Borderline personality disorder as a female phenotypic expression of psychopathy?

Relationships Between Psychopathy and DSM Personality Disorders in Men and Women

The current investigation asseses the relationship between DSM personality disorders (PDs) and PCL psychopathy in a community study: the Cambridge Study in Delinquent Development (CSDD). The children (Generation 3) of the original CSDD males (Generation 2) were assessed for PDs and psychopathy in early adulthood. Generation 3 consisted of both males (n = 291) and females (n = 260) and allowed for analyses separately for each gender. Cluster B PDs showed the strongest relationships with psychopathy, especially Borderline and Antisocial PD. Histrionic PD did not appear to have strong relationships with psychopathy, and there were no indications that histrionic PD overlaps with psychopathy in females as past research has hypothesized. There were however some other gender-specific relationships in the analyses, most notably between psychopathy and schizoid and schizotypal PDs for females, and between psychopathy and paranoid PD in males. Implications for the understanding of psychopathy in males and females are discussed.

The Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) Model for the Development of Secondary Psychopathic Traits

Understanding and treatment of antisocial behavior have improved through efforts to subtype individuals based on similar risk factors and outcomes. In particular, the presence of psychopathic traits is associated with distinct etiological factors and antisocial behavior that begins early in life, is aggressive, persistent, and less likely to normalize with traditional treatments, relative to individuals low on psychopathy or its childhood precursor, callous-unemotional (CU) traits. However, important distinctions can be made within individuals with CU/psychopathic traits according to the presence of elevated anxiety symptoms and/or adverse childhood experiences, known as secondary psychopathy/CU traits. This paper provides a broad and brief overview of theory and empirical literature supporting the existence of secondary psychopathy/CU variants as a distinct subtype of childhood antisocial behavior. It outlines the Emotionally Sensitive Child-Adverse Parenting Experiences-Allostatic (Over)Load (ESCAPE-AL) model for the developmental psychopathology of secondary psychopathic/CU traits and discusses research and theory supporting this perspective. Future research directions for testing this conceptual model and its implications for assessing and treating high-risk individuals with secondary CU/psychopathic traits are discussed.

Implicit Gender Bias in the Clinical Judgment of Psychopathy and Personality Disorders among Licensed Psychologists in the USA

The role of implicit gender bias in the assessment of mental disorders remains a contentious and consequential issue. Inaccurate assessment of psychopathy and personality disorders (PD) among health care professionals can have deleterious consequences with respect to treatment access and planning, as well as legal decision making within forensic settings. Using a quantitative cross-sectional experimental design, 180 licensed psychologists from the USA were recruited via email using non-probability convenience sampling. Implicit gender bias was measured by randomly assigning participants to one of two experimental conditions (i.e., male vs. female pronoun case vignette). While adjusted logistic regression models confirmed significant associations between gender pronoun of case vignette and clinical judgment of PDs, this was not supported for psychopathy. Licensed psychologists were significantly more likely to render a judgment of borderline PD in the female, compared to the male, gender pronoun condition. Conversely, they were significantly more likely to render a judgment of antisocial PD in the male, compared to the female, gender pronoun condition. These findings suggest that despite progress in the understanding of gender role behaviors, personality disorders, and clinical training protocols, implicit gender bias persists among licensed psychologists in the USA.

Reduced structural integrity of the uncinate fasciculus in incarcerated women scoring high on psychopathy

Both men and women scoring high on psychopathy exhibit similar structural and functional neural abnormalities, including reduced volume of the orbitofrontal cortex (OFC) and reduced hemodynamic activity in the amygdala during affective processing experimental paradigms. The uncinate fasciculus (UF) is a white matter (WM) tract that connects the amygdala to the OFC. Reduced structural integrity of the UF, measured via fractional anisotropy (FA), is commonly associated with men scoring high on psychopathy. However, only one study to date has investigated the relationship between psychopathic traits and UF structural integrity in women, recruiting participants from a community sample. Here, we investigated whether Hare Psychopathy Checklist-Revised (PCL-R) facet scores (measuring interpersonal, affective, lifestyle/behavioral, and antisocial psychopathic traits, respectively) were associated with reduced FA in the left and right UF in a sample of 254 incarcerated women characterized by a wide range of psychopathy scores. We observed that PCL-R Facet 3 scores, assessing lifestyle/behavioral psychopathic traits, were associated with reduced FA in the left and right UF, even when controlling for participant's age and history of previous substance use. The results obtained in the current study help improve our understanding of structural abnormalities associated with women scoring high on psychopathy. Specifically, reduced UF structural integrity may contribute to some of the deficits commonly associated with women scoring high on psychopathy, including emotion dysregulation.

Is borderline personality disorder really an emotion dysregulation disorder and, if so, how? A comprehensive experimental paradigm

BACKGROUND

Leading theories suggest that borderline personality disorder (BPD) is an emotion dysregulation disorder involving lower basal vagal tone, higher baseline emotion, heightened emotional reactivity, delayed emotional recovery, and emotion regulation deficits. However, the literature to date lacks a unifying paradigm that tests all of the main emotion dysregulation components and comprehensively examines whether BPD is an emotion dysregulation disorder and, if so, in what ways. This study addresses the empirical gaps with a unified paradigm that assessed whether BPD is characterized by five leading emotion dysregulation components compared to generalized anxiety disorder (GAD) and healthy control (HC) groups.

METHODS

Emotion was assessed across self-report, sympathetic, and parasympathetic indices. Participants with BPD, GAD, and HCs (N = 120) first underwent baseline periods assessing basal vagal tone and baseline emotional intensity, followed by rejection-themed stressors assessing emotional reactivity. Participants then either reacted normally to assess emotional recovery or attempted to decrease emotion using mindfulness or distraction to assess emotion regulation implementation deficits.

RESULTS

Individuals with BPD and GAD exhibited higher self-reported and sympathetic baseline emotion compared to HCs. The BPD group also exhibited self-reported emotion regulation deficits using distraction only compared to the GAD group.

CONCLUSIONS

There is minimal support for several emotion dysregulation components in BPD, and some components that are present appear to be pervasive across high emotion dysregulation groups rather than specific to BPD. However, BPD may be characterized by problems disengaging from emotion using distraction.

Fluid Intelligence Moderates the Link Between Psychopathy and Aggression Differently for Men and Women

Research on sex differences in the association of psychopathy with fluid intelligence is limited, and it remains unknown if fluid intelligence plays a meaningful role in explaining the psychopathy-aggression link for men and women. The present study aimed to test for sex differences in the relation between the four-facet model of psychopathy and intelligence, and to assess whether fluid intelligence moderates the link between psychopathy and aggression. In a community sample of men (n = 356) and women (n = 196), we assessed psychopathy using the Psychopathy Checklist: Screening Version (PCL:SV), fluid intelligence using the Raven's Progressive Matrices, and types of aggression using the Aggression Questionnaire (AQ). Hierarchical regressions showed that the psychopathy lifestyle facet was negatively associated with intelligence and there were no sex differences. Our analyses for types of aggression revealed sex differences and similarities. For both men and women, total AQ scores were predicted by higher antisocial facet scores. Lower intelligence moderated the link between higher antisocial facet scores and aggression in men, but not for women. Physical aggression in women was associated with higher interpersonal, affective, and antisocial facet scores, whereas for men, it was only associated with higher antisocial facet scores. Verbal and indirect aggression were associated with higher intelligence in both men and women. For men only, higher antisocial facet scores were associated with verbal and indirect aggression. Higher intelligence moderated the link between the lifestyle facet and indirect aggression for women, whereas for men, it moderated the link between the affective facet and indirect aggression. This study further highlights sex differences in mechanisms of psychopathy-related aggression, which need to be considered in the development of violence interventions and risk assessment.

Psychopathy in women: insights from neuroscience and ways forward for research

Psychopathy is a severe form of personality disturbance, resulting in a detrimental impact on individuals, healthcare systems, and society as a whole. Until relatively recently, most research in psychopathy has focused on male samples, not least because of its link with criminal behavior and the large proportion of violent crime committed by men. However, psychopathy in women also leads to considerable problems at an individual and societal level, including substance misuse, poor treatment outcomes, and contribution to ever-increasing numbers of female prisoners. Despite this, due to relative neglect, most research into adult female psychopathy is underpowered and outdated. We argue that the field needs revitalizing, with a focus on the developmental nature of the condition and neurocognitive research. Recent work international consortia into conduct disorder in female youth-a precursor of psychopathy in female adults-gives cause for optimism. Here, we outline key strategies for enriching research in this important field with contemporary approaches to other psychiatric conditions.

A Multidimensional Examination of Psychopathy Traits and Gray Matter Volume in Adults

Uncovering the neurobiological abnormalities that may contribute to the manifestation of psychopathic traits is an important step toward understanding the etiology of this disorder. Although many studies have examined gray matter volume (GMV) in relation to psychopathy, few have examined how dimensions of psychopathic traits interactively relate to GMV, an approach that holds promise for parsing heterogeneity in neurobiological risk factors for this disorder. The aim of this study was to investigate the affective-interpersonal (Factor 1) and impulsive-antisocial (Factor 2) dimensions of psychopathy in relation to cortical surface and subcortical GMV in a mixed-gender, high-risk community sample with significant justice-system involvement (N = 156, 50.0% men). Cortex-wide analysis indicated that (i) the Factor 1 traits correlated negatively with GMV in two cortical clusters, one in the right rostral middle frontal region and one in the occipital lobe, and (ii) the interaction of the affective-interpersonal and impulsive-antisocial traits was negatively associated with GMV bilaterally in the parietal lobe, such that individuals high on both trait dimensions evidenced reduced GMV relative to individuals high on only one psychopathy factor. An interactive effect also emerged for bilateral amygdalar and hippocampal GMV, such that Factor 1 psychopathic traits were significantly negatively associated with GMV only at high (but not low) levels of Factor 2 traits. Results extend prior research by demonstrating the neurobiological correlates of psychopathy differ based on the presentation of Factor 1 and 2 traits.

Exploring the neural correlates of (altered) moral cognition in psychopaths

Research into the neurofunctional mechanisms of psychopathy has gathered momentum over the last years. Previous neuroimaging studies have identified general changes in brain activity of psychopaths. In an exploratory meta-analysis, we here investigated the neural correlates of impaired moral cognition in psychopaths. Our analyses replicated general effects in the dorsomedial prefrontal cortex, lateral prefrontal cortex, fronto-insular cortex, and amygdala, which have been reported recently. In addition, we found aberrant brain activity in the midbrain and inferior parietal cortex. Our preliminary findings suggest that alterations in both regions may represent more specific functional brain changes related to (altered) moral cognition in psychopaths. Furthermore, future studies including a more comprehensive corpus of neuroimaging studies on moral cognition in psychopaths should re-examine this notion.

Content Validation of the Comprehensive Assessment of Psychopathic Personality-Basic Version (CAPP-Basic) Using Prototypical Analysis

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a lexically based conceptual model of psychopathy. Despite widespread use in research settings, the Lexical Rating Scale for the CAPP (CAPP-LRS) requires an advanced reading level for completion. The present study is the first to evaluate the content validity of the CAPP-Basic, a lexically simplified version of the CAPP-LRS designed for use with individuals possessing lower verbal skills. Symptoms were rated by mental health professionals (N = 121). Findings were largely in line with results of previous studies, indicating good content validity of the CAPP-Basic at the domain and symptom level.

Women and men of mafia between traditional cultural contexts and new social roles

The Italian mafia organizations represent a subculture with values, beliefs, and goals that are antithetical to and undermining of the predominant society. The conduct of individual members includes such extreme violence for material gain, it may at least superficially suggest a severe personality disorder. Since the first edition of the DSM and into the 21st century, various terms have been used, sometimes interchangeably, but over time inconsistently, to designate the mentality and practices of mafia members. Only recently has the psychology of mafia members become a focus of serious scientific study. For the first time, investigators for the present study applied instruments, including the PCL-R, to examine for character psychopathology and specifically degrees of psychopathy in male and female mafia members, 20 female and 21 male members. Results showed some gender difference with the women having a higher score on Factor 1, in contrast to men who showed a lower score. Psychopathy and personality disorder were not found to be associated with membership in the mafia for either gender. Some psychopathic traits and gender differences warrant further research. Meanwhile these findings are consistent with a mentality characterized by beliefs and practices determined by a deviant culture rather than psychopathology.

Testing for Sex Differences in the Nomological Network of the Triarchic Model of Psychopathy in Incarcerated Individuals

The triarchic model of psychopathy conceptualizes variants of this clinical condition as expressions of three distinct biobehavioral dispositions, termed boldness, meanness, and disinhibition. As a trait-oriented model, the triarchic model situates psychopathy within a broader nomological network of personality and psychopathology, and has proven useful for characterizing how psychopathy relates to variables in these domains as well as to biological and behavioral variables. The current study was the first to examine sex differences in the external correlates of psychopathic traits as described by the triarchic model in a prison sample. Results were generally consistent with hypotheses: The triarchic traits related to measures of personality and psychopathology in patterns that were largely consistent across sex, but with some notable differences between males and females, in the correlates of disinhibition in particular. These included stronger associations for disinhibition with substance use problems, self-harm, and staff ratings of prison misbehavior among females compared to males. Findings from this study support the value of the triarchic model for understanding similarities and differences in the nomological network of psychopathy in incarcerated males and females.

Clarifying fearlessness in psychopathy: An examination of thrill-seeking and physical risk-taking

Fearlessness has been described among the traits associated with psychopathy; however, disparities in conceptualizations of fear and how related elements are operationalized among different measures of psychopathic traits have led to some enduring controversy. Here we address a subset of elements characterizing fearlessness represented in thrill-seeking and physical risk-taking among a large sample of incarcerated individuals (n = 688). We examine these relationships utilizing Hare's Psychopathy Checklist Revised (PCL-R), the Psychopathy Personality Inventory-Short Form (PPI-SF), and the Zuckerman Sensation Seeking Scale (SSS). Among males, the Thrill and Adventure Seeking (TAS) scale of the SSS was not related to features of the PCL-R, but was highly correlated with Fearless Dominance (FD) of the PPI-SF. Among females, TAS was only modestly correlated with PCL-R total score, but neither of the two PCL-R factors. PPI-SF FD remained a strong predictor of TAS among females. We argue for a careful consideration of the boundaries of the term "fearlessness" as it relates to diverse manifestations of behavior and varied conceptualizations of psychopathy. We also reiterate apparent differences between males and females in the presentation of psychopathic traits.

The psychopathic dimension in women of mafia

The authors focus their interest on the socially deviant mafia world, especially on the question of a psychopathic dimension of individuals in mafia. From the scientific point of view this continues to be an unknow world. In all these cases, individuals in mafia, their "feats", their profiles seem to correspond to popular conceptions of the psychopath. Even less known is the women's role in criminal organizations. Their historical role in recent decades has gradually shifted and become more important than it was in the past. The investigators' interest was focused on identifying the prevalence of the psychopathic dimension in mafia women. So the authors examined a sample of 20 convicted mafia women coming from Campania and Calabria, the regions of Camorra and 'Ndrangheta respectively, historical Italian criminal organizations. These women inherited their roles from previous bosses and successfully carried on the criminal business. The authors compared this sample of mafia women with a sample of female offenders with full criminal responsibility who were in common female prisons. Like men of mafia, the women of mafia have a low prevalence of the psychopathic dimension. Further research is necessary to identify the psychopathic dimension in larger samples of women, and then compare them with similar male samples.

Schizotypy and psychopathic tendencies interactively improve misattribution of affect in boys with conduct problems

Psychopathic tendencies are associated with difficulties in affective theory of mind (ToM), that is, in recognizing others affective mental states. In clinical and non-clinical adult samples, it has been shown that where psychopathic tendencies co-occur with schizophrenia spectrum disorders, the impairing effects of psychopathic tendencies on ToM are attenuated. These effects are yet to be examined in adolescents. We examined if the impairing effect of psychopathic tendencies on affective ToM was attenuated with increasing severity of schizotypal personality disorder (PD) in a sample of 80 incarcerated adolescent boys. We showed that the impairing effect of psychopathic tendencies on the recognition of neutral mental states, but not positive or negative mental states, was evident when the relative severity of schizotypal PD was low. However, with higher scores on both measures, we observed better performance in judging neutral mental states. The preservation of affective ToM in adolescents who show elevations in psychopathic tendencies and schizotypal PD may enable them to manipulate and extort their victims for personal gain. Our results emphasize the need to consider comorbidity in clinical case formulation when working with adolescents with conduct problems and psychopathic tendencies. More broadly, our results also suggest that the pattern of social cognitive abilities associated with co-occurring psychopathology does not always conform to an often-theorized double-dose of deficit hypothesis.

A Systematic Review of Primary and Secondary Callous-Unemotional Traits and Psychopathy Variants in Youth

Two variants of callous-unemotional (CU) traits and psychopathy have been proposed, referred to as primary and secondary. Whereas primary variants are thought to be underpinned by insufficient arousal to emotional cues, secondary variants are thought to develop as a coping mechanism in response to trauma exposure. Compared with adult samples, research on primary and secondary variants in children and adolescents under the age of 18 has only emerged in the past decade, and there is ongoing debate with regards to the identification, defining characteristics, and distinct correlates of these variants. The present systematic review synthesizes the current literature on primary and secondary variants in relation to: (1) constructs used to distinguish and define primary and secondary variants; (2) study population characteristics; (3) data analytic techniques to differentiate variants; and (4) differential associations with theoretically relevant indices related to emotional processing, maltreatment, biomarkers, and behavioral outcomes (e.g., substance use, aggression). This is the first systematic review to examine the growing literature on primary and secondary CU and psychopathy variants among youth. Findings support the distinction between youth with primary versus secondary variants and demonstrate that this distinction is related to unique clinical correlates. Recommendations are made for future research in the field.

An Exploratory Study of Female Psychopathy and Drug-Related Violent Crime

There is a clear link between drugs and violence, and the extensive burden drug-related violence inflicts on society. However, drug-related violence is largely understudied, especially in female populations. The aim of the present study was to explore whether women convicted of drug-related violent crime differed on individual-level risk factors from women convicted of a nondrug-related violent crime and women convicted of nonviolent crimes. One hundred and twenty-five female inmates were classified using official criminal records. Multinomial logistic regression indicated inmates higher in antisocial psychopathic traits and low level of educational attainment were more likely to be in the drug-related violent crime group. In comparison, inmates higher in callous psychopathic traits were more likely to be in the nondrug-related violent crime group. Using official records of prison misconduct, a secondary aim tested whether prison violence increased the likelihood of being in either of the violent crime groups. Results show inmates who had committed violent misconducts over a 6-month period were more likely to be the nondrug-related violent crime group. Prison violence did not differentiate inmates in the nonviolent crime group from the drug-related violent crime group. These findings are the first to explore the relation between psychopathy and drug-related violent crime, and drug-related violent crime predicting future violent behavior in female criminals. This study demonstrates the heterogeneity in female violent behavior. Furthermore, psychopathy is not only shown to be an important risk factor for violence in women but also highlights that the dimensional construct is essential for understanding context-dependent violence.

Executive Dysfunction Associated With the Primary Psychopathic Features of Borderline Personality Disorder

Purpose: The aim of the present study is to investigate whether the presence of psychopathic features in BPD is related to dysfunction in executive functions and other neuropsychological functions in these patients. Methods: 82 patients diagnosed with borderline personality disorder and 54 control subjects were studied through clinical and neuropsychological evaluation protocols and the Levenson Psychopathy Inventory. Results: BPD patients showed significantly higher scores on both primary (F1) and secondary (F2) global rates of psychopathy, than controls. The results for these patients also showed a statistically significant association between high scores in primary psychopathy and deficits in executive functions. However, no associations were found between the scores of secondary psychopathy and executive dysfunction. Conclusion: Primary psychopathic features present in patients with BPD are associated with patterns of executive dysfunction. It would therefore be interesting to investigate the role of cognitive rehabilitation in the empathy dysfunctions within these disorders.

Personality Disorders as Emergent Interpersonal Syndromes: Psychopathic Personality as a Case Example

Personality disorders have long been bedeviled by a host of conceptual and methodological quandaries. Starting from the assumption that personality disorders are inherently interpersonal conditions that reflect folk concepts of social impairment, the authors contend that a subset of personality disorders, rather than traditional syndromes, are emergent interpersonal syndromes (EISs): interpersonally malignant configurations (statistical interactions) of distinct personality dimensions that may be only modestly, weakly, or even negatively correlated. Preliminary support for this perspective derives from a surprising source, namely, largely forgotten research on the intercorrelations among the subscales of select MMPI/MMPI-2 clinical scales. Using psychopathic personality as a case example, the authors offer provisional evidence for the EIS hypothesis from four lines of research and delineate its implications for personality disorder theory, research, and classification. Conceptualizing some personality disorders as EISs elucidates long-standing quandaries and controversies in the psychopathology literature and affords fruitful avenues for future investigation.

Psychopathic traits, gender, and motivations for sex: Putative paths to sexual coercion

Evidence suggests that both men and women perpetrate sexual coercion. Psychological factors, including psychopathic traits and power motivations, have been proposed to characterize male-perpetrated sexual coercion; however, it is unclear whether these factors play a similar role in female-perpetrated coercion or whether other motivations (e.g., intimacy, affect regulation) should be considered. To improve our understanding in this area, the current study first examined relationships between psychopathic traits and sexual coercion in a sample of 1199 undergraduate students (756 women), with gender as a potential moderator of these relationships. Second, the role of motivations for sex (e.g., power, affect regulation) in accounting for the psychopathy-coercion relationship was examined in men and women. Data were collected using an online survey and analyzed using multigroup path analysis. Results implicated impulsive-antisocial traits as particularly important to male-perpetrated verbal (e.g., manipulative) and nonverbal (e.g., physical) coercion, and that this relationship was partially explained by motives for sex involving power. In contrast, psychopathic traits did not appear to play a major role in female perpetrated coercion; instead, emotional value (i.e., intimacy-related) motivations for sex were associated with verbal (e.g., manipulation) coercion in women. In sum, our results support a conceptual model of male perpetration where men who are high in impulsive-antisocial traits may engage in sexual coercion in an attempt to feel powerful. Further, the findings in the female sample suggest that factors other than psychopathy, such as gender role beliefs in regard to sexual encounters, may be particularly important to female perpetrated sexually coercive behavior.

Psychopathy and Female Gender: Phenotypic Expression and Comorbidity; A Study Comparing a Sample of Women Hospitalized in Italy's Maximum Security Facility with Women Who were Criminally Sentenced and Imprisoned

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL-R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation.

Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample

Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI-2-RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI-2-RF triarchic psychopathy scales.

Psychopathic Personality in the General Population: Differences and Similarities Across Gender

This study aimed to identify distinct subgroups of adults in a general population sample (N = 2,500; 52.6% females) based on their scores on three psychopathy dimensions. Using latent profile analysis, five groups were identified among males and females separately, including a psychopathic personality group. Multivariate analyses of variance showed that this latter group had higher levels of aggression, offending, substance use, attention-deficit/hyperactivity symptoms, internalizing problems, and maltreatment than most of the other groups. Associated features of males and females with a psychopathic personality were very similar; however, salient gender differences did emerge. Specifically, females with a psychopathic personality were more frequently exposed to sexual abuse, expressed more emotional difficulties, and engaged in higher levels of relational aggression. In conclusion, person-oriented analyses identified adults with a personality that looks like psychopathy, and furthered our understanding of gender similarities and differences in these adults.

A psychometric investigation of gender differences and common processes across borderline and antisocial personality disorders

The comorbidity between borderline personality disorder (BPD) and antisocial personality disorder (ASPD) is well-established, and the 2 disorders share many similarities. However, there are also differences across disorders: most notably, BPD is diagnosed more frequently in women and ASPD in men. We investigated if (a) comorbidity between BPD and ASPD is attributable to 2 discrete disorders or the expression of common underlying processes, and (b) if the model of comorbidity is true across sex. Using a clinical sample of 1,400 drug users in residential substance abuse treatment, we tested 3 competing models to explore whether the comorbidity of ASPD and BPD should be represented by a single common factor, 2 correlated factors, or a bifactor structure involving a general and disorder-specific factors. Next, we tested whether our resulting model was meaningful by examining its relationship with criterion variables previously reported to be associated with BPD and ASPD. The bifactor model provided the best fit and was invariant across sex. Overall, the general factor of the bifactor model significantly accounted for a large percentage of the variance in criterion variables, whereas the BPD and AAB specific factors added little to the models. The association of the general and specific factor with all criterion variables was equal for men and women. Our results suggest common underlying vulnerability accounts for both the comorbidity between BPD and AAB (across sex), and this common vulnerability drives the association with other psychopathology and maladaptive behavior. This in turn has implications for diagnostic classification systems and treatment. (PsycINFO Database Record

Identifying the Manipulative Mating Methods Associated With Psychopathic Traits and BPD Features

Psychopathy and borderline personality disorder (BPD) traits are associated with coercion and manipulation within relationships. The authors investigated whether BPD traits were uniquely associated with manipulation for emotional closeness whereas psychopathy was used for the purpose of attaining physical closeness. A community sample (N = 164) reported on mating behaviors, psychopathic traits, and BPD traits. Hierarchical regressions were conducted to predict mating behaviors that would account for the overlap between psychopathy and BPD. Total psychopathic traits were associated with lower levels of relationship exclusivity, greater use of partner poaching, and perpetration of sexual coercion. Specifically, callousness and egocentricity were related to lower relationship exclusivity. BPD traits were associated with the use of mate retention strategies, mate poaching, and victimization in sexual coercion. These findings indicate that manipulative mating behaviors encompass tools to achieve sex and intimacy. Those with BPD traits use these tools for emotional closeness, whereas those with psychopathic traits use them to obtain physical closeness and gratification.

Do seriously offending girls differ from their age- and offence type-matched male counterparts on psychopathic traits or psychopathy-related background variables?

BACKGROUND

More research is needed to improve our understanding of the manifestation of psychopathic traits in violently offending girls. Our aim here was to assess psychopathic traits and psychopathy-related background variables in a Finnish nationwide consecutive sample of girls charged with violent crimes and referred to a pretrial forensic psychiatric examination. These girls were then compared to their male counterparts.

METHODS

The forensic psychiatric examination statements of 15- to 17-year-old juveniles who underwent a pretrial forensic psychiatric examination over a 31-year period (1980-2010) were reviewed. For each non-psychotic girl with a normal IQ (n = 25), an age- and offence type-matched male control was randomly selected. Offence and offender characteristics were collected from the forensic psychiatric examination reports, and a file-based assessment of psychopathic traits was performed using the Hare psychopathy checklist-youth version.

RESULTS

Approximately every third girl exhibited high traits of psychopathy, and no significant difference was observed between the genders. Focusing on the underlying factor and item scores, the girls scored significantly lower than boys on the Antisocial factor. Their interpersonal relationships were significantly more unstable and they significantly more often exhibited a history of child sexual abuse. During the index offence the girls were significantly less frequently intoxicated, and their victims were significantly more often family members or current or ex-intimates but significantly less often strangers.

CONCLUSIONS

Although violently offending girls and boys do not differ on psychopathy total scores, significant gender differences exist on underlying factor and item scores as well as in background- and offence-related variables. Interventions should take into account these special features of violent girls.

Psychopathic traits mediate the association of serotonin transporter genotype and child externalizing behavior

Although the promoter polymorphism of the serotonin transporter (5-HTTLPR) gene is associated with externalizing behavior, its mediating pathways are unknown. Given their sensitivity to serotonin neurotransmission and unique association with attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), we tested callous-unemotional (CU) traits and narcissism as separate mediators of the association of 5-HTTLPR with ADHD and ODD. We evaluated 209 5-9 year-old children with and without ADHD at baseline; approximately 2 years later (i.e., Wave 2), parents and teachers separately rated ADHD and ODD symptoms and youth self-reported antisocial behavior. Controlling for race-ethnicity and baseline ADHD/ODD, narcissism uniquely mediated predictions of multi-informant rated Wave 2 ADHD and ODD from variation in 5-HTTLPR; CU traits mediated predictions of Wave 2 ADHD from variations in 5-HTTLPR, but did not mediate the associations of 5-HTTLPR with ODD or youth self-reported antisocial behavior. Specifically, the number of 5-HTTLPR long alleles positively predicted CU traits and narcissism; narcissism was positively associated with Wave 2 ADHD and ODD symptoms, whereas CU traits were positively associated with Wave 2 ADHD. Child sex also moderated indirect effects of CU traits and narcissism, such that narcissism mediated predictions of ADHD/ODD in girls but not boys. Psychopathic traits may represent a relevant pathway underlying predictions of prospective change in ADHD and ODD from 5-HTTLPR, particularly in girls. We consider the role of psychopathic traits as a potential intermediate phenotype in genetically sensitive studies of child psychopathology. Aggr. Behav. 42:455-470, 2016. © 2016 Wiley Periodicals, Inc.

Dysfunctional error-related processing in female psychopathy

Neurocognitive studies of psychopathy have predominantly focused on male samples. Studies have shown that female psychopaths exhibit similar affective deficits as their male counterparts, but results are less consistent across cognitive domains including response modulation. As such, there may be potential gender differences in error-related processing in psychopathic personality. Here we investigate response-locked event-related potential (ERP) components [the error-related negativity (ERN/Ne) related to early error-detection processes and the error-related positivity (Pe) involved in later post-error processing] in a sample of incarcerated adult female offenders (n = 121) who performed a response inhibition Go/NoGo task. Psychopathy was assessed using the Hare Psychopathy Checklist-Revised (PCL-R). The ERN/Ne and Pe were analyzed with classic windowed ERP components and principal component analysis (PCA). Consistent with previous research performed in psychopathic males, female psychopaths exhibited specific deficiencies in the neural correlates of post-error processing (as indexed by reduced Pe amplitude) but not in error monitoring (as indexed by intact ERN/Ne amplitude). Specifically, psychopathic traits reflecting interpersonal and affective dysfunction remained significant predictors of both time-domain and PCA measures reflecting reduced Pe mean amplitude. This is the first evidence to suggest that incarcerated female psychopaths exhibit similar dysfunctional post-error processing as male psychopaths.

Gender differences in psychopathy links to drug use

Although the relationship between psychopathic personality traits and substance use has received some attention (Hart & Hare, 1989; Smith & Newman, 1990), gender differences have not been thoroughly assessed. The current study examined whether gender modified the relationship between 2 criminally relevant constructs, (a) psychopathy and its factors and (b) drug use. A sample of 318 participants with criminal histories and recent substance use was assessed for psychopathy using the Psychopathy Checklist: Screening Version and for illicit drug use using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. As expected, the impulsive-antisocial traits (Factor 2) of psychopathy were positively related to a number of drug use characteristics (symptoms, age of drug initiation, extent of drug experimentation), whereas the interpersonal-affective traits (Factor 1) showed a negative relationship with drug abuse symptoms and a positive relationship with age of first use. In terms of gender differences, analyses revealed that women showed a stronger association between Factor 1 traits and later age of initiation compared to men, and that Factor 2, and the antisocial facet in particular, were more strongly related to drug abuse in women than men. These findings suggest that psychopathic traits serve as both protective (Factor 1) and risk (Factor 2) correlates of illicit drug use, and Factor 1 may be especially protective in terms of initiation of drug use among women. These conclusions add to the growing literature on potential routes to substance use and incarceration in women.

Are fearless dominance traits superfluous in operationalizing psychopathy? Incremental validity and sex differences

Researchers are vigorously debating whether psychopathic personality includes seemingly adaptive traits, especially social and physical boldness. In a large sample (N = 1,565) of adult offenders, we examined the incremental validity of 2 operationalizations of boldness (Fearless Dominance traits in the Psychopathy Personality Inventory [Lilienfeld & Andrews, 1996]; Boldness traits in the triarchic model of psychopathy [Patrick, Fowles, & Krueger, 2009]), above and beyond other characteristics of psychopathy, in statistically predicting scores on 4 psychopathy-related measures, including the Psychopathy Checklist-Revised (PCL-R). The incremental validity added by boldness traits in predicting the PCL-R's representation of psychopathy was especially pronounced for interpersonal traits (e.g., superficial charm, deceitfulness). Our analyses, however, revealed unexpected sex differences in the relevance of these traits to psychopathy, with boldness traits exhibiting reduced importance for psychopathy in women. We discuss the implications of these findings for measurement models of psychopathy. (PsycINFO Database Record

Psychopathic traits are associated with reduced attention to the eyes of emotional faces among adult male non-offenders

Psychopathic traits are linked with impairments in emotional facial expression recognition. These impairments may, in part, reflect reduced attention to the eyes of emotional faces. Although reduced attention to the eyes has been noted among children with conduct problems and callous-unemotional traits, similar findings are yet to be found in relation to psychopathic traits among adult male participants. Here we investigated the relationship of primary (selfish, uncaring) and secondary (impulsive, antisocial) psychopathic traits with attention to the eyes among adult male non-offenders during an emotion recognition task. We measured the number of fixations, and overall dwell time, on the eyes, and the mouth of male and female faces showing the six basic emotions at varying levels of intensity. We found no relationship of primary or secondary psychopathic traits with recognition accuracy. However, primary psychopathic traits were associated with a reduced number of fixations, and lower overall dwell time, on the eyes relative to the mouth across expressions, intensity, and sex. Furthermore, the relationship of primary psychopathic traits with attention to the eyes of angry and fearful faces was influenced by the sex and intensity of the expression. We also showed that a greater number of fixations on the eyes, relative to the mouth, were associated with increased accuracy for angry and fearful expression recognition. These results are the first to show effects of psychopathic traits on attention to the eyes of emotional faces in an adult male sample, and may support amygdala based accounts of psychopathy. These findings may also have methodological implications for clinical studies of emotion recognition.

Genetic and environmental overlap between borderline personality disorder traits and psychopathy: evidence for promotive effects of factor 2 and protective effects of factor 1

BACKGROUND

Previous studies have reported strong genetic and environmental overlap between antisocial-externalizing (factor 2; F2) features of psychopathy and borderline personality disorder (BPD) tendencies. However, this line of research has yet to examine etiological associations of affective-interpersonal (factor 1, F1) features of psychopathy with BPD tendencies.

METHOD

The current study investigated differential phenotypic and genetic overlap of psychopathy factors 1 and 2 with BPD tendencies in a sample of over 250 male and female community-recruited adult twin pairs.

RESULTS

Consistent with previous research, biometric analyses revealed strong genetic and non-shared environmental correlations of F2 with BPD tendencies, suggesting that common genetic and non-shared environmental factors contribute to both phenotypes. In contrast, negative genetic and non-shared environmental correlations were observed between F1 and BPD tendencies, indicating that the genetic factors underlying F1 serve as protective factors against BPD. No gender differences emerged in the analyses.

CONCLUSIONS

These findings provide further insight into associations of psychopathic features - F1 as well as F2 - and BPD tendencies. Implications for treatment and intervention are discussed, along with how psychopathic traits may differentially influence the manifestation of BPD tendencies.

Gender, psychopathy factors, and intimate partner violence

The present study sheds light on relationships between distinct psychopathic traits and perpetration of intimate partner violence (IPV) in women versus men. Men and women with recent drug and/or violence histories (N = 250) were assessed for psychopathic traits using the Psychopathy Checklist: Screening Version and for their and their partner's use of IPV with the Revised Conflict Tactics Scale. The first goal was to examine the moderating role of gender in psychopathy factor relationships to IPV. Although both the interpersonal-affective traits (Factor1) and the impulsive-antisocial traits (Factor 2) of psychopathy were related to higher frequency of IPV perpetration, the relationship between Factor 1 and IPV was stronger in men. Our second goal examined the moderating role of psychopathy traits in the relationship between partner's perpetration of IPV and participant perpetration (mutual violence) in the 2 genders. Relationships between partner- and self-IPV were similar at both low and high levels of Factor 1 in men, although the partner- and self-IPV relationship was significantly stronger among women at low relative to high levels of Factor 1. The relationship between partner- and self-IPV was stronger at high levels of Factor 2 in men, whereas Factor 2 did not moderate mutual violence in women. These results indicate that relationships between psychopathy factors and IPV differ by gender, with psychopathy generally exacerbating IPV perpetration in men and Factor 1 traits playing a unique role in mutual violence in women. These findings add to the literature on female psychopathy and have important implications for future research on gender and IPV. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Psychopathy factor interactions and co-occurring psychopathology: Does measurement approach matter?

The 2 dimensions of psychopathy as operationalized by various measurement tools show differential associations with psychopathology; however, evidence suggests that the statistical interaction of Factor 1 (F1) and Factor 2 (F2) may be important in understanding associations with psychopathology. Findings regarding the interactive effects of F1 and F2 are mixed, as both potentiating and protective effects have emerged. Moreover, approaches to measuring F1 (e.g., clinical interview vs. self-report) are based on different conceptualizations of F1, which may influence the interactive effects. The current study aims to (a) elucidate the influence of F1 and F2 on psychopathology by using both variable-centered and person-centered approaches and (b) determine whether the measurement of F1 influences the interactive effects of F1 and F2 by comparing the strength of interactive effects across F1 measures in a sample of over 1,500 offenders. Across analytic methods, there were very few cases in which F1 statistically influenced the association between F2 and psychopathology, such that F1 failed to evidence either potentiating or protective effects on F2. Furthermore, the conceptualization of F1 across psychopathy measures did not impact the interactive effects of F1 and F2. These findings suggest that F2 is probably driving the relations between psychopathy and other forms of psychopathology and that F1 may play less of a role in interacting with F2 than previously believed.

[Psychopathic personality in women. Diagnostics and experimental findings in the forensic setting and the business world]

Highly psychopathic women are rare in the context of forensic psychiatry; however, the concept of psychopathy plays an important role in diagnostics, for court expertises as well as for treatment. Another so far neglected yet relevant field is the business world. The so-called successful female psychopaths are characterized by highly psychopathic traits but low antisocial behavior, at least with reference to criminal behavior. The basis for investigating and interpreting gender differences is the assessment of psychopathy. Gender differences have been repeatedly demonstrated, especially in the assessment of antisocial behavior and the differentiation of borderline personality disorder and psychopathy which have to be addressed. Group comparisons based on these diagnostic methods found lower inhibitory deficits but less aggressive behavior in female participants with respect to the first main symptom category. For the second symptom category, emotional detachment, so far there are almost no findings reporting gender differences but only few direct gender comparisons have been carried out. However, highly psychopathic women from the general population demonstrate a stronger correlation between psychopathic traits and self-perception as negotiation partner compared to men: they make more use of manipulation and perceive themselves as more powerful in negotiation situations. Future studies should address the diagnostic variability, direct gender comparisons in experimental tasks and the relationship between psychopathic traits, the core symptom categories and career-related success.

Borderline personality disorder features and risk for prescription opioid use disorders

Although there is evidence for high comorbidity between borderline personality disorder (BPD) and substance use disorders, particularly alcohol use, more research is needed on the associations between BPD and prescription opioid use because of the increasing national problem of prescription opioid misuse. The purpose of the present study was to examine relationships between BPD features and prescription opioid use, risk for misuse, consequences, and dependence features, and to determine which aspects of BPD account for these associations. As predicted, BPD features were associated with greater quantity and frequency of opioid use, risk for pain medication misuse, consequences, and dependence features. Additional analyses indicated that most of these effects were accounted for by the self-harm/impulsivity component of BPD. The authors conclude that individuals with more pronounced BPD features may be at risk for use and dependence on prescription opioids, and that this association may be primarily associated with the impulsivity features of BPD.

Reduced negative affect response in female psychopaths

Studies that investigate the differences between high and low psychopathic persons in brain activity during emotional facial expression processing are rare and commonly focus on males. The current study assessed whether previously reported behavioral differences would be reflected in differential brain activity in a sample of female offenders. The participants included 23 female forensic inpatients with high and low scores on the Psychopathy Checklist Revised (PCL-R). ERPs were recorded during presentation of emotional facial expressions (i.e., fear, angry, and happy). Results revealed no differences in N170, P3 and late positive potential components between groups, but a significant difference in N2 only for angry and fear facial expressions, with high psychopathic participants showing lower reactivity. This N2 effect was found to be related to Factor 2 but not Factor 1 of the PCL-R. In time frequency analysis, theta activity underlying N2 best reflected these differences. Findings in this female sample are consistent with a cortical deficit in processing facial expression of negative emotions in psychopathic men. In addition, differences in processing seem to appear relatively early.

Antisocial and borderline personality disorders revisited

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) have an overlap in both symptoms and risk factors, suggesting that they might reflect the same form of psychopathology, shaped by gender. However other lines of evidence point to the presence of partly unique, albeit overlapping, trait dimensions, specifically affective instability which differentiates BPD from ASPD. Our conclusion is that ASPD and BPD are separate disorders.