective, and lifestyle characteristics, which are (...) operationalized by proxy scales derived from the HEXACO-PI-R inventory. Research findings showed that interpersonal traits were positively related to the number of children and negatively to the number of grandchildren and problems in physical health; lifestyle characteristics were positively associated with problems in physical health in participants’ offspring. The data are in line with previous studies which explored the relations between psychopathy and fitness. The findings extend on previous studies by suggesting that psychopathy may be involved in evolutionary trade-offs, especially the quantity-quality trade-off. These trade-offs may in return maintain inter-individual variation in psychopathy. (shrink)

In this study, we consider concurrently a disorder view and functional design view of psychopathy using different methods of fluctuating asymmetry (FA) and a target and rater paradigm involving filmed interactions. Targets were young men (N = 46) assessed on psychopathic traits and FA who took part in a video recorded deceptive emotion story where they were incentivized to convince others and gain their trust. Raters were young men and women (N = 1060) who rated the target's videos for genuineness (...) and trust, followed by measures of individual differences such as personality traits. Results showed psychopathy was not related to FA. However, psychopathy was related to higher trust ratings over and above target men's attractiveness and appearance. Additionally, men highest in psychopathy scored significantly higher genuineness and trust ratings compared to men lowest in psychopathy. Lastly, interactions between rater's sex and personality predicted preferential ratings for high psychopathy men, with women higher in Emotionality showing more genuineness and trust of high psychopathy men. Findings suggest that in deceptive emotion contexts young men higher in psychopathy may be successful at convincing others and gaining trust, and particularly so from those with certain personality traits, which may indicate selective exploitation. (shrink)

Questionable research practices are a well-recognized problem in psychology. Coding bias, or the tendency of review studies to disproportionately cite positive findings from original research, has received comparatively little attention. Coding bias is more likely to occur when original research, such as neuroimaging, includes large numbers of effects, and is most concerning in applied contexts. We evaluated coding bias in reviews of structural magnetic resonance imaging studies of PCL-R psychopathy. We used PRISMA guidelines to locate all relevant original sMRI studies (...) and reviews. The proportion of null-findings cited in reviews was significantly lower than those reported in original research, indicating coding bias. Coding bias was not affected by publication date or review design. Reviews recommending forensic applications—such as treatment amenability or reduced criminal responsibility—were no more accurate than purely theoretical reviews. Coding bias may have contributed to a perception that structural brain abnormalities in psychopaths are more consistent than they actually are, and by extension that sMRI findings are suitable for forensic application. We discuss possible sources for the pervasive coding bias we observed, and we provide recommendations to counteract this bias in review studies. Until coding bias is addressed, we argue that this literature should not inform conclusions about psychopaths' neurobiology, especially in forensic contexts. (shrink)

The harm usually associated with psychopathy requires therapeutically, legally, and ethically satisfactory solutions. Scholars from different fields have, thus, examined whether empirical evidence shows that individuals with psychopathic traits satisfy concepts, such as responsibility, mental disorder, or disability, that have specific legal or ethical implications. The present paper considers the less discussed issue of whether psychopathy is a disability. As it has been shown for the cases of the responsibility and mental disorder status of psychopathic individuals, we argue that it (...) is undecided whether psychopathy is a disability. Nonetheless, based on insights from disability studies and legislations, we propose that interventions to directly modify the propensities of individuals with psychopathic tendencies should be balanced with modifications of the social and physical environments to accommodate their peculiarities. We also suggest how this social approach in some practical contexts that involve non-offender populations might be effective in addressing some of the negative effects of psychopathy. (shrink)

The problems psychopathic individuals impose on society and in their interpersonal relationships can be held in stark contrast to reports of their appeal and sexual success in some of those relationships. In the current paper, we seek to contextualize this enigma by focusing on the interpersonal dynamics of psychopathic individuals in romantic encounters. We first formulate a plausible evolutionary function, the sexual exploitation hypothesis, that proposes psychopathy exhibits “special design” features for subverting female mate choice, facilitating the induction of favorable (...) impressions and desire in prospective intimate relationships. We then test the hypothesis in two studies with university samples. Study 1 had young men assessed on psychopathy, social intelligence, and sociosexuality engage in a filmed dating interaction. Study 2 had young women view a subsample of the videos, rate them on desirability, and leave voice messages. Results show psychopathy was related to sociosexuality, specific factors of social intelligence, and generating higher desirability ratings from women after controlling for men’s physical attractiveness. Analyses involving comparisons of two men showed women’s ratings increased in favor of the more psychopathic man. Women’s voice pitch also changed, but only in response to different facets of psychopathy. The results provide preliminary support for the sexual exploitation hypothesis and suggest that more dynamic assessment of putative desirability in psychopathy may be required to capture its plausible special design features in prospective dating encounters. (shrink)

Das Themengebiet der Psychopathie hat in den letzten Jahrzehnten vor allem durch Filme, die sich mit (vermeintlich) psychopathischen Charakteren beschäfti- gen, ein breites gesellschaftliches Interesse erfahren (vgl. Swart 2016). Holly- woods Blockbuster zeigen hier Beispiele hochintelligenter (z. B. Hanibal Lector in „Das Schweigen der Lämmer“) oder sexuell devianter (z. B. Patrick Bateman in „American Psycho“) Serienkiller, welche aus klinischer Sicht tatsächlich hoch psy- chopathische Tendenzen aufweisen. Demgegenüber werden psychisch andersartig beeinträchtigte Filmcharaktere, wie z. B. Norman Bates („Psycho“) oder Travis Bickel (...) („Taxi Driver“) wohl aufgrund ihrer schreckenseinflößenden Wirkung im allgemeinen Sprachgebrauch oft als Psychopathen bezeichnet, obwohl ihre Symptome aus forensisch-psychiatrischer Sicht eher schizoiden Wahnvorstellungen ähneln und keine Anzeichen einer klas- sischen Psychopathie darstellen (vgl. Leistedt / Linkowski 2014). Auch Medienbe- richte über tatsächlich existierende, brutale (z.B. Serienkiller Ted Bundy) oder dreiste (z.B. Anlagebetrüger Bernard Madoff) Figuren der Zeitgeschichte haben die konzeptionelle Unübersichtlichkeit des in der Öffentlichkeit wahrgenommenen Bildes der Psychopathie befeuert. Und sogar in medizinischen bzw. psychiatri- schen Kreisen scheint eine uneinheitliche Sichtweise die Konfusion um das Stö- rungsbild Psychopathie weiter anzufachen (vgl. Berg et al. 2013). (shrink)

The term psychopathy refers to a personality disorder associated with callous personality traits and antisocial behaviors. Throughout its research history, psychopathy has frequently been described as a peculiar form of moral blindness, engendering a narrative about a patient stereotype incapable of taking a genuine moral perspective, similar to a blind person who is deprived of proper visual perceptions. However, recent empirical research has shown that clinically diagnosed psychopaths are morally more fit than initially thought, and the blindness-analogy now comes across (...) as largely misleading. In this contribution, the moral-blindness analogy is explored in an attempt to qualify anew its relevance in psychopathy theory and research. It is demonstrated that there are indeed theoretically relevant parallels to be drawn between blindness and psychopathy, parallels that are especially illuminating when accounting for the potential symptomatology, dimensionality, and etiological nature of the disorder. (shrink)

The Hare Psychopathy Checklist (PCL; Hare, Neumann, & Mokros 2018) scales are among the most widely used forensic assessment tools. Their perceived utility rests partly on their ability to assess stable personality traits indicative of a lack of conscience, which then facilitates behavioral predictions useful in forensic decisions. In this systematic review, we evaluate the empirical evidence behind 3 fundamental justifications for using the PCL scales in forensics, namely, that they are empirically predictive of (1) criminal behavior, (2) treatment outcomes, (...) and (3) a lack of conscience. We found the PCL scales can predict criminal behavior to a statistically significant degree, though with important limitations. We found no evidence of PCL psychopathy being predictive of treatment and rehabilitation outcomes. We found no evidence of PCL psychopathy being predictive of a lack of conscience. These findings disprove widespread beliefs about PCL psychopathy among forensic practitioners and questions the current and future role of the PCL scales in forensic settings. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

Baccarini and Malatesti (2017) defend the idea that we must use coercively biomedical means to enhance the morality of a specific group of individuals: psychopaths, diagnosed through the Psychopathy Checklist-Revised (PCL-R) standards (Hare, 2003). Their argument is theoretical, thus it goes independently from the actual effectiveness of existent treatments, and it is based on a logical reasoning. Moral bioenhancement (MB) means include psychotropic drugs, brain stimulations, neurosurgeries, genetic editing, etc. -/- In short, the authors apply Gerald Gaus' account of open (...) justification (Gaus, 1996, 2011), according to which “a prescription addressed to an agent is a reasoning that includes premises that consider the system of reasons (such as beliefs, preferences, etc.) of that agent” (Baccarini and Malatesti, 2017, p. 1). In their view, coercive MB of psychopaths is morally sound and deducible by reasons within the psychopath's cognitive-affective system—even if the psychopath needs not to be able to consciously or sincerely endorse them. We believe that this argument is flawed. In sum, we argue that the psychopath's cognitive-affective system would consistently justify reasons against mandatory MB to herself, even if she wishes differently for others, and that the prescription cannot be extended. (shrink)

It has been argued that a biomarker-informed classification system for antisocial individuals has the potential to overcome many obstacles in current conceptualizations of forensic and psychiatric constructs and promises better targeted treatments. However, some have expressed ethical worries about the social impact of the use of biological information for classification. Many have discussed the ethical and legal issues related to possibilities of using biomarkers for predicting antisocial behaviour. We argue that prediction should not raise the most pressing ethical worries. Instead, (...) issues connected with ‘biologisation’, such as stigmatization and negative effects on self-image, need more consideration. However, we conclude that also in this respect there are no principled ethical objections against the use of biomarkers to guide classification and treatment of adult antisocial individuals. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

The neuromoral theory of antisocial behaviors argues that impairment to the neural circuitry underlying morality provides a common foundation for antisocial, violent, and psychopathic behavior in children, adolescents, and adults. This article reviews new findings in two research fields since this theory was first proposed: brain mechanisms underlying moral decision-making, and brain systems subserving antisocial behaviors. The neuromoral theory is updated to take into account new empirical findings. Key areas implicated in both moral decision-making and the spectrum of antisocial behaviors (...) include fronto-polar, medial, and ventral prefrontal cortical regions, and the anterior cingulate, amygdala, superior temporal gyrus, and angular gyrus / temporoparietal junction. It is hypothesized that different manifestations of antisocial behavior are characterized by differing degrees of neuromoral dysfunction, with primary psychopathy, proactive aggression, and life-course persistent offending being more affected, and secondary psychopathy, reactive aggression, and crimes involving drugs relatively less affected by neuromoral dysfunction. Limitations of the current model, social contextual factors, neural remediation interventions, ascertaining whether the affective or cognitive component of empathy is most implicated, and directions for future research are outlined. One forensic implication of the model is that significant impairment to the neuromoral circuit could constitute diminished criminal responsibility. (shrink)

Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms. But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between the two approaches, psychiatry is (...) divided... (shrink)

Antisocial behavior is a heterogeneous construct that can be divided into subtypes, such as antisocial personality and psychopathy. The adverse consequences of antisocial behavior produce great burden for the perpetrators, victims, family members, and for society at-large. The pervasiveness of antisocial behavior highlights the importance of precisely characterizing subtypes of antisocial individuals and identifying specific factors that are etiologically related to such behaviors to inform the development of targeted treatments. The goals of the current review are to briefly summarize research (...) on the operationalization and assessment of antisocial personality and psychopathy; to provide an overview of several existing treatments with the potential to influence antisocial personality and psychopathy; and to present an approach that integrates and uses biological and cognitive measures as starting points to more precisely characterize and treat these individuals. A focus on integrating factors at multiple levels of analysis can uncover person-specific characteristics and highlight potential targets for treatment to alleviate the burden caused by antisocial behavior. (shrink)

The diagnosis of psychopathic personality disorder has salience for forensic clinical practice. It influences decisions regarding risk, treatability and sentencing, indeed, in certain jurisdictions it serves as an aggravating factor that increases the likelihood of a capital sentence. The concatenation of symptom that is associated with modern conceptions of the disorder can be discerned in early writings, including the book of Psalms. Despite its forensic clinical importance and historical pedigree the concept remains elusive and controverted. In this paper I describe (...) an attempt to map the concept of psychopathic personality disorder—the Comprehensive Assessment of Psychopathic Personality (CAPP). I outline the processes used to create the concept map; I summarise evidence in support of the content validity of the map and describe different operations designed to operationalise the construct. It is only when conceptual clarity is achieved that valid operations and measures can be created. I end with a plea for more carefully considered application of statistical methods; applications that better fit the theoretical questions being posed. (shrink)

The question of whether psychopaths are criminally and morally responsible has generated significant controversy in the literature. In this paper, we discuss what relevance a psychopathy diagnosis has for criminal responsibility. It has been argued that figuring out whether psychopathy is a mental illness is of fundamental importance, because it is a precondition for psychopaths’ eligibility to be excused via the legal insanity defense. But even if psychopathy counts as a mental illness, this alone is not sufficient to show the (...) insanity defense is applicable; it must also be shown that, as a result of the illness, specific deficits in moral understanding or control are present. In this paper, we show that a diagnosis of psychopathy will generally not indicate that a defendant is eligible for an insanity defense. This is because the group of individuals subsumed under the diagnosis is so heterogeneous that while some psychopaths do show significant impairments in affect and control which may impact on their responsibility, many psychopaths are not incapacitated in a way relevant to responsibility. (shrink)

Editorial introduction to the special issue of the European Journal of Analytic Philosophy.

One of the most prominent models of psychopathy operationalizes this construct as consisting of four factors: interpersonal, affective, lifestyle and antisocial traits. These traits show different relationship patterns with other constructs, and these relations may differ in men and women. The aim of this study was to investigate whether the relations between psychopathic traits and indicators of emotional distress (depression, anxiety and stress), differ between men and women. Data was collected on 650 students (60% women) at the University of Zagreb. (...) The results of Canonical Correlation Analysis indicated that affective psychopathic traits have adaptive potential and represent a protective factor for experiencing emotional distress, while Lifestyle and Antisocial behavior represent risk factors for emotional distress. Moreover, sex had a moderating role in the relationship between Interpersonal and Lifestyle traits and distress, indicating that psychopathic traits seem to be more adaptive in males, compared to females. (shrink)

Objective: Two major etiological theories on psychopathy propose different mechanisms as to how emotional facial expressions are processed by individuals with elevated psychopathic traits. The Response Modulation Hypothesis (RMH) proposes that psychopathic individuals show emotional deficits as a consequence of attentional deployment, suggesting that emotional deficits are situation-specific. The Integrated Emotions System theory (IES) suggests that psychopathic individuals have a fundamental amygdala dysfunction which precludes adequate responsiveness to the distress of others. Methods: Participants performed a visual search task in which (...) they had to find a male target face among two female distractor faces. Top-down attentional set was manipulated by having participants either respond to the face's orientation, or its emotional expression. Results: When emotion was task-relevant, the low-scoring psychopathy group showed attentional capture by happy and fearful distractor faces, whereas the elevated group showed capture by fearful, but not happy distractor faces. Conclusion: This study provides evidence for the RMH such that top-down attention influences the way emotional faces attract attention in individuals with elevated psychopathic traits. However, the different response patterns for happy and fearful faces suggest that top-down attention may not determine the processing of all types of emotional facial expressions in psychopathy. (shrink)

The Antisocial personality disorder and several other psychiatric constructs are questioned and deconstructed in this review, that uses psychoanalytic approach to explain the nature of psychopathy and to give recommendations in this respect. -/- In vorliegender Rezension werden psychiatrische Konstrukte psychoanalytischer Bewertung unterzogen und dekonstruiert. Während die Entität „Antisoziale Persönlichkeitsstörung“ aufgrund ihrer Unwissenschaftlichkeit verworfen wird, besteht mentales Konstrukt „Psychopathie“ der Realitätsprüfung. In weiterem Verlauf der Rezension wird Versuch unternommen, das Phänomen der Psychopathie aufzuklären, um sie begrifflich sowie gesundheitlich einzugrenzen.

This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal psychopathic (...) traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation. (shrink)

Reactive theories of responsibility see moral accountability as grounded on the capacity for feeling reactive-attitudes. I respond to a recent argument gaining ground in this tradition that excludes psychopaths from accountability. The argument relies on what Paul Russell has called the 'subjectivity requirement'. On this view, the capacity to feel and direct reactive-attitudes at oneself is a necessary condition for responsibility. I argue that even if moral attitudes like guilt are impossible for psychopaths to deploy, that psychopaths, especially the "successful" (...) and "secondary" subtypes of psychopathy, can satisfy the subjectivity requirement with regard to shame. I appeal to evidence that embarrassment and shame are grounded on the same affective process and data that psychopathic judgments about embarrassment are neurotypical. If I am right, then psychopaths ought to be open to shame-based forms of accountability including shame punishments. I conclude by considering why psychopaths rarely self-report shame. I argue that lacking a capacity to see oneself as flawed is a different sort of failure than lacking the capacity to feel. (shrink)

We argue that the mandatory moral bioenhancement of psychopaths is justified as a prescription of social morality. Moral bioenhancement is legitimate when it is justified on the basis of the reasons of the recipients. Psychopaths expect and prefer that the agents with whom they interact do not have certain psychopathic traits. Particularly, they have reasons to require the moral bioenhancement of psychopaths with whom they must cooperate. By adopting a public reason and a Kantian argument, we conclude that we can (...) justify to a psychopath being the recipient of mandatory moral bioenhancement because he has a reason to require the application of this prescription to other psychopaths. (shrink)

In this paper it is proposed that important components of moral development and moral judgment rely on two forms of emotional learning: stimulus-reinforcement and response-outcome learning. Data in support of this position will be primarily drawn from work with individuals with the developmental condition of psychopathy as well as fMRI studies with healthy individuals. Individuals with psychopathy show impairment on moral judgment tasks and a pronounced increased risk for instrumental antisocial behavior. It will be argued that these impairments are developmental (...) consequences of impaired stimulus-aversive conditioning on the basis of distress cue reinforcers and response-outcome learning in individuals with this disorder. (shrink)

In the forensic field, psychopathy is a disorder that raises many questions. Indeed, the diagnostic evaluation by the PCL-R offers no opportunity to assess the variability of the disorder on the entire life. However, the dimensional scales used to assess this fluctuation, at least in the medium term. This study helps to validate the CAPP-IRS using the PCL-R with forensic patients.

Current legal practice holds that a diagnosis of psychopathy does not remove criminal responsibility. In contrast, many philosophers and legal experts are increasingly persuaded by evidence from experimental psychology and neuroscience indicating moral and cognitive deficits in psychopaths and have argued that they should be excused from moral responsibility. However, having opposite views concerning psychopaths’ moral responsibility, on the one hand, and criminal responsibility, on the other, seems unfortunate given the assumption that the law should, at least to some extent, (...) react to the same desert-based considerations as do ascriptions of moral responsibility. In response, Stephen Morse has argued that the law should indeed be reformed so as to excuse those with severe psychopathy from blame, but that psychopaths that have committed criminal offences should still be subject to some legal repercussions such as civil commitment. We argue that consequentialist and norm-expressivist considerations analogous to those that support punishing psychopaths or at least retaining some legal liability, might also be drawn on in favour of holding psychopaths morally accountable. (shrink)

Neurobiological theories of psychopathy typically include abnormalities in paralimbic circuits, and a neurobiological profile of paralimbic dysfunction in increasingly invoked in applied legal settings. The current study systematically evaluated whether sMRI and fMRI findings in PCL-R defined psychopaths suggest paralimbic dysfunction. Our review indicates diffuse and variable neural correlates of psychopathy, with numerous issues complicating the interpretation of these heterogeneous data. Our review also extends previous discussions concerning how this heterogeneity may be related to sample characteristics, methodological variations, and statistical (...) analyses. To elucidate the neural correlates of psychopathy, researchers may need to clarify the relationship between psychopathy and co-occurring conditions (such as substance use disorders) both conceptually and methodologically. Our review also indicates that caution is warranted when introducing these data in applied contexts. (shrink)

Psychopathy is associated with persistent antisocial behavior and a striking lack of regret for the consequences of that behavior. Although explanatory models for psychopathy have largely focused on deficits in affective responsiveness, recent work indicates that aberrant value-based decision making may also play a role. On that basis, some have suggested that psychopathic individuals may be unable to effectively use prospective simulations to update action value estimates during cost–benefit decision making. However, the specific mechanisms linking valuation, affective deficits, and maladaptive (...) decision making in psychopathy remain unclear. Using a counterfactual decision-making paradigm, we found that individuals who scored high on a measure of psychopathy were as or more likely than individuals low on psychopathy to report negative affect in response to regret-inducing counterfactual outcomes. However, despite exhibiting intact affective regret sensitivity, they did not use prospective regret signals to guide choice behavior. In turn, diminished behavioral regret sensitivity predicted a higher number of prior incarcerations, and moderated the relationship between psychopathy and incarceration history. These findings raise the possibility that maladaptive decision making in psychopathic individuals is not a consequence of their inability to generate or experience negative emotions. Rather, antisocial behavior in psychopathy may be driven by a deficit in the generation of forward models that integrate information about rules, costs, and goals with stimulus value representations to promote adaptive behavior. (shrink)

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers to the existence of (...) some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)

Psychopathy is a disorder characterized by severe and frequent moral violations in multiple domains of life. Numerous studies have shown psychopathy-related limbic brain abnormalities during moral processing; however, these studies only examined negatively valenced moral stimuli. Here, we aimed to replicate prior psychopathy research on negative moral judgments and to extend this work by examining psychopathy-related abnormalities in the processing of controversial moral stimuli and positive moral processing. Incarcerated adult males (N = 245) completed a functional magnetic resonance imaging protocol (...) on a mobile imaging system stationed at the prison. Psychopathy was assessed using the Hare Psychopathy Checklist–Revised (PCL-R). Participants were then shown words describing three types of moral stimuli: wrong (e.g., stealing), not wrong (e.g., charity), and controversial (e.g., euthanasia). Participants rated each stimulus as either wrong or not wrong. PCL-R total scores were correlated with not wrong behavioral responses to wrong moral stimuli, and were inversely related to hemodynamic activity in the anterior cingulate cortex in the contrast of wrong > not wrong. In the controversial > noncontroversial comparison, psychopathy was inversely associated with activity in the temporal parietal junction and dorsolateral prefrontal cortex. These results indicate that psychopathy-related abnormalities are observed during the processing of complex, negative, and positive moral stimuli. (shrink)

Psychopathy is a personality disorder characterized by interpersonal manipulation and callousness, and reckless and impulsive antisocial behavior. It is often seen as a disorder in which profound emotional disturbances lead to antisocial behavior. A lack of fear in particular has been proposed as an etiologically salient factor. In this review, we employ a conceptual model in which fear is parsed into separate subcomponents. Important historical conceptualizations of psychopathy, the neuroscientific and empirical evidence for fear deficits in psychopathy are compared against (...) this model. The empirical evidence is also subjected to a meta-analysis. We conclude that most studies have used the term "fear" generically, amassing different methods and levels of measurement under the umbrella term "fear." Unlike earlier claims that psychopathy is related to general fearlessness, we show there is evidence that psychopathic individuals have deficits in threat detection and responsivity, but that the evidence for reduced subjective experience of fear in psychopathy is far less compelling. (shrink)

Recent developments in neuroscience have inspired proposals to perform deep brain stimulation on psychopathic detainees. We contend that these proposals cannot meet important ethical requirements that hold for both medical research and therapy. After providing a rough overview of key aspects of psychopathy and the prospects of tackling this condition via deep brain stimulation, we proceed to an ethical assessment of such measures, referring closely to the distinctive features of psychopathic personality, particularly the absence of subjective suffering and a lack (...) of moral motivation. Scrutiny of these factors reveals that two essential bioethical criteria, individual medical benefit and voluntary informed consent, cannot be met in performing neurosurgical experiments or treatments on psychopathic inmates. (shrink)

Researchers who argue that moral judgment is based on emotions (`emotion-backers') and those who believe that it is based on reasoning and deliberation (`reasoning-backers') have both struggled to account for the notorious moral deviance of incarcerated psychopaths. Emotion-backers, such as Jonathan Haidt, focus on psychopaths' lack of a affect,or defciencies in particular emotions, such as sympathy. Reasoning-backers, such as Lawrence Kohlberg, focus instead on psychopaths' de cient reasoning. Both accounts offer separate descriptions of what goes wrong in the disorder, but (...) neither can fully explain psychopathic moral deviance. The moral account that I built, bridges these accounts in an attempt to better and more fully describe the empirical data available on psychopathic moral judgment. I argue that their judgment is best explained with a dual-process account of moral judgment that incorporates a large system of moral emotions as well as integrates multiple bases of morality, such as concerns of fairness, harm, and purity. It is only by focusing on both the reasoning and emotional de cits in psychopaths that we can begin to understand psychopaths' use of utilitarian reasoning, general population psychopaths, and psychopaths' di erential presence in the prison popu- lation. All of these issues are best described using a dual-process account of moral judgment that incorporates a larger system of moral emotions than other accounts of morality as well as a pluralistic conception of moral foundations. I used psychopaths because their moral deviance can teach us about morality more broadly. By understanding the cognitive processes implicated in the moral judgment of psychopaths, I better explain how moral judgment works in the general population more broadly. My account of moral judgment has both theoretical and practical applications. Theoretically, it o ers a new dual-process paradigm for describing moral behaviour which bridges reasoning-based and emotion-based accounts. This description can explain both the moral deviance of psychopaths as well as, more broadly, moral judgment in non-psychopaths. Additionally, my theory challenges accounts of moral emotion that narrowly focus on speci c emotions, such as guilt or empathy. It in- stead integrates all emotions, including disgust, fear, and sympathy, and links speci c emotions to moral judgments. Practically, my paradigm of moral judgment encourages the development of new moral judgment measurements such as new self-report questionnaires of moral reasoning. According to my research, in order for these tools to accurately measure morality, they need to account for both emotion-based and reasoning-based judgments. (shrink)

Background -/- Psychopathy is a mental health disorder characterized by callous and impulsive antisocial behavior, and it is associated with a high incidence of violent crime, substance abuse, and recidivism. Recent studies suggest that the striatum may be a key component of the neurobiological basis for the disorder, although structural findings have been mixed, and functional connectivity of the striatum in psychopathy has yet to be fully examined. Methods -/- We performed a multimodal neuroimaging study of striatum volume and functional (...) connectivity in psychopathy using a large sample of adult male prison inmates (N = 124). We conducted volumetric analyses in striatal subnuclei and subsequently assessed resting-state functional connectivity in areas where volume was related to psychopathy severity. -/- Results -/- Total Psychopathy Checklist Revised and factor 2 scores (which index the impulsive/antisocial traits of psychopathy) were associated with larger striatal subnuclei volumes and increased volume in focal areas throughout the striatum, particularly in the nucleus accumbens and putamen bilaterally. Furthermore, at many of the striatal areas where volume was positively associated with factor 2 scores, psychopathy severity was also associated with abnormal functional connectivity with other brain regions, including dorsolateral prefrontal cortex, ventral midbrain, and other areas of the striatum. The results were not attributable to age, race, IQ, substance use history, or intracranial volume. Conclusions -/- These findings associate the impulsive/antisocial dimension of psychopathy with enlarged striatal subnuclei and aberrant functional connectivity between the striatum and other brain regions. Furthermore, the colocalization of volumetric and functional connectivity findings suggests that these neural abnormalities may be pathophysiologically linked. (shrink)

nstrumental or goal-directed aggression is a core feature in violent offenders with psychopathic tendencies. To understand this type of behavior, previous work in the field of aggression has focused on affective processing, with mixed results. We propose that instrumental aggression is best understood in terms of the consequences of affective processing for instrumental behavior rather than affective processing per se. Therefore, we assessed the degree of affective biasing of instrumental action in a group of violent offenders with psychopathic tendencies and (...) healthy controls using a validated affective decision-making task. Participants learned whole body approach-avoidance actions upon instrumental targets based on monetary feedback, while being primed by aversive versus appetitive facial stimuli. Unlike controls, instrumental behavior in violent offenders was not influenced by the affective stimuli. Specifically, violent offenders showed reduced instrumental avoidance in the context of aversive (vs. appetitive) stimuli relative to controls. This finding suggests that reduced affective biasing of instrumental behavior may underlie the behavioral anomalies observed in violent offenders with psychopathic tendencies. More generally, the finding underscores the relevance of examining the interaction between affect and instrumental behavior for a better understanding of dysfunctional behaviors in psychiatric populations. (shrink)

Deficits in reinforcement learning are presumed to underlie the impulsive and incorrigible behavior exhibited by psychopathic criminals. However, previous studies documenting reversal learning impairments in psychopathic individuals have not investigated this relationship across a continuous range of psychopathy severity, nor have they examined how reversal learning impairments relate to different psychopathic traits, such as the interpersonal-affective and lifestyle-antisocial dimensions. Furthermore, previous studies have not considered the role that childhood maltreatment and substance use may have in this specific cognitive deficit. Using (...) a standard reversal learning task in a sample of N = 114 incarcerated male offenders, we demonstrate a significant relationship between psychopathy severity and reversal learning errors. Furthermore, we show a significant interaction between psychopathy and childhood maltreatment, but not substance use, such that individuals high in psychopathy with an extensive history of maltreatment committed the greatest number of reversal learning errors. These findings extend the current understanding of reversal learning performance among psychopathic individuals, and highlight the importance of considering childhood maltreatment when studying psychopathy. (shrink)

This groundbreaking volume of original essays presents fresh avenues of inquiry at the intersection of philosophy and psychiatry. Contributors draw from a variety of fields, including evolutionary psychiatry, phenomenology, biopsychosocial models, psychoanalysis, neuroscience, neuroethics, behavioral economics, and virtue theory. Philosophy and Psychiatry’s unique structure consists of two parts: in the first, philosophers write five lead essays with replies from psychiatrists. In the second part, this arrangement is reversed. The result is an interdisciplinary exchange that allows for direct discourse, and a (...) volume at the forefront of defining an emerging discipline. Philosophy and Psychiatry will be of interest to professionals in philosophy and psychiatry, as well as mental health researchers and clinicians. (shrink)

In the first meta-analytic review of the response modulation hypothesis (RMH), an attention-based model for understanding the etiology of psychopathy, Smith and Lilienfeld (2015) report that the average effect size for response modulation deficits in psychopathic individuals fell in the small to medium range (r = .20; p. < .001, d = .41). Moreover, support for the RMH extended to both psychopathy dimensions, across diverse assessments and settings, and spanned child, adult, female, and male samples. The analysis also revealed good (...) empirical support for a central tenet of the RMH, namely that response modulation deficits are not limited to the processing of threat or other emotion stimuli. Unfortunately, the Smith and Lilienfeld meta-analysis contains several theoretical and quantitative problems, including failing to distinguish adequately between the tasks used to evaluate RMH predictions and the theory itself, confusion regarding the evolution of the RMH and its impact on effect sizes, misinterpretations of RMH predictions and evidence regarding dominant response sets, passive avoidance, and primary task performance, and biased statements promoting the low fear model over the RMH. In this response, we endeavor to reduce misunderstanding by addressing the most salient issues, with the hope that increasing clarity will sharpen the focus of future research and result in more valid assessments of the RMH. (shrink)

Hübner and White argue that we should not administer DBS to psychopathic prisoners. While we are sympathetic to their conclusion, we argue that the authors’ two central arguments for this conclusion are problematic. Their first argument appeals to an overly restrictive conception of individual medical benefit: namely, that an individual medical benefit must alleviate subjective suffering. We highlight cases that clearly constitute individual medical benefits although there is no relief of subjective suffering. The second argument depends on an overly restrictive (...) conception of the sort of motivation needed to ground consent to a medical procedure. It is also too quick to treat it as unproblematic to consider psychopaths as fully competent. We argue that this view overlooks certain kinds of internal motivation. It also overlooks the possibility that after successful activation of underactive brain-regions, a former psychopath might become a better representative of his or her “true self.” -/- . (shrink)

I argue that deep brain stimulation (DBS) is a bad approach for incarcerated psychopaths for two reasons. First, given what we know about psychopathy, empathy, and DBS, it is unlikely to function as an effective treatment for the moral problems that characterize psychopathy. Second, considerations of neurodiversity speak against seeing psychopathy as a mental illness in the first place.

Psychopathy is a personality disorder characterized by emotional deficits and a failure to inhibit impulsive behavior and is often subdivided into “primary” and “secondary” psychopathic subtypes. The maladaptive behavior related to primary psychopathy is thought to reflect constitutional “fearlessness,” while the problematic behavior related to secondary psychopathy is motivated by other factors. The fearlessness observed in psychopathy has often been interpreted as reflecting a fundamental deficit in amygdala function, and previous studies have provided support for a low-fear model of psychopathy. (...) However, many of these studies fail to use appropriate screening procedures, use liberal inclusion criteria, or have used unconventional approaches to assay amygdala function. We measured brain activity with BOLD imaging in primary and secondary psychopaths and non-psychopathic control subjects during Pavlovian fear conditioning. In contrast to the low-fear model, we observed normal fear expression in primary psychopaths. Psychopaths also displayed greater differential BOLD activity in the amygdala relative to matched controls. Inverse patterns of activity were observed in the anterior cingulate cortex (ACC) for primary versus secondary psychopaths. Primary psychopaths exhibited a pattern of activity in the dorsal and ventral ACC consistent with enhanced fear expression, while secondary psychopaths exhibited a pattern of activity in these regions consistent with fear inhibition. These results contradict the low-fear model of psychopathy and suggest that the low fear observed for psychopaths in previous studies may be specific to secondary psychopaths. (shrink)

Cognitive remediation is a treatment approach with the potential to translate basic science into more specific, mechanism-based interventions by targeting particular cognitive skills. The present study translated understanding of two well-defined cognitive-affective dysfunctions into novel deficit-matched interventions and evaluated whether cognitive remediation would demonstrate specific and generalizable change. Two antisocial subtypes, individuals with psychopathy and externalizing traits, are characterized by cognitive-affective problems that predispose them to engage in significant substance abuse and criminal behavior, culminating in incarceration. Whereas individuals with psychopathy (...) fail to consider important contextual information, individuals with externalizing traits lack the capacity to regulate affective reactions. Training designed to remedy these subtype-specific deficits led to improvement on both trained and nontrained tasks. Such findings offer promise for changing neural and behavioral patterns, even for what many consider to be the most recalcitrant treatment population, and presage a new era of translating cognitive-affective science into increasingly specific and effective interventions. (shrink)

Three studies examined Jones’(Perspectives onPsychological Science, 9, 445-451,2014) suggestion that psy-chopathic individuals use mimicry to avoid detection. In study1, student, community, and offender participants posed fearfulfacial expressions while looking at a prototypical fear face.Expressions were coded for facial movements associated withfear and were rated on genuineness by a separate sample ofundergraduates. Across samples, psychopathic traits were as-sociated with increased use of typical action units for fearfulfacial expressions and with genuineness ratings. In study 2,undergraduates completed the Psychopathic PersonalityInventory and told a (...) story about a time when they did some-thing that theyshouldhave felt remorseful for but did not.Factor 1 traits were found to positively relate to genuinenessscores given by a separate sample of undergraduates. Finally,in study 3, four videos of false remorse stories told by violentoffenders were rated by a sample of undergraduates. Thetwo high factor 1 videos received significantly highergenuineness ratings, supporting the relationship betweenfactor 1 and affective mimicry. Overall, findings suggestthat the psychopathic traits (specifically, factor 1) may beassociated with the ability to accurately mimic emotionalexpression (fear and remorse) leading others to perceiveemotional genuineness. (shrink)

The standard philosophical definition of placebos offered by Grünbaum is incompatible with Cartwright’s conception of randomized clinical trials. I offer a modified account of placebos that respects this role and clarifies why many current medical trials fail to warrant the conclusions they are typically seen as yielding. I then consider recent changes to guidelines for reporting medical trials and show that pessimism over parsing out the cause of “unblinding” is premature. Specifically, using a trial of antidepressants, I show how more (...) sophisticated statistical analyses can parse out the source of such effects and serve as an alternative to placebo control. (shrink)

There is a paucity of research on how psychopathy relates to decision-making. In this study, we assessed the relationship between affective decision-making and psychopathic personality. A sample of prisoners (n D 49) was characterized in terms of psychopathic traits using the Psychopathic Checklist: Screening Version (PCL:SV). Decision-making was assessed using the Iowa Gambling Task (IGT). Higher levels of psychopathy related to more advantageous choices (p D .003). Also counter-intuitively, higher levels of antisocial traits (facet 4) predicted advantageous choices during the (...) learning phase of the task (p D .004). Our findings suggest that some psychopathic facets may be more relevant to decisionmaking under risk, and highlight the importance of further investigations considering facet and trait-level relationships with decision-making. (shrink)