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Personality Disorders With Psychopathy Notes

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Personality disorders (with psychopathy)
= tendency to persistently disregard and violate the rights of others through deceitful, aggressive, and antisocial behaviours
A. Pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years
B. At least 18 years old
C. Evidence of CD with onset before age 15 years
D. Occurrence of antisocial behaviour is not exclusively during the course of SZ or bipolar disorder

Repeatedly performing acts that are grounds for arrest
Shows deceitfulness impulsivity, irritability, aggressiveness
Disregard for safety
Consistent irresponsibility in work or financial matters

ASPD = 3% M, 1% F
BUT Hare et al., 2012: found ASPD prevalence is 5 in 1 in males and estimates general prevalence of psychopathy at 1% in North America

= moral insanity
 affective and interpersonal traits eg lack of empathy, inflated/arrogant self-appraisal, superficial charm
Cleckley (1976): distinguished from general externalising problems by 'emotional detachment', which is a lack of normal emotional sensitivity and social relatedness
Subtypes of Psychopathy
Porter (1996):
Primary Psychopathy: born with a predisposition to interpersonal and affective features of psychopathy
Secondary Psychopathy: acquired deficits associated with psychopathy following negative life events
Assessment of Psychopathy - PCL-R (Hare, 1991) Personality disorders (with psychopathy)
2nd dimension if more closely related to the DSM diagnosis of ASPD
Patrick, 2005: 70-80% of prisoners qualify for a diagnosis of ASPD but only 25-30% meet the criteria for psychopathy
½ those with ASPD are also psychopathic, but most who are psychopathic also have ASPD
Hare, 1999: show antisocial/aggressive behaviour of ASPD but not selfish/callous traits of psychopathy
Many researcher use Cleckley/Hare psychopathy diagnosis rather than DSM ASPD diagnosis
Hare et al., 2012: psychopathy diagnosis has been shown to be a better predictor of a variety of important facets of criminal behaviour than the ASPD diagnosis
Concern of conceptualising ASPD:
Patrick 2006: Cleckley did not believe aggressive behaviour was central to the concept of psychopathy 
eg lawyers, politicians
Wisdom, 1977: advertised for adventurous, daring people in a newspaper  those who responded were tested and had similar personality makeup to that of institutionalised psychopaths
Ishikawa et al., 2001: aggressive vs nonaggressive psychopaths may differ biologically

Walters & Kiehl, 2015:
Negative correlations between:
 Fearlessness dimension of the Psychopathy Checklist and gray matter vol in amygdala
 Amygdala involved in fear conditioning
 Disinhibition dimension and gray matter vol in the hippocampus
 Hippocampus involved in behavioural inhibition
 supports construct validity of the Psychopathy Checklist

Inadequate conscience development
Unable to understand and accept ethical values other than superficially = empty words to psychopaths
Frick & Marsee, 2006: behave as those social regulations and laws do not apply to them
BUT normal intelligence  2 dimensions:

1. Affective interpersonal dimension is positively related to verbal intelligence

2. Antisocial dimension is negatively related to intelligence

Irresponsible and impulsive behaviour  RE ASPD dimension
Thrill seeking, impulsive behaviour without regard for consequences
Taylor & Lang, 2006: ASPD and some psychopaths have high rates of alcohol abuse and dependence
Patrick, 2005: alcohol abuse only related to the antisocial dimension
Verona et al., 2001: elevated rates of suicide attempts only associated with the second dimension Personality disorders (with psychopathy)
Ability to impress and exploit others
Cleckley, 1941: superficially charming, with a disarming manner that easily wins new friends
Good insight into others' needs  exploit them
Manipulates friends  struggles to keep LT friends

Cognitive Processing
Impairments in processing emotional stimuli
Adolescents with anti-social behaviour problems fail to process affective stimuli in the same way
Problems with impulse control: Christian et al., 1997
Barry et al., 2000:
CU traits + impulsivity + Conduct problems = reward dominant response style, thrill seekers
Lack of fear to threatening stimuli
Kimonis et al., 2006:
Examined aggression, psychopathy traits and processing of negative emotion stimuli in children
Those with high scores on psychopathy and aggression had a reduced response to distressing images
Children with high aggressive traits and low psychopathy scores showed enhanced response to distressing stimuli

Lynam et al., 2007:
Measured the predictive efficiency of age 13 psychopathy
At age 24, Ps were divided into those who would receive a possible diagnosis of psychopathy and those who would definitely not be considered psychopathic
Approx. 9% of the sample were identified as possibly psychopathic at age 24
Psychopathy was assessed by interviewers using the Psychopathy Checklist
Found stability of psychopathy from adolescence into adulthood

Charac of CU traits
Lynam (1998, 1999) suggests that psychopathy widely theorised to be a personality attribute, ought to be recognisable prior to adulthood
 Lack of remorse/guilt
 Lack of empathy
 Shallow affect
 Manipulate others
 Sense of grandiosity
Frick et al., 2006:
CU traits correlated sig with measures of conduct problems and psychosocial impairment
CU traits showed predicted assoc with sensation seeking and the Big 5 personality dimensions, supporting the construct validity of the measure of CU traits Personality disorders (with psychopathy)
Waller et al., 2013:
Dimensions of parenting predict CU traits in prospective longitudinal studies
Those with high levels of CU traits and Antisocial Behaviour experienced negative parenting practices
Parenting-focused interventions are effective in reducing the level of AB and CU traits in youths
Implications for later life
McMahon et al., 2010:
Longitudinal study examining CU traits in young people
Parents reports of psychopathy was gathered in school
High scores of CU traits were linked to self-reported general delinquency, juvenile and adult arrests, and both early adult antisocial PD criterion and diagnosis
Frick et al., 2013: Psychopathic traits remain stable from childhood to adulthood in its severest form

Genetics and Heredity
Viding & McCroy, 2012: Twin studies: CU traits in childhood show moderate-to-high levels of heritability
Viding et al., 2005: twin study at age 7  early sings of callous/unemotional traits were highly heritable
Hare et al. 2006: psychopathy and some of its important features show a moderate heritability

Blonigen et al., 2008:
Focused on 2 time points 7 years apart, when the twins were 17 and 24 y/o 58% of the stability of CU traits was due to genetic influences
Brain structure
Kiehl, 2006: Paralimbic system dysfunction  meta-analysis
Brain regions implicated =
 Orbital frontal cortex
 Insula
 Anterior and posterior cingulate
 Amygdala
 Parahippocamapl gyrus
 Anterior superior temporal gyrus
 ie paralimbic system
Reduced activity is observed in psychopaths during language processing in the R anterior superior temporal gyrus, amygdala, and anterior/posterior cingulate
Psychopathy is assoc with abnormal ERP waveforms for a variety of stimuli salient, visual and auditory stimuli
Orbital frontal cortex

Damasio, 1994: Damage to the orbital frontal cortex leads to 'acquired sociopathic personality'
Patients with orbital frontal lesions show impairment on:

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