Transcript Psychopaths- Scary people that look frightening

WOMEN WHO LOVE PSYCHOPATHS
PRESENTED BY:
SHARON O’HARA
Clinical Director
Sexual Recovery Institute
Los Angeles CA
http://www.sexualrecovery.com/
DEBORA WARDLOW
Nova Outpatient Recovery
Public Psychopathy Education
Institute of Relational Harm Reduction
[email protected]
MAVIS HUMES BAIRD
MHB Consulting LLC
Trauma & Addictions Recovery Specialist
Recovery Coach
[email protected]
Copyright 2012 Mavis Humes Baird
Sex Addicted
Psychopath
Psychopathic
Spectrum
Psychopath Partner
of a Psychopath
Sex Addicted
Partner of a Sex
Addict
Partner of a
Sex Addicted
Psychopath
Partners of
Psychopathic
Spectrum
All
Sex Addicts
Copyright 2012 Mavis Humes Baird
Partners of
Sex Addicts
Research Study by Sandra Brown
MA and Liane Leedom MD
• 75 women worldwide completed study
• Full Histories, via clinical interview
• Temperament /Traits Assessment
– TCI “Temperament and Character Inventory” by Robert
Cloninger
• Self- reporting of Symptoms
– Open-ended questioning
• Relationship dynamics
– Open-ended questioning
Partners of
Psychopaths
Copyright 2012 Mavis Humes Baird
Women Who Love Psychopaths
Partners of
Psychopaths
• Significant other- not
recognized or diagnosed as
Psychopath
• Typical “domestic violence
survivor”
• Labeled codependent
• A relationship/sex addict
• Assumed to be Dependent
Personality Disorder
Psychopathic
Spectrum
Psychopaths
• Hide behind mask- called “Disorder of Social
Hiding”
• ‘Self report’ is a problem-lying is one of the
main traits
• Not diagnosed
• Do not think they need help
• Many therapists aren’t looking for one in their
office.
Psychopathic
Spectrum
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Look for:
Lack of remorse
Lack of empathy
Impulsive- do not think of consequences
Grandiose
Takers- sexual needs
Blame shifting
Present excellent first impression
Manipulation
Pathological liars
Psychopathic
Spectrum
Look for:
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Exploit others
Smooth talker/charismatic
Pity play
Self centeredness
Lack of accountability
Mood disorders
Inability to see own unacceptable behaviors
Distorted understanding of other’s perceptions
Psychopathic
Spectrum
Who Are Psychopaths?
•Score of 30-40 on the Hare’s Psychopathy Check List (Revised)
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Interpersonal
– Glibness– superficial charm
– Grandiose sense of self-worth
– Pathological lying
– Conning—manipulative
Affective
– Lack of remorse or guilt
– Shallow affect
– Callous—lack of empathy
– Failure to accept responsibility
Lifestyle
– Need for stimulation
– Parasitic lifestyle
– Lack of realistic, long-term goals
– Impulsivity
– Irresponsibility
Antisocial
– Poor behavioral controls
– Early behavioral problems
– Juvenile delinquency
– Revocation of conditional release
– Criminal versatility
Psychopathic
Spectrum
RED FLAGS of Relationships
• Moves quickly
• Overly attentive
• Mirrors or mimics
interests/hobbies
• Isolates from friends/family
• Love bombing
• He is: dominant, grandiose,
belittling
Partners of
Psychopaths
Sandra Brown, The Institute’s Model of Care Approach 2012
Psychopathic
Spectrum
Honeymoon Phase
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Partners of
Psychopaths
Luring
Eye gazing
Sexual Bonding
Idealizing
Rapid pacing
Overwhelming and
distracting her
Psychopathic
Spectrum
Intensity
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Partners of
Psychopaths
Intense to experience
Charismatic
Exciting
Magnetic pull/vortex
Sexual Bonding
Positive memory storage
Trance- focus on one
thing to the exclusion of
other things
Psychopathic
Spectrum
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Intensity
Low impulse control
Excitement seeking
Power and dominance
High sex drive
Intense pursuit
Partners of
Psychopaths
Psychopathic
Spectrum
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Language
Insights into thoughts and outlook
Use language related to self more than others.
Excellent storytellers
Successfully “con” others
Communication disrupted - lack of insight
Linguistical differences
Mimic/Parrot
Gas lighting
Partners of
Psychopaths
Her Super Traits-most highly elevated
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Extraversion/Excitement Seeking
Relationship Investment
Competitiveness
Hyper-Empathy
Attachment
Sentimentality
Low Harm Avoidance
Cooperation
Responsibility and Resourcefulness
Research by Sandra Brown M.A. and Liane Leedom, M.D.
Partners of
Psychopaths
Psychopathic
Spectrum
Points of
attraction
Partners of
Psychopaths
Psychopaths & Their Partners
From Sandra Brown’s Model (Brown, 2012):
*In comparison to Hare’s list of psychopath traits
Traits of a Psychopath
Supertraits of Partners
+Excitement seeking
*Impulsivity
+Extraversion
+Dominance
+Competitiveness
*Lacks
—Sentimentality
remorse/empathy
—Tolerance
+/—Friendliness
*Lacks
—Empathy
remorse/empathy
—Helpfulness
*Lacks
—Compassion
remorse/empathy
—Responsibility
*Is irresponsible
—Purposefulness
*Lacks goals
—Resourcefulness
—Self-Acceptance
—Loyalty
—Trust
—Bonding
—Attachment
+Excitement seeking
+Extraversion
+Dominance
+Competitiveness
+Sentimentality
+Tolerance
+Friendliness
+Empathy
+Helpfulness
+Compassion
+Responsibility
+Purposefulness
+Resourcefulness
+Self-Acceptance
+Loyalty
+Trust
+Bonding
+Attachment
Brown, S. (2012). Supertraits: Developing a New Outlook. In S. Brown (Comp.), Training Materials for The Institute's Model of Care Approach
Copyright 2012 Mavis Humes Baird
2009 (2012 ed.). Author.
Why do Super Traits matter?
• Affect patterns of
selection
• Affect tolerance
• Start out as least
dependent type on
planet
• Sees others through
who she is
Partners of
Psychopaths
Women in the Study:
Higher than normal:
•Suggestibility
•Dissociation/trance
•Hypnosis
Related to:
Pacing
•Exhaustion
•Increased focus
•PTSD
Partners of
Psychopaths
Psychopathic
Spectrum
Inevitable Harm
• Too much empathy
• Plus high bonding
• Plus high sentimentality
• Plus low harm avoidance
• = inevitable harm
Sandra Brown, Women Who Love Psychopaths
Partners of
Psychopaths
Psychopathic
Spectrum
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Event Cycle
Rage
Faked insight
Tender
Bribery
Mutual pathology
Other woman
Carrot dangling
Medical Issues
Partners of
Psychopaths
From Sandra Brown MA, The Institute’s Model of Care Approach 2012
Psychopathic
Spectrum
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Dichotomies
Bonding/Abandonment
Idealizing/Devaluing her
Protection/Risk
Trust/Distrust
Excitement/Exhaustion
Child-like/Adult Mystery
Loving/Loathing
Partners of
Psychopaths
Sandra Brown MA, The Institute’s Model of Care Approach 2012
Treatment Options for the Partner
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Partners of
Psychopaths
Pathology education
PTSD treatment
Bibliotherapy
Anticipate behavior
Understand risk of “Super Traits”
Understand patterns of selection
Understand intensity
Unique dynamics and dichotomies
Recognize “red flags”
Relapse prevention
Mindfulness
Self care
Get a great life!
Sandra Brown MA, The Institute’s Model of Care Approach 2012
Psychopathic
Spectrum
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Therapists Might:
Sex Addicts
Misread
Misdiagnose
Minimize
Explain away
Believe fabrications as plausible explanations
Not recognize acting ability
Psychopathic
Spectrum
Mental Health Professionals
• “Psychopathy is often misread, misdiagnosed,
minimized, or explained away by professionals
whose jobs require regular interaction with
psychopaths.” Mental health professionals…
“might believe a psychopath’s complete
fabrications as seemingly plausible explanations.”
– FBI Law Enforcement Bulletin July 2012
Psychopathy: An Important Forensic Concept for the
21st Century
Psychopathic
Spectrum
Mental Health Professionals
• “Psychiatrists are often helplessly manipulated by
the psychopath; just as are the psychopath’s
other victims.” Dr. Ken Magid, “High Risk, Children
Without a Conscience.”
• “There are psychopathic personalities in the
highest echelons of government, and even within
the religious hierarchies in America. You just can’t
assume that a person with the title judge or
hospital orderly got there honestly and won’t
manipulate the hell out of you.” Psychologist
Schreibman to H. Cleckley 2/10/86
Psychopathic
Spectrum
Character Disturbance by
Dr. George K. Simon
• “Aggressive personalities strive for the dominant position at
all times and all circumstances. This premise is very hard for
the average person to understand, let alone accept. It’s
incomprehensible for most of us to conceive that in every
situation, every encounter, every engagement, the aggressive
personality is predisposed to jockey with us for the superior
position, even with no recognizable need to do so. The failure
to understand and accept this, however, is how aggressive
personalities so often succeed in their quest to gain
advantage over others.”
From the book, Character Disturbance by Dr. George Simon
Psychopathic
Spectrum
Sex Addicts
Therapists Might:
• Believe clients think and feel as much as
therapist does
• Become target of manipulation
• Become target of “head games”
• Expect different dynamics in these sessions
• Get caught in drama triangles
• Not want to diagnose
• NOT DIAGNOSE
• PSYCHOPATHS DON’T THINK THEY NEED HELP
and MIGHT PRESENT AS LEVEL HEADED next to
traumatized spouse
Partners of
Psychopaths
Partners of
Sex Addicts
Copyright 2012 Mavis Humes Baird
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Partners of
Psychopaths
Sex Addicts
Partners of
Sex Addicts
Psychopathic
Spectrum
Things That Create CONFUSION
about Psychopaths
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No ONE definition for the disorder
Term ‘psychopath’ is often misused or overused; Not in DSM
Clinicians filter clients’ symptoms “through their own lenses”
Misdiagnosed as Cluster C, Asperger’s, Bipolar, Addiction, impulse
control disorder, leadership qualities, ‘lucky.’
• Repercussions of misdiagnosis and mistreatment
• Several personality assessment tools don’t assess for pathology
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examples: Meyers-Briggs, 16 PF, Enneagram
• Most clinicians not trained to spot or diagnose psychopathy
• Clinicians tend to under-refer clients to other specialists
• Some assessment tools (such as the MMPI) do successfully flag PDs
and PD traits but until recently none tested for psychopathy (PCL-R–
NEW!)
Copyright 2012 Mavis Humes Baird
Things That Create CONFUSION
about Sex Addicts
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Sex Addicts
No ONE definition for the disorder
Term ‘sex addict’ is often misused or overused; Not in DSM
Clinicians filter clients’ symptoms “through their own lenses”
Misdiagnosed as Axis II, OCD, Bipolar, red-blooded, ‘lucky.’
Repercussions of misdiagnosis and mistreatment
Most assessment tools don’t assess for sex addiction
Most clinicians not trained to spot or diagnose sex addiction
Clinicians under-refer clients to other specialists
Some assessment tools (such as the MMPI) do successfully flag a few
traits but until recently none tested for sex addiction (SDI-R– NEW!)
Copyright 2012 Mavis Humes Baird
Things That Create CONFUSION
about Partners and Relational Trauma
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No consensus on whether partners/families have their own disorder.
Terms (codependency, PTSD, love addiction) are often misused or overused;
Not in DSM
• Clinicians may filter clients’ symptoms “through their own lenses”
• Misdiagnosed as Axis I, Axis II, Love addiction, inhibition, ‘unlucky.’
• Repercussions of misdiagnosis and mistreatment
• Most assessment tools don’t assess for relational trauma
• Many clinicians are not trained to spot or diagnose relational trauma and
• Clinicians tend to under-refer clients to other specialists
• Some assessment tools (such as the MMPI) do successfully flag relational
trauma and betrayal but until recently none tested for it (PTSI-R and Sandra
Brown’s checklists NEW!)
• Family and addictions therapists can tend to assign responsibility equally,
disregarding domestic violence, hostage syndromes and betrayal bonding, and
disregarding AAMFT ethical guidelines for same.
Partners of
Partners of
Psychopaths
Sex Addicts
Copyright 2012 Mavis Humes Baird
CONFUSION
Empathy is a Difficult Diagnostic Criterion
(benevolently imagining what others are experiencing)
Everyone
• Empathy for all living things
Empathy for one team or political party or side in a drama
•Empathy for one specific group or demographic
Some
MOST OF US
DON’T
HAVE
EMPATHY FOR
EVERYONE or
ALL THE TIME.
•Empathy for the small group or
“the family”
•Empathy for one person or
“the couple”
•Empathy for the self only or
no one
No one
Super-empathic
Empathic
Sociopathic
Copyright 2012 Mavis Humes Baird
Psychopathic
Psychopathic
Spectrum
Sex Addicts
Empathy; too much or too little?
• “Empathy is our ability to identify what someone else is thinking
or feeling and to respond to those with an appropriate emotion.”
Simon Baron-Cohen author of The Science of Evil: On Empathy and
the Origins of Cruelty
• Another way to put it is; Grasp of and care for what others are
experiencing; benevolent acknowledgment or concern;
compassion.
Partners of
Psychopaths
Partners of
Sex Addicts
Copyright 2012 Mavis Humes Baird
“FIRST THOUGHT WRONG”
A Recovery Mantra for Partners of Paths
Thirteen Rules to Dealing with a Sociopath in Everyday Life
(Taken from Martha Stout’s The Sociopath Next Door)
1. Accept that some people have NO CONSCIENCE
2. In contest between your instincts and the role someone
has taken, GO WITH YOUR INSTINCTS
3. When considering a new relationship, PRACTICE RULE 2
when considering the claims and promises someone makes,
and the responsibilities they have.
4. QUESTION AUTHORITY
5. SUSPECT FLATTERY
6. If necessary, redefine your concept of respect. IS IT
BASED ON FEAR?
7. DO NOT join the game.
8. The best way to protect yourself is to avoid him, TO
REFUSE ANY KIND OF CONTACT OR COMMUNICATION!
9. QUESTION YOUR TENDENCY TO PITY
10. DO NOT try to redeem the unredeemable
11. NEVER AGREE, out of pity or any other reason, to help a
sociopath conceal his or her true character.
12. DEFEND YOUR PSYCHE.
13. LIVING WELL IS THE BEST REVENGE.
Partners of
Psychopaths
Copyright 2012 Mavis Humes Baird
“BE MINDFUL”
A Recovery Mantra for Partners of Sex Addicts
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2.
They are JUST DEVELOPING a conscience.
GO WITH YOUR INSTINCTS about what they tell you, and if you aren’t
sure ASK OUR SUPPORT SYSTEM what they think.
3. Remember that IT TAKES AT LEAST A YEAR to get to know someone,
and that it will take awhile to learn the ‘sober personality’
4. QUESTION the addict when they take an authoritative stance.
5. SUSPECT FLATTERY, or take it with a grain of salt especially if they
have used it before to feed the addiction.
6. DO NOT define ‘respect’ for the addict by fear of abandonment.
7. Find your own pace of recovery; if the addict is trying to manipulate
you, DON’T GIVE IN TO THE GAME.
8. If the addict is dangerous or is negatively affecting your life, PROTECT
YOURSELF.
9. Question your tendency to pity or feel CODEPENDENT GUILT for the
addict’s well-being.
10. LET THEM redeem themselves by changing over time; do not redeem
them when they don’t deserve it.
11. Never agree to LIE to feed the addiction.
12. Individuate yourself, DEFEND your psyche.
13. Live well, learn SELF-CARE.
Partners of
Sex Addicts
Copyright 2012 Mavis Humes Baird
Hope for the Future
“Partners with Relational Trauma”
• DSM-5 suggests a continuum for measuring empathy, intimacy, etc.
• As this develops, it will reinforce and inform cases for clinicians, for family
members, and for the criminal justice system
• Expect to see a dialectical shift in our understanding of personality via
contributions in competing fields
• Re-conceptualizing psychopathy spectrum disorders and re-educating the
public will lead to greater understanding and support for families
• By creating a valid and reliable grid for assessing risk and severity, we will
be empowered to responsibly advise precautions
It's entirely possible that as a group we tend to downplay psychopathy as a primary driver of
hypersexual, chronically deceptive or similarly problematic sexual behavior. I've had
discussions with an articulate advocate of the "trauma model" of partner recovery who thinks
that we as a profession need to do a much better job of closely assessing our clients for the
presence of narcissistic and antisocial personality disorders. I've become more sensitized to
this position and think it's probably a fair assessment.
Partners of
Partners of
– Bill Herring to SASH Listserv 2012
Sex Addicts
Psychopaths
Copyright 2012 Mavis Humes Baird
Sex Addicted
Psychopath
Psychopathic
Spectrum
Psychopath Partner
of a Psychopath
Sex Addicted
Partner of a Sex
Addict
Partner of a
Sex Addicted
Psychopath
Partners of
Psychopathic
Spectrum
All
Sex Addicts
Partners of
Sex Addicts
“Partners with Relational Trauma”
Copyright 2012 Mavis Humes Baird
A brief overview and sample of Sandra Brown’s
Institute for Relational Harm Reduction
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Website
Newsletter
Psycho-education
5 Day Training
• Manual
• Treatment protocols
Self Tests
Data Collection and Study Results
Coaching
Retreats
Referrals
Advocacy for Social Change
Partners of
Psychopaths
Sandra Brown, Jennifer Young, Susan Murphy-Milano et al:
Model of Care Approach
Copyright 2012 Mavis Humes Baird
Overview of IRHR’s Training
for Professionals
Book, CDs, an invaluable manual, checklists and worksheets
• 5 Days
– Day 1: psychoeducation on PDs, presenting traits and
psychopathy
– Day 2: overview of relationship patterns with a path,
discuss attachment and bonding
– Day 3: neuroscience of pathology and of women who are
attracted to paths; evening case presentations
– Day 4: PTSD as a result of the relationship, explanation of
PTSD and how to deal with it
– Day 5: coaching
Partners of
Psychopaths
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
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More about Robert Hare’s assessment
The Psychopathy Check List, Revised (PCL-R)
Psychopathy Checklist, Revised
– Must be certified
– Semi-structured interview
• Can be biased
– Predictive validity, construct validity
– Receives royalties
PCL-SV to screen
Best diagnostic tool we have for psychopathy
– Measures “Personality”
(Interpersonal/Affective) and “Lifestyle”
(Lifestyle/Antisocial)
Not a DSM recognized diagnosis yet
– What to submit to insurance?
Future work needs to be done to establish
convergent validity
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Referrals
Sex Addicts
For treating psychopathic spectrum clients:
•Read through the DSM V website or sign up for a clinical update
to educate yourself on changes to the DSM
•Buy the PCL-SV (for screening only)
https://ecom.mhs.com/(S(ruyld5zm5mno5l45ba0hm0jd))/inv
entory.aspx?gr=saf&prod=pccsv&id=pricing&RptGrpID=pcs
•Buy the PCL-R Manual
http://www.pearsonassessments.com/HAIWEB/Cultures/enus/Productdetail.htm?Pid=PAapclr&Mode=summary
•Become certified to administer the Hare PCL-R:
http://www.hare.org/training/
•Micro-expression Face Recognition Training
•Linguistic differences training
•Sex offender treatment conference attendance; certification
Copyright 2012 Mavis Humes Baird
Referrals
For your clients
Support networks:
• Yahoo groups/Google Groups for women in toxic, abusive or
pathological relationships
• Domestic Violence/ women’s empowerment organizations, meetings
and retreats
• Safe Relationships Magazine
Sandra Brown, M.A. Institute for Reduction of Relational Harm
http://saferelationshipsmagazine.com/
•LoveFraud website
Calls it sociopathy, same clear messages
http://lovefraud.com/
For you
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Partners of
Psychopaths
Seek Domestic Violence training and learn basic screening protocols
for mental health practitioners
Use PTSI with all partners
incorporate IRHR materials with Partners’ treatment
Martha Stoudt’s 13 tips
Betrayal Bond by Patrick Carnes PhD.
Partners of
Sex Addicts
Copyright 2012 Mavis Humes Baird
The End
Psychopathic
Spectrum
What we are looking for is someone who
perhaps due to physical factors to do with
abnormal brain connectivity and chemistry,
lacks a conscience, has few emotions and
displays an inability to have any feelings,
sympathy or empathy for other people
Sex Addicts
Then I’m your
man.
Psychopathic
Spectrum
But they’re few and far between…right?
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1% of general male population
15-20% of prison population
4% of corporate professionals
Higher concentration in places of power, where there is easy prey: politics, corporations, even helping
professions such as ours
• These high scores were positively associated with charisma and presentation style
• These were negatively associated with responsibility and performance.
Babiak, Neumann and Hare
(Behavioral Sciences and the Law, 2010, 28,174-193)
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Sex Addicts
But He’s Charming and Successful…
CORPORATE PSYCHOPATHS
-People assume people are good
-Blind obedience (Milgrim)
-The Halo Effect
-Corporate “movers and shakers”
-Leadership traits
-Ability to lie, mimic leaders
-Good performer
-Charm vs. charisma
-Lack of affect makes ‘hard stuff’
easy
-Risk-taking seen as impressive
Source: Babiak, P., & Hare, R. D. (2007). Snakes in Suits. New York, USA: Harper.
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Sex Addicts
Different Types of Corporate Psychopaths:
Consider applications to Sex Addict population
The classic style has a high
score on interpersonal,
affective, lifestyle and
antisocial measures.
High
The macho style has a low
score on interpersonal and
affective lifestyle and a high
score antisocial measures.
AKA ‘the do-er’
The manipulative style has a
low score on interpersonal and
affective lifestyle and a high
score antisocial measures.
AKA ‘the say-er’
Low
(From ‘Snakes in Suits’ pg. 27, 185-186)
superficiality,
grandiosity,
deceit
lacks
remorse &
empathy
impulsive,
lacks goals,
irresponsible
Traits
Copyright 2012 Mavis Humes Baird
poor behavior
controls,
antisocial
behavior
Psychopathic
Spectrum
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Commonly
Co-Occurring Traits
Manipulative
Hypersexual
Substance abuse
Gambling, spending, stealing, other $
Rule-breaking
Lack trust or respect of authorities
Dominant
CONFUSION
Copyright 2012 Mavis Humes Baird
Sex Addicts
Psychopathic
Spectrum
Wide Range of Opinion on
Treatability of Psychopaths
YES
-Oxytocin creates empathy
-Omega-3s create empathy
-Limbic system, hippocampus,
amygdala
-Teaching empathy
-Mirror neurons
-Arousal patterns/threshold
-Therapy shown to strengthen
the illness
Developmental Psychology
Neuropsychology
Dialectical Behavioral Therapy
Teaching empathy
Trauma/Addictions Fields
Neuroscience
Harm reduction
Partner Violence Specialty
Criminal Justice
NO
CONFUSION
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Alcoholics Anonymous
Perspective
Sex Addicts
Rarely have we seen a person fail who has thoroughly
followed our path. Those who do not recover are people who
cannot and will not completely give themselves to this simple
program, usually men and women who are constitutionally
incapable of being honest with themselves. There are such
unfortunates. They are not at fault; they are born that way.
They are naturally incapable of grasping and developing a
manner of living which demands rigorous honesty. Their
chances are less than average. There are those, too, who
suffer from grave emotional and mental disorders, but many
of them do recover if they have the capacity to be honest. (The
Big Book, pg. 58)
Psychopathic
Spectrum
Addict, Psychopathic, Both, Neither
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Sex Addicts
Active and recovering addicts may display traits of personality disorders.
Diagnosis of PD often on hold for first six months of sobriety. Before this time, diagnosis is
usually provisional.
– Common wisdom in 12 Step tradition is to wait for substantial step work to be completed.
– Certain kinds of reactive character armoring may be diagnosed as PD, but more amenable
to treatment.
– Get to know and use a full range of assessment tools so you are making a thorough
diagnosis. Reliable measures include: SDI-R MMPI, PTSI, PCL-R
• Do you tend to ascribe PD traits to addiction? Or are you more likely to look for personality but
not grasp applicability of addiction?
• Possible misdiagnosis because of socio-cultural differences: role definition, sexism, etc.
– Ex: Men are more likely to be diagnosed as ‘Narcissistic’ and women as ‘Borderline’ when
they have similar presenting symptoms.
• Conceptualize each case as whether personality problem is secondary to addiction, addiction is
secondary to personality problem, or both are equally dominant. Do both run the motor?
Safety First!
• Be aware that treatment can make the personality disorder stronger.
• Know your limits and have referral options ready.
• Use written safety plans and contracting.
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
PG. 18
Payson, E. D. (2002). The wizard of oz and other narcissists: Coping with the one-way
relationship in work, love, and family. Julian Day.
Psychopathic
Spectrum
Sex Addicts
At best, what happens when we apply
Addiction Treatment Models for Psychopathy
… and for aiding Partners of Psychopaths?
• Is addiction-type remission possible for psychopathy
or is this concept a contradiction in terms?
– Further clarification of the connection/separation between
the addictive disease paradigm and traits of personality
disorders.
– Criteria has been developed via AA, Carnes, Gorski,
Mellody that defines and tracks a range of distinctions, etc.
• Being used to help validate treatment
– Viewing psychopath through ‘arousal’ or ‘stimulation’
perspective or as helped via regulation practices
– Managing its symptoms, traits similarly to, or as part of,
addictions
• 12 Steps for PD Recovery?
• Path-Anon?
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
The DSM IV-R & Antisocial Personality Disorder vs.
Psychopathy Definitions
-The DSM IV-R did not include psychopathy - other than to say that Antisocial
Personality Disorder.is sometimes called psychopathy.
- DSM definition of ASPD and ‘psychopathy’ definitions agree up to a point.
-Hare and Neumann wrote that ASPD was used as a way to better define
psychopathy, but got lost along the way; “When [ASPD was] introduced by
DSM-III in 1980 the intention was to provide a reliable means of measuring the
traditional construct of psychopathy by focusing on easily measured antisocial
behaviors, albeit at the expense of inferred personality traits fundamental to
psychopathy, which were considered too difficult to measure reliably” (Hare &
Neumann, 2009, p 795).
“Identifying someone as ‘having’ [ASPD] is about as nonspecific and
scientifically unhelpful as diagnosing a sick patient as having a fever or an
infectious or a neurological disorder” (Hare & Neumann, 2009, pg. 796).
The ICD-10 has changed from ICD-9 and uses Dissocial Personality Disorder
instead.
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
What’s the difference btwn DSM IV-R and
Hare/defs of psychopathy?
•Engaging in violence
•Functioning within or without of societal constraints
•Frustration tolerance
•Concern for punishment/learning from punishment
•Dyssocial vs. APD
•“…APD diagnoses are strongly coordinated with social deviance
(factor 2) components of psychopathy as measured by PCL-R, but
only weakly correlated with its interpersonal and affective (factor 1)
components” (Hare, 2003, pg 6)
•“…APD place[s] more emphasis on antisocial and criminal
behaviors and less emphasis on personality traits [than PCL-R and
other psychopathy definitions” (Hare, 2003, pg 5)
Hare, R. D. (2003). Hare psychopathy checklist-revised: (PCL-R) 2nd
edition (2nd ed.).
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Rationale for DSM-5 Proposed Changes
• Extensive co-occurrence among PDs
• Extreme heterogeneity among patients receiving the
same diagnosis
• Lack of synchrony with modern medical approaches
to diagnostics thresholds
• Temporal instability
• Poor coverage of personality psychopathology
• Poor convergent validity
See www. dsm5.org
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the
following criteria must be met:
A. Significant impairments in personality functioning manifest by:
1. Impairments in self functioning (a or b):
a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.
AND
2. Impairments in interpersonal functioning (a or b):
a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.
b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to
control others.
B. Pathological personality traits in the following domains:
1. Antagonism, characterized by:
a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one‘s ends.
b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.
c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one‘s actions on others; aggression; sadism.
d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
2. Disinhibition, characterized by:
a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow through on – agreements and promises.
b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and
following plans.
c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of
activities to counter boredom; lack of concern for one‘s limitations and denial of the reality of personal danger.
C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual’s personality trait expression are not better understood as normative for the individual’s developmental stage or socio-cultural environment.
E. The impairments in personality functioning and the individual’s personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general
medical condition (e.g., severe head trauma).
F. The individual is at least age 18 years.
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
DSM 5 Rationale for new
conceptualization of PDs
“The importance of these findings cannot be overemphasized. These data
mean that the entire PD literature is built upon shifting sands: had each
of the thousands of PD studies been conducted with a different PD
assessment, the study participants would have been a largely different set
of individuals, thus yielding study results that would be different to an
unknown degree. In contrast, the proposed DSM-5 personality trait set is
based on an extensive research literature whose origins are more than half
a century old, culminating in recent years in a consensual, highly robust,
personality traits hierarchical structure that has a high degree of
convergent and discriminant validity across a wide rage of measures,
primarily questionnaires, but also encompassing structured interviews.
Further, this structure has been shown to be invariant across clinical and
non-clinical populations, including being influenced by overlapping
genetic and environmental factors, and to be sufficiently comprehensive
as to capture the variance in– and thus to provide coverage for–
personality disorders”
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
DSM-V*
*This information is consistent with DSM-V website postings
as of 9/10/2012. Updates may have been made since then.
Please consult www.dsm5.org
• Set to be published in May 2013
• Dissocial Personality Disorder criteria are very consistent
with Hare’s definition and could substitute
• Diagnosis on a ‘spectrum basis’
• Now includes rule-outs for acute substance impairment,
general medical conditions, developmental stages and
socio-cultural environmental factors
• http://www.dsm5.org/proposedrevision/Pages/proposedre
vision.aspx?rid=16#
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
The Causes
We’re not sure where exactly psychopathy
comes from.
There are many ideas, but not one
consensus.
•
•
•
•
Copyright 2012 Mavis Humes Baird
Genetics
Early trauma or neglect
– Parenting styles
– What is their ‘reality’?
Cultural
– “Born under a bad sign”
Socioeconomic
– Natural selection
Psychopathic
Spectrum
•
•
•
•
•
Sex Addicts
Pathology and Addiction
Disease or disorder?
Chronic or acute?
Progressive or stable?
Incurable or curable?
Treatable or untreatable?
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
One of the Most Vocal Critics of the PCL-R
• Israeli writer who has received diagnoses of
Borderline PD, Narcissistic PD, psychopathy
– Has a criminal record
• Huge online presence (check YouTube)
http://www.youtube.com/watch?v=YclFOwcfxCI
• In I, Psychopath by Ian Walker
• Scored high for psychopathy in PCL-R (says 13)
• His website:
http://samvak.tripod.com/indexqa.html
• Critiques the PCL-R
Copyright 2012 Mavis Humes Baird
Psychopathic
Spectrum
Some Comic Reflief
Psychopathic
Spectrum
Personality
A personality is related to how a person
•Thinks
•Feels
•Relates
•Behaves