Triarchic conceptualization of psychopathy: Developmental ...

Triarchic conceptualization of psychopathy:Developmental origins of disinhibition,boldness, and meanness

CHRISTOPHER J. PATRICK,a DON C. FOWLES,b AND ROBERT F. KRUEGERc

aUniversity of Minnesota; bUniversity of Iowa; and cWashington University–St. Louis

Abstract

The clinical concept of psychopathy (“psychopathic personality”) is generally considered to entail persistent behavioraldeviancy in the company of emotional–interpersonal detachment. However, longstanding debates continue regardingthe appropriate scope and boundaries of the concept. Here, we review alternative historic descriptions of the disordertogether with empirical findings for the best-established assessment instruments in use with adolescents and youth asa basis for formulating an integrative, triarchic model of psychopathy. The essence of the triarchic model is thatpsychopathy encompasses three distinct phenotypic constructs: disinhibition, which reflects a general propensity towardproblems of impulse control; boldness, which is defined as the nexus of social dominance, emotional resiliency, andventuresomeness; and meanness, which is defined as aggressive resource seeking without regard for others (“dysaffliatedagency”). These differing phenotypic components are considered in terms of relevant etiologic and developmentalpathways. The triarchic conceptualization provides a basis for reconciling and accommodating alternative descriptiveaccounts of psychopathy, and a framework for coordinating research on neurobiological and developmental processescontributing to varying manifestations of the disorder.

Psychopathy, or psychopathic personality, re-fers to a pathologic syndrome involving prom-inent behavioral deviancy in the presence ofdistinctive emotional and interpersonal features.The phenomenon of psychopathy has been oflongstanding interest to psychological research-ers because it offers an intriguing referent for thestudy of basic affective and behavioral–controlprocesses (i.e., psychopathic individuals exhibitmarked deficits in inhibitory control and are the-orized to be deficient in basic emotional reactiv-ity). Psychopathy has also been of longstandinginterest to practitioners because of the importantimpact that psychopathic behavior has on soci-

ety as a whole (e.g., offenders diagnosed as psy-chopathic account for a disproportionate amountof criminal offending; in particular, violentcriminal offending). Especially for this latterreason, a great deal of attention has been devotedin recent years to how psychopathy develops andwhat can be done to prevent it. However, despitethe many years of study devoted to the topic andthe wealth of published research that exists on it(cf. Patrick, 2006), heated controversies are stillunderway regarding the appropriate definitionand scope of the psychopathy construct, andthe optimal means for assessing it (Cooke, Mi-chie, & Hart, 2006; Hare & Neumann, 2006;Skeem & Cooke, in press). The current reviewadvances a novel conceptualization of psychop-athy based on the central recurring themes evi-dent in historic and contemporary accounts ofthe disorder, and discusses how established con-cepts and empirical findings from the develop-mental literature can be applied to this concep-tualization.

Address correspondence and reprint requests to: Chris-topher J. Patrick, Department of Psychology, University ofMinnesota, Elliott Hall, 75 East River Road, Minneapolis,MN 55455. E-mail: [email protected].

Preparation of this article was supported by GrantsMH65137 and MH072850 from the National Institute ofMental Health and funds from the Hathaway Endowmentat the University of Minnesota.

Development and Psychopathology 21 (2009), 913–938Copyright # 2009 Cambridge University PressPrinted in the United States of Americadoi:10.1017/S0954579409000492

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The traditional counterpart to psychopathyin the general child psychopathology literature,preceding the introduction of specific inventor-ies for the assessment of psychopathy in youth,has been the concept of “externalizing” psycho-pathology (cf. Achenbach & Edelbrock, 1978).The phenomenon of psychopathy can be con-sidered distinct from the concept of externaliz-ing in that it entails a deficiency rather than anexcess of affective reactivity. That is, psychop-athy is distinguished from general externalizingby “emotional detachment,” which is a lack ofnormal emotional sensitivity and social related-ness (Cleckley, 1976; Lykken, 1995; McCord& McCord, 1964; Patrick, Bradley, & Lang,1993). From this perspective, understandingthe phenomenon of psychopathy requires eluci-dation of factors that give rise to disinhibitedbehavior in the company of emotional detach-ment (i.e., distinctive manifestations of exter-nalizing deviancy in which emotional detach-ment is salient).

Toward this end, considerable effort has beendevoted over the past 15 years to the study ofpsychopathy in childhood and adolescence. Themajor focus of work in this area has been on so-called “downward extensions” of the adult psy-chopathy construct (e.g., Forth, Kosson, & Hare,1996; Frick & Hare, 2001; Lynam, 1997). Thiswork has yielded important advances, but un-certainties remain regarding what psychopathyin youth entails, how it should be measured,and how it intersects with normal and abnormaldevelopment. We argue that work in this areacan be advanced by conceptualizing psychopathyin terms of more elemental phenotypic constructswith clearer psychological and neurobiologicalreferents. Further, we believe that progress inthis area can be advanced by considering howestablished concepts and findings from the gen-eral developmental literature with potential rele-vance to these key phenotypic constructs can be“upwardly extended” to inform the psychopathyliterature.

Thus, one objective of the current review isto describe contemporary research pertainingto the assessment of psychopathy in adults aswell as youth as a basis for defining core pheno-typic constructs of disinhibition, boldness, andmeanness. A second major objective is to dis-cuss how established concepts and findings

from the general developmental literature canbe tied to these core phenotypic constructs.

Historical Perspectives on Psychopathy

Early accounts of the syndrome of psychopathyassigned prominent emphasis to violent and an-tisocial behavior, presumably owing to the sa-lience of such behavior in otherwise rational-appearing individuals. Explosive, impulsive,reckless, and irresponsible actions, which wereoften accompanied by alcohol or drug problems(e.g., Partridge, 1928a, 1928b; Prichard, 1835)and sometimes by suicidal behavior (e.g., Par-tridge, 1928a; Pinel, 1962), emerged repeatedlyas themes. As described further below, thesefeatures reflect the disinhibitory (Gorenstein& Newman, 1980) or externalizing (Kruegeret al., 2002; Patrick, Hicks, Krueger, & Lang,2005) component of psychopathy included inmodern conceptualizations. For Pinel (1962),explosive violence (“abstract and sanguinaryfury”) was the most salient clinical feature. Par-tridge’s (1928a, 1928b) description of the “so-ciopathic” individual in particular emphasizedtendencies toward emotional instability, feel-ings of inadequacy or inferiority, alienation,and angry aggression. This pattern of emotionalvolatility and impulsive–reactive violence ap-pears characteristic of high externalizing indi-viduals (cf. Patrick & Bernat, 2009) rather thanindividuals who would be considered psycho-pathic according to contemporary definitions.

A second set of attributes emphasized in theseearly accounts, which appears somewhat at oddswith the features just mentioned, consists ofcharm, self-assurance, interpersonal dominance,attention seeking, persuasiveness, and affectiveshallowness. For example, a subgroup labeled“swindlers” by Kraepelin (1904) were character-ized as glib and charming but lacking in basicmorality or loyalty to others; they typically spe-cialized in fraudulence and con artistry and in-variably accumulated large debts that went un-paid. “Self-seeking” psychopaths as describedby Schneider (1934) were described as pleasantand affable, but egocentric, demanding of atten-tion, and superficial in their emotional reactionsand their relations with others. Like Kraepelin’sswindlers, Schneider’s self-seeking types werepathologically deceitful and prone to fraudulent

C. J. Patrick, D. C. Fowles, and R. F. Krueger914

behavior. As described below, this set of featureswas central to Cleckley’s (1976) conception ofpsychopathic personality.

A third prominent emphasis in early histori-cal accounts consists of features relating to bru-tality, emotional coldness, and callous exploi-tation of others. For example, one of threeillustrative cases presented by Pinel (1962) wascharacterized as efficacious and successful in hisfinancial dealings but self-centered and viciouslyantagonistic in his interactions with others.Rush (1812) emphasized cruelty and vicious-ness in his account of the psychopath and pos-ited that a deep-rooted “moral depravity” layat the core of the disorder. Schneider’s (1934)“active affectionless” type was characterizedas unscrupulous, cold, and unfeeling. Schnei-der attributed these tendencies, which he sawas emerging early in life, to a core deficit inemotional sensitivity rather than to a weaknessin moral judgment.

Cleckley’s classic treatise The Mask of Sanity(1976) served as the foundation for modern con-ceptualizations and measures of psychopathy.Central to Cleckley’s account, which was basedon his direct experiences with psychopathicindividuals in a large inpatient psychiatric facil-ity, was the idea that psychopathy entails the pre-sence of severe underlying pathology maskedby an outward appearance of robust mentalhealth. In contrast with other psychiatric patientswho present as irrational, agitated, dysphoric,socially withdrawn, or otherwise disturbed, psy-chopaths impress as confident, personable, andpsychologically well adjusted on first contact.It is only through continued observation acrossa range of settings that the psychopath’s under-lying pathology reveals itself. To provide a basisfor diagnostic clarity and specificity, Cleckleyset forth a list of 16 specific criteria for the dis-order, which can be grouped into three categor-ies (Patrick, 2006): (a) positive adjustment indi-cators (good intelligence and social adeptness,absence of delusions or irrationality, absenceof nervousness, and low incidence of suicide);(b) behavioral deviance indicators (“unreliabil-ity,” i.e., irresponsibility, sexual promiscuity,impulsive antisocial acts, failure to learn fromexperience, absence of any clear life plan, andenhanced recklessness when intoxicated); and(c) indicators of emotional unresponsiveness

and impaired social relatedness (lack of remorseor shame, poverty in affective reactions, ego-centricity and inability to love, deceitfulnessand insincerity, absence of loyalty, and deficientinsight).

Notably, Cleckley (1976) did not describepsychopathic patients as antagonistic, violent,or cruel, and few (only 3 of 15) of his clinicalcase examples showed strong indications ofinterpersonal aggressiveness. Indeed, Cleckleymaintained that the characteristic emotional unre-sponsiveness of psychopaths mitigates againstangry, vengeful reactions. Furthermore, Cleck-ley’s concept of psychopathy extended beyondindividuals who engaged repeatedly in antisocialacts that caused them problems. Cleckley alsodescribed examples of “successful psychopaths”who established careers as physicians, scholars,or businessmen. His perspective on the etiologyof psychopathy was that it reflected a deep-rootedimpairment in emotional processing akin to se-mantic aphasia (in the realm of language pro-cessing) or colorblindness (in the realm of percep-tual processing; cf. Maudsley, 1874). From thisperspective, it was the occurrence of this coreunderlying impairment that defined the presenceof the disorder, as opposed to a particular overt be-havioral expression.

However, in contrast, other writers of Cleck-ley’s time concerned with psychopathy in crim-inal offender samples presented a somewhatdifferent picture of the disorder. McCord andMcCord’s (1964) volume The Psychopath: AnEssay on the Criminal Mind emphasized fea-tures of emotional coldness, social detachment,and dangerousness, along with behavioral dis-inhibition. Like Cleckley, McCord and McCordconsidered psychopaths to be deficient in anxi-ety and emotional responsiveness. However, intheir view, these affective impairments werea reflection of profound social disconnected-ness (“lovelessness” and “guiltlessness”) ratherthan of a global deficit in affective-motivationalcapacity. In particular, McCord and McCordmaintained that psychopathic individuals, lack-ing in social conscience and inhibitions againstaggression, characteristically responded withrage as opposed to fear in frustrating or threaten-ing situations. Thus, in contrast with Cleckley,who described psychopathic inpatients as neither“deeply vicious” nor “volcanically explosive,”

Triarchic conceptualization of psychopathy 915

McCord and McCord characterized psychopathiccriminals as cold, vicious, and predatory.

Writers of Cleckley’s era concerned with psy-chopathy in criminal samples also highlightedcruelty and aggressiveness as features. Lindner(1944) characterized criminal psychopaths astruculent and antagonistic. Craft (1966) iden-tified a “vicious” criminal psychopathic subtype,whom he described as “affectionless, impulsive,and persistently aggressive.” (p. 212). Robins(1966, 1978) likewise emphasized early and per-sistent aggressive antisociality in her empiricalaccounts of maladjusted youth who developedinto adult “sociopaths.” Robins’ work served asthe cornerstone for the modern notion of antiso-cial personality disorder (APD) included in thethird and fourth editions of the Diagnostic andStatistical Manual of Mental Disorders (DSM-III, DSM-IV; American Psychiatric Association,1980, 2000), which emphasizes aggression, de-structiveness, and other forms of delinquencyin childhood and behavioral evidence of impul-sivity, deception, recklessness, aggressiveness,and criminal deviancy in adulthood.

In terms of core phenotypic constructs dis-cussed in detail below, Cleckley and his con-temporaries similarly highlighted disinhibition(proneness to externalizing behavior) in theiraccounts of psychopathy, but differed in theemphasis they assigned to boldness versusmeanness in conceptualizing the disorder. Themost obvious explanation for this difference isthat Cleckley’s psychopathic case examplesconsisted of psychiatric inpatients rather thanincarcerated criminal offenders. The antisocialacts they perpetrated were generally of a lesser,nonviolent nature and appeared irrational (“un-motivated”) in ways suggestive of an underly-ing mental disorder. In addition, Cleckley’spatients tended to come from higher rather thanlower socioeconomic backgrounds and in manycases possessed familial and other sources ofsocial support that buffered them against legalconsequences. In contrast, writers of Cleckley’stime concerned with youthful and adult crim-inals sought to delineate a specific subgroup whoseantisocial deviancy was distinguished by itsamorality, severity, persistence, and recalcitranceto treatment. Individuals of this kind were no-table for their aggressiveness, emotional cold-ness, indifference to the feelings and welfare of

others, and predatory victimization. They tendedto come from impoverished, abusive back-grounds (e.g., McCord and McCord identifiedparental abuse and neglect as distinctively patho-genic for criminal psychopathy) and engaged inserious forms of antisocial behavior that pro-voked harsh legal penalties.

Summary

Differing conceptualizations of psychopathy areevident in historic accounts of the disorder. Oneperspective, advanced by Cleckley in his accountof hospital inpatients considered to be psycho-pathic, portrays the disorder as a paradoxicalcondition in which an outward veneer of positiveadjustment (absence of obvious mental distur-bance, high social efficacy, emotional resiliency)masks a severe underlying pathology manifestedby persistent impulsive, irresponsible behaviorwithout regard for consequences to oneself orothers. As discussed in the next section, this con-ceptualization appears to be operationalized lesseffectively by assessment instruments that indexpsychopathy as a putatively unitary (unidimen-sional) construct, and more effectively by instru-ments that measure psychopathy in terms of sepa-rate components. In contrast with this, the othermajor perspective evident in historic writings isof psychopathy as a distinctly affectionless andpredatory form of criminal deviancy (cf. McCord& McCord, 1964). In contrast with Cleckley’sportrayal of psychopathic patients as personableand ostensibly well meaning but feckless and un-trustworthy, this latter perspective conceptualizespsychopathic individuals as cold, abrasive, andaggressively exploitative in their interactionswith others. As discussed in the next sectionbelow, contemporary clinical diagnostic instru-ments for the assessment of psychopathy in youthand adults reflect this conceptualization of psy-chopathy more so. Assessment instruments ofthis kind, although designed to assess psychop-athy as a unitary construct, nonetheless evidencedistinguishable affective–interpersonal and be-havioral deviance factors.

Contemporary Approaches toConceptualizing and Assessing Psychopathy

Table 1 provides a summary of major currentinventories for the assessment of psychopathy


in adult and youthful participant samples. Rel-evant empirical findings for each are reviewedbelow.

Psychopathy in adult offender samples

Currently, the dominant instrument for assess-ing psychopathy in adult criminal offendersamples is Hare’s (2003) Psychopathy Check-list—Revised (PCL-R). Before the PCL-Rwas developed, Hare’s empirical research em-ployed a global rating approach in which a diag-nostic rating from 1 to 7 was assigned to indi-cate the participant’s degree of resemblance toCleckley’s description of the prototypic psy-chopath (1¼ clearly nonpsychopathic, 7¼ def-initely psychopathic). The original PCL, whichconsisted of 22 items, was developed to clarifyand systematize the assessment of psychopathyin correctional and forensic samples based onCleckley’s conceptualization. The items of thePCL were distilled from a larger candidatepool by selecting those that best discriminated

between high versus low scorers on the 1–7Cleckley Global Scale. Two items were omittedfrom the revised version (Hare, 1991, 2003) andthe scoring criteria for the remaining 20 itemswere modified in various ways. Regarding theitem content of the PCL-R, the affective–inter-personal and behavioral maladjustment featuresdescribed by Cleckley are well represented.However, the positive adjustment features arenot. In particular, absence of nervousness/neu-roticism is not part of the PCL-R, nor is “ab-sence of delusions or irrationality” or immunityto suicide. Further, although ostensibly similarto Cleckley’s “superficial charm and good in-telligence,” “glibness and superficial charm”in the PCL-R (Item 1) is defined in a more de-viant manner, that is, reflecting an excessivelytalkative, slick, and insincere demeanor.

Patrick (2006) attributed this omission of pos-itive adjustment indicators to the strategy thatwas used to select items for the original PCL.Items were chosen to index psychopathy as a uni-tary construct in criminal offenders using overall

Table 1. Summary of inventories for the assessment of psychopathy in differing participantsamples

Sample/Inventory Rating Format Total Items Facets/Factors Assessed

AdultsCriminal

PCL-R Inteviewer 20 Interpersonal, affective, lifestyle,antisocial

NoncriminalPPI Self-report 187 Fearless dominance, impulsive

antisocialityYouth

DelinquentPCL:YV Interviewer 18 Interpersonal, affective, lifestyle,

antisocialAPSD Parent/teacher a 20 Impulsive/conduct problems,b

callous–unemotionalCPS Parent/teacher a 41 Affective–interpersonal,

behavioral devianceNondelinquent

YPI Self-report 53 Grandiose–manipulative,callous–unemotional,impulsive–irresponsible

Note: PCL-R, Psychopathy Checklist—Revised (Hare, 2003); PPI, Psychopathic Personality Inventory (Lilienfeld & An-drews, 1996); PCL:YV, Psychopathy Checklist: Youth Version (Forth et al., 2003); APSD, Antisocial Process ScreeningDevice (Frick & Hare, 2001); CPS, Child Psychopathy Scale (Lynam, 1997); YPI, Youth Psychopathic Traits Inventory(Andershed et al., 2002).aSelf-report version available also.bSeparates into distinct “impulsive” and “narcissistic” subfactors in some work (e.g., Frick, Boden, & Barry, 2000).


Cleckley prototype ratings as the criterion, anditems were retained that demonstrated high inter-nal consistency with one another as well as effec-tive discrimination between low and high Cleck-ley groups (Hare, 1980). Because more ofCleckley’s criteria reflect deviancy (12 of 16)as opposed to positive adjustment (4 of 16)and because participants in the PCL develop-ment sample were criminals rather than non-incarcerated patients or nonpatients, it seemslikely that the initial candidate pool includedmany more deviance-related items, such thatpositive adjustment indicators dropped out inthe selection process. The result is that thePCL-R, compared with Cleckley’s original di-agnostic criteria, contains items that are uni-formly indicative of deviancy and psychologi-cal maladjustment. In addition, the overallscores on the PCL-R show robust positive rela-tions with varying measures of deviancy andmaladjustment including extent and severity ofcriminal acts, antagonism and aggression, andalcohol and drug problems, but negligible asso-ciations with measures of positive adjustmentsuch as verbal ability, anxiousness, internaliz-ing symptoms, and suicide immunity (Hall,Benning, & Patrick, 2004; Hare, 2003; Lynam& Derefinko, 2006; Smith & Newman, 1990;Verona, Patrick, & Joiner, 2001).

However, despite the fact that the PCL-Rwas developed to index psychopathy as a uni-tary syndrome, factor analytic and correla-tional-validation research indicates that it none-theless taps distinguishable component factors.The best-known structural model of the PCL-Ris the two-factor model (Harpur, Hakstian, &Hare, 1988; Hare et al., 1990), in which Factor1 encompasses the interpersonal and affectivefeatures of psychopathy and Factor 2 encom-passes the antisocial deviancy features. How-ever, Cooke and Michie (2001) proposed an al-ternative three-factor model in which Factor 1 isparsed into two components (“arrogant and de-ceitful interpersonal style,” marked by charm,grandiosity, deceitfulness, and manipulation;and “deficient affective experience,” consistingof absence of remorse, callousness, shallow af-fect, and failure to accept responsibility) andFactor 2 is pared down to an “impulsive–irre-sponsible behavioral style” factor consistingof five items (boredom proneness, parasitism,

impulsivity, irresponsibility, and absence ofgoals) considered to reflect underlying traitsas opposed to behavioral outcomes associatedwith those traits. In addition, Hare and Neu-mann (2006) advanced a four-factor model inwhich Factor 1 is parsed into two “facets” mirror-ing Cooke and Michie’s interpersonal and affec-tive factors, and Factor 2 is divided into a “life-style” facet identical to Cooke and Michie’simpulsive–irresponsible factor and an “antisocial”factor encompassing aggressiveness, early behav-ior problems, juvenile delinquency, revocation ofconditional release, and criminal versatility.

Reflecting the unitary conception of psy-chopathy that guided the PCL-R’s develop-ment, constituent factors within each of thesefactor models show moderate (�.5) correlationswith one another. Nonetheless, these separablefactors also show diverging relations with var-ious external criterion measures. In the two-factor model, high scores on Factor 1 are associ-ated with higher scores on indices of selfishnessand exploitativeness such as narcissism andMachiavellianism (Harpur, Hare, & Hakstian,1989; Hare, 1991; Verona et al., 2001), height-ened use of proactive (instrumental/premedi-tated) aggression (Patrick & Zempolich, 1998;Porter & Woodworth, 2006), and lower scoreson measures of empathy (Hare, 2003). In addi-tion, scores on Factor 1 (in particular, the var-iance in Factor 1 that is unrelated to Factor 2)show some relationship with adaptive tenden-cies. For example, Factor 1 shows positive cor-relations with measures of social dominance(Hare, 1991; Harpur et al., 1989; Verona et al.,2001) and negative correlations with measuresof fearfulness, distress/anxiety, and depression(Harpur et al., 1989; Hicks & Patrick, 2006).Evidence of diminished physiological respon-siveness to fearful and aversive stimuli hasalso been reported specifically in relation toFactor 1 of the PCL-R (cf. Patrick, 1994,2007). In contrast, Factor 2 of the PCL-R showsselective positive relations with trait measuresof aggression, impulsivity, and general sensa-tion seeking (Harpur et al., 1989; Hare, 1991),as well as child symptoms of DSM APD, andis correlated to a markedly higher degree thanFactor 1 with adult APD symptoms and vari-ables reflecting frequency and severity of crim-inal offending (Hare, 2003; Verona et al., 2001).


In contrast with Factor 1, Factor 2 is associatedmore with angry-reactive forms of aggression(Patrick & Zempolich, 1998; Porter & Wood-worth, 2006). Factor 2 also shows robust positiveassociations with measures of alcohol and drugdependence, whereas Factor 1 shows negligiblerelations (Hare, 2003; Smith & Newman, 1990).

Studies of the external correlates of compo-nents of the PCL-R identified by the three- andfour-factor models have also begun to appear.Skeem, Mulvey, and Grisso (2003) reportedthat the impulsive–irresponsible (“Lifestyle”)factor was most related to overall frequencyand severity of criminal offending, incidenceof property crimes, and substance-related disor-ders. The Affective factor was most related tohistoric and future violence and crimes againstpeople, and the Interpersonal factor was associ-ated to a lesser degree with past and future crim-inal deviancy than either the Affective or Life-style factors. Hall et al. (2004) reported that theInterpersonal factor accounted for aforemen-tioned associations between PCL-R Factor 1and measures of social efficacy and emotionalresilience. The unique variance in the Interper-sonal factor (i.e., that unrelated to the Affectiveand Lifestyle factors) was associated positivelywith five-factor model (FFM) extraversion,openness, and conscientiousness, and nega-tively with FFM neuroticism. This factor alsoshowed distinctive positive associations withverbal intelligence and personal and parentalsocioeconomic status. In contrast, scores onthe Lifestyle factor showed selective relationswith varying measures of externalizing de-viancy and maladjustment including traits ofimpulsivity, sensation seeking (disinhibitionand boredom facets, in particular), anger, alie-nation, high neuroticism and dysphoria/dis-tress, and low conscientiousness and achieve-ment motivation; fighting in childhood andadulthood; drug and alcohol problems; andlow personal socioeconomic status. ReplicatingSkeem et al. (2003), scores on the Affective fac-tor were associated selectively with violentcriminal offending (including incidence of as-sault, weapons possession, kidnapping, andmurder). The most salient personality correlatesof this factor were aggressiveness, low agree-ableness, and low affiliation (low social close-ness/communality). Scores on this factor also

predicted a reduced incidence of specific fears.The antisocial facet of the PCL-R (cf. Hare &Neumann, 2006), although generally parallel-ing the lifestyle facet in its associations with cri-terion measures, showed higher correlationswith aggression-related than impulsivity-re-lated personality traits and stronger associationswith violent criminal charges. In other workwith female offenders, Verona, Hicks, and Pat-rick (2005) reported the antisocial and (to alesser degree) lifestyle facets of the PCL-R tobe positively associated with past suicidal at-tempts, whereas the interpersonal facet showeda selective negative association with suicidality.Similar results were reported by Douglas et al.(2008) for a male offender sample.

Summary. Hare’s PCL-R was developed to as-sess the syndrome of psychopathy as describedby Cleckley in adult criminal offender samples.The development strategy for the PCL-R em-phasized measurement of psychopathy as a uni-tary construct, resulting in a generally interre-lated set of behavioral indicators. Nonetheless,factor analyses of the PCL-R items indicatethe presence of distinctive (albeit correlated) af-fective–interpersonal and behavioral deviancefactors. In terms of concepts discussed below,the item content of the PCL-R appears to tapdisinhibition and meanness primarily, andboldness only secondarily. In particular, thepositive adjustment features of psychopathyemphasized by Cleckley (e.g., absence of psy-chotic symptoms; lack of anxiety or nervous-ness; immunity to suicide) are weakly repre-sented in the PCL-R.

The meanness and disinhibition componentsof psychopathy (preferentially reflected in Fac-tors 1 and 2 of the PCL-R, respectively) areimportant to distinguish because research on psy-chopathy in youth (cf. Frick & Marsee, 2006;Frick & Morris, 2004; see below) indicates thatthese components have different etiologic sub-strates, with the former theorized to derive (atleast in part) from diminished fear capacity, andthe latter from impairments in inhibitory control.

Psychopathy in adult noncriminal samples

To date, only a few studies have been conductedin which adults from the community have been


assessed for psychopathy using clinical diag-nostic procedures (Ishikawa, Raine, Lencz,Bihrle, & lacasse, 2001; Raine et al., 2004; Van-man, Mejia, Dawson, Schell, & Raine, 2003;Widom, 1977). However, participants identifiedas psychopathic in these studies evidenced highlevels of antisocial deviancy and thus couldmore accurately be labeled “subclinical” than“noncriminal” or “successful” (cf. Hall & Ben-ning, 2006). Some other published studieshave assessed psychopathy in student (e.g.,Forth et al., 1996), civil psychiatric (e.g., Skeem,Miller, Mulvey, Tiemann, & Monahan, 2005),or at-risk community samples (e.g., Farringtonet al., 2006) using a screening version of thePCL-R (PCL:SV; Hart, Cox, & Hare, 1995).However, the range of PCL:SV scores in generalcommunity samples tends to be highly restricted,and concerns have been raised regarding the sen-sitivity of PCL-based ratings for assessing corefeatures of psychopathy in nonincarcerated indi-viduals, particularly in view of the strong em-phasis on criminal deviancy in the scoring ofmost PCL items (Skeem & Cooke, in press; Wi-diger, 2006; see also Widiger et al., 1996).

The other major assessment approach that hasbeen used to identify psychopathic individualsin nonincarcerated adult samples is self-report.A variety of self-report measures have been de-veloped and utilized over the years (Lilienfeld& Fowler, 2006), but for the most part these in-dex mainly the antisocial deviance (Factor 2)component of psychopathy (Hare, 1991, 2003;Harpur et al., 1989; Lilienfeld & Fowler,2006). A notable exception is the PsychopathicPersonality Inventory (PPI; Lilienfeld & An-drews, 1996; Lilienfeld & Widows, 2005), whichwas developed to assess psychopathy as de-scribed by Cleckley in nonincarcerated samples.Unlike the PCL-R, the PPI was not developedto index psychopathy as a unitary construct. In-stead, an inclusive personality-based approachwas taken with the aim of capturing the fullspectrum of trait constructs embodied in Cleck-ley’s description. Eight unidimensional sub-scales were developed to assess these varyingconstructs, and exploratory factor analyses ofthese subscales have revealed two distincthigher order factors (Benning, Patrick, Hicks,Blonigen, & Krueger, 2003; Benning, Patrick,Salekin, & Leistico, 2005; Ross, Benning, Pat-

rick, Thompson, & Thurston, 2009). Social po-tency, stress immunity, and fearlessness sub-scales load preferentially on one factor (PPI-I),and impulsive nonconformity, blame externali-zation, Machiavellian egocentricity, and care-free nonplanfulness subscales load on a secondfactor (PPI-II). Benning, Patrick, Blonigen,Hicks, and Iacono (2005) labeled these factorsfearless dominance and impulsive antisociality.Unlike PCL-R Factors 1 and 2, which are mod-erately correlated, the two higher order factorsof the PPI are uncorrelated. The eighth PPI sub-scale, coldheartedness (reflecting low senti-mentality and imaginative capacity, and low re-sponsiveness to others’ distress), does not loadappreciably on either PPI factor but instead de-fines a separate factor in an expanded three-fac-tor solution (Benning et al., 2003).

Like the two PCL-R factors, the higher orderfactors of the PPI show meaningful, diverging re-lations with a variety of external criterion vari-ables (Benning et al., 2003; Benning, Patirck,Bloigen, et al., 2005; Benning, Patrick, Salekin,et al., 2005; Blonigen et al., 2005; Douglaset al., 2008; Patrick, Edens, Poythress, & Lilien-feld, 2006; Ross et al., 2009). In general, the cor-relates of PPI Factors 1 and 2 mirror those of theunique variance in PCL-R Factor 1 (its interper-sonal component, in particular) and of Factor 2,respectively. That is, high scores on PPI-I are as-sociated with positive psychological and socialadjustment as well as with tendencies toward nar-cissism, thrill seeking, and low empathy, whereasscores on PPI-II are more generally indicative ofpsychological and behavioral maladjustment, in-cluding impulsivityand aggressiveness, child andadult antisocial behavior, alcohol and drug prob-lems, high anxiousness and somatic complaints,and suicidal ideation. The two higher orderfactors of the PPI, despite their independencefrom one another and differential relations withexternal criteria, show comparable robust asso-ciations with scores on Miller, Lynam, Widiger,and Leukefild’s (2001) FFM personality-basedpsychopathy prototype (Ross et al., 2009), indi-cating that the PPI factors capture differing ele-ments of the prototypic psychopath defined interms of FFM constructs: PPI-I is associatedwith low neuroticism (N) and agreeableness (A)and high extraversion (E) and openness (O);PPI-II is associated with high N, low A, and


low conscientiousness (C). Notably, the cold-heartedness subscale of the PPI (which, as men-tioned, is relatively independent of PPI-I and II)also evinces a robust positive association withFFM prototype scores, the basis of the associa-tion being low N, low E, low A, and low O (Rosset al., 2009).

Despite showing parallel associations withcriterion measures, the two factors of the PPIdiffer in essential ways from PCL-R Factors 1and 2 (e.g., they are assessed via self-report vs.clinical rating; they are uncorrelated vs. moder-ately correlated; they show stronger, more direct,i.e., zero order, associations with adjustment-related variables), and direct comparisons ofthe PPI and PCL-R factors have revealed onlymodest and somewhat asymmetric correspon-dence. PPI-I is related mainly to the interper-sonal component of the PCL-R, to a modest de-gree (r � .3; Benning, Patrick, Blonigen, et al.,2005). Scores on PPI-II show a somewhatstronger relationship to PCL-R Factor 2 scoresas a whole (r � .4; Benning, Patrick, Blonigen,et al., 2005). Regarding the PPI Coldhearted-ness scale, which as noted appears to tap some-thing distinct from PPI-I and II, available dataindicate that this scale shows moderate andmodest associations (.37 and .21), respectively,with PCL-R Factors 1 and 2 (Poythress, Edens,& Lilienfeld, 1998).

Summary. Historically, measures of psychopa-thy developed for use in adult nonoffender sam-ples have focused mainly on the salient behav-ioral deviancy component of the syndrome(Lilienfeld & Fowler, 2006). A notable exceptionis the PPI, which was designed to comprehen-sively assess trait constructs embodied in Cleck-ley’s descriptive account of the disorder. In con-trast with the PCL-R, the subscales of the PPIwere developed without assuming or requiringcoherence around a unitary higher order con-struct. Consistent with Cleckley’s portrayal ofpsychopathy as a configuration of disparate ten-dencies, structural analyses of the PPI subscalesreveal two broad, largely uncorrelated factors:one reflecting social efficacy, imperturbability,and tolerance of danger, and the other reflectingimpulsivity, rebelliousness, alienation, and ag-gression. In terms of concepts discussed below,PPI-I (the Fearless Dominance factor) predomi-

nantly reflects boldness, whereas PPI-II (the Im-pulsive Antisociality factor) reflects disinhibitionand to a lesser extent meanness. An eighth PPIsubscale, Coldheartedness, does not load prefer-entially on either of these broad factors; this sub-scale can be viewed as tapping elements of mean-ness not captured by PPI-II (i.e., elementsreflecting a lack of empathic concern).

The boldness component of psychopathy,which is tapped weakly and incompletely bythe items of the PCL-R, is important to distin-guish in turn from the meanness component,which is well represented in the PCL-R. Onereason is that the distinction between boldnessand meanness is crucial to reconciling Cleck-ley’s conception of psychopathy with that ad-vanced by more criminologically oriented theor-ists (e.g., McCord & McCord, 1964; Robins,1966). Another is that boldness, although phe-notypically distinct from meanness, appears toshare a key etiologic substrate (i.e., diminishedfear capacity). This raises the important devel-opmental question, discussed in the last majorsection below, of what intersecting etiologic fac-tors give rise to meanness as opposed to bold-ness in temperamentally fearless individuals.Yet another reason is that the construct of bold-ness is likely to be of unique importance in un-derstanding so-called “successful psychopaths”:individuals exhibiting high levels of charm, per-suasiveness, imperturbability, and venturesome-ness who achieve success in society as military,political, or corporate-industrial leaders (cf.Lykken, 1995).

Psychopathy in conduct-disordered youth

Historically, research on psychopathy in child-hood and adolescence (e.g., Robins, 1966,1978) has emphasized the behavioral deviance(externalizing) features of psychopathy more sothan the core affective–interpersonal features.However, researchers over the past 15 yearshave devoted systematic effort to indexing thesecore features in order to identify a distinct sub-group of conduct-disordered youth who qualifyas psychopathic. Much of this work has em-ployed youth-adapted versions (or “downwardextensions”; Salekin, 2006) of Hare’s PCL-R.The earliest of these was the PCL Youth Ver-sion (PCL:YV; Forth, Brown, Hart, & Hare,


2003; Forth et al., 1996), a modified 18-itemvariant of the PCL-R developed for use withadolescent offenders ages 13–18. Researchfindings to date indicate that the PCL:YVlargely parallels the PCL-R in terms of its factorstructure and associations with external criter-ion measures (Forth et al., 2003).

Frick and colleagues (Frick & Hare, 2001;Frick, O’Brien, Wooten, & McBurnett, 1994)developed the Antisocial Process Screening De-vice (APSD) to assess psychopathic tendenciesin younger children (ages 6–13 years) with con-duct problems. The APSD consists of a 20-itemrating scale completed by parents or teachers. (Anewer self-report version for use with adoles-cents aged 13–18 is also available; Loney,Frick, Clements, Ellis, & Kerlin, 2003.) Itsitem content was patterned after the PCL-Rwith the goal of representing all features of psy-chopathy embodied in the PCL-R that could beassessed meaningfully in children (Frick et al.,1994). An initial structural analysis of the itemsof the APSD (Frick et al., 1994) revealed twodistinctive factors: an Impulsive/Conduct Prob-lems (I/CP) factor reflecting impulsiveness, be-havioral deviancy, and inflated self-importance;and a Callous–Unemotional (CU) factor reflect-ing tendencies toward emotional insensitivityand interpersonal callousness. Scores on thesetwo factors were correlated moderately (.5). Sub-sequent work by Frick, Boden, and Barry (2000)suggested that the I/CP factor could be parsed intodistinctive “impulsive” (e.g., bored easily, actswithout thinking, fails to plan) and “narcissistic”(e.g., high self-importance, brags, uses/cons oth-ers) subfactors.

An extensive literature has accumulated re-garding psychological and behavioral differ-ences between impulsive conduct-disordered(i.e., high I/CP) children exhibiting low versushigh levels of CU tendencies (for recent re-views, see Frick & Dickens, 2006; Frick &Marsee, 2006; Frick & White, 2008). Com-pared with nonclinic control children and highCU clinic-referred youth, high I/CP childrenwith low levels of CU features show evidenceof intellectual (in particular, verbal IQ) impair-ment and difficulty in regulating their emotions(e.g., enhanced reactivity to negative emotionalstimuli of varying types and higher reportedlevels of trait anxiety). In addition, they are

prone to reactive (angry–impulsive) aggression,but not proactive (instrumental–strategic) ag-gression. By comparison, children high in CUas well as I/CP tendencies score lower on self-report measures of anxiety and neuroticism,are attracted to activities entailing novelty andrisk, show reduced behavioral responsivenessto threatening or affectively distressing stimuliof various types, and exhibit impairments inpassive avoidance learning (i.e., reduced abilityto inhibit behavior that results in punishment).In addition, compared with control children,high CU conduct-problem children exhibithigh levels of proactive as well as reactive ag-gression. Relatedly, there is evidence that thepresence of CU traits prospectively predicts la-ter incidence of aggression and violence overand above I/CP tendencies (Frick, Stickle, Dan-dreaux, Frrrell, & Kimonis, 2005).

A third approach to capturing the PCL-Rconcept of psychopathy in youth with conductproblems is that of Lynam and colleagues. Ly-nam’s (1997) Child Psychopathy Scale (CPS)was developed by identifying items from twoestablished child behavior problem inventoriesthat appeared to tap features similar to itemsof Hare’s PCL-R. Item analytic procedureswere used to narrow these candidate indicatorsdown to a set of 41 that provided coverage of 13of the 20 PCL-R items with high internal con-sistency. A factor analysis of these items inthe CPS development sample (430 boys fromthe Pittsburgh youth study, a cohort that in-cluded a high proportion of individuals at riskfor delinquency; Lynam, 1997) revealed evi-dence of two distinguishable item subsets thatparalleled the affective–interpersonal and be-havioral deviance factors of the PCL-R. How-ever, in contrast with the PCL-R factors whichare correlated only moderately (�.5), the twofactors of the CPS were correlated very highly(r ¼ .95).

Lynam (1997) reported that high overallscores on the CPS distinguished a subgroupof stable, seriously delinquent boys. OverallCPS scores were associated positively withscores on various self-report, other-report, andbehavioral measures of impulsivity, and withself- and teacher-reported levels of aggression,delinquency, and externalizing problems. In ad-dition, controlling for levels of externalizing


psychopathology, higher scores on the CPSwere associated with lower levels of anxiety,withdrawal, and internalizing problems. Morerecently, Lynam et al. (2005) examined rela-tions of self- and mother-reported scores on arevised 55-item version of the CPS with FFMpersonality traits. The two factors of the revisedCPS were not so highly interrelated in this studysample (which consisted of two separate co-horts from the Pittsburgh Youth Study), andthus correlations were reported separately forCPS factor scores (affective–interpersonal, be-havioral deviance) and total scores. Overallscores on the CPS (whether based on self- ormother report) showed marked negative associa-tions with FFM A and C, and modest positive andnegative associations, respectively, with N andopenness. In one of the two study cohorts, overallCPS scores based on mother report showed a sig-nificant negative association with extraversion(E). In addition, hierarchical regression analysesrevealed that, across informants and cohorts,the unique variance in the affective–interpersonalfactor of the CPS (i.e., that unrelated to the behav-ioral deviance factor) was associated negativelywith A and (consistently, but to a lesser degree)N. In contrast, the unique variance in the antiso-cial deviance factor of the CPS was associatedpositively with N, and negatively with C and(consistently, but to a lesser degree) A.

Summary. The best-known inventories for as-sessing psychopathic tendencies in childrenand adolescents (PCL:YV, APSD, CPS) wereconstructed to emulate the item content of thePCL-R. Like the PCL-R, these youth-orientedpsychopathy inventories appear to tap con-structs of disinhibition and meanness primarily,with limited representation of boldness; thesame can be said of the self-report based YouthPsychopathy inventory, described in the nextsubsection. The growing literature on distinctexternal correlates of the Fearless Dominancefactor of the PPI (PPI-I), which include aspectsof positive adjustment (e.g., reduced incidenceof internalizing disorders and suicidal behav-ior) as well as deviancy (e.g., narcissism, thrillseeking, and deficient empathic concern), pointto assessment of dispositional boldness as a ripearea of opportunity in the child psychopathyliterature. Some key questions of interest that

might be addressed through the constructionof developmentally appropriate measures ofboldness are: what factors early in life contrib-ute to the emergence of dispositional boldnessversus meanness in temperamentally fearlessindividuals? What developmental interplay ex-ists between each of these distinct phenotypicstyles and disinhibitory (externalizing) tenden-cies? What moderating factors contribute tosuccessful versus unsuccessful outcomes inhigh bold individuals? Is there a late-onsetform of persistent criminality associated selec-tively with high dispositional boldness?

The youth psychopathy measure that hasbeen investigated most extensively to date, theAPSD, includes distinguishable I/CP and CUfactors. Youth high on both of these factorsshow reduced emotional reactivity, greaterphysical daring, and high levels of proactive ag-gression compared with youth who score highon the I/CP factor alone. As discussed in thenext major section below, the unique variancein the CU factor of the APSD can be conceptu-alized as tapping meanness, whereas the I/CPfactor can be considered an index of generaldisinhibition. The final major section considersdevelopmental–etiologic processes that giverise to these two distinctive components of psy-chopathy, along with factors that may contrib-ute distinctively to the boldness component.

Psychopathy in nondelinquent youth

As is true of research to date on psychopathyin adults, the study of psychopathy in childrenand adolescents has focused predominantly onindividuals with conduct problems, and the phe-nomenon of psychopathy in nondelinquent youthremains understudied. An inventory developedquite recently for assessing psychopathic tenden-cies in nondelinquent as well as delinquent youthis the 50-item, self-report based Youth Psycho-pathic Traits Inventory (YPI; Andershed, Kerr,Stattin, & Levander, 2002). The item content ofthe YPI was designed to capture the coherent traitdomains represented in Cooke and Michie’s(2001) three-factor model of the PCL-R: arro-gant–deceitful interpersonal style, deficient af-fective experience, and impulsive–irresponsiblebehavior. Like the items of the PCL-R, the itemsof the YPI are largely indicative of deviancy (i.e.,


dishonesty, grandiosity, lying, manipulation; cal-lousness, unemotionality, remorselessness; im-pulsivity, thrill seeking, irresponsibility), withfactor analysis revealing distinct but moderatelyinterrelated interpersonal (“grandiose–manipula-tive”), affective (“callous–unemotional”), andbehavioral (“impulsive–irresponsible”) factors(Andershed et al., 2002). An initial investigationof nondelinquent youth revealed significant asso-ciations for all three YPI factors with various cri-terion measures of externalizing deviancy. Re-search with clinic-referred youth (Andershed,Hodgins, & Tengstrom, 2007) has demonstratedmoderate statistical convergence between the fac-tors of the YPI and the corresponding factors ofthe PCL:YV. Other work with delinquent youth(Poythress, Dembo, Wareham, & Greenbaum,2006) has replicated the finding of robust associa-tions for all three YPI factors with measures ofexternalizing deviancy. Paralleling results forthe PCL-R (Hicks & Patrick, 2006), this workalso revealed evidence of suppressor effects forthe interpersonal (and to a lesser degree, affec-tive) factor of the YPI in relations with internal-izing problems.

Conceptual integration

The PCL-R, which was developed to assesspsychopathy as a unitary construct in criminaloffender samples, indexes a distinctly differentphenotypic variant of psychopathy than thatemphasized by Cleckley in his clinical descrip-tions of psychopathic hospital inpatients (cf.Patrick, 2006). High scores on the PCL-R as awhole are associated with aggressive external-izing tendencies including low FFM agree-ableness (high antagonism), low affiliation/communality, low empathy, Machiavellianism,impulsive sensation seeking, and persistent vio-lent offending (Hare, 2003; Harpur et al., 1989;Lynam & Derefinko, 2006; Verona et al.,2001). This descriptive picture is more in linewith the conception of criminal psychopathyadvanced by Cleckley’s contemporaries thanwith Cleckley’s own portrayal of psychopathicinpatients as charming ne’er-do-wells whoharm others incidentally rather than deliber-ately. At the same time, factor analytic studiesindicate that the PCL-R item set taps distin-guishable interpersonal, affective, and impul-

sive–irresponsible components (Cooke & Mi-chie, 2001; Hare & Neumann, 2006; Patrick,Hicks, Nichol, & Krueger, 2007) that exhibitdiverging relations with external criterionvariables.1 The unique variance in the interper-sonal component (that associated with the“glibness/charm” and “grandiose self-worth”items in particular; Patrick et al., 2007) appearsto capture some of the adaptive elementsof psychopathy emphasized by Cleckley. Fur-thermore, subtyping studies (Hicks, Markon,Patrick, Krueger, & Newman, 2004; Skeem,Johansson, Andershed, Kerr, Eno, & Louden,2007) have revealed that high PCL-R scorerscomprise two distinct subgroups: a (smaller)low anxious, surgent subgroup akin to the typedescribed by Cleckley and a (larger) aggres-sive, unconstrained, socially detached subgroupmore akin to that described by McCord andMcCord.

The best-known instruments for assessingpsychopathy in children and adolescents, whichwere devised for use with adjudicated and clinic-referred populations, were constructed to mirrorthe item coverage of the PCL-R. Accordingly,overall scores on these inventories appear totap the same aggressive–externalizing variantof psychopathy indexed by overall scores onthe PCL-R. Again, however, these instrumentscontain distinctive subsets of items that exhibitdiverging relations with external criterion mea-sures. The child psychopathy inventory thathas been studied most extensively in terms ofits distinctive factors is Frick’s APSD. Whereasthe I/CP factor of the APSD (paralleling Factor 2of the PCL-R; Patrick et al., 2005) appears to in-dex general externalizing tendencies, the CUfactor is associated uniquely with a lack of anx-iety and negative emotional reactivity and withventuresomeness, thrill seeking, and use of pro-active (strategic, goal-oriented) aggression. Inaddition, research with the APSD has reliablydemonstrated that conduct problem childrenwith high levels of CU traits are less responsive

1. Items associated with the antisocial component of thePCL-R included in Hare and Neumann’s (2006) four-factor model appear to tap the broad aggressive–external-izing dimension underlying the PCL-R as a whole, asopposed to a distinctive subdimension (Patrick et al.,2007).


to treatment and more likely to persist in theirdeviant behavior; in particular, behavior entail-ing violence toward others (Frick & Dickens,2006). Based on the emotional and behavioralcorrelates of the CU factor, Frick and colleagueshave postulated that this phenotypic componentof child psychopathy reflects the pathologic ex-pression of an underlying fearless temperament.

In contrast with the PCL-R and its youth-adapted variants, the PPI, which was developedto comprehensively assess trait constructs em-bodied in Cleckley’s conceptualization, indexespsychopathy in terms of two orthogonal higherorder factors: one reflecting social dominance,stress immunity, and fearlessness, and the otherreflecting externalizing deviancy. As discussedin the next section below, the first PPI factor ap-pears to reflect a purer, more benign expression ofunderlying temperamental fearlessness (termed“boldness”) than Factor 1 of the PCL-R or theCU factor of the APSD, which can be viewedas tapping “meanness” more so than boldness.The construct of boldness indexed by PPI-I islikely to be particularly relevant to the conceptu-alizationandmeasurementofpsychopathy innon-criminal samples, including identification of indi-viduals with psychopathic tendencies who ascendto positions of leadership and influence in society(cf. Cleckley, 1976; Lykken, 1995).

Distinct Phenotypic Components ofPsychopathy: Disinhibition, Boldness,and Meanness

The foregoing review of historic and contempo-rary efforts to conceptualize the syndrome ofpsychopathy reveals three prominent recurringthemes, which for ease of reference can be desig-nated disinhibition, boldness, and meanness.Consideration of the broader personality, psy-chopathology, and neurobiological literatures in-dicates that these three constructs, although inter-related at some levels empirically and in terms oftheir mutual connections with the phenomenonof psychopathy, have distinctive phenotypic iden-tities and can be conceptualized, measured, andunderstood separately. Our view is that thesethree phenotypic constructs represent the keyto understanding psychopathy in its varyingmanifestations: criminal and noncriminal, pri-mary, and secondary (cf. Karpman, 1941; Lykken,

1957, 1995; Skeem et al., 2007), stable and ag-gressive (Hicks et al., 2004), unsuccessful andsuccessful (Hall & Benning, 2006). Below, weconsider each of these key constructs in turn.

Disinhibition

The term “disinhibition” is used here to describea general phenotypic propensity toward impulsecontrol problems entailing a lack of planfulnessand foresight, impaired regulation of affect andurges, insistence on immediate gratification,and deficient behavioral restraint. Related con-cepts include externalizing (Achenbach & Edel-brock, 1978; Krueger et al., 2002), disinhibitorypsychopathology (Gorenstein& Newman, 1980;Sher & Trull, 1994), and low inhibitory control(Kochanska, Murray, and Coy, 1997).2 In per-sonality terms, disinhibition can be viewed asthe nexus of impulsivity and negative affectivity(Krueger, 1999a; Sher & Trull, 1994). Promi-nent behavioral manifestations of disinhibitioninclude irresponsibility, impatience, impulsiveaction leading to negative consequences, aliena-tion and distrust, aggressive acting out (in partic-ular, angry–reactive aggression), untrustworthi-ness, proneness to drug and alcohol problems,and engagement in illicit or other norm-violatingactivities (Krueger, Markon, Patrick, Benning, &Kramer, 2007).

Historic conceptualizations of psychopathyhave emphasized this externalizing componentto varying degrees, and to an important extent,differences of opinion regarding the appropriatedefinition and boundaries of the psychopathyconstruct can be traced to this component. Exter-nalizing encompasses a broad range of patho-logic behavioral phenomena including child con-duct problems, adult criminal deviance, angryaggression, and addictive behaviors of varyingsorts (Krueger et al., 2002, 2007; Young, Stal-lings, Corley, Krauter, & Hewitt, 2000). Somehistoric writers defined psychopathy broadly to

2. The term disinhibition as used here differs from Kagan’s(1994) conception of disinhibited temperament in children,which connotes a lack of timidity in novel situations and isassociated prospectively with a reduced incidence of anxi-ety-related problems (Kagan & Snidman, 1999). This con-ception is more similar to the construct of boldness de-scribed here.


include substance-related addictions and othernonnormative behaviors (e.g., sexual deviancyof varying kinds) that intersect with the exter-nalizing spectrum (e.g., Prichard, 1835); otherwriters characterized psychopathy in terms thatappear more applicable to externalizing indi-viduals (e.g., Arieti, 1963, 1967; Partridge,1928a, 1928b); and others described subtypesof psychopaths who would more aptly beclassified as high externalizers (e.g., Craft,1966; Kraepelin, 1915). The traditional notionof the “symptomatic” or secondary psychopath(Karpman, 1941; Lykken, 1957) appears consis-tent with the clinical presentation of the highexternalizing individual. Contemporary researchdemonstrates that the distinct variance asso-ciated with the antisocial deviance (Factor 2)component of the PCL-R largely reflects theexternalizing factor (Patrick et al., 2005) andthe impulsive antisociality component of thePPI (PPI-II) exhibits a robust genetic associationwith scores on the externalizing factor (Blonigenet al., 2005). Based on its known correlates, theI/CP component of Frick and Hare’s (2001)APSD also appears to index the externalizingfactor.

However, contemporary researchers in thefield would generally not view disinhibition orexternalizing as equivalent to psychopathy. Inparticular, as mentioned, externalizing is associ-ated with heightened negative affectivity as op-posed to an absence of anxiety or fear. Highexternalizing is also associated with an in-creased rather than reduced incidence of inter-nalizing (anxiety, mood) problems in childhoodand adulthood (Achenbach & Edelbrock, 1978;Krueger, 1999b) and with a higher rather thanlower incidence of suicidal behavior in adultoffenders and community participants (Verona& Patrick, 2000; Verona, Sachs-Ericsson, &Joiner, 2004). It is when externalizing tenden-cies are coupled with dispositional boldness ormeanness that a diagnosis of psychopathywould be considered applicable.

Boldness

The term bold is used here to describe a pheno-typic style entailing a capacity to remain calmand focused in situations involving pressure orthreat, an ability to recover quickly from stress-

ful events, high self-assurance and social effi-cacy, and a tolerance for unfamiliarity and dan-ger. Terms related to boldness include fearlessdominance (Benning, Patrick, Blonigen, et al.,2005), daringness, audacity, indomitability, re-siliency (Block & Block, 1980), and hardiness(Kobasa, 1979). In personality terms, boldnesscan be viewed as the nexus of social dominance,low stress reactivity, and thrill–adventure seek-ing (Benning et al., 2003; Benning, Patrick, Blo-nigen, et al., 2005). Prominent behavioral man-ifestations of boldness include imperturbability,social poise, assertiveness and persuasiveness,bravery, and venturesomeness.

As used here, boldness is not consideredsynonymous with the term “fearless.” Rather,fearlessness is conceptualized as an underlyingconstitutionally based (genotypic) dispositionentailing reduced sensitivityof the brain’s defen-sive motivational system to cues signaling threator punishment (Fowles & Dindo, 2006; Patrick& Bernat, 2006, in press). Boldness is one wayin which genotypic fearlessness can be ex-pressed phenotypically. However, as discussedin the next subsection, genotypic fearlessnessmay also contribute to phenotypic meanness.Cleckley’s conceptualization of psychopathyemphasized phenotypic boldness together withdisinhibitory (externalizing) tendencies. Bold-ness was evident in his case descriptions and di-agnostic criteria in terms of poise and high socialefficacy, absence of anxiety or neurotic symp-toms, diminished emotional responsiveness, im-perviousness to punishment (“failure to learn byexperience”), and low suicidality. Other historicwriters concerned with psychopathy in psychiat-ric patients as opposed to criminal samples (e.g.,Kraepelin, Schneider) also identified bold exter-nalizing types. More contemporaneously, fear-lessness, and unresponsiveness to punishmentcues were emphasized prominently in Hare’s clas-sic psychophysiological studies of the 1960s and1970s (cf. Hare, 1978) in influential theories ofpsychopathy advanced by Fowles (1980) andLykken (1995).

Lilienfeld’s self-report PPI, which was de-veloped to index traits embodied in Cleckley’sconception, includes a broad factor (PPI-I) thatdirectly reflects the construct of boldness. Thesubscales that define this factor are stress immu-nity, social potency, and (to a lesser degree)


fearlessness.3 Notably, this factor of the PPI isuncorrelated with tendencies toward impulsiveantisocial deviance tapped by PPI-II. In this re-spect, the construct of boldness tapped by PPI-Ican be viewed as indexing a more benign ex-pression of dispositional fearlessness: one thatis phenotypically distinct from aggressive ex-ternalizing deviance and likely of importanceto conceptualizing psychopathy in nonviolent,noncriminal samples (cf. Lykken, 1995). Theconstruct of boldness also appears to be tappedsomewhat by Factor 1 of the PCL-R (Benning,Patrick, Blonigen, et al., 2005), in particular, byitems comprising its interpersonal facet, mostnotably Items 1 (charm/glibness) and 2 (gran-diose sense of self-worth; Patrick et al., 2007).However, the PCL-R interpersonal facet over-laps with the PCL-R’s Affective, Lifestyle, andAntisocial facets, indicating that the PCL-R in-dexes the construct of boldness less directlyand less distinctively than the PPI-I. As de-scribed next, Factor 1 of the PCL-R as a whole ap-pears to index meanness more so than boldness.

Meanness

The term mean describes a constellation ofphenotypic attributes including deficient empa-thy, disdain for and lack of close attachmentswith others, rebelliousness, excitement seeking,exploitativeness, and empowerment throughcruelty. Terms related to meanness include cal-lousness (Frick et al., 1994), coldheartedness(Lilienfeld & Widows, 2005), and antagonism(Lynam & Derefinko, 2006). With respect to ba-sic dimensions of interpersonal behavior (Leary,1957; Wiggins, 1982), meanness can be viewedas occupying a position midway between (high)dominance and (low) affiliation (Blackburn,

2006; Harpur et al., 1989). Consistent with this,Saucier (1992) identified a construct akin tomeanness (represented by adjective descriptorssuch as rough, tough, unemotional, and insensi-tive) as the nexus of high dominance, low af-filiation, and low neuroticism (high emotionalstability); notably, this configuration of traitsmirrors the FFM correlates of PPI coldhearted-ness, which include low A, low E, and low N(as well as low O; Ross et al., 2009). Fromthis perspective, meanness can be viewed asagentic disaffiliation, which is a motivationalstyle in which pleasure and satisfaction are ac-tively sought without regard for and at the ex-pense of others (cf. Schneider’s, 1934, “activeaffectionless” type). In contrast with socialwithdrawal, which entails passive disengage-ment from others (“moving away from people”;Horney, 1945), meanness entails active exploi-tativeness and confrontation (“moving againstpeople”; Horney, 1945). Characteristic behav-ioral manifestations include arrogance and ver-bal derisiveness, defiance of authority, lack ofclose personal relationships, aggressive com-petitiveness, physical cruelty toward people andanimals, predatory (proactive, premeditated)aggression, strategic exploitation of others forgain, and excitement seeking through destruc-tiveness.

The notion of meanness is central to concep-tions of psychopathy in criminal and delinquentsamples. McCord and McCord (1964) identifiedlovelessness and guiltlessness as central to crim-inal psychopathy. Quay (1964) listed lack ofconcern for others, an absence of normal affec-tional bonds, and destructive and assaultive be-havior as characteristic features of psychopathy(later dubbed “undersocialized aggressive delin-quency”; Quay, 1986) in juvenile offenders. Theaffective facet of Hare’s PCL-R consists of itemsthat cover McCord and McCord’s lovelessness(Item 7, “shallow affect,” which includes refer-ence to a lack of genuine attachments/love rela-tionships with others; and Item 8, “callous/lackof empathy,” which encompasses cruel/sadistictreatment of others, contemptuousness, and de-structiveness) and guiltlessness (Item 6, “lackof remorse or guilt,” and Item 16, “failure to ac-cept responsibility for own actions”). Notably,the interpersonal items of the PCL-R also in-clude elements of meanness in their definitions:

3. In addition to loading to a lesser degree than either stressimmunity or social potency on PPI-I, the fearlessnesssubscale of the PPI also cross-loads reliably on PPI-II.The likely explanation appears to be that PPI fearless-ness contains variance related to boredom susceptibilityand disinhibition facets of sensation seeking, as well asthrill–adventure seeking and experience-seeking facets(cf. Zuckerman, 1979); the thrill–adventure seekingcomponent of PPI fearlessness in particular accountsfor its association with PPI-I, whereas the boredom sus-ceptibility and disinhibition components account for itsassociation with PPI-II (cf. Benning, Patrick, Blonigen,et al., 2005).


Item 1 (“glibness and superficial charm”) in-cludes reference to excessive slickness and is as-signed a score of 1 (out of 2) in cases where theexaminee exhibits a “macho” or “tough guy” de-meanor; Item 2 (grandiose sense of self-worth)includes reference to arrogance and a sense ofsuperiority over others; the criteria for Item 4( pathological lying) describe an individualwho is routinely deceptive in interpersonal inter-actions and who enjoys deceiving others; Item 5(conning/manipulative) refers to predatory ex-ploitation of others for personal gain withoutconcern for the welfare of victims. The best-known instruments for assessing psychopathyin youth (PCL:YV, CPS, and APSD) were mod-eled after the PCL-R and likewise emphasizemeanness (social and emotional detachment,callousness, and exploitativeness) in their affec-tive–interpersonal items.

A key question is whether meanness can bemeasured separately from criminal or antisocialbehavior. In the case of the PCL-R, a hierarchical(bifactor) analysis revealed that the majority ofits items are primarily indicators of a generaloverarching factor that reflects aggressive exter-nalizing deviancy (Patrick et al., 2007). Thestrongest and purest indicators of this factorwere items reflecting aggressive criminal behav-ior (i.e., items associated with the antisocialfacet of the PCL-R): early behavioral problems,poor behavioral controls, criminal versatility,and juvenile delinquency. In addition, most ofthe affective and interpersonal items of thePCL-R also loaded appreciably on this generalfactor with two of four items from each facetloading more strongly on the general factorthan on distinguishable affective or interpersonalsubfactors. Specifically, the pathological lyingand conning/manipulative items loaded morestrongly on the general factor than on the inter-personal subfactor (on which glibness/charmand grandiosity showed their primary loadings),and the shallow affect and callous/lack of empa-thy items loaded more strongly on the generalfactor than on the affective subfactor (on whichlack of remorse and failure to accept responsibil-ity showed their primary loadings). As noted ear-lier, the heavy saturation of most PCL-R itemswith externalizing deviancy reflects the factthat the scoring criteria for most of its items in-clude reference to antisocial behavior.

However, recent research on the scope andstructure of the externalizing spectrum suggeststhat the meanness component of psychopathycan be disaggregated from its disinhibitory (ex-ternalizing) component. Specifically, using datacollected across multiple iterative waves fromsamples including male and female prisoners aswell as nonincarcerated men and women, Krue-ger et al. (2007) developed self-report scales tocomprehensively index the domain of externaliz-ing problems and traits in terms of elemental con-structs. Unidimensional scales were developed tomeasure 23 separate constructs including: vary-ing facets of impulsivity, differing forms of ag-gression (physical–reactive, relational–proactive,and destructive), irresponsibility, rebelliousness,excitement seeking, blame externalization, andalcohol, drug, and marijuana use/problems. Con-firmatory factor analyses of these 23 scalesyielded evidence of a superordinate factor (exter-nalizing) on which all subscales loaded substan-tially (.45 or higher), and two subordinate factorsthat accounted for residual variance in particularsubscales. The strongest and purest indicators ofthe overarching externalizing factor were scalesindexing irresponsibility and problematic impul-sivity (i.e., proneness to impulsive acts resultingin harm to oneself or others). One of the two sub-ordinate factors was defined by residual variancein subscales measuring callousness, aggression(relational/proactive and destructive, in particular;physical/reactive aggression loaded more sub-stantially on the superordinate externalizing fac-tor), excitement seeking, rebelliousness, and(low) honesty. The other subfactor was definedby residual variance in subscales indexing alco-hol/drug use and substance-related problems. Itis important to note that the variance definingeach of these subfactors consisted of variance incommon among specific scales that was unrelated(orthogonal) to the broad externalizing factor.

These findings indicate that a separate pro-pensity entailing low empathy and stimulation-seeking tendencies, distinguishable from thegeneral externalizing factor, contributes inde-pendently to aggressive behavior, particularlyaggression that involves instrumental coercionand abuse of others. Other variables that loadedto some extent on this callous–aggression sub-factor included dishonesty and rebelliousness.Notably, these indicator variables closely parallel


the item content and known correlates of the CUfactor of the APSD. Specifically, (a) the items ofthe APSD CU factor reflect lack of concern forthe feelings of others, disregard for formal re-sponsibilities (schoolwork), shallow affect andinsincerity, lack of guilt, and lying/conning(Frick et al., 1994); and (b) among youth exhibit-ing symptoms of conduct disorder (CD), thosehigh in CU traits show increased levels of proac-tive aggression (along with comparable levels ofreactive aggression) and enhanced thrill-seekingtendencies compared with those low in CU traits(Frick & Dickens, 2006; Frick & White, 2008).

In turn, the known external correlates of theAPSD CU factor point to low dispositional fearas one contributor to phenotypic meanness.Specifically, as noted earlier, higher scores onthis factor of the APSD are associated withlower scores on measures of anxiety and neurot-icism, diminished responsiveness to threateningand affectively distressing stimuli, and height-ened tolerance of unfamiliarity and risk (Blair,2006; Frick & Dickens, 2006; Frick & White,2008; Marsh et al., 2008). However, to the ex-tent that meanness constitutes a phenotypic ex-pression of underlying fearlessness, it is a ma-lignant expression of low fear in comparisonwith boldness.

Established Developmental ConstructsRelevant to an Understanding of TheseDistinctive Psychopathy Components

As suggested above, it is potentially valuable toexamine established concepts and findingsfrom the developmental psychopathology litera-ture that bear on the phenotypic constructs of dis-inhibition, boldness, and meanness. In so doing,one must expect complexity rather than simplerelationships. The constructs of equifinality andmultifinality (Cicchetti & Rogosch, 1996), fun-damental to developmental psychopathology,underscore that multiple pathways lead to a givenphenotype (equifinality) and that early etiologi-cal risk factors interact with other influences incomplex causal chains to yield varied pheno-types (multifinality) (e.g., Hinshaw, 2008). Sim-ilarly, etiological pathways involve a host ofcomplex mechanisms such as gene–environmentinteractions, gene–gene interactions, reciprocalor mutually interactive individual–environment

processes, gene–environment correlations, ge-netic and environmental influences on gene ex-pression, genetic effects on environments, andenvironmental influences on brain development(plasticity), making it more appropriate to thinkin terms of risk factors than causal factors andto expect modest contributions from any givenrisk factor (Hinshaw, 2008; Rutter, 2006).

An important context for this literature isMoffitt and Lynam’s (e.g., Moffitt, 1993; Ly-nam, 1998; Moffitt & Lynam, 1994) distinctionbetween early-onset and adolescent-onset anti-social behavior in which early onset is associ-ated with a risk of life-course persistent antiso-cial behavior, including some individuals whomeet adult criteria for psychopathy. The early-onset trajectory involves oppositional defiantdisorder that “matures” into CD around age10 and is associated with comorbid attention-deficit/hyperactivity disorder (ADHD) involv-ing hyperactivity (i.e., not the predominantlyinattentive subtype). One very large and onesmaller literature attempts to articulate two tem-perament-based pathways to severe conductproblems in children. Frick and Morris (2004)provide a comprehensive review of these litera-tures, and the current summary is adapted fromtheir review unless otherwise noted. The largerliterature encompasses the notion of “difficulttemperament” in infants, and somewhat interre-lated developmental concepts of “failure of se-cure attachment” and “coercive exchanges.”These concepts, discussed in the first subsec-tion below, appear most relevant to phenotypicconstructs of disinhibition and meanness. Thesmaller, more recent literature focuses on dispo-sitional fearlessness as a pathway to psycho-pathy. This concept appears most relevant to phe-notypic constructs of boldness and meanness.

Factors contributing to disinhibition andmeanness

Difficult temperament. The developmental con-cept of “difficult temperament” is a complexone involving high negative affect and irritabil-ity, high activity, withdrawal from novel stim-uli, poor performance where sustained attentionis required, and difficulty adapting to changesin the environment, characteristics found to beassociated with a risk of conduct problems


that begin early in childhood with a risk of life-long antisocial behavior. Frick and Morris(2004) suggest that the intense negative emo-tional reactions of anger and frustration arethe core risk factor, consistent with the clinicalpicture of irritability, low tolerance for frustra-tion, and angry outbursts in oppositional defiantdisorder, the early childhood syndrome associ-ated with a high risk of early onset conductproblems and chronic antisocial behavior. Al-most by definition, these excessive negativeemotional reactions point to difficulties in emo-tion regulation, or more specifically regulationof anger. The development of emotion regula-tion abilities involves both child characteristicsand the efforts of parents and other socializingagents to help the child learn to manage emo-tions (e.g., Cole & Hall, 2008; Frick & Morris,2004; Thompson, 2001).

An important, relatively recent distinction be-tween automatic and effortful dimensions of emo-tional responsiveness is important to appreciatingthe multiple influences on emotion regulation.Automatic reactivity refers to involuntary or pas-sive reactions to emotional stimuli with separatedimensions for reactions to cues for positive (re-wards) and negative (punishment, threateningemotional stimuli) events. Effortful or voluntarycontrol refers to inhibiting dominant or prepotentbehavioral and emotional responses and to direct-ing attention in adaptive ways in order to regulatebehavior and emotions. Given that effortful con-trol helps to inhibit a tendency to strong automaticnegative reactivity, both dimensions are relevantto emotion regulation. The most severe difficulttemperament will involve a combination of strongautomatic negative reactivity with weak effortfulcontrol. The separate assessment of automatic andeffortful responsiveness is not well developed,although Frick and Morris offer suggestionsas to how to achieve it. Because effortful controlstrategies often are seen as components of thebroader concept of executive functions, it is notclear whether difficulty in regulating anger andhostility is the core risk factor for conduct prob-lems or whether a broader deficit in executivefunctions is the critical risk factor.

The deficit in emotion regulation increases therisk of conduct problems in a variety of ways: in-terfering with the acquisition of appropriate so-cial cognitions and behavior, increasing peer re-

jection with subsequent reduction in positivesocializing experiences and increased deviantpeer association, facilitating the development ofreactive aggression regarding peers, producingexcessively strong negative affect to punishmentthat undermines the efficacy of skilled maternalgentle discipline, and increasing the probabilityof mutually coercive exchanges with parents.Thus, difficult temperament involving poor emo-tion regulation and/or poor executive functions(attributes embodied in the construct of disinhibi-tion) increases the risk of severe antisocial behav-ior and aversive interactions with caretakers andpeers, setting the child on a pathway that may de-velop into behavior that meets the criteria for psy-chopathy as defined by the PCL-R in adulthood.

Failure of secure attachment. A second relevant(and overlapping) literature concerns the develop-mental concept of “secure attachment” (Camp-bell, 1998), assessed at 1 year of age and viewedas providing the infant with a secure base for ex-ploring the environment and a major source ofcomfort when distressed, fearful, or ill. This litera-ture, too, focuses on difficult temperament as arisk factor, but the issue of secure attachment is ap-plicable to any factors that affect early parentingand it has direct implications for relationshipswith others. The basic model suggests that a diffi-cult temperament is a challenge for the parent, re-quiring much greater parenting skill than infantswith a pleasant, happy, and easily soothable tem-perament. Absent such unusually good parentingskill or strong social support, adverse effects onparent–infant interactions are likely to result inan insecure or “anxious or ambivalent attachmentcharacterized by excessive anger, clinging, and/oravoidance behavior on the part of the infant”(Campbell, 1998, p. 13). Contextual factors ofpoverty and stressful life events increase the riskof insecure attachment (probably by disruptingparenting). Extreme environments such as abuseand neglect or chronic maternal psychopathologycan produce insecure or even disorganized attach-ments (more severe than insecure attachment),quite apart from the infant’s temperament.

There is some, but mixed, evidence that at-tachment problems at age one year are predic-tive of later internalizing and externalizingproblems (Campbell, 1998). The primary pointin the present context is that temperamental and


other factors that challenge or disrupt optimalparent–child interactions during the first yearlikely have an adverse impact on the infant’s at-tachment to the primary caregiver. This devel-opment is hypothesized to produce “internalworking models” of social interactions thatare less adaptive, coloring the infant’s subse-quent social interactions. Optimal environ-ments probably effectively reverse or attenuatethis effect, but the development of poor attach-ments in infancy sets the stage for further fail-ures to develop positive relationships with oth-ers. The range of negative orientations to othersin psychopaths (i.e., hostile, angry, callous, ex-ploitive) can be argued to reflect at least in parta failure to develop positive attachments. If so,the failure of secure attachment constitutes arisk factor for some of the affective–interper-sonal aspects of psychopathy, that is, those em-bodied in the concept of meanness.

Coercive exchanges. A major line of research onthe development of antisocial behavior by Patter-son and his colleagues (e.g., Dishion, French, &Patterson, 1995; Patterson, Reid, & Dishion,1992; Patterson, Reid, and Eddy, 2002; Snyder,Reid, Patterson, 2003) focused on the “coercionhypothesis.” According to this now well-estab-lished model, when there is conflict between par-ent and child (e.g., the parent urges the child tostop something the child wants to do or to dosomething the child does not want to do), if thechild’s coercive response (e.g., noncompliance,temper tantrums, generally aversive behavior)causes the parent to give in, the child’s coercive re-sponse is negatively reinforced. Similarly, whenthe parent gives in and the child terminates thecoercion, the parent is negatively reinforced. InPatterson’s social learning model, thousands ofthese coercive exchanges produce a response re-pertoire in which coercion is a dominant andstrongly reinforced behavior. Coercive exchangesgeneralize to peers and teachers, with subsequentimmediate rewards but delayed negative conse-quences in the form of rejection. The combinationof coercive behaviorand rejection by normal peersfacilitates association with deviant peers and sub-sequent socialization into a wide range of antiso-cial behaviors.

These investigators view an infant tempera-ment associated with a risk for developing

ADHD involving hyperactivity as a risk factorfor coercive exchanges (Patterson, DeGarmo, &Knutson, 2000). In the actual study, a structuralequation model was presented to support their hy-pothesis that the comorbidity of ADHD and CDreflects an early (ADHD) and late (CD) manifes-tation of a shared process. Although their ownresearch has involved olderchildren, these authorshypothesize that the combination of an extremelyactive and difficult (irritable) infant and a nonre-sponsive (noncontingent) caretaker initiate thisprocess, which probabilistically results in coerciveand socially unskilled behavior by age 24 months,consistent with a diagnosis of hyperactivity be-tween the ages of 2 and 4 years. Thus, the literatureon coercion points to a temperament strongly sim-ilar to that described above for difficult tempera-ment and for poor emotion regulation, and it fo-cuses on the etiology of coercive, antagonisticsocial interactions, followed by socialization intoan antisocial subculture by deviant peers. Likethe Frick and Morris review, Patterson and col-leagues link this developmentalmodel toearly-on-set, chronic severe antisocial behavior.

In summary, this developmental approachcombines a hyperactive, irritable temperament,parenting that is not up to the challenge of sucha temperament, family interactions that facili-tate the characteristics of hyperactivity, comor-bidity of ADHD and antisocial behavior, andthe early-onset of antisocial behavior associatedwith later psychopathy by Moffitt and Lynam.

Low fear as a substrate for meannessand boldness

Given the emphasis on affective–interpersonal(Factor 1) features in classic views of psychop-athy and the association of those features withlow fear in the adult psychopathy literature,there should be an additional etiological path-way for more classic, emotionally detachedpsychopaths in the childhood literature. As de-scribed earlier, the APSD developed by Frickand colleagues can be used to identify youthhigh on CU traits, which capture many of the af-fective–interpersonal features of psychopathyand are characterized by such low fear attributesas low scores on anxiety and neuroticism scales,reduced sensitivity to stressful stimuli andsituations, and a dominance of reward-seeking


approach over passive avoidance of punishmentin conflict situations (cf. Frick & Morris, 2006).High CU youth are characterized by high levelsof instrumental, premeditated, or proactive ag-gression (directed toward acquisition of goods,services, or dominance) as well as by highlevels of reactive, hostile, or impulsive aggres-sion (usually an angry response to threat orprovocation), whereas antisocial youth low on CU(those with “difficult temperaments,” as de-scribed above) show predominantly reactive ag-gression. Of interest in the present context, Frick(Frick & Marsee, 2006; Frick & Morris, 2004)cites research on the development of internalizedconscience in children by Kochanska and hercolleagues (1993, 1995, 1997; Kochanska,Gross, Lin, & Nichols, 2002) as relevant to thelow fear pathway for psychopathy.

Based on initial classifications of fearfultemperament at toddler age, Kochanska iden-tified two pathways to the development of inter-nalized conscience by age 4. Using a mediansplit for fearful temperament, maternal gentlediscipline (“good” discipline: parental gentlediscipline deemphasizing power and capitaliz-ing instead on internal discomfort) predictedinternalized conscience for fearful but not fear-less children. Thus, this discipline-based path-way was ineffective for fearless children, con-sistent with the hypothesis that poor fearconditioning impairs mild punishment-basedsocialization. In contrast, security of attachment(a stand-in for a close, mutually positive par-ent–child relationship) predicted internalizedconscience for fearless children. These resultsdemonstrate that a low fear temperament doesnot inevitably lead to a failure of conscience de-velopment. With sufficient skill on the part ofthe parent, a mutually positive relationshipcapitalizes on the child’s fully functional re-ward-based learning to promote socialization,a process likely to foster boldness as opposedto meanness (see next section). Quite possibly,however, extremely low fear may make thechild more difficult to control with a potentialfor conflict that would interfere with the devel-opment of a mutually positive relationship.Combined with other risk factors (e.g., low ge-notypic affiliativeness; parental abuse or ne-glect), this may push genotypic fearlessness inthe direction of phenotypic meanness.

Implications for ConceptualizingPathways to Psychopathy

Although the developmental psychopathologyliterature does not directly address the implica-tions of the aforementioned etiologic factors fordistinctive phenotypic components of adult psy-chopathy (disinhibition, boldness, meanness),some reasonable extrapolations from exist-ing data can be advanced. Figure 1 provides agraphic depiction of interrelations among thesedistinct phenotypic constructs, and illustratesaforementioned ideas as to how factors of diffi-cult temperament and low dispositional fearpresumably contribute to these phenotypic out-comes. The remainder of this section elaboratesfurther on contributory processes/pathways.

One notable point, implied in the foregoingsection, is that both the attachment and coerciontrajectories probably contribute to psychopathicoutcomes in low fear as well as difficult tem-perament youth, by promoting tendencies towardantagonism and callousness (i.e., meanness). Tothe extent that a low fear temperament creates achallenge for parents, there may well be interfer-ence with the development of positive (secure) at-tachments and emergence of coercive processeswithin the family that then generalize to peersand teachers and result in deviant peerassociation,consistent with the principle of equifinality. Thus,these developmental influences will be commonto the two temperament-based risk factors, andwill tend to produce overlapping phenotypes inimportant respects (i.e., individuals exhibitingtendencies toward interpersonal antagonism andexploitative behavior). To be sure, the affectivecomponents will differ in clear cases, but poor at-tachments, coercive repertoires, and exploitativeattitudes would characterize both groups.

A second point, also alluded to earlier, is thatthe difficult temperament involving poor emotionregulation/poor executive functions maps mostclearly onto the phenotype of disinhibition or ex-ternalizing. The inept or unskilled impulsivityandthe irritable high negative affect combine with de-velopmental experiences of adversarial interac-tions with caregivers, peers, and teachers to pro-mote high levels of anger, hostility, fighting,drug and alcohol problems, academic and occupa-tional failure, and so forth, in the context of highscores on anxiety and neuroticism. To distinguish


the concept of difficult temperament from that offearless temperament, which as noted can also beconstrued as “difficult,” and to highlight its rele-vance to the phenotypic construct of disinhibitiondescribed earlier, we advocate use of the alterna-tive expression “disinhibited temperament.”

Although there are few direct data in the devel-opmental literature that speaks to alternative phe-notypic outcomes of boldness versus meanness,there can be reasonable speculation. Consistentwith aforementioned suggestions, one hypothesisis that boldness reflects a phenotypic orientationthat evolves more naturally from the low fear ge-notype (“a purer, more benign expression of un-derlying temperamental fearlessness”), whereasmeanness likely reflects an overlay because ofdevelopmental experiences gone awry. Thelow stress reactivity element of boldness can be

viewed as a direct manifestation of low defense-system sensitivity, with high social dominanceand thrill–adventure seeking representing affili-ated phenotypic expressions of reward seekingunrestrained by fear and anxiety. In contrast, themeanness attributes of deficient empathy, disdainforand lackof close attachments with others, rebel-liousness, exploitativeness, and empowermentthrough cruelty can be viewed as outcomes ofa low fear temperament (fearless genotype) inwhich the processes of socialization have failed.As suggested above, the failure of positive attach-ment combined with the experience of coerciveinteractions with others is likely to promote a cal-lous, exploitive attitude toward others, and theseattitudes are likely to be supported and strength-ened through deviant peer association. However,these features may also be associated with the

Figure 1. A schematic depiction of hypothesized interrelations among phenotypic constructs of disinhibi-tion, boldness, and meanness (circles) and contributions made to each by underlying etiologic-dispositionalfactors of difficult temperament and low fear (arrows), as described in the developmental literature. Disin-hibition and meanness are depicted as moderately interrelated, based on findings for various existing psy-chopathy inventories that include coverage of these constructs. Difficult temperament is depicted as contrib-uting to each of these constructs, as discussed in the final section of the main text. Disinhibition and boldnessare depicted as minimally interrelated, based on findings for the Psychopathic Personality Inventory, inwhich fearless dominance (boldness) represents a separate factor from impulsive antisociality. Meannessand boldness are depicted as somewhat interrelated, based on evidence for a contribution of low disposi-tional fear to each (see text). The triarchic model conceives of psychopathy as encompassing these three dis-tinct phenotypic dispositions. The syndrome of psychopathy as defined clinically entails disinhibition inconjunction with either boldness or meanness. Cleckley’s (1941, 1976) conceptualization of psychopathemphasized boldness more so than meanness. Criminologic conceptions, and instruments developed to as-sess psychopathy in adult criminals and delinquent youth, emphasize meanness more so than boldness. Lyk-ken’s (1995) conception of the successful (high achieving, or “heroic”) psychopath places predominant em-phasis on boldness.


disinhibited (“difficult”) developmental trajec-tory, causing a blurring of phenotypes. Consistentwith the traditional adult literature, when associ-ated with a low fear temperament the interper-sonal callousness and exploitation will occur inthe context of emotional coolness and indiffer-ence, whereas in association with a disinhibitedtemperament they will occur with stronger emo-tions, especially pronounced anger and hostility.4

Finally, it cannot be emphasized too stronglythat continuous rather than discrete variables

and processes are involved. Consequently, pa-rameters of temperament and of various devel-opmental experiences vary continuously, pro-ducing a broad array of phenotypic outcomes.Thus, the phenotypes will vary not only in se-verity but also in configuration. For example,should deviant peer association be minimized,consequences of that developmental experiencewill also be minimized, or should parental reac-tions be especially harsh (abuse), the conse-quences of those experiences will be greater.

References

Achenbach, T. M., & Edelbrock, C. S. (1978). The classifi-cation of child psychopathology: A review and analysisof empirical efforts. Psychological Bulletin, 85, 1275–1301.

American Psychiatric Association. (1980). Diagnostic andstatistical manual of mental disorders (3rd ed.). Wash-ington, DC: Author.

American Psychiatric Association. (2000). Diagnostic andstatistical manual of mental disorders (4th ed., textrevision). Washington, DC: Author.

Andershed, H., Kerr, M., Stattin, H., & Levander, S. (2002).Psychopathic traits in non-referred youths: A new as-sessment tool. In E. Blau & L. Sheridan (Eds.), Psycho-paths: Current international perspectives (pp. 131–158). Amsterdam: Elsevier.

Andershed, H., Hodgins, S., & Tengstrom, A. (2007). Con-vergent validity of the Youth Psychopathic Traits Inven-tory (YPI): Association with the Psychopathy Check-list: Youth version. Assessment, 14, 144–154.

Arieti, S. (1963). Psychopathic personality: Some views onits psychopathology and psychodynamics. Comprehen-sive Psychiatry, 4, 301–312.

Arieti, S. (1967). The intrapsychic self: Feeling, cognition,and creativity in health and mental illness. New York:Basic Books.

Benning, S. D., Patrick, C. J., Blonigen, D. M., Hicks, B.M., & Iacono, W. G. (2005). Estimating facets of psy-chopathy from normal personality traits: A step towardcommunity–epidemiological investigations. Assessment,12, 3–18.

Benning, S. D., Patrick, C. J., Hicks, B. M., Blonigen, D.M., & Krueger, R. F. (2003). Factor structure of the Psy-chopathic Personality Inventory: Validity and implica-tions for clinical assessment. Psychological Assess-ment, 15, 340–350.

Benning, S. D., Patrick, C. J., Salekin, R. T., & Leistico, A.R. (2005). Convergent and discriminant validity of psy-chopathy factors assessed via self-report: A comparisonof three instruments. Assessment, 12, 270–289.

Blackburn, R. (2006). Other theoretical models of psychop-athy. In C. J. Patrick (Ed.), Handbook of psychopathy(pp. 35–57). New York: Guilford Press.

Blair, R. J. R. (2006). Subcortical brain systems in psychop-athy: The amygdala and associated structures. In C. J.Patrick (Ed.), Handbook of psychopathy (pp. 296–312). New York: Guilford Press.

Block, J. H., & Block, J. (1980). The role of ego-control andego resiliency in the organization of behavior. In W. A.Collins (Ed.), The Minnesota symposium on child psy-chology: Vol. 13. Development of cognition, affect, andsocial relations (pp. 39–101). Hillsdale, NJ: Erlbaum.

Blonigen, D., Hicks, B., Patrick, C., Krueger, R., Iacono,W., & McGue, M. (2005). Psychopathic personalitytraits: Heritability and genetic overlap with internalizingand externalizing pathology. Psychological Medicine,35, 637–648.

Campbell, S. B. (1998). Developmental perspectives. InT. H. Ollendick & M. Hersen (Eds.), Handbook of childpsychopathology (3rd ed., pp. 3–35). New York: Ple-num Press.

Cicchetti, D., & Rogosch, F. A. (1996). Equifinality andmultifinality in developmental psychopathology. De-velopment and Psychopathology, 8, 597–600.

Cleckley, H. (1941). The mask of sanity (1st ed.). St. Louis,MO: Mosby.

Cleckley, H. (1976). The mask of sanity (5th ed.). St. Louis,MO: Mosby.

Cole, P. M., & Hall, S. E. (2008). Emotion dysregulation asa risk factor for psychopathology. In T. P. Beauchaine &S. P. Hinshaw (Eds.), Child and adolescent psychopa-thology (pp. 265–298). Hoboken, NJ: Wiley.

Cooke, D. J., & Michie, C. (2001). Refining the construct ofpsychopathy: Towards a hierarchical model. Psycholog-ical Assessment, 13, 171–188.

Cooke, D. J., Michie, C., & Hart, S. D. (2006). Facets ofpsychopathy: Toward clearer measurement. In C. J. Pat-rick (Ed.), Handbook of psychopathy (pp. 91–106).New York: Guilford Press.

Craft, M. (1966). Conclusions. In M. Craft (Ed.), Psycho-pathic disorders and their assessment (pp. 206–226).New York: Pergamon Press.

Dishion, T. J., French, D. C., & Patterson, G. R. (1995). Thedevelopment and ecology of antisocial behavior. In D.Cicchetti & D. J. Cohen (Eds.), Developmental psycho-pathology: Vol. 2. Risk, disorder, and adaptation (pp.421–471). New York: Wiley.

Douglas, K. S., Lilienfeld, S. O., Skeem, J. L., Poythress, N.G., Edens, J. F., & Patrick, C. J. (2008). Relation of

4. An alternative perspective emphasized by some writers(e.g., Lykken, 1995) is that meanness (callous exploita-tiveness) represents the more natural outcome of geno-typic fearlessness, with protective factors such as aboveaverage intelligence, talent, privileged socioeconomicstatus, and/or highly skilled parenting required for bold-ness to emerge instead.


antisocial and psychopathic traits to suicide-related be-havior among offenders. Law and Human Behavior,32, 511–525.

Farrington, D. P., Coid, J. W., Harnett, L., Joliffe, D., Soter-iou, N., Turner, R., & West, D. J. (2006). Criminal ca-reers up to age 50 and life success up to age 48: Newfindings from The Cambridge Study in Delinquent De-velopment (Home Office Research Study No. 299).London: Home Office.

Forth, A. E., Brown, S. L., Hart, S. D., & Hare, R. D.(1996). The assessment of psychopathy in male and fe-male noncriminals: Reliability and validity. Personalityand Individual Differences, 20, 531–543.

Forth, A. E., Kosson, D. S., & Hare, R. D. (2003). The Psy-chopathy Checklist: Youth Version manual (2nd ed.).Toronto: Multi-Health Systems. (Original work pub-lished 1996)

Fowles, D. C. (1980). The three arousal model: Implicationsof Gray’s two-factor learning theory for heart rate, elec-trodermal activity, and psychopathy. Psychophysiology,17, 87–104.

Fowles, D. C., & Dindo, L. (2006). A dual deficit model ofpsychopathy. In C. J. Patrick (Ed.), Handbook of psy-chopathy (pp. 14–34). New York: Guilford Press.

Frick, P. J., Boden, D. S., & Barry, C. T. (2000). Psycho-pathic traits and conduct problems in community andclinic-referred samples of children: Further develop-ment of the Psychopathy Screening Device. Psycholog-ical Assessment, 12, 382–393.

Frick, P. J., & Dickens, C. (2006). Current perspectiveson conduct disorder. Current Psychiatry Reports, 8,59–72.

Frick, P. J., & Hare, R. D. (2001). Antisocial ProcessScreening Device. Toronto: Multi-Health Systems.

Frick, P. J., O’Brien, B. S., Wooten, J. M., & McBurnett, K.(1994). Psychopathy and conduct problems in children.Journal of Abnormal Psychology, 103, 700–707.

Frick, P. J., & Marsee, M. A. (2006). Psychopathy and de-velopmental pathways to antisocial behavior in youth.In C. J. Patrick (Ed.), Handbook of psychopathy (pp.353–374). New York: Guilford Press.

Frick, P. J., & Morris, A. S. (2004). Temperament and de-velopmental pathways to conduct problems. Journalof Clinical Child and Adolescent Psychology, 33,54–68.

Frick, P. J., Stickle, T. R., Dandreaux, D. M., Farrell, J. M.,& Kimonis, E. R. (2005). Callous–unemotional traits inpredicting the severity and stability of conduct problemsand delinquency. Journal of Abnormal Child Psychol-ogy, 33, 471–487.

Frick, P. J., & White, S. F. (2008). The importance of cal-lous–unemotional traits for developmental models ofaggressive and antisocial behavior. Journal of ChildPsychology and Psychiatry, 49, 359–375.

Gorenstein, E. E., & Newman, J. P. (1980). Disinhibitorypsychopathology: A new perspective and a model forresearch. Psychological Review, 87, 301–315.

Hall, J. R., & Benning, S. D. (2006). The “successful” psy-chopath: Adaptive and subclinical manifestations ofpsychopathy in the general population. In C. J. Patrick(Ed.), Handbook of psychopathy (pp. 459–478).New York: Guilford Press.

Hall, J., Benning, S. D., & Patrick, C. J. (2004). Criterion-related validity of the three-factor model of psychopa-thy: Personality, behavior, and adaptive functioning.Assessment, 11, 4–16.

Hare, R. D. (1978). Electrodermal and cardiovascular corre-lates of psychopathy. In R. D. Hare & D. Schalling

(Eds.), Psychopathic behavior: Approaches to research(pp. 107–143). Chichester: Wiley.

Hare, R. D. (1980). A research scale for the assessment ofpsychopathy in criminal populations. Personality andIndividual Differences, 1, 111–119.

Hare, R. D. (1991). The Hare Psychopathy Checklist—Re-vised. Toronto: Multi-Health Systems.

Hare, R. D. (2003). The Hare Psychopathy Checklist—Re-vised (2nd ed.). Toronto: Multi-Health Systems.

Hare, R. D., Harpur, T. J., Hakstian, A. R., Forth, A. E.,Hart, S. D., & Newman, J. P. (1990). The Revised Psy-chopathy Checklist: Reliability and factor structure.Psychological Assessment, 2, 338–341.

Hare, R. D., & Neumann, C. S. (2006). The PCL-R assess-ment of psychopathy: Development, structural proper-ties, and new directions. In C. J. Patrick (Ed.), Handbookof psychopathy (pp. 58–88). New York: Guilford Press.

Harpur, T. J., Hakstian, A. R., & Hare, R. D. (1988). Factorstructure of the Psychopathy Checklist. Journal of Con-sulting and Clinical Psychology, 56, 741–747.

Harpur, T. J., Hare, R. D., & Hakstian, A. R. (1989). Two-factor conceptualization of psychopathy: Construct va-lidity and assessment implications. Psychological As-sessment, 1, 6–17.

Hart, S., Cox, D., & Hare, R. D. (1995). Manual for the Psy-chopathy Checklist: Screening version (PCL:SV). To-ronto: Multi-Health Systems.

Hicks, B. M., Markon, K. E., Patrick, C. J., Krueger, R. F.,& Newman, J. P. (2004). Identifying psychopathy sub-types on the basis of personality structure. Psychologi-cal Assessment, 16, 276–288.

Hicks, B. M., & Patrick, C. J. (2006). Psychopathy andnegative affectivity: Analyses of suppressor effects re-veal distinct relations with trait anxiety, depression,fearfulness, and anger-hostility. Journal of AbnormalPsychology, 115, 276–287.

Hinshaw, S. P. (2008). Emotion dysregulation as a risk fac-tor for psychopathology. In T. P. Beauchaine & S. P.Hinshaw (Eds.), Child and adolescent psychopathology(pp. 3–26). Hoboken, NJ: Wiley.

Horney, K. (1945). Our inner conflicts. New York:W. W. Norton.

Ishikawa, S. S., Raine, A., Lencz, T., Bihrle, S., & Lacasse,L. (2001). Autonomic stress reactivity and executivefunctions in successful and unsuccessful criminal psy-chopaths from the community. Journal of AbnormalPsychology, 110, 423–432.

Karpman, B. (1941). On the need for separating psychopa-thy into two distinct clinical types: Symptomatic andidiopathic. Journal of Criminology and Psychopathol-ogy, 3, 112–137.

Kagan, J. (1994). Galen’s prophecy: Temperament in hu-man nature. New York: Basic Books.

Kagan, J., & Snidman, N. (1999). Early childhood predic-tors of adult anxiety disorders. Biological Psychiatry,46, 1536–1541.

Kobasa, C. S. (1979). Stressful life events, personality, andhealth: An inquiry into hardiness. Journal of Personal-ity and Social Psychology, 37, 1–11.

Kochanska, G. (1993). Toward a synthesis of parental so-cialization and child temperament in early developmentof conscience. Child Development, 64, 325–347.

Kochanska, G. (1995). Children’s temperament, mothers’discipline, and security of attachment: Multiple path-ways to emerging internalization. Child Development,66, 597–615.

Kochanska, G. K. (1997). Multiple pathways to consciencefor children with different temperaments: From tod-


dlerhood to age 5. Developmental Psychology, 33, 228–240.

Kochanska, G. K., Gross, J. N., Lin, M. H., & Nichols, K. E.(2002). Guilt in young children: Development, determi-nants, and relations with a broader system of standards.Child Development, 73, 461–482.

Kochanska, G., Murray, K., & Coy, K. C. (1997). Inhibitorycontrol as a contributor to conscience in childhood:From toddler to early school age. Child Development,68, 263–267.

Kraepelin, E. (1904). Psychiatrie: Ein lehrbuch (7th ed.).Leipzig: Barth.

Kraepelin, E. (1915). Psychiatrie: Ein lehrbuch (8th ed.).Leipzig: Barth.

Krueger, R. F. (1999a). Personality traits in late adolescencepredict mental disorders in early adulthood: A prospec-tive–epidemiological study. Journal of Personality, 67,39–65.

Krueger, R. F. (1999b). The structure of common mentaldisorders. Archives of General Psychiatry, 56, 921–926.

Krueger, R. F., Hicks, B., Patrick, C. J., Carlson, S., Iacono,W. G., & McGue, M. (2002). Etiologic connectionsamong substance dependence, antisocial behavior, andpersonality: Modeling the externalizing spectrum. Jour-nal of Abnormal Psychology, 111, 411–424.

Krueger, R. F., Markon, K. E., Patrick, C. J., Benning, S. D.,& Kramer, M. (2007). Linking antisocial behavior, sub-stance use, and personality: An integrative quantitativemodel of the adult externalizing spectrum. Journal ofAbnormal Psychology, 116, 645–666.

Leary, T. (1957). Interpersonal diagnosis of personality.New York: Ronald Press.

Lilienfeld, S. O., & Andrews, B. P. (1996). Developmentand preliminary validation of a self report measureof psychopathic personality traits in noncriminal pop-ulations. Journal of Personality Assessment, 66, 488–524.

Lilienfeld, S. O., & Fowler, K. A. (2006). The self-reportassessment of psychopathy: Problems, pitfalls, andpromises. In C. J. Patrick (Ed.), Handbook of psychopathy(pp. 107–132). New York: Guilford Press.

Lilienfeld, S. O., & Widows, M. R. (2005). PsychopathicPersonality Inventory—Revised (PPI-R) professionalmanual. Odessa, FL: Psychological Assessment Re-sources.

Lindner, R. M. (1944). Rebel without a cause: The story of acriminal psychopath. New York: Grune & Stratton.

Loney, B. R., Frick, P. J., Clements, C. B., Ellis, M. L., &Kerlin, K. (2003). Callous–unemotional traits, impul-sivity, and emotional processing in antisocial adoles-cents. Journal of Clinical Child and Adolescent Psy-chiatry, 32, 66–80.

Lykken, D. T. (1957). A study of anxiety in the sociopathicpersonality. Journal of Abnormal and Clinical Psychol-ogy, 55, 6–10.

Lykken, D. T. (1995). The antisocial personalities. Hills-dale, NJ: Erlbaum.

Lynam, D. R. (1997). Pursuing the psychopath: Capturingthe fledgling psychopath in a nomological net. Journalof Abnormal Psychology, 106, 425–438.

Lynam, D. R. (1998). Early identification of the fledglingpsychopath: Locating the psychopathic child in the cur-rent nomenclature. Journal of Abnormal Psychology,107, 566–575.

Lynam, D. R., Caspi, A., Moffitt, T. E., Raine, A., Loeber,R., & Stouthamer-Loeber, M. (2005). Adolescent psy-chopathy and the Big Five: Results from two samples.Journal of Abnormal Child Psychology, 33, 431–444.

Lynam, D. R., & Derefinko, K. J. (2006). Psychopathy andpersonality. In C. J. Patrick (Ed.), Handbook of psy-chopathy (pp. 133–155). New York: Guilford Press.

Marsh, A. A., Finger, E. C., Mitchell, G. V., Reid, M. E.,Sims, C., Kosson, D. S., et al. (2008). Reduced amyg-dala response to fearful expressions in children and ado-lescents with callous–unemotional traits and disruptivebehavior disorders. American Journal of Psychiatry,165, 712–720.

Maudsley, H. (1874). Responsibility in mental disease.London: King Publishers.

McCord, W., & McCord, J. (1964). The psychopath: An es-say on the criminal mind. Princeton, NJ: Van Nostrand.

Miller, J. D., Lynam, D. R., Widiger, T. A., & Leukefeld, C.(2001). Personality disorders as extreme variants ofcommon personality dimensions: Can the five-factormodel adequately represent psychopathy? Journal ofPersonality, 69, 253–276.

Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxon-omy. Psychological Review, 100, 674–701.

Moffitt, T. E., & Lynam, D., Jr. (1994). The neuropsychol-ogy of conduct disorder and delinquency: Implicationsfor understanding antisocial behavior. In D. Fowles, P.Sutker, & S. Goodman (Eds.), Progress in experimentalpersonality and psychopathology research 1994. Spe-cial focus on psychopathy and antisocial behavior: Adevelopmental perspective (pp. 233–262). New York:Springer.

Partridge, G. E. (1928a). A study of 50 cases of psycho-pathic personality. American Journal of Psychiatry, 7,953–973.

Partridge, G. E. (1928b). Psychopathic personalities amongboys in a training school for delinquents. AmericanJournal of Psychiatry, 8, 159–186.

Patrick, C. J. (1994). Emotion and psychopathy: Startlingnew insights. Psychophysiology, 31, 319–330.

Patrick, C. J. (2006). Back to the future: Cleckley as a guideto the next generation of psychopathy research. In C. J.Patrick (Ed.), Handbook of psychopathy (pp. 605–617).New York: Guilford Press.

Patrick, C. J. (2007). Getting to the heart of psychopathy. InH. Herve & J. C. Yuille (Eds.), Psychopathy: Theory,research, and social implications (pp. 207–252). Hills-dale, NJ: Erlbaum.

Patrick, C. J., & Bernat, E. (2009). From markers to mech-anisms: Using psychophysiological measures to elu-cidate basic processes underlying aggressive exter-nalizing behavior. In S. Hodgins, E. Viding, & A.Plodowski (Eds.), Persistent violent offenders: Neuro-biology and rehabilitation (pp. 223–250). Oxford:Oxford University Press.

Patrick, C. J., & Bernat, E. (in press). Neurobiology of psy-chopathy: A two-process theory. In G. G. Berntson &J. T. Cacioppo (Eds.), Handbook of neuroscience forthe behavioral sciences. New York: Wiley.

Patrick, C. J., & Bernat, E. (2006). The construct of emotionas a bridge between personality and psychopathology.In R. F. Krueger & J. Tackett (Eds.), Personality andpsychopathology (pp. 174–209). New York: GuilfordPress.

Patrick, C. J., Bradley, M. M., & Lang, P. J. (1993). Emotionin the criminal psychopath: Startle reflex modulation.Journal of Abnormal Psychology, 102, 82–92.

Patrick, C. J., Edens, J. F., Poythress, N., & Lilienfeld, S. O.(2006). Construct validity of the PPI two-factormodel with offenders. Psychological Assessment, 18,204–208.


Patrick, C. J., Hicks, B. M., Krueger, R. F., & Lang, A. R.(2005). Relations between psychopathy facets and ex-ternalizing in a criminal offender sample. Journal ofPersonality Disorders, 19, 339–356.

Patrick, C. J., Hicks, B. M., Nichol, P. E., & Krueger, R. F.(2007). A bifactor approach to modeling the structure ofthe Psychopathy Checklist—Revised. Journal of Per-sonality Disorders, 21, 118–141.

Patrick, C. J., & Zempolich, K. A. (1998). Emotion and ag-gression in the psychopathic personality. Aggressionand Violent Behavior, 3, 303–338.

Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Anti-social boys. Eugene, OR: Castalia.

Patterson, G. R., Reid, J. B., & Eddy, J. M. (2002). A briefhistory of the Oregon model. In J. B. Reid, G. R. Patter-son, & J. Snyder (Eds.), Antisocial behavior in childrenand adolescents: A developmental analysis and modelfor intervention. (pp. 3–21). Washington, DC: Ameri-can Psychological Association.

Patterson, G. R., DeGarmo, D. S., & Knutson, N. (2000).Hyperactive and antisocial behaviors: Comorbid ortwo points in the same process. Development and Psy-chopathology, 12, 91–106.

Pinel, P. (1962). A treatise on insanity (D. Davis, Trans.).New York: Hafner. (Original work published 1806)

Porter, S., & Woodworth, M. (2006). Psychopathy and ag-gression. In C. J. Patrick (Ed.), Handbook of psychopa-thy (pp. 481–494). New York: Guilford Press.

Poythress, N. G., Edens, J. F., & Lilienfeld, S. O. (1998).Criterion-related validity of the Psychopathic Personal-ity Inventory in a prison sample. Psychological Assess-ment, 10, 426–430.

Poythress, N. G., Dembo, R., Wareham, J., & Greenbaum,P. E. (2006). Construct validity of the Youth Psycho-pathic Traits Inventory (YPI) and the Antisocial ProcessScreening Device (APSD) with justice-involved adoles-cents. Criminal Justice and Behavior, 33, 26–55.

Prichard, J. C. (1835). Atreatiseon insanityandother disordersaffecting the mind. London: Sherwood, Gilbert & Piper.

Quay, H. C. (1964). Dimensions of personality in delin-quent boys as inferred from the factor analysis of casehistory data. Child Development, 35, 479–484.

Quay, H. C. (1986). Classification. In H. C. Quay & J. S.Werry (Eds.), Psychopathological disorders of child-hood (3rd ed., pp. 1–42). New York: Wiley.

Raine, A., Ishikawa, S. S., Arce, E., Lencz, T., Knuth, K. H.,Bihrle, S., et al. (2004). Hippocampal structural asym-metry in unsuccessful psychopaths. Biological Psychia-try, 55, 185–191.

Robins, L. N. (1966). Deviant children grown up. Balti-more, MD: Williams & Wilkins.

Robins, L. N. (1978). Sturdy predictors of adult antisocialbehaviour: Replications from longitudinal studies. Psy-chological Medicine, 8, 611–622.

Ross, S. R., Benning, S. D., Patrick, C. J., Thompson, A., &Thurston, A. (2009). Factors of the Psychopathic Per-sonality Inventory: Criterion-related validity and rela-tionship to the BIS/BAS and Five-Factor models ofpersonality. Assessment, 16, 71–87.

Rush, B. (1812). Medical inquiries and observations uponthe diseases of the mind. Philadelphia, PA: Kimber &Richardson.

Rutter, M. (2006). Genes and behavior: Nature–nurture in-terplay explained. Malden, MA: Blackwell.

Salekin, R. T. (2006). Psychopathy in children and adoles-cents: Key issues in conceptualization and assessment.In C. J. Patrick (Ed.), Handbook of psychopathy (pp.389–414). New York: Guilford Press.

Saucier, G. (1992). Benchmarks: Integrating affective andinterpersonal circles with the Big-Five personality fac-tors. Journal of Personality and Social Psychology,62, 1025–1035.

Schneider, K. (1934). Die psychopathischen personlichkei-ten (3rd ed.). Vienna: Deuticke.

Sher, K. J., & Trull, T. (1994). Personality and disinhibitorypsychopathology: Alcoholism and antisocial personalitydisorder. Journal of Abnormal Psychology, 103, 92–102.

Skeem, J. L., & Cooke, D. J. (in press). Is antisocial behav-ior essential to psychopathy? Conceptual directions forresolving the debate. Psychological Assessment.

Skeem, J. L., Johansson, P., Andershed, H., Kerr, M., &Eno Louden, J. (2007). Two subtypes of psychopathicviolent offenders that parallel primary and secondaryvariants. Journal of Abnormal Psychology, 116, 395–409.

Skeem, J. L., Miller, J. D., Mulvey, E. P., Tiemann, J., &Monahan, J. (2005) Using a five-factor lens to explorethe relation between personality traits and violence inpsychiatric patients. Journal of Consulting and ClinicalPsychology, 73, 454–465.

Skeem, J. L., Mulvey, E. P., & Grisso, T. (2003). Applic-ability of traditional and revised models of psychopathyto the Psychopathy Checklist: Screening Version. Psy-chological Assessment, 15, 41–55.

Smith, S. S., & Newman, J. P. (1990). Alcohol and drugabuse-dependence disorders in psychopathic and non-psychopathic criminal offenders. Journal of AbnormalPsychology, 99, 430–439.

Snyder, J., Reid, J., & Patterson, G. (2003). A social learn-ing model of child and adolescent antisocial behavior.In B. B. Lahey, T. E. Moffitt, & A. Caspi (Eds.), Causesof conduct disorder and juvenile delinquency (pp.27–48). New York: Guilford Press.

Thompson, R. A. (2001). Childhood anxiety disorders fromthe perspective of emotion regulation and attachment. InM. W. Vasey & M. R. Dadds (Eds.), The developmentalpsychopathology of anxiety (pp. 160–182). New York:Oxford University Press.

Vanman, E. J., Mejia, V. Y., Dawson, M. E., Schell, A. M.,& Raine, A. (2003). Modification of the startle reflex ina community sample: Do one or two dimensions of psy-chopathy underlie emotional processing? Personalityand Individual Differences, 35, 2007–2021.

Verona, E., Hicks, B. M., & Patrick, C. J. (2005). Psychop-athy and suicidality in female offenders: Mediating ef-fects of temperament and abuse history. Journal ofConsulting and Clinical Psychology, 73, 1065–1073.

Verona, E., & Patrick, C. J. (2000). Suicide risk in external-izing syndromes: Temperamental and neurobiologicalunderpinnings. In T. E. Joiner (Ed.), Suicide science:Expanding the boundaries, pp. 137–173. Boston:Kluwer Academic.

Verona, E., Patrick, C. J., & Joiner, T. E. (2001). Psychop-athy, antisocial personality, and suicide risk. Journal ofAbnormal Psychology, 110, 462–470.

Verona, E., Sachs-Ericsson, N., & Joiner, T. E. (2004). Suicideattempts associated with externalizing psychopathologyin an epidemiological sample. American Journal of Psy-chiatry, 161, 444–451.

Widiger, T. A. (2006). Psychopathy and DSM-IV psychopa-thology. In C. J. Patrick (Ed.), Handbook of psychopa-thy (pp. 156–171). New York: Guilford Press.

Widiger, T. A., Cadoret, R., Hare, R., Robins, L., Ruther-ford, M., Zanarini, M., et al. (1996). DSM-IV antisocialpersonality disorder field trial. Journal of AbnormalPsychology, 105, 3–16.


Widom, C. S. (1977). A methodology for studying noninsti-tutionalized psychopaths. Journal of Consulting andClinical Psychology, 45, 674–683.

Wiggins, J. S. (1982). Circumplex models of interpersonalbehavior in clinical psychology. In P. C. Kendall &J. N. Butcher (Eds.), Handbook of research methods inclinical psychology (pp. 183–221). New York: Wiley.

Young, S. E., Stallings, M. C., Corley, R. P., Krauter, K. S.,& Hewitt, J. K. (2000). Genetic and environmental in-fluences on behavioral disinhibition. American Journalof Medical Genetics (Neuropsychiatric Genetics), 96,684–695.

Zuckerman, M. (1979). Sensation seeking: Beyond the op-timal level of arousal. Hillsdale, NJ: Erlbaum.


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