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Wednesday, June 22, 2022

New article re Schema Therapy, etc.

 I stumbled upon this article from the American Psychological Association "A broader view of psychopathy" while looking for a quick legitimate source for psychopathy being a personality disorder and it had a wealth of interesting information including the origin of psychopathy being part of ASPD:

For these and other reasons, the mental health community has not had an easy time homing in on a uniform definition of psychopathy. For decades, its symptoms were examined in two very different populations: people in criminal or forensic settings and people in inpatient or community mental health settings. These groups had somewhat different characteristics, which led to different ways of conceptualizing and assessing psychopathy, said Florida State University psychologist Chris Patrick, PhD, who studies and has written extensively on the condition.

To add to the complexity, psychopathy is not a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)—one reason the area tends to be both underfunded and undertreated, Marsh added. In part, that is due to earlier disagreements in the field: Some of those studying the disorder worried that a psychopathy diagnosis would stigmatize people too much, while others were concerned that clinicians would have difficulty in accurately assessing traits like callousness or cruel or indifferent disregard of others. So, although psychopathy was included in the first two editions of the DSM, it was replaced in the third edition by antisocial personality disorder (ASPD), which focuses mainly on the behavioral aspects of psychopathy, such as aggression, impulsivity, and violations of others’ rights, but only minimally on personality characteristics like callousness, remorselessness, and narcissism. As a result, only about a third of those diagnosed with ASPD also meet the criteria for psychopathy, according to research using validated scales, which often leads to confusion over how and if the two conditions are related, Marsh noted.

And regarding successful treatment, including schema therapy:

Collectively, these findings suggest that those with or at risk for psychopathy need more than single-dose therapy. Rather, therapy needs to be both correctly tailored to the problems the person is facing and of sufficiently long duration to ensure that changes stick, Viding said. 


Thursday, February 20, 2020

The origins of criminality as a feature in sociopathy (part 2)


Cleckley’s sociopath was “bold”, boldness here being “a capacity to remain calm and focused in situations involving pressure or threat, an ability to recover quickly from stressful events, high self-assurance and social efficacy, and a tolerance for unfamiliarity and danger. Terms related to boldness include fearless dominance (Benning, Patrick, Blonigen, et al., 2005), daringness, audacity, indomitability, resiliency (Block & Block, 1980), and hardiness (Kobasa, 1979).” Id. Bold individuals are likely to show: “social dominance, low stress reactivity, and thrill–adventure seeking (Benning et al., 2003; Benning, Patrick, Blonigen, et al., 2005) . . . imperturbability, social poise, assertiveness and persuasiveness, bravery, and venturesomeness.” Id.

Boldness was evident in [Cleckley’s] case descriptions and diagnostic criteria in terms of poise and high social efficacy, absence of anxiety or neurotic symptoms, diminished emotional responsiveness, imperviousness to punishment (“failure to learn by experience”), and low suicidality. Other historic writers concerned with psychopathy in psychiatric patients as opposed to criminal samples (e.g., Kraepelin, Schneider) also identified bold externalizing types. Id.

Cleckley studied non-criminal sociopaths at a large inpatient facility. No other researcher has focused so extensively on non-criminal sociopaths.

Most researchers studied criminals, and consequently defined sociopathy as a dark strain of criminal deviance. Early researchers William Maxwell McCord and Joan McCord painted a picture in “The Psychopath: An Essay on the Criminal Mind” (1964) of a socially detached, predatory, aggressive, and remorseless individual plagued by angry-reactive forms of aggression and resultant criminality. Similarly Lee Robins, whose work underlies the DSM-V’s “Antisocial Personality Disorder” (ASPD), focused on a maladjustedness marked by persistent aggression, criminality, and destructiveness. Robins (1966, 1978).

Around that same time, Robert Hare developed his Psychopathy Checklist (now revised, PCL-R), based on the Canadian criminal population. The PCL-R is the most popular diagnostic tool for sociopathy. Hare based it on Cleckley’s sociopath, however, it is distinctly darker:

In contrast with Cleckley’s portrayal of psychopathic patients as personable and ostensibly well meaning but feckless and untrustworthy, this latter perspective conceptualizes psychopathic individuals as cold, abrasive, and aggressively exploitative in their interactions with others.

Patrick, et al. (2009).

Cleckley saw “boldness.” Hare substituted “meanness.” Why? Interestingly, Hare’s own early work also found boldness instead of meanness. Id. What changed?

Alice, a sociopath I met in Australia, theorizes that it wasn’t the sociopaths that changed, but Hare. Alice thinks Hare is biased. In fact, she goes so far as to tell me she believes he’s a subclinical narcissist. Her evidence for narcissism includes Hare’s statements that suggest he has a fragile ego and needs to be liked by others. For instance, you could read the following statement as a theory about how most people feel, or you could read between the lines and see someone who is overly concerned with how he is perceived by others:

“We are haunted to some degree by questions about our self-worth. As a consequence, we continually attempt to prove to ourselves and others that we are okay people, credible, trustworthy, and competent.”

He does seem to take the misdeeds of sociopaths personally, for example he warns:

“All the reading in the world cannot immunize you from the devastating effects of psychopaths. Everyone, including the experts, can be taken in, conned, and left bewildered by them.”

Hare speaks from personal experience. He is on record describing his first encounter with a sociopath “Ray” as a long con in which Ray influenced Hare to break prison rules. Hare said he did what Ray asked to build a “rapport”. Due in part to Hare’s influence, Ray received a plum job in the prison mechanic shop. When Hare’s tenure at the prison ended, Ray performed a tune-up on Hare’s car. The brakes failed while Hare was driving down a hill, family in tow. A local mechanic confirmed that the brakes had been rigged with a slow leak. 

Alice thinks this early experience and his continuing inability to build a rapport with prison sociopaths caused him to harden his heart against them. Alice thinks he sought payback by portraying them in the worst psychological light possible, destroying their possibility of parole.

Alice’s theory for Hare’s anti-sociopath bias is consistent with the facts as we know them.

To give you an idea of Hare’s lack of scientific objectivity, in his book Without Conscience: The Disturbing World of the Psychopaths Among Us he calls sociopaths the “monsters of real life” and warns:

“On a more personal level, it is very likely that at some time in your life you will come into painful contact with a psychopath. For your own physical, psychological, and financial well-being it is crucial that you know how to identify the psychopath, how to protect yourself, and how to minimize the harm done to you.”

Hare has manifested other narcissistic traits. In a widely publicized move, he threatened to enjoin the publication of an academic, peer-reviewed article that criticized his PCL-R. The article, by researchers Jennifer Skeem and David Cooke, argued that “the PCL–R weighs antisocial behavior as strongly as—if not more strongly than—traits of emotional detachment in assessing psychopathy.” Consequently, it “is overly saturated with criminality and impulsivity (Blackburn, 2005; Forouzan & Cooke, 2005)” and as such, it “imperfectly maps psychopathy” and “does not fully correspond to Cleckley’s (1941) conceptualization, on which it is purportedly based.” 

Tuesday, October 4, 2016

An Introduction to Psychopathy

I am still surprised by the amount of disagreement about psychopathy, sociopathy, antisocial personality disorder, etc. that you'll get from any source -- academic, pop psychology, etc. With that small caveat (nothing is definitive), I found this article on psychopathy to be a good overview with academic cites (and links in the original). Here are some selections:

While it is past antisocial behavior that is particularly important in predicting future criminal activity (Walters, 2003), it is CU (callous unemotional) traits that are at the core of developmental trajectory associated with psychopathy (Frick and White, 2008). The disorder is developmental. It has been shown that CU traits in particular and the psychopathy more generally are relatively stable from childhood into adulthood (Lynam et al., 2007; Munoz and Frick, 2007). In addition, the functional impairments seen in adults with psychopathy (e.g., in responding to emotional expressions, aversive conditioning, passive avoidance learning, reversal learning, extinction) are also seen in adolescents with psychopathic tendencies (see later).
***
Psychopathy is not equivalent to the psychiatric conditions of conduct disorder (CD) or antisocial personality disorder (ASPD) as defined by DSM-5 or their ICD-10 counterparts. The diagnostic criteria for these disorders focus on antisocial behaviors rather than on etiological factors such as the emotion dysfunction seen in psychopathy (Blair et al., 2005). As such these psychiatric conditions describe individuals with difficulties in executive dysfunction (Moffitt, 1993), as well as individuals with symptoms stemming from CU traits. Consequently, individuals with psychopathy are a more homogenous group than those individuals meeting the criteria for CD and ASPD (Karnik et al., 2006). It should be noted, however, that DSM-5 includes the specifier for CD ‘with limited pro-social emotions,’ which stem directly from research on youth with CD and CU traits (Pardini et al., 2010; Pardini and Fite, 2010). Furthermore, the diagnosis of ASPD now includes components of psychopathy (APA, 2013). While the disorder of psychopathy will still not be equivalent to the DSM-5 diagnoses of CD and ASPD, there will be greater overlap in diagnostic conceptualization.

Psychopathy is characterized by an increased risk for antisocial behavior (Frick and Dickens, 2006; Hare, 2003). While several psychiatric disorders and neurological conditions, including CD and ASPD (APA, 2013), confer an increased risk of reactive aggression (Anderson et al., 1999; Leibenluft et al., 2003), psychopathy is unique in that it conveys increased risk for instrumental aggression (Frick et al., 2003). 

Interestingly, an article that was cited included this assessment of treatment options: "While treatment recommendations are currently sparse, recent work has shown that previous assessments of treatment amenability in this population may have been overly pessimistic."

Also, because I had to look this up too:
"A classic measure of stimulus-reinforcement learning is aversive conditioning -- the individual learns that a particular stimulus is associated with threat. Individuals with elevated CU traits show marked impairment in stimulus-reinforcement learning. Indeed, an individual's ability to perform aversive conditioning at 15 years has predictive power regarding whether that individual will display anti-social behavior 14 years later (Raine et a., 1996)."

Monday, November 16, 2015

Seeing the world as an extension of ourserlves

This was an interesting comment on an old post from someone who identifies as narcissistic, but actually became self-aware and got better:

Everything I've read about narcissism says leave them alone...I was physically abused as a child and had a series of crises (death of the parent who abused me, failed relationships etc)

Now I can remember how I slowly died and became an unfeeling shell.

For 20 years of my life I lived the life of a narcissist..compartmentalised life..using and abusing everyone and everything..A part of me knew it was wrong but it was a very small part of me..For the most part there was an unfeeling emptiness that I hid very well.

I got married and had 2 children..compartmentalising allowed me to have something that remotely resembled a marriage on the surface.
But nothing filled the hole till I decided to try spiritual practise...even that was narcissistic in its nature..I felt that I was better and knew more than anyone.

I had an experience..I guess you could call it a spiritual experience..After the experience I slowly started feeling again..It's taken 7 years so far..I ve learnt to take leaps of faith..and I've taken many..Every leap revealed something about myself to me..my marriage began to crumble..and I recently took another leap because I could not deal with it..Nothing helped...and something snapped in my head..The pain was gone..All of a sudden..I'm ok on my own...my wife is a person my children are their own beings...I don't know if this is just a phase..We put labels on things we don't understand thinking the labels are reality..forgetting that we've just collected a set of traits...grouped them together and put a label on the group. 


I thought that last paragraph was particularly interesting, especially, "my wife is a person my children are their own beings". My current therapist (and I apologize, I haven't had the time to verify or source this assertion) says that all of the cluster Bs suffer from a common ailment -- that they fail to see others as separate individuals, but rather perceive them to be an extension of themselves. Apparently we all start that way as infants, seeing mother and world as all being the same "us/I". Eventually as a toddler we expand our reach a little and realize that there can be a distance between us and mother, that we are our own autonomous self, and that psychological development allows us to see our true place in the world: that we are one of many people who also have separate identifies, inner worlds, volition, likes and dislikes, and finally that we all have separate realities and to challenge someone else's reality and assert ones own instead can be as violative to that person's personhood as rape. I've always thought that attitude was particular to narcissism, or at least not shared by sociopaths, who seem to very well understand that everyone is different, which is why we can both seem so tolerant and skilled at manipulation, because we see and target people's individual predilections. But my therapist believes that this is common (or perhaps even necessary) in an ASPD diagnosis. I do admit that in my most antisocial, I disregard the personhood of the people around me. But it's not because I have an inability to see them as anything other than just an extension of myself/universe. I wonder, is this a possible distinction between the classic sociopathic diagnosis versus the DSM's ASPD? Can any other sociopathic leaning individuals or people that know sociopaths speak to whether this trait is shared not just in ASPD but the broader sociopathy?

Friday, October 9, 2015

Only 36% of Psychology Findings Replicable

One of my friends was just diagnosed with a psychological disorder that does not yet exist, her therapist says, but is very likely to be added as an autism spectrum disorder in the DSM-6. It made me smile a little to hear and I realized that I forgot to write anything about this back in August. This NY Times article, "Psychologists Welcome Analysis Casting Doubt on Their Work" reports:

The field of psychology sustained a damaging blow Thursday: A new analysis found that only 36 percent of findings from almost 100 studies in the top three psychology journals held up when the original experiments were rigorously redone.

After the report was published by the journal Science, commenters on Facebook wisecracked about how “social” and “science” did not belong in the same sentence.

Yet within the field, the reception was much different. Along with pockets of disgruntlement and outrage — no one likes the tired jokes, not to mention having doubt cast on their work — there was a sense of relief. One reason, many psychologists said, is that the authors of the new report were fellow researchers, not critics. It was an inside job.

“It’s like we’ve come clean,” said Alan Kraut, the executive director of the Association for Psychological Science, which publishes one of the journals analyzed in the new report. “This kind of correction is something that has to happen across science, and I’m proud that psychology is leading the charge on this.”

My friend was relating to me how her therapist walked her through her diagnosis, including regarding how he had eliminated personality disorder as a possible diagnosis. He explained to her that to diagnose any personality disorder, the person first has to fit into the parent category "personality disorder", and only then (at least officially, or at least apparently) can the mental health professional diagnose you with a specific form of personality disorder. I thought of how my current therapist diagnosed me with personality disorder not otherwise specified with features of ASPD because he said that the ASPD was more developing than fully developed, like a tween I guess. Which I sort of preferred, as it's a much nicer thing to tell people if I was ever required to do so by a police state or something.

I try to keep an open mind about psychology, but it's hard not to think that if you went to a dozen different mental health professionals, you might not get at least several different diagnoses out of the bunch. I'd actually be super curious if someone were to do this as a study -- what sort of agreement do mental health professionals have in their diagnoses in practice. I'm sure it's already been done?

Tuesday, February 10, 2015

Empath hypocrisy?

This was an interesting recent comment on an old post:

as an almost permanent tourist in western society, i notice that this particular civilisation is clearly built by and for ppl referred to as sociopaths. Most of the DSM defined traits are essential in the practice of business, law etc as defined by the western cultural model.

Clearly the western media/propaganda machine is either responding to or encouraging widespread worship and admiration of ppl who can kill, fight and act without the accepted social and moral restraints.

in fact, the main difference that i can see between western 'empaths' and 'sociopaths' is that the latter are not inclined to the (mostly) hypocritical displays of 'caring' that the former use as evidence of their so-called humanity.

i know empaths who will readily cry when watching poverty porn, and will discuss starving children with other similarly emotive empaths....but have absolutely no problem chowing down on, say, chocolate produced on plantations that exploit slave children. The majority of westerners buy and wear clothing made by enslaved children in sweatshops, because the pleasure of a killer discount and convenience outweighs any bad feelings over tortured children.

i hear that sociopaths use compartmentalisation to deal with contradiction, but it seems that empaths use cognitive dissonance...and i think the latter may actually be more effective.

So-called empaths can cry about little kittens and cute doggies being hurt, and can weep as heart-rendingly for a fictional, cartoon being as they would for one in real life. Perhaps more so, because they are often without any discernible discomfort when consuming, say, meat that has been produced by basically torturing hundreds and thousands of animals as a matter of course. The inhumane conditions of factory farmed animals well documented, but the western business model is concerned purely with monetary profit and loss.

in fact, the most extreme empaths, called 'sensitives', would rather be shielded from the truth of their hypocrisy, rather than endure the material inconveniences involved in facing most moral dilemmas in this culture.

Being seen as 'nice' and seeing themselves as 'nice' seems to be more important to them than taking actions that actualise this 'niceness' they seem to feel is part of their nature.

i notice the glaring hypocrisy most when i think about the holocaust the nazis created and the western democracies' historical responses.
Americans, for instance, complained about the cruelty of the nazis, the heartless torture and genocide endured by jewish ppl (those who were gypsies, disabled, african and so forth incurred less sympathy for whatever reason). Yet in their own country AT THE SAME TIME they were still up to their elbows in the blood of the African descendants who had been forcibly brought over to that country hundreds of years earlier.
The torture, rape, bio-terror and abuse the status quo of american culture enacted against African and Native american ppl are well documented, and yet the cognitive dissonance employed to ignore this fact and cast euro-americans as the 'good guys' is amazingly still in place.
Western empaths say things like 'never forget', but only when it concerns those they have been programmed to care about.

Right through until the sixties (described as the swinging era of peace and love in this culture) black americans were being publicly lynched, and those events were captured in postcards that were sold door to door and still feature in the family albums of many white american families.
[this links to many of these images http://withoutsanctuary.org/main.html]

in these postcards, you see men, women AND children looking at the bloodied, castrated corpses hanging from the trees....and their expressions register the kind of gay pleasure, excitement and convivial community spirit you might expect at a neighbourhood carnival or block party.

i recently read a news article that could have described this macabre atmosphere perfectly, but it was in fact talking about 'islamists', the new fabricated boogey man of the morally bankrupt west.

From the Metro, February 5th:
""crowds cheer burning death on big screen.
Jubilant crowds of IS supporters have been celebrating as big screens reportedly showed the jordanian pilot being burned to death." The article laments the "sick celebration in the face of international outrage" and marvelled at " a smiling boy aged about six talking excitedly about the killing."

Now, i mentiion this in this forum, because it at least purports to be full of ppl who dont get all emotionally defensive, illogical etc, and who dont have strong attachments to identity etc.

i am interested in a response.

Wednesday, October 8, 2014

Psychopathy in the Army

From a reader:

As a veteran reading “Natural Killers – Turning the Tide of Battle” by Major David Pierson, I was a stricken by the assumption that it’s sociopaths who make up “natural killers” on the battlefield.  A member of Joint Special Operations Command, I was one of the guys sneaking around at night snatching up all those high value targets in the war on terror.  I was also a sniper in one of these units.  More than one source of data suggests psychopaths are drawn to commando units and sniper teams in particular.  Hell, I remember feeling a vague sense of discomfort after reading the last DSM criteria for ASPD, which listed impulsivity, aggression, tendency to break social norms, enjoy alcohol, and engage in a series of sexual relationships with little emotional attachment.  Most of us in my unit really enjoyed our time overseas, had fun in combat, and still crave the thrill of assaulting an objective.  The implications are… unnerving.  

But despite Pierson’s presumption, there’s a more nuanced perspective of ASPD, psychopathy, and sociopathy in relation to his idea of natural killers on the battlefield.  I believe archetypal psychopaths, though drawn to commando units, typically wash out of the elite selection processes.  This is because elite military units require a strong sense of social cohesiveness.  

Major David Pierson’s research draws heavily from Colonel Grossman’s research for his book On Killing, which drew heavily from the Gen. Marshall study on soldiers’ ability to kill following WWII.  Pierson describes an experience in Iraq, in which he witnessed a friend of his, a soldier, who had become battle fatigued after a brief fire fight.  He described the soldier as being “shaken by the episode,” and “not a natural killer.”  A natural killer wouldn’t have been shaken by the incident above.  A natural killer, Pierson goes on, is callous, adventurous, possesses a dark sense of humor, is athletic, and enjoys fighting.  

These are all the common traits of the unit I served with, and traits which couldn’t describe me better.  My unit rarely had problems with guys being battle-fatigued, and never had problems with guys failing to pull the trigger when needed.  Indeed, Pierson points out that aggressive psychopaths seek out positions in “airborne, Ranger, and special forces” units.  However, Pierson jumps to the conclusion that natural killers in combat are necessarily aggressive psychopaths.  After all, the traits described above do not necessarily a psychopath make.  In fact, they only apply to some facets of the diagnosis for ASPD in the DSM.  Though many expect most of us to be sociopathic, there’s actually limited data to suggest psychopaths are overrepresented in the profession. 

In my experience, commandos do have a certain profile that is almost ubiquitous in the industry.  Obviously, thrill seeking is the biggest prerequisite for special operations, but other, maybe surprising traits tend to pop up in the community.  We tend to be obsessive, single minded kind of guys, so the addiction trait is quite, quite common (every guy I know, including myself, are mild to severe addicts).  Next is some form of mild Attention Deficit Disorder.  Last, the guys are generally smart and eccentric.  These are not the “military” types you see running around with cropped haircuts and army boots in their off time (think – Marine) though they are tough guys.

That being said, some traits above do tend to mesh with some ASPD criteria.  Being an elite soldier means jumping out of planes and helicopters, mastering weapons of violence, applying medical trauma skills at the EMT-P level, and enjoying hand-to-hand combat.  There must be a powerful intuition to suppress emotions and engage in violence.  So to a certain extent, lack of empathy and remorse, a desire to break social norms, impulsivity, and aggression are prerequisites of the job.  While Pierson’s essay encourages leaders to identify natural killers in their units, the selection process for special operations units does a brilliant job finding them, institutionally.  

The selection process for elite units can be divided into two major assessment portions.  The hard physical selection weed-out process, like hell-week for navy seals’ Basic Underwater Demolition School, or the first week of the Ranger Assessment and Selection Program, coerces groups of cadets into performing strenuous group activities which depend on cooperation.  These drills require a sort of pack-like behavioral sense for cadets to succeed.  I can’t stress enough how socially demanding group drills are in a selection setting.
On the opposite end, however, comes individual talent drills which do not allow for others to pick up any slack.  One way the army selects for individual talent draws heavily from the British commando schools of the 40s, by requiring land navigation challenges, orienteering for the civilian reader, to assess whether an applicant can think on his feet and surmount arduous physical demands without any help from a comrade.  Land navigation, basically being dropped in the woods with a map and compass and told to find a bunch of points, is the LSAT or GMAT for the commando.  I suspect an intelligent psychopath could thrive on the latter, though struggle with the former.  

It’s hard to explain the mindset of working in an elite military unit.  While individual skills are necessary to succeed in the environment, group cohesion is equally important.  Small unit movements are a thing of awe.  Each member of the team works off one another, effortlessly, to flow through rooms, maintain 360 degrees of security, and achieve an objective.  There is an almost preternatural sense of being aware what the entire unit is doing, an exercise of reptilian and mammalian brain functions.  It takes a degree of yes, empathetic feeling to experience this as second nature.  The less you have to concentrate on what everyone else is doing, the more your cognitive attention can focus on what’s in front of you, and how to accomplish the larger mission.  This takes a lot of practice.  I would conjecture that the psychopath, who has a remarkably lower blood flow to the socially activated portions of the brain, would have a harder time concentrating during small unit tactics.  At least he’d have more difficulty developing the bonds necessary to thrive in the environment.  

All that being said, during my time as a DOD contractor and commando in Afghanistan and Iraq, I did come across what you’d call a traditional psychopath, albeit rarely.  I’m talking about the archetypal psychopath, the guy who stares at people and makes them uncomfortable, the guy incapable of reacting to other peoples’ emotional states without effort, who genuinely won’t feel guilty after a bad shooting incident, who sincerely enjoys playing head games with people.  But they had a hard time staying in a crew.  Sometimes it’d be the occasional inappropriate assault, sometimes the attempted murder of a comrade (yes, I’m not kidding).  There were a couple guys I knew, though, traditional sociopaths, but smart enough to fake it and control themselves to gel on a team.  I tended to enjoy their company, actually.  There’s a lot of entertainment to be had with a legit sociopath. 

Last, Pierson makes some great observations in identifying killers in a unit.  Overwhelmingly, guys in special operations come from middle-to-upper class backgrounds, are extroverted, and have higher technical scores than the rest of the military.  The class background in particular warrants further study.  While many who join the military do so for job skills or college money, men who enlist for commando units have no expectation of gaining either of these.  The types who volunteer for a professionally worthless job skill do so for adventure, and little else.  Ironically, volunteering for the most arduous, Hollywood positions in the military comes from a position of privilege.  I still struggle to wrap my head around that.  

Ultimately, I suspect most true aggressive psychopaths drawn to commando units wash out during some point of the selection process, or are kicked out because they either have a hard time getting along with comrades or get caught conducting illegal activity.  Otherwise Pierson’s description of a natural killer is pretty accurate.  To most of us who thrive during our time in a deadly unit, we have just enough ASPD traits to do well, but also enough empathy to flow as a cohesive unit and genuinely care for one another in the event of a casualty.  You could say we have ASPD in all the right places.  


Thursday, May 15, 2014

Female sociopath: fact or fiction?

Merve Emre writes for Digg ("The Female Sociopath") on the popularity of the female sociopath in fiction (TV/books, etc.), and the reality. Worth reading in its entirety, the first little bit:

If you don’t know who Rosamund Pike is, you will soon. In October, she will appear in David Fincher’s film adaptation of Gone Girl, one of the most popular and addictive novels of the past decade, as Amy Dunne — the beguiling and cerebral housewife who stages her own murder and frames her philandering husband. Amy’s creator, the novelist Gillian Flynn, has proudly described her character as a “functioning sociopath,” which she is quick to distinguish from “the iconic psycho bitch.” The iconic psycho bitch, Flynn explains, is crazy because “her lady parts have gone crazy.” Think of Glenn Close in Fatal Attraction, so consumed with desire for Michael Douglas that she boils his daughter’s pet rabbit to death; think of Sharon Stone and Jennifer Jason Leigh (and Kathy Bates and Rebecca De Mornay) chasing men through dim rooms with sharp objects. 

Unlike these women, the functional sociopath isn’t “dismissible” as a slave to her emotions. She is not outwardly violent. Patently remorseless, clear-eyed and calculating, she is chameleonic in the extreme, donning one feigned feeling after another (interest, concern, sympathy, simpering insecurity, confidence, arrogance, lust, even love) to get what she wants.

And why should she feel bad about it?

For M.E. Thomas, author of Confessions of A Sociopath, such affective maneuvers are tantamount to “fulfilling an exchange.” “You might call it seduction,” she suggests, but really “it’s called arbitrage and it happens on Wall Street (and a lot of other places) every day.” Whatever you choose to call it, its appeal is undeniable when linked to the professional and personal advancement of women. “In general, the women in my life seemed like they were never acting, always being acted upon,” Thomas laments. Sociopathy’s silver lining was that it gave her a way to combat that injustice, in the boardroom of the corporate law firm she worked for in Los Angeles, but also in the bedroom, where she marveled at how her emotional detachment let her commandeer her lovers’ hearts and minds. Somewhere along the way, pathology became recoded as practice — a set of rules for how to manage the self and others.

No wonder the female sociopath cuts such an admirable figure. Intensely romantic, professionally desirable, she is the stuff of fiction, fantasy, and aspirational reading. And while actual female sociopaths like Thomas are rare, and sociopathy isn’t even recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM), the female sociopath looms large in our cultural imagination. Amy Dunne may stand as the perfect example — a “Cool Girl” on the outside, ice cold within — but she is not alone. Of late, she has faced stiff competition from fictional females like Lisbeth Salander, the ferocious tech genius in The Girl With the Dragon Tattoo, or Laura, the shape-shifting alien who preys on unwitting men in Under the Skin. Network television has been even kinder to the female sociopath, placing her at the center of workplace dramas like Damages, Revenge, Bones, The Fall, Rizzoli and Isles, Person of Interest, Luther, and 24. Here, she has mesmerized audiences with how nimbly she scales the professional ladder, her competence and sex appeal whetted by her dark, aggressive, risk-taking behavior, and lack of empathy.

And so we lean in to the cultural logic of the female sociopath, for she is the apotheosis of the cool girl power that go-getter “feminists” have peddled to frustrated women over the last half-decade. The female sociopath doesn’t want to upend systems of gender inequality, that vast and irreducible constellation of institutions and beliefs that lead successful women like Gillian Flynn to decree that certain women, who feel or behave in certain ways, are “dismissible.” The female sociopath wants to dominate these systems from within, as the most streamlined product of a world in which well-intentioned people blithely invoke words like arbitrage, leverage, capital, and currency to appraise how successfully we inhabit our bodies, our selves. One could easily imagine the female sociopath devouring books with titles like Bo$$ Bitch, Nice Girls Don’t Get the Corner Office, The Confidence Gap, and Play Like a Man, Win Like a Woman to hone her craft — to learn how to have it all. From atop the corporate ladder, she can applaud her liberation from the whole messy business of feeling as a step forward for women, when it’s really a step back.

The result is a self-defeating spectacle of feminism that finds a kindred spirit in Rosamund Pike on the cover of W, erasing her own perfect face to reveal that what lies beneath might be nothing. Like Gone Girl’s Amy Dunne, who confesses that she “has never really felt like a person, but a product” — plastic, fungible, ready to be consumed by anyone, at any time — the female sociopath is a product of a broken promise made to women, by women. She is a product poised to disappear into the immense darkness from which she came. 

One of my favorite parts of studying music was learning that the representation of women in professional orchestras skyrocketed when they started doing blind auditions (i.e. the judges couldn't see who was performing). When I taught, I told my students to use their initials on their C.V.s and résumés, because it seems like every year there is another study that shows that everywhere in every field there is gender and racial bias. Sometimes I wish we could do the equivalent of blind auditions everywhere. Maybe we shouldn't out any sort of name on our résumés. Maybe we should make that illegal, like it is illegal to put your name on a standardized test. Because why should it matter?

When I first started writing this blog, it was like a blind audition. No one knew who I was, only what I wrote. I didn't realize at the time how great that felt, what a respite from my normal life that was. Without realizing even to what extent, I had been swimming against the current all of my life, until I was allowed to just be me. And then when I came out as being female there was a certain significant portion backlash that wasn't really explainable apart from being a reaction to my gender. (See also, popular science blogger Elise Andrew who got a cyclone of hate only after it was discovered that she was female.) There was probably as much backlash in my sociopath life for being female as there was in my normal life for being a sociopath. And now when I write or say things, it is seen through a different, distorted lens of my perceived femininity. I used to never get accused of the typical "oh man, you won't believe how crazy my ex-girlfriend was" type behavior -- "classic female traits" like self-harm/cutting, attention seeking, jealousy, vanity, histrionics, woman-scorned flavored vengeance, man-hating flavored vengeance, or anything else that is likely to get a woman slapped with the term "crazy". Now I get them all of the time. Which was sort of a surprise to me. Why did it bother people that I had been given the diagnosis "sociopath". Because it really seemed to. They took what I said and twisted it to fit something else, until I was "just borderline." as if the biased-female diagnosis was lesser than the sort-of male equivalent. Until I was "just crazy". Until I was something or someone that could be dismissed as a nobody nothing. Because that's how we marginalize people, I guess.

See also SNL – Red Flag | Katabatic Digital


Thursday, March 27, 2014

An aspie's view of sociopathy

From an Aspie reader reader:

I found your blog by chance, a week or two ago, and can't help but feel intrigued. I have Asperger's syndrome (or as the next version of the DSM has it, "autism spectrum disorder") and the experiences you describe seem to have as many similarities to as differences from my own. 

We both find it necessary to mask ourselves for daily life because most people, most of the time, don't want to know what we're really like. They want an interface they know how to use, and an impression they can easily categorize. I don't switch masks with the fluidity of a sociopath, nor do I have as large a repertoire to choose from. I'd be willing to bet that I have to put more conscious effort into each one, so once a given mask passes I have greater incentive to stick with it and practice until perfect. (I don't know what you look like without yours, but at times when I can't maintain a mask I've been told that I either don't emote, or that the other (neurotypical) person doesn't know how to interpret my body language.)

Changing contexts, some facets of my personality behind that mask may fold away and others unfold such that people in either seem to form substantially different impressions of me, but I don't make a conscious decision to change what aspects I have on display, nor bother with deception. I simply omit what isn't relevant.

On the other hand, I'm pretty sure that I lack the typical sociopaths' need for stimulation and excitement, nor do any of your examples mention sociopaths with a typical autistics' sensory hypersensitivities. Sitting in a quiet room with dim lights, my experience is finally not *over*stimulating.

In that vein, there's one thing that I really don't understand. What do sociopaths get out of manipulating or otherwise having power over other people? What about it interests you? To my view, people are mostly boring and interacting with them is a nontrivial drain on my resources. (There are rare exceptions to that rule, and I've married one. He describes me as "asocial".) And so I have to ask: Why bother?

I look forward to your answer.

My response:

Thanks for this! I think that sociopaths get a lot of things from power. They get a sense of connection and intimacy with another person. They get a sense of purpose or sense that they are a being in the world that acts, not just gets acted upon. I think for a lot of sociopaths there was some sort of childhood trauma that made them feel like they weren't the masters of their own destiny. Not everyone is bothered by this, but I think for sociopaths it goes too strongly against their megalomania. But these are sort of just guesses. For me I have felt the need for power as a basic need, like the need for love or acceptance must be for most people, but I'm not sure why. Thoughts?

Friday, September 20, 2013

The psychopath problem

The psychology world seems to be taking a fresh look at sociopathy. Apparently once people dared question the infallibility of Hare's diagnostic criteria, the Psychopathy Check List Revised ("PCL-R"), it opened the door for other heresies against established views.

In his new book "Forensic Psychology: A Very Short Introduction," David Canter, a psychology professor at the University of Hudderfield, briefly describes the psychopath problem:

Until you have met someone whom you know has committed horrific violent crimes but can be charming and helpful, it is difficult to believe in the Hollywood stereotype of the psychopath. Without doubt, there are people who can seem pleasant and plausible in one situation but can quickly turn to viciousness. There are also people who just never connect with others and are constantly, from an early age, at war with those with whom they come into contact. If we need a label for these people, we can distinguish them as type 1 and type 2 psychopaths. The former have superficial charm, are pathological liars, being callous and manipulative. The clearest fictional example of this sort of psychopath is Tom Ripley, who has the central role in many of Patricia Highsmith’s amoral novels. The type 2 psychopaths are more obviously criminal, impulsive, and irresponsible with a history of juvenile delinquency and early behavioural problems.

Another label that may be assigned to people who are habitually involved in illegal, reckless, and remorseless activities that has a much broader net than ‘psychopathy’ is ‘antisocial personality disorder’. But we should not be seduced into thinking that these diagnoses are anything other than summary descriptions of the people in question. They do not help us to understand the causes of people behaving in these unacceptable ways. Some experts have even commented that they are actually moral judgements masquerading as medical explanations. So although the labels ‘personality disorder’ and ‘psychopath’ do summarize useful descriptions of some rather difficult, and often nasty, people, we need to look elsewhere for explanations of how they come to be like that.
The psychopath problem for society is "how do we keep psychopaths from acting in antisocial ways?" The psychopath problem for psychologists is "what are we really dealing with here?" Before psychologists can even begin understanding psychopaths, they must be able to identify them. Before psychologists can identify psychopaths, they must be able to understand them. It's a classic chicken/egg dilemma that leads critics like our favorite narcissist Sam Vaknin to quip that "psychopathy seems to be merely what the PCL-R measures!" and probably led the good folks putting together the DSM to eventually exclude psychopathy as a diagnosis in favor of the more criminal-sentencing friendly ASPD.

Still, these tests are being used, and brains of people flagged by these tests are being scanned and studied, helping scientists to learn more about . . . the brains of people who would be flagged by these tests. Some of the new discoveries or theories about psychopathy jive with my own personal experiences, and some of them strike me as being less than accurate -- an attempt to add an epicycle to support some of the weaker premises that provide the basis for the modern study of psychopathy. Maybe it is true that we are on the verge of a breakthrough, as some psychologists think -- a unifying theory of the causes and explanations for psychopathic behavior. If we are, I think it will have to be a product of fresh thinking, rather than continuing to focus on the same "20 items designed to rate symptoms which are common among psychopaths in forensic populations (such as prison inmates or child molesters)."

Monday, August 19, 2013

Sociopaths feel emotion

I have been surprised by how often I hear or read someone saying that sociopaths don't have emotions or can't form emotional bonds with other people. Most often it's people talking about how sociopaths are soulless monsters or must live lives completely devoid of any real meaningful relationships, but sometimes it's someone saying that he couldn't possibly be a sociopath because he feels emotions and love, etc. This is all fallacy. The three main diagnostic criterions actually have relatively little to say about emotions: Cleckley only mentions "general poverty in major affective reactions" and a poorly integrated sex life, Hare's PCL-R also lists shallow affect, and the DSM-V's ASPD only says that sociopaths tend to experience irritability and don't feel remorse. Nowhere does it say that sociopaths don't love. Nowhere does it say that sociopaths can't form emotional bonds. There is not a single historical example of a sociopath who is a completely emotionless, robot loner, so I don't know from where people are getting this image of the emotionless sociopath.

I thought about this popular misconception when I read this recent comment:

"How does a sociopath know when the missing emotions that make him supposedly so different, since he does not feel them, are feigned? In other words how does he learn to differentiate between feigned and real emotions?"

I am sociopathic, but have some emotion. These emotions are egocentric and only arise with events I am directly involved with, but they are still there. I feel joy and happiness at doing my favorite activities and I can (but may not always) feel anger or sadness when things do not go my way. Nonetheless, these are 'feelings' because they provide information that goes beyond the intellectual analysis of the situation at hand.

Because I have those feelings I can easily contrast those with situations where I do not or am faking them. If I am 'acting' in such a way to not betray myself, and my only contribution to that acting is my intellectual state, then I know that there is an absence of feeling there. If one tells me about how their friend died and they are in tears, I know that I must contribute with an appropriate response so that they 1) do not realize my status and 2) are not feeling any worse. Going through the motions because of this intellectual realization is far different than the automatic response given by most non-sociopaths. I think, by and large, we realize that we are not giving the same response as non-sociopaths because we realize that we have to craft the *entire* interaction with another person, not just the words.

But I don't think even this idea of faking emotions is so different than most people. Do you always mean it when you say "oh, I'm so sorry to hear that"?

Of course who knows whether sociopaths are feeling the same emotions that everyone else is, but I don't think anyone's emotional palette is completely identical to anyone else. Rather people's emotions are going to depend on their culture, their belief system, their education, the societal expectations placed on them, along with the vast natural and physical differences between people's brain and brain chemistry. This applies particularly to a complex emotion like love. I was actually just talking to a friend about how the only reason he can tell his wife loves him is that she very actively ensures that he is sexually satisfied (she's not a sociopath, but this "complaint" could very well be said about many sociopathic spouses). But whatever, right? Who is to say that this is a lesser or less desirable love than someone who would love to hold your hand in a hot air balloon?

Friday, May 10, 2013

DSM-5 = "lack of validity"

Says the Dr. Thomas R. Insel, director of the National Institute of Mental Health. From the NY Times:


While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

Insel describes the problem of all psychiatric diagnoses:

“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

It's interesting, a lot of people will come on here and baldly assert, "sociopaths don't do this" or "that's not what borderline personality disorder is." And that's fine. I understand the flaws and ambiguities in my own working definitions of psychiatric disorders. And I also understand that despite the fuzziness of the definitions, it's still useful to acknowledge that there seems to be commonalities between certain categories of people that deserve further explanation. But I do believe that people have used the DSM unquestioningly for far too long, taking it to the level of being DSM apologists rather than accepting new information with an open-mind, and I'm glad that there is now more pressure to provide actual science behind the various assertions.

For more on the DSM-5's explicit rejection in one instance of actual scientific proof of a separate psychiatric disorder, see this New Yorker article's discussion of melancholia:

[T]he inclusion of a biological measure [for melancholia] would be very hard to sell to the mood group." Coryell explained that the problem wasn’t the test’s reliability, which he thought was better than anything else in psychiatry. Rather, it was that the D.S.T. would be "the only biological test for any diagnosis being considered." A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring.
***
This notion—that the apparent mental condition is all that can matter—underlies not only the depression diagnosis but all of the D.S.M.’s categories. It may have been conceived as a stopgap, a way to bide time until the brain’s role in psychological suffering has been elucidated, but in the meantime, expert consensus about appearances has become the cornerstone of the profession, one that psychiatrists are reluctant to yank out, lest the entire edifice collapse.

"What can be asserted without evidence can be dismissed without evidence."






Thursday, April 11, 2013

Why we need psychopaths (part 2)

Regarding emotions and manipulation:


As psychopaths become less associated with demonic bloodlust a more accurate image is formed of just what this set of symptoms really looks like. They have “shallow emotions” which simply means their emotions are much less intense than non-psychopaths (DSM-IV-TR (2000) 4th ed., text. rev.). To demonstrate, imagine that a company is interviewing candidates to fill a vacant position. After several mediocre interviews, the recruiters are introduced to a charismatic, energetic, intelligent and striking woman whose credentials align perfectly with the job description. Obviously she is hired on the spot. Her low emotionality keeps her calm under pressure and cool-headed when resolving conflicts with co-workers. She’s able to make critical decisions for the company because “it’s not personal; it’s a business decision,” and has no problem sleeping at night while putting hundreds of employees out of work. Some of her co-workers go home emotionally exhausted after a day of rejected sales attempts, but not her. Little do they know her attractive outwardly appearance merely serves as a cover for the hollow shell within. Emotional detachment and regulation are important while in a business setting but for psychopaths their emotions are consistently “turned down.”

The flip side to this would be someone who is overemotional, which is often synonymous with “irrational.” This is why people are granted bereavement time from work. When mourning the loss of a loved one, they will be overcome by emotion and unable to concentrate effectively on their job duties. In some careers, such carelessness can be dangerous. It is this same extreme emotional state that sets the stage for crimes of passion because emotions have a tendency to distort reasoning - unbalanced emotions overwhelm balanced judgment (Hare 1999). For psychopaths, problems are evaluated in black and white terms with very little “gray area” distortion. Factor in the other leading characteristic, lack of empathy, and it is understandable why they describe having an “unburdened mind.” (Thomas 2013)

Psychopaths compensate for these deficits by learning to be experts on human behavior and honing their ability to mimic appropriate emotions. This overcompensation is often described as “deception” and “manipulation” in diagnostic criteria, but it is the same concept as “impression management” techniques regular people frequently utilize (DSM-IV-TR (2000) 4th ed., text. Rev). It is also called social masks in some literature. This is the idea that people slightly alter their personality depending on the situation they are in, thus “playing to the crowd” (Hare 1999). An example would be maintaining a professional appearance and demeanor while at work but “being yourself” at home. Adolescents or even young adults may use crude language in front of their friends but refrain in the presence of their families. Trying to show your best attributes during a first date and gradually “letting your guard down” describes the same concept. This could be “making a good impression” or being manipulative and deceptive depending upon perspective.

Regardless of one’s opinion of such practice, another important part of impression management and successful social interaction is learning to display proper emotion at certain times with appropriate intensity. Failing to display appropriate social cues can be off-putting and uncomfortable for the people who would describe this person as “hard to read.” So people learn to smile on cue, chuckle at a joke whether it is humorous or not, feign concern over a matter that doesn’t genuinely trouble anyone but the people involved, and so on. This process is generally automatic although errors occur occasionally, which is called “sending mixed signals.” It could be chalked up to having good manners and refined social skills but just how much feigned emotion people can handle is debatable. At what point is a person accused of “putting on a show” or being “fake?” When someone’s ego is at risk of injury they attempt to “save face” or avoid negative action. There is not a clearly defined manual for impression management and some pull it off better than others.

Saturday, December 22, 2012

Heroes and sociopaths

I have posted before about how being a sociopath can make you *feel* like you are a superhero. I think this feeling (narcissistic self-import) is relatively common among sociopaths. For instance, I stumbled upon this not-me description of it here:
Being a sociopath doesn't mean you have to be evil. We struggle to feel the difference between right and wrong, but we do know the difference since we have had it drilled into our heads since we were children, right? Fact is, us sociopaths have more choice in this world than the rest. That is because we can choose to be heroes or we can choose to be villains. No one else can do that, they have to be what they are, they are born a certain way, they will always be that way. Us sociopaths can change to our surroundings. We can do anything we choose to do.
Interestingly, some say this feeling goes both ways -- that superheroes can sometimes feel (or act) like sociopaths.
We look at heroes and do-gooders as a special sort of breed: people who possess extraordinary traits of altruism or self-less concern for the well-being of others, even at the expense of their own existence. On the other end, sociopaths also have an extraordinary set of traits, such as extreme selfishness, lack of impulse control, no respect for rules, and no conscience.

As crazy as it sounds, there may be a closer link than than most people would think between the extreme-altruistic personality and sociopathic personality. Would it shock you to know that two people, one with the traits of extreme-altruism (X-altruism) and the other the traits of a sociopath, could be related? Even siblings? And that their personality traits are very similar, with only a few features to distinguish them? Research by Watson, Clark, and Chmielewki from the University of Iowa, “Structures of Personality and Their Relevance to Psychopathology” [pdf], present a convincing argument in which they support the growing push for a trait dimensional scheme in the new DSM-V to replace the current categorical system.

[X- altruists are risk takers and rule breakers.] When they are faced with that moment, they just act. Compulsively. Barely considering any other course. The lack the impulse control to stop themselves from doing “the right thing” when it comes to the welfare of others, yet ironically, it almost always results in some form of negative consequence for themselves. They have no problem breaking the rules when it means helping an innocent, yet they highly value the importance of obeying rules in other contexts. That’s crazy, you say? Now you’re getting the idea.

[but sociopaths are unfeeling monsters, altruists are so great, bla bla bla]

Interestingly, these two type of individuals, the sociopath and the X-altruist, may appear similar in their displays of behavior, and at times, even confused for the other type. If an X-altruistic person is compelled to break rules without remorse in order to help a disadvantaged person, is may seem as if he is acting rebelliously, especially if the motives behind his behavior are not known. On the other hand, a sociopath may donate a large sum of money to a charity, a seemingly altruistic behavior, but his actions may have been motivated by his selfish need to appear better than or more generous than a colleague. The defining characteristic that separates the two personality types is their ability to empathize, either not at all or too much, which then drives the extreme behavior of each.
And my favorite comment from the article:
Interesting article, but not without bias, and in my opinion, unprofessionally written. Never before have I heard a health-care professional refer to a sociopath as "nasty". As a behavioral specialist, I would expect you to know better than anyone that sociopaths do not choose their hereditary personality disorders anymore than your beloved X-altruists do. Why call names?

And how do you define virtue and "good" intent? Is not the X-altruist's all-consuming desire to help others, at the expense breaking these rules you seem to value so much, just as selfish as the sociopath?
followed closely by this one:
Your intentions are obvious. Try as you like, we'll never associate heroes with sociopaths.

And the social order will thus survive, despite your kind's attempt to weaken and destroy it.
It's an interesting point, though. Are sociopaths considered "bad" just because they seem to do, on average, more "bad for society" type things? If so, can't we just punish the "bad behavior" without singling out everyone with the condition and eradicating them? For another interesting look at heroes and sociopaths in fiction/media, see this article on the "heroic sociopath," including such gems as this rationalization of Peter Pan: "He's only slightly less uncaring towards others as his nemesis Captain Hook and comes across better mostly because his sociopathy is a result of being a perpetual child, whereas Hook really has no excuse." Aspies or Auties, anyone? I'm not so much saying that the hate against sociopaths isn't at all warranted, more that there is no principled way to hate sociopaths and not hate other people/personalities/disorders that are widely accepted or even beloved in society.

Friday, September 14, 2012

Take the Test

From TNP, describing the test:


It essentially breaks down all known psychopathic behavior into individual clusters that branch off of a base psychopathic tree. It's an evaluation, which a person can take themselves, to see just where they fall, and what characteristics and predominant in their personality. It takes away the arbitrary binary designation Yes/No to psychopathy, and instead focuses on the type of psychopathic features a person displays.

My academic sources are rooted in the works of Hare, Millon, and the DSM, though I do avoid complete redundancy, and nixed a few aspects that seemed obsolete, or unrelated to psychopathy.



The test itself:


Psychopathic Trait Tendency Assessment (PTTA)

This evaluation measures an individual's potentially psychopathic personality traits. It measures four different clusters of acknowledged psychopathic traits, and has a scoring system to measure if an individual meets enough of the criteria to acknowledge how much their personality is affected by each cluster of psychopathy. The evaluation also makes the distinction between each cluster being a primary personality tendency or a secondary one if indeed an individual displays enough traits for a cluster on a consistent basis.

This test does not evaluate whether an individual is a psychopath or not. It simply measure how their personality measures up to researched psychopathic features. The criteria, thresholds, and clusters are derived from the works and research of Hare, Millon, and the DSM IV.


Scoring System

Each trait has a max score of 4. There is no "3" in the scoring system, due to the severity of difference of a pathological trait, and a learned and utilized trait due to environmental adaptation necessities.*

0 - manifests rarely if at all
1 - manifests occasionally
2 - manifests frequently
4 - is an ever-present pathological manifestation in the personality of the person and is rarely if ever not utilized
  
*Examples of this would be when a person lives in a life-situation where classically psychopathic traits are needed to survive and thrive. This usually applies to hostile or high-stress work-environments for the likes of soldiers, career criminals, police, emergency responders, doctors/nurses, et cetera.


PTTA Evaluation

Assign a score to each trait based on the scoring system above. Add up the total for each cluster.

Core Base Psychopathic Personality Traits

-Superficial usage of charm
-Drastically lower levels of fear and anxiety
-Lack of empathy
-Lack of remorse
-Underdeveloped emotions
-Lack of respect or understanding of social norms and morals
-Impersonal relationships with family, friends and lovers
-Shallow to nonexistent affect
-High levels of cunning, deception and manipulation


Primary Psychopath threshold 28+/36
Secondary Psychopath threshold 20-27/36


Core Antisocial Personality Traits

-High levels of apathy and lack of life goals
-Disregard and violation of the boundaries of others
-Recidivist criminality
-Low levels of impulse control
-Low tolerance for frustration
-Prone to violent outbursts
-Prone to parasitic relationships with friends, family, and lovers
-Prone to indulgence of narcotics, alcohol, and other habit forming chemicals
-Sexual promiscuity

Primary Antisocial threshold: 28+/36
Secondary Antisocial threshold: 20-27/36


Core Narcissistic Personality Traits

-Highly susceptible to criticism or praise
-Grandiose self-image
-Sense of entitlement
-Delusional and unrealistic goals
-Obsession with self
-Requires constant attention and prefers to be the center of it
-Easily and often jealous and angry
-Wants and feels they deserve "the best" of whatever they want or need
-Indulges in fantasy of wealth, power and fame

Primary Narcissist threshold: 28+/36
Secondary Narcissist threshold: 20-27/36


Core Sadistic Personality Traits

-Prone to use physical or psychological harm to achieve their goals
-Humiliates or demeans others
-Utilizes unusually harsh punishments and lessons
-Takes pleasure or is amused by viewing or participating in the harming of animals and or humans
-Usage of intimidation
-Restricts the autonomy of those closest to the person
-Highly interested weapons, violence and torture
-Views others as toys to be played with and discarded when bored
-Takes pleasure in terrorizing and inducing fear and panic in others

Primary Sadist threshold: 28+/36
Secondary Sadist threshold: 20-27/36


Each core personality type represents a cluster of traits typically associated with Psychopaths and their behavior. As these are personality clusters, some are usually represented more than others, but it is possible that an individual would score very high on all clusters, or possibly only high on one if they were somewhere in the psychopathic spectrum.

Each cluster has nine traits, and the thresholds are kept at levels that require a majority of points being pooled into each cluster.

Secondary represents that an individual not only represents most traits to a moderate degree, but has at least one that falls into the realm of pathological.

Primary represents that not only does an individual have most traits to a moderate degree, but that they have most to a pathological degree.

Thresholds are not meant to include or exclude the possibility that someone encompasses a personality cluster. For example, an individual with only three or four traits in a cluster to a pathological degree would probably be represented by the personality cluster, even if the other traits did not appear present or that noticeable. It is rare (but not impossible) than an individual would only have a few traits in a cluster at pathological levels, and not the rest, to at least achieve the Secondary status for that cluster.

Friday, June 22, 2012

The modern psychiatric diagnosis: DSM

This was an interesting NY Times op-ed about the DSM, its origins, and questioning its continuing role in society, written by a former contributor to the DSM.

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Psychiatric diagnosis was a professional embarrassment and cultural backwater until D.S.M.-3 was published in 1980. Before that, it was heavily influenced by psychoanalysis, psychiatrists could rarely agree on diagnoses and nobody much cared anyway.

D.S.M.-3 stirred great professional and public excitement by providing specific criteria for each disorder. Having everyone work from the same playbook facilitated treatment planning and revolutionized research in psychiatry and neuroscience.

Surprisingly, D.S.M.-3 also caught on with the general public and became a runaway best seller, with more than a million copies sold, many more than were needed for professional use. Psychiatric diagnosis crossed over from the consulting room to the cocktail party. People who previously chatted about the meaning of their latest dreams began to ponder where they best fit among D.S.M.’s intriguing categories.

The fourth edition of the manual, released in 1994, tried to contain the diagnostic inflation that followed earlier editions. It succeeded on the adult side, but failed to anticipate or control the faddish over-diagnosis of autism, attention deficit disorders and bipolar disorder in children that has since occurred.

Indeed, the D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence. It has become the arbiter of who is ill and who is not — and often the primary determinant of treatment decisions, insurance eligibility, disability payments and who gets special school services. D.S.M. drives the direction of research and the approval of new drugs. It is widely used (and misused) in the courts.

Until now, the American Psychiatric Association seemed the entity best equipped to monitor the diagnostic system. Unfortunately, this is no longer true. D.S.M.-5 promises to be a disaster — even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription. The association has been largely deaf to the widespread criticism of D.S.M.-5, stubbornly refusing to subject the proposals to independent scientific review.

Many critics assume unfairly that D.S.M.-5 is shilling for drug companies. This is not true. The mistakes are rather the result of an intellectual conflict of interest; experts always overvalue their pet area and want to expand its purview, until the point that everyday problems come to be mislabeled as mental disorders. Arrogance, secretiveness, passive governance and administrative disorganization have also played a role.

There were a couple things I thought this this piece did a good job of illustrating.  First, that the history of the DSM wasn't Allah speaking directly to his prophet who then immortally inscribed these truths into the first issue of the DSM, but that it was largely just an attempt to assemble what most people thought about things out of the primordial ooze that was mainstream psychology as recently as a few decades ago.  Second, that despite these somewhat inauspicious origins, most people believe the word of the DSM like it is the bible, including decisionmakers like courts and legislatures.  Third, that there will never be a perfect DSM because of fundamental disagreements and the accompanying political machinations amongst the experts that write it.  So, in a word, the DSM is not the most reliable system in the world.

The conclusion:

Consumers should play an important role in the review process, and field testing should occur in real life settings, not just academic centers.Psychiatric diagnosis is simply too important to be left exclusively in the hands of psychiatrists. They will always be an essential part of the mix but should no longer be permitted to call all the shots.

Monday, May 14, 2012

Kid sociopath

Quite a few people emailed me this NY Times article that has hit the most emailed: Can you Call a 9-Year-Old a Sociopath?"  Here are selections (the article is quite long, but an engaging read):
  • “We’ve had so many people tell us so many different things,” Anne said. “Oh, it’s A.D.D. — oh, it’s not. It’s depression — or it’s not. You could open the DSM and point to a random thing, and chances are he has elements of it. He’s got characteristics of O.C.D. He’s got characteristics of sensory-integration disorder. Nobody knows what the predominant feature is, in terms of treating him. Which is the frustrating part.” . . . . Following a battery of evaluations, Anne and Miguel were presented with another possible diagnosis: their son Michael might be a psychopath.
  • Currently, there is no standard test for psychopathy in children, but a growing number of psychologists believe that psychopathy, like autism, is a distinct neurological condition — one that can be identified in children as young as 5.
  • “If they can get what they want without being cruel, that’s often easier,” Frick observes. “But at the end of the day, they’ll do whatever works best.”
  • “This isn’t like autism, where the child and parents will find support,” Edens observes. “Even if accurate, it’s a ruinous diagnosis. No one is sympathetic to the mother of a psychopath.”
  • “As the nuns used to say, ‘Get them young enough, and they can change,’ ” Dadds observes. “You have to hope that’s true. Otherwise, what are we stuck with? These monsters.”
  • “They’re not like A.D.H.D. kids who just act impulsively. And they’re not like conduct-disorder kids, who are like: ‘Screw you and your game! Whatever you tell me, I’m going to do the opposite.’ The C.U. kids are capable of following the rules very carefully. They just use them to their advantage.”
  • Their behavior — a mix of impulsivity, aggression, manipulativeness and defiance — often overlaps with other disorders. “A kid like Michael is different from minute to minute,” Waschbusch noted. “So do we say the impulsive stuff is A.D.H.D. and the rest is C.U.? Or do we say that he’s fluctuating up and down, and that’s bipolar disorder? If a kid isn’t paying attention, does that reflect oppositional behavior: you’re not paying attention because you don’t want to? Or are you depressed, and you’re not paying attention because you can’t get up the energy to do it?”
  • Most researchers who study callous-unemotional children, however, remain optimistic that the right treatment could not only change behavior but also teach a kind of intellectual morality, one that isn’t merely a smokescreen. . . . “I try to tell him: You’re here with a lot of other people, and they all have their own ideas of what they want to be doing. Whether you like it or not, you just have to get along.”
  • “I’ve always said that Michael will grow up to be either a Nobel Prize winner or a serial killer.”

Some of these selections are regarding a clinical study/camp for these youngsters.  That was probably the most entertaining part--seeing how they interact with each other.

  • The study had a ratio of one counselor for every two children. But the kids, Waschbusch said, quickly figured out that it was possible to subvert order with episodes of mass misbehavior. One child came up with code words to be yelled out at key moments: the signal for all the kids to run away simultaneously.

And this little vixen:

  • Charming but volatile, L. quickly found ways to play different boys off one another. “Some manipulation by girls is typical,” Waschbusch said as the kids trooped inside. “The amount she does it, and the precision with which she does it — that’s unprecedented.” She had, for example, smuggled a number of small toys into camp, Waschbusch told me, then doled them out as prizes to kids who misbehaved at her command. That strategy seemed particularly effective with Michael, who would often go to detention screaming her name.



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