Psychopathic Personality in Young People: Mairead Dolan
Psychopathic Personality in Young People: Mairead Dolan
Psychopathic Personality in Young People: Mairead Dolan
10, 466473
Dolan
Aetiology of psychopathy
The biological and environmental factors responsible for the development and maintenance of
antisocial behaviour and psychopathy are not well
understood. Studies in children and adolescents
(Forth & Burke, 1998) indicate that several family
background variables (e.g. parental rejection,
inconsistent discipline, abuse) are associated with
the development of conduct disorder and psychopathy. However, an independent literature also
suggests that children with conduct disorder,
Mairead Dolan is a reader in forensic psychiatry at the University of Manchester (The Edenfield Centre, Bolton, Salford &
Trafford Mental Health NHS Trust, Prestwich, Manchester M25 3BL, UK. E-mail: [email protected]). Her
research interests include antisocial and psychopathic personality disorders.
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personality.
To date, few of these theories have been extensively
tested in child and adolescent samples. However,
some support for the violence inhibition mechanism
model has emerged in studies showing a selective
impairment in the processing of sad and fearful faces
in children with psychopathic tendencies (Blair et
al, 2001).
Psychopathy in children
and adolescents
The existence and assessment of psychopathy in
children and adolescents is a contentious issue
(Edens et al, 2001; Hart et al, 2002; Seagrave & Grisso,
2002). Key concerns centre on the reliability and
validity of current assessment tools, the developmental appropriateness of these measures, how
closely the construct mimics that in adulthood and
the potentially negative impact of attaching a label
of psychopathy to those who have not yet reached
maturity (Box 1).
Frick (2002) argues that psychopathy presents no
more of a challenge than any other measure of
psychopathology in children and adolescents, and
suggests that psychopathy assessment in juveniles
may be a means of early detection and intervention
in high-risk groups.
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Prevalence of psychopathy
in forensic samples
At present, there are no data on the prevalence of
psychopathy in the juvenile general population.
Using a PCLYV cut-off score of >30 in a population
of adolescents already involved with criminal or
psychiatric services, Forth & Burke (1998) found
rates of psychopathy of 3.5% in young people in
community care, 12% in those on probation and
28.3% in those incarcerated. Brandt et al (1997)
reported a prevalence of 37% in incarcerated youths,
using a PCLYV cut-off score of >28. As there are no
recommended cut-off scores for diagnoses of
psychopathy using the CPS, PSD or YPI, prevalence
rates using these measures have not been reported.
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Box 3 Item content of the Hare Psychopathy Checklist: Youth Version (after Forth et al, 2004)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Impression management Conforms with notions of social desirability, presents him- or herself in a
good light, is superficially charming
Grandiose sense of self-worth Is dominating, opinionated, has an inflated view of own ability
Stimulation-seeking Needs novelty, excitement, is prone to boredom and risk-taking behaviours
Pathological lying Exhibits pervasive lying, lies readily, easily and obviously
Manipulation for personal gain Is deceitful, manipulates, engages in dishonest or fraudulent schemes
that can result in criminal activity
Lack of remorse Has no guilt, lacks concern about the impact of his or her actions on others; justifies
and rationalise their abuse of others
Shallow affect Has only superficial bonds with others, feigns emotion
Callous or lacking empathy Has a profound lack of empathy, views others as objects, has no
appreciation of the needs or feelings of others
Parasitic orientation Exploits others, lives at the expense of friends and family, gets others to do his
or her schoolwork using threats
Poor anger control Is hotheaded, easily offended and reacts aggressively, is easily provoked to violence
Impersonal sexual behaviour Has multiple casual sexual encounters, indiscriminate sexual
relationships, uses coercion and threats
Early behavioural problems Lying, thieving, fire-setting before 10 years of age
Lacks goals Has no interest or understanding of the need for education, lives day-to-day, has
unrealistic aspirations for the future
Impulsivity Acts out frequently, quits school, leaves home on a whim, acts on the spur of the moment,
never considers the consequences of impulsive acts
Irresponsibility Habitually fails to honour obligations or debts, shows reckless behaviour in a variety
of settings, including school and home
Failure to accept responsibility Blames other for his or her problems, claims that he or she was set
up, is unable and unwilling to accept personal responsibility for their actions
Unstable interpersonal relationships Has turbulent extrafamilial relationships, lacks commitment
and loyalty
Serious criminal behaviour Has multiple charges of convictions for criminal activity
Serious violations of conditional release Has two or more escapes from security or breaches of probation
Criminal versatility Engages in at least six different categories of offending behaviour
Comorbidity
The only published studies looking at comorbidity
of psychopathy with other psychiatric disorders in
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Outcome
In the adult literature there is some evidence that
psychopathy is a significant negative moderator
of treatment outcome (Losel, 1998). To date, two
studies have looked at the relationship between
psychopathy and treatment outcome in adolescents,
but none has considered this in children. Rogers
et al (1997) found modest correlations between
psychopathy scores and ratings of non-compliance
with treatment in 81 adolescent in-patients. ONeill
et al (2003) also reported that psychopathy score was
negatively correlated with attendance rates, quality
of participation and clinical improvement in
adolescents in a substance misuse treatment programme. These findings suggest that psychopathy
may be an important moderator of treatment
outcome in adolescents as in adults, and specialised
programmes may be needed for young people with
psychopathic traits. Forth & Burke (1998) also point
out that juveniles identified as psychopathic may
be more malleable and benefit more from treatment
than their older counterparts
Conclusions
The assessment of psychopathy in children and
adolescents is a very important area of research
and it is still in its infancy. There seems to be
reasonable evidence that juvenile psychopathy shows
similar correlates (e.g. aggression, neurocognitive
deficits, substance misuse) to adult psychopathy.
Our knowledge about the nature, stability and
consequences of juvenile psychopathy, however, is
still very limited. There have been no published
longitudinal studies of the stability of psychopathy
as assessed by any of the current measures and it
remains unclear to what degree the antisocial
behavioural items that contribute to the psychopathy
label change over time, given what we know about
adolescent-limited antisocial behaviours. The limited
data on the psychometric properties of current
instruments, particularly information on recommended or specific cut-off scores for prototypical
psychopathy, suggest that it is premature to assign
this label to younger cohorts. For this reason many
researchers in this field refer to juveniles with
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References
Andershed, H., Kerr, M., Stattin, H., et al (2002) Psychopathic
traits in non-referred youths: a new assessment tool. In
Psychopaths Current International Perspectives (eds Blaauw,
E. & Sheridan, L.). The Hague: Elsevier.
Asherson, P. P. (2004) Bridging the service divide. Invited
commentary on Attention-deficit hyperactivity disorder
in adults. Advances in Psychiatric Treatment, 10, 257259.
Barry C. T., Frick P. J., DeShazo T. M., et al (2000) The
importance of callous-unemotional traits for extending
the concept of psychopathy to children. Journal of Abnormal
Psychology, 109, 335340.
Berney, T. (2004) Asperger syndrome from childhood into
adulthood. Advances in Psychiatric Treatment, 10, 341351.
Blair, R. J. R. (1995) A cognitive developmental approach to
morality: investigating the psychopath. Cognition, 57,
129.
Blair, R. J. R. (1997) Moral reasoning and the child with
psychopathic tendencies. Personality and Individual
Differences, 22, 731739.
Blair, R. J. R. (1999) Responsiveness to distress cues in the
child with psychopathic tendencies. Personality and
Individual Differences, 27, 135145.
Blair, R. J. R., Colledge, E., Murray, L, et al (2001) A selective
impairment in the processing of sad and fearful expressions
in children with psychopathic tendencies? Journal of
Abnormal Child Psychology, 29, 491498.
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MCQs
1 Which of the following best answer the question Is
psychopathy the same as conduct disorder and
antisocial personality?
a yes
b no
c it overlaps with antisocial personality
d it overlaps with conduct disorder
e not all conduct disorder and antisocial personality
disorders meet the criteria for psychopathy.
MCQ answers
1
a
b
c
d
e
F
F
T
T
T
2
a
b
c
d
e
F
T
F
T
T
3
a
b
c
d
e
F
F
F
F
T
4
a
b
c
d
e
T
T
T
T
T
5
a
b
c
d
e
F
T
T
F
T
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