Psychopathy and Axis I and Axis II psychiatric disorders in a forensic psychiatric population in Sweden

Relationship between the Dark Triad and depressive symptoms

The Dark Triad (DT) is composed of three closely related personality traits: psychopathy, Machiavellianism and narcissism. These traits have been linked to emotional deficits. The aim of the present study was to analyze the relationship between the DT traits, including sub-dimensions, and depressive symptoms in order to identify those factors most strongly associated with the development of depression in individuals scoring high on DT. For these purposes, a total of 791 adults (M = 35.76 years; 24.91% males) completed a questionnaire battery including DT traits and depression measures. A positive significant correlation was found between psychopathy and Machiavellianism traits (total score and all sub-dimensions) and depressive symptoms. For narcissism, the direction of the correlation was dependent on the sub-dimension assessed. A model explaining 26.2% of the depressive symptoms scores was composed of the callous affect and criminal tendencies sub-dimensions of psychopathy, cynical view of human nature, which is a sub-dimension of Machiavellianism, and entitlement and self-sufficiency, which are sub-dimensions of narcissism. In addition, some of the relationships found between DT sub-dimensions and depressive symptoms appeared to depend on gender. Our results could have implications for detection and intervention programs aimed at decreasing the negative emotional consequences suffered by individuals with high DT scores. Limitations and future lines of research are discussed.

Do psychopathic birds of a feather flock together? Psychopathic personality traits and romantic preferences

OBJECTIVE

The goal of the present studies was to investigate whether people are especially attracted to psychopathic traits, and whether there are individual differences in such attraction.

METHOD

Female undergraduates (N = 270; M_age  = 19; 57% White, 20% Asian, 8% Black) and female and male community members (N = 426; M_age  = 37; 56% female; 81% Caucasian, 10% African American, 4% Asian) reported on their own personality and constructed their ideal mate for a dating, short-term, and long-term relationship from a list of 70 characteristics drawn from well-validated criteria for psychopathic personality and diagnostic criteria for DSM-5 personality disorders (PDs).

RESULTS

Across both studies, absolute romantic preferences for psychopathic traits collapsed across time point were low on average, but higher than those for most all other PDs. In addition, they were higher for Factor 1 (i.e., interpersonal/affective) as opposed to Factor 2 (i.e., impulsive, antisocial) psychopathy traits. Participants with marked PD features, including Factor 2 psychopathy traits, were more inclined than others to endorse a preference for psychopathic males.

CONCLUSIONS

Relative attraction to psychopathic males and observed homophily may be avenues through which psychopathic traits persist in the population across time.

Subtypes of homicide offenders based on psychopathic traits

The aim of the present study was to explore the subtypes of offenders based on psychopathic traits in a sample of 127 adult homicide offenders (n=40.3% convicted of murder, n=32.6% convicted of aggravated murder, n=27.1% convicted of attempted murder). A two-step cluster analysis of the four factors of psychopathy yielded three clusters, which were then compared on the general dimensions of personality defined by the HEXACO model, intelligence, sadism and psychopathology variables conceptualized by the MMPI-202. Cluster 1 was characterized by moderate scores on psychopathy factors, Agreeableness and aggressiveness. Cluster 2 was a psychopathic-like group with the highest scores on psychopathy factors, sadism, aggressiveness and paranoia, and with the lowest scores on Emotionality and Agreeableness. Cluster 3 was a non-psychopathic group with the lowest scores on psychopathy factors and aggressiveness, and with the highest scores on Agreeableness and Honesty-Humility. There were no significant differences between the clusters on intelligence, Openness to experience, Extraversion, Conscientiousness, and a number of psychopathological variables, including depression and anxiety. Present findings did not provide support for the distinction between primary and secondary psychopathy. The current study further contributes to the person-oriented research of psychopathy by emphasizing the differences between the individuals with high, moderate and low psychopathic traits.

Brain volumes differ between diagnostic groups of violent criminal offenders

Studies on structural abnormalities in antisocial individuals have reported inconsistent results, possibly due to inhomogeneous samples, calling for an investigation of brain alterations in psychopathologically stratified subgroups. We explored structural differences between antisocial offenders with either borderline personality disorder (ASPD-BPD) or high psychopathic traits (ASPD-PP) and healthy controls (CON) using region-of-interest-based and voxel-based morphometry approaches. Besides common distinct clusters of reduced gray matter volumes within the frontal pole and occipital cortex, there was remarkably little overlap in the regional distribution of brain abnormalities in ASPD-BPD and ASPD-PP, when compared to CON. Specific alterations of ASPD-BPD were detected in orbitofrontal and ventromedial prefrontal cortex regions subserving emotion regulation and reactive aggression and the temporal pole, which is involved in the interpretation of other peoples' motives. Volumetric reductions in ASPD-PP were most significant in midline cortical areas involved in the processing of self-referential information and self-reflection (i.e., dorsomedial prefrontal cortex, posterior cingulate/precuneus) and recognizing emotions of others (postcentral gyrus) and could reflect neural correlates of the psychopathic core features of callousness and poor moral judgment. The findings of this first exploratory study therefore may reflect correlates of prominent psychopathological differences between the two criminal offender groups, which have to be replicated in larger samples.

Facets of psychopathy among mentally disordered offenders: clinical comorbidity patterns and prediction of violent and criminal behavior

The complexity and consequences of psychopathy are still debated, and its relation to other mental disorders, pathological personality traits, and criminality needs to be further investigated by clinical, longitudinal studies using structured diagnostic instruments. The present study used two groups of mentally disordered offenders (N=153) investigated with in-depth clinical assessments and prospective long-term follow-up to identify the convergence between 1) the four facets of psychopathy defined by the Psychopathy Checklist-Revised (PCL-R; Interpersonal, Affective, Lifestyle, and Antisocial), 2) mental disorders according to SCID I and II interviews, 3) personality traits as measured by the Karolinska Scales of Personality, and 4) criminal recidivism. The Interpersonal facet differed substantially from the other three facets by not being significantly associated with substance use disorders, antisocial personality disorder (the other facets at P≤0.001 level), or personality traits involving impulsive and aggressive antisocial behaviors (the other facets at P<0.01 level). Furthermore, the interpersonal facet could not predict violent recidivism better than random. The Antisocial facet outperformed not only the other facets but also the total PCL-R score in the prediction of violent recidivism, P<0.001.The findings confirm psychopathy as a heterogeneous phenomenon and have clinical implications for assessments of psychopathy and violence risk assessments in clinical and forensic contexts.

Neural correlates of risk taking in violent criminal offenders characterized by emotional hypo- and hyper-reactivity

Recent approaches suggest that emotional reactivity can be used to differentiate between subgroups of individuals who are at risk for showing elevated levels of aggression and violence. In this study, we examined how emotion governs decision making within two subgroups of antisocial criminal offenders with either emotional hypo- or hyper-reactivity compared with healthy, noncriminal controls. Offenders were recruited from high-security forensic treatment facilities and penal institutions and underwent functional magnetic resonance imaging during a financial decision-making task. In this task, participants were required to choose between low-risk (bonds) and high-risk alternatives (stocks). Bonds were always the safe choice; stocks could win or lose, with a varying degree of uncertainty. We found that emotionally hypo-reactive offenders differed most from healthy controls by showing diminished neural activation in the rostral anterior cingulate cortex in response to uncertainty as well as decreased activity in the prefrontal cortex when trying to regulate their behavior accordingly (i.e., when consistently choosing "safe alternatives"). Hence, the data indicate that emotionally hypo-reactive offenders (with psychopathic traits) constitute a special subgroup within antisocial offenders characterized in particular by a limited capacity to emotionally represent uncertainty and to anticipate punishment.

Are patients deemed 'dangerous and severely personality disordered' different from other personality disordered patients detained in forensic settings?

BACKGROUND

In 1999, the UK government initiated a programme for the assessment and treatment of individuals deemed to have 'dangerous and severe personality disorder' (DSPD). After over 10 years of specialist service development, it is not clear whether DSPD patients represent a distinct group.

AIMS

The aim of this study was to establish whether people admitted to DSPD hospital units could be distinguished in presentation or personality traits from people with personality disorder admitted to standard secure hospital services.

METHODS

Thirty-eight men detained in high-security hospital DSPD units were compared with 62 men detained in conventional medium or high security hospital units, using the Psychopathy Checklist-Revised (PCL-R) and other standard personality disorder, clinical and offending measures.

RESULTS

Compared with their counterparts in standard services, the DSPD group had higher scores on PCL-R psychopathy, significantly more convictions before age 18 years, greater severity of institutional violence and more prior crimes of sexual violence. Regression analysis confirmed that only PCL-R Factor 1, reflecting core interpersonal and affective features of psychopathy, predicted group membership.

CONCLUSION

The DSPD group emerged as having higher psychopathy scores, but as there is currently no evidence that the core personality features of psychopathy are amenable to treatment, there is little justification for treating high-psychopathy forensic patients differently from those with other disorders of personality.

Psychopathy and lifetime experiences of depression

BACKGROUND

Previous studies have investigated an association between psychopathy and depression as part of the broader study of co-morbidity between psychopathy and Axis I psychopathology or as part of validity tests for psychopathy. These study methods have, however, been limited, for example, by exclusive use of questionnaires, or categorical measures of depression, and by low base rates of psychopathology.

AIMS

Our aims were to extend previous research on psychopathy and depression and to test the hypothesis that total Psychopathy Checklist - Revised (PCL-R) scores, and the four facets of interpersonal, affective, lifestyle and anti-social behaviour, would be negatively associated with depressive symptom scores.

METHODS

Dimensional measures of psychopathy and lifetime major depression were derived from structured interviews (the PCL-R and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised) with adult male prisoners. The emotional experience of depression was also studied through analysis of the narratives used by the men to describe their depressive symptoms.

RESULTS

The PCL-R scores, and in particular the interpersonal, affective and lifestyle facets of the PCL-R, were inversely associated with depression scores.

CONCLUSION

Our findings suggest that psychopathy does influence the way depression is experienced.

Neurocognitive deficits and psychiatric disorders in a NSW prison population

Approximately 75% of inmates in New South Wales (NSW) have mental health issues (Butler & Alnutt, 2003). Scarce resources force the management of acute psychiatric symptoms only, meaning that co-morbid conditions such as neurocognitive deficits are less likely to be assessed. The objective of this study was to investigate the utility of a computerized battery in the assessment of inmates within the criminal justice system. Thirty male inmates were assessed. Data were compared to matched controls. The custodial sample was characterized by an increase in the prevalence of previous trauma; high levels of depression, anxiety and stress and neurocognitive deficits, including sustained attention, impulsivity and executive dysfunction.

Psychopathy: a confusing clinical construct

Although psychopathy has traditionally been cited as a disorder of personality, confusion arises as the term is used interchangeably with the terms antisocial personality disorder and dissocial personality disorder, both of which are largely behaviorally based. This paper aims to provide an overview of the literature on the topic of psychopathy, which examines this conundrum. Included in the discussion are definitions of psychopathy, incidence, approaches to diagnosis, and the debates that surround causes, manifestations, and treatability. Experimental studies and theoretical papers have been included if considered to be informative and of relevance to forensic nursing practice. The review demonstrates that studies are fragmented and no clear consensus seems to emerge concerning any of the discussion areas or even the construct of psychopathy itself. It is concluded that further research is required in psychopathy as encountered in both institutional and community settings. Until complete clarification is provided by the research community, forensic nurses need to maintain positive views about their own role when working with people with this challenging condition and strive to maintain a therapeutic ward atmosphere.

The role of gender differences and other client characteristics in the prevalence of DSM-IV affective disorders among a European therapeutic community population

There is a lack of research illustrating the extent of psychiatric problems in European TCs. Furthermore, there is a need to obtain more insight into gender differences concerning comorbidity in the TC population. In an attempt to respond to previous shortcomings, three specific goals were formulated for the current study. The primary aim was to explore the lifetime prevalence of affective disorders in European TC clients. The second aim was to focus on related gender differences. And finally, client characteristics measured by the EuropASI were related to mood and anxiety disorders measured by the SCID-I. Nine out of ten substance abusers treated in a European TC program have an affective disorder. Gender differences are noted for two anxiety disorders: men have more obsessive-compulsive disorders; women have more post-traumatic stress disorders. The study illustrates that not only gender but also other client characteristics should be taken into account when organizing treatment.

The relationship between DSM-IV cluster B personality disorders and psychopathy according to Hare's criteria: clarification and resolution of previous contradictions

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders. To clarify some contradictions among several previous studies on this issue, individual cluster B PDs were looked at alone, excluding any cases of comorbidity with other PDs of this cluster. We found highly significant relationships between antisocial and borderline PD and Factor II of the PCL and a highly significant correlation between narcissistic PD and Factor I of the PCL. These results were to be expected from the theoretical basis of the development of the PCL and provide a contribution to the construct validity of the PCL, which until now has not been validated on such a large sample in Germany.

Psychopathy/antisocial personality disorder conundrum

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

A preliminary study on findings of psychopathy and affective disorders in adult sex offenders

The construct of psychopathy has often been considered mutually exclusive to the presence of genuine depressive or anxiety symptomotology. This article addresses the hypothesized reasons for this dichotomous relationship. In this study, 68 civilly committed adult male sex offenders were evaluated using a variety of psychological measures to determine if psychopathic individuals in this group would demonstrate clinically significant affective symptoms. Results indicate that the men in this sample endorsed high rates of psychopathy on the PCL-R, with 42% of these expressing concurrent symptoms of depression and 26% manifesting symptoms of an anxiety disorder. Relationships between affective symptoms and PCL-R factor scores and qualitative differences between these constructs in child molesters and rapists are also discussed.

Reliability and Validity Evaluation of the Psychopathy Checklist: Screening Version (PCL:SV) in Swedish correctional and forensic psychiatric samples

This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

Mental health in prison populations. A review--with special emphasis on a study of Danish prisoners on remand

OBJECTIVE

To review the literature on mental health and psychiatric morbidity in prison populations and relate findings to a Danish study on remand prisoners.

METHOD

The literature is reviewed and subdivided in the following section: validity of psychometrics in prison populations, prevalence of psychiatric disorders prior to imprisonment, incidence of psychiatric disorders during imprisonment, psychopathy related to psychiatric comorbidity, dependence syndromes with special emphasis on different administrations of heroin use (smoke vs. injection). The results are compared with a longitudinal Danish study on remand prisoners in either solitary confinement (SC) or non-SC.

RESULTS

Many factors must be taken into consideration when dealing with prisoners and mental health, e.g. international differences, the prison setting, demographics and methodological issues. The prison populations in general are increasing worldwide. Psychometrics may perform differently in prison populations compared with general populations with the General Health Questionnaire-28 having a low validity in remand prisoners. Psychiatric morbidity including schizophrenia is higher and perhaps increasing in prison populations compared with general populations with dependence syndromes being the most frequent disorders. The early phase of imprisonment is a vulnerable period with a moderately high incidence of adjustment disorders and twice the incidence in SC compared with non-SC. Prevalence of psychopathy is lower in European than North American prisons. Medium to high scores of psychopathy is related to higher psychiatric comorbidity. Opioid dependence is the most frequent drug disorder with subjects using injection representing a more dysfunctional group than subjects using smoke administration. Many mentally ill prisoners remain undetected and undertreated.

CONCLUSION

There is a growing population of mentally ill prisoners being insufficiently detected and treated.

Psychopathy in violent female offenders in Finland

BACKGROUND

The base rate and construct of psychopathy in violent female offenders were examined.

SAMPLING AND METHODS

More than half of all violent female offenders in Finland who where either hospitalised (n=12) or incarcerated (n=46) during the year of the study were assessed by the Hare Psychopathy Checklist-Revised (PCL-R), Structured Clinical Interview II for DSM-IV, Beck Anxiety Inventory, Beck Depression Inventory-II and Wechsler Adult Intelligence Scale-Revised.

RESULTS

PCL-R mean scores and a base rate of psychopathy were found to be in line with earlier studies, showing both lower values and prevalence in females. The PCL-R correlated with symptoms of cluster B personality disorders as well as with depressive personality disorder. Factor 2 was observed to positively correlate with anxiety and depression and negatively with verbal cognitive ability. Logistic regression analysis on the PCL-R items revealed that the items shallow affect, lack of remorse or guilt, conning/manipulation and lack of realistic goals seem to be important indicators of female psychopathy together with callous/lack of empathy, impulsivity and failure to accept responsibility for own actions.

CONCLUSION

The finding indicates that the prevalence of psychopathy is lower among female offenders than among male offenders, but further research is needed to examine the base rate of psychopathy in women, and whether the symptoms of psychopathy are expressed differently in women than in men.

Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account

This paper reviews the role of orbitofrontal cortex (OFC) lesions in antisocial behaviors and the adequacy of a strict OFC account of antisocial disorders where there is no evidence of lesion. Neurocognitive accounts of antisocial behaviors are extended beyond the OFC. Several methodological shortcomings specific to this neuroscience approach to antisocial behavior are identified. A developmental approach is advocated to chart the developmental sequences of impaired brain development and of the various comorbid states typically seen in antisocial disorders.

Long-term validity of biological markers of psychopathy and criminal recidivism: follow-up 6-8 years after forensic psychiatric investigation

This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.

Self-reported personality traits and disorders (DSM-IV) and risk of criminal recidivism: a prospective study

Assessment and management of criminal offenders require valid methods to recognize personality psychopathology and other risk and protective factors for recidivism. We prospectively explored the association between dimensional and categorical measures of personality disorder (PD) measured with the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q, Ottosson et al., 1995) and registered reconvictions in adult offenders. One hundred and sixty-eight offenders consecutively referred for pre-sentencing forensic psychiatric evaluation in Sweden during 1995-1996 completed DIP-Q self-reports. The subjects received different types of sanctions and were followed for an average of 36 months after release from prison, discharge from a forensic psychiatric hospital, or onset of nondetaining sentences. Age-adjusted odds ratios revealed a 4.8 times higher risk for any recidivism and a 3.7 times higher risk for violent recidivism among subjects whose self-reports suggested a categorical diagnosis of antisocial PD as compared to offenders without antisocial PD. The remaining nine categorical DSM-IV PD diagnoses were not significantly related to recidivism. In dimensional analyses, each additional antisocial and schizoid PD symptom endorsed by participants at baseline increased the risk for violent reoffending. Our results suggest a relationship between self-reported behavioral instability and interpersonal dysfunction captured primarily by DSM-IV antisocial and schizoid PD constructs, and criminal re-offending also in a multi-problem sample of identified offenders.

Affective disorder and 'psychopathy' in a sample of younger male delinquents

OBJECTIVE

The authors' goal was to determine the prevalence of affective disorder, a history of traumatic events and the prevalence of post-traumatic stress disorder (PTSD) diagnosis in their relationship to 'psychopathy' in a sample of younger male delinquents admitted to a correctional institution.

METHOD

As part of routine mental health screening, the SCID-1 and Psychopathy Checklist (PCL-R) were administered to 102 inmates aged 17-27 years.

RESULTS

Affective disorder was found in 28% and 29% had a history of suicidal attempts. The PCL-R-score was significantly correlated with the number of prior threatening events, but PTSD could not be diagnosed in the 'psychopathic' group. The prevalence of affective disorder was significantly higher in the 'non-psychopathic' group.

CONCLUSION

The inverse relationship between threatening events and the PTSD diagnosis seems to indicate other coping modalities than those found in 'non-psychopaths'. That finding is discussed against the background of psychophysiological data and psychosocial learning models.

Relationships between attempted suicide, temperamental vulnerability, and violent criminality in a Swedish forensic psychiatric population

The relationship between suicide attempts and different vulnerability factors was investigated in 61 male subjects during forensic psychiatric examination. Personality traits and psychopathy were determined by means of the Karolinska Scales of Personality (KSP) and the Psychopathy Checklist-Revised (PCL-R). Clinical diagnoses were determined by the use of Structured Clinical Interview for DSM-III-R (SCID). Platelet monoamine oxidase (MAO) activity was investigated in 58 subjects. Suicide attempters had extremely low socialization and high impulsive aggression. This was independent of a history of repeatedly criminal violence or not. They had higher PCL-R scores and lower levels of platelet MAO activity than non-attempters. No relationship was found between suicide attempts and repeated violent criminality. However, among the subjects with repeated criminal violence there was a highly significant difference between suicide attempters and non-attempters, indicating different personality profiles in violent offenders with and without suicidal behavior. Suicidal behavior was significantly associated with borderline personality disorder, but not with any other single DSM-III-R disorder. The results show a far more severe personality disturbance in suicide attempters than in other violent patients in this type of population. Suicidal behavior should therefore be evaluated and treated per se.

Associations of past conduct disorder with personality disorders in 'non-psychotic' psychiatric inpatients

The aim was to investigate associations of a history of features of DSM-III-R conduct disorder (CD) with features of DSM-III-R personality disorders (PDs) and psychopathy, in inpatient psychiatric practice. Fifty-six psychiatric inpatients, without a history of specified 'psychoses', were assessed by the SCID structured interview for DSM-III-R PDs and the 'Psychopathy Checklist Revised' (PCL-R). In a sample in which 59% had borderline PD, significant associations between a history of CD criteria and the adult features of antisocial PD (APD) were relatively specific compared with other PDs, but were weaker in women. However, significant correlations between the number of positive CD criteria and PCL-R scores were similar in both genders. The relatively specific associations between CD and adult features of APD are likely to be relevant to psychiatric patients who show various presentations of PD, if these include some adult features of APD. The findings inform the understanding of the development and classification of PDs.

Construct validity of the Psychopathic Personality Inventory in a correctional sample

The relations between the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996) and 4 theoretically related constructs (empathy, aggression, work ethic, and borderline personality disorder) were examined. Additionally, the relation between the PPI and heroism was explored. One hundred male inmates were administered the PPI, the Questionnaire Measure of Emotional Empathy (Mehrabian & Epstein, 1972), the Aggression Questionnaire (Buss & Perry, 1992), the Protestant Ethic Scale (Mirels & Garrett, 1971), the Self-Report for Borderline Personality Scale (Oldham et al., 1985), and the Activity Frequency Inventory (Lilienfeld, 1998). As predicted, the PPI was significantly negatively correlated with empathy and significantly positively related to aggression and borderline personality. Contrary to prediction, the correlation between the PPI and work ethic was not significant. Eight of 11 hypotheses regarding the relations of the PPI subscales to these 4 constructs were corroborated. Results support the construct validity of the PPI in a correctional sample. The exploratory analysis of the relation between the PPI and heroism revealed no significant relations.

Temperament traits in male suicide attempters and violent offenders

With the purpose of comparing temperament traits in subjects who have been violent towards others and with subjects who have shown self-directed violence, 34 male suicide attempters and 34 male violent offenders were matched for age and psychiatric diagnosis. Violent offenders with a history of suicide attempts were excluded. Temperament traits were assessed by means of the Karolinska Scales of Personality. The temperament profiles of suicide attempters and violent offenders were very similar, with high trait anxiety and very low socialization. Violent offenders displayed significantly higher social desirability (P < 0.001). Suicide attempters tended to have higher indirect aggression and monotony avoidance. Impulsiveness, verbal aggression, and inhibition of aggression were within the normal range in both groups. There were substantial temperamental similarities between suicide attempters and violent offenders. In order to disentangle the differential mechanisms behind aggression towards self and others, we probably need to consider historical as well as current situation factors in a systematic way.

Reliability of file-based retrospective ratings of psychopathy with the PCL-R

A rapidly emerging consensus recognizes Hare's Psychopathy Checklist-Revised (PCL-R; Hare, 1991) as the most valid and useful instrument to assess psychopathy (Fulero, 1995; Stone, 1995). We compared independent clinical PCL-R ratings of 40 forensic adult male criminal offenders to retrospective file-only ratings. File-based PCL-R ratings, in comparison to the clinical ratings, yielded categorical psychopathy diagnoses with a sensitivity of .57 and a specificity of .96. The intraclass correlation (ICC) of the total scores as estimated by ICC(2,1) was .88, and was markedly better on Factor 2, ICC(2,1) = .89, than on Factor 1, ICC(2,1) = .69. The findings support the belief that for research purposes, file-only PCL-R ratings based on Swedish forensic psychiatric investigation records can be made with good alternate-form reliability.

Serum levels of thyroid hormones as biological markers in a Swedish forensic psychiatric population

BACKGROUND

In a Swedish study, delinquent boys had high serum levels of triiodothyronine (T3). Furthermore, former delinquents, followed up after about 30 years, had T3 levels significantly related to repeated criminality. The aim of the present study was to shed further light on the relationship between the thyroid hormones and specific behaviors and personality characteristics.

METHODS

Serum levels of T3 and free thyroxine (FT4) were measured in 61 nonpsychotic male subjects at forensic psychiatric examinations and 66 normal controls. Psychopathy was determined by means of the Psychopathy Checklist-Revised (PCL-R) and DSM-III-R, DSM-IV, and ICD-10 diagnoses.

RESULTS

The study population had high T3 and low FT4 values. Elevated T3 levels were related to type II alcoholism, Cluster B personality disorders, psychopathy as measured by the PCL-R, criminality, a diagnosis of a DSM-IV antisocial disorder, and an ICD-10 dissocial disorder. Serum levels of FT4 were negatively related to the same disorders and personality traits.

CONCLUSIONS

The results indicate an intimate relationship between T3 and FT4, and abuse and antisocial behavior. They emphasize the importance of further studies on T3 as a biological marker for abuse, social deviance, and repeated violent behavior.

Testosterone as a biological marker in psychopathy and alcoholism

The aim of the present study was to clarify the relationships between testosterone and alcohol abuse, alcohol dependence and specific personality characteristics and behaviors in a forensic psychiatric population. Serum levels of total testosterone (TT), free testosterone (FT-DPC) and sex hormone-binding globulin (SHBG) were determined in 61 male subjects undergoing forensic psychiatric examinations. All subjects had been detoxified from drugs and alcohol during previous incarceration in jail or hospital. TT and FT-DPC were found to be highly correlated (r=0.63, P < 0.0001). High concentrations of TT and SHBG were consistently related to type II alcoholism, but not pure alcohol dependence. TT and SHBG were also related to antisocial personality disorder. Furthermore, TT and SHBG were related to socially deviant behavior, reflected in factor 2 in the Psychopathy Checklist (PCL-R). In a multiple regression, FT-DPC was also clearly associated with the psychopathy-related scales of the Karolinska Scales of Personality (KSP) when age and signs of hepatic damage were kept under control.

Methodological advances and developments in the assessment of psychopathy

The last decade has witnessed a number of significant methodological advances and developments in the assessment of psychopathy. The Psychopathy Checklist-Revised and the two-factor model of psychopathy have facilitated the assessment of psychopathy and clarified the differential correlates of the personality- and behavior-based operationalizations of this syndrome. Although preliminary evidence suggests that certain features of psychopathy may be underpinned by a latent taxon, the categorical versus dimensional status of psychopathy requires clarification. Researchers have accorded increasing attention to the assessment of psychopathy in non-criminal samples, although the construct of subclinical psychopathy remains controversial. Other recent methodological developments include: (a) the extension of the Five-Factor Model and other higher-order personality taxonomies to psychopathy; (b) development of a Q-sort methodology to permit the assessment of psychopathy by observers; (c) standardized assessment of psychopaths' interpersonal behaviors; (d) assessment of psychopathy in children; and (e) examination of gender, ethnic, and cross-cultural differences in psychopathy.

Platelet monoamine oxidase activity as a biological marker in a Swedish forensic psychiatric population

Platelet monoamine oxidase (MAO) activities were determined in 58 non-psychotic males at forensic psychiatric examinations. The aim of the study was to investigate the role of platelet MAO activity as a biological marker in forensic psychiatry, a clinical field with growing need of safe predictors for both treatment outcome and behavior. The study population was heterogeneous with respect to clinical and personality disorders and personality traits. The results confirmed the role of platelet MAO activity as a biological marker for stable personality traits such as impulsiveness, monotony avoidance and aggressiveness. Disorders with high frequencies of these personality traits such as borderline personality disorder and type II alcoholism could secondarily be associated with low levels of platelet MAO activity, whereas no such associations could be found regarding other clinical or personality disorders. Neither psychopathy as assessed by the means of PCL-R nor behavior such as abuse or criminality could be associated with platelet MAO activity. The conclusion is that, due to its close relationship with stable personality traits, platelet MAO activity serves a marker for vulnerability also in forensic psychiatric populations. On the other hand it is not a marker for clinical or personality disorders, or behavior per se.