Encyclopedia of Psychology and Law

may be a “secondary” variant of psychopathy, marked

by psychological disturbance and violence potential.

Practical Interest in Psychopathy

A variety of psycholegal issues that arise in the crimi-

nal and juvenile justice system call for the identifica-

tion of individuals who are inalterably dangerous.

Increasingly, measures of psychopathy are being

applied to inform decisions about the length of offend-

ers’ sentences, their level of institutional supervision,

whether they should be released from prison on parole,

whether they should receive any treatment, and whether

they should be sentenced to death. Psychopathy mea-

sures predominantly are used as prosecution tools. As

shown in this section, there are reasons to question the

assumption that these measures identify individuals

who are inalterably dangerous.

VViioolleennccee PPrreeddiiccttiioonn

The most widely used measure of psychopathy is

also the number one tool used to assess risk of future

violence. In fact, forensic psychologists use the PCL–R

to assess risk twice as often as they use tools that were

specifically designed as risk assessment tools. This is

not the case for other well-validated measures of psy-

chopathy such as the Psychopathic Personality

Inventory (PPI). Instead, the diagnostic measure for

personality disorders has become the most widely used

tool for assessing violence risk, owing to a series of

studies indicating that the PCL measures robustly pre-

dict violence and recidivism for offenders, forensic

patients, and even psychiatric patients. Although the

absolute size of this relationship is weak (r ≈.25), the

PCL–R is among the strongest single predictors of vio-

lence and other criminal behavior, on a level that com-

petes with leading risk assessment tools.

Although this relationship suggests that emotion-

ally detached psychopaths callously use violence to

achieve control over and exploit others, recent research

suggests otherwise. The lion’s share of the PCL–R’s

utility in predicting violence is attributable to its satu-

ration with indices of past violence and criminality.

Although there is debate about its factor structure, the

original PCL–R model has two moderately correlated

scales: The first assesses core interpersonal and affec-

tive features of emotional detachmentthat are central

to most conceptualizations of psychopathy; the second

assesses impulsivity, irresponsibility, poor anger con-

trols, and antisocial behavior, which some view as

peripheral to psychopathy. A meta-analysis of 42

studies indicated that the PCL–R’s antisocial behavior

scale is significantly more predictive of violent and

general recidivism than its emotional detachment

scale. Moreover, three original studies indicate that the

emotional detachment scale does not significantly pre-

dict future violence, independent of its association

with the antisocial behavior scale.

Psychopathy explains the predictive utility of the

PCL–R less than do two other factors. First, indices of

past violent and criminal behavior naturally are linked

with future, like behavior. Information about criminal

behavior determines one’s ratings of some PCL–R items

and heavily affects one’s ratings of many others. Second,

ratings of past violent and criminal behavior appear to

capture something traitlike that is clinically useful but

not specific to psychopathy. The PCL–R (antisocial or

total scores) manifests some incremental utility in pre-

dicting future violence and crime, beyond indices of past,

like behavior. Recent research suggests that the PCL–R

may tap constructs of antagonism or “externalizing” that

place individuals at high risk of involvement in violent

situations. Antagonism involves suspiciousness, hostility,

combativeness, and irritability. Externalizing weaves

together traits of aggression and behavioral disinhibition,

antisocial behavior, and substance use. Neither construct

is specific to psychopathic personality disorder. Both are

related to violent and antisocial behavior.

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Practical interest in psychopathy revolves around

its implications for assessing both violence risk and

treatment amenability. The prevailing assumption is

that psychopathy cannot be effectively treated. In fact,

the results of one early study led many to opine that

treatment only “made psychopaths worse”—that is,

more likely to re-offend than if they had not been

treated. This study was a retrospective matched trial

that compared the recidivism rates of mentally disor-

dered offenders released from either a prison or a rad-

ical therapeutic community program. The treatment

program was active in the 1960s and involved uncon-

ventional interventions such as extended nude

encounter groups and administration of psychedelics,

alcohol, and other drugs to psychopaths to disrupt

their defenses, increase their anxiety, and generally

make them more accessible to treatment.

Therapeutic pessimism about psychopathy is so

deeply entrenched in clinical and forensic circles that

it rarely has been subjected to empirical evaluation.

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