11a
David K. Marcus and Madeline G. Nagel
Brislin and Patrick’s chapter (this volume) on antisocial personality disorder and psychopathy provides a comprehensive and scholarly review of the past and current thinking about these two related, but distinct, conditions. These authors are ideally suited to contribute this chapter because their work developing the triarchic model of psychopathy has been highly influential in shaping the modern conceptualization of psychopathy as a constellation of overlapping, yet distinct traits, as well as generating research in the field. Although the paper that introduced the triarchic model (Patrick, Fowles, & Krueger, 2009) is fewer than 10 years old, according to PsychINFO it has already been cited over 450 times. Our own work on psychopathy has been strongly influenced by this model.
The debate over what components are essential to, or part of psychopathy may have its origins in the differing classic accounts provided by Cleckley (1976), who described psychiatric inpatients who were irresponsible, egocentric, but also charming and socially influential; and the more aggressive and vicious criminal offenders identified as psychopaths by McCord and McCord (1964) and Robbins (1966). However, this question about what constitutes psychopathy remains controversial today (e.g., Hare & Neumann, 2010; Lilienfeld et al., 2012; Miller & Lynam, 2015; Skeem & Cooke, 2010). The power of the triarchic model is that it provides an inclusive framework for organizing the various elements that have been proposed to constitute psychopathy into three dispositional constructs: boldness, meanness, and disinhibition. By erecting a big tent that encompasses all of the primary components that have been implicated in classic and contemporary conceptualizations of the psychopathy, the triarchic model avoids getting pulled into some of the most contentious debates among psychopathy researchers. Paradoxically, the triarchic model’s broad formulation may leave the basic question of what is psychopathy unanswered. In this brief commentary we attempt to describe this central challenge to the field.
There are some personality disorders whose various symptoms are essentially expressions of a single trait. For example, the seven symptoms of paranoid personality disorder are different descriptions or manifestations of suspiciousness, and the seven symptoms of avoidant personality disorder each describe different aspects of excessive sensitivity to social judgment and rejection. Hence, there is no need for a multifaceted model of paranoid or avoidant personality disorder. There may be controversies associated with each of these disorders (e.g., is avoidant personality disorder distinct from social anxiety disorder?), but there is no controversy about what is at the core of these personality disorders. In contrast, despite its long history and status as one of the most studied forms of personality pathology (a PsychINFO search of “psychopathy or psychopath” yields over 9,500 citations), there is little agreement about what (if anything) is at the core of psychopathy and the very definition of psychopathy can differ between researchers.
According to the triarchic model, boldness, meanness, and disinhibition are the three constructs that “account for the observable symptoms and correlates of psychopathy” (Brislin & Patrick, this volume, p. 254 in the previous chapter). This formulation does not, however, stipulate that all three of these constructs must be present for a “diagnosis” of psychopathy. Miller and Lynam (2015) identified this issue as the debate regarding necessity and sufficiency. In a previous paper, Patrick and Drislane (2015, p. 628) suggested that individuals high in disinhibition “would warrant a diagnosis of psychopathy if also high in boldness and/or meanness, which contribute to a more detached (insouciant-persuasive or callous-predatory) expression of disinhibitory tendencies, but not if high on only one of these tendencies.” It would follow from this formulation that none of the components of the triarchic model are sufficient for psychopathy, but that disinhibition is necessary. Nevertheless, disinhibition may not be essential to psychopathy, especially to primary psychopathy (Poythress & Hall, 2011). As Karpman (1948, p. 527) wrote over 60 years ago, “the true psychopath is the least impulsive of them all” noting that “the psychopath often coolly and deliberately plans his actions as seen in the case of professional criminals; there is no hot-headedness here at all.” Conversely, it is also questionable whether all individuals who are high in disinhibition and boldness would necessarily be psychopathic (e.g., a fearless, charming, assertive person with ADHD who is scrupulously moral).
In contrast, Miller and Lynam (2015) have asserted that antagonism/disagreeableness, as represented by the meanness component of the triarchic model, is necessary and possibly sufficient for psychopathy. In fact, two recent network analyses of the items from the Psychopathy Checklist – Revised (Hare, 1991) found that meanness items, such as callousness and a lack of remorse, were among the most central items across a variety of forensic samples (Preszler, Marcus, Edens, & McDermott, 2018; Verschuere et al., 2018). It seems unlikely, however, that meanness or disagreeableness is sufficient for psychopathy, because there are other conditions or personality types that are also characterized by disagreeableness or meanness that are distinct from psychopathy. For example, sadism appears to be at least as strongly associated with disagreeableness as psychopathy is (e.g., van Geel, Goemans, Toprak, & Vedder, 2017), but sadism and psychopathy are distinguishable constructs (e.g., Buckels, Jones, & Paulhus, 2013). If meanness were to be sufficient for psychopathy it would have to be a more specific subtype or form of antagonism than general disagreeableness. Furthermore, meanness may not be necessary for psychopathy. Community participants who rated the original Cleckley (1976) case studies on a set of psychopathy-related and general personality traits did not rate most of the cases as especially high in meanness (Crego & Widiger, 2016). Thus many of the patients who informed Cleckley’s conceptualization of psychopathy, which influenced most subsequent psychopathy research, including the development of the Psychopathy Checklist scales (Hare, Neumann, & Mokros, 2018) “were not particularly cruel, callous, or physically aggressive” (Crego & Widiger, 2016, p. 86).
Whereas there is reason to question whether disinhibition or meanness are each necessary or sufficient for psychopathy, as noted by Brislin and Patrick, there is controversy regarding whether boldness should even be included as a component of psychopathy. Measures of boldness are at best weakly correlated with other measures of psychopathy. Furthermore, boldness is negatively associated with internalizing pathology and can be adaptive in some situations, leading some (e.g., Miller, Lamkin, Maples-Keller, Sleep, & Lynam, 2018; Miller & Lynam, 2012) to argue that it should not be included as an element of a pathological construct. Brislin and Patrick’s chapter made a strong case for the inclusion of boldness, noting that boldness to a greater extent than meanness characterized Cleckley’s cases (Crego & Widiger, 2016), and that boldness may be the component of the triarchic model that differentiates psychopathy from antisocial personality disorder (Venables, Hall, & Patrick, 2014; Wall, Wygant, & Sellbom, 2014). In our own research, we found that self-reported boldness was significantly related to peer reports of academic dishonesty but not to self-reported academic dishonesty among well-acquainted college students (Marcus, Robinson, & Eichenbaum, 2019), suggesting that studies that rely entirely on self-reports may underestimate the association between boldness and antisocial behavior. Thus, despite concerns that boldness is not pathological in and of itself, removing boldness from the psychopathy is likely to diminish the construct, possibly reducing psychopathy simply to antisociality.
Further complicating matters, the three components of the triarchic model do not all hang together. In most studies, boldness is unrelated to or weakly positively correlated with meanness, and boldness is often weakly negatively correlated with disinhibition. If boldness is hardly related to the other two components of the triarchic model and the triarchic model is an accurate representation of psychopathy, then psychopathy is not a syndrome in the traditional sense of the term (Marcus, Fulton, & Edens, 2013). Lilienfeld (2013) proposed that psychopathy may be better understood as an emergent trait. Because an emergent trait arises when two (or more) characteristics co-occur, this proposal suggests that powerful interaction effects should be found when the components of the triarchic model are analyzed (e.g., the interaction of boldness and disinhibition should lead to especially negative outcomes). A few studies have found that the interaction of boldness and disinhibition is associated with negative outcomes such as predatory aggression by forensic psychiatric inpatients (Smith, Edens, & McDermott, 2013) and more positive attitudes toward sexually manipulative tactics by college men (Marcus & Norris, 2014). However, other studies have failed to find this posited interaction between boldness and disinhibition (e.g., Gatner, Douglas, & Hart, 2016; Miller, Maples-Keller, & Lynam, 2016). Some studies have even found interactions between boldness and disinhibition in which high levels of boldness served as a protective factor for individuals high in disinhibition against negative outcomes such as heavy episodic drinking (Sylvers, Landfield, & Lilienfeld, 2011) and maladjustment following risky sexual behavior (Fulton, Marcus, & Zeigler-Hill, 2014).
The three components of the triarchic model all clearly have something to do with psychopathy, but none appear to be necessary or sufficient. Although the idea of psychopathy as a compound trait that emerges from the interaction of various combinations of three components is intriguing and could clarify the definition of psychopathy, the empirical support for this proposition is mixed, at best. Given that the triarchic model posits that the three components of the model are each underpinned by a different biobehavioral system (inhibitory control for disinhibition, empathic sensitivity for meanness, and defensive reactivity for boldness), this model would not necessarily predict strong associations among its three components. If anything, the high correlations between the Triarchic Psychopathy Measure (Patrick, 2010) Disinhibition and Meanness scales raise questions about why these presumably independent dimensions should be so closely related. Ultimately, the value of the triarchic model comes from its ability to generate research that advances the field and it is not responsible for solving a problem that has bedeviled psychopathy scholars going back to pioneers like Cleckely (1976) and Karpman (1948). Still, it would be reassuring to know that psychopathy experts are all talking about the same thing when we talk about psychopathy.
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