Psychopathy: A Clinical and Forensic Overview
Section snippets
Assessment
Because of space limitations, this article focuses on the most widely accepted measure of psychopathy, the Psychopathy Checklist—Revised (PCL-R) [25], [26]. Occasional references also are made to its direct derivatives, the Psychopathy Checklist: Screening Version (PCL: SV), the Psychopathy Checklist: Youth Version (PCL: YV), and the Antisocial Process Screening Device (APSD), each supported by extensive evidence for their reliability and validity [27], [28], [29].
Validity
Evidence for the validity of the PCL-R and the construct it measures is extensive (see Refs. [22], [23], [26]) and comes from research examining relationships to various other instruments and scales; associations with behavioral data, such as recidivism and violence; and basic laboratory research involving information processing, functional magnetic resonance imaging, electrocortical activity, and biochemical correlates. This research is discussed in detail elsewhere (see Refs. [15], [16], [22]
Psychopathy and Crime
In the past few years there has been a dramatic change in the perceived and actual role played by psychopathy in the criminal justice system. Formerly, a prevailing view was that clinical diagnoses such as psychopathy were of little value in understanding and predicting criminal behaviors. However, many of the characteristics important for inhibiting antisocial and violent behavior—empathy, close emotional bonds, fear of punishment, and guilt—are lacking or seriously deficient in psychopaths.
Treatment
Unlike most other offenders, psychopaths suffer little personal distress, see little wrong with their attitudes and behavior, and seek treatment only when it is in their best interests to do so, such as when seeking probation or parole. They derive little benefit from traditional prison programs, particularly those aimed at the development of empathy, conscience, and interpersonal skills (see Refs. [17], [100], [101]). Indeed, there have been reports that some programs designed to modify the
Some Cautions
Although the research evidence for the reliability and validity of the PCL-R and its derivatives is extensive, this does not ensure that an individual assessment will be reliable or valid. In a research context, misuse of these instruments will have few negative consequences for the individual. However, when the scores are used in clinical and criminal justice contexts, the implications of misuse are potentially serious, especially if the scores are used to guide treatment or adjudication
Summary
There is a substantial amount of empirical evidence that psychopathy, as measured by the PCL-R and its derivatives, is a predictor of recidivism and violence in prison, forensic psychiatric, and civil psychiatric populations. The PCL-R is one of the most generalizable of the risk factors identified thus far, and for this reason it is included in various actuarial and structured clinical risk assessment procedures. Although psychopathy is not the only risk factor for recidivism and violence, it
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