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									    A comprehensive
  developmental view of
psychopathic personalities

   David X. Swenson PhD LP
Gerald Henkel-Johnson PsyD LP

     MnATSA Conference
        April 6, 2006
      Minneapolis, MN

• Why this workshop?
• Meet the psychopath (video vignettes)
• Diagnostic criteria for ASP & the “antisocial
• Incidence of antisocial behavior
• Family attachment
• Developmental pathways
• Brain research
• The cost of antisocial behavior
                          Current Issues in ASP Diagnosis

Drivers of the Psychopathy Model
•     Popularity of psychopathic media themes
•     Need to distinguish between low and high risk offenders, especially
      if violent; Crisis in prediction of “super-predators,”
•     Prevent juvenile exposure to adult sanctions epidemic of juvenile
      violence; grounds for transfer to adult system
•     Origins of condition (possible organic bases); fMRI
•     Available diagnostic test to distinguish (e.g., PCL-R, PCL-YV)
•     Remanding youth to the court prematurely
•     Giving up on the youth as incorrigible
•     Inconclusive data supporting psychopathic diagnosis in youth
•     Risk that psychopathic label is not used to indicate need for
      further assessment, but are used for disposition of adults

Laurence Steinberg, The Juvenile: fads, fictions, & facts about identification and treatment of serious
juvenile offenders.
"When I'm good, I'm very good. When I'm bad, I'm better." (Mae West)
The DSM-IV, describes Antisocial Personality Disorder (301.7) as a pervasive
    pattern of disregard for and violation of the rights of others, as indicated
    by three (or more) of the following:
•    failure to conform to social norms with respect to lawful behaviors as
     indicated by repeatedly performing acts that are grounds for arrest;
•    deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
     personal profit or pleasure;
•    impulsivity or failure to plan ahead;
•    irritability and aggressiveness, as indicated by repeated physical fights or
•    reckless disregard for safety of self or others; .
•    consistent irresponsibility, as indicated by repeated failure to sustain consistent
     work behavior or honor financial obligations;
•    lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
     mistreated, or stolen from another.
The individual is at least 18 years, there is evidence of Conduct Disorder with onset
     before age 15 years, and the occurrence of antisocial behavior is not exclusively
     during the course of Schizophrenia or a Manic Episode.
                                                    The Family of Antisocial
“A rose by any                                           Personalities
other name…”
                                 Sociopathic             Psychopathic           Character
                                 Personality              Personality           Neurosis

                                 Common                     Primary              Super-Ego
                                 Sociopath                 Psychopath             Lacunae

                                 Dyssocial                 Secondary            Punishment
                                 Sociopath                 Psychopath            Seekers

                                Aggressive                Charismatic           Adolescent
                                Sociopath                 Psychopath             Rebellion

                                 Alienated                Distempered            Paranoid
                                 Sociopath                Psychopath            Personality

                             • Disaffiliated Type     • Epileptic Equivalent
                             • Disempathetic Type     • Choleric Type           Inadequate
Lykken, D. T. (1995). The                             • Hypersexed Type         Personality
                             • Hostile Type
 antisocial personalities.                            • Pathological Cravings
                             • Cheated Type
                                                      • Hysterical Type
      Hard core: The psychopathic personality (PCL-R)
1.    Glibness/superficial charm (1)
2.    Grandiose sense of self-worth (1)
3.    Pathological lying (1)
4.    Cunning/manipulative (1)
5.    Lack of remorse or guilt (1)
6.    Shallow affect (1)
7.    Callous/lack of empathy (1)
8.    Failure to accept responsibility for own
      actions (1)
9.    Need for stimulation/proneness to
      boredom (2)
10.   Parasitic lifestyle (2)
11.   Poor behavioral controls (2)
12.   Early behavior problems (2)                Factor 1: Callous emotional and interpersonal
                                                     detachment; unrelated to environmental factors
13.   Lack of realistic, long-term plans (2)         (e.g., dysfunctional family), lifetime stability;
14.   Impulsivity (2)                                correlated with narcissistic, histrionic
                                                     personality & machiavellianism, negatively
15.   Irresponsibility (2)                           correlated with anxiety and empathy
16.   Juvenile delinquency (2)                   Factor 2: Chronic and unstable lifestyle; socially
17.   Revocation of conditional release (2)          deviant antisocial behaviors; tends to
                                                     extinguish about age 40; correlated with
18.   Promiscuous sexual behavior (T)                criminal behavior
19.   Many short-term relationships (T)
20.   Criminal versatility (Hare, 1986) (T)
Psychopathy & APD in Offender Populations (Hare, 2006)

                                    All offenders

                   APD (50%+)

                              PCL-R                   White Collar
                           Psychopaths                “Successful
                             (10-20%)                 Psychopaths” ?

   Many treatable with
                                   Difficult to treat with
   current programs
                                    current programs
Psychopathy Checklist: Youth Version

               Factor 1

              Factor 2
  1% PDD
  1-20% ADHD
  1% FAS/FAE                                         Antisocial “Spectrum”
  4-6% Bipolar
  2-8% LD
                     2-16%              40-50% of CD becomes ASP

                                     6-16% boys
                                     2-9% girls        3% males
      PDD                                              1% females
      ADHD           Oppositional
                                        Conduct          Antisocial        Psychopathic
      FAS/FAE          Defiant
                                        Disorder         Personality        Personality
      Bipolar         Disorder                            Disorder           Disorder
                                                                            Stimulus seeking
                                                        Criminal acts       Lack goals
                                    Aggression          Impulsiveness       Parasitic
                                    Destruction         Disregard safety    Predatory
                      Hostile       Deceitfulness       Irresponsibility    Violent
Inattention           Defiant       Rule violation      Lack remorse
Poor social skills    Negative      Manipulation
Learning deficits

80% of kids with ADHD as children carried it into adolescence, and 60%
of those had developed ODD or CD. 100% of antisocial personality
disorder have Dx as CD as youth.
Oppositional Defiance                  Conduct Disorder                          Psychopathy

1.   Loses temper             1.    Bullies, threatens, &             1.    Glibness/superficial charm (1)
2.   Argues with adults             intimidates                       2.    Grandiose sense of self-worth (1)
3.   Actively defies or       2.    Initiates physical fights         3.    Failure to accept responsibility for
     refuses to comply        3.    Used weapon that can cause              own actions (1)
     with adults requests           serious physical harm             4.    Pathological lying (1)
     or rules                 4.    Physically cruel to people        5.    Cunning/manipulative (1)
4.   Deliberately annoys      5.    Physically cruel to animals       6.    Lack of remorse or guilt (1)
     people                   6.    Stolen while confronting victim   7.    Shallow affect (1)
5.   Blames others for        7.    Forced sexual activity            8.    Callous/lack of empathy (1)
     his/hers mistakes        8.    Deliberately engaged in fire      9.    Parasitic lifestyle (2)
6.   Touchy or easily               setting with intentional damage   10.   Poor behavioral controls (2)
     annoyed                  9.    Deliberately destroyed            11.   Early behavior problems (2)
7.   Angry or resentful             property                          12.   Lack of realistic, long-term plans (2)
8.   Spiteful or vindictive   10.   Broken into someone’s house,      13.   Impulsivity (2)
                                    building, car                     14.   Irresponsibility (2)
                              11.   Lies to obtain goods or favors    15.   Need for stimulation/proneness to
                                    or avoid obligations                    boredom (2)
                              12.   Stolen nontrivial items without   16.   Juvenile delinquency (2)
                                    confronting victim                17.   Revocation of conditional release (2)
                              13.   Stays out at night despite        18.   Promiscuous sexual behavior (T)
                                    parental prohibitions
                                                                      19.   Many short-term relationships (T)
                              14.   Run away from home
                                                                      20.   Criminal versatility (Hare, 1986) (T)
                                    overnight twice while living in
                                    parent/surrogate home
                              15.   Truant from school
        Incidence of Psychopathy

•   ASP M=3%, F=1%; Psychopathy = 1% gen. population
•   15-20% of prisoners
•   Across all races, cultures & ethnic groups
•   Common among drug dealers, spouse and child
    abusers, swindlers and con men, high-pressure
    salesmen and stock promoters, gang members,
    mercenaries, corrupt politicians, unethical lawyers
    and doctors, terrorists, cult leaders, and black marketeers.
•   Recidivism 2x other offenders; violent recidivism 3x
•   4x more likely to commit violent offense after treatment release from
    intensive treatment community
•   Treated psychopaths are more likely than untreated to commit crime
    (develop better manipulations & deceptions)
•   Court mandated therapy for spouse abusers are ineffective for 25-35% who
    are psychopaths
•   Base rates of psychopaths among is 6-10% for pedophiles, 35% for rapists,
    and 64% for those who sexually perpetrate against both children and adults
           What we know about
     antisocial behavior among youth

• Persistent aggression after third grade (age 8) is predictive of continued
  aggressiveness; its stability is similar to that of intelligence; the more
  severe the more stable
• 40% of 8 year-olds with conduct disorder are repeatedly convicted of theft,
  vandalism, & assault in adolescence
• Conduct problems can be predicted with 80% accuracy 5 years later based
  on social skills, negative/aggressive behavior, and disciplinary contacts
• Drop-out rate is 12% for at-risk youth and 62% for antisocial youth
• Three years after leaving school, 70% of antisocial youth have been
  arrested at least once.
• Forty percent of the offenders who victimized children under age 6 were
• ½ of all adult offenders had at least one deviant interest before age 18
            •   Stealing
            •   Lying, cheating, sneaking
            •   Behavior problems
  Risk      •   Peer rejection
Screening   •   Low academic achievement
  Scale     •   Negative attitude
            •   Aggressive behavior
  Development of behavior disorders in youth
Environmental         • Prematurity
• pop. density        • low birth weight
• poor housing        • brain injury
• mobile residents    • FAS/FAE                     Peers
• discrimination      • ADHD                        • delinquent/deviant peers
• media violence      • attachment                  • antisocial sibs
• cultural norms      • hyperreactive               • bullying
• no support svc.     • “colicky”                   • rejection by norm group
• discrimination      • unhealthy                   • attention/recognition
• crime rate          • disability                  • belonging
                      • pain                        • act out
                      • multiple placements         • revenge

                                                                         PROBABLE OFFENSE
       Pre-family               • cohesion                  Personality-- What prevents you from offending?
       •   poverty              • flexibility               • values (“It’s wrong”)
       •   single               • poor boundaries           • empathy (“it would hurt others”)
       •   unwanted             • inconsistent discipline
                                • poor supervision
                                                            • consequences (“I’d get in trouble”)
       •   MI (depression)
       •   AODA                 • marital relationship      • ego dystonic (“that’s not me”)
       •   teen/immature        • handle emotions           • shame/embarrassment (“what would other think”)
       •   abused               • poor role modeling        • esteem (I’d feel awful”)
       •   antisocial           • criminality               • identification (“wouldn’t want that to happen to me”)
       •   divorce              • physical, emotional,      • personal responsibility (“I would be responsible”)
       •   assortative mating     sexual abuse
                                • explicit sexuality
                                                            • self monitoring & control (“I’d stop myself”)
       •   transgenerational
           problems             • disorganization           • coping (“other ways to deal with tension”)
                                • cold, rejecting
                                • large family
                                • father absence
                                • long unemployment
Nature or nurture?– yes!

 • heritability of ASP (as well as prosocial behavior) estimated at 50%
 • trauma modifies the risk
 • incompetent parenting further modifies the risk
Family Considerations:
 Attachment Theory &
Offender Development
Normative Healthy Attachment
                             • eye contact
    • discomfort             • cooing         Availability
    • hot/cold               • crying         Sensitivity
    • hungry                 • smiling        Responsiveness
    • happy                  • reaching       Consistency
    • afraid                 • grasping
    • angry                  • approaching
    • tired                                                    • prolonged gazing
                             • following                       • kissing
    • wet
                                                               • cuddling
                                                               • fondling
                                                               • high voicing
                   • seek closeness & reciprocity              • rocking
                   • frustration tolerant                      • rhythmic contact
                   • high intimacy
                   • long lasting relationships
                   • high levels of commitment                 Secure attachment
                   • high relationship satisfaction            • trust
                   • stress resilient                          • safe/secure
                   • fewer physical & psychological problems   • regularity
                   • less aggressive, more cooperative         • easier to comfort
                   • high belonging                            • more affectionate
Attachment Problems                                   • mental illness
                                                      • postpartum depression
                                                      • attachment disordered
                                                      • chemical abuse
                                                      • physical illness
                                                      • multiple caretakers
                                                      • frequent moves
                                                      • criminal behavior
                                                      • preoccupation
Unresponsive to Comforting                            • separation/divorce
• severe illness                                      • death
• premature birth                                     • PDD
• surgeries/pain
• hyperactive
                                         • physical abuse
• hospitalizations
• colicky                                • domestic violence
• autistic         Insecure Attachment   • absence
• FAS/FAE          • untrusting          • neglect
                • fearful                • inconsistency
                • angry                  • over/under stimulate
                                         • over/under attentive
                                         • rejecting
The effects of multiple caregivers
• Insecure attachment– unstable image of
• Confusion over different caregiver &
  household rules
• Poor, variable boundaries
• Conflicted guilt over attachment to foster
  parents vs. parents
• Mistrust, caution (due to previous abuse)
• Displace anger onto new caregivers from past resentments
• Learn superficial charm to manipulate others
• Play people off against each other
• Continuous testing to see if they are rejected
• Fear of removal, loss, grief; closeness means pain
• Preoccupation with fantasy of returning to family of origin
                                                     Adjustment: low self efficacy, low
   Internal Working Model                            confidence, emotionally expressive & labile,
   & Types of Attachment                             intense, too close too fast, inconsistent,
                                                     dominating, controlling, unsatisfactory
                                          _          intimacy, jealousy, obsessive, compulsive,
                                                     idealizing, oversensitive, shame prone,
                                    Preoccupied      deficient problem solving, dislike authority &
                                      Anxious-       rules, self-defeating,
      +   Available, responsive,
          nurturing, consistent      avoidant,       Offenders: nonthreatening, seek immature
Others                                               victims, groom over time, quasi-romantic
            Avoidant-               Avoidant-
     _      Dismissive               Fearful
                                                     relationships, (borderlines, bipolar)
             Violent, abusive,       inconsistent,
           threatening, punitive,     over/under
                 rejecting            responsive
                                                     Adjustment: self blame, not seek or
                                                     accept help, fear rejection, fear disclosure
 Adjustment: uncaring, avoid                         & closeness, lack trust, emotionally aware
 closeness, non-disclosing, high                     but unexpressive, passive, superficial
 confidence, aloof, indifferent, impatient,          intimacy, not recall childhood, hypervigilant
 shallow, vain, hostile, arrogant,                   (depressive, schizoid)
 grandiose, reject treatment, selfish,
 controlling, AODA, vengeful                         Offenders engage in impersonal, single
 (narcissistic, psychopathic)                        contact sex, acquaintance rape, cruising

 Offenders: coercive & assaultive, no
 guilt, remorse, shame                                             (Bartholomew, Shaver, et al.)
 Pathways for

         A                       Animal                         B
 Property Violations             Cruelty                    Aggression

             Stealing                       Spiteful
                           Vandalism                   Cruel Blaming
    Fire setting                                        Fighting
                        Lying                             Bullying
Covert                                                                    Overt

   Runaway                      Swearing     Temper
         Truancy                 Breaking    Arguing     Angry Stubborn   ODD
          C                                                    D
  Status Violations                                        Oppositional

The Male Brain and ASP
   The case of Phineas Gage

• Gage was a railroad construction
  supervisor in 1848 when a tamping
  rod was driven through his skull by
  an explosion
• The tamping rod severed the
  connections in the frontal area
• Prior to the accident he was a
  moral, hardworking, sensitive,
  conscientious, intelligent, and
  well liked
• Following the accident, his
  personality changed: lying,
  swearing, fighting, drinking,
  extravagance, seizure prone,
  and antisocial
Time-lapse imagery of brain age 5 to 20

                                                     Use it or lose it!

Note: red shows more gray matter while blue shows less gray matter. Gray matter
wanes as the brain matures and neurons are pruned. Areas for basic function
mature early; higher executive functions later.
Undersocialized subjects have more difficulty than control subjects in
naming the color, suggesting frontal lobe involvement (Waid & Orne, 1982)
Brain “CEO”: Forebrain or Prefrontal Area

       •   Planning
       •   Attention
       •   Judgment
       •   Reflection
       •   Prioritizing
       •   Self control
       •   Strategizing
       •   Sequencing
       •   Anticipation
       •   Organization
       •   Impulse control
       •   Second thought
       •   Working memory
       •   Modulating mood
       •   Response flexibility
       •   Goal-directed behavior
       •   Foresee consequences
          Effects of Stress & Trauma on the Brain

•   Long term exposure to stress & violence produces high
    level of fear hormone, cortisol (reduces connections &
    may shrink hippocampus)
•   High stress homes, & multitasking technology (computer
    games) more often produce short attention (ADHD)
•   Verbal abuse (repeated yelling, scolded, criticized) has adverse
    effects on the limbic (emotional) system, likely through stress pathways
•   Physical and/or sexual abuse increases limbic system dysfunction
    including olfactory hallucinations, visual disturbances, déjà vu, jamais vu
•   Repeated recollection and obsessing can intensify the stress effects
•   Physical/sexual abuse or neglect is associated with decrease in the size of
    the hippocampus (working memory) in adulthood
•   Stress tends to short-circuit frontal lobe processing (what little there is)
    and switch to emotional processing (resulting in over-sensitivity)
•   Such impairments may make the challenges of school even more
    stressful– a vicious cycle
    Reading Emotion—
    Normal Youth
•   Youth seem to do nothing but
    socialize, yet are poor readers of
•   Undeveloped prefrontal cortex plays
    role in assessment of social relations,
    planning, and impulse control in social   When reading emotion, teens (left) rely more
    relations                                 on the amygdala, while adults (right) rely more
•   Compared with adults (100%), teens        on the frontal cortex.
    (50%) have greater difficulty correctly
    identifying emotional facial expression      Conduct Disordered Youth:
•   This confusion may lead to                   • Errors in evaluating motive and
    misinterpretation & inappropriate              intent
    reaction                                     • Misinterpret social cues
•   Girls somewhat more accurate than            • Attribute hostile intentions
    boys; boys misinterpret cues
                                                 • Tease others but respond
•   Deep emotional relationships comes             negatively to others
    from ability to read subtle cues
                                                 • Abnormal standards and
•   When one observes a close friend               expectations regarding own
    receiving a shock, although the                behavior
    sensory cortex does not activate, the
    emotional one does
      The Brain of the Psychopath

•   64% of violent people have abnormal
    frontal lobes, 50% brain atrophy, 40%
    EEG abnormalities
•   84% victims of severe physical or sexual
•   Ratio of brain abnormalities of violent to normals is 31:1
•   Normal people blink to a startling noise when viewing an unpleasant
    picture compared to a pleasant one– psychopaths don’t
•   Brains may not be able to construct an emotional facsimile (empathy) of
    others’ discomfort
•   Less able to process deep semantic meaning of words & emotional
    significance of events
•   Show less response to startle, lower GSR to expected painful stimuli,
    less fear of common hazards, higher pain thresholds, less avoidance of
    shock-punished errors in learning task
Antisocial behavior & the brain

•   Impulsive, violent emotions appears
    to be a failure of emotional regulation
•   ASP shows impairment in the orbito-
    frontal cortex (impulse control,
    judgment, tact) and its connections
    with anterior cingulate cortex (conflict
    coping) & amygdala (fear & anger)
•   Abnormalities in serotonin function
•   Early neglect (sensory deprivation)
    trauma & abuse affects the
    development of the brain
•   During 1st three years the brain grows
    rapidly, later “prunes” unused areas
•   Result: poor impulse control, lack of
    socialization, poor empathy, reactivity
Normal people show fear, startle, and avoidance reactions to painful
stimuli– psychopaths don’t
Non-reactivity to Emotional Stimulation
   Less easily-socialized youth require more
competent parenting to avoid personality disorders
           Essential Components of a Moral Self Core

       Empathy (2-7 yrs): see from other’s perspective
       Sympathy: sorrow for another person’s distress
       Remorse: regret & sadness at one’s role in another’s pain

Anxiety (5-11 yrs):                              Guilt (3-4 yrs): signal to
apprehension about                               repress impulses so not
violation of other’s                             to offend or upset
standards                                        another; includes regret
                                                 over actions

          Shame (1-2 yrs): Inner sense of not meeting expectations
          Embarrassment (3 yrs): expansion of shame involving
          standards of others and fear of judgment
     Development of Empathy

Year 1: Global Distress
• chain reaction when other infants cry

Year 1-2: Egocentric Empathy
• Imitative distress & behavior of another child;
concern for others & try to comfort them

Year 2-3: Empathy for Other’s Feelings
• Empathy with distress, disappointment, fear,
surprise, sadness, anger, enjoyment

Year 3-8: Empathy for Other’s Life Conditions
• Imagine pain/pleasure of remote persons & groups
Emotional Intelligence Skills (Goleman)
1.   Self Awareness: Knowing one’s internal states, resources, and limitations
     •    Emotional awareness: recognizing one’s emotions and their effects
     •    Accurate self assessment: knowing one’s strengths and limits
     •    Self confidence: strong sense of self worth and capabilities

2.   Self Regulation: Managing one’s internal states, impulses and resources
     •    Self control: keeping disruptive emotions and impulses in check
     •    Trustworthiness: Maintaining standards of honesty and integrity
     •    Take responsibility for personal performance
     •    Adaptability: Flexibility in handling change
     •    Innovation: Being comfortable with new ideas

3.   Motivation: Emotional tendencies that guide or facilitate reaching goals
     •   Achievement drive: striving to improve
     •   Commitment: aligning with the goals of the agency or group
     •   Initiative: Readiness to act on opportunities
     •   Optimism: Persistence in pursuing goals
4. Empathy: Awareness of others’ feelings, needs, perceptions and concerns
    • Understanding others: Sensing others’ feelings and concerns
    • Identifying their development needs: bolstering their abilities
    • Service orientation: recognizing and meeting users’ needs
    • Political awareness: Reading a group’s emotional currents and power

5. Social Skills: Ability to induce desirable responses in others
    • Influence: ability to persuade
    • Communication: listening openly
    • Conflict management: negotiating and resolving disagreements
    • Change catalyst: Initiating and managing change
    • Building bonds: nurturing key relationships
    • Collaboration and cooperation: working with others towards shared goals
    • Team capabilities: Creating group energy in pursuing collective goals
 Possible pathways among traits

                  Low fear,
  High pain        anxiety
                                      Low motivation to            Opportunist
  threshold                              anticipate                (versatility)
                   Inability to
                anticipate, learn,
                                        Poor planning, present
                                        orientation, unrealistic      Predatory
                 Impulsiveness            Early behavior
 inattention                                problems
                Poor identification                                   Parasitic
                   with others                                     Irresponsible
                                          No remorse,
                                          shame, guilt,
Poor social    grandiosity
attachment                                              Superficiality
                                       Charm            Promiscuity
                                      glibness          Short term relations
               Verbal fluency

              The cost of antisocial behavior
• Young people who represent only 20% of the population produce
  40% of reported crimes
• Out of district juvenile placement can cost about $200,000/year
• By the time youth are finally referred to day treatment programs they
  have already cost $250,000 in services
• By age 28, the costs for public service for individuals with conduct disorder were 10
  times higher than non-CD persons, especially related to crime (Scott, et al., 2001)
• Antisocial persons have longer and more periods of unemployment
• The cost of incarceration per prisoner per year is $20,000-$50,000
• Recurrent or lifetime incarceration costs about $3 million per person NOT counting the
  indirect costs of adjudication, damage to victims, and related costs over the years
• Execution is more expensive than lifetime incarceration: Execution can be from $2.1
  (CA) to 3.2 million (FL), and incarceration from $600K (FL) to $1.4 million (CA)
• Net annual direct & indirect cost of criminal behavior in the US is estimated at $1 trillion
  (Journal of Law & Economics, 1999)
• High quality early childhood development programs have high cost-benefit ratios of $3
  for every $1 invested (Lynch, 2004)
• early invention programs can prevent as many as 250 crimes per $1 million spent while
  the same amount spent in prisons would prevent only 60 such crimes a year (Rand
  Corp, 1997)

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