Lecture 3 Clinical Construct - Hare and the the Psychopathy Checklist-Revised

J.B. Helfgott, PhD/ Department of Criminal

Justice/ Seattle University

CRJS 450

THE PSYCHOPATH

Lecture 3: Clinical Considerations in

Understanding PsychopathyRobert Hare and the PCL-R



Clinical-Cultural Perspectives on Psychopathy

• Clinical– Psychopathy can be

considered categorically as a clinical disorder of personality.

– Disorder is characterized by a particular set of traits and behaviors that are often associated with criminality.

– Shaped by environmental and cultural forces.

• Cultural– Psychopathy can be

considered dimensionally as a personality dynamic used by non-psychopaths, to a greater or lesser extent, as a tool with which to commit immoral acts without remorse or shame.

– Shaped by environmental and cultural forces.



The PCL-R• Concept of psychopathy has become

operational for use in empirical research with the advent and standardization of the Psychopathy Checklist (PCL) and subsequent Psychopathy Checklist Revised (PCL-R).

• The PCL-R differs from Antisocial Personality Disorder in that its criteria capture both the behavioral and personality features of traditional concept of psychopathy based on Cleckley’s work.

• The PCL-R is regarded as the first reliable and valid measure of psychopathy offering researchers a long-awaited tool with which to empirically study and clinically assess the condition



Versions and Offshoots of the PCL-R



Cleckley’s Psychopathy Criteria(From The Mask of Sanity (1941))

• Superficial charm and good intelligence• Absence of delusions and other signs of irrational thinking• Absence of nervousness or psychodeurotic manifestations• Unreliability• Untruthfulness and insincerity• Lack of remorse or shame• Inadequately motivated antisocial behavior• Poor judgement and failure to learn from experience• Pathological egocentricity and incapacity for love• General poverty in affective reactions• Specific loss of insight• Unresponsive in general interpersonal relations• Fantastic and uninviting behavior with or without drink• Suicide rarely carried out• Sex life impersonal, trivial, and poorly integrated• Failure to follow any life plan



DSM-IV-TR Antisocial Personality Disorder• Pervasive pattern of disregard for and violation of the

rights of others occurring since age 15 years, as indicated by three (or more) of the following: – failure to conform to social norms with respect to lawful behaviors

as indicated by repeatedly performing acts that are grounds for arrest – deceitfulness, as indicated by repeated lying, use of aliases, or

conning others for personal profit or pleasure– impulsivity or failure to plan ahead– irritability and aggressiveness, as indicated by repeated physical fights

or assaults– reckless disregard for safety of self or others– consistent irresponsibility, as indicated by repeated failure to sustain

consistent work behavior or honor financial obligations– lack of remorse, as indicated by being indifferent to or rationalizing

having hurt, mistreated, or stolen from another

• Individual is at least age 18 years.

• Evidence of Conduct Disorder with onset before age 15 years.

• Occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.



Robert Hare’s Research• Hare has worked for over 25 years on the

development and standardization of the PCL-R.

• The “Hare Psychopath” is a hybrid of the Cleckley psychopath and the DSM APD classification.

• Encompasses both personality and behavioral features of the condition.



The PCL-R• 20 Characteristics consisting of:

– Factor 1 (Personality/Aggressive Narcissism)– Factor 2 (Behavior/ Antisocial Lifestyle)

• Recent studies using Item Response Theory suggests 4 factor model:– Interpersonal– Affective– Lifestyle– Antisocial



The PCL-R Factors 1 & 2• Factor 1

– Glibness/Superficial charm

– Grandiose sense of self-worth

– Pathological lying– Conning/manipulative– Lack of remorse or guilt– Shallow affect– Callous/lack of

empathy– Failure to accept

responsibility for own actions

• Factor 2– Need for

stimulation/proneness to boredom

– Parasitic lifestyle– Poor behavioral

controls– Early behavior

problem– Impulsivity– Irresponsibility– Juvenile delinquency– Revocation of

conditional release



Items not included in factors

– Many short-term marital relationships– Criminal versatility– Promiscuous sexual behavior– Lack of realistic, long-term goals



Factors may not carry equal weight

• Some research suggests that Factor 1 may be a more important discriminant.

• Better reflects the “defect in affect” or “fundamental disidentification with humanity (though some would argue that even the PCL-R does not adequately assess this central feature of the disorder).



Hare & Neumann (2006). The PCL-R Assessment of Psychopathy. In Patrick, C.J. (Ed.) Handbook of Psychopathy, pp. 58-90).



Administering and Scoring the PCL-R• Each of the 20 items is scored on a 0 to 2

point scale based on interviews and case file information: – 0 indicates the item does not apply, that the

individual does not exhibit the characteristic or exhibits opposite characteristics

– 1 indicates that the item applies to a certain extent, but not to the degree necessary to score a 2 because of too many exceptions or doubts

– 2 indicates that the item applies and shows a good match in essential respects.

– In cases where there is not enough information to confidently score a particular item, the item is omitted, and the total score prorated.



What do PCL-R scores mean?

• ≥ 30 = primary/“true” psychopath• 20-29 = secondary psychopath/APD• < 20 = nonpsychopath



Research on the PCL-R• Individual studies and metaanalyses

show that high PCL-R scores are associated with:– Violent recidivism– General recidivism– Sexual sadism and deviant sexual arousal– Institutional misconduct– Escapes from correctional facilities– Assault/murder of police officers



Important to Keep in Mind . . .• Most psychopaths (PCL-R ≥ 30) meet the criteria

for diagnosis of APD.

• Most APDs are not psychopaths.

• In forensic populations, are 50-80% APD and 15-25% psychopaths.

• A PCL-R score ≥ 30 has powerful implications – important to consider ethical-legal consequences of test.

• Administration and scoring of the PCL-R requires specialized training – don’t try it at home!



Recommended Reading(Not included in required reading for course)

• Hart, S. & Hare, R.D. (1997). Psychopathy: Assessment and association with criminal conduct. In Stoff, D.M., Breiling, J., & Maser, J.D. (Eds), Handbook or Antisocial Behavior (pp. 22-35). New York: John Wiley.

• Patrick, C. J. (Ed). (2005). The handbook of psychopathy. New York: The Guilford Press.

Lecture 3 Clinical Construct - Hare and the the Psychopathy Checklist-Revised

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