11b
Donald R. Lynam
Brislin and Patrick provide an excellent discussion of descriptive work on psychopathy since Cleckley and on the relations between DSM antisocial personality disorder and psychopathy as typically assessed using Hare’s PCL. In addition, they provide a very thorough description of the triarchic model of psychopathy (TPM). In this commentary, I highlight a few key tenets of the model that I believe deserve more careful scrutiny and consideration. My main concerns lie with the underlying theoretical and empirical support for the relative emphases placed on each component of the model, with an especial focus on the dominant role played by Boldness and the more limited roles played by antisocial behavior (ASB) and Meanness. Because of limited space, I restrict myself to the concerns regarding points of emphasis.
I will repeatedly reference traits from the Five-Factor Model of personality (FFM) – a model that my colleagues and I use to conceptualize and assess psychopathy. A number of studies have shown a strong correspondence between the TPM components and FFM traits (e.g., Crego & Widiger, 2016; Miller, Lamkin, Maples-Keller, & Lynam, 2016). In recent work, we have shown that the TPM can be understood using the FFM (Hyatt, Crowe, Lynam, & Miller, in press) where Boldness is represented using a combination of FFM Extraversion and reversed FFM Neuroticism (E+/N‒), Meanness is represented with reversed FFM Agreeableness (A‒), and Disinhibition is represented with reversed FFM Conscientiousness (C‒). In fact, these FFM dimensions can largely recreate the empirical relations manifested by the Triarchic Psychopathic Measure (TriPM), suggesting that the latter is embedded within the former.
The (Over)Importance of Boldness (and Fearless Dominance)
Newer measures and models of psychopathy, including the TPM and PPI (Lilienfeld & Andrews, 1996), have placed great emphasis the role of Boldness or Fearless Dominance (FD) in psychopathy – claiming to have discovered Cleckley’s mask of sanity. While it is true that Cleckley referenced the absence of anxiety and overt psychosis in his descriptions, there is a strong argument to be made that Boldness/FD is too salutatory a construct to take on the prominent role it has been granted. In a meta-analysis of the PPI, Miller and Lynam (2012) found FD to be mostly unrelated to ASB, aggression, and broad externalizing. Results were similar in a recently completed meta-analysis of the TriPM (Sleep, Weiss, Lynam, & Miller, 2019); Boldness was weakly related to ASB, aggression, and broad externalizing. Rather than being related to what has typically driven interest in psychopathy (i.e., ASB), scores on Boldness/FD are most strongly related to positive psychological outcomes. The largest effect sizes observed by Miller and Lynam for FD were the positive ones for positive affect and extraversion and the negative ones for negative affect and internalizing. Results from Sleep et al. for Boldness were virtually identical. Boldness had strong positive correlations with indicators of extraversion and positive emotionality, and strong negative correlations with indicators of negative affect and internalizing psychopathology.
Emotionally stable Extraversion and immunity from internalizing psychopathology are not the outcomes that have driven interest in psychopathy for the last 40 years, nor is Boldness/FD, as is sometimes claimed, Lykken’s (1995) fearlessness – that etiologic factor underlying primary psychopathy and accounting for all of its symptoms including serious ASB. The absence of substantial relations between Boldness/FD and ASB and other features of psychopathy, including Meanness and Disinhibition rules Boldness/FD out as an index of Lykken’s fearlessness. Neither are these the outcomes that placed psychopathic individuals in the institutions at which Cleckley worked. It is interesting that among all of the potential differential diagnoses for psychopathy that Cleckley described (e.g., psychosis, criminality, alcoholism, and malingering), good adjustment/psychological health was not one of them. However, that is exactly the diagnostic confusion posed by Boldness/FD.
Instead of serving as the core for psychopathy, data suggest that Boldness/FD and its outcomes may be the core of what makes for healthy people and good friends and neighbors. For example, Bleidorn and colleagues (in press) recently developed an expert rated personality index of the healthy personality and provided correlations between their index and 52 other indicators of health and dysfunction, including the TriPM. Boldness was correlated at .48 with this index – the fifth highest of the criteria examined. The only four correlations that were higher were for explicit indices of positive adjustment (rs range from .52 to .60).
In the context of empirical and theoretical arguments that are inconsistent with the approach to Boldness/FD taken in the TPM, several modifications of the role of Boldness/FD in ASB have been offered. Lilienfeld et al (2012) suggested that Boldness/FD might predict ASB when combined with high scores on Meanness or Disinhibition but this hypothesis has received little support (e.g., Gatner, Douglas, & Hart, 2016; Maples et al., 2014; Miller, Maples-Keller, & Lynam, 2016; Vize, Lynam, Lamkin, Miller, & Pardini, 2016). Alternatively, Blonigen (2013) offered that Boldness/FD might be related to ASB at especially high ends of the trait, but this hypothesis has not been supported (Crowe, Lynam, & Miller, 2018; Gatner et al., 2016; Vize et al., 2016). In the end, the existing evidence suggest that Boldness/FD is related to positive psychological health and unrelated to externalizing behaviors, the long-time hallmark of psychopathy.
The (Under)Importance of Antisocial Behavior
This new emphasis on Boldness/FD and elevation of psychological health to a cardinal feature has been accompanied by a corresponding de-emphasis on the role of ASB in psychopathy – a serious departure from previous conceptions. The core feature of psychopathy has always been intransigent ASB. Patrick and Brislin correctly note this in their descriptions of manie sans delirium, “moral insanity,” and “moral weakness,” but they underemphasize ASB in modern conceptualizations. They write: “Cleckley characterized psychopathy as a distinct and severe form of psychopathology masked by an appearance of good psychological health.” This is misleading, as the psychopathology that Cleckley (1976) observed in all 15 of his cases was serious and chronic antisocial behavior. He explicitly included “inadequately motivated ASB” as a key characteristic, writing that “not only is the psychopath undependable, but also in more active ways he cheats, deserts, annoys, brawls, fails, and lies without any apparent compunction. He will commit theft, forgery, adultery, fraud, and other deeds” (1976, p. 343). Long histories of ASB appear in all 15 of Cleckley’s cases (see Lynam & Miller, 2012); without such behavior, there is no psychopathy.
Recalcitrant ASB is the feature that is shared across Karpman’s two subtypes – primary and secondary – where Boldness is frequently taken as an indicator of the former. Karpman’s (1941) distinction between primary and secondary psychopathy was offered as a means of reducing the heterogeneity in the larger group of patients labeled psychopathic on the basis of their long histories of ASB. He argued that scholars of his day had created a problematically heterogeneous construct by failing to consider the “dynamics” that contribute to the observed traits. Persistent and pervasive ASB was characteristic of both forms of psychopathy, although the underlying causes of these behaviors were different – a lack of conscience and concern for others in the primary variant and frustration/anger due to conscious or unconscious conflicts in the secondary variant.
ASB is central to psychopathy in Lykken’s (1995) writings as well. He wrote: “I use psychopath to refer to these people who have puzzled psychiatry for so long, whose ASB appears to result from a defect or aberration within themselves rather than in their rearing” (1995, p. 113). In his taxonomy, Lykken indicated that psychopathy is a genus belonging to the family of antisocial personalities whose members “are characterized by a persisting disposition toward ASB” (1995, p. 21).
The (Under)Importance of Meanness (Antagonism)
There is considerable evidence indicating that the cardinal trait for psychopathy beyond ASB in the TPM is meanness – a trait that shares great similarity with the FFM trait of Antagonism. Defined extensionally, the Antagonism–Agreeableness dimension consists of five lower-order traits: callousness, immorality, distrust, combativeness, and arrogance (Crowe et al., 2018). As with ASB, Brislin and Patrick undersell the role of Meanness/Antagonism in historical and contemporary conceptualizations of psychopathy. For example, they suggest that Meanness is present in only one of four facets of the PCL-R (i.e., the affective facet), in only a single criterion within the DSM-5 APD criteria (i.e., lack of remorse), and in only a single subscale of the PPI-R (i.e., “coldheartedness”). In actuality, Antagonism is the most ubiquitous element in trait descriptions of psychopathy, the strongest and most consistent correlate of all measures of psychopathy, and the glue that holds psychopathy inventories together.
From Cleckley (1976) through more current conceptualizations, descriptions of psychopathy are rife with Antagonism-related content. First, any description that includes an explicit representation of ASB (i.e., Cleckley, Karpman, Hare (2003), and DSM-5), is assessing Antagonism as it is the largest and most robust personality correlate of all forms of ASB. In their meta-analytic investigation of the relation between the FFM and antisocial and aggressive behavior, Vize, Collison, Miller, and Lynam (2019) found the average effect size for Agreeableness (r = ‒.38) was largest, followed by the effect size for Conscientiousness, the FFM variant of TPM Disinhibition (r = ‒.22), and then Neuroticism (r = .15). Second, beyond the indirect assessments of Antagonism via ASB, these descriptions are rife with Antagonism-related content: lack of empathy and remorse, lying and manipulation, arrogance and egocentricity, and incapacity to love others. Fully six of Cleckley’s 16 criteria, 12 of Hare’s 20 PCL-R criteria, and four of the seven DSM-5 APD criteria assess Antagonism. In direct contradiction to what Brislin and Patrick suggested, Antagonism is represented by three subscales within the PPI-R – Coldhearteness, Machiavellian Egocentricity, and Blame Externalization. Within our own Elemental Psychopathy Assessment (Lynam et al., 2011), eight of the 18 subscales assess a higher-factor labeled Interpersonal Antagonism.
Clinical scientists view Antagonism/Meanness as the central aspect of psychopathy. Miller et al. (2016) presented clinical scientists with empirically-derived FFM profiles of the components of the TriPM (plus the total score) and asked them to rate the degree to which such profiles could be expected to manifest symptoms of various forms of psychopathology. For psychopathy, the Meanness profile was seen as most psychopathic with a mean of 3.90 on a scale ranging from 0 to 6 with 3 representing “many symptoms.” The profile for the total TPM scale was rated as next most symptomatic (M = 3.09), followed by the profiles for Disinhibition (M = 2.00) and Boldness (M = 1.27).
Antagonism is the strongest personality correlate of psychopathy; Lynam and Miller (2019) examined four meta-analyses of the relations between psychopathy and the FFM. Applying relative weights analyses to these meta-analyses, they found that Antagonism accounts for the majority of the variance in psychopathy, 50–75 percent, accounted for by FFM traits.
Finally, not only does Antagonism unify different operationalizations of psychopathy, it binds subscales within an inventory together. For example, the Childhood Psychopathy Scale (CPS; Lynam, 1997) is an early developmental analog of the PCL-R, with two factors. Antagonism accounts for large portions of the variance in Factor 1 and Factor 2 with Conscientiousness and Neuroticism also contributing to Factor 2 (Lynam et al., 2005). When a measure of Antagonism is partialed out of the two factors, their inter-correlations are significantly reduced; the same pattern has been demonstrated for a number of different inventories including the Youth Psychopathic Traits Inventory, Levenson Self-Report Psychopathy Scale, and the Self-Report Psychopathy Scale-III (Lynam & Miller, 2015).
In my commentary, I have critically evaluated the TPM’s overemphasis on Boldness and underemphasis on ASB and Meanness/Antagonism. These specific concerns align well with other critiques that address the idiosyncratic derivation and absence of factor-analytic support for the three TPM domains (Gatner, Douglas, & Hart, 2018; Neumann, Uzieblo, Crombez, & Hare, 2013; Shou, Sellbom, & Xu, 2017). The most compelling support for the three TPM domains may lie in the similarities they bear to their FFM counterparts (Hyatt, Crowe, Lynam, & Miller, in press). Given that the TPM has become quite widely used – indeed, Sleep et al. (2019) identified 87 studies using the TPM measure or one of eight translations – it is important for the issues raised here and elsewhere to be given further attention as the field considers the most appropriate approach to conceptualize the relevant factors at the heart of psychopathy.
References
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