Psychopathy is a … disorder
neurodevelopmental disorder
When do the first symptoms emeger?
Which ones?
Early childhood (age 5)
disconnection from emotions, langauge and distractions
Is Antisocial PD the same as Psychopathy?
DSM5 doesnt seperat them BUT There is overlap between ASPD and psychopathy, but definitely not the same
Psychotic features such as manipulatives, glibness and superficial charm, and grandiose self-worth are not necessarily present in antisocial personality disorder
Psychopaths have a: Mask of …
Sanity
on the surface they look quite normal, but behind the mask there is an emotionally disturbed person
-> you do not notice that they are sick right away
Prevalence
population and prison
general pop.: 1%
Prison: up to 25%
Heritability rate?
50%
means that early environment is also important
What is with the recidivism rate?
Psychopathic prisoners have significantly higher rates of violent crime and recidivism
more likely to finagle an early release using the deceptive skills
Psychopathy has neurological causes. What are they?
almost certainly either genetic or the product of very early developmental problems.
Interactive Model of Psychopathy
People who become psychopaths are seen as having a genetic or early developmental predisposition for the disorder, which then blossoms into psychopathy when the predisposed individual interacts with a poor environment
Which questionnaire can be used to measure psychopathy?
2
- Psychopathy Checklist revised (PCL-R)
- Psychopathic Personality Inventory
Psychopathic personality inventory
a self-report scale used in studies of non-criminal samples
includes 187 first person statements (e.g., ‘ I am easily flustered in pressured situations ’ )
Psychopathy Checklist Revised (PCL-R)
20 items that need to be scores by clinician.
scores 0-2 (max. total 40)
-NOT a self-report! Psychopaths usually don’t acknowledge that they have psychopathic tendencies
- Need to talk to the person and additional look at collateral information (police files, school records, job records, relatives/colleague)
Most gruesome crimes often committed by people with high PCL-R scores
PCL-Rscore predict: Recidivism (high->high); Behaviour in prison (high-> more incidents); Treatmenat outcome (high-> poorer outcome)
4 domains of the PCL-R
- Interpersonal (e.g. glibness and superficial charm, grandiose self-worth)
- Affective (e.g. lack of remorse/guilt, shallow affect, callousness, lack of empathy)
- Lifestyle (e.g. lack of realistic long-term goals, promiscuous sexual behaviour, short-term relationships)
- Antisocial (e.g. criminal activity (often starts at young age), impulsivity, criminal versatility (many different crimes: fraud, sexual, violent, theft, property damage))
Treatment for adults
- No adequate therapy for psychopaths, but schema-focused therapy might work
schema-focused therapy
maladaptive patterns are changed by replacing the maladaptive schemas by healthy schemas (“limited parenting”)
What is about talking therapy or psychotherapy?
Talking: aimed at patients who know at one level or another they need help (psychopaths usually do not think they need help)
Psychothrapy:: requires patients to participate actively in their own recovery (psychopaths are not distressed) Psychopaths go through the therapeutic motions and are incapable of the emotional insights on which most talk therapy depends
Medication?
no one knows how to restore impaired paralimbic functions of psychopaths
Is group therapy good?
No
Group therapy may lead to increased psychopathy levels
Repetitive transcranial magnetic stimulation
non-invasive technique of stimulating the brain, has been found to alter emotional processing and moral judgment
The most optimal solution ?
prevent the development of psychopathic traits in juveniels
psychopathic tendencies in juveniles may be amenable (zugänglich) to treatment, at least for some part of the juvenile offender population
Treatment for adolecents
for adolecents
decompression treatment
(Caldwell’s) Decompression therapy
-focused on the slow + methodical rebuilding of the social connections that are absent in psychopath
- Juveniles need to be treated early enough, one-on-one, intense, over long period of time
- might make juvenile delinquents with psychopathic tendencies less criminal
-Consistes of a combination of different techniques (behavioural therapy, social skills training, family therapy etc.)
- Only works in juvenile and NOT in adults because brain development is already done
-very expernsive but may save money in the long run
What is part of 1. early interventions and 2. early envriomental enrichment programs?
- could reduce the risk for developing psychopathic traits, whether by directly influencing neurodevelopment (e.g. nutrition) or by indirectly affecting biology via psychological processes (e.g. parent–child interactions affecting hormone levels)
- proper nutrition, physical exercise, and stimulating educational activities -> may reduce the risk of psychopathy by improving neurodevelopment
How successful is decompression therapy?
- successful in decreasing recidivism rate
- BUT only if it was lengthy and only for juveniles scoring in the low to moderate ranges of the PCL-YV (≤ 31)
