ASSESSMENT OF PERSONALITY DISORDERS:Different cutoff scores

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Forensic Psychology (PSY - 513)

Lesson 27

ASSESSMENT OF PERSONALITY DISORDERS

Objectives

To understand the use of Psychopathy Checklists in Forensic settings

To understand the scoring method of Psychopathy Checklists

To understand the need of differential diagnosis in Forensic settings

Few important check lists used to Screen Anti Social personalities in Forensic settings are:

Psychopathy check list Revised

Psychopathy check list Screening Version

Psychopathy check lists for women

Psychopathy check list for young offenders

Psychopathy check list-Revised

The Psychopathy Checklist Revised was developed by Hare, R.D. in 1985, and was formally

published in 1991. The 20-item revision of the Psychopathy Checklist (PCL-R) is a rating scale

designed to measure traits of psychopathic personality disorder.

Type of Instrument and Scoring Method

20 items

Scores of 0, 1, and 2

The PCLR is a 20-item clinical rating scale, each item reflects a different symptom or

characteristic of psychopathy. The items are rated on a 3-point scale.

0 means absence

If clinician is completely convinced that person under assessment does not possess a Specific trait

like individual in not a poly drug user or not irresponsible.

2 means certain

But if clinician is obvious that certain trait is present and observations and file information also

confirms then a score of 2 is given.

1 means may be

If the clinician is dubious then the score of 1 is given.

The items are rated on the basis of the person's lifetime functioning and not solely on the basis of

the person's present state; this state may be atypical of his/her usual functioning due to extreme

situational factors or an exacerbation of acute psychopathology.

The items are summed to yield total scores, ranging from 0 to 40, that reflect the degree to which an

individual resembles the prototypical psychopath. Scoring PCL-R items requires clinical judgement

and inference, as well as the ability to carry out the task in an objective, professional manner (Hare,

1998).

Different cutoff scores

A cutoff score of 30 or greater (in some studies 25 and in some even 20) is used to diagnose

psychopathy. The PCL-R items are scored on the basis of an individual's functioning over most of

the life span. Although 30 is the standard cutoff score.

Forensic Psychology (PSY - 513)

Items included in Psychopathy check list-Revised

Absolute disregard for the rights of others

Conning and manipulative (deceitful)

Pathological Liar (habitual liar)

Impulse control problem

Irresponsible

Sexually promiscuous (at the same time having relationships with more than one woman)

Poly drug use

(Poly drug use is using more than 3 drugs excluding cigarettes and tea. If using 6 different drugs,

score of 2 is specified if using drugs in between 3-6, score of 1 is given. Less then 3 score of "0" is

awarded.

Thrill seeking

Multiple crime types

Conduct disorder as minor (having history of running from home as a youngster or/ school

expels e.t.c)

Lack of empathy (inability to feel, what others are feeling)

Lack of remorse ( no feeling of guilt)

Different versions being developed like screening version, women and young offender's version e.t.c

Psychopathy check list Screening Version

The original Hare Psychopathy Checklist Revised (PCL-R) has become the standard assessment

measure for forensic populations. However, many professionals requested a brief instrument that has

high validity and high reliability ratings similar to the complete Hare PCL-R. The Hare PCL:SV was not

designed to replace the PCL-R, but to offer a tool to screen for the possible presence of psychopathy in

politicians, bureaucrats and senior executives. This checklist measures the presence of following traits

and scoring method is done on similar grounds using three point scale of 0-3.

Superficial Charm

Grandiose

Deceitful

Lacks Remorse

Lacks Empathy

Doesn't accept responsibility

Impulsive

Poor behavioral controls

Lacks goals

Irresponsible

Adolescent anti-social behavior

Adult anti-social behavior

Psychopathy check lists for women

The PCL-R has been used with only a few samples of female offenders. Early indications from several

studies are encouraging. Thus far, it appears that the distribution of scores and reliability are comparable

with those obtained in male samples. However, it appears that several items may not be as useful with

female offenders as they are with male offenders (Hare, 1990).

Psychopathy check list for young offenders

Although the PCL-R was developed for use with adults, there is evidence from a study conducted by

Forth, Hart, & Hare (1990) indicating its use in the assessment of psychopathy in young male offenders.

Forensic Psychology (PSY - 513)

Need of differential diagnosis in forensic settings

Diagnosis of personality disorder is usually individualized but a problem in forensic psychology is that

we need very fine and clear diagnosis. Being already biased due to the referral information, a Forensic

Psychologist is more likely to use only one checklist measuring Borderline Personality Disorder or

Asperger's syndrome or Antisocial Personality Disorder, many time people are diagnosed in different

category (although having another personality disorder) and the most misunderstood diagnosis is

Asperger's syndrome that is confused by the ASPD.

During my experience while working with incarcerated individuals with the labels of anti social

personality, I realized that they are not really antisocial rather they are Aspergers and had been used and

manipulated by the other people. Because of their inability to understand social norms and surroundings,

they were assumed as having lack of empathy and remorse. Though it is true that some similarities

between the two conditions do exist, there are vast differences, few of them are illustrated below

Similarities between Psychopaths and People with Asperger's Syndrome

The things that people with Asperger's Syndrome and ASPD have in common are that those with either

condition are often intelligent and gifted in some ways. You can't tell someone has Asperger's

Syndrome merely by looking at them and you can't tell that someone is a ASPD merely by looking at

them. Symptoms of both only appear when you get to know that person or when you have dealings with

them. Neither a ASPD nor someone with Asperger's Syndrome is out of touch with reality.

Both can make comments which upset other people, though with a Psychopath it is often calculated to

be upsetting and hurtful, or they may not care one way or the other that they have upset someone's

feelings. Someone with Autism or Asperger's Syndrome will say such things because they don't

understand the invisible but complex rules governing social interaction that Neuro-Typicals take for

granted.

Both lack sense of empathy and remorse although ASPD are emotionally numb but on the other hand

AS are unable to express their feelings according to the societal fashion.

Differences between Psychopaths and People With Asperger's Syndrome

Innocence vs cunning

A clear distinction is present that Aspergers are very innocent people and not cunning and manipulative

like Antisocial personalities. People with AS are not manipulative. They are too rigid in their thinking to

be opportunistic. They find it hard to be something they are not and don't possess social intelligence.

They are so innocent that if they are found in forensic settings that are due to the

manipulation/exploitation of other criminal personalities.

Many ASPD typically get kicks and enjoyment out of doing things such as attaching bangers to tails of

Dogs or Cats or torturing animals or bullying younger children. When they describe the event, they can

get sexually or emotionally aroused by reliving the moment. This type of behaviour would be

unpleasant to most people with Asperger's Syndrome, who are usually law abiding and if they ever do

commit crimes, it is because someone has tricked them into it or have said they would be friends with

the person with AS if they do it, or in some cases, to gain revenge on someone who has committed an

offence against them.

For instance, once an antisocial used an Asperger to trap children from park for sexual abuse and in

response that anti social used to give him some thing to eat or small amount of money. When police

arrested both of them, they labeled both as Antisocial Personalities. But once labeled as psychopath, all

of their innocent acts are perceived as frauds and deceitful behaviours. So, need of an accurate diagnosis

is very essential.

Forensic Psychology (PSY - 513)

In fact,the crime of AS would be almost comical, if it wasn't so serious, to watch their bungling, inept

responses when they get caught, and how they would react in a Police station. This would contrast with

the responses of a ASPD if caught, who would often display no emotion and would rationalize or justify

their actions, although again, they have been known to fake mental illness if in extremely severe trouble

or when they know they have been cornered and there is little chance of getting away with something.

Pathological lying

As compared to pathological liars, Aspergers can not lie. Even they do not understand the typical

language of jokes.

Poly drug use

In Aspergers use of multiple drugs is found. But unlike Anti social, they don't use drugs for thrill

seeking but they learn drug use as a rule to avoid worries and problems. AS are isolated because of their

poor social skills and narrow interests. They may approach other people, but make normal conversation

impossible by inappropriate or eccentric behavior, or by wanting only to talk about their singular

interest. Drug use is found as a rule to escape from such worries. They easily quit drug use once they

are convinced that it is illegal and against rules.

Obsessive interests

One quality to distinguish Aspergers from Antisocial is their obsessive interest like radio listening,

enjoying fire or collecting things of some specific colourse.t.c.

Usually AS do not commit multiple type of crimes.

Treatment of Asperger's Syndrome and Anti Social Personality Disorder

Treatment of Asperger's syndrome is not possible because in my opinion it is not a disorder. They are

born different with superior qualities and intelligence and Allah have sent them to become good

scientists. They follow "rule governed behaviour" and science is to find the hidden rules about

universe. AS want to know everything about their topic of interest and their conversations with others

will be about little else. Their expertise, high level of vocabulary, and formal speech patterns make

them professors.

Aspergers vs ASPD, BPD, PD in general

Naiveté vs cunning

Misunderstanding vs malice

Lack of remorse common

Lack of empathy common

100

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