A Rorschach investigation of incarcerated female offenders with antisocial personality disorder

Although male psychopathy has been linked to histrionic, narcissistic, and antisocial personality disorders (ASPD), less is known about female psychopathy. The Psychopathy Checklist-Revised (PCL-R) and the Rorschach were used to explore the personality functioning of 45 incarcerated female offenders with ASPD delineated by their psychopathy level. Psychopaths (PCL-R > or = 30) and nonpsychopaths (PCL-R < 24) were compared on Rorschach measures of self-perception, interpersonal relatedness, and reality testing. Compared to female offenders with ASPD who were nonpsychopathic, female offenders with ASPD who were psychopathic exhibited marked disturbances in self-perception, interpersonal relatedness, and reality testing. Our findings highlight the heterogeneity of the ASPD diagnosis in women, support the utility of the psychopathy construct with female offenders, and implicate important differences between men and women with ASPD. These gender differences have relevance to the evaluation (PCL-R scoring) and treatment of female offenders. Our findings are discussed within the context of the female psychopath's hypothesized hysterical character style.     

Psychopathy and Female Gender: Phenotypic Expression and Comorbidity; A Study Comparing a Sample of Women Hospitalized in Italy's Maximum Security Facility with Women Who were Criminally Sentenced and Imprisoned,

Various studies have shown that women with psychopathy tend to commit crimes that are less violent than those of psychopathic men. The present study was designed to address the influence of psychopathy on the crimes committed by female offenders. A national sample of female offenders found NGRI or of diminished responsibility and at risk for criminal recidivism (OPG patients) was compared with a sample of female offenders who were convicted and imprisoned. Results of this comparison between the two groups of female offenders indicate that psychopathy is a transversal psychopathological dimension which may or may not be associated with other mental disorders. In both samples, the most commonly reported offenses among women with high PCL‐R scores were minor offenses, not particularly violent, but they appear to be related to typical psychopathic features such as superficial charm, pathological lying, and manipulation.     

Psychopathic traits in Finnish homicide offenders with schizophrenia

There is a paucity of studies examining psychopathy in comparable samples of violent individuals with and without psychotic illness. The main goal of the study was to assess the prevalence and nature of psychopathic traits as measured by PCL-R among Finnish homicide offenders with schizophrenia. Further, the impact of co-morbid psychopathy on the homicidal incidents, as well as the associations of psychopathy and offender background factors, among offenders with schizophrenia was investigated.A retrospective study was performed using extensive forensic psychiatric evaluation reports and crime reports as sources of information. The sample consisted of 72 homicide offenders with schizophrenia and 72 controls without psychotic illness.Psychopathic features were prevalent among Finnish homicide offenders with schizophrenia, although for the most parts to a lesser extent compared to other homicide offenders. Like non-mentally ill psychopathic offenders, offenders with schizophrenia and many psychopathic traits are likely to present early starting problems in many areas of life and they also commit homicides that resemble other psychopathic offenders' in their choice of victims, intoxication and post-offense behavior.The observed prevalence of psychopathic traits highlights the importance of psychopathy assessment among violence-prone individuals with schizophrenia. In most respects, offenders with schizophrenia and high levels of psychopathic traits seem to be similar to psychopathic offenders without psychotic illness, which has implications for early intervention and management.     

Psychopathy,intelligence, and impulsivity in German violent offenders

Previous studies have reported numerous correlations between psychopathy and various personality traits, behavioural tendencies or clinical characteristics. The present study examined in greater depth the relationships between the components of psychopathy as measured by the Psychopathy Checklist—Revised (PCL-R) and intelligence as well as impulsivity. A total of ninety male violent offenders were recruited from a prison and a forensic–psychiatric hospital in Germany. All of the subjects were assessed using the PCL-R, the Barratt Impulsiveness Scale (BIS-11), and a short version of the German Wechsler Adult Intelligence Scale (WIP). As expected, a canonical correlation analysis showed a negative association between spatial intelligence and the Factor 2 subtotal on the PCL-R (reckless lifestyle/antisociality). In addition, our results agreed with the assumption of an association between impulsivity and the subtotal for PCL-R Factor 2. The positive relationship between verbal intelligence and the subtotal for Factor 1 of the PCL-R (insincere, manipulative conduct/affective deficits) vanished after controlling for educational level. The results indicate that there is a relationship between the spatial components of intelligence and the concept of psychopathy as described by Hare. This result supports the spatial impairment aetiological model of antisocial behaviour.     

Psychopathy and Recidivism Among Female Inmates

Despite a plethora of studies investigating psychopathy among male offenders, little is known about the applicability of this construct to female populations. Research has shown that prevalence rate, symptom presentation, and diagnostic comorbidity differ for females as compared to males. The current study is the first to examine the relationship between psychopathy and recidivism among women. Recidivism data on a sample of 78 female inmates were examined at a 1-year interval in relation to the Psychopathy Checklist-Revised (PCL-R), inclusion criteria for the Antisocial Personality Disorder Diagnosis from the Personality Disorder Examination (PDE), and selected scales from the Personality Assessment Inventory (PAI; Antisocial and Aggression scales). The egocentricity subscale of the PAI, Factor 1 of the PCL-R, and the verbal aggression subscale of the PAI were the best predictors of future recidivism. Specific differences emerged between male and female offenders when comparing the present data with previous studies of male psychopaths.     

A preliminary study on findings of psychopathy and affective disorders in adult sex offenders

The construct of psychopathy has often been considered mutually exclusive to the presence of genuine depressive or anxiety symptomotology. This article addresses the hypothesized reasons for this dichotomous relationship. In this study, 68 civilly committed adult male sex offenders were evaluated using a variety of psychological measures to determine if psychopathic individuals in this group would demonstrate clinically significant affective symptoms. Results indicate that the men in this sample endorsed high rates of psychopathy on the PCL-R, with 42% of these expressing concurrent symptoms of depression and 26% manifesting symptoms of an anxiety disorder. Relationships between affective symptoms and PCL-R factor scores and qualitative differences between these constructs in child molesters and rapists are also discussed.     

Psychopathy among prisoners in England and Wales

Most research into psychopathy among prisoners is based on selected samples. It remains unclear whether prevalences are lower among European populations. This study aimed to measure the prevalence of psychopathy, and the distribution and correlates of psychopathic traits in a representative national sample of prisoners. Psychopathy was measured using the revised Psychopathy Checklist (PCL-R) in a second stage, cross-sectional survey of prisoners in England and Wales in 1997 (n = 496). Poisson regression analysis was carried out to examine independent associations between correlates and PCL-R total and factor scores. The prevalence of categorically diagnosed psychopathy at a cut off of 30 was 7.7% (95%CI 5.2–10.9) in men and 1.9% (95%CI 0.2–6.9) in women. Psychopathic traits were less prevalent among women. They were correlated with younger age, repeated imprisonment, detention in higher security, disciplinary infractions, antisocial, narcissistic, histrionic, and schizoid personality disorders, and substance misuse, but not neurotic disorders or schizophrenia. The study concluded that psychopathy and psychopathic traits are prevalent among male prisoners in England and Wales but lower than in most previous studies using selected samples. However, most correlates with psychopathic traits were similar to other studies. Psychopathy identifies the extreme of a spectrum of social and behavioral problems among prisoners.     

The PCL-R and violent recidivism in a prospective follow-up of a nationwide sample of female offenders

Psychopathy has been linked to violent reoffending in men, but the findings in women have been contradictory. The aim of this study was to examine the predictive validity of the Psychopathy Checklist-Revised (PCL-R) for violent recidivism in a nationwide sample of female violent offenders. The offenders (n = 48) had been assessed by the PCL-R and were followed after their release from prison or a psychiatric hospital. The average follow-up period was 8 years. Of the offenders, 16 (33%) had been reconvicted of a violent crime. Current findings of the performance indicators did not support the use of the PCL-R as a predictive instrument assessing risk of violent recidivism in females. The findings indicate that impulsivity plays a crucial role in female violent recidivism and that the PCL-R should be used with caution in risk assessment with female populations.     

The violent female perpetrator and her victim

The aim of the present study was to examine the relationship between violent female offenders and their victims as well as the putative differences in the motives and specific psychological factors among three groups of female offenders: women who have victimised someone closely related to them, those who have victimised an acquaintance and lastly women who have victimised a stranger. More than half (N=61) of all violent female offenders hospitalised or incarcerated in Finland during the year of study were interviewed and assessed by Structured Clinical Interview II for DSM-IV (SCID-II) and Hare's Psychopathy Checklist-Revised (PCL-R). In 34% of the cases the victims were persons close to the offender, in 41% the victims were acquaintances and in 25% strangers. The victims in homicide offences were more often both male and closer to the perpetrator than in assault offences. Although motives were related to interpersonal problems, self-defence and long-term physical or psychological abuse were reported by only a few women, even for the small proportion of women whose victims were intimate partners. The most frequent reason for offences stemmed from confrontational situations in connection with alcohol use. Women who victimised acquaintances and strangers were also more likely to have a history of criminality and substance abuse than women who victimised those in close personal relationships. The latter were also more likely to have an antisocial personality disorder (PD) and psychopathic characteristics. There were, however, no significant differences found between those who had experienced physical or psychological abuse in childhood or adulthood and those who had no adverse experiences. These findings suggest that the violent behaviour by females leads more often to the death of the victim, when the victim is closely related to the perpetrator. The commonly-held view that violent female offending occurs primarily as a consequence of precipitation by the victim was not supported.     

The impact of pre-treatment responsivity and treatment participation on violent recidivism in a violent offender sample

This study assessed whether pre-treatment responsivity (psychopathy, motivation to attend treatment, denial and minimisation of offending behaviour, and feelings of guilt or shame) predicted violent recidivism and/or moderated the effectiveness of a violence intervention programme. Participants were 114 male violent offenders who were referred to a structured violent offender group treatment programme; 84 offenders commenced the programme. Results showed that treatment completion did not have a significant main effect on recidivism but that psychopathy scores moderated the effects of treatment. Offenders with high scores on the Psychopathy Checklist: Screening Version (PCL:SV) who were rated as having good engagement with treatment, or who completed treatment, had similar violent recidivism rates compared to offenders with low PCL:SV scores. In contrast, offenders with high PCL:SV scores who dropped out of treatment or were poorly engaged had significantly higher rates of violent recidivism. These findings indicate that treatment effectiveness could be enhanced, and greater reductions in recidivism achieved, if programmes find ways to engage and maintain psychopathic offenders in treatment.     

Psychopathy (PCL-R) as a Predictor of Violent Recidivism Among Criminal Offenders with Schizophrenia

Hare's Psychopathy Checklist-Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score 26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.     

Crime profiles and conditional release performance of psychopathic and non‐psychopathic sexual offenders

Purpose. This study investigated the influence of psychopathy and sex offender subtype on criminal history, probability of being granted conditional release, and performance while on conditional release in a diverse group of violent offenders. We predicted that psychopathic sexual offenders would be associated with relatively prolific violent and sexual offending, a high probability of successful conditional release applications despite their past behaviour (resulting from ‘putting on a good show’ in a parole hearing), and poor performance in the community. Methods. Information was gathered via a correctional file review of 310 Canadian male federal offenders. Offenders were categorized into groups based on their sexual offence history (non‐sex offender, rapist, child molester, or mixed rapist/molester) and Psychopathy Checklist – Revised (PCL‐R; Hare, 2003) ratings. Their offences (sexual, violent, or non‐violent) and their complete conditional release histories were coded. Results. Psychopathy was associated with more violent and non‐violent, but not sexual, offences. A significant interaction between psychopathy and offender subtype revealed that psychopathy was associated with a greater number of sex offences within child molesters. High‐psychopathy offenders (both sexual and non‐sexual offenders) were about 2.5 times more likely to be granted conditional release than non‐psychopathic offenders. Conclusions. Psychopathy is associated with more prolific sexual offending among child molesters and – despite their extensive criminal histories and high recidivism rate – a great proficiency in persuading parole boards to release them into the community. Specialized education and training in dealing with psychopathic offenders is urgently needed.     

Assessing the relevance of self-reported ADHD symptoms and cognitive functioning for psychopathy using the PCL-R and the TriPM

Psychopathy and ADHD are highly comorbid disorders, possibly linked to the underlying trait of impulsivity. It is therefore likely that ADHD symptoms are also of importance when studying cognitive functioning linked to psychopathy. Few studies of psychopathy and cognitive functioning have taken ADHD symptoms into account. In this cross-sectional study, male offenders (n = 201 of whom 105 were neuropsychologically tested) were recruited from all high security correctional facilities in Sweden. The aim of the study was to investigate if self-reported ADHD symptoms and cognitive functioning could predict specific subcomponents of psychopathy in offenders. Results showed that self-rated ADHD symptoms (ASRS) and psychopathy were highly correlated. Furthermore, the associations of ASRS and PCL-R Facet 3, as well as TriPM Disinhibition, were remarkably high. As expected, ASRS was not related to either Facet 1 or 2 of the PCL-R, or to TriPM Boldness. Cognitive functioning did not contribute in predicting psychopathy beyond the effect of ASRS. The high overlap in reported symptoms highlights the importance of thorough clinical assessments to be able to distinguish psychopathic personality traits from ADHD and lessen the risk of misdiagnosis. Further, it points to the need of finding discriminative measures possibly linked to etiological underpinnings.     

Women and Men who Committed Murder: Male/Female Psychopathic Homicides

The present study was designed to compare gender differences in psychiatric diagnosis with the dimension of psychopathy in women and men who had attempted or committed homicide. The study samples consisted of 39 homicidal females and 48 homicidal males who were confined in one of Italy’s REMS or prison facilities in two southern provinces of Italy (Puglia and Basilicata). Assessment instruments included the SCID-5, the PID-5 IRF, and the PCL-R. Each gender group was stratified according to the level of criminal responsibility for the homicidal offense (full, partial, absent), and after assessments, according to the degree of the psychopathic dimension. There were clear gender differences in homicidal individuals. Female offenders were less likely to have had a record of criminal charges/convictions or imprisonment, and their homicides were more often intrafamilial, victimizing especially of their children, whereas males targeted intimate partners and extrafamilial victims. In the entire group, there was an inverse relationship between the level of psychopathy and the personality disorder on one side, and the psychotic disturbance on the other. Factor 2 (lifestyle/antisocial dimension) of the PCL-R was higher among the homicidal males, whereas females tended to score higher on Factor 1 (the interpersonal/affective dimension). Finally, if the psychopathic dimension is a qualifier for antisocial personality disorder, as indicated in DSM-5, this appears to be less true for females who tend to have other personality disorders.     

Blame attribution and guilt feelings in violent offenders

Offenders with high psychopathic traits and/or antisocial personality disorder (ASPD) are hypothesised to experience less guilt and less responsibility for their actions than offenders without these problems. These hypotheses were tested and partly substantiated. The study investigates blame attributions and guilt feeling using Gudjonsson Blame Attribution Inventory–Revised (GBAI-R) for 177 young male violent offenders. GBAI scores were compared to ASPD and psychopathy according to the Psychopathy Checklist–Revised. Results showed that individuals with ASPD and those with higher degrees of psychopathy tended to report significantly less guilt and higher degree of mental control than other subjects. Another finding was a weak relationship between ASPD, high scores on psychopathic traits and external attribution. We suggest these results might be explained by admitting poor mental control may be extra difficult for individuals belonging to either of these groups and that the external attribution items do not separate causal from moral responsibility.     

Deceptive behaviour and instrumental violence among psychopathic and non-psychopathic violent forensic psychiatric patients

Deceptive behaviour and instrumental violence are well-known psychopathic features and as such play important roles in the assessment of psychopathy. This study examined first, the nature of the violence committed by offenders that have been admitted to forensic psychiatric care and whether scores on the Psychopathy Checklist: Screening Version (PCL:SV), Part 1, were associated with the instrumentality of violence. Second, we examined the proneness of offenders to re-frame the instrumentality in their past violent crimes, and whether this was associated with scores on the PCL:SV. The results show that the PCL:SV, Part 1 (interpersonal/affective features), was positively related to the officially coded instrumentality of the violent crimes. As expected, this association disappeared when the instrumentality was self-reported. However, the majority of the patients tended to exaggerate the reactivity of their violent crimes when it was self-reported, indicating that most offenders, independently of level of psychopathy, used deception when questioned about the characteristics of their past violent crimes. The reasons for, and implications of, the use of deception are discussed.     

Psychopathy and internalizing psychopathology

There is general consensus in clinical and research literature that the core feature of psychopathy consists of an affective deficit. However, previous studies tend to find weak and inconsistent associations between psychopathy and measures of internalizing psychopathology. In this study we test whether the predominant practice of using questionnaires to assess internalizing psychopathology has influenced the results of previous research. We argue that questionnaires measure general distress rather than specific symptoms of internalizing psychopathology, and that the validity of questionnaires might be impaired by psychopathic traits, such as impression management and lack of affective experience. Combining a questionnaire (Depression Anxiety Stress Scales-21; DASS-21) and a semi-structured interview (Structured Clinical Interview for DSM-IV-R Axis 1 Disorders; SCID-I) for internalizing psychopathology, we test the differential association of both measures with the Psychopathy Checklist-Revised (PCL-R) in a sample of 89 male detainees. In accordance with our prediction, we found moderate negative associations between the Interpersonal and Affective facets of the PCL-R and SCID-I, but no significant associations with the DASS-21. We found no evidence that psychopathic traits decrease the validity of the responses on a questionnaire. We conclude that the interpersonal and affective features of psychopathy are negatively related to specific symptoms of internalizing psychopathology, but not with general distress.     

Psychopathy, traumatic exposure, and lifetime posttraumatic stress

This study examined two theoretical models on the interaction between psychopathy, traumatic exposure, and lifetime posttraumatic stress in a sample of 81 male detainees. In Model 1, the interpersonal and affective features of psychopathy were assumed to protect against posttraumatic stress. In Model 2, the lifestyle and antisocial traits of psychopathy were assumed to lead to a lifestyle that increases the risk of traumatic exposure and subsequent posttraumatic stress. The authors found significant negative bivariate associations between Psychopathy Checklist-Revised (PCL-R) total, Interpersonal and Affective facet scores, and posttraumatic stress. Model 1 was confirmed, as they found the interaction between the Affective facet and traumatic exposure had a significant negative effect on posttraumatic stress. Model 2 was rejected. The authors' findings confirm that the interpersonal and affective features of psychopathy are associated with an emotional deficit and that the affective features of psychopathy are crucial for understanding the relationship between psychopathy and anxiety.     

Understanding the risk factors for violence and criminality in women: the concurrent validity of the PCL-R and HCR-20

This study explores the performance of 132 female maximum-security inmates on the Psychopathy Checklist-Revised (PCL-R) and the HCR-20 (Historical, Clinical, and Risk Management Scheme) to examine the concordance between these two risk assessment instruments, and to assess their potential usefulness in determining level of risk for violent behavior and other forms of criminality. The two instruments demonstrated consistent and highly significant correlations across total scores, factor scores, and subscale scores. When the two instruments were entered into a multiple regression analysis to predict violent and non-violent crime, the HCR-20 did not add to the variance explained by the PCL-R. These results confirm earlier research that suggests that there is little or no difference between these two risk assessment instruments in their relationship to community or institutional violence. Further, Receiver Operating Characteristics (ROC) analyses show that both instruments demonstrated an inverse ability to predict convictions for murder, a close to chance ability to predict violent crime, but a shared ability to predict property and minor crime. Broadly, these results suggest that psychopathic women are involved in chronic patterns of non-violent criminality, while women charged and convicted of murder generally do not have elevated scores on the PCL-R or HCR-20. The relevance of these findings to rehabilitation and treatment is discussed.