Perhaps the most convincing recent evidence for subtypes of psychopathy has come from the application of statistical techniques to develop clusters, or classes, of individuals who vary in the specific collection of traits they appear to show. Using such techniques in a large sample of adult male offenders, three distinct variants of extreme scorers on the PCL-R have been identified: two of these variants presented as ‘true’ psychopaths, and were termed manipulative and aggressive types, while a third variant, termed sociopathic, was found to be conceptually more similar to ASPD (Mokros, Hare, Neumann, Santtila, Habermeyer, & Nitschke, 2015).
3.3 PSYCHOPATHY AND AGGRESSION
Psychopathy is associated with high levels of violent behaviour. Hemphill, Hare, & Wong (1998) identified significant correlations of PCL-R scores with general recidivism, violent recidivism and sexual recidivism. While general recidivism was three times higher among psychopaths, violent recidivism was found to be four times higher among psychopaths than non-psychopaths. Moreover, it was found that PCL-R scores offer additional predictive power over other actuarial (e.g., criminal history, personality disorder) risk scales for violent, but not general recidivism. However, the relationship of psychopathy and violence is not straightforward. Acts of aggression can be classified as either reactive or proactive/instrumental (see Textbox 3.2). Blair (1995, 2001) has argued that high levels of instrumental aggression distinguish psychopaths from sufferers of other disorders that are similarly linked with elevated levels of aggression or violence. Support for this proposition has come from studies of violent offenders (Cornell, Warren, Hawk, Stafford, Oram, & Pine, 1996) and murderers (Woodworth & Porter, 2002; Porter, Woodworth, Earle, Drugge, & Boer, 2003), with virtually all murders committed by psychopaths being perpetrated for instrumental motives.
TEXTBOX 3.2
Reactive aggression refers to an unplanned or impulsive act of violence in response to some form of provocation, threat or danger. By contrast, instrumental aggression is characterised by goal-directed acts of violence (for example, to gain money or drugs) that are typically executed in a predetermined and calculated manner.
3.4 CORRELATES OF PSYCHOPATHY IN ADOLESCENTS AND CHILDREN
There has been much debate over whether adolescents can be diagnosed as psychopaths. This in part reflects reluctance on behalf of some practitioners to label an individual with such a serious diagnostic label at a young age. Moreover, there have been concerns that any apparent callous and unemotional personality features seen in adolescence may in fact be transient and not enduring traits. The term “conduct disorder” (CD) (see Textbox 3.3) is applied to adolescents and children who show persistent antisocial behaviour and whose actions appear impulsive and irresponsible. The prevalence of CD is high, with Forth and Burke (1998) suggesting that up to 97% of adolescent offenders meet the diagnostic criteria. However, children with CD may also show a pattern of callous and unemotional (CU) traits. These traits are associated with a pattern of instrumental aggression similar to that seen in adult psychopaths (Frick, Cornell, Barry, Bodin, & Dane, 2003; Kruh, Frick, & Clements, 2005). Recent work that has examined CU traits in children has shown that these traits are stable from childhood to adolescence (Muñoz & Frick, 2007) and are predictive of psychopathy in adulthood (Burke, Loeber, & Lahey, 2007; Lynam, Caspi, Moffitt, Loeber, & Stouthamer-Loeber, 2007). The conclusion is supported by the observation that children with CU traits also show behavioural and neuropsychological characteristics previously observed among adult psychopaths, including fear deficits.
TEXTBOX 3.3
Conduct disorder (CD) is defined as a repetitive and persistent pattern of behaviour in childhood in which the basic rights of others, or societal conventions are flouted. It is often seen as precursor of later antisocial behaviour. Many individuals with CD show little empathy and concern for others, and may frequently misperceive the intentions of others as being more hostile and threatening than is actually the case.
3.5 GENETIC BASIS OF PSYCHOPATHY
Speculation that psychopathy may have a genetic basis dates back to Karpman (1941) who noted that the core personality features of the condition may be familial. Recent work has supported this idea with several studies now showing that CU traits may be heritable. Much of this work has been based on twin studies, with Blonigen, Carlson, Krueger, and Patrick (2003), for example, studying psychopathic traits in 353 male twins. The twin study of Taylor, Loney, Bobadilla, Iacono, and McGue (2003) concluded that the total genetic variance in the CU features of psychopathy is 42%. This is substantially greater than their estimate of 23% for the genetic basis of antisocial behaviour. The study of a sample of 1,090 monozygotic and dizygotic twins (see Textbox 3.4) by Larsson, Andershed, and Lichtenstein (2006) assessed the genetic and environmental contributions to the interpersonal, affective and behavioural/lifestyle features of psychopathy. The results suggested that there was an overall genetic influence on each of these three features and, in addition, unique heritable contributions to the affective and behavioural/lifestyle features.
TEXTBOX 3.4
Monozygotic (MZ) twins develop from the same fertilised egg that will later split to form two embryos. MZ twins share nearly identical genetic information, are of the same sex and appear physically similar. Dizygotic (DZ) twins develop from two different eggs that are fertilised by separate sperm cells. DZ twins may be of the same or opposite sex, and differ both physically and genetically.
One of the largest twin samples included in psychopathy research was that of 3,687 twin children aged around 7 years, studied by Viding, Blair, Moffitt, and Plomin (2005). The work focussed on CU traits and antisocial behaviour with the results showing a strong genetic influence for CU traits and antisocial behaviour even when the twins did not share a common environment. The genetic influence on antisocial behaviour was substantially attenuated in children who did not show high CU traits. Similar relationships were seen in these twin pairs when reassessed at the age of 9 (Viding, Jones, Frick, Moffitt, & Plomin, 2008). Furthermore, the genetic contribution of CU traits increased when symptoms of hyperactivity were controlled for.
3.6 FAMILY FACTORS ASSOCIATED WITH THE DEVELOPMENT OF PSYCHOPATHY
Early traumatic experience, whether it is via neglect or abuse (see Chapter 5, Section 5.2), is often considered to be a predictor of antisocial behaviour in later life. The relationship of early adverse experiences and psychopathy, however, is complex. As detailed above, the affective deficits that are fundamental to psychopathy are assumed to be inherited and therefore should be relatively immune to the influence of societal and environmental factors (Skeem, Poythress, Edens, Lilienfeld, & Cale, 2003; Poythress & Skeem, 2006). However, the lifestyle and antisocial features of the disorder, that is those that are related to Factor 2 on the PCL-R, are assumed to be acquired (Skeem, Johansson, Andershed, Kerr, & Louden, 2007) and may constitute an emotional response to a harsh environment. These environmental factors would include parental conflict, rejection, neglect and harsh or inconsistent punishment. This view is supported by the work of Campbell, Porter, and Santor (2004), which showed that psychopathic traits among youth were associated with early physical abuse and non-parental living arrangements. These conclusions are supported by the results of longitudinal studies that have identified several family risk factors that are predictive of the development of the antisocial aspects of psychopathy but not the interpersonal and affective features (Lang, Klinteberg, & Alm, 2002; Farrington, 2003).
This relatively simple model, however, is complicated by the need to distinguish between early abuse and neglect. Weiler and Widom (1996) reported that high PCL scores of adults were associated with the experience of childhood abuse and neglect. However, Marshall and Cooke (1999) argued that psychopathic tendencies are more associated with parental neglect rather than early physical abuse. The distinction between abuse and neglect and their relationship to psychopathy has important implications when considering potential neurochemical changes in psychopaths.
3.
7 ATTACHMENT, PSYCHOPATHY AND OFFENDING
Considerable attention in criminological research has focussed on the role of attachment in offending. The style of attachment bond between an infant and its primary caregiver is assumed to be relatively constant across development and shapes the nature of intimate romantic relationships in adulthood. Chapter 4 of this volume discusses attachment in slightly more depth, but to briefly reiterate here, four different styles of attachment have been described based on the classic work of Ainsworth et al. using the strange situation paradigm (Ainsworth, Blehar, Waters, & Wall, 1978). These styles are referred to as secure, ambivalent, avoidant and disorganised (Crittenden, 1988; Main & Solomon, 1990). The last three styles are considered to be variants of insecure attachment styles with disorganised resulting from a mix of avoidant-anxious attachment types. An equivalent of these infant attachment styles has also been identified in adult relationships, though a different nomenclature has been developed to describe them, namely, secure, preoccupied, dismissive and fearful (Bartholomew & Horowitz, 1991). These four styles are thought to result from differing levels of anxiety over abandonment and the avoidance of intimacy (Brennan, Clark, & Shaver, 1998; Shaver & Hazan, 1993). A secure attachment style in adults is characterised by low levels of anxiety and avoidance whereas preoccupied and dismissive styles result from high levels of anxiety and avoidance, respectively. By contrast, fearful attachment styles reflect heightened levels of both anxiety and avoidance tendencies.
Negative early family factors, such as neglect, and sexual and physical abuse (Farrington, 2003) play important roles in the emergence of antisocial behaviour and may also be associated with the development of psychopathic traits. However, it should be noted that the effects of neglect on social functioning may be different to those of abuse. Some of the negative effects of early abuse and neglect that may initially manifest themselves are problems with attachment. Finzi, Ram, Har-Even Shnitt, & Weizman (2001) noted that children who had experienced early physical abuse tended to show an avoidant attachment style whereas neglect was associated with ambivalent attachment. Furthermore, physically abused children showed greater levels of aggression and antisocial behaviour than neglected and control children (Finzi et al., 2001). Similarly, Allen, Hauser and Borman-Spurrell (1996) showed that attachment difficulties are associated with criminality and drug abuse and a dismissive style of attachment has been associated with antisocial personality traits (Rosenstein & Horowitz, 1996) and sexual offending (Ward, Hudson & Marshall, 1996). A direct link between insecure attachment style and psychopathy has been reported by Frodi, Dernevik, Sepa, Philipson and Bragesjö (2001) who noted that that incarcerated psychopaths typically show dismissive attachment styles. However, this observation may be indicating that dismissive attachment style is predictive of antisocial behaviour and personality disorders in general, rather than psychopathy in particular.
3.8 FACIAL EXPRESSION RECOGNITION
Psychopathic traits may be linked to a relatively specific profile of neuropsychological deficits. Key amongst these deficits is problems with recognising facial expressions of emotion in others, with particular deficits observed for the expression of fear (Blair et al., 2004). Blair (1995, 2001) has constructed a model, the Violence Inhibition Mechanism (VIM) to account for why psychopaths are so prone to using instrumental aggression. The model assumes that recognising that one’s actions are causing distress in another individual is experienced as aversive, and thus leads to the inhibition of the distress inducing behaviours. It is argued by Blair (1995, 2001) that the inability of psychopaths to detect facial expressions communicating distress, notably fear and sadness, leaves them vulnerable to continuing to act in fear inducing ways. As psychopathy represents a developmental disorder these deficits would be expected to be present across the lifespan. Indeed, Blair, Colledge, Murray, and Mitchell (2001) have shown that deficits in recognising fearful and sad facial expressions are present in children with psychopathic tendencies. As such, from an early age, individuals with elevated psychopathic traits would be expected to show an impaired ability to experience others distress as aversive, owing to deficits in the recognition of fear and sadness cues.
PHOTO 3.1 Psychopaths have problems with recognising facial expressions of emotion in others, with particular deficits observed for the expression of fear.
Source: © Benoit Daoust/Shutterstock.
The amygdala has been assumed for some time as being the neural structure that is most critically involved in the processing of emotional facial expressions, and expressions of fear in particular (Adolphs, 2002; Blair, 2003). Thus, patients with bilateral amygdala damage show impaired recognition of fear face affect (Adolphs, Tranel, Damasio, & Damasio, 1994; Calder, 1996). When considering work on patients with unilateral amygdala damage, however, there are some inconsistencies, and these patients typically show intact recognition of fearful faces (Adolphs, Tranel, Damasio, & Damasio, 1995). Whether such deficits in emotion recognition following bilateral amygdala damage extend to other emotions, for example, anger, is still a matter of debate. However, Adolphs et al. (1999) have argued that the deficits in fearful face recognition associated with amygdala damage may result from problems retrieving previously acquired knowledge about the emotion of fear.
PHOTO 3.2 The amygdala has been assumed for some time as being the neural structure that is most critically involved in the processing of emotional facial expressions, and expressions of fear in particular. It lies at the anterior pole of the temporal lobe, which is shown here in green.
Source: © Vasiliy Yakobchuk/iStockphoto
3.8.1 A Neurobiological Model of Fearful Face Recognition Deficits in Psychopathy
A tight relationship has been observed between the processing of fearful facial expressions and neural activity in the amygdala (Breiter, et al., 1996; Morris et al., 1996; Morris, Öhman, & Dolan, 1999; Whalen et al., 2001). It would accordingly be predicted that psychopathy is associated with low levels of amygdala activity. Evidence to support this hypothesis has been found by Gordon, Baird, and End (2004) who showed that the amygdala of non-offenders with high scores on the PPI were less active than participants with low scores when doing a facial emotion recognition task. These diminished neural responses were related to the emotional-interpersonal aspect of the condition. Interestingly, the high scoring participants also showed increased activity in prefrontal areas, implying that high level cognitive mechanisms were being deployed to solve the emotional recognition task. By contrast, high scores on the social deviance aspects of the PPI was associated with increased as opposed to decreased activity in the amygdala during these tasks.
Attempts to replicate this amygdala hypoactivity finding in convicted psychopaths have been unsuccessful, potentially as a result of small sample sizes (Deeley et al., 2006). However, support has been found in studies of children with callous-unemotional traits (Marsh et al., 2008; Jones, Laurens, Herba, Barker, & Viding, 2009). The abnormal amygdala functioning in these children when processing fearful facial expressions appears to be linked to CU traits rather than ADHD or generally antisocial behaviour. These adolescents also showed a reduction in the functional connectivity between ventromedial prefrontal cortex (VMPFC) and the amygdala, which was related to the severity of the psychopathic symptoms.
3.8.2 Eye Scan Paths, Fearful Face Recognition and Psychopathy
Children with callous-unemotional traits show a tendency to look at the mouth region of faces rather than the eyes. This deficit correlates with a failure to be able to detect facial expressions of fear, potentially because the eyes represent the major source of facial information relating to this emotion (Dadds et al., 2006; Dadds, El Masry, Wimalaweera, & Guastella, 2008). In keeping with this interpretation, instructing children with CU traits to specifically focus on the eye region of the face results in an increase in their ability to detect fearful expressions (Dadds et al., 2006). A similar lack of attention to the eye region has also been noted in relation to the interpersonal/affective
, but not the lifestyle/antisocial features of psychopathy among adult male non-offenders (Gillespie, Rotshtein, Wells, Beech, & Mitchell, 2015).
These deficits may reflect abnormal amygdala functioning, and are consistent with studies of amygdala activation in that reduced attention to the eyes was related to the affective aspects, but not the behavioural aspects, of psychopathic personality. Support for a relationship of amygdala function with attention to the eyes is presented in studies of amygdala patients who show poor fearful face recognition. In one patient with bilateral amygdala damage, impaired fear recognition was associated with reduced attention to the eye region of emotional faces (Adolphs et al., 2005). This implies that the amygdala is critically involved in directing visual attention toward the eye region of fearful faces.
3.9 PSYCHOPATHY AND AVERSIVE CONDITIONING
The deficits in fearful facial expression recognition and poor focussing on the eye region of the face are both indicative of impaired amygdala functioning. Studies with experimental animals have shown that the destruction of specific groups of neurons in the monkey amygdala results in a loss of conditioned fear responses without having an apparent effect on anxiety-like behaviours (Kalin, Shelton, Davidson, & Kelley, 2001). Thus, psychopaths may lack amygdala-based fear responses without lacking in the experience of anxiety.
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