Psychopathy and Treatment

Questionable research practices are a well-recognized problem in psychology. Coding bias, or the tendency of review studies to disproportionately cite positive findings from original research, has received comparatively little attention. Coding bias is more likely to occur when original research, such as neuroimaging, includes large numbers of effects, and is most concerning in applied contexts. We evaluated coding bias in reviews of structural magnetic resonance imaging studies of PCL-R psychopathy. We used PRISMA guidelines to locate all relevant original sMRI studies (...) and reviews. The proportion of null-findings cited in reviews was significantly lower than those reported in original research, indicating coding bias. Coding bias was not affected by publication date or review design. Reviews recommending forensic applications—such as treatment amenability or reduced criminal responsibility—were no more accurate than purely theoretical reviews. Coding bias may have contributed to a perception that structural brain abnormalities in psychopaths are more consistent than they actually are, and by extension that sMRI findings are suitable for forensic application. We discuss possible sources for the pervasive coding bias we observed, and we provide recommendations to counteract this bias in review studies. Until coding bias is addressed, we argue that this literature should not inform conclusions about psychopaths' neurobiology, especially in forensic contexts. (shrink)

Das Themengebiet der Psychopathie hat in den letzten Jahrzehnten vor allem durch Filme, die sich mit (vermeintlich) psychopathischen Charakteren beschäfti- gen, ein breites gesellschaftliches Interesse erfahren (vgl. Swart 2016). Holly- woods Blockbuster zeigen hier Beispiele hochintelligenter (z. B. Hanibal Lector in „Das Schweigen der Lämmer“) oder sexuell devianter (z. B. Patrick Bateman in „American Psycho“) Serienkiller, welche aus klinischer Sicht tatsächlich hoch psy- chopathische Tendenzen aufweisen. Demgegenüber werden psychisch andersartig beeinträchtigte Filmcharaktere, wie z. B. Norman Bates („Psycho“) oder Travis Bickel (...) („Taxi Driver“) wohl aufgrund ihrer schreckenseinflößenden Wirkung im allgemeinen Sprachgebrauch oft als Psychopathen bezeichnet, obwohl ihre Symptome aus forensisch-psychiatrischer Sicht eher schizoiden Wahnvorstellungen ähneln und keine Anzeichen einer klas- sischen Psychopathie darstellen (vgl. Leistedt / Linkowski 2014). Auch Medienbe- richte über tatsächlich existierende, brutale (z.B. Serienkiller Ted Bundy) oder dreiste (z.B. Anlagebetrüger Bernard Madoff) Figuren der Zeitgeschichte haben die konzeptionelle Unübersichtlichkeit des in der Öffentlichkeit wahrgenommenen Bildes der Psychopathie befeuert. Und sogar in medizinischen bzw. psychiatri- schen Kreisen scheint eine uneinheitliche Sichtweise die Konfusion um das Stö- rungsbild Psychopathie weiter anzufachen (vgl. Berg et al. 2013). (shrink)

The term psychopathy refers to a personality disorder associated with callous personality traits and antisocial behaviors. Throughout its research history, psychopathy has frequently been described as a peculiar form of moral blindness, engendering a narrative about a patient stereotype incapable of taking a genuine moral perspective, similar to a blind person who is deprived of proper visual perceptions. However, recent empirical research has shown that clinically diagnosed psychopaths are morally more fit than initially thought, and the blindness-analogy now comes across (...) as largely misleading. In this contribution, the moral-blindness analogy is explored in an attempt to qualify anew its relevance in psychopathy theory and research. It is demonstrated that there are indeed theoretically relevant parallels to be drawn between blindness and psychopathy, parallels that are especially illuminating when accounting for the potential symptomatology, dimensionality, and etiological nature of the disorder. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

The psychiatric diagnosis of psychopathic personality—or psychopathy—signifies a patient stereotype with a callous lack of empathy and strong antisocial tendencies. Throughout the research record and psychiatric practices, diagnosed psychopaths have been predominantly seen as immune to psychiatric intervention and treatment, making the diagnosis a potentially strong discriminator for treatment amenability. In this contribution, the evidence in support of this proposition is critically analyzed. It is demonstrated that the untreatability perspective rests largely on erroneous, unscientific conclusions. Instead, recent research suggests that (...) practitioners should be more optimistic about the possibility of treating and rehabilitating diagnosed psychopaths. In light of this finding, concrete ethical challenges in the forensic practice surrounding the psychopathy diagnosis are discussed, adding to a growing body of research that expresses skepticism about the forensic utility of the diagnosis. (shrink)

English Abstract: The Antisocial personality disorder and several other psychiatric constructs are questioned and deconstructed in this review, that uses psychoanalytic approach to explain the nature of psychopathy and to give recommendations in this respect. -/- German Abstract: In vorliegender Rezension werden psychiatrische Konstrukte psychoanalytischer Bewertung unterzogen und dekonstruiert. Während die Entität „Antisoziale Persönlichkeitsstörung“ aufgrund ihrer Unwissenschaftlichkeit verworfen wird, besteht mentales Konstrukt „Psychopathie“ der Realitätsprüfung. In weiterem Verlauf der Rezension wird Versuch unternommen, das Phänomen der Psychopathie aufzuklären, um sie begrifflich (...) sowie gesundheitlich einzugrenzen. (shrink)

The aim of this paper is to analyze, from a philosophical perspective, the scientific robustness of the construct of psychopathy as measured by the Psychopathy Checklist Revised that was developed by Robert Hare (1991; 2003). The scientific robustness and validity of classifications are topics of many debates in philosophy of science and philosophy of psychiatry more specifically. The main problem consists in establishing whether scientific classifications reflect natural kinds where the concept of a natural kind refers to the existence of (...) some objective divisions in nature that do not depend exclusively on subjective judgments of the classifier. The construct of psychopathy is especially interesting since the diagnosis of psychopathy has substantial social consequences. In the light of the recent debates regarding the problem of natural kinds in philosophy of psychiatry, we advocate the following distinction between two types of scientific classifications: natural and practical kinds. Natural kinds refer to those categories that are united by common causal mechanisms or properties. Practical kinds refer to categories that fulfill some practical classificatory goals such as prediction. We argue that the construct of psychopathy can fulfill the role of a practical kind. In addition, we contend that our current scientific knowledge about psychopathy does not allow us to conclude that this category is a natural kind. (shrink)

Recent developments in neuroscience have inspired proposals to perform deep brain stimulation on psychopathic detainees. We contend that these proposals cannot meet important ethical requirements that hold for both medical research and therapy. After providing a rough overview of key aspects of psychopathy and the prospects of tackling this condition via deep brain stimulation, we proceed to an ethical assessment of such measures, referring closely to the distinctive features of psychopathic personality, particularly the absence of subjective suffering and a lack (...) of moral motivation. Scrutiny of these factors reveals that two essential bioethical criteria, individual medical benefit and voluntary informed consent, cannot be met in performing neurosurgical experiments or treatments on psychopathic inmates. (shrink)

I argue that deep brain stimulation (DBS) is a bad approach for incarcerated psychopaths for two reasons. First, given what we know about psychopathy, empathy, and DBS, it is unlikely to function as an effective treatment for the moral problems that characterize psychopathy. Second, considerations of neurodiversity speak against seeing psychopathy as a mental illness in the first place.

There is a paucity of research on how psychopathy relates to decision-making. In this study, we assessed the relationship between affective decision-making and psychopathic personality. A sample of prisoners (n D 49) was characterized in terms of psychopathic traits using the Psychopathic Checklist: Screening Version (PCL:SV). Decision-making was assessed using the Iowa Gambling Task (IGT). Higher levels of psychopathy related to more advantageous choices (p D .003). Also counter-intuitively, higher levels of antisocial traits (facet 4) predicted advantageous choices during the (...) learning phase of the task (p D .004). Our findings suggest that some psychopathic facets may be more relevant to decisionmaking under risk, and highlight the importance of further investigations considering facet and trait-level relationships with decision-making. (shrink)

Psychopathic individuals are characterized by impaired affective processing, impulsivity, sensation-seeking, poor planning skills and heightened aggressiveness with poor self-regulation. Based on brain self-regulation studies using neurofeedback of Slow Cortical Potentials (SCPs) in disorders associated with a dysregulation of cortical activity thresholds and evidence of deficient cortical functioning in psychopathy, a neurobiological approach seems to be promising in the treatment of psychopathy. The results of our intensive brain regulation intervention demonstrate, that psychopathic offenders are able to gain control of their brain (...) excitability over fronto-central brain areas. After SCP self-regulation training, we observed reduced aggression, impulsivity and behavioral approach tendencies, as well as improvements in behavioral-inhibition and increased cortical sensitivity for error-processing. This study demonstrates improvements on the neurophysiological, behavioral and subjective level in severe psychopathic offenders after SCP-neurofeedback training and could constitute a novel neurobiologically-based treatment for a seemingly change-resistant group of criminal psychopaths. (shrink)