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Measures of psychopathy

Dr. Simon Moss

Overview of measures

Often, psychologists and other professionals need to predict whether or not a person is likely to be violent or dangerous in the future (for a discussion, see Salekin, Rogers, & Sewell, 2006). Measures of psychopathy, especially the Hare psychopathy checklist, were developed to fulfill this goal. Elevated scores on these instruments increase the likelihood of violence in the future (e.g., Serin, Peters, & Barbaree, 1990).

Overview of psychopathy

Psychopathy is one example of several orientations or disorders that relate to antisocial or criminal behavior, collectively called the antisocial spectrum. Other instances of this spectrum include conduct disorder, oppositional defiant disorder, and antisocial personality disorder.

In short, psychopathy seems to entail two distinct facets. The first facet, sometimes called primary psychopathy or Factor 1 psychopathy, corresponds to a callous and manipulative orientation, devoid of empathy and emotion. The second facet, sometimes called secondary psychopathy or Factor 2 psychopathy, corresponds to a more impulsive form of aggression, representing an emotional response to negative events (Hare, 1991, 1993). This second facet is more closely related to antisocial personality disorder. In other words, psychpathy, unlike antisocial personality disorder, often coincides with a callous and unempathic demeanor.

The criteria to be diagnosed with antisocial personality disorder is not as strict as the criteria to be diagnosed with psychopathy. Antisocial personality disorder is diagnosed in over 80% of incarcerated individuals (Hare, 1993). In contrast, psychopathy is diagnosed in only about 20% of incarcerated criminals but 50% of serial rapists (Hare, 1993).

In short, psychopathy is distinct from antisocial personality disorder and broader in scope. Accordingly, psychopathology is not represented in the Diagnostic Manual of Psychiatric Disorder (Hare, 2003).

Hare psychopathy checklist

The psychopathy checklist--revised, or PCL-R (Hare, 1991, 2003), is the tool that clinicians most often use to assess psychopathy. Psychologists or other professionals evaluate individuals on 20 items or traits, such as a grandiose sense of self or pathological lying, on a three point scale: 0 if the item does not apply, 1 if the item does apply somewhat, and 2 if the item applies fully. A standardized, semistructured interview is conducted to evaluate these items. Documentation and other forms of information are also consulted.

Two other variants of this checklist have also been developed. First, the original tool, called the psychopathy checklist, is similar to the revised version but comprises two additional items (see Hare, 1985). Second, a condensed version has been developed, comprising only 12 items, and used primarily for screening purposes.

To select the items, four criteria were considered (for a discussion, see Hart, Hare, & Harpur, 1992). First, none of the items overlap considerably with each other. That is, individuals who exhibit one of the characteristics might or might not exhibit any of the other 19 characteristics. Second, all the items correlate sufficiently with a global rating of psychopathy (Hare & Cox, 1978), as defined by Cleckley (1976). Third, none of the characteristics are especially rare or common. Finally, the characteristics are applicable to a broad range of samples.

Two factors

The PCL-R seems to comprise two distinct factors (Hare, 1991). According to the two factor solution, eight of the items correspond to Factor 1: Glibness or superficial charm, a grandiose sense of self, pathological lying, a cunning or manipulative orientation, limited remorse or guilt, shallow emotions, callous rather than empathic attitudes, and a tendency to blame other people, called externalization.

Factor 1 coincides roughly with primary psychopathology, assumed to be the root disorder of individuals diagnosed with this orientation (Lykken, 1995). That is, primary psychopathy implies this trait is the primary cause of the undesirable and aggressive behavior. When Factor 1 is elevated, individuals tend to perceive other people as instruments to fulfill their personal needs rather than sentient beings with feelings, curbing feelings of empathy, guilt, or remorse. That is, aggression in these individuals is usually instrumental, intended to fulfill some goal, such as accumulating money or status (Cornell, Warren, Hawk, Stafford, Oram, & Pine, 1996)

Ten of the items correspond to Figure 2: A need to seek stimulation and avoid boredom, a parasitic lifestyle (cf Karpman, 1949), a limited capacity to control behavior, promiscuous sexual behavior, few realistic aspirations, impulsive behavior, juvenile delinquency, early behavioral problems, and violations of release conditions. These items represent impulsive behavior, corresponding to an inability to inhibit temptations and pursue future objectives.

Factor 2 roughly corresponds to secondary psychopathology, assumed to represent a consequence of other disorders, such as impairments in impulse control (Lykken, 1995). When Factor 2 is elevated, aggression usually represents an inability to regulate emotions or control behavior appropriately (e.g., Cornell, Warren, Hawk, Stafford, Oram, & Pine, 1996).

In short, primary psychopathology seems to be related to a relative neglect of threatening cues and manifests as callous, arrogant, and manipulative behavior. Secondary psychopathology represents a pronounced response to these negative cues and, thus, manifests as reactive aggression. Accordingly, primary psychopathology seems to be related to Factor 1 psychopathy& in contrast, secondary psychopathology seems to be related to Factor 2 psychopathology.

Two of the items in the PCL-R do not relate to either of these two factors: fleeting marital relationships and a broad range of criminal activities.

Psychometric properties of the Hare psychopathy checklist

Interrater reliability seems to be elevated, with intraclass correlations ranging from .78 to 89, in male prisoners (for summaries, see Hare, 1991). For individual items, these correlations tend to be lower, ranging from .42 to .84. Test retest reliability over a month has been shown to range from .84 to .94 (e.g., Alterman, Cacciola, & Rutherford, 1993& for a review, see Salekin, Rogers, & Sewell, 2006).

The PCL-R has been shown to predict recidivism and violence. Specifically, as Hare and Hare (1992) summarize, scores on the PCL-R predict future violence, aggression in prison, and recidivism that does not entail violence. Indeed, studies indicate the PCL-R, at least in some contexts, predicts violence more effectively than diagnosis of antisocial personality disorders (for comparisons, see Rice & Harris, 1992).

Serin, Peters, and Barbaree (1990) conducted a meta-analysis to ascertain the extent to which the psychopathy checklist predicts violent and criminal behavior. Across all studies, the average effect size, d, was .68. The average effect size to predict violence was .79. Indeed, one study, in which psychiatric patients who acted violently were compared to psychiatric patients who had not acted violently, the shortened version of the inventory generated a d value of 1.92, a very large effect. In contrast, when the inventory was used to predict recidivism, the effect size was generally lower, with a mean of .55.

Neurobiological correlates of global scores on the PCL-R

PCL-R is positively related to functioning of the amygdala. In particular, volumetric magnetic resonance imaging indicates the size of this region is negatively related to psychopathy (Tiihonen et al, 2000& cited in Blair, 2003), as gauged by the PCL-R.

Furthermore, when the PCL-R is elevated, the amygdala does not respond as effectively to negative events. That is, in the general population, when individuals need to memorize words, the items that coincide with negative states, like murder, tend to activate the amygdala, as shown by functional MRI (Kiehl, Smith, Hare, Mendrek, Forster, Brink, & Liddle, 2001). This activation of the amygdala, however, is impaired in individuals who generate elevated scores on the PCL-R (Kiehl, Smith, Hare, Mendrek, Forster, Brink, & Liddle, 2001).

Dysfunction of the amygdala could underpin the insensitivity of psychopathic individuals to moral socialization (Blair, 2003). That is, when children or adolescents behave inappropriately, they are often punished , eliciting unpleasant emotions. Over time, they begin to associate these inappropriate behaviors with negative emotions, called aversive conditioning. If the amygdala is impaired, this unpleasant experience is tempered and thus aversive conditioning is stifled. Similarly, when individuals offend someone else, they might experience the distress this other person exhibits, representing empathy. Again, this distress becomes associated with the offensive act, curbing this behavior in the future. If the amygdala is impaired, this sequence of events is also less likely to unfold (Blair, 2003).

Consistent with this proposition, when parents are supportive but firm, the likelihood of antisocial behavior diminishes& aggressive and impulsive acts are curbed. However, in individuals who exhibit elevated levels of psychopathy, this form of parenting does not necessarily curb antisocial behavior (Wootton, Frick, Shelton, & Silverthorn, 1997).

This dysfunction in the amygdala could, arguably, emerge from problems with the noradrenergic system. To illustrate, propranolol, which inhibits this system, compromises episodic memory for emotional events as well as impairs recognition of sad faces (Harmer, Perrett, Cowen, & Goodwin, 2001)--deficits that coincide with amygdala dysfunction. Hence, pathology in the noradrenergic system might underpin the dysfunction in the amygdala. That is, both inhibition of the noradrenergic system and lesions in the amygdale generate a similar sequence of consequences.

In addition to problems in amygdala functioning, dysfunction of the orbitofrontal cortex, which is often exacerbated by chronic amphetamine use (Rogers, Everitt, Baldacchino, Blackshaw, Swainson, Wynne et al., 1999), might also be related to psychopathy. Nevertheless, dysfunction in this region tends to be associated with impulsive, rather than instrumental, aggression (Anderson, Bechara, Damasio, Tranel, & Damasio, 1999). Problems in the orbitofrontal region might be associated more with Factor 2, rather than Factor 1, items in the PCL-R.

Correlates of Factor 1

Overall, Factor 1 psychopathology is positively related to extraversion and positive affect. In addition, this factor is positively associated with a narcissistic and histrionic personality disorder.

Factor 1 psychopathology, representing a callous rather than empathic orientation, is negatively associated with behavioral inhibition (Wallace, Malterer, & Newman, 2009), as defined by (see reinforcement sensitivity theory& e.g., Gray & McNaughton, 2000). In particular, if individuals are callous and arrogant, they are less sensitive to potential conflicts or problems. As a consequence, they do not inhibit their prevailing tendencies.

Glenn, Raine, Yaralian, and Yang (2010) showed that corpus striatum might underpin some of the behaviors that are associated with psychopathy. The corpus striatum comprises the caudate head, the caudate body, the putamen, and the globus pallidus. This study compared the volume of these structures between individuals who exhibit psychopathy, as gauged by the Psychopathy Checklist-Revised (Hare, 2003), and control participants. Features of primary psychopathy, such as limited empathy, were associated with large caudate bodies.

The caudate body is activated during deception or the inhibition of truthful responses (e.g., Lee, Liu, Tan, Chan, Mahankali, & Feng, 2002). Conceivably, in primary psychopathy, in which individuals often deceive other people, this region is often activated, increasing the size of this body.

As Gregory et al (2015) showed, relative to violent offenders who do not demonstrate callous variants of psychopathy, violent offenders who do demonstrate callous variants of psychopathy may not learn from punishments as effectively. To clarify, in one study, both constellations of violent offenders completed a task in which they needed to identify which images should be paired with one another. Initially, they received a reward for pairing specific images. Later, however, individuals received punishments for pairing the same images. In contrast to violent offenders who do not demonstrate callous variants of psychopathy, violent offenders who do demonstrate callous variants of psychopathy did not shift their responses in response to these punishments. Furthermore, as measured by fMRI, they exhibited abnormal activity in the posterior cingulate and insula during trials in which stimuli that had been rewarded were now punished.

This connection between the posterior cingulate and insula is vital to learning about punishments. The posterior cingulate represents the information about what people like and dislike, whereas the insula represents negative evaluations. Dysfunction in the connections between these regions could undermine the capability of individuals to respond to punishments and, ultimately, explain some of the behaviours of people who demonstrate callous psychopathic tendencies.

Correlates of Factor 2

In general, Factor 2 psychopathology is positively related to antisocial personality disorder, criminal behavior, and reactive anger. Indeed, many scholars assumed that psychopathy and antisocial personality disorder might be equivalent: The American Psychiatric Association, for example, assume that psychopathy, as well as sociopathy, are obsolete terms to describe antisocial personality disorder. Arguably, Factor 2, but not Factor 1, psychopathology is tantamount to antisocial personality disorder.

Factor 2 psychopathology, representing an impulsive orientation, is positively associated with behavioral activation (Wallace, Malterer, & Newman, 2009), as defined by (see reinforcement sensitivity theory& e.g., Gray & McNaughton, 2000). In particular, when individuals often engage in impulsive, risky, and aggressive acts, they are more inclined to crave excitement and seek rewards.

Factor 2, which represents impulsive behavior, coincides with large caudate heads, a component of the corpus striatum. The caudate head seems to be involved in processing rewarding information (e.g., Seger & Cincotta, 2005). An undue emphasis on reward might culminate in impulsive behavior, increasing the likelihood of secondary psychopathy.

Limitations of the Hare psychopathy checklist

Several limitations of the Hare psychopathy checklist have been acknowledged (for a review, see Salekin, Rogers, & Sewell, 2006). First, some scholars maintain the PCL and PCL-R are not underpinned by a theoretical framework (e.g., Rogers, 1995). In particular, Cleckley (1941, 1976) enumerated 16 criteria that define psychopathy. The Hare psychopathy checklist was intended to represent these criteria (Hare, 1991). Nevertheless, according to Rogers (1995), the checklist diverges considerably from the criteria defined by Cleckley (1976)& nine of the characteristics that were delineated by Cleckley (1976) are not represented in the PCL-R or PCL.

Second, the precise criterion or level that should be utilized to differentiate psychopathic individuals from other individuals has generated controversy. Scores on the PCL-R vary from 0 to 40. Hare (1991) suggested that individuals who exhibit scores of 30 or more could be classified as psychopathic. When this criterion is applied, the sensitivity, equivalent to the probability that actual psychopaths are indeed identified as psychopaths, is .72& the specificity, or probability that non-psychopaths are identified as non-psychopaths, is .93. In a review, Salekin, Rogers, and Sewell (2006) showed the criteria that researchers use to distinguish psychopathic individuals from other individuals ranges from 25 to 33.

Nevertheless, this criterion assumes that all the items should be conferred the same weight. For example, a 2 on one item should be equivalent to a 2 on another item. This assumption, however, has been challenged. To clarify, items on Factor 2 seem to predict criminal behavior more effectively than items on Factor 1 (cf Hare, 1991). Two individuals could both generate a high score, such as 30& one individual, however, might exhibit all the characteristics that pertain to Factor 2 and thus be likely to engage in criminal behavior. The other individuals might exhibit the characteristics that pertain to Factor 1 and thus be less likely to engage in criminal behavior. Thus, a mere aggregate of the scores might not represent the best approach to predict violence.

Finally, although the psychometric properties of this instrument are encouraging, most of the research has been conducted in North America, particularly Canada, usually with white, forensic populations. Kosson, Smith, and Newman (1990) showed the factor structure of this instrument, and the correlations between measured psychopathy and impulsive behavior, differs between African Americans and Anglo Americans. Similarly, few studies have examined the utility of this instrument in adolescents (Salekin, Rogers, & Sewell, 2006).

Other factor structures

Cooke and Michie (2001) uncovered three factors from the PCL-R. In this analysis, items that coincided only with antisocial behavior were excluded. Specifically, a limited capacity to inhibit behavior, early behavioral difficulties, juvenile delinquency, violation of conditional release, and versatile criminal activities were omitted--all of which corresponds to Factor 2.

When these items were excluded, three factors emerged. The first factor represented arrogant and deceitful interpersonal style, such as a grandiose sense of self and pathological lying. The second factor was deficient affective experiences and entailed limited remorse or guilt and shallow emotions. The third factor was impulsive and irresponsible behavior, including a need to seek stimulation and avoid boredom.

Hare and Neumann (2008) challenged the legitimacy of this analysis. They questioned the statistical analyses, arguing that model generates negative variances, for example.

Genetic factors

Research indicates that genetic factors might be related to psychopathy. Twin studies do indicate that psychopathy might be partly genetic. Some studies indicate that Factor 1 psychopathy, representing limited empathy and emotion but a cunning and manipulative orientation, is partly genetic. Nevertheless, many studies indicate that Factor 2 psychopathy, representing impulsive behavior or anger, is even more related to genetic factors than is Factor 1 psychopathy.

The Psychopathic Personality Inventory

In contrast to the Hare psychopathology checklist, which is completed by clinicians, the psychopathic personality inventory is a self report measure (for other self report measures, see Benning, Patrick, Salekin, & Leistico, 2005). The psychopathic personality inventory comprises 187 items (Lilenfeld & Andrews, 1996). The inventory generates an overall score as well as a score for each subscale. The eight subscales are:

Furthermore, Lilenfeld and Widows (2005) constructed a shortened version, comprising only 154 items. Impulsive nonconformity was relabeled as rebellious nonconformity& otherwise, the name of each subscale remain unchanged.

Psychometric properties

Lilenfeld and Fowler (2006) summarized the psychometric properties of this inventory, indicating the scale is reliable and valid. Similarly, Sadeh and Verona (2008) showed the internal consistency of each subscale ranged from .78 to .90. Furthermore, although initially intended to be completed by civilian rather than incarcerated populations, scores on the psychopathy personality inventory correlate appreciably with conclusions derived from the Hare psychopathy checklist (Lilenfeld & Fowler, 2006& see also Poythress, Edens, & Lilienfeld, 1998).

Factor structure

Although the scale comprises eight subscales, other factor structures have been uncovered. Indeed, many researchers have examined the factor structure of this scale (e.g., Benning, Patrick, Hicks, Blonigen, & Krueger, 2003& Neumann, Malterer, & Newman, 2008& Ross, Benning, Patrick, Thompson, & Thurston, 2009). Most of these studies indicate the eight subscales can be divided into main clusters. These two clusters roughly relate to primary and secondary psychopathology respectively (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005)

Benning, Patrick, Blonigen, Hicks, and Iacono (2005) subjected the eight subscales to a factor analysis. The first overall factor comprised social potency, fearlessness, and stress immunity, roughly coinciding with primary psychopathy, representing a callous rather than emotional orientation. This scale is sometimes called fearless dominance (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005). The second overall factor comprised Machiavellian egocentricity, blame externalization, carefree non-planfulness,and impulsive non-conformity, roughly coinciding with secondary psychopathy, representing an impulsive orientation. This scale is sometimes called impulsive antisociality (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005).

Similarly, Sadeh and Verona (2008) also subjected the eight subscales to principal axis factoring, generating the same pattern of factors. They also showed that coldheartedness does not relate to the two main factors, but constituted a separate factor. Nevertheless, this subscale was combined with the factor that represented primary psychopathy.

Correlates of the two factors

Vidal, Skeem, and Camp (2010) showed that emotional intelligence might be impaired in individuals with secondary, but not in individuals with primary, psychopathy. In this study, undergraduate students completed the Psychopathic Personality Inventory& two factors were extracted, representing primary psychopathy or fearless dominance and secondary psychopathy or impulsive antisociality respectively. In addition, participants completed the MSCEIT, to assess emotional intelligence.

These researchers showed that individuals who exhibited secondary psychopathy--corresponding to elevated levels of impulsive behavior and reactive anger as well as elevated anxiety--did not perform well on the MSCEIT, relative to participants who exhibited primary psychopathy or no psychpathy (Vidal, Skeem, & Camp, 2010). Specifically, when presented with anecdotes about a problem that someone has experienced, and asked to specify a suitable approach to resolve this difficulty, they chose a response that other participants tend to regard as inappropriate. Similarly, when asked which moods or emotions might be suitable in specific contexts, such as coordinating a military march, they also tended to choose inappropriate answers. Emotional intelligence was not impaired in the participants who reported primary psychopathy, however.

In addition to emotional intelligence, responses to the Psychopathic Personality Inventory are related to personality, as represented by the five factor model. Fearless dominance is positively related to extraversion, labeled as dominance, openness, and conscientiousness but inversely related to neuroticism (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005). Impulsive antisociality is positively related to neuroticism and inversely related to love, an analogue to agreeableness.

One peculiarity is that both factors of the Psychopathic Personality Inventory correlate highly with antisocial personality (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005), as gauged by the Personality Diagnostic Questionnaire 4+ (Hyler, 1994). Typically, only secondary, and not primary, psychopathy is assumed to manifest as antisocial behavior. Nevertheless, these findings indicate that both fearless dominance and impulsive antisociality, at least when measured by self report, could predict antisocial behavior.

Self Report Psychopathy Scale

The self report psychopathology scale was developed by Hare. This scale was regarded as a self report version of the PCL (Hare, 1985), Nevertheless, the correlation between this self report scale and the PCL was low, approximating .28 (Hare, 1985), prompting a revision. The revised version, called the Self Report Psychopathy Scale II, comprises 60 items and can generate correlations of approximately 0.55 with the PCL (see Hare, 1991).

Like the PCL-R, the Self Report Psychopathy Scale comprises two distinct clusters of items, called Factor 1 and Factor 2. Factor 1 roughly corresponds to primary psychopathology, representing low anxiety, low empathy, and considerable narcissism. Factor 2 roughly corresponds to secondary psychopathology or impulsive behavior, but also seems to correlate with narcissism.

Benning, Patrick, Salekin, and Leistico (2005), however, argued these two facets of the Self Report Psychopathy Scale do not align closely with Factor 1 and Factor 2 of the PCL-R. Specifically, the first facet of the Self Report Psychopathy seems to primarily relate to level of dominance. The second facet primarily relates to level of arrogance as well as reflecting a calculative orientation.

Psychometric properties of the Self Report Psychopathy Scale

Hare (1991), however, showed the psychometric properties of this Self Report Psychopathy Scale is also modest. Internal alpha consistency sometimes approximates .47 and .77 for the two factors respectively. Nevertheless, although the scale comprises 60 items, the first factor entails only nine 9 and the second factor entails only 13 items.

As a reflection of concurrent validity, both factors of the Self Report Psychopathy Scale are positively related to global scores on the Psychopathic Personality Inventory, a more comprehensive self report measure. These correlations approximate .54 and .71 for the two factors respectively.

The Self Report Psychopathy Scale is correlated with personality, as represented by the five factor model. In particular, Factor 1, which supposedly represents a manipulative rather than empathic orientation, is correlated with elevated levels of extraversion but limited levels of neuroticism. Factor 2, which should represent impulsive aggression, is positively correlated with extraversion, openness, and neuroticism but inversely correlated with conscientiousness, as hypothesized (see Williams & Paulhus, 2004& for similar findings, see Benning, Patrick, Blonigen, Hicks, & Iacono, 2005) .

Measures of psychopathic traits in children and adolescents

Some of the traits or characteristics that underpin psychopathy can be identified in children and adolescents. Several instruments have been developed to fulfill this purpose: the Antisocial Process Screening Device (Frick & Hare, 2001), the Psychopathy Checklist-Youth Version (Forth, Kosson, & Hare, 2003) or the Youth Psychopathy traits Inventory (YPI& Andershed, Kerr, Stattin, & Levander, 2002).

Psychopathic traits in children and adolescents often predict similar characteristics in adulthood. That is, psychopathy seems to be stable over time (Lynam,, Caspi, Moffitt, Loeber, & Stouthamer-Loeber, 2007).

The Antisocial Process Screening Device

The Antisocial Process Screening Device, which comprises 20 items, was originally developed to assess psychopathy in children and adolescents. Usually, parents, teachers, or other authorities rated the individuals on these items. Nevertheless, self reports are also plausible.

Like other measures of psychopathy, the Antisocial Process Screening Device can be divided into two factors. The first factor is called callous-unemotional, roughly corresponding to primary psychopathology or Factor 1 on the PCL-R. The second factor is called impulsive-conduct problems and roughly overlaps with secondary psychopathology or Factor 2 on the PCL-R.

Frick and Hare (2001) indicate the internal alpha consistency, or Cronbach's alpha, is only modest, approaching .54 and .64 for each factor respectively.

Benning, Patrick, Salekin, and Leistico (2005), however, challenged the factor structure of the Antisocial Process Screening Device. They showed the first factor, called callous-unemotional, seems to represent general distress and not the absence of emotion. That is, this factor was positively associated with most facets of personality disorder, including paranoia and avoidance?personality disorders that often coincide with anxiety. In contrast, analogous factors of the Psychopathic Personality Inventory and the Self Report Psychopathy Scale were inversely related to paranoia and avoidance, as gauged by the Personality Diagnostic Questionnaire 4+ (Hyler, 1994). Furthermore, this factor was not inversely related to neuroticism or positively related to extraversion or dominance.

Overarching themes

Triarchic conceptualization of psychopathy

The number of dimensions that underpin psychopathy has stimulated considerable controversy. Hare (1991) originally conceptualized psychopathy as a single dimension. Many authors, however, distinguish two dimensions. Although these two dimensions often manifest in various guises, in general, a cold and callous facet is distinguished form an impulsive and antisocial facet.

In contrast, some authors distinguish three main facets or classes of psychopathy. Patrick, Fowles, and Krueger (2009), for example, differentiated three main phenotypes and developed a model that characterizes the relationships between these propensities. In particular, the first phenotype is disinhibition, representing problems with controlling impulses, planning carefully, and regulating emotions. The second phenotype, boldness, represents the capacity to recover rapidly from stress, behave assertively, and seek dangerous contexts. The third phenotype, meanness, represents a callous rather than empathic orientation, in which individuals seek resources from other people without remorse or guilt, manifesting as arrogance, cruelty, premeditated aggression, and exploitation of other people (for links to measures, see TriPM).

Each of these phenotypes are represented in historical conceptualizations of psychopathy. Disinhibition, in which individuals behave impulsively, aggressively, and inappropriately, coincides roughly with Factor 2 of the PCL-R (e.g., Patrick, Hicks, Krueger, & Lang, 2005) or the impulsive antisocial facet of the PPI (e.g., Blonigen, Hicks, Patrick, Krueger, Iacono, & McGue, 2005). Specifically, disinhibition is analogous to the concept of externalizing--encompassing conduct problems, criminal deviance, and even substance abuse. Such externalizing is often regarded as a key feature of psychopathy (e.g., Arieti, 1963& Krueger, Markon, Patrick, Benning, & Kramer, 2007), at least in secondary or symptomatic variants (e.g., Lykken, 1957).

Nevertheless, disinhibition is not equivalent to psychopathy: Most conceptualizations of psychopathy refer to an absence of fear. Hence, disinhibition needs to be coupled with either boldness or meanness to be designated as psychopathy (Patrick, Fowles, & Krueger, 2009).

Boldness corresponds to many of the features that Cleckley (1941, 1976) delineated to characterize psychopathy, such as poise, confidence in social settings, negligible anxiety, and insensitivity to punishment. Similarly, boldness resembles some of the subscales of the PPI, including immunity to stress and social potency.

Meanness is crucial to many characterizations of psychopathy (e.g., Quay, 1986). Although Factor 1 of the PCL-R comprises some elements of boldness, such as charm and a grandiose sense of self (Patrick, Hicks, Nichol, & Krueger, 2007), this factor more closely mirrors meanness. That is, items on the PCL-R such as limited empathy, limited remorse, shallow affect, pathological lying, and manipulative behavior, all reflect meanness (for a discussion, see Patrick, Fowles, & Krueger, 2009).

Patrick, Fowles, and Krueger (2009) also specified the likely determinants of these three phenotypes. In short, they argued that a difficult temperament often evolves into dishibition and meanness. In contrast, low fear tends to evolve into meanness and boldness. Thus, meanness, which emanates from both a difficult temperament and limited fear, departs from disinhibition and boldness, each of which is associated with only one of these antecedents.

In this model, a difficult temperament reflects maladaptive reactions to emotional stimuli. Individuals might become unduly stressed or irritable, unable to tolerate unpleasant states. Alternatively, they might withdraw from novel stimuli. They cannot, therefore, adapt to changes effectively. These problems might entail undue automatic responses, impaired controlled strategies in response to emotional events, or both. According to Patterson, Reid, and Eddy (2002), these children might thus be especially challenging, demonstrating incessant irritability and aggression. Parents might, eventually, relinquish their efforts to control these children, inadvertently reinforcing these unsuitable behaviors, called the coercion hypothesis.

These irritable outbursts, sometimes reinforced by parents, evolve into disinhibition. The inclination to disregard the needs of parents or other figures also escalates into meanness.

In contrast, the absence of fear can foster meanness and boldness. These individuals are insensitive to punishment, instead directing their attention almost exclusively on their own desires and potential rewards. Because of this bias to rewards rather than punishments, these individuals are unlikely to respond aggressively to punishments& reactive punishment is infrequent. Instead, aggression represents a motivation to secure resources, regardless of the feelings or needs of anyone else (Patrick, Fowles, & Krueger, 2009).


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