11c
Sarah J. Brislin and Christopher J. Patrick
Mysteries Still to be Solved: Response to Marcus and Nagel
It is a riddle, wrapped in a mystery, inside an enigma.
– Winston Churchill
Marcus and Nagel (M&N; this volume) frame their commentary around the question, “What constitutes psychopathy?” Inherent to this longstanding question is the premise that psychopathy is “one thing.” Yet there is abundant evidence now that psychopathy is non-unitary. Contemporary assessment instruments (see Patrick, 2018, chapters 3, 9–10, 20) quantify it in terms of distinct subdimensions (factors or facets), and cluster analyses of high scorers on these instruments have revealed distinct variants or subtypes – differentiated especially by presence versus absence of anxiousness or negative affectivity (Patrick, 2018, ch. 13). Additionally, recent years have seen growing interest in the topic of “successful psychopathy” (Patrick, 2018, ch. 24), as a counterpoint to the dominant historic focus on psychopathy in criminal offenders.
The variegated nature of psychopathy is considered in the triarchic model and it provides a useful reference point for addressing issues raised by M&N. If psychopathy is multifaceted and different variants exist, then issues of “necessity” and “sufficiency” become moot. For example, certain features important to a clinical diagnosis of psychopathy (e.g., reckless, irresponsible behavior; lack of planfulness; persistent violation of norms/rules/laws) are less relevant to the concept of successful psychopathy. And even among clinical cases, variation is clearly evident. As noted by M&N, Cleckley’s hospital patients exhibited disinhibition and boldness in particular, whereas disinhibition and meanness are more salient in historic accounts of criminal psychopathy (Patrick, 2018, ch. 1). Further, criminal psychopathy itself includes distinct variants – one marked by reckless, irresponsible behavioral deviancy in the absence of emotional turmoil (“primary” variant), and the other by deviancy of this type accompanied by high negative affectivity (“secondary” variant). What is considered central to one variant of psychopathy may be peripheral or irrelevant to another variant.
M&N question whether disinhibitory tendencies are central to (necessary for) a diagnosis of psychopathy. When it comes to clinical descriptions and clinical diagnostic criteria, reckless-irresponsible behavioral deviancy is invariably represented. Indeed, Karpman characterized both primary and secondary psychopathy as involving behavioral deviance in the form of unreliability, irresponsibility, deceitfulness, fraudulence, thievery, and failure to learn from mistakes; it is for this reason he considered both variants to be clinically psychopathic. His primary/secondary typology was advanced to highlight differing etiologic pathways for behavior of this kind and implications of this for treatment and prognosis.
M&N identify certain aspects of our discussion of the construct of disinhibition that may be confusing to some readers. When the triarchic model refers to disinhibition as an essential part of clinical presentations of psychopathy, it uses the term in the broad phenotypic sense of reckless, irresponsible behavioral deviancy (as Karpman ascribed to both primary and secondary criminal psychopathy). All historic descriptions of psychopathy as a clinical condition include reference to persistent behavioral deviancy of this kind. However, historic and contemporary experts in the field generally agree that the presence of persistent behavioral deviancy does not itself qualify an individual for a diagnosis of psychopathy. In line with this, the triarchic model proposes that persistent behavioral deviancy must be accompanied by affective-interpersonal detachment – in the form of boldness, meanness, or both – to be diagnosable as psychopathy. Again, the reference here is to observable-phenotypic features of psychopathy such as glibness, persuasiveness, overconfidence or arrogance, emotional insensitivity, absence of remorse, and lack of empathic concern.
Importantly, the triarchic model also considers disinhibition, boldness, and meanness as dispositions with linkages to distinct biobehavioral systems, and it provides descriptions of individuals who epitomize high levels of each, unto itself. For example, individuals high in biobehavioral disinhibition exhibit difficulties in regulating emotion and restraining impulses in connection with reckless-irresponsible behavioral deviancy. They are also prone to substance abuse, internalizing problems, and suicidal behavior, and show impaired performance and brain responding in cognitive tasks (Patrick, 2018, chs. 6 and 18). However, only a subset of clinically psychopathic individuals – those whose behavioral deviancy arises primarily from biobehavioral disinhibition (or what has been termed externalizing proneness ([/liability]; Patrick, 2018, chs. 6 and 18) – will exhibit these characteristics. Others will exhibit reckless, irresponsible deviancy in part, or wholly, for other reasons. This idea of alternative pathways to “psychopathic behavior” (i.e., phenotypic disinhibitory deviance), introduced by Karpman, has been strongly emphasized in contemporary developmental theories of psychopathy (Patrick, 2018, chs. 19–20) and empirical research on psychopathy subtypes (Patrick, 2018, ch. 13).
However, many mysteries surround the nature of constitutional and environmental factors contributing to (or protecting against) the emergence of psychopathic behavior across time and developmental stages. The question of which attributes contribute to distinct subdimensions and variants (subtypes) of psychopathy, and in what combinations, is one that cannot be addressed fully through questionnaire or interview assessments of phenotypic features. It will also need to be addressed in terms of basic biobehavioral dispositions, and etiologic influences that give rise to them (Patrick, 2018, ch. 18), over the course of development (Patrick, 2018, chs. 5, 7, 19, 31).
Considering the Bases for Repetitive, Insistent Criticisms: An Empathic Response to Lynam’s Critique
Before you criticize a man, walk a mile in his shoes. That way, when you criticize him, you’ll be a mile away and have his shoes.
– Steve Martin
Professor Lynam’s commentary (this volume) reiterates points made in prior works he and his collaborators have published since the 2012 meta-analysis he cites. One of these is that boldness is irrelevant to psychopathy because it relates to healthy outcomes and is weakly and inconsistently predictive of antisocial behavior. This issue has been addressed extensively in the literature (for relevant citations, see Patrick, 2018, chs. 1, 3, 8, 24) and, given space constraints, we do not readdress it here – except to say that the boldness construct is clearly represented in prominent historic conceptualizations of psychopathy and many contemporary inventories for assessing it (Patrick, 2018, chs. 1 and 8).
Other points that Lynam raises are readily addressable. He cites evidence that much of the variance in subscales of the Triarchic Psychopathy Measure can be accounted for by FFM trait scores – but fails to mention that much of the variance in his FFM-based psychopathy prototype can be accounted for by the triarchic model facets (Drislane, Brislin, Jones, & Patrick, 2018; Poy, Segarra, Esteller, López, & Moltó, 2014). He suggests that the triarchic model de-emphasizes the role of antisocial deviancy in psychopathy, when (per our response to M&N) the model identifies reckless-irresponsible behavioral deviancy as an essential feature of clinical psychopathy. He also suggests that the triarchic model “undersells” the importance of meanness (callousness) in psychopathy, when in fact the model places considerable emphasis on this construct – identifying it as central to historic descriptions of psychopathy in adult criminal offenders and contemporary accounts of psychopathy in youth.
The triarchic model was formulated to address disputes that have plagued the psychopathy area for many years and it is meant to be inclusive of differing perspectives on psychopathy. Given the ecumenical focus of the model, we have endeavored to understand the roots of persistent, vigorous criticisms of the model by Lynam and his collaborators. One source for their criticisms appears to lie in strong allegiance to the FFM personality framework: Lynam was prominent in advancing an FFM-personality based approach to characterizing psychopathy (see, e.g., Patrick, 2018, ch. 11), and so it is natural to question why an alternative trait-descriptive framework is useful. Our answer is twofold: (1) the triarchic model constructs were directly deduced from the conceptual-empirical literature on psychopathy and (2) the triarchic constructs are explicitly biobehavioral (Patrick, 2018, ch. 18), and correspond to dimensions of an emerging biobehavioral model of general psychopathology (Patrick, Iacono, & Venables, 2019). While compatible with the FFM, the triarchic model is potentially advantageous for particular purposes – e.g., interfacing psychopathy dimensions with neurobiological concepts/measures and etiologic models for other forms of psychopathology.
Another ostensible basis for Lynam et al.’s criticisms of the triarchic model is that Lynam views psychopathy through the lens of adult offender studies and developmental research on conduct problems in youth. The focus of these literatures is on the understanding, prediction, and amelioration of antisocial behavior – in particular, persistent and aggressive forms. The triarchic model acknowledges that constructs of meanness and disinhibition are particularly important to criminal and delinquent expressions of psychopathy (e.g., Patrick, 2018, ch. 1). However, the model is open to the possibility that other expressions of psychopathy exist – including a clinical variant marked by charm, persuasiveness, and insouciance along with reckless-irresponsible deviance, and non-clinical (“successful”) variants in which boldness and meanness are most salient (Patrick, 2018, chs. 1, 18, 24).
References
Drislane, L. E., Brislin, S. J., Jones, S., & Patrick, C. J. (2018). Interfacing five-factor model and triarchic conceptualizations of psychopathy. Psychological Assessment, 30(6), 834–840.
Patrick, C. J. (2018). Handbook of Psychopathy (2nd ed.). New York: Guilford Press.
Patrick, C. J., Iacono, W. G., & Venables, N. C. (2019). Incorporating neurophysiological measures into clinical assessments: Fundamental challenges and a strategy for addressing them. Psychological Assessment. Advance online publication. doi: 10.1037/pas0000713
Poy, R., Segarra, P., Esteller, À., López, R., & Moltó, J. (2014). FFM description of the triarchic conceptualization of psychopathy in men and women. Psychological Assessment, 26, 69–76.