ArticlePDF AvailableLiterature Review

Psychopathy as a Clinical and Empirical Construct

February 2008
Annual Review of Clinical Psychology 4(1):217-46

February 2008
4(1):217-46

DOI:10.1146/annurev.clinpsy.3.022806.091452

Source
PubMed

Authors:

Robert Hare

University of British Columbia

Craig S Neumann

University of North Texas

In this review, we focus on two major influences on current conceptualizations of psychopathy: one clinical, with its origins largely in the early case studies of Cleckley, and the other empirical, the result of widespread use of the Hare Psychopathy Checklist-Revised (PCL-R) for assessment purposes. Some investigators assert that the PCL-R, ostensibly based on Cleckley's work, has "drifted" from the construct described in his Clinical Profile. We evaluate this profile, note its basis in an unrepresentative sample of patients, and suggest that its literal and uncritical acceptance by the research community has become problematical. We also argue that the idea of construct "drift" is irrelevant to current conceptualizations of psychopathy, which are better informed by the extensive empirical research on the integration of structural, genetic, developmental, personality, and neurobiological research findings than by rigid adherence to early clinical formulations. We offer some suggestions for future research on psychopathy.

Four-factor PCL-R item-based model of psychopathy (N = 6929). Reprinted with permission of Guilford Press.

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ANRV339-CP04-09 ARI 22 February 2008 18:19

Psychopathy as a Clinical

and Empirical Construct

Robert D. Hare

and Craig S. Neumann

University of British Columbia, Vancouver, British Columbia BC V6T 1Z4;

University of North Texas, Denton, Texas 76203-1280;

email: rhare@interchange.ubc.ca, csn0001@unt.edu

Annu. Rev. Clin. Psychol. 2008. 4:217–46

First published online as a Review in Advance on

November 20, 2007

The Annual Review of Clinical Psychology is online

at http://clinpsy.annualreviews.org

This article’s doi:

10.1146/annurev.clinpsy.3.022806.091452

 2008 by Annual Reviews.

1548-5943/08/0427-0217$20.00

Key Words

Cleckley, PCL-R, construct, personality, neuroscience, structure,

antisocial

Abstract

In this review, we focus on two major inﬂuences on current concep-

tualizations of psychopathy: one clinical, with its origins largely in

the early case studies of Cleckley, and the other empirical, the re-

sult of widespread use of the Hare Psychopathy Checklist-Revised

(PCL-R) for assessment purposes. Some investigators assert that the

PCL-R, ostensibly based on Cleckley’s work, has “drifted” from the

construct described in his Clinical Proﬁle. We evaluate this proﬁle,

note its basis in an unrepresentative sample of patients, and suggest

that its literal and uncritical acceptance by the research community

has become problematical. We also argue that the idea of construct

“drift” is irrelevant to current conceptualizations of psychopathy,

which are better informed by the extensive empirical research on

the integration of structural, genetic, developmental, personality,

and neurobiological research ﬁndings than by rigid adherence to

early clinical formulations. We offer some suggestions for future

research on psychopathy.

217

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Contents

INTRODUCTION................. 218

THE PSYCHOPATHY

CHECKLIST-REVISED ........ 219

Measure as Construct?............ 221

CLECKLEY REVISITED .......... 221

Construct Drift? ................. 222

Evidence for Construct Drift?..... 223

Does It Matter? .................. 224

Cleckley’s Patients ................ 225

Cleckley’s Clinical Proﬁle:

Empirical Analyses ............ 225

Cleckley’s Clinical Proﬁle:

Rational Analyses.............. 226

Cleckley and Antisocial Behavior . . 229

Clinician as Construct? ........... 230

EMPIRICAL ASPECTS OF

THE PSYCHOPATHY

CONSTRUCT .................. 231

Finding Structure in Psychological

Phenomena ................... 231

Searching for the Structure

of Psychopathy ................ 232

The Superordinate Nature

of Psychopathy ................ 233

The Dimensional Nature

of Psychopathy ................ 234

Associations of Normal-Range

Personality with Psychopathy . . 235

Behavior Genetics of

Psychopathic Traits............ 238

Longitudinal Nature of

Psychopathic Traits............ 238

Biological and Cognitive Features

of Psychopathy ................ 239

CONCLUSIONS................... 240

INTRODUCTION

Hervey Cleckley’s clinical descriptions, in-

sights, and speculations, detailed in The Mask

of Sanity (1941/1976), have had a strong in-

ﬂuence on empirical investigations of psy-

chopathy, particularly in North America. An

important outgrowth of Cleckley’s work, as

well as that of other early twentieth-century

clinicians, was the search for reliable and

valid instruments to assess the disorder. The

most widely used of these instruments is the

Hare Psychopathy Checklist-Revised (PCL-

R; Hare 1991, 2003). The enormous increase

in theory and research on psychopathy over

the past two decades owes much to the de-

velopment and adoption of the PCL-R as a

common metric for assessing the disorder. Its

impact has been felt by researchers who con-

duct basic research on the etiology and na-

ture of psychopathy (e.g., Blair et al. 2005,

Newman et al. 2007, Patrick 2006a), and by

those more concerned with the implications of

psychopathy for the mental health and crimi-

nal justice systems (e.g., Felthous & Saß 2007,

Gacono 2000, Herv

e & Yuille 2007). The

Buros Mental Measurements Yearbooks de-

scribed the PCL-R as the standard tool for the

assessment of psychopathy (Acheson 2005,

Fulero 1995). It is a basis for the develop-

ment and validation of most otherinstruments

currently in use for the assessment of the

disorder.

In this review, we examine the associations

between selected clinical and empirical con-

ceptualizations of psychopathy, the former as

reﬂected in Cleckley’s writings, and the latter

as obtained from the use of the PCL-R and

related instruments. The main themes for the

analyses are (a) an examination of Cleckley’s

Clinical Proﬁle and the uncritical acceptance

of it as the deﬁnitive word on psychopathy;

(b) the argument that the PCL-R has “drifted”

from its roots in the writings of Cleckley

and other clinicians; (c) the role of antisocial

behavior in the conceptualization and mea-

surement of psychopathy; (d ) the structural

properties of the psychopathy construct,

with emphasis on its measurement with the

PCL-R; and (e) concerns that the PCL-R has

become the construct. The latter theme is

discussed brieﬂy below; the other themes are

addressed in separate sections throughout

this review. We begin with a synopsis of the

PCL-R.

218 Hare

Neumann

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THE PSYCHOPATHY

CHECKLIST-REVISED

The popularity and importance of the PCL-

R and its derivatives for basic and applied

research have led to many reviews, discus-

sions, and meta-analyses, as well as unusu-

ally intensive scrutiny, both theoretical and

empirical. This literature is too extensive to

summarize here, but many recent accounts

are readily available elsewhere (e.g., Blairet al.

2005, Book et al. 2006, Felthous & Saß 2007,

Hare 2007, Hare & Neumann 2006, Herv

& Yuille 2007, Leistico et al. 2007, Patrick

2006a).

Brieﬂy, the PCL-R and its predecessor, the

PCL (Hare 1980), arose because of the se-

nior author’s concern in the 1970s about the

lack of reliable, valid, and generally accepted

tools for the assessment of psychopathy. This

concern was fuelled in large part by events

that occurred at a 1975 NATO conference

(see Hare & Neumann 2006 for details) and

that played a role in the subsequent develop-

ment of the PCL and the criteria for antisocial

personality disorder (APD) in the Diagnos-

tic and Statistical Manual of Mental Disorders,

Third Edition (DSM-III; American Psychi-

atric Association 1980). The PCL and PCL-R

combined personality traits and antisocial be-

haviors, whereas the emphasis in APD was,

and continues to be, antisocial behavior (see

Widiger et al. 1996).

The PCL-R is a clinical construct rat-

ing scale that uses a semistructured interview,

case history information, and speciﬁc scor-

ing criteria to rate each of 20 items on a

3-point scale (0, 1, 2) according to the ex-

tent to which it applies to a given individ-

ual. As described below (Searching for the

Structure of Psychopathy section; Figure 1),

18 of the items form four factors or di-

mensions: Interpersonal (glibness/superﬁcial

charm, grandiose sense of self worth, patho-

logical deception, conning/manipulative); Af-

fective (lack of remorse or guilt, shallow affect,

callous/lack of empathy, failure to accept re-

sponsibility for actions); Lifestyle (need for

stimulation/proneness to boredom, parasitic

lifestyle, lack of realistic long-term goals,

impulsivity, irresponsibility); and Antisocial

glib/

superficial

grandiose

self-worth

pathological

lying

conning

manipulative

Interpersonal

Lifestyle

lack of

realistic goals

stimulation

seeking

impulsivity

irresponsible

parasitic

orientation

.73

.71

.66

.73

.71

.60

.58

.60

.50

lack remorse

or guilt

shallow

affect

callous

lack empathy

fail to accept

responsibility

Affective

poor behavior

controls

early behavio

problems

juvenile

delinquency

Antisocial

.51

.80

.82

.65

.59

.65

.70

.67

.54

.64

.55

.42

.70

.73

revocation of

cond. release

criminal

versatility

Figure 1

Four-factor PCL-R

item-based model of

psychopathy (N =

6929). Reprinted

with permission of

Guilford Press.

www.annualreviews.org

•

Psychopathy as a Clinical and Empirical Construct 219

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ANRV339-CP04-09 ARI 22 February 2008 18:19

glib/

superficial

grandiose

self-worth

pathological

lying

conning

manipulative

Interpersonal

Lifestyle

lack of

realistic goals

stimulation

seeking

impulsivity

irresponsible

parasitic

orientation

.73

.71

.66

.73

.71

.60

.58

.60

lack remorse

or guilt

shallow

affect

callous

lack empathy

fail to accept

responsibility

Affective

poor behavior

controls

early behavior

problems

juvenile

delinquency

Antisocial

.80

.82

.65

.59

.65

.70

.67

.54

.64

revocation of

cond. release

criminal

versatility

.68

.91

.81

.77 .90

Figure 2

Two-factor PCL-R

higher-order

representation of

the four correlated

factors model

(N = 6929).

(poor behavioral controls, early behavior

problems, juvenile delinquency, revocation

of conditional release, criminal versatility).

Two other items (promiscuous sexual behav-

ior, many short-term relationships) do not

load on any factor but contribute to the to-

tal PCL-R score. The Interpersonal/Affective

dimensions and the Lifestyle/Antisocial di-

mensions comprise, respectively, the PCL-R

Factors 1 and 2 (see Figure 2) described by

Hare (2003). Total PCL-R scores can vary

from 0 to 40 and reﬂect the degree to which

the individual matches the prototypical psy-

chopath. For research and “diagnostic” pur-

poses, a cut score of 30 typically is used for

psychopathy, perhaps implying to some that

the construct measured by the PCL-R is tax-

onic. However, there now is good evidence

that the structure of psychopathy is dimen-

sional in nature, whether measured by the

PCL-R (Edens et al. 2006, Guay et al. 2007,

Walters et al. 2007a), the Psychopathy Check-

list: Screening Version (PCL: SV; Hart et al.

1995, Walters et al. 2007b), the Psychopathy

Checklist: Youth Version (PCL: YV; Forth

et al. 2003, Murrie et al. 2007), the Antiso-

cial Process Screening Device (APSD; Frick

& Hare 2001, Murrie et al. 2007), or by self-

report (Marcus et al. 2004). Because there are

no exclusion criteria for its use, it is possi-

ble to investigate PCL-R comorbidity with

other disorders, but its dimensional nature

suggests that a likely scenario is overlap of

symptoms. There is an extensive literature at-

testing to the reliability and validity of the

PCL-R, as well as increasing evidence that

it generalizes well across a variety of pop-

ulations and contexts (e.g., Bolt et al. 2007,

Cooke et al. 2005, Hare 2003). Debates about

its structural properties are examined in the

section on Searching for the Structure of

Psychopathy.

220 Hare

Neumann

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The PCL-R was designed as a research

scale to measure the clinical construct of

psychopathy, and it is widely used for this pur-

pose. However, because of its demonstrated

ability to predict recidivism, violence, and

treatment (e.g., Leistico et al. 2007), the PCL-

R routinely is used in forensic assessments, ei-

ther on its own or, more appropriately, as part

of a battery of variables and factors relevant to

forensic psychology and psychiatry (see Hare

2007b, Hilton et al. 2007, Quinsey et al. 2006,

Webster et al. 1997).

A derivative of the PCL-R, the PCL:

SV, was constructed for use in nonforensic

contexts. It is used as a screen for psychopa-

thy or as a stand-alone instrument for assess-

ing psychopathy in civil psychiatric and com-

munity populations (Guy & Douglas 2006,

Hare 2007b). It is strongly related to the

PCL-R, both conceptually and empirically

(Cooke et al. 1999, Guy & Edens 2006). The

Psychopathy Checklist: Youth Version (PCL:

YV; Forth et al. 2003) is an age-appropriate,

downward extension of the PCL-R. Both

the PCL: SV and the PCL: YV have much

the same conceptual, psychometric, struc-

tural, and predictive properties as the PCL-R

(e.g., Book et al. 2006, Neumann et al. 2006,

Vitacco et al. 2005).

Measure as Construct?

There is little doubt that the PCL-R and

its derivatives have become the dominant in-

struments for the assessment of psychopa-

thy and that their use has resulted in the

accumulation of a large body of replicable

ﬁndings, both basic and applied. Although

some might view such a situation as felic-

itous, others (e.g., Cooke et al. 2005) have

expressed concerns that the PCL-R has be-

come the construct. The ﬁrst two meetings

(2005, 2007) of the new Society for the Scien-

tiﬁc Study of Psychopathy made it clear that

although the PCL-R may be the dominant

measure of psychopathy, it clearly has not im-

peded attempts by researchers to devise and

validate other measurement tools, a healthy

development for the ﬁeld. Indeed, efforts over

the past decade have expanded the assessment

repertoire to include a variety of behavioral

rating scales, specialized self-report scales,

and omnibus personality inventories (see

Frick & Hare 2001, Lilienfeld & Fowler 2006,

Livesley 2007, Lynam & Gudonis 2005,

Lynam & Widiger 2007, Williams et al.

2007). Many of these measures are concep-

tually related to the PCL-R; others have

their origins in empirical research on psy-

chopathology and general personality. All

beneﬁt from the large body of theory and re-

search that resulted from widespread adop-

tion of the PCL-R family of instruments.

Rather than being concerned about its popu-

larity, clinicians might better view the PCL-R

as an “anchor for the burgeoning nomologi-

cal network of psychopathy” (Benning et al.

2005b, p. 271). This network not only in-

cludes diverse measurement tools but also in-

put from behavioral genetics, developmental

psychopathology, personality theory, cogni-

tive neuroscience, and community studies.

CLECKLEY REVISITED

In a recent article, Westen & Weinberger

(2004) commented, “An emerging body of re-

search suggests that clinical observations, just

like lay observations, can be quantiﬁed us-

ing standard psychometric procedures, so that

clinical description becomes statistical predic-

tion” (p. 595). They went on to say, “Virtu-

ally all current research on psychopathy...

presupposes the observations of a bril-

liant clinical observer [Cleckley 1941] whose

clinical immersion among psychopaths over

60 years ago still provides the foundation

for the measure considered the gold stan-

dard in psychopathy research ...” (p. 599).

The measure to which they refer is the PCL-

R. Similarly, Minzenberg and Siever (2006,

p. 251) noted, “DSM-IV criteria for APD

consist almost exclusively of behavioral indi-

cators, neglecting the affective-interpersonal

features that appear to reﬂect much of the no-

tion of a distinct personality type as described

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ANRV339-CP04-09 ARI 22 February 2008 18:19

by Cleckley [1941/1976]. To address these is-

sues, Hare and colleagues revived the con-

struct of psychopathy, operationally deﬁned

by the Psychopathy Checklist, presently avail-

able in a revised version.”

Their comments illustrate the conceptual

connection that exists between the work of

Cleckley and the development and nature of

the PCL-R and its derivatives. It is important

to note, however, that Cleckley was not the

only inspiration for the PCL-R and its pre-

decessor, the PCL (Hare 1980). Many other

clinicians and investigators, including Arieti,

Karpman, Gough, Quay, and William and

Joan McCord, to name but a few, also made

major contributions to a “traditional concept

of psychopathy” (Hare 1991). The PCL, and

later the PCL-R, were designed to tap this

clinical tradition, as exempliﬁed in, but not

restricted to, the writings of Cleckley. In par-

ticular, derivation of the PCL and the PCL-R

was not based on uncritical acceptance and

mechanical application of the 16 characteris-

tics (the so-called Cleckley criteria) listed in

his Clinical Proﬁle, but rather on (a) an ap-

preciation of the rich clinical material con-

tained in the body of the text, much original

and some an interpretation and integration of

other clinical writings; and (b) ﬁfteen years of

experience and empirical research by the se-

nior author and his colleagues, as well as the

many scores of theoretical and empirical arti-

cles on psychopathy published in the years be-

fore the PCL was ﬁrst described (Hare 1980)

and before a draft version of the PCL-R was

ﬁrst circulated in 1985. We mention this be-

cause some commentators have asserted that

the PCL-R actually is characterized by “con-

struct drift” from the entity that Cleckley had

in mind when he wrote the various editions

of The Mask of Sanity. We address this and

related issues in the sections that follow.

Construct Drift?

Cleckley (1976) listed the following features

in his Clinical Proﬁle: 1) superﬁcial charm

and good “intelligence”; 2) absence of delu-

sions and other signs of irrational thinking;

3) absence of “nervousness” or psychoneu-

rotic manifestations; 4) unreliability; 5) un-

truthfulness and insincerity; 6) lack of remorse

or shame; 7) inadequately motivated antiso-

cial behavior; 8) poor judgment and failure to

learn by experience; 9) pathologic egocentric-

ity and incapacity for love; 10) general poverty

in major affective reactions; 11) speciﬁc loss of

insight; 12) unresponsiveness in general in-

terpersonal relations; 13) fantastic behavior

with drink and sometimes without; 14) suicide

rarely carried out; 15) sex life impersonal, triv-

ial, and poorly integrated; 16) failure to follow

any life plan.

Based on earlier comments about the

PCL-R made by Rogers (1995), Salekin

(2002) had this to say: “[W]hile psychopa-

thy has received increasing attention from

both clinicians and scientists over the last two

decades, it is important to note that the deﬁni-

tions of the disorder have drifted from earlier

conceptualizations provided by Cleckley and

theorists before him” (p. 81). More recently,

Patrick (2006b) suggested that PCL-R scores

“index a construct somewhat different from

Cleckley,” for several reasons. First, Cleck-

ley’s description of the psychopath as not par-

ticularly hostile or aggressive is at odds with

empirical data that the PCL-R is strongly re-

lated to “the personality traits of aggression

and antagonism” and is “reliably predictive

of aggressive behavior and violent recidivism

in criminal offenders” (p. 608). We see this

as less of a problem with the PCL-R than as

indication of scientiﬁc progress. Patrick also

noted that Cleckley’s Clinical Proﬁle included

several items (1, 2, 3, and 14) indicative of

“positive adjustment,” whereas these items are

not part of the PCL-R. We address this is-

sue below. Cooke et al. (2005) also have ar-

gued that the PCL-R deviates from its roots

in Cleckley because it includes antisocial be-

havior in the conceptualization and measure-

ment of psychopathy. The impression given

by these commentators is that the PCL-R has

strayed from the “truth,” that this represents

a problem for the PCL-R and the ﬁeld, and

222 Hare

Neumann

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ANRV339-CP04-09 ARI 22 February 2008 18:19

that subsequent research should go “back to

the future” (Patrick 2006b, p. 605).

Evidence for Construct Drift?

The term “construct drift” is catchy, but what

is the theoretical or empirical evidence that

the idea has any validity at all? We note that

Cleckley did not compile (nor rank-order) the

list of characteristics in the Clinical Proﬁle for

purposes of formal assessment, but rather as a

clinical synopsis of what he considered to be

typical of his psychopathic patients.

Prior to the PCL, Hare and his colleagues

used Cleckley’s writings as a general frame-

work for making global clinical (prototypical-

ity) ratings of psychopathy. However, in some

cases each of the 16 characteristics in the Clin-

ical Proﬁle was scored on a 3-point scale, with

0 indicating that the characteristic deﬁnitely

was not present or did not apply, 1 indicat-

ing some uncertainty about whether or not

it applied, and 2 indicating that it deﬁnitely

was present or applied. Hare (1980) reported

that the resulting scale had good internal con-

sistency but that some items were difﬁcult to

score or were only weakly related to the other

items.

In developing the PCL, care was taken to

make it conceptually consistent with much

of what Cleckley had to say about psychopa-

thy. However, we also took into account the

work of other inﬂuential clinicians, as well

as the many years of experience and em-

pirical research by the senior author and

other investigators, with the result that several

items not in the Clinical Proﬁle were added.

Nonetheless, the PCL was strongly correlated

(r = 0.83) with the 16-item scale described

above, and a series of factor analyses and

canonical correlations led to the conclusion

that “All of the clinically important informa-

tion contained in the Cleckley criteria ap-

pears to be covered by the checklist” (Hare

1980, p. 118). Moreover, the global ratings of

the “Cleckley psychopath” were highly cor-

related (independent raters) with the 16-item

scale (r = 0.84). In several studies by Hare

and other researchers, these global ratings

were highly correlated (r’s = 0.80–0.90) with

the PCL and the PCL-R (see Hare 2003).

The correlations among these three measures

(global ratings, 16-item scale, PCL scales)

approach their reliabilities and suggest that

they measure much the same construct. Vir-

tually the same pattern of correlations among

the PCL-R, Cleckley global ratings, and total

scores derived from the Cleckley items, was

obtained in a recent study of female offenders

(Kennealy et al. 2007). To put these correla-

tions into context, they are in the same range

as the correlations between the PCL-R and its

derivative, the PCL: SV. Item response the-

ory (IRT) analysis indicated that the latter is

“so strongly and linearly related to PCL-R

total scores that the scales can be considered

metrically equivalent measures of the same

psychological construct” (Cooke et al. 1999,

p. 11). Although IRT has not been used to

compare the three measures described above,

it is not a big stretch to conclude from these

early studies that they tap much the same

construct and that the PCL scales are con-

ceptually consistent with Cleckley’s views on

psychopathy. As Lynam & Gudonis (2005,

p. 382) put it, “Since Cleckley’s original writ-

ings, other clinicians and researchers [Buss

1966, Hare 2003, Karpman 1941, McCord &

McCord 1964] have been remarkably consis-

tent in their descriptions of the psychopath.”

After the introduction of the PCL, there

have been few studies in which individuals are

identiﬁed as psychopathic through use of the

16-item clinical proﬁle described by Cleckley.

In sharp contrast, numerous empirical studies

have used the PCL and the PCL-R to gen-

erate a large body of ﬁndings that generally

is in line with the traditional conception of

psychopathy, as exempliﬁed by Cleckley and

other clinicians. Ironically, if there has been

construct drift, it is the construct measured

by the PCL-R—not the one some argue was

described by Cleckley—that has received the

vast majority of empirical support. Cleckley’s

views were based on intensive study of several

hundred patients (see below), whereas sup-

port for the validity of the PCL-R and the

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Psychopathy as a Clinical and Empirical Construct 223

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ANRV339-CP04-09 ARI 22 February 2008 18:19

construct it measures is provided by hundreds

of studies involving many thousands of indi-

viduals from a variety of populations. In any

case, we contend that arguments in favor of

the drift hypothesis are not based on empirical

evidence but rather on side-by-side armchair

comparisons of two lists of characteristics, one

based on clinical/empirical and psychometric

considerations and the other on literal appli-

cations of a clinical synopsis provided more

than half a century ago.

Does It Matter?

Before attempting to answer the question of

whether it matters, we should note that if the

term “construct drift” is meant to describe dif-

ferences between the Cleckley and the PCL-R

conceptions of psychopathy, it clearly is mis-

applied. A more appropriate term would be

“construct shift.” If substantive differences ex-

ist, they did not develop gradually but rather

were present at the inception of the PCL, the

result of item selection procedures that were

based on experience and empirical research.

In any case, we suggest that both terms may

be irrelevant to current discussions about the

nature and measurement of psychopathy, un-

less we uncritically view The Mask of Sanity as

a bible and those who deviate from its teach-

ings as apostates. We believe that Cleckley’s

work should be put into perspective and sub-

jected to some of the intensive analyses and

critiques directed at the PCL-R. Given that

virtually no empirical data exist on which to

base such analyses and critiques, we are forced

to fall back on the same sort of appraisals, in-

terpretations, and use of quotations that have

led some to the belief that any deviation from

Cleckley is problematic. Because of space lim-

itations, we conﬁne our comments to several

of the more salient examples used by com-

mentators to argue their position.

When discussing Cleckley, many contem-

porary researchers make simultaneous refer-

ence to the 1941 and 1976 editions of The

Mask of Sanity, apparently on the assumption

that the material and arguments in each edi-

tion are much the same. Although the edi-

tions are very similar, there also are some sub-

stantive differences. For example, the 1941

chapter titled “A Clinical Proﬁle” listed 21

characteristics of psychopathy, paraphrased

as follows: 1) usually very attractive person

superﬁcially, more clever than average, su-

perior general objective intelligence; 2) free

from demonstrable symptoms of psychosis,

free from any marked nervousness of other

symptoms of a psychoneurosis; 3) no sense

of responsibility, not concerned about irre-

sponsible behavior; 4) total disregard for the

truth; 5) does not accept blame for actions;

6) no sense of shame; 7) undependable, cheats

and lies without compunction, commits an-

tisocial acts without adequate motivation;

8) execrable judgment; 9) inability to learn or

proﬁt from experience; 10) egocentricity, in-

capacity for object-love; 11) general poverty

of affect, readiness of expression rather than

depth of feeling; 12) lacks insight, cannot see

self as others see him; 13) no appreciation for

kindness or consideration shown by others;

14) alcoholic indulgences; 15) when drinking

readily places self in disgraceful or ignomin-

ious position, bizarre behavior when drinking,

seeking a state of stupefaction; 16) does not

choose to attain permanent unconsciousness

by taking own life; 17) sex life shows pecu-

liarities, casual sex; 18) no evidence of adverse

heredity, familial inferiority; 19) often no evi-

dence of early maladjustment; 20) inability to

follow any life plan consistently; 21) goes out

of way to make a failure of life.

Some of these items were curious (e.g., 18,

19, 21), perhaps a reﬂection of the lack of in-

formation in the 1930s about behavioral ge-

netics and developmental psychopathology, as

well as a psychodynamic orientation to un-

derstanding abnormal behavior. In any case,

they were short-lived. Most of the other items

were included and expanded upon in later edi-

tions of The Mask of Sanity, as illustrated in

the 1976 (ﬁfth) edition. One item from 1941

(item 2) was split into two characteristics, sev-

eral (items 8 and 9; items 14 and 15) were

pooled into single items, and three (items 18,

224 Hare

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19, and 21) were deleted. There were nine

case studies (all males) in 1941, seven of which

were included in the 1976 edition, which con-

tained 15 case studies (two females). Because

these case studies and references to other pa-

tients seen by Cleckley form the basis for his

Clinical Proﬁle, it is important to understand

something about them.

First, though, we suggest that The Mask of

Sanity is so detailed and complex in its descrip-

tions and speculations that a suitable quote

can be found to support a variety of divergent

opinions. Unfortunately, this makes it easy for

various commentators (including the present

authors) to “cherry pick” quotes to suit their

particular position. Quotes should be accom-

panied by additional supporting arguments

and evidence, a practice we try to adopt here.

Cleckley’s Patients

Unfortunately, it is difﬁcult to obtain a clear

picture of the extent to which Cleckley’s pa-

tients were representative of the general pop-

ulation or even of the other patients he had

observed over the years. It is apparent that

his “psychopathic” patients had psychologi-

cal and behavioral problems severe enough to

warrant psychiatric attention, but no informa-

tion is provided about the procedure used to

select those described in The Mask of Sanity.

In each edition, he estimated that from 12%

to 27% of the psychiatric patients in the var-

ious facilities in which he worked were psy-

chopathic, depending on the degree of mal-

adjustment needed for such a diagnosis and

on Cleckley’s uncertainty about whether or

not those with serious alcohol abuse should

be included. These estimates are much higher

than typically found in modern day psychiatric

samples (e.g., Jackson et al. 2007), suggesting

that Cleckley was somewhat overinclusive in

his diagnoses.

Cleckley’s Clinical Proﬁle:

Empirical Analyses

Although some researchers appear to treat the

16 items in the Clinical Proﬁle as if they re-

ﬂect a unitary construct, supporting evidence

is sparse. An early empirical analysis of these

items is of interest here (see Hare 1980, 2003).

Coefﬁcient alpha for the total 16-item scale

was 0.80. However, the item-total correlation

for “absence of ‘nervousness’ or other psy-

choneurotic manifestations” was only 0.05,

suggesting that it was unrelated to the con-

struct measured by the total scale. Two other

features also had a small item-total correla-

tion: “absence of delusions and other signs

of irrational thinking” (–0.02) and “suicide

rarely carried out” (0.21). For this and con-

ceptual reasons, these items were not included

in the PCL (see below). Interestingly, a re-

cent attempt to develop a self-report version

of the Cleckley items also resulted in exclu-

sion of the same three items. The Minnesota

Temperament Inventory (MTI) includes “16

psychopathy items that were designed to tap

the hallmark features of psychopathy origi-

nally outlined by Cleckley [1976]. These items

were adapted into a self-report format and

consist of brief behavioral ... and personal-

ity referents” (Loney et al. 2007, p. 244). A

“rationale-empirical” approach led to the re-

moval of the anxiety item, “I am an anxious,

nervous, and fearful person,” whereas factor

analyses resulted in deletion from the scale of

two items derived from Cleckley’s “superﬁcial

charm and good intelligence.” These were “I

am very charming, and tend to make a good

impression on others,” and “I give the im-

pression of being intelligent; show sound rea-

soning and common sense in conversation.”

The Cleckley item, “Absence of delusions and

other signs of irrational thinking,” was not

included in the analyses. The MTI subscales

used for research purposes thus are based on

only 13 items, seven in the Antisocial scale and

six in the Detachment scale. As with the PCL

and the PCL-R, the Cleckley items having to

do with “absence of nervousness,” “absence

of delusions,” and “good intelligence” were

omitted from the scale. The remaining items

in the Antisocial and Detachment scales look

very much like items in the PCL-R (see Loney

et al. 2007, Table 1).

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Cleckley’s Clinical Proﬁle:

Rational Analyses

The literal use of the items in Cleckley’s

Clinical Proﬁle presents the clinician and re-

searcher with several unresolved problems.

The items could be used as a framework

for global impressions, but difﬁculties with

this procedure prompted development of the

PCL. If the features in the Clinical Proﬁle are

to be used for assessment, how does one go

about scoring them? In the early research de-

scribed above, Hare and colleagues attempted

to score each item on a three-point scale based

on a careful reading of The Mask of Sanity.

The process proved to be cumbersome and

unsatisfactory. Cleckley did not offer useful

advice on how much maladjustment or pathol-

ogy must be exhibited to warrant a conclusion

that a given feature is present, beyond saying,

“Standard textbooks did not and still do not

make clear to what precise degree the person

must be affected to be justiﬁably placed in this

category” (Cleckley 1976, p. 452). This raises

the question of how many of the features in

the Clinical Proﬁle are required to warrant a

diagnosis of psychopathy. Cleckley apparently

believed that psychopathy is a taxon, a “very

deﬁnite clinical entity” (p. 188), but that there

also are incomplete manifestations, a “milder

or more limited” (p. 189) form of the disor-

der. What is the threshold for number and

severity of features required for inclusion in

the putative taxon? Are all of the 16 listed fea-

tures necessary for a diagnosis of psychopathy,

and if not, which ones are essential, impor-

tant, or useful? These issues take on added

importance in light of the dimensional nature

of psychopathy, at least as measured by the

PCL-R and related instruments.

Some commentators suggest that the

PCL-R is incomplete because it does not

“capture important Cleckley criteria” (Salekin

2002, p. 81). But how important are the “cri-

teria” (a term not used by Cleckley with re-

spect to his Clinical Proﬁle) that the PCL-R

fails to capture? Are there important features

of psychopathy that Cleckley might have left

out of his Clinical Proﬁle, features that other

clinicians had described or that have emerged

from the extensive empirical research over the

past half century? Large-sample IRT analy-

ses have provided us with information about

the contribution of each PCL-R item to the

construct of psychopathy (Bolt et al. 2004),

but similar information has not been provided

for the items in Cleckley’s Clinical Proﬁle. In

any case, the consequences of this omission

of “important criteria” for diagnosis may be

relatively minor, given that the PCL-R and

the Clinical Proﬁle (scored globally or from

items) are strongly associated with one an-

other, and result in much the same individuals

being assessed as psychopathic (Hare 2003).

More generally, there is virtually no empiri-

cal evidence that systematic use of the Clin-

ical Proﬁle over the past few decades would

have generated different or more informative

results or conclusions about psychopathy than

those obtained through use of the PCL-R and

its derivatives.

Cleckley (1976, p. 371) considered the fun-

damental factor in psychopathy to be an in-

ability to participate in, or understand, the

emotional aspects of humanity. “Let us say

that, despite his otherwise perfect function-

ing, the major emotional accompaniments are

absent or so attenuated as to count for lit-

tle .... If we grant the existence of a far-

reaching and persistent blocking, absence,

deﬁcit, or dissociation of this sort, we have

all that is needed, at the present level of our

inquiry, to account for the psychopath.” We

know of no theoretical or empirical attempts

to “account” for all, or even most, of the

features in the Clinical Proﬁle in terms of

such an emotional defect. Indeed, it is dif-

ﬁcult to imagine how this defect might be

associated with at least two features con-

tained in the Clinical Proﬁle (good intelli-

gence and absence of delusions) but omit-

ted from the PCL-R. At the same time, even

most of those who believe that the PCL-R

deviates from Cleckley agree that it does a

good job in capturing the emotional features

he considered fundamental to psychopathy

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(e.g., Patrick 2006b). Indeed, perhaps the ﬁrst

empirical support for some of Cleckley’s spec-

ulations about emotion was provided by a

PCL study of psychopathy (Williamson et al.

1991). Almost all of the subsequent studies of

affective processing in psychopaths have been

based on the PCL-R, with ﬁndings that are, in

the main, consistent with Cleckley. However,

since his time there have been enormous ad-

vances in modeling and measuring brain func-

tion; these studies go well beyond what Cleck-

ley might have imagined during his writings

about psychopathy.

Comparisons between lists of items form

the basis for most arguments that the PCL-R

has drifted from its roots. Four items in the

1976 Clinical Proﬁle that did not make it into

the PCL-R are superﬁcial charm and good

“intelligence, Absence of delusions and other

signs of irrational thinking, Suicide rarely car-

ried out, and Absence of “nervousness” or psy-

choneurotic manifestations. Patrick (2006b,

p. 612) described these items as compris-

ing a “positive adjustment” category. Appar-

ently, their omission from the PCL-R is prob-

lematical, for Patrick (2006b, p. 613) states,

“the effort to operationalize Cleckley’s crite-

ria as a unitary construct in the PCL resulted

in an item set that was generally more re-

ﬂective of deviance and maladjustment.” But

why is this considered a problem? Psychi-

atric disorders, including personality disor-

ders, typically are deﬁned in terms of malad-

justment, not in terms of positive adjustment

(Livesley 2007). Perhaps what is in need of ex-

planation and justiﬁcation is not the exclusion

of positive adjustment items from the PCL-

R but rather their inclusion in the Clinical

Proﬁle.

None of these positive adjustment items

played a role in the empirical analyses of the

Clinical Proﬁle described above. Further, we

know of no clinicians or researchers who actu-

ally make explicit use of three of these items

in their work, for good reason in our view.

We brieﬂy consider these items, followed by

a somewhat longer discussion of an item (re-

lated to anxiety) that is more controversial.

Absence of delusions and other signs of

irrational thinking. In 1941, Cleckley con-

sidered psychopaths to be “frankly and un-

questionably psychotic” (p. 257). He seemed

to modify this view somewhat in later editions,

but nonetheless still considered psychopathy

as a “masked psychosis” (p. 253) and an in-

dividual with the disorder as a “downright

madman” (p. 370). He also explicitly acknowl-

edged that psychotic symptoms did not pre-

clude a diagnosis of psychopathy: “If the psy-

chopath develops a major or minor disorder

of a type classed among ‘the psychoses,’ it can

be signiﬁed by addition of the usual term, just

as if he had developed a brain tumor or peptic

ulcer” Cleckley (1976, pp. 248). Because the

PCL-R does not have an exclusion criterion

for psychosis, and because of its dimensional

nature, there now is a substantial literature

on the nature and implications of comorbid-

ity between psychopathy and other disorders

(e.g., Harris & Rice 2007, Quinsey et al. 2006,

Tengstr

om et al. 2004, Vitacco et al. 2005).

Good Intelligence. This item is listed as

an indication of positive adjustment that is

not captured by the PCL-R. We contend

that Cleckley included “good intelligence”

in his Clinical Proﬁle because of the selec-

tive nature of his patients, many of whom

were well educated and from middle- or

upper-class backgrounds. However, a sub-

stantial literature indicates that the associa-

tion between the PCL-R total score and stan-

dard measures of intelligence is weak at best

(Hare 2003). Moreover, there is no obvious

theoretical reason why the disorder described

by Cleckley or other clinicians should be re-

lated to intelligence; some psychopaths are

bright, others less so.

Suicide rarely carried out. This is a cu-

rious item, for several reasons. Beside the

fact that it hardly is speciﬁc to psychopathy,

what does “rarely” mean, and compared with

what? Cleckley (1976, p. 359) noted, “It was

only after a good many years of experience

with actual psychopaths that I encountered

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my ﬁrst authentic instance of suicide in a pa-

tient who could be called typical.” For the

sake of argument, let’s assume that this sin-

gle suicide occurred in 1000 psychopathic pa-

tients. This would have been an event 10

times more frequent than would have been ex-

pected in the general population in the 1930s

(Monk 1987). And of course, we do not know

how many of Cleckley’s patients later com-

mitted suicide without his knowledge. The

senior author knows of several well-deﬁned

psychopaths who took their own lives when it

was clear to them that there was “no other way

out” of what seemed like an intolerable situa-

tion: surrounded by the police, facing a heavy

prison term, incurable illness, and so forth.

We suspect that at least some cases of “sui-

cide by cop” involved psychopaths who were

trapped and wished to go out in a “blaze of

glory” (Mohandie 2007). Finally, the results

of an extensive study on psychopathy and sui-

cidality (Douglas et al. 2006) concluded that

“clinicians should not consider psychopathy a

buffer against suicidal behavior” (p. 97).

Absence of nervousness and other psy-

choneurotic manifestations. Evaluation of

this item in Patrick’s positive adjustment cat-

egory is not straightforward, for several rea-

sons. First, the item typically is treated as

if it were equivalent to “anxiety.” Second,

Cleckley was somewhat unclear and inconsis-

tent concerning the deﬁnition and role of this

item, and of anxiety, in his conceptualization

of psychopathy. In the ﬁrst edition of The Mask

of Sanity, the Clinical Proﬁle devoted only

half a sentence to the topic: “He is ... usu-

ally free from any marked nervousness or other

symptoms of psychoneurosis” (Cleckley 1941,

p. 239; emphasis in original). But so are most

normal people. Coverage in later editions in-

creased to about half a page, although there

are references throughout the text to anxiety

of one form or another. Cleckley said, “Within

himself he appears almost as incapable of anx-

iety as of profound remorse” (p. 340), a state-

ment oft quoted by those who believe that lack

of anxiety should have been included in the

PCL-R. However, in the previous sentence,

Cleckley commented that psychopaths expe-

rience tension or uneasiness but that it “seems

provoked entirely by external circumstances,

never by feelings of guilt, remorse, or intra-

personal insecurity.” This psychodynamic

perspective suggests that it is not so much a

lack of anxiety that differentiates psychopaths

from others as it is the source of the anxi-

ety (intra- or extrapsychic). Similarly, some

early inﬂuential clinicians (e.g., Arieti 1967,

Karpman 1961) believed that psychopaths

were capable of experiencing anxiety, but as

a “proto-emotion,” a superﬁcial, short-lived

reaction to immediate needs, frustrations,

threats, concerns, and discomforts. Even the

level of manifest anxiety in psychopaths, how-

ever it is deﬁned, is unclear in Cleckley’s

writings. For example, he says, “The true

psychopaths personally observed have usually

been free, or as free as the general run of hu-

manity, from real symptoms of psychoneuro-

sis” (Cleckley 1976, p. 259).

Presumably, most of the psychiatric pa-

tients Cleckley saw were beset by a myriad

of serious psychological problems, including

personal distress and anxiety-related symp-

toms. Psychopaths, by contrast, must have

seemed relatively free of anxiety and related

symptomatology. Some of his psychopathic

patients may indeed have experienced subjec-

tive distress, but it is unlikely that they would

have disclosed their symptoms unless it was to

their advantage to do so, given their penchant

for impression management. It also can be dif-

ﬁcult to make valid inferences about anxiety

when a psychopathic patient is able to mimic

emotions so well that he “appears to react with

normal emotions” (Cleckley 1976, p. 239).

If Cleckley considered lack of anxiety to

be a deﬁning feature of psychopathy, as some

commentators argue, then the disorder should

be incompatible with disorders characterized

by anxiety and other psychoneurotic symp-

toms. Although he noted that differences typ-

ically exist between the psychopath and the

psychoneurotic, he also referred to a study

in which Caldwell (1944) “reports neurotic

228 Hare

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manifestations in patients whose chief features

were plainly those of the psychopath. I be-

lieve that the two types of reaction are not

characteristically seen together but perhaps

there are no two pathologic syndromes in psy-

chiatry, however distinct, that may not some-

times overlap” (Cleckley 1976, p. 259). And,

of course, the possibility of overlap is greatly

increased when at least one of the disorders is

dimensional in nature, as psychopathy appears

to be.

Several ﬁnal points can be made. First, in

a previous section, we described research in-

dicating that the “anxiety” item did not “be-

long” with the other items in the Clinical Pro-

ﬁle, a ﬁnding that held when the item was

rated or when it was a self-report. Second,

a great deal of empirical literature indicates

that psychopathy, measured with the PCL-

R or self-report, is at best only weakly re-

lated to various measures of anxiety (Hare

2003). In a recent study, Hale et al. (2004,

p. 705) concluded that the PCL-R was un-

related to contemporary measures of anxiety

and that the “ﬁnding raises questions about

traditional conceptualizations of psychopathy

that posit an attenuated capacity for anxiety

[e.g., Cleckley 1976].” Admittedly, there is an

extensive research literature (to which the se-

nior author has contributed) indicating that

the concepts of “low fear arousal” or “fearless-

ness” (e.g., Lykken 1995) may help to explain

the psychopath’s apparent social poise, sensa-

tion seeking, and difﬁculty in staying out of

trouble. We suggest that these concepts are

subsumed under PCL-R items associated with

more general emotional experiences and pro-

cesses, including lack of remorse or guilt, shal-

low affect, and callous/lack of empathy. Al-

though Cleckley (1976, p. 319) believed that

“fearlessness stand(s) out in contrast” to psy-

chopathy, we agree that its role and that of

anxiety are in need of further empirical in-

vestigation, not only as potential deﬁning fea-

tures but also as variables whose interactions

with psychopathy may have explanatory value

in a variety of learning and motivational con-

texts (e.g., Newman et al. 2007).

Cleckley and Antisocial Behavior

A misconception promulgated by some ob-

servers is that the PCL-R’s inclusion of items

related to antisociality is inconsistent with

the conception of psychopathy provided by

Cleckley and other early clinicians. Cooke

et al. (2005) have reformulated this miscon-

ception by wrongly stating that Hare and col-

leagues consider criminality to be an essential

component of psychopathy. Cooke and col-

leagues contend that factor analytic models of

the PCL-R that include items related to anti-

social behavior are not viable, whereas a model

that excludes these items yields a three-factor,

personality-based model. But their bases for

inclusion and exclusion of items are convo-

luted and difﬁcult to defend, as is the con-

tention that only personality traits have been

retained in the model (e.g., “parasitic lifestyle”

is considered to be a personality trait, whereas

“poor behavior controls” is not). This and

other issues having to do with the struc-

tural properties of the PCL-R and related

instruments are discussed at length in the

section Searching for the Structure of Psy-

chopathy. Here we comment only on the

claims that Cleckley did not include anti-

sociality in his conception and diagnosis of

psychopathy. We leave aside the problems

inherent in inferring psychopathy-related

dispositions from only prosocial behavior,

without reference to the asocial, antisocial,

and problematic behaviors that distinguish

between psychopathic and other individuals,

and that bring the former to our attention (see

discussions by Hare 2003, Hare & Neumann

2006, Neumann et al. 2005).

Inspection of the items that comprise

the 1941 and 1976 Clinical Proﬁles in The

Mask of Sanity clearly conveys the important

role played by antisocial behavior in Cleck-

ley’s description of psychopathy. Certainly,

his patients could not be considered proso-

cial, or even simply asocial, without stretch-

ing the meanings of these terms. In 1941, al-

cohol abuse and the problems it caused for

the individual and those around him were

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emphasized. Later editions also described at

length the socially disruptive behaviors exhib-

ited by psychopaths under the effects of al-

cohol. More directly, Cleckley (1976) stated

that he was “in complete accord” with the de-

scription of the psychopath as “simply a basi-

cally asocial or antisocial individual” (p. 370).

“Not only is the psychopath undependable,

but also in more active ways he cheats, deserts,

annoys, brawls, fails, and lies without any ap-

parent compunction. He will commit theft,

forgery, adultery, fraud, and other deeds for

astonishingly small stakes, and under much

greater risks of being discovered than will the

ordinary scoundrel” (p. 343). Some commen-

tators (e.g., Cooke & Michie 2001) have ar-

gued that such behaviors (reﬂected in the item

“inadequately motivated antisocial behavior”)

are not speciﬁc to psychopathy and therefore

should not play a role in assessment of the dis-

order. Of course, none of the other 15 features

in the Clinical Proﬁle is speciﬁc to psychopa-

thy but, nonetheless, they do not recommend

that these features be excluded from either the

description or the assessment of the disorder.

Finally, we note that other researchers

do not accept the argument that Cleckley

excluded antisocial behavior from his de-

scriptions and diagnosis of psychopathy. As

Patrick (2006b, p. 608) wrote, “There is no

question that Cleckley considered persistent

antisocial deviance to be characteristic of psy-

chopaths. Without exception, all the individ-

uals represented in his case histories engage

in repeated violations of the law—including

truancy, vandalism, theft, fraud, forgery, ﬁre-

setting, drunkenness and disorderly conduct,

assault, reckless driving, drug offenses, pros-

titution, and escape.”

Clinician as Construct?

Unlike the case with other inﬂuential ﬁg-

ures, including Freud, critical examination of

Cleckley’s work is virtually nonexistent. To

a large extent, the clinician has become the

construct for many investigators and com-

mentators. In our view, this presents the ﬁeld

with a problem that is more serious than

heavy reliance on a single measure of psy-

chopathy. The senior author admits to having

contributed to the problem by “promoting”

Cleckley’s work over the past four decades,

and that he now might be considered a “back-

slider.” However, in his defense he might ar-

gue that the construct drift for which he is

charged is presumptive evidence that his orig-

inal intention to rely more-or-less entirely on

Cleckley soon was compromised by research

experience, as reﬂected in the content of the

PCL. In any case, we contend that it makes lit-

tle sense to base theory and research primarily

on conceptions of psychopathy that are frozen

in time, a time (the 1930s) when psychody-

namic models were prevalent, experimental

psychopathology and psychometric the-

ory were in their infancy, and behav-

ioral genetics, developmental psychopathol-

ogy, and cognitive neuroscience had yet to

arrive on the scene. This is not meant to di-

minish in any way the brilliant writings of a

renaissance man whose clinical insights and

dramatic case studies have had a profound in-

ﬂuence on generations of clinicians and re-

searchers. We can continue to beneﬁt from

the testable insights and speculations con-

tained in The Mask of Sanity. But Cleckley

cannot be the ﬁrst and last word on psychopa-

thy and its measurement, a point he himself

made in extensive correspondence over the

years with Hare. “Going back to the future”

in this case would really be going back to the

past.

As put by Livesley (2007, p. 216), “[The

PCL-R] is based on a ‘top-down’ deﬁnition

of psychopathy based on Cleckley’s [1976]

observations of relatively few individuals.

The important question is whether PCL-

R psychopathy converges with ‘bottom-up’

models identiﬁed from empirical analyses

of the structure of personality characteris-

tics in different samples.” The following sec-

tions indicate that convergence does occur,

not only with research in psychopathology

and personality theory but also with ﬁnd-

ings from such relevant ﬁelds as behavioral

230 Hare

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genetics, developmental psychopathology,

and neurobiology.

EMPIRICAL ASPECTS OF THE

PSYCHOPATHY CONSTRUCT

The concept of psychopathic personality has

a long history that began well before Cleck-

ley and is closely tied to early conceptions

of personality (e.g., Herv

e 2007). As dis-

cussed in detail by Berrios (1996), “Impul-

sion and impulsive insanity provided the ker-

nel around which the notion of psychopathic

personality was eventually to become orga-

nized” (p. 428). Even Cleckley (1941) noted

the essential fact that the “psychopath shows

a striking inability to follow any sort of life

plan consistently” (p. 255). As it turns out,

many of the ﬁndings presented below are con-

sistent with the early conceptual beginning

of psychopathic personality. On the other

hand, some investigators do not consider psy-

chopathy to be fundamentally linked to un-

dercontrolled pathology and instead view an

affective deﬁcit as the core of the disorder.

Nevertheless, a growing body of literature in-

dicates that the affective features of psychopa-

thy are intimately tied—i.e., psychometrically,

genetically, and longitudinally—to the under-

controlled and fundamentally antisocial fea-

tures of psychopathy. Thus, there appears to

be no basis for holding one component of psy-

chopathy as more essential than other compo-

nents (Neumann et al. 2005).

Finding Structure in Psychological

Phenomena

A very old Aristotelian idea is that “form fol-

lows function” (e.g., knifes were designed to

cut, eyes designed to see). If something is

known about a phenomenon’s structural form,

then it is possible to glean an understanding

of how it functions. In modern science, expli-

cation of a phenomenon in terms of its struc-

ture remains a critical area of investigation,

whether it involves identiﬁcation of the struc-

ture of atoms, DNA, or human personality.

Moreover, identiﬁcation of the basic struc-

ture of physical, biological, and psychological

phenomena frequently precedes theory devel-

opment (Stelmack 1997). Paradoxically, ad-

herence to Cleckley’s (1941/1976) theoretical

perspective often determines whether investi-

gators value the ﬁndings of structural research

on psychopathy, despite the fact that Cleckley

relied solely upon case study methodology.

One of the major challenges in trying

to elucidate the structure of psychopathy

is that, as a latent construct, it is not di-

rectly observable. Indeed, most everything

in psychological science refers to latent con-

structs (Bollen 2002), as do most concepts

in science (Cartwright 1983; Devitt 1991, as

cited in Borsboom et al. 2003). Fortunately,

the groundbreaking work of Spearman in

1904 on factor analytic models opened a new

paradigm that provided investigators a means

for mathematically representing latent vari-

ables (Borsboom et al. 2003). With the devel-

opment of conﬁrmatory factor analysis (e.g.,

Bentler 1980, Joreskog 1971, Sorbom 1974)

and other latent variable approaches (e.g.,

Thissen & Steinberg 1984), it became possi-

ble to move beyond exploratory analyses and

instead to precisely hypothesize model spec-

iﬁcations (e.g., variable-to-factor and factor-

to-factor relations) that could then be tested

statistically. It is important to emphasize that

good statistical ﬁt of a latent variable model

does not prove the existence of causal la-

tent variables (Bentler 1980). However, such

models do involve testable hypotheses (e.g.,

ﬁve factors account for the natural language

terms referencing normal personality) and,

therefore, good model ﬁt can be “adduced”

as evidence in support of such hypotheses

(Borsboom et al. 2003). In addition, a key as-

pect of latent variable models is that “latent

variables provide a degree of abstraction that

permits us to describe relations among a class

of events or variables that share something in

common, rather than making highly concrete

statements restricted to the relation between

more speciﬁc, seemingly idiosyncratic vari-

ables. In other words, latent variables permit

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us to generalize relationships” (Bollen 2002,

p. 606). Thus, if a latent variable model re-

ceives additional support from independent

replications based on diverse samples of in-

dividuals assessed via different methods, the

model’s verisimilitude increases as a viable

representation of a theoretical construct.

Searching for the Structure

of Psychopathy

A number of recent studies, based on latent

variable analyses of the PCL instruments, pro-

vide considerable support for a four-factor

model of psychopathy across diverse and pri-

marily very large samples of male and female

offenders (Hare & Neumann 2006, Neumann

et al. 2007), forensic and civil psychiatric pa-

tients (Hill et al. 2004, Jackson et al. 2007,

Neumann et al. 2007, Vitacco et al. 2005), and

youth offenders ( Jones et al. 2006, Neumann

et al. 2006, Salekin et al. 2006, Vitacco et al.

2006), as well as individuals from the gen-

eral community (Hare & Neumann 2006;

Neumann & Hare 2007). Figure 1 illustrates

the form and content of the model, as well

as standardized item-discrimination parame-

ters, based on a mega-sample of 6929 male

and female adult offenders and male forensic

psychiatric patients.

In this model, the four strongly correlated

psychopathy dimensions represent interper-

sonal (e.g., pathological lying, conning), af-

fective (e.g., shallow affect, remorseless), im-

pulsive lifestyle (e.g., irresponsible, stimulus

seeking, impulsivity), and diverse external-

izing, antisocial tendencies (e.g., poor be-

havioral controls, versatile antisociality). The

model has also shown structural invariance

across North American and United Kingdom

samples of adolescent offenders (Neumann

et al. 2006) and adult male African Ameri-

can and Caucasian civil psychiatric patients

( Jackson et al. 2007; see also Bolt et al. 2004,

2007). Although the PCL-R and its deriva-

tives cannot be equated with the construct of

psychopathy (Neumann et al. 2005), the ro-

bustness of the four-factor model across

such a diverse set of samples suggests

that the measure is highly compatible

with both traditional-clinical and modern-

empirical conceptualizations of psychopathy.

The results show that the PCL-based psy-

chopathic personality dimensions reﬂect a

broadly antisocial and undercontrolled per-

sonality disposition, involving deceptiveness,

pathological lying, and absence of remorse

and guilt, as well as irresponsible, impulsive,

and versatile antisocial tendencies.

Based on other recent research, several

self-report measures also appear to have la-

tent dimensions that resemble the four PCL

dimensions. Using large samples of young

adults to conduct a two-stage study for ex-

traction and then cross-validation of a new

structural model for the Self-Report Psy-

chopathy Scale III (SRP-III), Williams et al.

(2007) identiﬁed four factors that closely ap-

proximated the four PCL dimensions. Each

SRP-III factor displayed substantive links to

critical external correlates, in line with pre-

vious PCL validation studies. Similarly, the

self-report Youth Psychopathic Traits Inven-

tory (YPI; Andershed et al. 2002) was de-

signed to reﬂect the interpersonal, affective,

and impulsive lifestyle dimensions of psy-

chopathy in youth. However, based on a

large population-based sample of twins, the

three YPI factors were modeled in conjunc-

tion with a fourth facet reﬂecting antisocial

tendencies (Larsson et al. 2007). Although

not designed speciﬁcally for assessment of

psychopathy, the Multidimensional Person-

ality Questionnaire (MPQ; Tellegen 2003)

is a normal-range personality measure that

has been suggested to contain underlying di-

mensions that reﬂect interpersonal-affective

(called Fearless-Dominance) and impulsive-

antisocial (called Impulsive-Antisociality) fea-

tures (Blonigen et al. 2005). Thus, rather than

reﬂecting four dimensions, the MPQ model

combines the interpersonal and affective di-

mensions into a single factor and the lifestyle

and antisocial factor into its own factor, rem-

iniscent of the traditional PCL-R Factor 1

and 2 dimensions. The MTI (Loney et al.

232 Hare

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2007, Taylor et al. 2003) does not contain

four dimensions, but it has two factors (De-

tachment and Antisocial) that are strongly

correlated, similar to the antisocial and af-

fective PCL factors. Similarly, the APSD, a

20-item teacher/parent rating scale, measures

three dimensions of behavior thought to be

precursors to psychopathic traits: Callous/

Unemotional, Narcissism, and Impulsivity.

Each of these latent dimensions is signiﬁ-

cantly linked to PCL: YV/PCL: SV dimen-

sions reﬂecting interpersonal-affective and

impulsive-antisocial tendencies (Vitacco et al.

2003). Finally, psychopathic personality has

also been understood with respect to the ﬁve-

factor model (FFM) of personality and has

been described by Lynam & Widiger (2007,

p. 171) in terms that reﬂect the interper-

sonal (e.g., “cunning and manipulative”), af-

fective (e.g., “callous and ruthless”), impulsive

lifestyle (e.g., “pan-impulsive”), and antiso-

cial (e.g., “greedy and exploitive, oppositional

and combative”) PCL-R dimensions. In sum,

there is currently good evidence for at least

four psychopathy dimensions across a diverse

set of measures and wide array of samples.

We do not discuss here the structure of

the Psychopathic Personality Inventory (PPI;

Lilienfeld & Andrews 1996) beyond noting

that its factor structure is complex and in-

consistent with the two-factor model orig-

inally proposed (Lynam & Widiger 2007;

C.S. Neumann, M. Malterer, & J.P. Newman,

manuscript submitted) and that the PPI to-

tal score is signiﬁcantly correlated with both

Factor 1 (r = 0.54) and Factor 2 (r = 0.42) of

the PCL-R (Poythress et al. 1998). We also do

not discuss the Cooke & Michie (2001) hier-

archical “three”-factor model, given that this

model has severe statistical problems—i.e., it

actually contains ten factors and results in

impossible parameters (negative variances)—

as well as conceptual problems. For detailed

critiques of this model, see Neumann et al.

(2005), Vitacco et al. (2005), Neumann (2007)

and Neumann & Hare (2007).

Although the majority of studies cited

above provide evidence of four possible di-

mensions of the psychopathy construct, some

investigators continue to ﬁnd the traditional

two-factor model (Hare et al. 1990, Harpur

et al. 1989) useful in helping them to organize

and understand the correlates of psychopa-

thy. Interestingly, inspection of the pattern

of factor correlations in Figure 1 indicates

that the four-factor model can easily be con-

verted to two-factor form (see Figure 2).

While this model shows the same degree of

good ﬁt as that of the four-factor model, it

may not be advantageous to use the tradi-

tional two-factor model in some instances.

For example, several studies have found that

the four psychopathy dimensions have diverse

associations with various external correlates

(e.g., Dolan & Anderson 2003, Salekin et al.

2004, Vitacco et al. 2005). Also, Bishopp &

Hare (2007), using a multidimensional scal-

ing approach, have provided some evidence

that at least four domains may be neces-

sary to comprehensively map the psychopathy

construct.

The Superordinate Nature

of Psychopathy

In addition to viewing the psychopathy con-

struct in terms of lower-order domains, it

is also possible to view it in more abstract

and general terms. For instance, using large

samples of male (N = 4865) and female

(N = 1099) offenders and forensic psychiatric

patients (N = 965), all assessed with the

PCL-R, Neumann et al. (2007) found that all

four psychopathy factors were explained by

a single superordinate factor. In each sam-

ple separately, and when the samples were

combined, the superordinate factor accounted

for the majority of variance in each of the

four ﬁrst-order factors with but one excep-

tion: The superordinate factor accounted for

43% of the variance in the interpersonal fac-

tor for the psychiatric sample. Similarly, in

a large (N = 738) cross-national study of

adolescent offenders, Neumann et al. (2006)

found that a superordinate PCL: YV factor

accounted for the majority of the variance in

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the interpersonal (60%), affective (82%), im-

pulsive lifestyle (81%), and antisocial (60%)

factors. These results provide support for us-

ing total scores from the PCL instruments to

study groups of individuals and indicate that

the superordinate factor captures something

essential that runs across the separate lower-

order factors—i.e., the broad dissocial nature

of psychopathic traits. Although there may be

heuristic value in considering the constituent

dimensions in isolation of one another (e.g.,

for investigating their external correlates), we

believe that psychopathy can best be under-

stood in terms of the interrelations of these

dimensions, akin to a general factor in per-

sonality theory. Similarly, the practice of par-

tialling independent variables from one an-

other, though informative, runs the danger

of losing sight of the original construct un-

der investigation or of changing the nomo-

logical network (see Lynam et al. 2007). As

put by Livesley et al. (1998, p. 944), “Since

the components of personality are parts of an

integrated system, disturbance in one system

is likely to affect the whole system.” In this

sense, antisocial tendencies are fundamentally

tied to other psychopathy dimensions since

all four PCL-R factors stem from a cohesive

higher-order factor. An early illustration of

this point, based on the original PCL two-

factor model, was provided by Harpur & Hare

(1991), who found that inclusion of the inter-

action of the two factors (F1 × F2) signif-

icantly improved the prediction of violence.

Zeier & Newman (2007) similarly found that

it was the interaction of PCL: SV Factors

1 and 2, rather than their unique variances,

that predicted anomalies in the performance

of a selective attention task. Finally, a recent

child twin study (Baker et al. 2007) found that

a single unidimensional factor explained the

majority of the variance in the covariation of

childhood psychopathy traits, aggression, and

delinquency.

As indicated above, Cleckley (1941/1976)

too believed that antisocial tendencies,

broadly conceived, were essential to under-

standing the psychopath as a whole. Below we

discuss a wealth of studies employing different

methodologies and samples that support the

contention that general antisocial tendencies

represent an empirically demonstrable feature

of the psychopathy construct, in conjunction

with features reﬂecting disturbances in inter-

personal, affective, and impulsive behavioral

functioning.

The superordinate PCL-R/YV ﬁndings

are consistent with more general research on

personality disorder (PD). Speciﬁcally, two

large-scale empirical studies (Livesley et al.

1998, Ullrich & Marneros 2007) and a com-

prehensive review of personality disorder re-

search (Trull & Durrett 2005) all suggest that

a unidimensional factor reﬂecting dissocial-

ity/psychopathy emerges when symptoms of

all PDs are factor analyzed. The Livesley

et al. (1998) study is noteworthy in that use

of a dimensional PD symptom measure re-

sulted in the same factor solution across large

twin, clinical, and general population samples.

The dissocial or psychopathy factor was com-

posed of the following PD items: callousness,

conduct problems, narcissism, rejection, and

stimulus seeking. In the Ullrich & Marneros

(2007) study, dimensionalized International

Classiﬁcation of Diseases-Tenth Edition

(ICD-10) PD symptoms resulted in a fac-

tor made up of the dissocial, paranoid, histri-

onic, and impulsive PD traits and was the only

ICD-10 PD factor (out of three) that was

strongly correlated (r = 0.77) with the PCL:

SV.

The Dimensional Nature

of Psychopathy

The psychopath is often portrayed in the me-

dia as vile, inhuman, and qualitatively differ-

ent from other individuals. However, research

described above suggests that psychopathic

personality traits in adults and adolescents are

best viewed as existing on a continuum. The

results of these studies are consistent with a

very large literature indicating that person-

ality disorders in general are dimensional in

nature (Clark 2007).

234 Hare

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In line with the taxometric studies men-

tioned above, there is evidence for a con-

cordant latent structure of psychopathic

traits across adults and adolescents (Hare &

Neumann 2006, Neumann et al. 2006). Simi-

larly, antisocial and other externalizing behav-

iors also appear to be dimensional in nature

(Markon & Krueger 2005). Thus, it may be

more efﬁcient to study individuals in terms of

level of psychopathic traits rather than pars-

ing individuals into psychopath and nonpsy-

chopath groups.

Community studies on psychopathy are in-

creasing (Lilienfeld & Fowler, 2006), given

the strength of the dimensional perspective.

However, few studies have been conducted

with large, randomly ascertained samples that

allow investigators to more conﬁdently gen-

eralize their ﬁndings as well as to understand

the distribution and function of psychopathic

traits in the general population. In one com-

munity study (Hare & Neumann 2006), we

found strong support for the four-factor la-

tent variable model of psychopathy, despite

relatively low levels of these traits in the sam-

ple. We also found that the psychopathy traits

were signiﬁcantly linked to a range of exter-

nal correlates, particularly violent behavior

(Neumann & Hare, manuscr. submitted). De

Oliveira-Souza et al. (2007) found relatively

high PCL: SV scores in a sample of patients

referred or brought to a Brazilian psychiatric

facility for evaluation and consultation be-

cause of a chronic pattern of social and behav-

ioral problems. The correlates of the PCL: SV

were consistent with the research literature on

psychopathy in criminal and forensic psychi-

atric populations.

Taken together, the vast array of factor an-

alytic and other statistical ﬁndings previously

discussed all help to ﬂesh out the dimensions

of the psychopathy construct. Thus, we dis-

agree with Lynam & Widiger’s (2007) sug-

gestion that factor analysis of particular scales

might not be optimal for uncovering core

components of the psychopathy construct. In-

deed, the FFM of personality (McCrae &

Costa 1990), which Lynam & Widiger (2007)

advocate, owes much of its existence to pre-

vious factor analyses of the NEO Personal-

ity Inventory-Revised (NEO PI-R; Costa &

McCrae 1992). In his review of the person-

ality structure of the FFM, Digman (1990,

p. 418) stated, “views regarding the structure

of the concepts of personality ... were based

on the ... hope that the method of factor anal-

ysis would bring a clarity to the domain of per-

sonality, a hope voiced years ago by Eriksen

[1957] and Jensen [1958].” Digman proposed

that the FFM of personality has given us a

“useful set of very broad dimensions that char-

acterize individual differences ...” and that

these dimensions provide a “good answer to

the question of personality structure” (p. 436).

Digman’s (1997) FFM meta-analytic study

suggests that the ﬁve-factor domains may not

represent the most basic structure of normal-

range personality, given that the covariance

among the FFM domains can be accounted

for in terms of two higher-order personal-

ity domains referred to as Alpha (agreeable-

ness, conscientiousness, low neuroticism) and

Beta (extraversion, openness). Interestingly,

the factor analytic work on normal-range per-

sonality seems remarkably similar to the ﬁnd-

ings discussed above with respect to the di-

mensions of psychopathy (i.e., they can be

modeled in terms of four lower-order domains

or two higher-order domains).

Associations of Normal-Range

Personality with Psychopathy

Research on normal-range personality traits is

also informative for understanding psychopa-

thy. Lynam (2002) and Widiger & Lynam

(1998) have mapped out in detail the associ-

ation between each of the PCL-R items and

the domains and facets of the FFM (Costa &

McCrae 1992); they view psychopathic per-

sonality as a maladaptive variant of common

personality traits (many of which are anti-

social in nature). Widiger (1998) noted that

PCL-R and FFM conceptualizations of psy-

chopathy are complementary and that while

the FFM enriches “the understanding of the

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syndrome of prototypic psychopathy by plac-

ing it within the broader context of normal

personality ... the PCL-R in turn provides a

vivid description of an especially problematic

and even volatile constellation of personality

traits” (Widiger 1998, pp. 64–65). Similarly,

Widiger et al. (2002, pp. 448–449) described

psychopathy as a particularly “virulent con-

stellation of (FFM) traits.” This latter quote

suggests that it is the combination and pro-

ﬁle of various personality traits that creates

the psychopathic personality, consistent with

the superordinate modeling results discussed

above.

Are normal range (i.e., nonpathological)

personality traits more basic than patholog-

ical dispositions of psychopathic individuals?

Lynam & Widiger (2007) have outlined how

the FFM can be used to study the elements

of psychopathy. Their proposal is based on

the assumption that the 30 facets of the FFM

are “relatively more distinct” than the PCL-

R items (p. 165). For instance, based on their

previous translational research (e.g., Widiger

& Lynam 1998), Lynam & Widiger (2007)

suggested that the PCL-R items might be seen

as blends of several FFM facet domains, and

therefore the former may be less elemental

than the latter. However, large sample fac-

tor analysis of the lower-order NEO facets

that make up the ﬁve higher-order FFM do-

mains reveals that a number of facets show

substantial factor cross-loadings among dif-

ferent FFM domains (cf. Aluja et al. 2005).

That certain PCL-R items can be translated

to ﬁt under several FFM facets may stem

from the fact that the FFM facets themselves

demonstrate empirical overlap across FFM

domains. Thus, one might question whether

the FFM facet domains are indeed more dis-

tinct, or elemental, than the PCL-R items

(and by extension, PCL factors). In addition,

Digman’s (1997) meta-analytic factor analytic

results clearly demonstrate higher-order al-

pha and beta factors that explain the signiﬁ-

cant covariation among the lower-order FFM

domains. Similar results have been reported

in other large-sample factor analytic research

(DeYoung et al. 2001, Musek 2007). Thus,

whether the FFM domains represent distinct

elements of personality that can explain psy-

chopathic personality remains an open area

of investigation. Nevertheless, despite such

questions and considerations, we support the

line of FFM-psychopathy research being pur-

sued by a number of investigators and be-

lieve such endeavors not only complement

research on the PCL instruments, but also

represent important avenues of investigation.

Moreover, using self-report instruments such

as the FFM in conjunction with the interview-

based PCL instruments might provide excel-

lent opportunities to conduct hetero-method

studies, which may provide additional cover-

age of the psychopathy construct as well as

the opportunity to model method effects (e.g.,

multitrait, multimethod conﬁrmatory factor

analysis).

Assuming that normal-range personality

traits are not synonymous with, or more ele-

mental than, psychopathy traits, an important

avenue for future research concerns the na-

ture of the association between nonpathologi-

cal and pathological personality trait domains.

There is no doubt that normal-range per-

sonality traits are correlated with psychopa-

thy traits. For instance, aggregate data can

be obtained using the results reported in

Table 1 in Lynam & Widiger (2007, p. 168),

which displays the correlations between the

FFM facets and the PPI and Hare Self-Report

Psychopathy Scale (HSRP; Hare 1991) based

on a combined sample of 560 young adults.

The average (absolute) correlation is approxi-

mately r = 0.22 between the FFM facets and

the two self-report psychopathy scales. If one

uses only the highly prototypic FFM facets,

then the aggregate correlation (derived from

Table 1 in Lynam & Widiger 2007) between

the FFM facets and the PPI or HSRP scales is

r = 0.27. Interestingly, similar results are ob-

tained with offender populations, based on a

hetero-method approach. For example, mod-

est MPQ/PCL-R correlations have been re-

ported for a sample of 218 male offend-

ers (Benning et al. 2005a). Similar modest

236 Hare

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associations were found between the MPQ

and the PCL-R facets in a sample of 157 male

offenders (P. Wupperman, C.S. Neumann, &

J.P. Newman, unpublished data).

Generally similar ﬁndings of modest cor-

relations have been reported in a meta-

analysis by Lynam & Dereﬁnko (2006). They

used both mono-method and hetero-method

studies of either adult or youth samples to

gauge the strength of the association between

normal-range personality and psychopathy.

They reported that the majority of normal-

range personality dimensions was modestly,

at best, related to psychopathy traits. Interest-

ingly, neuroticism was found to be positively

associated with psychopathy, contrary to the-

ory. Most importantly, the normal range di-

mension of agreeableness tended to display a

moderately strong (negative) association with

psychopathy. Lynam & Dereﬁnko (2006) sug-

gested that low agreeableness reﬂects individ-

uals who are suspicious, deceptive, exploitive,

aggressive, arrogant, and tough-minded. Per-

haps the relation between low agreeableness

and psychopathy reﬂects overlap in antiso-

cial tendencies. Taken together, the results

of these studies suggest that the empirical

link between normal-range personality traits

and psychopathic personality traits is mod-

est at the measurement level, though the

association may be stronger at the latent

level.

We agree with Livesley’s (2007) sugges-

tion that a strength of dimensional models

of personality disorder is that they are based

on clinical descriptions of personality disor-

ders, and also that it is difﬁcult to explain

how “extreme positions on dimensions such

as agreeableness, sociability, or conscientious-

ness are necessarily pathological” (p. 203).

At the same time, there appears to be a fair

degree of convergence between models of

normal-range traits and PD traits (Widiger

& Simonsen 2005). Thus, continued research

on the integration of pathological and non-

pathological trait domains is necessary. For in-

stance, do the same genetic factors pertain to

both normal-range and pathological person-

ality traits (Livesley et al. 1998)? If so, per-

haps pathological traits are simply maladap-

tive expressions of normal-range personality

traits. However, an alternative empirical re-

lation might be that normal-range traits are

reciprocally related to pathological personal-

ity traits. If this assumption is correct, then

normal range traits may contribute to the de-

velopment of personality disorder traits, but

additional factors, such as pathological in-

teractions with parents or peers (e.g., Frick

et al. 2003, Pardini et al. 2007), may be

necessary for the development of personal-

ity disorder traits, including those that deﬁne

psychopathy.

The discussions so far of lower-order and

higher-order normal-range personality and

psychopathy domains suggest that there may

not be an optimal level of analysis for math-

ematically representing psychopathy-related

traits. For instance, higher-order levels may

be linked to broad general genetic factors,

and lower-order levels linked to more spe-

ciﬁc, residual genetic factors (Livesley 2005,

Livesley et al. 1998). However, as Little et al.

(2002) have discussed, it is often necessary

to represent mathematically broad constructs

like personality in terms of many indicators.

As mentioned above, Baker et al. (2007) re-

ported that a broad set of items reﬂecting

antisocial behavior, aggression, delinquency,

and psychopathic traits all formed a single

cohesive factor, which had signiﬁcant genetic

effects across child, caregiver, and teacher

ratings. The strength of measures such as

the PCL instruments (Hare & Neumann

2006), the YPI (Andershed et al. 2002), the

APSD (Vitacco et al. 2003), and the SRP-

III (Williams et al. 2007) is that the item-

to-factor relations have been clearly worked

out and each of these measures can be pre-

cisely represented in terms of lower-order

as well as cohesive higher-order latent vari-

able models. Once the latent structure of

a measure is known, it is then possible to

determine if the same structure can be re-

vealed with biometric data (e.g., Livesley et al.

1998).

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ANRV339-CP04-09 ARI 22 February 2008 18:19

Behavior Genetics

of Psychopathic Traits

There is increasing evidence that broad ge-

netic factors may account for a substantial por-

tion of the variance and covariance of diverse

sets of psychopathy traits. For instance, inves-

tigators have reported bivariate analyses that

suggest that there are genetic inﬂuences on

the covariance of psychopathy scales reﬂect-

ing emotional detachment and antisocial ten-

dencies (Taylor et al. 2003, Viding et al. 2005).

Relatedly, both MPQ dimensions (fearless-

dominance and impulsive-antisociality) show

genetic covariation with externalizing psy-

chopathology in men (Blonigen et al. 2005).

In a large sample of 9- to 10-year-old twins,

Baker et al. (2007) found that a common anti-

social behavior factor (composed of child psy-

chopathy traits, aggression, and delinquency)

across informants was strongly heritable. Re-

cently, Viding et al. (2007) found a com-

mon genetic component to the covariation

between callous-unemotional traits and an-

tisocial tendencies in children. Finally, based

on a large adolescent twin sample, Larsson

et al. (2007) reported that the same general

four factors present in the four-factor model

of psychopathy (e.g., Hare & Neumann 2006,

Neumann et al. 2006, Vitacco et al. 2005) all

loaded onto a single genetic factor. The vari-

ance in the male psychopathic traits in each

factor accounted for by the common genetic

factor was 25% for grandiose/manipulative,

20% for callous/unemotional, 42% for im-

pulsive/irresponsible, 19% for antisocial be-

havior (ages 13 to 14), and 30% for antisocial

behavior (ages 16 to 17). For females, the vari-

ance accounted for by the common genetic

factor was 37% for grandiose/manipulative,

22% for callous/unemotional, 45% for im-

pulsive/irresponsible, 21% for antisocial be-

havior (ages 13 to 14), and 41% for antiso-

cial behavior (ages 16 to 17). Notably, in both

sexes the impulsive/irresponsible and antiso-

cial facets showed some of the strongest ge-

netic components, consistent with the very

early conceptions of psychopathy.

Taken together, the behavior genetic re-

search on psychopathy ﬁts with the structural

research discussed previously. The results re-

ported by Livesley et al. (1998) may be the

most informative, given that the same latent

psychopathy factor resulted when using ei-

ther phenotypic or genotypic PD symptom

data. Thus, consistent with the observations of

Eley (1997), the behavioral genetic evidence

suggests, “genetic factors might be acting as

general inﬂuences” (i.e., general genes) in

the manifestation of covarying psychopathic

traits, with environmental factors inﬂuenc-

ing the form of speciﬁc psychopathic traits

(pp. 90–91). At the same time, as discussed by

Livesley (2005), lower-order speciﬁc residual

genetic effects may also be important for un-

derstanding personality disorders such as psy-

chopathy. For example, Larsson et al. (2007)

found this type of residual genetic effect for

the grandiose/manipulative scale of the YPI

in girls.

Longitudinal Nature

of Psychopathic Traits

Several recent longitudinal studies have pro-

vided good evidence that psychopathic traits

are at least moderately stable across develop-

ment. For instance, Frick et al. (2003) found

that the APSD trait dimensions were stable

over a four-year period in a sample of non-

referred children in the third, fourth, sixth,

and seventh grades at ﬁrst assessment. In this

study, baseline antisocial behavior, socioeco-

nomic status (SES), and quality of parenting

were signiﬁcant predictors of stability. Using

a large sample of inner-city boys assessed an-

nually from ages 8 to 16 and items from a child

behavior checklist to model interpersonal-

callousness, Obradovic et al. (2007) found ev-

idence of signiﬁcant stability across a nine-

year period, as well as longitudinal invariance.

The latter ﬁnding is important because it sug-

gests that the same construct was being mod-

eled across time. In related research, Burke

et al. (2007) reported that the same behav-

ior checklist-based interpersonal-callousness

238 Hare

Neumann

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ANRV339-CP04-09 ARI 22 February 2008 18:19

measure signiﬁcantly predicted PCL-R scores

at age 19 in a clinic-referred sample of boys

assessed at ages 7 to 12.

Loney et al. (2007) used a large sample of

twins and found that the MTI detachment and

antisocial tendencies showed good stability.

Lynam et al. (2007) also found moderate sta-

bility from ages 13 to 24, respectively, using

the Child Psychopathy Scale (Lynam 1997)

and the PCL: SV. This latter study is notable

for its use of a hetero-method approach. Also,

Lynam et al. (2007) found that in addition to

Child Psychopathy Scale scores, family struc-

ture and SES also predicted PCL: SV scores,

consistent with the Frick et al. (2003) ﬁndings.

Blonigen et al. (2005) reported greater genetic

than environmental contributions to the sta-

bility of the MPQ factors from late adoles-

cence to young adulthood, but that nonshared

environmental factors contributed more to

their change over time. Importantly, across

many of these studies there appear to be

fundamental longitudinal relations between

the antisocial-tendencies component of psy-

chopathy and other psychopathic traits, in

line with the behavior genetic and structural

research ﬁndings discussed above. Similarly,

Larsson et al. (2007) found that prior (ages

13 to 14) antisocial tendencies were signif-

icantly positively associated with later (ages

16 to 17) interpersonal, affective, and impul-

sive lifestyle psychopathic traits via cross-twin

cross-trait biometric data. In sum, across a

diverse set of psychopathy or psychopathy-

related instruments and samples, there is good

evidence for the stability of psychopathic traits

from childhood and adolescence into adult-

hood. At the same time, family factors, SES,

and unique environmental factors also play

important roles in the stability and change of

psychopathic traits over time.

Biological and Cognitive Features

of Psychopathy

Much of the research literature on psy-

chopathy has to do with its clinical and

forensic implications and applications. How-

ever, an equally robust literature aims at un-

derstanding the basic nature of the disor-

der. We discussed some of this literature

in preceding sections on behavioral genet-

ics, developmental psychopathology, and gen-

eral personality theory. Here we refer to

empirical research into the biological and

cognitive mechanisms of psychopathy, begin-

ning more than half a century ago with the-

ories and methodologies derived from the

then new ﬁeld of psychophysiology (e.g.,

Hare 1968, Lykken 1957) and continuing

today with the active collaboration of sci-

entists in a variety of disciplines, includ-

ing biochemistry, neuroanatomy, and cog-

nitive/affective neuroscience (e.g., see Blair

et al. 2005, Hare 2003, Kiehl 2006, Newman

et al. 2007, Patrick 2006a, Raine & Yang

2006). Space limitations do not allow for a

review of this literature, but a few notable

trends can be mentioned. Particularly exciting

is the recent surge in neuroimaging research

on the structural and functional correlates of

psychopathy. Most of this research uses the

PCL-R or one of its derivatives, with results

that generally are consistent with the view

that psychopathy is characterized by anoma-

lies in cognitive and affective processes. Per-

haps the most interesting ﬁndings are that

some clinical and behavioral features of psy-

chopathy, such as impulsivity, poor response

inhibition, and difﬁculty in processing emo-

tional material, are mirrored in brain function

and perhaps in brain structure. In most stud-

ies, it is the total PCL-R or PCL: SV score

that is important, but in some tasks the psy-

chopathy dimensions are differentially—and

meaningfully—related to brain function (e.g.,

Blair et al. 2005, Kiehl 2006). Although early

investigations implicated relatively localized

brain regions (e.g., amygdala, hippocampus,

frontal cortex) in psychopathy, more recent

theory and research takes the view that psy-

chopathy can better be understood in terms

of complex interactions among various re-

gions and functions (e.g., Kiehl 2006), per-

haps as part of more general models related to,

for example, externalizing psychopathology

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•

Psychopathy as a Clinical and Empirical Construct 239

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ANRV339-CP04-09 ARI 22 February 2008 18:19

(e.g., Markon & Krueger 2005), affective pro-

cessing (Kiehl 2006), and moral behavior (e.g.,

Moll et al. 2005, Raine & Yang 2006). A no-

table trend is the interest shown by neuro-

scientists in using psychopathy as a vehicle

for evaluating their own models of behav-

ior, personality, and brain function. The result

may ultimately be an integration of psychopa-

thy theory and research with more general

psychobiological, behavioral genetic, devel-

opmental, and personality models.

CONCLUSIONS

Prior to the development of the PCL-R, re-

search on psychopathy was quite chaotic, with

different investigators using deﬁnitions and

measures of the disorder that often were un-

related to one another and of uncertain re-

liability and validity. We now have an im-

pressive body of replicable and meaningful

empirical ﬁndings, due in large part to the

widespread adoption of the PCL-R and its

derivatives as a common working model of

psychopathy. Nonetheless, some commenta-

tors are concerned that the PCL-R has be-

come so popular that many researchers and

clinicians ostensibly confuse the measure with

the construct. Others are concerned that the

PCL-R has deviated from its “roots” in a par-

ticular clinical case method; they seem less

concerned that they might be confusing the

clinician with the construct. We ﬁnd it incon-

gruous that empirical research ﬁndings should

be judged by how well they ﬁt with clinical

observations described more than half a cen-

tury ago. We have addressed these issues, as

well as arguments about the role of antisocial-

ity in the conceptualization and measurement

of psychopathy. We also noted that the re-

search on psychopathy is beginning to beneﬁt

from the use of multitrait, multimethod ap-

proaches to research, and from its integration

with other disciplines.

DISCLOSURE STATEMENT

R.D. Hare receives royalties from the sale of the PCL-R and its family of instruments.

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Annual Review of

Clinical Psychology

Volume 4, 2008

Contents

Ecological Momentary Assessment

Saul Shiffman, Arthur A. Stone, and Michael R. Hufford ppppppppppppppppppppppppppppppp1

Modern Approaches to Conceptualizing and Measuring Human

Life Stress

Scott M. Monroe ppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp33

Pharmacotherapy of Mood Disorders

Michael E. Thase and Timothey Denko pppppppppppppppppppppppppppppppppppppppppppppppppp 53

The Empirical Status of Psychodynamic Therapies

Mary Beth Connolly Gibbons, Paul Crits-Christoph, and Bridget Hearon ppppppppppppp93

Cost-Effective Early Childhood Development Programs from

Preschool to Third Grade

Arthur J. Reynolds and Judy A. Temple pppppppppppppppppppppppppppppppppppppppppppppppp109

Neuropsychological Rehabilitation

Barbara A. Wilson ppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp141

Pediatric Bipolar Disorder

Ellen Leibenluft and Brendan A. Rich ppppppppppppppppppppppppppppppppppppppppppppppppppp163

Stress and the Hypothalamic Pituitary Adrenal Axis in the

Developmental Course of Schizophrenia

Elaine Walker, Vijay Mittal, and Kevin Tessner pppppppppppppppppppppppppppppppppppppppp189

Psychopathy as a Clinical and Empirical Construct

Robert D. Hare and Craig S. Neumann pppppppppppppppppppppppppppppppppppppppppppppppp217

The Behavioral Genetics of Personality Disorder

W. John Livesley and Kerry L. Jang pppppppppppppppppppppppppppppppppppppppppppppppppppp247

Disorders of Childhood and Adolescence: Gender and

Psychopathology

Carolyn Zahn-Waxler, Elizabeth A. Shirtcliff, and Kristine Marceau pppppppppppppppp275

vii

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AR339-FM ARI 5 March 2008 23:50

Should Binge Eating Disorder be Included in the DSM-V? A Critical

Review of the State of the Evidence

Ruth H. Striegel-Moore and Debra L. Franko ppppppppppppppppppppppppppppppppppppppppp305

Behavioral Disinhibition and the Development of Early-Onset

Addiction: Common and Speciﬁc Inﬂuences

William G. Iacono, Stephen M. Malone, and Matt McGue ppppppppppppppppppppppppppp325

Psychosocial and Biobehavioral Factors and Their Interplay

in Coronary Heart Disease

Redford B. Williams pppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppppp

349

Stigma as Related to Mental Disorders

Stephen P. Hinshaw and Andrea Stier pppppppppppppppppppppppppppppppppppppppppppppppppp367

Indexes

Cumulative Index of Contributing Authors, Volumes 1–4 ppppppppppppppppppppppppppp395

Cumulative Index of Chapter Titles, Volumes 1–4 pppppppppppppppppppppppppppppppppppp397

Errata

An online log of corrections to Annual Review of Clinical Psychology chapters (if any)

may be found at http://clinpsy.AnnualReviews.org

viii Contents

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SARTAN. The regulatory function of affect in norm-relevant action, based on Julius Kuhl's PSI theory

Thesis

Full-text available

May 2024

Marie Joséphine Hamatschek

This dissertation introduces the self and affect regulation theory of adherence to social norms (SARTAN), addressing the need for specific, integrative explanations of criminal behavior grounded in basic psychological research. Rooted in Julius Kuhl’s personality-systems-interactions (PSI) theory, SARTAN explains norm-relevant behavior as a result of the interaction between affect (positive and negative), its regulation, and internal and external controls. The theory identifies two primary modes of action regulation: the introjective mode, where intentions are formed based on external cues, and the self-mode, guided by personal norm commitment. The affective state is assumed to determine the mode of action generation (i.e., introjective mode vs. self mode) in given situations. In four studies using offender samples, hypotheses and research methods derived from the theory were tested. Although support for specific hypotheses was mixed, the findings underscore the psychological significance of the distinction between positive and negative affect in norm-relevant behavior. The potential of PSI theory for criminal psychology is explored within the SARTAN frame and beyond. The empirical and theoretical work is discussed in terms of its implications for predicting criminal behavior and enhancing offender treatment. Its limitations are acknowledged both in terms of internal and external validity, and avenues for future research are outlined.

Functional Connectivity of Moral Cognition and Traits of Psychopathy in Youth: An Analysis of the Scientific Literature

Article

Full-text available

Jun 2024

The aim of the study is to analyze the scientific literature and evidence on the mechanisms of functional connectivity involved in moral cognition processes in youth with psychopathy traits. Scientometric methods of citation networks based on graph theory were used. Bibliometrix, Sci2 Tool, and Gephi were used for the analysis. It was found that the dorsal and ventral regions of the prefrontal cortex, orbitofrontal cortex, amygdala, hippocampus, angular gyrus, anterior cingulate and temporal cortex evidence functional alterations in young people with psychopathic traits. It was also reported that graymatter concentration in the left posterior and right anterior cingulate are possible endophenotypes of psychopathic traits. The theoretical, empirical, and legal implications of a moral neural perspective of psychopathy andantisocial behavior are discussed. The results demonstrated that psychopathic traits, which occasionally lead to criminal and violent behaviors, have a neurobiological basis related to moral cognition processes. However, a neuronal moral model has theoretical and practical limitations, as well as legal implications for free will and moral agency capacity.

Exploring a paradox: Psychopathy, Morality and Organisational Citizenship Behaviour

Article

Full-text available

Jun 2024
J BUS ETHICS

Studies of the association between psychopathic traits and prosocial behavior are limited, with explanatory mechanisms of such dynamics being similarly scant within the empirical literature. Using a large sample of people in leadership roles, we explore the associations between the three facets of psychopathy (TriPM, Patrick CJ (2010) Operationalizing the triarchic conceptualization of psychopathy: preliminary description of brief scales for assessment of boldness, meanness, and disinhibition. Unpublished test manual, Florida State University, pp. 1110–1131), and organizational citizenship behavior (OCB, Smith et al (1983) J Appl Psychol 68:653–663). We examine the mediating role of individualizing and binding moral foundations (MFQ, Graham et al. (2013) Adv Exp Soc Psychol 47:55–130) within these relationships. Correlation analysis revealed that boldness was positively correlated with OCB, while both meanness and disinhibition were negatively correlated with OCB. Mediation analysis demonstrated that only individualizing moral foundations (IMF) mediated the relationship between meanness and OCB, such that meanness led to lower IMF and reduced levels of OCB. Our findings signal that lower IMF enables the nefarious behavior of people with darker psychopathic traits, while moral foundations as a whole play no role in advancing the prosocial behavior of people with so-called adaptive psychopathic traits. The contributions of these findings to the literature are discussed.

Can perpetrators discern survivors from voice?

Article

Full-text available

Jun 2024

Background: Research has shown that potential perpetrators and individuals high in psychopathic traits tend to body language cues to target a potential new victim. However, whether targeting occurs also by tending to vocal cues has not been examined. Thus, the role of voice in interpersonal violence merits investigation. Objective: In two studies, we examined whether perpetrators could differentiate female speakers with and without sexual and physical assault histories (presented as rating the degree of ‘vulnerability’ to victimization). Methods: Two samples of male listeners (sample one N = 105, sample two, N = 109) participated. Each sample rated 18 voices (9 survivors and 9 controls). Listener sample one heard spontaneous speech, and listener sample two heard the second sentence of a standardized passage. Listeners’ self-reported psychopathic traits and history of previous perpetration were measured. Results: Across both samples, history of perpetration (but not psychopathy) predicted accuracy in distinguishing survivors of assault. Conclusions: These findings highlight the potential role of voice in prevention and intervention. Gaining a further understanding of what voice cues are associated with accuracy in discerning survivors can also help us understand whether or not specialized voice training could have a role in self-defense practices.

Exploring Relationship between Social Media Use and Antisocial Behaviour among Tertiary Institution Students: An Investigative Study of Influencing Factors

Article

Full-text available

Nov 2023

This study explored the relationship between social media use, antisocial behaviour and its impact on tertiary institution students. The influencing factors were examined. The prevalent types of antisocial behaviour on social media platforms among students in tertiary institutions, contributory factors to the development of antisocial behaviour, the average hours spent by students on social media per day, as well as the difference between male and female students in their use of social media to facilitate online harassment in tertiary institutions were identified. A descriptive survey design was used with a structured questionnaire. A total of two hundred and twenty respondents who were students of the University of Ibadan and Polytechnic Ibadan participated in the study and a descriptive data analysis technique was used to present and analyse the data. The questionnaire consisted of questions relating to the types of prevalent antisocial behaviour, contributory factors to antisocial behaviour on social media as well as the relationship between the use of social media and antisocial behaviour among others. While the questionnaires were administered online to respondents in the University of Ibadan, printed questionnaires were administered to respondents at the Polytechnic, Ibadan The study found that social media has a significant impact on antisocial behaviour among students in tertiary institutions. It also revealed the contributory factors to the development of antisocial behaviour among students in tertiary institutions. It was recommended among others, that campaigns, and workshops should be organized to create awareness on responsible social media usage and the consequences of antisocial behaviour.

Association Between Traumatic Brain Injury and Psychopathic Traits Among Justice-Involved Adolescents

Article

Jun 2024

Traumatic brain injury (TBI) is a global public health problem and is highly prevalent among justice-involved populations. Pediatric TBI is linked with long-term negative outcomes and is correlated with substance use, criminal behavior, psychiatric disorders, and disruptions in neurocognition. These same TBI correlates are evident among youth with psychopathic traits. Given ongoing neurobiological and social development in adolescence, understanding the link between psychopathic traits and TBI in justice-involved youth is critical. A sample of 263 male adolescents were recruited from a maximum-security juvenile justice facility. Using a structural equation modeling (SEM) framework, measurement invariance of psychopathic traits (TBI ±) was tested, and psychopathy scores were accounted for in terms of TBI variables (severity, age of first TBI, total number), participant’s age, IQ, substance use, and internalizing psychopathology. There was evidence of strong invariance across TBI status and those with TBI had higher affective and impulsive lifestyle psychopathic traits than adolescents without TBI. The SEM indicated that TBI severity was associated with lower IQ scores, which in turn were associated with increased lifestyle/antisocial (Factor 2) psychopathic traits. Total number of TBIs was associated with higher substance use, which was associated with both increased interpersonal/affective (Factor 1) and Factor 2 psychopathic traits. These TBI variables also had indirect associations with psychopathic traits through IQ and substance use. The findings indicate that TBI is associated with psychopathic traits and suggest that disturbances in cognition and substance use may be treatment targets for youth with TBI and psychopathic traits.

Unmasking the dark triad: exploring its relationship with attitudes toward intimate partner violence

Article

Full-text available

Jun 2024

Purpose Although it is a relatively recent conceptualization of malevolent personality, the dark triad (DT) has been widely researched and shown to be responsible for increases in physical violence, controlling behavior, short-term mating preferences and poor relationship quality. This study aims to investigate whether DT traits predict acceptance toward intimate partner violence (IPV) in the general population, addressing a gap in the literature regarding predictors of harmful attitudes toward romantic relationships. Design/methodology/approach In total, 150 adults aged 18–74 (76% women) completed two self-report questionnaires: the short DT and the IPV attitude scale-revised. Findings A series of hierarchical multiple regression analyses were conducted, with gender as predictor in the first models and DT traits added as predictors in second models. The results showed that male participants were more accepting of IPV than female participants. Over and above the contribution of gender, psychopathy and Machiavellianism positively predicted overall IPV acceptance, but narcissism did not. Psychopathy and Machiavellianism positively predicted acceptance of psychological abuse, and psychopathy positively predicted acceptance of controlling behaviors. Narcissism did not predict any facet of IPV acceptance. Originality/value To the best of the authors’ knowledge, as the first study to explore the roles of DT traits in acceptance of IPV behaviors, the results contribute to the understanding of how these traits may predispose individuals to harmful intimate partner behaviors. These findings can inform IPV prevention efforts to aid in the early identification of individuals who hold maladaptive beliefs surrounding romantic relationships.

Psychopathie und ihre aktuelle Evolution

Chapter

Jan 2024

Janko Međedović

Psychopathy and Fun-Seeking Predicting Alcohol Drinking: The Role of Thinking Styles

Article

Full-text available

Jun 2024

INTRODUCTION: The study examined the effect of trait psychopathy and BAS fun-seeking on alcohol drinking and whether this effect is moderated by thinking styles. We hypothesized that psychopathy will indirectly predict alcohol drinking through BAS fun-seeking, moderated by experientiality and rationality. METHODS: The research sample of the cross-sectional study consisted of 241 working adults (47.30% men). Participants completed the Short Dark Triad, Behavioral Inhibition (BIS) and Behavioral Activation Scales (BAS), the Rational-Experiential Inventory-40, and the Health Behavior Inventory. RESULTS: Psychopathy indirectly predicted alcohol drinking through BAS fun-seeking. Experientiality significantly moderated the relationship between BAS fun-seeking and alcohol drinking. In the context of high experientiality, BAS fun-seeking predicted alcohol drinking positively and significantly. Rationality did not create a significant context for predicting alcohol drinking by BAS fun-seeking and psychopathy. CONCLUSIONS: Moderated mediation analysis showed that thinking styles and individual differences in behavioral activation co-created psychological mechanisms underlying alcohol drinking in adults with traits of psychopathy.

Arousal, interindividual differences and temporal binding a psychophysiological study

Article

Full-text available

May 2024
PSYCHOL RES-PSYCH FO

The sense of agency varies as a function of arousal in negative emotional contexts. As yet, it is unknown whether the same is true for positive affect, and how inter-individual characteristics might predict these effects. Temporal binding, an implicit measure of the sense of agency, was measured in 59 participants before and after watching either an emotionally neutral film clip or a positive film clip with high or low arousal. Analyses included participants’ individual differences in subjective affective ratings, physiological arousal (pupillometry, skin conductance, heart rate), striatal dopamine levels via eye blink rates, and psychopathy. Linear mixed models showed that sexual arousal decreased temporal binding whereas calm pleasure had no facilitation effect on binding. Striatal dopamine levels were positively linked whereas subjective and physiological arousal may be negatively associated with binding towards actions. Psychopathic traits reduced the effect of high arousal on binding towards actions. These results provide evidence that individual differences influence the extent to which the temporal binding is affected by high arousing states with positive valence.

The History of Mental Symptoms: Descriptive Psychopathology since the Nineteenth Century

Book

Apr 1996

German E. Berrios

Review of the hare psychopathy checklist-revised

Article

Jan 1995

S.M. Fulero

Psychopathy and personality

Article

Jan 2006

The structure of neurosis: With special differentials between neurosis, psychosis, homosexuality, alcoholism, psychopathy, and criminality

Article

Jan 1961

B. Karpman

Psychopathy from the perspective of the fi ve-factor model of personality

Article

Jan 2013

The self-report assessment of psychopathy: problems, pitfalls, and promises

Article

Jan 2006

Refining the construct of psychopathy: Towards a hierarchical model

Article

Jun 2001

Psychopathy is characterized by diverse indicators. Clinical accounts have emphasized 3 distinct facets: interpersonal, affective, and behavioral, Research using the Psychopathy Checklist-Revised (PCL-R), however, has emphasized a 2-factor model, A review of the literature on the PCL-R and related measures of psychopathy, together with confirmatory factor analysis of PCL-R data from North American participants, indicates that the 2-factor model cannot be sustained. A 3-factor hierarchical model was developed in which a coherent superordinate factor, Psychopathy, is underpinned by 3 factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience, and Impulsive and Irresponsible Behavioral Style. The model was cross-validated on North American and Scottish PCL-R data, Psychopathy Screening Version data, and data derived from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) antisocial personality disorder field trial.

Psychopathy and Normal Personality

Chapter

Jan 1998

Thomas A. Widiger

The purpose of this chapter is to discuss the construct of psychopathy from the perspective of normal personality. It will be suggested that psychopathy can be understood as a maladaptive variant of common personality traits. The chapter will begin with a discussion of the constructs of mental and personality disorders, suggesting the absence of a discrete or qualitative point of demarcation between the presence versus absence of a personality disorder. Psychopathy, as a personality disorder, will then be considered from the perspective of a model of normal personality functioning. It will be suggested that the traits of psychopathy (and antisocial personality disorder) can be understood from the perspective of this model, but only the most prototypic cases would display all of the features. The complexity of the psychopathic personality profile and the variability in presentation is important to appreciate when attempting to understand individual cases of psychopathy, to explain variability in findings across different settings and populations, to identify the maladaptivity of the disorder within different social and environmental contexts, and to understand its etiology.

Legal Competencies in Relation to Confession Evidence

Chapter

Feb 2008

Legal CompetenciesThe Legal Framework in the USAThe Legal Framework in England and WalesFalse Confessions and Personality DisordersConclusions References

The PCL-R and PCL: YV: forensic applications and limitations

Article

Jan 2006

Psychopathy as a Clinical and Empirical Construct

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