This article was downloaded by: [Temple University Libraries]On: 18 November 2014, At: 00:07Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK

International Journal of Forensic Mental HealthPublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/ufmh20

The Multifaceted Construct of Psychopathy: Associationwith APD, Clinical, and Criminal Characteristics amongMale and Female InmatesJanet I. Warren a & Mandi Burnette ba University of Virginia , Charlottesville , Virginia , USAb University of Rochester , Rochester , New York , USAPublished online: 18 Dec 2013.

To cite this article: Janet I. Warren & Mandi Burnette (2013) The Multifaceted Construct of Psychopathy: Association withAPD, Clinical, and Criminal Characteristics among Male and Female Inmates, International Journal of Forensic Mental Health,12:4, 265-273, DOI: 10.1080/14999013.2013.857739

To link to this article: http://dx.doi.org/10.1080/14999013.2013.857739

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon andshould be independently verified with primary sources of information. Taylor and Francis shall not be liable forany losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use ofthe Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH, 12: 265–273, 2013Copyright C© International Association of Forensic Mental Health ServicesISSN: 1499-9013 print / 1932-9903 onlineDOI: 10.1080/14999013.2013.857739

The Multifaceted Construct of Psychopathy:Association with APD, Clinical, and Criminal

Characteristics among Male and Female Inmates

Janet I. WarrenUniversity of Virginia, Charlottesville, Virginia, USA

Mandi BurnetteUniversity of Rochester, Rochester, New York, USA

Our study examined the multiple facets of psychopathy and their relationship with personal-ity, mental health and criminal behavior in male and female inmates. At an item level, manyAntisocial Personality Disorder (APD) symptoms were not significantly associated with theAffective facet of the PCL-R, yet all were significantly associated with the other three facetsof psychopathy. At a diagnostic level, the associations between APD and PCL-R facets wereconsistent and pervasive, but varied in strength by psychopathy facet. Despite a great dealof overlap between psychopathy and APD, we found some differences in the direction andmagnitude of association between APD, psychopathy facets, and criminal and clinical charac-teristics. Notably, among a forensic sample, psychopathy facets conferred additional risk forantisocial behavior, violence, and other forms of personality pathology, even after adjustingfor levels of APD. Future directions for psychopathy research are discussed.

Keywords: Facets of psychopathy, Antisocial Personality Disorder, personality disorders,male and female inmates

The study of Antisocial Personality Disorder (APD) andpsychopathy has been complicated by changing diagnosticcriteria; inconsistent definitions of antisocial, criminal, andviolent behavior; and varying models of psychopathy as aspecific form of personality pathology. Recently, the DSM-5Working Group on Personality and Personality Disordersproposed, but ultimately rejected, the idea of combiningthe two into an Antisocial/Psychopathy Personality Disor-der Type. This proposal reflected the first formal integrationof research conducted in the field of forensic psychology andpsychiatry with research designed to describe psychopathol-ogy among the general population.

The convergence of psychopathy with APD has been im-plied in prior versions of the DSM. Psychopathy research hasbeen routinely cited in the descriptions of APD, alongsideassertions that the same personality traits have been labeled

Address correspondence to Janet I. Warren, Institute of Law, Psychiatryand Public Policy, PO Box 800660, UVA Health System, Charlottesville,VA 22908-0660, USA. E-mail: jiw@virginia.edu

differentially over the years as psychopathy, sociopathy,and dyssocial personality disorder (American PsychiatricAssociation, 2000). However, research among incarcera-ted populations using the Psychopathy Checklist-Revised(PCL-R; Hare, 1991, 2003) has not supported the notion thatAPD and psychopathy are the same (Hare, 1983). Indeed,research suggests modest, or in some instances, inversecorrelations between specific facets of psychopathy (e.g.,interpersonal and affective dimensions) and the behavioralcriteria seen in APD (Kennealy et al., 2010; Patrick &Bernat, 2009).

The current study aimed to better understand the interfacebetween APD and psychopathy, and test the independentcontributions of psychopathy as a multifaceted construct, inthe prediction of clinical and criminal behavior of male andfemale inmates. Specifically, we hypothesized that the psy-chopathy facets and APD would be strongly associated withone another, particularly the lifestyle and antisocial facets ofpsychopathy and APD. Yet, we hypothesized that individ-ual psychopathy facets would contribute unique variance inthe prediction of criminal behavior and substance use among

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

266 WARREN AND BURNETTE

incarcerated men and women, after adjusting for levels ofAPD. Based on prior literature, we hypothesized that theantisocial and lifestyle facets of psychopathy might add util-ity in understanding criminal behavior, whereas the affec-tive facet of psychopathy would be strongly associated withclinical characteristics related to affect regulation, includingdepression and anger.

The Evolution of Psychiatric Terminology

The modern conceptualization of psychopathy has beentraced to the work of Hervey Cleckley and his monograph,The Mask of Sanity: An Attempt to Clarify Some Issues Aboutthe So-called Psychopathic Personalities (Cleckley, 1941).Cleckley viewed psychopathy as a “grave disorder” withwide-reaching effects on others and a profound impact on so-ciety. He proposed 16 defining characteristics and observedthat such individuals “perfectly mimic man, theoretically,”but experience a profound failure in the “practice of actualliving.” His 16 criteria included superficial charm, poor judg-ment, failure to learn from experience, unreliability, imper-sonal sex, fantastic behavior with or without alcohol, deceit-fulness, lack of remorse or shame, inadequately motivatedantisocial behavior, incapacity for love, diminished affectivereactions, limited insight, and a failure to follow any lifeplan. According to Cleckley, psychopathy occurred withoutdelusions or other psychoneurotic manifestations and wasnot associated with completed suicide.

Cleckley’s conceptualization informed the diagnostic cri-teria for APD. In DSM-II, Personality Disorder, AntisocialType (American Psychiatric Association, 1968) was identi-fied as reflecting impairments in the inner experiences of theindividual and their relationships with others. However, inDSM-III, an effort was made to focus more on behavior andless on personality characteristics and traits to better increasethe reliability of diagnostic terms (American Psychiatric As-sociation, 1980). Work by Robins (1966, 1978) and McCordand McCord (1964) suggested that antisocial and criminal be-havior across development (e.g., from adolescence into earlyadulthood) was often associated with APD. The emphasis onantisocial behavior was useful in improving the reliability ofthe APD diagnosis, but coalesced into what some feared wasa class-induced, non-specific description of chronic criminalbehavior.

In the late 1970s, Hare used the Cleckley list of attributesto develop a semi-structured interview and a 22-item cod-ing form to quantify psychopathic traits among incarceratedmale offenders. This instrument was revised to 20 items in1991 as the Psychopathy Checklist Revised (PCL-R) andagain in 2003 (Hare, 1991, 2003). With revision came atransition from a two-factor description of the underlyingstructure of the personality disorder (Interpersonal/Affectiveand Deviant Lifestyle) to a four-facet conceptualization thatincluded distinct Interpersonal, Affective, Lifestyle, and An-tisocial dimensions.

Antisocial Behavior and Its Significanceto Psychopathy

The PCL-R is primarily used in forensic settings as a riskmarker for violence, making the PCL-R a clinical instrumentwith far-reaching significance (Hart, 1998; Salekin et al.,1996; Tolman & Mullendore, 2003). This has prompted psy-chopathy researchers to test the strength of the associationbetween explicit antisocial behavior and the psychopathyconstruct. Early on, Hare underscored the asymmetric re-lationship between APD and psychopathy, reporting that15–25% of 246 incarcerated men in two prisons met cri-teria for psychopathy on the PCL-R, versus 50–75% whomet diagnostic criteria for APD using the DSM-III criteria(Hare, 1983). Hare argued that APD left out many Factor 1personality traits that were useful in differentiating betweenpsychopathic and other types of criminal behavior. More re-cently, Hare (2003) published data suggesting that the PCL-R is best described by a four-facet model of psychopathythat includes affective, interpersonal, antisocial, and deviantlifestyle facets.

From a structural perspective, Hare and Neumann (2010)argue that antisociality is distinct from a simple constellationof criminal behaviors and is central to psychopathy. They citegenetic and longitudinal studies of children, adolescents, andadults, and reference numerous replications of the four-factormodel. Further, they point to the interchange between theoryand research that has emerged using psychopathy in diversedomains, including criminal justice, neuroscience, develop-mental psychopathology, behavioral genetics, and generalpersonality theory. Leistico and colleagues (2008) conducteda meta-analysis of 95 studies with a composite N of 15,826,and found that PCL-R Total, as well as Factor 1 and Factor2 were moderately associated with increased antisocial be-havior. These effect sizes were moderated by the country inwhich the research was conducted, racial composition, gen-der compositions, institutional setting, the information usedto score psychopathy, and the independence of psychopathyand transgression assessments.

Conversely, Cooke and colleagues (2004) used structuralequation modeling to explore a measurement versus causalmodel of the relationship between psychopathy and anti-social behavior. They concluded that the data better fit acausal model, in which antisocial behavior is best viewed asa consequence of psychopathy. From this perspective, crim-inal behavior is an epiphenomenon that is neither diagnosticof psychopathy, nor specific to personality pathology (Cookeet al., 2006). Further meta-analyses challenged the interactiveeffects that are assumed between the PCL-R factors and vio-lence (Kennealy et al., 2010). These findings have promptedSkeem and Cooke (2010) to argue that the association be-tween the PCL-R and violence is “mythical” at best and tocontend that factor analytic studies of the PCL-R in a be-havioral vacuum cannot reveal the underlying structure ofthe personality construct. They emphasize the importance

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

MULTIFACETED CONSTRUCT OF PSYCHOPATHY 267

of separating a measure from its theoretical construct andadvocate for an iterative process that separates theory devel-opment from empirical validation.

The DSM-5 Working Group on Personality and Person-ality Disorders proposed significant restructuring of the as-sessment and diagnosis of adaptive problems associated withpersonality. Minimizing reliance on a discrete number of cat-egorical disorders, the new framework was designed to inte-grate an abbreviated list of prototypic disorders with a traitassessment of major personality characteristics, specific per-sonality deficits associated with self-differentiation and in-terpersonal relatedness, and differing degrees of personalitypathology. In 2010, the DSM-5 Working Group on Person-ality and Personality Disorders proposed the identificationof a personality disorder prototype—Antisocial/PsychopathyPersonality Disorder Type. Drawing from Patrick and col-leagues’ (2009) triarchic model of psychopathy, this formu-lation supported the proposition that the construct was madeup of phenotypic constructs of disinhibition, boldness, andmeanness. In 2011, this proposal was rejected, and the pro-posed diagnostic label reverted back to a diagnosis of Anti-social or Dyssocial Personality Disorder. This diagnostic cat-egory eliminated the behaviorally-based criteria (e.g., failureto conform to social norms with respect to lawful behavior),eradicated the need for the diagnosis of Conduct Disorderprior to the age of 15 years, and emphasized the domain ofantagonism and trait elevations in disinhibition (e.g., impul-sivity, irresponsibility, and risk taking). Of note, alongsidethis change, Narcissistic Personality Disorder (NPD) whichhad initially been deleted was reintegrated as one of six pro-totypical personality disorder types, arguably re-introducingthe grandiosity, shallow affect, and superficial charm oftenassociated with psychopathy. When the final version of theDSM-5 was published in 2013, all of the proposed changeswere bypassed with the criteria for both APD and NPD re-verting back to the same criteria identified in DSM-IV-TRaccompanied by the earlier assertion that “APD was alsoreferred to as psychopathy, sociopathy, and dissocial per-sonality disorder” (American Psychiatric Association, 2013,p. 659).

Diagnostic Revisions to DSM-5

The purpose of the current study was to examine the overlapand utility of psychopathy and APD among a large, incar-cerated sample of men and women. Given prior literaturesuggesting differential associations between different facetsof psychopathy and criminal and mental health outcomes,the current study broke psychopathy down into facets. Ourgoals were to: (1) better understand the association betweenthe various components of psychopathy and APD, and otherforms of personality pathology, and (2) test the unique asso-ciation between psychopathy facets and criminal and antiso-cial behavior, substance use, experiences of victimization inprison, and affective instability as expressed by depression

and anger, after adjusting for APD. This last set of analysessought to determine which components of psychopathy addpredictive utility beyond APD.

METHOD

Participants

Sample Demographics

Participants were a random sample of 288 men and 183women incarcerated in ten high-, medium-, and low-securityprisons in Ohio and Texas. Efforts were made to generate asample of equal numbers of males and female inmates. Theoverall response rate was 37% and varied across sites from56% to 28%. Among the sample, 45.2% (n = 213) reportednever having been married; 30.5% (n = 144) were separated,divorced, or widowed; and 24.4% (n = 110) were married.With regard to education, 19.1% (n = 90) reported less thana high school degree, 41.6% (n = 196) obtained a GED orhigh school degree, and 39.1% (n = 184) reported schoolingbeyond high school. Nearly half (46.3%, n = 218) of thesample identified as White, 37.4% (n = 176) as Black, 9.6%(n = 45) as Hispanic or Latino and 6.4% (n = 30) as “Other”ethnicity. The mean age was 37.32 (SD = 10.56) years witha range between 18 to 74 years of age. Prior to incarceration,the majority (71.3%, n = 336) reported employment, yet45.2% (n = 213) reported state support in the form of welfare,disability, or unemployment.

The two states were similar, except that the Texas samplecontained more male inmates, had more Hispanic and fewerBlack inmates, and contained fewer inmates who receivedstate support prior to incarceration. Some gender differenceswere found: women tended to have higher levels of edu-cation, were more likely to be married at the time of theirincarceration, and more often reported receiving some formof state support prior to incarceration. No gender differenceswere observed on race and employment history.

Recruitment and IRB Approval

Each state sent the PIs a list of all inmates housed ina combination of high-, medium-, and low-security institu-tions. From this list, a random selection of prisons in eachclassification and inmates within each institution was iden-tified based on prior agreements regarding the maximumnumber of inmates that could be recruited from each prison.No incentives were used. Inmates from the list who indicatedinterest in the study were provided with a full description ofthe study and asked to review and sign two consent forms;one approved by the University of Virginia’s InstitutionalReview Board (IRB) and one by each state’s IRB. Interviewslasted approximately 3.5 hours. Interviews were conductedby clinical faculty and advanced graduate students in clinicalpsychology. Record reviews were conducted at each prison

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

268 WARREN AND BURNETTE

by undergraduate students in criminal justice studies. Filereviews were conducted and were provided to clinical inter-viewers for review prior to their completion of scoring on thePCL-R which occurred each evening after the completion ofthe clinical interviews.

Measures

Personality

DSM-IV-TR diagnoses were assessed using the Struc-tured Interview for Personality Disorders (SIDP-IV; Pfohlet al., 1995). The SIDP-IV is composed of 101 questions,divided into 10 interrelated sections, with the final sectionallowing interviewers to rate criteria based on clinical ob-servation. Interrater reliability was evaluated using intraclasscorrelation coefficients (ICCs). ICCS ranged from .60 to .92,with most ICCs greater than .80.

Psychopathy

Psychopathy was assessed using the PsychopathyChecklist-Revised 2(PCL-R; Hare, 2003). The PCL-R is a20-item checklist designed to assess the interpersonal, affec-tive, and behavioral traits of psychopathy, and was completedusing a face-to-face clinical interview and a comprehensivefile review. Data were analyzed using the Hare four-facetmodel made up of an Interpersonal, Affective, Lifestyle, andAntisocial facets. The ICCs for PCL-R totals ranged from.69 to .87 for psychopathy facets and was .89 for total sores.The SIDP-IV and PCL-R were coded for each inmates bythe same clinical interviewer based upon a 39 page semi-structured interview.

Psychiatric History

Indices of psychiatric morbidity were obtained from thePrison Background Information Survey (Warren & Jackson,2013), a self-report instrument that queried each inmate abouta wide range of demographic, psychiatric, and criminal fac-tors, the Beck Depression Inventory (BDI-II) (Beck et al.,1996), and the Novaco Anger Scale (NAS) (Novaco, 2003).The BDI-II is a 21-item self-report instrument designed tomeasure the severity of depression in persons aged 13 yearsor older using a four-point scale with a maximum score of63 points. The NAS is a self-report questionnaire that con-tains 60 items and which yields five scales including Cogni-tive, Arousal, Behavioral, Anger Regulation, and NAS Totalscore.

Violence and Victimization

Measures of violence and victimization in the communityand in prison included the inmate’s instant offense, responseson the Prison Violence Inventory (PVI) (Warren et al., 2004),and the Revised Conflict Tactics Scale (CTS-2) (Straus et al.,

1996). The PVI is a self-report instrument that queries pris-oners about perpetrating and being victimized by physical,sexual, and relational violence. The CTS-2 is a self-reportmeasure designed to assess the extent to which partners indating, cohabitating, or marital relationships engage in psy-chological and physical attacks and their use of reason andnegotiation to deal with conflict.

Analyses

First, we examined bivariate associations between APD andpsychopathy. Second, we examined the bivariate associationsbetween psychopathy and DSM-IV personality disorders.Third, we conducted a series of bivariate logistic regressions(for categorical variables) or linear regressions (for contin-uous variables). In each model, gender, APD, and all fourfacets of psychopathy were entered simultaneously, adjust-ing for age. Models tested the unique value of each aspect ofpersonality in the prediction of clinical and criminal charac-teristics.

RESULTS

APD and Psychopathy Overlap

Table 1 displays the association between the PCL-R and APDsymptom counts. APD symptoms were correlated signifi-cantly with most PCL-R factors and facets, but were moststrongly associated with the lifestyle and antisocial facets.Notably, several APD symptoms were not associated, or onlymodestly associated with the Affective facet of the PCL-R.

Descriptive statistics and bivariate correlations betweenAPD and psychopathy are shown in Table 2. Consistent withprior literature, there was a strong association between APDsymptoms and the PCL-R (see Table 2). This association heldacross all four facets of psychopathy, though the Lifestyleand Antisocial facets demonstrated the strongest associationswith APD symptoms. Though each facet of psychopathy wasstrongly associated with APD, correlations between the Af-fective and Interpersonal facets were smaller in magnitude.

Psychopathy and Other Forms of PersonalityPathology

Table 2 also displays bivariate relationships betweenpsychopathy, and symptom counts for the other nine DSM-IV-TR personality disorders. Psychopathy was stronglyassociated with APD and Narcissistic personality, andwas moderately associated with Paranoid, Borderline, andHistrionic personality. APD demonstrated a similar patternof associations. With regard to Cluster A, moderate associ-ations were observed between Paranoid PD, Schizotypal PDand psychopathy. Schizoid PD was associated with all facetsof psychopathy except for the Interpersonal facet. Finally,

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

MULTIFACETED CONSTRUCT OF PSYCHOPATHY 269

TABLE 1Association between Antisocial Personality Disorder and Psychopathy Among Male and Female Inmates (N = 471)

Affective Interpersonal Lifestyle Antisocial PCL-R Total

APD Total .33∗∗∗ .46∗∗∗ .63∗∗∗ .60∗∗ .69∗∗∗Items2

Conduct .16∗∗∗ .17∗∗∗ .32∗∗∗ .61∗∗∗ .42∗∗∗Rule breaking .08 .29∗∗∗ .43∗∗ .44∗∗∗ .43∗∗∗Lying .17∗∗∗ .51∗∗∗ .38∗∗∗ .33∗∗∗ .48∗∗∗Impulsive .14∗∗ .21∗∗∗ .46∗∗∗ .31∗∗∗ .40∗∗∗Irritable .25∗∗∗ .28∗∗∗ .41∗∗∗ .57∗∗∗ .50∗∗∗Reckless .06 .17∗∗∗ .32∗∗ .24∗∗∗ .26∗∗∗Irresponsible .07 .19∗∗∗ .36∗∗∗ .17∗∗∗ .31∗∗∗Lacks remorse .67∗∗∗ .40∗∗∗ .39∗∗∗ .35∗∗∗ .59∗∗∗

Note. Spearman correlates were used for item-level analyses to account for non-normality of data.∗p < .05, ∗∗p <.01, ∗∗∗p < .001.

Cluster C personality disorders demonstrated small negativeassociations with psychopathy and its facets.

Clinical Characteristics

As shown in Table 3, after adjusting for gender and age, APDwas significantly associated with cocaine, marijuana, andmethamphetamine use, as well as in the prediction of druguse disorders. The Antisocial facet of psychopathy addedunique value in the prediction of regular use of nearly allsubstances, and the presence of a substance use disorder.The Lifestyle facet of psychopathy added unique value in theprediction of cognitive anger, behavior regulation, and totalanger.

In contrast, the Affective facet of psychopathy was nega-tively associated with regular use of cocaine and heroin, andwith the presence of a substance use disorder. The Affectivefacet was also negatively associated with levels of depres-sion. Similar patterns were observed for the Interpersonalfacet, which was negatively associated with the regular useof alcohol, cocaine, marijuana and methamphetamine. TheInterpersonal facet was associated with higher levels of angerregulation.

Criminal History

Also shown in Table 3, APD was generally associated with amore severe pattern of criminal behavior, and this held afteradjusting for age and gender. Once again, the Antisocial facetof psychopathy added unique variance to the prediction ofviolent, nonviolent, and juvenile offense histories. However,the Affective and Interpersonal facets of psychopathy tendedto be negatively associated with criminal offense histories.

Perpetration

Perpetration in prison was also associated with APD and theAntisocial facet of psychopathy. In contrast, the Affective

facet of psychopathy was negatively associated with rela-tional aggression in prison. Very few predictors emerged assignificant in the prediction of perpetration of psychologicaland physical aggression prior to incarceration. Consistentwith prior research, women were less likely to report phys-ical aggression toward and less likely to have caused injuryto a partner prior to prison, as compared to males.

Victimization

Similar patterns emerged for victimization in prison. APD,and the Antisocial facet of psychopathy were significant pre-dictors of having experienced threats. Physical victimizationwas significantly associated with APD. However, only theAntisocial facet of psychopathy predicted relational victim-ization.

DISCUSSION

Consistent with prior research, we found a strong associationbetween psychopathy and APD within an incarcerated sam-ple. However, results suggested psychopathy is multifaceted,and there may be some utility in breaking psychopathy downinto its facets. Namely, our findings suggested different pat-terns of associations with clinical and criminal characteristicsacross the facets of psychopathy, even after accounting forgender and APD. Implications for understanding the contri-bution of psychopathy beyond the DSM-IV conceptualiza-tion of APD are discussed below.

APD and Psychopathy—Distinct Yet Related

Despite overlap, psychopathy facets appear to add predictiveutility over and above APD. Not surprisingly, associationsbetween APD and the PCL-R facets were consistent andpervasive. Yet, the strength of association varied by facet.APD criteria tended to most strongly correlate with the An-tisocial facet, with strong associations between this facet

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

TAB

LE2

Cor

rela

tions

Bet

wee

nP

erso

nalit

yD

isor

ders

and

Psy

chop

athy

Am

ong

Mal

ean

dF

emal

eIn

mat

es( N

=47

1)

Psyc

hopa

thy

Clu

ster

AC

lust

erB

Clu

ster

C

Aff

.In

t.L

if.

Ant

.To

tal

Par.

Szoi

d.St

yp.

APD

.B

or.

His

.N

ar.

Avo

id.

Dep

.O

C.

Aff

ectiv

e—

Inte

rper

sona

l.4

5∗∗

—L

ifes

tyle

.32∗

∗.4

3∗∗

—A

ntis

ocia

l.3

0∗∗

.32∗

∗∗.4

8∗∗

—To

tal

.68∗

∗.7

2∗∗

.74∗

∗.7

3∗∗

—Pa

rano

id.1

8∗∗

.29∗

∗∗.3

6∗∗

.21∗

∗.3

2∗∗

—Sc

hizo

id.3

0∗∗

.01

.09∗

.10∗

.16∗

∗.2

9∗∗

—Sc

hizo

typa

l.2

7∗∗

.20∗

∗.2

2∗∗

.11∗

.28∗

∗.5

0∗∗

.49∗

∗—

Ant

isoc

ialP

D.3

2∗∗

.46∗

∗.6

4∗∗

.60∗

∗.6

9∗∗

.36∗

∗.0

5.2

4∗∗

—B

orde

rlin

e.0

3.2

1∗∗

.44∗

∗.2

9∗∗

.35∗

∗.4

8∗∗

.18∗

∗.4

1∗∗

.47∗

∗—

His

trio

nic

.05

.42∗

∗.3

4∗∗

.12∗

.33∗

∗.2

4∗∗

−.06

.13∗

∗.2

9∗∗

.38∗

∗—

Nar

ciss

istic

.31∗

∗.6

2∗∗

.45∗

∗.3

1∗∗

.57∗

∗.4

1∗∗

.10∗

.28∗

∗.4

6∗∗

.31∗

∗.4

7∗∗

—A

void

ant

−.14

∗∗−.

14∗∗

.05

−.09

−.10

∗.3

5∗∗

.26∗

∗.3

5∗∗

.03

.35∗

∗.0

7−.

01—

Dep

ende

nt−.

13∗∗

−.01

.13∗

∗−.

05.0

0.2

3∗∗

.09

.18∗

∗.1

2∗∗

.39∗

∗.2

1∗∗

.04

.52∗

∗—

Obs

.Com

p.−.

07.0

7−.

04−.

15∗∗

−.09

.22∗

∗.1

3∗∗

.20∗

∗−.

08.1

7.1

8.1

7∗∗

.24∗

∗.1

4∗∗

—M

ean

(SD

)3.

42(2

.34)

3.06

(2.2

3)4.

09(2

.05)

4.56

(2.7

2)17

.61

(7.7

3)2.

52(2

.02)

0.86

(1.1

3)1.

26(1

.41)

3.84

(2.1

3)2.

82(2

.04)

1.40

(1.4

9)2.

53(2

.26)

1.18

(1.7

5)0.

91(1

.38)

2.16

(1.7

9)

∗ p<

.05,

∗∗p

<.0

1.

270

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

MULTIFACETED CONSTRUCT OF PSYCHOPATHY 271

TABLE 3Association Between Gender, APD, Psychopathy, and Clinical and Criminal Characteristics Among Male and Female Inmates

(N = 471), Adjusting for Age

Gender Psychopathy Facets

Dependent Variables (female) APD Affective Interpersonal Lifestyle Antisocial

ClinicalSubstance Use

Alcohol .64∗∗ .05 −.05 −.13∗ .11 .11∗Cocaine −1.14∗∗∗ .35∗∗∗ −.15∗ −.16∗ .15 .15∗Heroin −1.01∗∗ .15 −.29∗∗∗ .07 .06 .23∗∗Marijuana .44 .19∗∗ −.01 −.19∗∗ .06 .17∗∗∗Methamphetamine −.25 .31∗ −.02 −.24∗ .11 .03

Alcohol Use Disorder −.21 .15 −.04 −.11 .13 .10Drug Use Disorder −.72∗∗ .24∗∗∗ −.22∗∗∗ −.09 .12 .13∗Depression (BDI) 1.28 .45 −.46∗ −.18 .35 .08Anger (NAS) 1.03 1.57∗∗∗ .35 −.32 1.08∗ .69∗

Cognitive −.53 .45∗∗ .02 −.05 .43∗∗ .17Arousal 1.48∗ .58∗∗ .11 −.14 .24 .21Behavior Reg. .09 .53∗∗ .16 −.14 .41∗∗ .31∗∗Anger Reg. .38 −.13 −.17 .24∗ −.15 −.05

CriminalMonths served −31.52∗∗∗ −.40 4.10∗∗ 1.95 −1.95 .32

Adult Offenses 1

Violent .69∗∗ .39∗∗∗ −.03 −.05 −.11 .15∗Sex .66 .14 −.02 −.28∗∗ .02 .11Non-violent −.27 .41∗∗ −.25∗∗ −.05 −.03 .30∗∗

Juvenile Offense .05 .31∗∗∗ −.10 −.17∗∗ −.03 .16∗∗

Note. 1N = 366 for violent offending, N = 342 for sex offending, and N = 359 for non-violent offending, due to missing data. BDI = Beck DepressionInventory, NAS = Novaco Anger Scale. Reg = regulation.

∗p ≤ .05, ∗∗p ≤ .01, ∗∗∗p ≤ .001.

TABLE 4Association Between Personality Type, Gender, and Violence and Victimization During and Before Incarceration (N = 471),

Adjusting for Age

Gender Psychopathy Facets

(female) APD Affective Interpersonal Lifestyle Antisocial

PerpetrationIn Prison

Threats (PVI) 1.27∗∗∗ .27∗∗∗ .04 .08 −.12 .15∗∗Physical (PVI) 1.88∗∗∗ .23∗∗ .04 .07 −.01 .16∗∗∗Relational (PVI) .51∗ .13 −.13∗∗ .04 .02 .08Any Fights (SRCH) .79∗∗∗ .24∗∗ .06 .04 −.08 .17∗∗∗Sexual (SAP) 1.19∗ .33∗ .13 −.11 −.15 .03

Before PrisonPsychologica l(CTS) −.55 .07 .01 .06 .13 .09Physical (CTS) −.59∗ .11 −.09 −.18∗ .04 .06Caused Injury (CTS) −.67∗ .05 .04 −.04 .10 .10

VictimizationIn Prison

Threats (PVI) .95∗∗∗ .19∗∗ −.03 .05 −.12 .13∗∗Physical (PVI) 1.22∗∗∗ .15∗ .01 .06 −.02 .10Relational (PVI) .27 .17 −.04 .10 −.13 .17∗∗Any Fights (SRCH) −.58∗ −.08 −.06 .12 −.03 .01

Before PrisonPsychological (CTS) −.19 ..06 .02 .02 .01 .10Physical (CTS) .59∗ .13 −.03 −.08 −.01 .04Caused Injury (CTS) −.83∗∗ .05 < −.01 .04 .10 .02

Note. PVI = Prison Violence Inventory, SRCH = Self-report of criminal history, SAP = Sexual Activity in Prison, CTS = Conflict Tactics Scale.∗p ≤ .05, ∗∗p ≤ .01, ∗∗∗p ≤ .001.

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

272 WARREN AND BURNETTE

and prior evidence of Conduct Disorder. Among a forensicsample, psychopathy conferred additional risk for antisocialbehavior, violence, and personality pathology. Even after ac-counting for APD, the Antisocial facet of psychopathy wassignificant in the prediction of substance use, some aspectsof anger, and criminal histories. This facet of psychopathyalso added value in the prediction of perpetration of aggres-sion in prison. Combined, such data suggest that psychopa-thy may be helpful in identifying individuals with height-ened risk for continued antisocial behavior and interpersonaldeficits—even among a sample of incarcerated individuals.In fact, the only measure that reflected no group differenceswas the BDI depression scale. These findings are consis-tent with the dual-process model of psychopathy (Fowles& Dindo, 2006, 2009; Patrick & Bernat, 2009), which sug-gests one constellation of temperamental deficits associatedwith the affective-motivational systems as regulated by theamygdala and affiliated brain structures (Lykken, 1982, 2006;Hare, 1978) and another with the fronto-cortical brain sys-tem linked to impulse control problems such as violence andsubstance abuse (Patrick et al., 2005).

Affective Contribution of Psychopathy

Notably, the Affective facet of psychopathy demonstrateda different pattern of associations as compared to other facetsof psychopathy. The Affective facet was not as strongly as-sociated with APD, and demonstrated a negative associationwith many violence and risk behaviors. The Affective facetincludes items such as a lack of remorse, shallow affect, lackof empathy, and failure to accept responsibility, which mayreflect core aspects of psychopathy. One possibility is thatthe origins of this facet may have roots in a neurobiologi-cal or environmentally based emotional non-reactivity anddeficits in affective–motivational functioning, though addi-tion research is needed to better understand the associationsbetween specific facets of psychopathy and neurobiologicalrisk.

Diagnostic Considerations

Our analyses indicated a strong association between theDSM-IV APD diagnostic criteria of conduct disorder beforeage 15 and the scoring on the Antisocial facet of psychopa-thy. This likely reflects a shared coding of early behavioralproblems and juvenile delinquency. The strong correlationsbetween psychopathy and NPD and PPP replicates earlierresearch and underscores the importance of including otherpersonality disorders in addition to APD, in further researchon psychopathy (Warren et al., 2003).

Limitations

Several limitations are important to consider when interpret-ing our findings. Of note, our sample represented a selectpopulation with high rates of antisocial behavior. As such, the

sample encompasses a skewed distribution that may not berepresentative of psychopathy in community samples. Sec-ond, the present study used the PCL-R to assess psychopathy.Patrick et al. (2009) have critiqued the PCL-R, suggestingthat this measure may not adequately assess the absence ofneuroticism or the presence of boldness that may characterizeindividuals described as successful psychopaths. Moreover,the two main instruments used in our study, the SIDP-IV andthe PCL-R, were completed by the one interviewer possiblyleading to an inflation of the correspondence between the twoinstruments. While we were able to identify a sample withhigh rates of APD and psychopathy, we also did not have acomparable community sample with which to compare theseclinical constructs. Research is needed to examine psychopa-thy and APD among community samples, in order to betterunderstand how some individuals high on psychopathy areable to avoid arrest and incarceration and function within so-ciety. In addition, much of our data was self-report in nature,possibly limiting or potentially enriching the quality of lifeexperience that was made available to us for study.

Implications

Findings confirm a strong association between APD and psy-chopathy as assessed by the PCL-R. However, we found adivergent pattern of associations when breaking psychopa-thy down into facets. More work is needed to understand thecomplexities of psychopathy and its components. Our find-ings suggest that continued efforts be made to identify therelationship between psychopathy, Cluster B disorders, andthe role of paranoid traits in the constellation of traits andbehaviors that we currently term psychopathy (Warren et al.,2003). This type of broader-based inquiry might well returnus to the earlier conceptualization of Cleckley and assist inthe translation of psychopathy out of the criminal arena intothe broader platform of exploitive and manipulative behaviorthat can be observed in all walks of life.

FUNDING

This research was funded by grant #2004-RP-BX-0004 bythe National Institute of Justice, Office of Justice Programs,U.S. Department of Justice to the University of Virginia.Points of views expressed in this document are those of theauthors and do not necessarily represent the official positionor policy of the U.S. Department of Justice.

REFERENCES

American Psychiatric Association (1968). Diagnostic and Statistical Man-ual of Mental Disorders, Second edition, Washington, DC: AmericanPsychological Association.

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014

MULTIFACETED CONSTRUCT OF PSYCHOPATHY 273

American Psychiatric Association (1980). Diagnostic and Statistical Man-ual of Mental Disorders, Third edition, Washington, DC: American Psy-chological Association.

American Psychiatric Association (2000). Diagnostic and Statistical Man-ual of Mental Disorders, Fourth edition text revision. Washington, DC:American Psychological Association.

American Psychiatric Association (2013). Diagnostic and Statistical Man-ual of Mental Disorders, Fifth edition. Washington, DC: American Psy-chological Association.

Beck, A. T., Steer, R. A., & Brown, K. G. (1996). Beck Depression Inven-tory – Second edition manual. San Antonio: The Psychological Corpo-ration.

Cleckley, H. (1941). The Mask of Sanity: An Attempt to Reinterpret theSo-called Psychopathic Personality. Oxford, UK: Mosby.

Cooke, D. J., Michie, C., & Hart, S. D. (2006). Facets of psychopathy:Toward clearer measurement. In C. J. Patrick (Ed.), Handbook of psy-chopathy (pp. 91–106). New York: Guilford Press.

Cooke, D. J., Michie, C., Hart, S. D., & Clark, D. A. (2004). Reconstructingpsychopathy: Clarifying the significance of antisocial and socially deviantbehavior in the diagnosis of psychopathic personality disorder. Journalof Personality Disorders, 18, 337–357.

Fowles, D. C., & Dindo, L. (2006). A dual-deficit model of psychopathy.In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 14–34). New York:Guilford Press.

Fowles, D. C., & Dindo, L. (2009). Temperament and psychopathy: Adual-pathway model. Current Directions in Psychological Science, 18,179–183. doi: 10.1111/j.1467–8721.2009.01632.x

Hare, R. D. (1978). Electrodermal and cardiovascular correlated of psy-chopathy. In R. D. Hare & D. Schalling (Eds.) Psychopathic behavior:Approaches to research (pp. 107–143). Chichester, UK: Wiley.

Hare, R. D. (1983). Diagnosis of antisocial personality disorder in two prisonpopulations. American Journal of Psychiatry, 140, 887–890.

Hare, R. D. (1991). The Hare Psychopathy Checklist-Revised. Toronto, On-tario, Canada: Multi-Health Systems.

Hare, R.D. (2003). The Hare Psychopathy Checklist-Revised (2nd edition).Toronto, Ontario, Canada: Multi-Health Systems.

Hare, R. D., & Neumann, C. S. (2010). The role of antisociality in thepsychopathy construct: Comment on Skeem and Cooke. PsychologicalAssessment, 22, 446–454. doi: 10.1037/a0013635.

Hart, S. D. (1998). The role of psychopathy in assessing risk for violence:Conceptual and methodological issues. Legal and Criminological Psy-chology, 3, 121–137.

Kennealy, P. J., Skeem, J. L., Walters, G. D., & Camp, J. (2010). Do coreinterpersaonl and affective traits of PCL-R psychopathy interact withantisocial behavior and disinhibition to predict violence? PsychologicalAssessment, 22, 569–580. doi: 10.1037/a0019618

Leistico, A. R., Slaekin, R. T., DeCoster, J., & Rogers, R. (2008). A large-scale meta-analysis realting the Hare measures of psychopathy to antiso-cial conduct. Law and Human Behavior, 32, 28–45.

Lykken, D. T. (1982). Fearlessness: Its carefree charm and deadly risks.Psychology Today, 16, 20–28.

Lykken, D. T. (2006). Psychopathic personality: The scope of the problem.In C. Patrick (Ed.) Handbook of psychopathy (pp. 3–13). New York:Guilford Press.

McCord, W., & McCord, J. (1964). The psychopath: An essay on the criminalmind. Princeton, NJ: Van Nostrand.

Novaco, R. (2003). The Novaco Anger Scale and Provocation InventoryManual. Los Angeles: Western Psychological Services.

Patrick, J. C., & Bernat, E. M. (2009). Neuroscientific foundations of psy-chopathy. In T. Millon, R.F. Krueger, & S. Simonsen (Eds.). Contempo-rary directions in psychopathology: Scientific foundations of the DSM-Vand ICD-II (pp. 419–452). New York: Guilford.

Patrick, J. C., Fowles, D. C., & Kruger, R. F. (2009). Triarchic conceptualiza-tions of psychopathy: Developmental origins of disinhibition, boldness,and meanness. Development and Psychopathology, 21, 913–938. doi:10.1017/S0954579409000492

Patrick, J. C., Hicks, B. M., Kruger, R. F. & Lang, A. R. (2005). Relationsbetween psychopathy facets and externalization in criminal offender sam-ple. Journal of Personality Disorders, 19, 339–356.

Pfohl, B., Blum, N., & Zimmerman, M. (1995). Structured interview forDSM-IV personality disorders: SIDP-IVA. Iowa City, IA. University ofIowa College of Medicine.

Robins, L. N. (1966). Deviant children grown up. Baltimore: Williams and& Wilkins.

Robins, L. N. (1978). Sturdy predictors of adult antisocial behavior: Repli-cations from longitudinal studies. Psychological Medicine, 8, 611–622.

Salekin, R. T., Rogers, R., & Sewell, K. W. (1996). A review and meta-analysis of the Psychopathy Checklist Revised: Predictive validity ofdangerousness. Clinical Psychology: Science and Practice, 3, 203–215.

Skeem, J. L., & Cooke, D. J. (2010). Is criminal behavior a central com-ponent of psychopathy? Conceptual directions for resolving the debate.Psychological Assessment, 22, 433–445. doi: 10.1037/a0008512.

Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D.B. (1996).The Revised Conflict Tactics Scale (CTS2): Development and preliminarypsychometric data. Journal of Family Issues, 17, 283–316.

Tolman, A. O. & Mullendore, K. B. (2003). Risk evaluations for the courts:Is service quality a function of specialization? Professional Psychology:Research and Practice, 34, 225–232. doi: 10.1037/0735–7028.34.3.225

Warren, J. I., Burnette, M. L., South, S. C., Chauhan, P., Bale, R., Friend, R.,& Van Patten, I. (2003). Psychopathy in women: Structural modeling andcomorbidity. International Journal of Law and Psychiatry, 26, 223–242.doi:10.1016/S0160-2527(03)00034-7

Warren, J. I., Hurt, S., Loper, A. B., & Chauhan, P. (2004). Exploringprison adjustment among female inmates: Issues of measurement andprediction. Criminal Justice and Behavior, 31, 624–645. doi: 10.1177/0093854804267096

Warren, J. I., & Jackson, S. L. (2013). Risk markers for sexual predationand violence in prison. New York: Routledge Press.

Dow

nloa

ded

by [

Tem

ple

Uni

vers

ity L

ibra

ries

] at

00:

07 1

8 N

ovem

ber

2014