PCL-R II Advanced PCL-R Training

Advanced PCL-R TrainingAdvanced PCL-R Training

Anna C. SalterAnna C. Salter

Anna C. SalterAnna C. [email protected]

R. D. HareR. D. [email protected]@interchange.ubc.ca

New web site for victimsNew web site for victims

www. aftermath-surviving-www. aftermath-surviving-psychopathy.orgpsychopathy.org

Society for the Scientific Study of PsychopathySociety for the Scientific Study of Psychopathy

SSSPSSSPwww.psychopathysociety.orgwww.psychopathysociety.org

““Subtypes” of Psychopathy?Subtypes” of Psychopathy?

PCL-R scores of 27 or higherPCL-R scores of 27 or higher

Three clear clusters or “subtypes” with high PCL-R Three clear clusters or “subtypes” with high PCL-R scoresscores

Classic or prototypical: high on all 4 facetsClassic or prototypical: high on all 4 facets

glib/superficial

grandioseself-worth

pathologicallying

conningmanipulative

Interpersonal

Lifestyle

lack ofrealistic goals

stimulationseeking

impulsivity

irresponsible

parasiticorientation

.73

.73

.71

.66

.73

.71

.60

.58

.60

.50

lack remorseor guilt

shallowaffect

callouslack empathy

fail to acceptresponsibility

Affective

poor behaviorcontrols

early behaviorproblems

juveniledelinquency

Antisocial

.51

.80

.82

.65

.59

.65

.70

.67

.54

.64

.55.42

.70

.73

revocation ofcond. release

criminalversatility

Model fit: x2(91)= 3842, TLI= .93, RMSEA= .07, SRMR= .05

Neumann, Hare, & Newman, 2007; NA Samples (male, female offenders, male forensic psychiatric : N = 6929

0

1

2

3

4

5

6

7

8

Facet 1 Facet 2 Facet 3 Facet 4

Prototypical (32%)

Macho: low on Interpersonal, high on Macho: low on Interpersonal, high on othersothers

0

1

2

3

4

5

6

7

8


Prototypical (32%) Macho (27%)

Manipulative: high on Interpersonal and Manipulative: high on Interpersonal and Affective, lower on othersAffective, lower on others

0

1

2

3

4

5

6

7

8


Prototypical (32%) Macho (27%) Manipulative (25%)

VariationsVariations

0

1

2

3

4

5

6

7

8


Prototypical (32%) Macho (27%) Manipulative (25%)


0

1

2

3

4

5

6

7

8


Prototypical (32%) Macho (27%)

Manipulative (25%) Pseudo (16%)

Asperger’s SyndromeAsperger’s Syndrome

Murphy, 2007Murphy, 2007 13 Asperger’s patients at Broadmoor13 Asperger’s patients at Broadmoor PCL-R scoresPCL-R scores

Mean = 15; varied from 11-22 Mean = 15; varied from 11-22


0

1

2

3

4

5

6

7

8


Prototypical Macho Manipulative Pseudo Asperger's

Bjørkly, 2009Bjørkly, 2009Table 2

Possible differences between characteristics of violence in Asperger’s syndrome and psychopathy.

Characteristic PsychopathyAsperger’s Syndrome

Sensory reactivity Hypo Hyper

Interpersonal communication

Manipulative Naïve

Typical violence Proactive Reactive

Reinforcement contingency Positive Negative

Relating to violence Denial Confession

“Findings from these comparisons indicated that there may be substantial differences between the two diagnostic disorders regarding these five criteria.”

Reasons for Cross-Cultural Reasons for Cross-Cultural Differences in Psychopathy Differences in Psychopathy

Rates?Rates?

Wernke & Huss, 2008Wernke & Huss, 2008

Wernke & Huss, 2008Wernke & Huss, 2008 Note international differences inNote international differences in

Crime ratesCrime rates Incarceration ratesIncarceration rates

Similar Similar crime ratescrime rates in NA, UK, and Europe in NA, UK, and Europe But much higher But much higher incarceration ratesincarceration rates in NA in NA Argue that psychopaths commit crimes that lead to:Argue that psychopaths commit crimes that lead to:

Incarceration in NAIncarceration in NA Probation, psychiatric facility, etc. in UK & EuropeProbation, psychiatric facility, etc. in UK & Europe

Psychopaths over-represented in NA, under-represented in Psychopaths over-represented in NA, under-represented in UK & Europe prisonsUK & Europe prisons

Incarceration Rates (% of Incarceration Rates (% of Convicted Offenders)Convicted Offenders)

USA UKUSA UK Murderers 96 94Murderers 96 94 Rapists 82 95Rapists 82 95 RobberyRobbery 79 6779 67 Assault 62 27Assault 62 27 Burglars 60 38Burglars 60 38 Motor vehicle 55 30Motor vehicle 55 30

Schizophrenia, Psychopathy, Substance Schizophrenia, Psychopathy, Substance Use, & CrimeUse, & Crime


TengstrTengströöm, Hodgins,Grann, Lm, Hodgins,Grann, Låångstrngströöm, & Kullgren m, & Kullgren (2004)(2004)

Criminal history of patients with various Criminal history of patients with various combinations of schizophrenia, substance use, combinations of schizophrenia, substance use, and psychopathyand psychopathy

Swedish male patients who received pretrial Swedish male patients who received pretrial assessments between 1988 and 1993, and were assessments between 1988 and 1993, and were found guilty of violent offencesfound guilty of violent offences 202 schizophrenics, & 78 offenders who met 202 schizophrenics, & 78 offenders who met

PCL-R criteria for psychopathyPCL-R criteria for psychopathy Lifetime convictions since age 15, per year at risk Lifetime convictions since age 15, per year at risk

(free)(free)

Number of Convictions Per Year at Risk

0

1

2

3

4

5

6

S S + SUD S + P S + P +SUD

P + SUD P

S = schizophrenia SUD = substance use disorder P = psychopathy


Among patients with schizophrenia, correlation Among patients with schizophrenia, correlation between PCL-R and number of convictions per year between PCL-R and number of convictions per year at risk: at risk: General = .62General = .62 Violent = .38Violent = .38

““High ratings of psychopathy are associated with High ratings of psychopathy are associated with earlier ages of first conviction for a criminal offense earlier ages of first conviction for a criminal offense and more convictions among the men with and more convictions among the men with schizophrenia, just as among men with no mental schizophrenia, just as among men with no mental illness” (p. 385).illness” (p. 385).

““These findings suggest that among These findings suggest that among offenders with psychopathic traits, the offenders with psychopathic traits, the traits, not substance abuse, are traits, not substance abuse, are associated with criminal offending” (p. associated with criminal offending” (p. 367).367).

What About ComorbidtyWhat About Comorbidty

Patients with schizophrenia and many Patients with schizophrenia and many psychopathic features are at high risk for psychopathic features are at high risk for violenceviolence

Tengström et al., 2000Tengström et al., 2000

Thomson et al., 2008Thomson et al., 2008

PCL-R as a Predictor of Violent Recidivism in Schizophrenic Offenders

Tengström et al., 2000

0

0.2

0.4

0.6

0.8

1

0 12 24 36 48 60 72

Months

% S

urvi

ving

PCL-R 0-25



0

0.2

0.4

0.6

0.8

1

0 12 24 36 48 60 72

Months

% S

urvi

ving

PCL-R 26-40

PCL-R 0-25



0

0.2

0.4

0.6

0.8

1

0 12 24 36 48 60 72

Months

% S

urvi

ving

PCL-R 26-40

PCL-R 0-25

Dolan & Fullam, in pressDolan & Fullam, in press

24 male patients with schizophrenia (DSM-IV)24 male patients with schizophrenia (DSM-IV)– Secure psychiatric facility in EnglandSecure psychiatric facility in England– All convicted for violent offencesAll convicted for violent offences

• PCL: SV scoresPCL: SV scores– Mean = 12.9Mean = 12.9– Median split: High, Low psychopathyMedian split: High, Low psychopathy

fMRI while pictures viewedfMRI while pictures viewed– Neutral, anger, disgust, sad, fearNeutral, anger, disgust, sad, fear– Differences between neutral and emotionalDifferences between neutral and emotional

–

Dolan & Fullam, in pressDolan & Fullam, in press

““Psychopathic traits in patients with schizophrenia Psychopathic traits in patients with schizophrenia are associated with dysfunction in the are associated with dysfunction in the prefrontal-prefrontal-limbic circuitrylimbic circuitry over and above that normally over and above that normally associated with schizophrenia alone.” associated with schizophrenia alone.”

Psychopathic AggressionPsychopathic Aggression

Nature of Aggression/ViolenceNature of Aggression/Violence

Primarily Reactive Primarily Reactive

• crime of passioncrime of passion• extreme provocationextreme provocation• self-defenseself-defense• response to threatresponse to threat• often relatively uncontrolledoften relatively uncontrolled

Nature of Aggression/ViolenceNature of Aggression/Violence

Primarily instrumentalPrimarily instrumental

cold-bloodedcold-blooded premeditatedpremeditated settle a score settle a score goal-directedgoal-directed

controlledcontrolled predatorypredatory

Psychopaths capable of both reactive and Psychopaths capable of both reactive and instrumental aggression/violenceinstrumental aggression/violence

But even the reactive aggression/violence is But even the reactive aggression/violence is more controlled than in othersmore controlled than in others

Woodworth & Porter, 2002; Porter et al., 2003)Woodworth & Porter, 2002; Porter et al., 2003)

Primary Nature of Canadian Homicides as a Function of PCL-R Scores

71.8

28.2

0

10

20

30

40

50

60

70

80

90

100

LOW PCL-R MEDIUM PCL-R HIGH PCL-R

PRIMARILYREACTIVE

PRIMARILYINSTRUMENTAL


71.8

32.628.2

67.4

0

10

20

30

40

50

60

70

80

90

100


PRIMARILYREACTIVE



71.8

32.6

6.7

28.2

67.4

93.3

0

10

20

30

40

50

60

70

80

90

100


PRIMARILYREACTIVE


AgingAging

Aging and PsychopathsAging and Psychopaths

Psychopathy and Age

Age Period

16-16-2020

21-21-2525

26-26-3030

31-31-3535

36-36-4040

41-41-4545

46-46-5050

51-51-5555

56-56-7070

00

22

44

66

88

1010

1212

1414

Mean

Fact

or

Sco

re

Factor 1

Factor 2

PCL-R

N = 800+Harpur & Hare

1994

Reduction in Criminality with Reduction in Criminality with AgeAge

1/2 Reduce Criminal Activity 1/2 Reduce Criminal Activity

About 35 to 40About 35 to 40

Non-Violent Offenses OnlyNon-Violent Offenses Only

(Hare, McPherson & Forth, 1988; Harris, (Hare, McPherson & Forth, 1988; Harris, Rice & Cormier, 1991)Rice & Cormier, 1991)

Effect of AgingEffect of Aging

Male Offenders & Forensic Psychiatric Male Offenders & Forensic Psychiatric PatientsPatients

File InfoFile Info File Info File Info

+ Interview+ Interview AloneAlone

TotalTotal Decrease .5Decrease .5 Decrease 4Decrease 4

Factor 1Factor 1 Increase .5Increase .5 Decrease .5Decrease .5

Factor 2Factor 2 Decrease 1Decrease 1 Decrease 4Decrease 4

(Hare, 2003)(Hare, 2003)

Reduction in Criminality with Reduction in Criminality with AgeAge

1/2 Reduce Criminal Activity 1/2 Reduce Criminal Activity

About 35 to 40About 35 to 40

Not for Violent CrimeNot for Violent Crime

(Hare, McPherson & Forth, 1988; Harris, (Hare, McPherson & Forth, 1988; Harris, Rice & Cormier, 1991)Rice & Cormier, 1991)

Effect of AgingEffect of Aging

Ages 46 - 50Ages 46 - 50

%% %%ConvictedConvicted ViolentViolent

PsychopathsPsychopaths 42.9%42.9% 30%30%

NonpsychopathsNonpsychopaths 40.4%40.4% 8.8%8.8%(Hare et. Al, 1992)(Hare et. Al, 1992)

Psychopathy & AgingPsychopathy & Aging

Almost ½ of psychopaths convicted of Almost ½ of psychopaths convicted of crimes after 40crimes after 40

Percentage of violent crimes increasedPercentage of violent crimes increased

(Hare et al., 1992)(Hare et al., 1992)

““It appears that the psychopath’s propensity It appears that the psychopath’s propensity for violence and aggression may be for violence and aggression may be relatively persistent across much of the life relatively persistent across much of the life span.” (Hare, 1992, p.295)span.” (Hare, 1992, p.295)

Performance on Conditional Release as a Performance on Conditional Release as a Function of PCL-R and Age at ReleaseFunction of PCL-R and Age at Release

Porter et al., 2001Porter et al., 2001

PCL-R 30+ PCL-R 30+ N N = 93= 93

PCL-R <30 PCL-R <30 N N = 224= 224

Days Free on Conditional Release Days Free on Conditional Release as a Function of PCL-R & Ageas a Function of PCL-R & Age

0

500

1000

1500

2000

2500

3000

18-24 25-29 30-34 35-39 40-44 45-49

Non-psychopathsPsychopaths

Porter et al., 2001Age

Me

an

# S

uc

ce

ss

ful D

ay

s

N = 224

N = 93

Older Psychopaths & Time in Older Psychopaths & Time in CommunityCommunity

AgeAge < 30< 30 >30>30

40 – 4440 – 44 1000 days1000 days 200 days200 days

45 – 4945 – 49 2500 days2500 days 100 days100 days

(Porter et al., 2001)(Porter et al., 2001)

““We found no evidence that older offenders We found no evidence that older offenders scoring high on the PCL-R were more scoring high on the PCL-R were more successful than their younger successful than their younger counterparts.” (Porter et al., 2001)counterparts.” (Porter et al., 2001)

““Clearly, older psychopaths had far less Clearly, older psychopaths had far less opportunity to offender . . . This suggests opportunity to offender . . . This suggests that the age-related decline in criminal that the age-related decline in criminal charges and convictions for psychopaths charges and convictions for psychopaths was, in part, an artifact, and that the was, in part, an artifact, and that the criminal (and violent) propensities of the criminal (and violent) propensities of the aging psychopaths may have been greatly aging psychopaths may have been greatly underestimated.”underestimated.”

(Hare, 2003, p. 62)(Hare, 2003, p. 62)

Performance of Sex Offenders Performance of Sex Offenders Following ReleaseFollowing Release

Porter, Ten Brinke, & Wilson, in Porter, Ten Brinke, & Wilson, in presspress

Porter et al., in pressPorter et al., in press

310 Male offenders: PCL-R310 Male offenders: PCL-R non-sexualnon-sexual sexual: child molesters, rapists, mixedsexual: child molesters, rapists, mixed

PCL-R predicted nonviolent and violent PCL-R predicted nonviolent and violent offenses, but not sexual offensesoffenses, but not sexual offenses

Porter et al., in pressPorter et al., in press

But among child molesters, high PCL-R scores But among child molesters, high PCL-R scores predictive of sex offensespredictive of sex offenses

Overall, psychopaths (PCL-R of 30 or more) 2 ½ Overall, psychopaths (PCL-R of 30 or more) 2 ½ times more likely to receive parole than other times more likely to receive parole than other offendersoffenders

They also manage to remain out of prison They also manage to remain out of prison following release for about half as long as other following release for about half as long as other offendersoffenders

Adjusting Violence Risk Adjusting Violence Risk Assessments for Age or Passage of Assessments for Age or Passage of

TimeTimeHarris & Rice, 2007Harris & Rice, 2007

Harris & RiceHarris & Rice

3 studies to determine if age at release is 3 studies to determine if age at release is a factor in risk for violencea factor in risk for violence

Over 1300 violent offendersOver 1300 violent offenders

VRAG, PCL-R, RRASOR, Static 99VRAG, PCL-R, RRASOR, Static 99

Age at release: Age at release: 10% over 50, 3% over 6010% over 50, 3% over 60


““Without doubt, age at release and the amount Without doubt, age at release and the amount an offender has aged must be better indexes of an offender has aged must be better indexes of the dynamic effects of aging than age at index the dynamic effects of aging than age at index offense.”offense.”

But not so.But not so. Age at 1Age at 1stst offence consistently better predictor offence consistently better predictor

of violence than age at releaseof violence than age at release


We suggest that these results imply the We suggest that these results imply the dynamic effects of aging are quite small (and dynamic effects of aging are quite small (and perhaps negligibleperhaps negligible) in comparison to the static ) in comparison to the static effects of enduring antisocial proclivityeffects of enduring antisocial proclivity


This proclivity is well-measured byThis proclivity is well-measured by the PCL-Rthe PCL-R PCL-R strongly correlated with age at 1PCL-R strongly correlated with age at 1stst

offenceoffence

PCL-R was as predictive of violence PCL-R was as predictive of violence at age 50+ at age 50+ as at younger agesas at younger ages

Behavioral GeneticsBehavioral Genetics

Blonigen, Carlson, Krueger, & Patrick, Blonigen, Carlson, Krueger, & Patrick, Personality and Individual DifferencesPersonality and Individual Differences, 2003, 35-, 2003, 35-179-197179-197

““Substantial evidence of genetic Substantial evidence of genetic contributions to variance in the contributions to variance in the personality construct of psychopathy.”personality construct of psychopathy.”

Blonigen, Hicks, Krueger, Patrick, & Iacono, Blonigen, Hicks, Krueger, Patrick, & Iacono, Psychological MedicinePsychological Medicine, 2005, 35, 1-12., 2005, 35, 1-12. ““The interpersonal-affective (Fearless The interpersonal-affective (Fearless

Dominance) and antisocial (Impulsive Dominance) and antisocial (Impulsive Antisociality) traits of psychopathy, …are Antisociality) traits of psychopathy, …are equally and substantially heritable with each equally and substantially heritable with each accounting for roughly half of the total accounting for roughly half of the total variance in both men and women.”variance in both men and women.”

Larrson, Andershed, & Lichstenstien, Larrson, Andershed, & Lichstenstien, Journal Journal of Abnormal Psychologyof Abnormal Psychology, 2006, 115, 221-230., 2006, 115, 221-230.

““A genetic factor explains most of the A genetic factor explains most of the variation in the psychopathic personality”variation in the psychopathic personality”

Behavioral GeneticsBehavioral Genetics

Viding, Blair, Moffitt, & Plomin (2005).Viding, Blair, Moffitt, & Plomin (2005). UK Twin study of 3687 7-year old twin pairsUK Twin study of 3687 7-year old twin pairs Rated by teachers and parents on items Rated by teachers and parents on items

similar to those on the similar to those on the APSDAPSD (Frick & Hare, (Frick & Hare, 2001)2001)

Assessed heritability:Assessed heritability:of antisocial behaviors; callous-emotional of antisocial behaviors; callous-emotional

traitstraits Concluded that genes account for 70% of Concluded that genes account for 70% of

the individual differences in callous-the individual differences in callous-unemotional traitsunemotional traits

““The core symptoms of psychopathy are The core symptoms of psychopathy are strongly genetically determined”strongly genetically determined”

Genetic contribution was highest when Genetic contribution was highest when callous-unemotional traits were callous-unemotional traits were combined combined with antisocial behaviorswith antisocial behaviors

OriginsOrigins

Behavioral geneticsBehavioral genetics Large-sample twin studiesLarge-sample twin studies

Evaluate heritability of traits that may be Evaluate heritability of traits that may be precursors to adolescent and adult psychopathyprecursors to adolescent and adult psychopathy

Referred to as Referred to as Callous-unemotional Callous-unemotional (CU) traits(CU) traits

General FindingsGeneral Findings

Consistent evidence of substantial heritability of Consistent evidence of substantial heritability of CU traitsCU traits

Common genetic factor may underlie CU traits Common genetic factor may underlie CU traits and antisocial behaviorsand antisocial behaviors

Williamson, Harpur, & Hare, 1991

• Words have both denotative (explicit, literal) and connotative (implicit, implied) meanings

• The impact of the affective connotations of words can be evaluated by recording:

− Lexical decision times− Brain activity associated with the decisions

−Event-related potentials (ERPs)

The Lexical Decision TaskThe Lexical Decision Task

The Lexical Decision TaskThe Lexical Decision Task

Neutral & emotional words, and pronounceable nonwords, briefly presented in random order on a

computer screen. e.g.,

RAPE

EPRA

TREE

ETER

“Press button as quickly as possible if you saw a word”

Reaction Time and Word Type

Williamson, Harpur, & Hare, 1991

Neutral Positive Negative700

750

800

850

900

950

Nonpsychopaths Psychopaths

msec

Emotionality of Words

Matching Emotional ToneMatching Emotional Tone

A man thrown overboard from a sinking shipA man thrown overboard from a sinking ship

1.1. A man running from a monsterA man running from a monster

2.2. A man surfing on a large waveA man surfing on a large wave

3.3. A woman standing on a yachtA woman standing on a yacht

4.4. A boy carrying a lamp into his roomA boy carrying a lamp into his room

(Hare, Williamson, et al., 1988; Williamson et al., 1991)(Hare, Williamson, et al., 1988; Williamson et al., 1991)

Matching Emotional Tone: Matching Emotional Tone: NonpsychopathsNonpsychopaths

A man thrown overboard from a sinking shipA man thrown overboard from a sinking ship

A man running from a monsterA man running from a monster

Matching Emotional Tone: Matching Emotional Tone: PsychopathsPsychopaths

A man thrown overboard from a sinking A man thrown overboard from a sinking shipship

A man surfing on a large waveA man surfing on a large wave

Rating MetaphorsRating Metaphors

6 Point Rating Scale6 Point Rating Scale

-3 Very Negative-3 Very Negative

+3 Very Positive+3 Very Positive

““Man is a worm that lives on the corpse of the Man is a worm that lives on the corpse of the earth”earth”

““Love is an antidote for the world’s ills”Love is an antidote for the world’s ills”

(Herve, Hayes, & Hare, in press)(Herve, Hayes, & Hare, in press)

Attributing EmotionsAttributing Emotions

Stories Design to Elicit EmotionsStories Design to Elicit Emotions

HappinessHappiness

SadnessSadness

EmbarrassmentEmbarrassment

GuiltGuilt

(Blair et al., 1995)(Blair et al., 1995)


No Differences Between Psychopaths & No Differences Between Psychopaths & NonPsychopathsNonPsychopaths

HappinessHappiness

SadnessSadness

EmbarrassedEmbarrassed


Differences in Psychopaths & NonpsychopathsDifferences in Psychopaths & Nonpsychopaths

Guilt StoriesGuilt Stories

PsychopathsPsychopaths

Little guilt to othersLittle guilt to others

Indifference or positive emotions, especially intentional Indifference or positive emotions, especially intentional harmharm

Happiness for intentional harmHappiness for intentional harm

Response to Acts of ViolenceResponse to Acts of Violence

Nonpsychopaths FeltNonpsychopaths Felt

AnxietyAnxiety

GuiltGuilt

FearFear

(Walsh, 1999)(Walsh, 1999)

Response to Acts of ViolenceResponse to Acts of Violence

Psychopaths FeltPsychopaths Felt

ExcitementExcitement

PowerPower

SatisfactionSatisfaction

JustificationJustification

Increased Self-EsteemIncreased Self-Esteem

(Walsh, 1999)(Walsh, 1999)

Institutional ViolenceInstitutional Violence

N = 728 MalesN = 728 Males

PCL-R ScorePCL-R Score No. with No. with InfractionsInfractions

>30>30 44%44%

<30<30 16%16%(Hare et al., 2000)(Hare et al., 2000)

Institutional Violence

Mean PCL-R score:• At least 1 infraction 19.2

• No infractions 14.6

• At least 1 violent infraction 21.0

• No violent infractions 13.6(Hare et al., 2000)

Functional DifferencesFunctional Differences

Some illustrations ofapplications of

cognitive/affective neuroscienceto the study of psychopathy

The major structures of the limbic system: amygdala, hippocampus, cingulate cortex, fornix, septum, mammillary body

Pinel, 2000

Pinel, 2000

Brain Imaging in PsychopathyBrain Imaging in PsychopathySPECT SPECT

single photon emission computed tomographysingle photon emission computed tomography(Intrator et al., 1997)(Intrator et al., 1997)

Substance abusersSubstance abusersLexical decision taskLexical decision taskAssessed with PCL-RAssessed with PCL-RNeutral & emotional wordsNeutral & emotional wordsRegional cerebral blood flow (rCBF)Regional cerebral blood flow (rCBF)Mid-ventricular slice: 50 mm above OM lineMid-ventricular slice: 50 mm above OM line

Nonpsychopath NeutralWords

Nonpsychopath Emotional Words

Psychopath NeutralWords

EmotionalWordsPsychopath

Note

Intrator et al., 1997• Psychopaths showed less anterior and more posterior activation during processing of neutral and emotional words

• Activation in psychopaths less widespread than in others

• Suggests superficial, localized processing, and little interaction among brain regions

• While processing emotional words psychopaths showed increased activity in areas related to linguistic processes

Functional Magnetic Resonance Imaging (fMRI)

• Blood Oxygen Level Dependent (BOLD) effect (Forster et al. 1998)

• Measures changes in blood flow during cognitive, emotional, behavioral tasks

• Research done at UBC• Bruce Foster, Peter Liddle, Kent Kiehl, Andra Smith, Kristin Laurens, Robert Hare

fMRI Study of Emotional WordsfMRI Study of Emotional Words

Kiehl, Smith, Hare, Mendrek, Forster, Kiehl, Smith, Hare, Mendrek, Forster, Brink, & Liddle, 2001Brink, & Liddle, 2001

fMRI Study of Emotional WordsfMRI Study of Emotional Words

Offenders brought from prison to universityOffenders brought from prison to universityPsychopaths and nonpsychopathic controlsPsychopaths and nonpsychopathic controls

Task involved memory for neutral and emotional Task involved memory for neutral and emotional wordswords

Images show areas where differences occurredImages show areas where differences occurred

Areas of Reduced Activation

Areas of Increased Activation

Anterior superior temporal gyrus

Müller et al., 2008Müller et al., 2008

Used structural MRI, event-related fMRI at same timeUsed structural MRI, event-related fMRI at same time Psychopaths showed:Psychopaths showed:

volume reductions in right superior temporal gyrus (STG)volume reductions in right superior temporal gyrus (STG) reduced event-related fMRI in STGreduced event-related fMRI in STG

Suggests disruption of Suggests disruption of frontotemporal integration frontotemporal integration in in high PCL-R high PCL-R

Poor cognitive-emotion integrationPoor cognitive-emotion integration

ConnectionsConnections

Differences only in RHDifferences only in RH Consistent with role of RH in executive Consistent with role of RH in executive

function & impulse control, and in affective function & impulse control, and in affective processesprocesses

““Taken together, our findings suggest that abnormal Taken together, our findings suggest that abnormal ‘connectivity’ in the amygdala–OFC limbic network ‘connectivity’ in the amygdala–OFC limbic network may contribute to the neurobiological mechanisms may contribute to the neurobiological mechanisms underpinning the impulsive, antisocial behaviour and underpinning the impulsive, antisocial behaviour and emotional detachment associated with psychopathy.”emotional detachment associated with psychopathy.”

Predicted by Kiehl, 2006; Kiehl et al., 2004Predicted by Kiehl, 2006; Kiehl et al., 2004

Newspaper Report, August 8, 2009

Neural Correlates of Moral Decision-Neural Correlates of Moral Decision-Making in PsychopathyMaking in Psychopathy

Glenn, Raine, & Schug, 2009Glenn, Raine, & Schug, 2009

Glenn et al., 2009Glenn et al., 2009 Reduced functioning in medial prefrontal cortex, Reduced functioning in medial prefrontal cortex,

posterior cingulate, and angular gyrus in individuals posterior cingulate, and angular gyrus in individuals high on the interpersonal factor of psychopathy may high on the interpersonal factor of psychopathy may indicate dysfunction of complex social processes indicate dysfunction of complex social processes important for interpersonal interactions central to important for interpersonal interactions central to behaving morally. behaving morally.

These regions have been found to be involved in These regions have been found to be involved in self-referential thinking, emotional perspective self-referential thinking, emotional perspective taking, recalling emotional experiences to guide taking, recalling emotional experiences to guide behavior, and integrating emotion into social behavior, and integrating emotion into social cognition. cognition.

Glenn et al., 2009Glenn et al., 2009

Dysfunction in these regions suggests failure to Dysfunction in these regions suggests failure to consider how one’s actions affect others, failure to consider how one’s actions affect others, failure to consider the emotional perspective of the harmed consider the emotional perspective of the harmed other, or a failure to integrate emotion into other, or a failure to integrate emotion into decision-making processes. decision-making processes.

Deeley et al., 2006Deeley et al., 2006 fMRI to emotional facesfMRI to emotional faces No group differences to happy faces. “In No group differences to happy faces. “In

contrast, when processing fearful faces contrast, when processing fearful faces compared with neutral faces, the control compared with neutral faces, the control group showed increased activation but the group showed increased activation but the psychopathy group decreased activation in psychopathy group decreased activation in the fusiform gyrus.”the fusiform gyrus.”

Fusiform gyrus:Fusiform gyrus: an an extrastriate visual cortical region extrastriate visual cortical region located in the inferior temporal lobe located in the inferior temporal lobe involved in involved in processing/identifying facesprocessing/identifying faces

Psychopathy and affective theory of Psychopathy and affective theory of mindmind

Shamay-Tsoory, Harari, Aharon-Peretz, Shamay-Tsoory, Harari, Aharon-Peretz, & Levkovitz, in press& Levkovitz, in press

Theory of MindTheory of Mind

Psychopathy: impaired recognition of affective Psychopathy: impaired recognition of affective state of othersstate of others

Theory of MindTheory of Mind Israeli criminals diagnosed with ASPDIsraeli criminals diagnosed with ASPD

SRP-II scaleSRP-II scale

ToM tasks : Inferences about others:ToM tasks : Inferences about others: CognitiveCognitive AffectiveAffective

Compared with:Compared with: Noncriminal controlsNoncriminal controls

Various patient groupsVarious patient groups

Theory of MindTheory of Mind

Theory of Mind (ToM):Theory of Mind (ToM): The capacity to make inferences The capacity to make inferences

regarding others’ mental states: their regarding others’ mental states: their knowledge, needs, intentions and beliefsknowledge, needs, intentions and beliefs

Hypothesis:Hypothesis: Psychopathy related to impairment only in Psychopathy related to impairment only in

emotional emotional aspects of ToM (affective ToM)aspects of ToM (affective ToM) associated with orbitofrontal (OFC) associated with orbitofrontal (OFC)

dysfunction.dysfunction.

Structural DifferencesStructural Differences

Psychopathy as a disorder of the moral Psychopathy as a disorder of the moral brain: Fronto-temporo-limbic grey matter brain: Fronto-temporo-limbic grey matter reductions demonstrated by voxel-based reductions demonstrated by voxel-based

morphometrymorphometry

de Oliveira-Souza, Hare, Bramati, Garrido, de Oliveira-Souza, Hare, Bramati, Garrido,

Ignácio, Tovar-Moll, & Moll, 2008Ignácio, Tovar-Moll, & Moll, 2008

Rio Structural Imaging StudyRio Structural Imaging Study

Civil psychiatric patients in Rio de JaneiroCivil psychiatric patients in Rio de Janeiro No criminal records but high PCL: SV scoresNo criminal records but high PCL: SV scores Control groupControl group

Grey matter reductions in patients with high PCL: SV Grey matter reductions in patients with high PCL: SV scoresscores Frontopolar cortexFrontopolar cortex Orbitofrontal cortexOrbitofrontal cortex Anterior temporal cortexAnterior temporal cortex Superior temporal sulcus regionSuperior temporal sulcus region InsulaInsula

ConclusionsConclusions

The pattern of grey matter reductions in The pattern of grey matter reductions in patients with high psychopathy scores patients with high psychopathy scores comprises a distributed comprises a distributed fronto-temporal fronto-temporal networknetwork that plays a critical role in moral that plays a critical role in moral sensibility and behaviorsensibility and behavior

““Abnormal temporal and prefrontal cortical Abnormal temporal and prefrontal cortical gray matter thinning ingray matter thinning in

psychopaths”psychopaths”

Yang, Raine, Colletti, Toga, & Narr, 2009Yang, Raine, Colletti, Toga, & Narr, 2009

Cortical ThinningCortical Thinning

Participants “recruited from the community”Participants “recruited from the community” 27 psychopaths27 psychopaths 32 nonpsychopaths32 nonpsychopaths

PCL-R; scores not provided for either groupPCL-R; scores not provided for either group

““Psychopaths showed significant cortical gray matter Psychopaths showed significant cortical gray matter thinning in the thinning in the rightright frontal and temporal cortices”frontal and temporal cortices”

Thinning significantly correlated with Thinning significantly correlated with AffectiveAffective factor, but factor, but not other PCL-R factorsnot other PCL-R factors

Cortical ThinningCortical Thinning

““Confirm(s) the contribution of structural Confirm(s) the contribution of structural impairments in psychopathy, and further indicates impairments in psychopathy, and further indicates that localized cortical thinning, especially in the right that localized cortical thinning, especially in the right medial temporal cortex, and to a lesser degree, in the medial temporal cortex, and to a lesser degree, in the right dorsolateral and ventromedial prefrontal cortices right dorsolateral and ventromedial prefrontal cortices may be linked to the emotional deficits in may be linked to the emotional deficits in psychopaths.”psychopaths.”

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