David D. Vachon

Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment

IMPORTANCE Several widely held beliefs about child abuse and neglect may be incorrect. It is most commonly assumed that some forms of abuse (eg, physical and sexual abuse) are more harmful than others (eg, emotional abuse and neglect); other assumptions are that each form of abuse has specific consequences and that the effects of abuse differ across sex and race. OBJECTIVE To determine whether widely held assumptions about child abuse and neglect are valid by testing the hypothesis that different types of child maltreatment (CM) actually have equivalent, broad, and universal effects. DESIGN, SETTING, AND PARTICIPANTS This observational study assessed 2292 racially and ethnically diverse boys (1254 [54.7%]) and girls (1038 [45.3%]) aged 5 to 13 years (mean [SD] age, 9.0 [2.0] years) who attended a research summer camp program for low-income, school-aged children from July 1, 1986, to August 15, 2012. Of these children, 1193 (52.1%) had a well-documented history of maltreatment. Analysis was conducted from September 25, 2013, to June 1, 2015. MAIN OUTCOMES AND MEASURES Various forms of internalizing and externalizing personality and psychopathologic traits were assessed using multiple informant ratings on the California Child Q-Set and Teacher Report Form as well as child self-reported depression and peer ratings of aggression and disruptive behavior. RESULTS Structural analysis showed that different forms of CM have equivalent psychiatric and behavioral effects, ranging from anxiety and depression to rule-breaking and aggression. We also found that nonsexual CM alters 2 broad vulnerability factors, internalizing (β = 0.185; SE = 0.028; P < .001) and externalizing (β = 0.283; SE = 0.023; P < .001), that underlie multiple forms of psychiatric and behavioral disturbance. We show that CM has comparable consequences for boys and girls of different races, and our results allowed us to describe a base rate and co-occurrence issue that makes it difficult to identify the unique effects of child sexual abuse. CONCLUSIONS AND RELEVANCE Our findings challenge widely held beliefs about how child abuse should be recognized and treated-a responsibility that often lies with the physician. Because different types of child abuse have equivalent, broad, and universal effects, effective treatments for maltreatment of any sort are likely to have comprehensive psychological benefits. Population-level prevention and intervention strategies should emphasize emotional abuse, which occurs with high frequency but is less punishable than other types of child maltreatment.

The (Non)Relation Between Empathy and Aggression: Surprising Results From a Meta-Analysis

Assumptions regarding the importance of empathy are pervasive. Given the impact these assumptions have on research, assessment, and treatment, it is imperative to know whether they are valid. Of particular interest is a basic question: Are deficits in empathy associated with aggressive behavior? Previous attempts to review the relation between empathy and aggression yielded inconsistent results and generally included a small number of studies. To clarify these divergent findings, we comprehensively reviewed the relation of empathy to aggression in adults, including community, student, and criminal samples. A mixed effects meta-analysis of published and unpublished studies involving 106 effect sizes revealed that the relation between empathy and aggression was surprisingly weak (r = -.11). This finding was fairly consistent across specific types of aggression, including verbal aggression (r = -.20), physical aggression (r = -.12), and sexual aggression (r = -.09). Several potentially important moderators were examined, although they had little impact on the total effect size. The results of this study are particularly surprising given that empathy is a core component of many treatments for aggressive offenders and that most psychological disorders of aggression include diagnostic criteria specific to deficient empathic responding. We discuss broad conclusions, consider implications for theory, and address current limitations in the field, such as reliance on a small number of self-report measures of empathy. We highlight the need for diversity in measurement and suggest a new operationalization of empathy that may allow it to synchronize with contemporary thinking regarding its role in aggressive behavior.

Psychopathy in Adolescence Predicts Official Reports of Offending in Adulthood

The study focused on the incremental predictive utility of psychopathy assessed at age 13 with the Childhood Psychopathy Scale (CPS) in predicting arrests and convictions between the ages of 18 and 26. Data from 338 men from the middle sample of the Pittsburgh Youth Study were used. A variety of control variables were included: demographics (race, family structure, socioeconomic status (SES), and neighborhood SES), parenting (physical punishment, inconsistent discipline, lax supervision, and low positive parenting), peer delinquency, and individual difference variables (impulsivity, verbal IQ, attention-deficit hyperactivity disorder, and conduct disorder). CPS scores at age 13 predicted the variety of arrests and convictions 5 to 13 years later, even after controlling for other well-established and well-measured risk factors. The study concluded that juvenile psychopathy is an important and useful risk factor for future antisocial behavior and also considered the implications of the findings and reasons for resistance to the juvenile psychopathy construct.

Personality disorders and pathological gambling: a review and re-examination of prevalence rates.

The current study reviews and reexamines the association between pathological gambling and personality disorders (PDs). To date, the majority of investigations have examined the prevalence of PDs in a single group of treatment-seeking pathological gamblers (PGs); very few of these studies included a comparison group, and even fewer compared PGs to nonpathological gamblers who, in contrast to nongamblers, resemble PGs in their attraction to and engagement in gambling behavior. The current study included a sample composed of nontreatment-seeking pathological gamblers and a comparison group of nonpathological gamblers (NPGs); these participants completed a self-report instrument (SCID-II/PQ) and were administered a structured clinical interview SCID-II) designed to assess PDs. Compared to the SCID-II, the SCIDII/PQ produced significantly higher PD prevalence rate estimates and symptom endorsements. Although the pattern of specific PD prevalence and symptom endorsement varied somewhat across the instruments, PGs consistently displayed significantly higher levels of borderline PD than NPGs; this pattern endured even after controlling for Axis I disorders and overlap among Axis II PDs.

Pathological Gambling Subtypes.

Although pathological gambling (PG) is regarded in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) as a unitary diagnostic construct, it is likely composed of distinct subtypes. In the current report, the authors used cluster analyses of personality traits with a non-treatment-seeking community sample of gamblers and identified 3 PG subtypes. Gamblers partitioned into a simple PG cluster, characterized by low rates of comorbid psychopathology and trait scores near the normative mean; a hedonic PG cluster, characterized by moderate rates of comorbid psychopathology and a proclivity for excitement seeking and positive affect; and a demoralized PG cluster, characterized by high rates of comorbid psychopathology and a propensity toward negative affect, low positive emotionality, and disinhibition. The findings provide preliminary support for an empirically based typology of gamblers, distinguishable in terms of personality structure, which may reflect different etiologies.

Generalizing the nomological network of psychopathy across populations differing on race and conviction status

Psychopathy has shown good construct validity in samples of Caucasian inmates. However, little is known about how well the nomological network surrounding psychopathy generalizes to non-Caucasian and nonincarcerated populations. Using longitudinal and concurrent data from the middle sample of the Pittsburgh Youth Study, this study demonstrates that the validity of total- and facet-level psychopathy is preserved in African American and nonincarcerated samples. Specifically, similar patterns of association were obtained for child variables (child psychopathy, socioeconomic status, risk status, parenting, delinquency, peer delinquency, and impulsivity) and adult variables (children, education, incarceration, unemployment, personality, substance use, and antisocial personality disorder) across ethnicity and conviction status.

Basic Traits Predict the Prevalence of Personality Disorder Across the Life Span The Example of Psychopathy

Personality disorders (PDs) may be better understood in terms of dimensions of general personality functioning rather than as discrete categorical conditions. Personality-trait descriptions of PDs are robust across methods and settings, and PD assessments based on trait measures show good construct validity. The study reported here extends research showing that basic traits (e.g., impulsiveness, warmth, straightforwardness, modesty, and deliberation) can re-create the epidemiological characteristics associated with PDs. Specifically, we used normative changes in absolute trait levels to simulate age-related differences in the prevalence of psychopathy in a forensic setting. Results demonstrated that trait information predicts the rate of decline for psychopathy over the life span; discriminates the decline of psychopathy from that of a similar disorder, antisocial PD; and accurately predicts the differential decline of subfactors of psychopathy. These findings suggest that basic traits provide a parsimonious account of PD prevalence across the life span.

Antisocial personality disorder in DSM-5: missteps and missed opportunities.

This paper evaluates the proposal for antisocial personality disorder (ASPD) in the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5). Some aspects of the proposal are appealing: personality disorders will be assessed using trait criteria, and these criteria are similar to trait descriptions of DSM-IV ASPD. Other aspects of the proposal are less appealing. First, the DSM-5 will depend on a newly constructed personality trait system rather than relying on a well validated, widely studied one. Second, the trait profile of ASPD is incomplete; although this profile reflects the traits included in DSM-IV, it maps poorly onto the full personality profile of ASPD. Third, the DSM Workgroup missed an opportunity to finally unify ASPD and psychopathy; history and research suggest that these disorders have diverged mistakenly. Fourth, the newly proposed criteria of impairments in self- and interpersonal functioning are of questionable derivation and utility.

Fixing the Problem With Empathy: Development and Validation of the Affective and Cognitive Measure of Empathy

Low empathy is a criterion for most externalizing disorders, and empathy training is a regular component of treatment for aggressive people, from school bullies to sex offenders. However, recent meta-analytic evidence suggests that current measures of empathy explain only 1% of the variance in aggressive behavior. A new assessment of empathy was developed to more fully represent the empathy construct and better predict important outcomes—particularly aggressive behavior and externalizing psychopathology. Across three independent samples (N = 210-708), the 36-item Affective and Cognitive measure of Empathy (ACME) was internally consistent, structurally reliable, and invariant across sex. The ACME bore significant associations to important outcomes, which were incremental relative to other measures of empathy and generalizable across sex. Importantly, the affective scales of the ACME—particularly a new “Affective Dissonance” scale—yielded moderate to strong associations with aggressive behavior and externalizing disorders. The ACME is a short, reliable, and useful measure of empathy.

A FIVE-FACTOR MODEL DESCRIPTION OF DEPRESSIVE PERSONALITY DISORDER

This investigation extends previous work on Five-Factor Model (FFM) personality disorder profiles. Specifically, a FFM expert consensus prototype for Depressive Personality Disorder (DPD) using the 30 facets of the NEO Personality Inventory-Revised (NEO PI-R) was developed. Initial validation of this prototype in a psychiatric population employed several clinical scales. When combined with trait information yielded by criteria translation and empirical approaches, the composite FFM profile emphasized several facets that represent the core components of DPD. In addition to several traits represented by the current DSM conceptualization of DPD, such as depressiveness, anxiousness, self-consciousness, and low tendermindedness, the composite profile was also characterized by several unrepresented traits, such as high modesty and low positive emotionality, warmth, assertiveness, trust, and achievement striving. Future definitions of depressive personality, conceptualized either as a DSM-V personality disorder or as a multifaceted construct, should consider these additional traits.