Prevalence and correlates of psychopathic traits in the household population of Great Britain,☆☆

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Abstract

There are no previous surveys of psychopathy and psychopathic traits in representative general population samples using standardized instruments. This study aimed to measure prevalence and correlates of psychopathic traits, based on a two-phase survey using the Psychopathy Checklist: Screening Version (PCL: SV) in 638 individuals, 16–74 years, in households in England, Wales and Scotland. The weighted prevalence of psychopathy was 0.6% (95% CI: 0.2–1.6) at a cut score of 13, similar to the noncriminal/nonpsychiatric sample described in the manual of the PCL: SV. Psychopathy scores correlated with: younger age, male gender; suicide attempts, violent behavior, imprisonment and homelessness; drug dependence; histrionic, borderline and adult antisocial personality disorders; panic and obsessive–compulsive disorders. This survey demonstrated that, as measured by the PCL: SV, psychopathy is rare, affecting less than 1% of the household population, although it is prevalent among prisoners, homeless persons, and psychiatric admissions. There is a half-normal distribution of psychopathic traits in the general population, with the majority having no traits, a significant proportion with non-zero values, and a severe subgroup of persons with multiple associated social and behavioral problems. This distribution has implications for research into the etiology of psychopathy and its implications for society.

Introduction

Psychopathy can be differentiated from other personality disorders on the basis of characteristic interpersonal, affective, and behavioral symptoms. The classic clinical features were described by Cleckley (1941) who asserted that these personalities are not only found in prisons but in the community, giving examples of apparently successful individuals of higher social status whose façade of normality could extend into superficial material and social success. More recently, several commentators (Babiak and Hare, 2006, Hall and Benning, 2006, Lykken, 1995) have argued that some traits of the interpersonal and affective domains of psychopathy might be of advantage to achieve professional success in certain areas. However, while anecdotal examples abound, the concept of the “successful psychopath” has been subjected to little systematic investigation. Ullrich, Farrington, and Coid (2008) found that the domains of psychopathy are unrelated to success in a community sample of men, but only a few of the men had high psychopathy scores. Nonetheless, De Oliveira-Souza, Ignácio, Moll, and Hare (2008) suggested that even among community members with high psychopathy scores their “success” often is ephemeral and defined without recognition of its negative impact on others.

The international standard for the assessment of psychopathy, the Psychopathy Checklist—Revised (PCL-R; Hare, 1991, Hare, 2003), was developed with offender populations, whereas its derivative, the Psychopathy Checklist: Screening Version (PCL: SV; Hart, Cox, & Hare, 1995), was developed and validated for use with non-forensic samples. The two instruments are highly correlated and measure the same construct (Cooke et al., 1999, Guy and Douglas, 2006). Although not included in the ICD or DSM classifications, analyses of traits associated with personality disorders reveal a dimension remarkably similar to the personality features that constitute psychopathy (Blackburn and Coid, 1998, Ullrich and Marneros, 2004, Ullrich and Marneros, 2007). This underlying factor consisted of impulsive, dissocial, paranoid, histrionic and borderline dimensions in terms of the ICD classification and antisocial, paranoid, histrionic, narcissistic, borderline, and passive–aggressive traits according to DSM.

The reliability and validity of the PCL-R and PCL: SV for the measurement of psychopathy are established (Acheson, 2005, Hare and Neumann, 2008), together with their predictive validity for future violent and criminal behavior (Douglas et al., 2005, Hemphill, 2007, Leistico et al., 2008). Recent developments in factor analysis have indicated the importance of different components of psychopathy. Although previously considered a higher-order construct underpinned by two correlated factors (Hare, 1991), subsequent confirmatory factor analysis has described a hierarchical three-factor model (Cooke & Michie, 2001) and more recently a four-factor model for both the PCL-R (Hare, 2003, Neumann et al., submitted for publication, Neumann et al., 2005) and the PCL: SV (Vitacco, Neumann, & Jackson, 2005). This model (Table 1) permits finer descriptive analysis of individuals encountered in clinical practice and allows empirical study of subcomponents of psychopathy, including the possibility that these have different etiologies. Although there is consensus on the necessity of differentiating the traditional factors of psychopathy, and researchers agree on the interpersonal, affective and impulsive/lifestyle components, divergent opinions result in debate over antisocial behaviors and whether they constitute an integral facet of psychopathy (Hare & Neumann, 2006) or are merely a negative outcome of the core psychopathic personality traits (Cooke, Michie, Hart, & Clark, 2004).

Research on correlates and etiology of psychopathy has focused heavily on male prisoners and psychiatric patients in high security settings. Little is known of the epidemiology of psychopathy based on representative samples from the general population. Such studies are rare and have to overcome various obstacles, particularly due to the low base rates of psychopathic traits (Hall & Benning, 2006). Nevertheless, clinicians and researchers have known that psychopaths exist in the general population and have recognized the importance of studying psychopathic traits in non-institutionalized studies (Kirkman, 2002). Studying psychopathy in non-forensic samples can rule out the effects of incarceration and recurrent institutionalization on dependent measures (Lilienfeld, 1994). Recent studies have demonstrated that psychopathic traits are continuously distributed among forensic, clinical and community samples, and that individuals with levels of psychopathy comparable with those in correctional and forensic psychiatric populations can be found in the general population (DeMatteo, Heilbonn, & Marczyk, 2006; De Oliveira-Souza et al.De Oliveira-Souza et al., 2008, Neumann and Hare, 2008). These studies indicate that high levels of psychopathy in community samples have much the same predictive value, with respect to antisocial and criminal behavior, as they do in forensic populations.

The aim of this study was to estimate the prevalence and correlates of psychopathy, as measured by the PCL: SV, in the general population of Great Britain, using a two-phase survey of a large representative household sample of adults, aged 16–74, conducted in 2000. Both the PCL-R (Guay, Ruscio, Knight, & Hare, 2007) and the PCL: SV (Walters et al., 2007) measure a dimensional construct, and our primary analyses therefore involved correlations between the PCL: SV (and its factors) and its correlates, including demographic characteristics, verbal intelligence, DSM-IV Axis-II personality disorder traits, ICD-10 clinical syndromes, and social and behavioral problems. In addition, however, the PCL-R and PCL: SV scores can be used to provide convenient threshold or cut-scores for psychopathy, thereby allowing estimates to be made of the prevalence of the disorder in our sample.

Section snippets

Sample

The sample included 638 subjects participating in the second of a two-phase survey of Psychiatric Morbidity among Adults aged 16–74 years living in Private Households in England, Wales and Scotland (Singleton, Bumpstead, O'Brien, Lee, & Meltzer, 2001). The Small Users Postcode Address File (PAF) was used as the sampling frame and the Kish Grid Method (Kish, 1965) to systematically select one person in each eligible household. A total of 8886 (69.5%) selected adults who agreed to complete a

Prevalence and score distribution

Unweighted data included 11 (1.8%) subjects who scored 11 or more on the PCL: SV, 4 (0.6%) scoring 13 or more, with only 1 subject above the recommended cut-off for probable psychopathy of 18, who scored 20. The weighted prevalence of “possible” psychopathy, using a suggested cut score of 11 or more points in this population was 2.3% (95% CI: 1.2–3.8); 3.7% (95% CI: 1.8–6.6) in men and 0.9% (95% CI: 0.2–2.8) in women. The prevalence of possible psychopathy using a cut score of 13 or more was

Prevalence of self-disclosed psychopathy in the British household population

To our knowledge, this survey is the first to measure psychopathy in a representative general population sample using a standardized instrument. Estimates of the prevalence of psychopathy and psychopathic traits depend on the measurement tool and the thresholds used. With the PCL: SV a score of 13 is used for “possible” psychopathy. Using this cut score, 0.6% of the sample of men and women met the threshold. Recalculation using a cut score of 11 yielded a prevalence of 2.3%; 3.7% in men and

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    Funding support: Department of Health, England and Wales.

    ☆☆

    Declaration of interest: R. Hare receives royalties from sales of the PCL: SV.

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