Cleckley's checklist --accurate or out-dated?

[WS]

In response to my last post you referenced Cleckley's criteria for psychopathy. When I read his work, it seemed to me that he used the label psychopathy *instead* of APD. Some of his case studies are people who never killed anyone, but instead did other antisocial behavour such as lying, neglecting spouces/family, etc. Is psychopathy listed in the DSM IV? I thought it was *replaced* by APD. Thanks.

 

[David Baxter PhD]

In response to my last post you referenced Cleckley's criteria for psychopathy. When I read his work, it seemed to me that he used the label psychopathy *instead* of APD.

That's correct. The term "psychopath" (sometimes called "sociopath" but that term is now outdated) refers to a very specific set of emotional and behavioral characteristics; the term "antisocial personality" or "antisocial personality disorder (APD)" is a more general one. An individual does not have to be a psychopath per se to meet the criteria for APD; indeed, almost everyone who is incarcerated for a criminal offence can meet the criteria for APD and that is by far the most common diagnosis for incarcerated males, although most of those individuals would not meet the more stringent criteria for psychopathy.

Some of his case studies are people who never killed anyone, but instead did other antisocial behavour such as lying, neglecting spouses/family, etc.

That's correct. Most psychopaths are not murderers because they don't need to be -- they are able to manipulate and charm people into getting what they want without having to resort to killing. A few psychopaths kill because it is expedient in the pursuit of their goals; a small percentage of psychopaths kill for the "thrill" of killing.

Is psychopathy listed in the DSM IV? I thought it was *replaced* by APD.

The DSM-III and and especially the DSM-IV criteria for Antisocial Personality Disorder were attempts to more narrowly restrict the use of the diagnosis and to bring it closer to what we know and understand to be the characteristics of psychopathy. However, the attempt proved to be unsuccessful for various reasons, at least so far, and there are still some critical differences between the criteria for Antisocial Personality Disorder (more general) and those for psychopathy (more specific). There currently is no DSM-IV diagnois for psychopathy.

The criteria for APD are:

Diagnostic criteria for 301.7 Antisocial Personality Disorder
(cautionary statement)
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

B. The individual is at least age 18 years.

C. There is evidence of Conduct Disorder with onset before age 15 years.

D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Note the "three or more" requirement above: As I said, it is difficult for an individual to end up incarcerated for a criminal act or criminal acts without meeting three or more of those criteria, but that does not necessarily define a psychopath.

Following the DSM field trials, because of problems with such things as interrater reliability, the core characteristics of what most clinicians would consider to be psychopathy were relegated to the "Associated Features" section of the APD diagnostic criteria. See this this article by Robert Hare et al., published originally as "Psychopathy and the DSM-IV criteria for antisocial personality disorder" in the Journal of Abnormal Psychology (1991, Aug;100(3):391-8).

Hare had developed his own Psychopathy Checklist to "diagnose" psychopaths. However, there are a number of problems with this scale too, including issues about the scoring system and research indicating that the scale actually measures two factors -- one relating to antisocial behavior which is more like APD and the other relating to the more emotional-psychological-interpersonal core characteristics of psychopathy. The problem is that the best. most reliable and valid factor, especially in terms of predicting future criminal or antisocial acts, is the "APD" factor rather than the "psychopathy" factor -- essentially, this is the same problem the DSM field testers ran into in the latest attempts to revise the DSM criteria.

I can tell you from direct experience that when you meet a true psychopath, you have little doubt that s/he is a psychopath... the problem is that some of the features are difficult to quantify.