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= Psychopathy Checklist =
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Introduction
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The Psychopathy Checklist or Hare Psychopathy Checklist-Revised, now
the Psychopathy Checklist�revised (PCL-R), is a psychological
assessment tool most commonly used to assess the presence of
psychopathy in individuals. It is a 20-item inventory of perceived
personality traits and recorded behaviors, intended to be completed on
the basis of a semi-structured interview along with a review of
'collateral information' such as official records.
The PCL was originally developed in the 1970s by Canadian psychologist
Robert D. Hare for use in psychology experiments, based partly on
Hare's work with male offenders and forensic inmates in Vancouver, and
partly on an influential clinical profile by American psychiatrist
Hervey M. Cleckley first published in 1941.
An individual's score may have important consequences for their
future, and because the potential for harm if the test is used or
administered incorrectly is considerable, Hare argues that the test
should be considered valid only if administered by a suitably
qualified and experienced clinician under scientifically controlled
and licensed, standardized conditions. Hare receives royalties on
licensed use of the test.
In psychometric terms, the current version of the checklist has two
factors (sets of related scores) that correlate about 0.5 with each
other, with Factor One closer to Cleckley's original personality
concept than Factor Two. Hare's checklist does not incorporate the
"positive adjustment features" that Cleckley did.
PCL-R model of psychopathy
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The PCL-R is used for indicating a dimensional score, or a categorical
diagnosis, of psychopathy for clinical, legal or research purposes. It
is rated by a mental health professional (such as a psychologist or
other professional trained in the field of mental health, psychology,
or psychiatry), using 20 items. Each of the items in the PCL-R is
scored on a three-point scale according to specific criteria through
file information and a semi-structured interview.
The scores are used to predict risk for criminal re-offense and
probability of rehabilitation.
The current edition of the PCL-R officially lists three factors (1.a,
1.b, and 2.a), which summarize the 20 assessed areas via factor
analysis. The previous edition of the PCL-R listed two factors. Factor
1 is labelled "selfish, callous and remorseless use of others". Factor
2 is labelled as "chronically unstable, antisocial and socially
deviant lifestyle". There is a high risk of recidivism and mostly
small likelihood of rehabilitation for those who are labelled as
having "psychopathy" on the basis of the PCL-R ratings in the manual
for the test, although treatment research is ongoing.
PCL-R Factors 1a and 1b are correlated with narcissistic personality
disorder. They are associated with extraversion and positive affect.
Factor 1, the so-called core personality traits of psychopathy, may
even be beneficial for the psychopath (in terms of nondeviant social
functioning).
PCL-R Factors 2a and 2b are particularly strongly correlated to
antisocial personality disorder and borderline personality disorder
and are associated with reactive anger, criminality, and impulsive
violence. The target group for the PCL-R in prisons in some countries
is criminals convicted of delict and/or felony. The quality of ratings
may depend on how much background information is available and whether
the person rated is honest and forthright.
Items
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Each of the 20 items in the PCL-R is scored on a three-point scale,
with a rating of 0 if it does not apply at all, 1 if there is a
partial match or mixed information, and 2 if there is a reasonably
good match to the offender. This is said to be ideally done through a
face-to-face interview together with supporting information on
lifetime behavior (e.g., from case files), but is also done based only
on file information. It can take up to three hours to collect and
review the information.
Out of a maximum score of 40, the cut-off for the label of psychopathy
is 30 in the United States and 25 in the United Kingdom. A cut-off
score of 25 is also sometimes used for research purposes.
High PCL-R scores are positively associated with measures of
impulsivity and aggression, Machiavellianism, persistent criminal
behavior, and negatively associated with measures of empathy and
affiliation.
Early factor analysis of the 'PCL-R' indicated it consisted of two
factors. Factor 1 captures traits dealing with the interpersonal and
affective deficits of psychopathy (e.g., shallow affect, superficial
charm, manipulativeness, lack of empathy) whereas factor 2 dealt with
symptoms relating to antisocial behavior (e.g., criminal versatility,
impulsiveness, irresponsibility, poor behavior controls, juvenile
delinquency).
The two factors have been found by those following this theory to
display different correlates. Factor 1 has been correlated with
narcissistic personality disorder, low anxiety, low empathy, low
stress reaction and low suicide risk but high scores on scales of
achievement and social potency. In addition, the use of item response
theory analysis of female offender PCL-R scores indicates factor 1
items are more important in measuring and generalizing the construct
of psychopathy in women than factor-2 items.
In contrast, factor 2 was found to be related to antisocial
personality disorder, social deviance, sensation seeking, low
socioeconomic status and high risk of suicide. The two factors are
nonetheless highly correlated and there are strong indications they do
result from a single underlying disorder. Research, however, has
failed to replicate the two-factor model in female samples.
In 2001 researchers Cooke and Michie at Glasgow Caledonian University
suggested, using statistical analysis involving confirmatory factor
analysis, that a three-factor structure may provide a better model,
with those items from factor 2 strictly relating to antisocial
behavior (criminal versatility, juvenile delinquency, revocation of
conditional release, early behavioral problems and poor behavioral
controls) removed. The remaining items would be divided into three
factors: arrogant and deceitful interpersonal style, deficient
affective experience and impulsive and irresponsible behavioral style.
Hare and colleagues have criticized the Cooke & Michie
three-factor model for statistical and conceptual problems, like in
fact consisting of up to ten different factors and resulting in
impossible parameters (negative variances).
In the 2003 edition of the 'PCL-R', Hare added a fourth antisocial
behavior factor, consisting of those factor-2 items excluded in the
previous model. Again, these models are presumed to be hierarchical
with a single, unified psychopathy disorder underlying the distinct
but correlated factors. In the four-factor model of the psychopathy,
supported by a range of samples, the factors represent the
interpersonal, affective, lifestyle, and overt antisocial features of
the personality disorder.
Usage
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The PCL-R is widely used to assess individuals in high security
psychiatric units, prisons and other settings. This may be of help in
deciding who should be detained or released, or who should undergo
what kind of treatment. It is also used for its original purpose, to
carry out basic psychology studies of psychopathy.
The PCL-R also has some wide use as a risk assessment tool that
attempts to predict who will offend or reoffend. It has been touted as
unparalleled in its ability in this regard, and there have been some
positive studies, especially early on. However, several recent studies
and very large-scale meta-analysis have cast serious doubt on whether
it performs as well as other instruments, or better than chance, and
to the extent that it does, whether this is largely due its inclusion
of past offending history, rather than the personality trait scores
that make it unique. In addition although in controlled research
environments the inter-rater reliability of the PCL-R may be
satisfactory, in real-world settings it has been found to have rather
poor agreement between different raters, especially on the personality
trait scores. Further, a review which pooled together various risk
assessment instruments including the PCL, found that peer-reviewed
studies on which the developer or translator of the instrument was an
author (which in no case was disclosed in the journal article) were
twice as likely to report positive predictive findings.
On the purported basis of concerns about false positives, inadequately
trained raters, and general misuse or overuse of the test including
with different racial groups, an advice guide was published in 2011 on
how to pass the Hare PCL-R.
There are additional inventories directly from the PCL-R, including
the Psychopathy Checklist: Screening Version (PCL:SV) and Psychopathy
Checklist: Youth Version (PCL:YV). The PCL:SV was developed as a
labor-saving assessment for the same forensic settings as the PCL-R
and to meet the needs of settings where clients do not necessarily
have criminal records (e.g. civil psychiatric patients). It includes
12 items and takes 90 minutes. According to the MacArthur violence
risk assessment study, there is a stronger correlation between the
PCL:SV results and later violence than any other of the 134 variables
evaluated in that study. The PCL:YV assesses early signs of juvenile
psychopathy in children and adolescents.
Comparison with psychiatric diagnoses
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Among laypersons and professionals, there is much confusion about the
meanings and differences between psychopathy, sociopathy, antisocial
personality disorder (ASPD), and the ICD-10 diagnosis, dissocial
personality disorder. Hare takes the stance that psychopathy as a
syndrome should be considered distinct from the DSM-IV's antisocial
personality disorder construct, although the DSM states ASPD has been
referred to as or includes the disorder of psychopathy. However, those
who created the DSM-IV felt that there was too much room for
subjectivity on the part of clinicians when identifying things like
remorse and guilt; therefore, the DSM-IV panel decided to stick to
observable behavior, namely socially deviant behaviors.
As a result, the diagnosis of ASPD is something that the "majority of
criminals easily meet". Hare goes further to say that the percentage
of incarcerated criminals that meet the requirements of ASPD is
somewhere between 80 and 85 percent, whereas only about 20% of these
criminals would qualify for a psychopathy diagnosis using the PCL-R.
This twenty percent, according to Hare, accounts for 50 percent of all
the most serious crimes committed, including half of all serial and
repeat rapists.
Although the diagnosis of ASPD covers two to three times as many
prisoners than the diagnosis of psychopathy, Hare believes the PCL-R
is better able to predict future criminality, violence, and recidivism
than a diagnosis of ASPD. He suggests there are differences between
PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use
of linguistic and emotional information", while such differences are
potentially smaller between those diagnosed with ASPD and without.
Additionally, Hare argued confusion regarding how to diagnose ASPD,
confusion regarding the difference between ASPD and psychopathy, as
well as the differing future prognoses regarding recidivism and
treatability, may have serious consequences in settings such as court
cases where psychopathy is often seen as aggravating the crime.
Hare wants the 'Diagnostic and Statistical Manual of Mental Disorders'
to list psychopathy as a unique disorder, saying psychopathy has no
precise equivalent in either the 'DSM-IV-TR', where it is most
strongly correlated with the diagnosis of antisocial personality
disorder, or the 'ICD-10', which has a similar diagnosis called
dissocial personality disorder. Both organizations state their
diagnoses have been referred to as or include the disorder of
psychopathy. But only a minority of those in institutions whom Hare
and his followers would diagnose as psychopaths are violent offenders.
Other PCL-R findings
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According to Hare, one FBI study produced in 1992 found that 44
percent of offenders who killed a police officer were psychopaths. The
study was 'Killed in the Line of Duty: A Study of Selected Felonious
Killings of Law Enforcement Officers.'
There has been some controversy over the use of the PCL-R by UK prison
and secure psychiatric services, including its role in the
government's new administrative category of 'Dangerous and Severe
Personality Disorder' (a separate older administrative category of
'psychopathic disorder' in the Mental Health Act was abolished in
2007). One leading forensic psychologist, while Deputy Chief at the
Ministry of Justice, has argued that it has not lived up to claims
that it could identify those who would not benefit from current
treatments or those most likely to violently reoffend.
A study by one of Hare's students, Randy Kropp, on a group of
prisoners found that among those who had low scores on the PCL-R,
about 20 to 25 percent would be re-convicted within four or five
years, while in the "high group", that risk was about 80 percent.
A study using the PCL-R to examine the relationship between antisocial
behavior and suicide found that suicide history was strongly
correlated to PCL-R factor 2 (reflecting antisocial deviance) and was
not correlated to PCL-R factor 1 (reflecting affective functioning).
Given that ASPD relates to factor 2, whereas psychopathy relates to
both factors, this would confirm Hervey M. Cleckley's assertion that
psychopaths are relatively immune to suicide. People with ASPD, on the
other hand, have a relatively high suicide rate.
The PCL-R is sometimes used to assess risk of sexual (re)offending,
with mixed results.
Since psychopaths frequently cause harm through their actions, it is
assumed that they are not emotionally attached to the people they
harm; however, according to the PCL-R checklist, psychopaths are also
careless in the way they treat themselves. They frequently fail to
alter their behavior in a way that would prevent them from enduring
future discomfort.
Because an individual's scores may have important consequences for his
or her future, the potential for harm if the test is used or
administered incorrectly is considerable. The test can only be
considered valid if administered by a suitably qualified and
experienced clinician under controlled conditions.
Hare has described psychopaths as 'social predators', 'remorseless
predators', or in some cases 'lethal predators', and has stated that
'Psychopathic depredations affect people in all races, cultures, and
ethnic groups, and at all levels of income and social status'.
Criticism
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In addition to the aforementioned report by Cooke and Michie that a
three-factor structure may provide a better model than the two-factor
structure, Hare's concept and checklist have faced other criticisms.
In 2010, there was controversy after it emerged that Hare had
threatened legal action that stopped publication of a peer-reviewed
article on the PCL-R. Hare alleged the article quoted or paraphrased
him incorrectly. The article eventually appeared three years later. It
alleged that the checklist is wrongly viewed by many as the basic
definition of psychopathy, yet it leaves out key factors, while also
making criminality too central to the concept. The authors claimed
this leads to problems in overdiagnosis and in the use of the
checklist to secure convictions. Hare has since stated that he
receives less than $35,000 a year from royalties associated with the
checklist and its derivatives.
Hare's concept has also been criticised as being only weakly
applicable to real-world settings and tending towards tautology. It is
also said to be vulnerable to "labeling effects", to be
over-simplistic, reductionistic, to embody the fundamental attribution
error, and not pay enough attention to context and the dynamic nature
of human behavior. It has been pointed out that half the criteria can
also be signs of mania, hypomania, or frontal lobe dysfunction (e.g.,
glibness/superficial charm, grandiosity, poor behavioral controls,
promiscuous sexual behavior, and irresponsibility).
Some research suggests that ratings made using the PCL system depend
on the personality of the person doing the rating, including how
empathic they themselves are. One forensic researcher has suggested
that future studies need to examine the class background, race and
philosophical beliefs of raters because they may not be aware of
enacting biased judgments of people whose section of society or
individual lives for whom they have no understanding of or empathy.
Notable evaluations
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*Canadian serial killer duo Paul Bernardo and Karla Homolka were
assessed using the checklist. Bernardo scored 35/40, and Homolka 5/40.
*Ted Bundy scored 39/40.
*Peter Lundin scored 39/40.
*Clifford Olson scored 38/40.
*Aileen Wuornos scored 32/40.
*Brian David Mitchell scored a 34/40.
*Brian Dugan scored 38/40.
*Wayne, subject of Channel 4's 2000 documentary film 'Psychopath',
achieved the "extremely rare" score of 40/40.
See also
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* Actuarial tools in criminology
* Levenson Self-Report Psychopathy Scale
* List of diagnostic classification and rating scales used in
psychiatry
* Narcissism
* Psychopathic Personality Inventory
* Psychopathy
Further reading
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*Hare, R. D. (2003). "The Psychopathy Checklist - Revised, 2nd
Edition." Toronto: Multi-Health Systems.
*
*
*
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*Babiak, P., & Hare, R. D. (2006). "Snakes in suits: When
psychopaths go to work", New York: Harper Collins.
*'The Psychopath Test: A Journey Through the Madness Industry' (2011),
an accessible book by gonzo journalist Jon Ronson
External links
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*[
http://www.thisamericanlife.org/radio-archives/episode/436/the-psychopath-test
This American Life radio documentary on the PCL-R and its use]
License
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Original Article:
http://en.wikipedia.org/wiki/Psychopathy_Checklist
