Scott O. Lilienfeld

A meta-analytic review of the relation between antisocial behavior and neuropsychological measures of executive function

Previous narrative reviews of the relation between antisocial behavior (ASB) and neuropsychological tests of executive functioning (EF) have raised numerous methodological concerns and produced equivocal conclusions. By using meta-analytic procedures, this study attempts to remedy many of these concerns and quantifies the relation between ASB and performance on six reasonably well validated measures of EF. Thirty-nine studies yielding a total of 4,589 participants were included in the analysis. Overall, antisocial groups performed .62 standard deviations worse on EF tests than comparison groups; this effect size is in the medium to large range. Significant variation within this effect size estimate was found, some of which was accounted for by differences in the operationalizations of ASB (e.g., psychopathy vs. criminality) and measures of EF. Evidence for the specificity of EF deficits relative to deficits on other neuropsychological tasks was inconsistent. Unresolved conceptual problems regarding the association between ASB and EF tests, including the problem of localizing EF tests to specific brain regions, are discussed.

Psychological Treatments That Cause Harm

The phrase primum non nocere (“first, do no harm”) is a well-accepted credo of the medical and mental health professions. Although emerging data indicate that several psychological treatments may produce harm in significant numbers of individuals, psychologists have until recently paid little attention to the problem of hazardous treatments. I critically evaluate and update earlier conclusions regarding deterioration effects in psychotherapy, outline methodological obstacles standing in the way of identifying potentially harmful therapies (PHTs), provide a provisional list of PHTs, discuss the implications of PHTs for clinical science and practice, and delineate fruitful areas for further research on PHTs. A heightened emphasis on PHTs should narrow the scientist-practitioner gap and safeguard mental health consumers against harm. Moreover, the literature on PHTs may provide insight into underlying mechanisms of change that cut across many domains of psychotherapy. The field of psychology should prioritize its efforts toward identifying PHTs and place greater emphasis on potentially dangerous than on empirically supported therapies.

The Scientific Status of Projective Techniques

Although projective techniques continue to be widely used in clinical and forensic settings, their scientific status remains highly controversial. In this monograph, we review the current state of the literature concerning the psychometric properties (norms, reliability, validity, incremental validity, treatment utility) of three major projective instruments: Rorschach Inkblot Test, Thematic Apperception Test (TAT), and human figure drawings. We conclude that there is empirical support for the validity of a small number of indexes derived from the Rorschach and TAT. However, the substantial majority of Rorschach and TAT indexes are not empirically supported. The validity evidence for human figure drawings is even more limited. With a few exceptions, projective indexes have not consistently demonstrated incremental validity above and beyond other psychometric data. In addition, we summarize the results of a new meta-analysis intended to examine the capacity of these three instruments to detect child sexual abuse. Although some projective instruments were better than chance at detecting child sexual abuse, there were virtually no replicated findings across independent investigative teams. This meta-analysis also provides the first clear evidence of substantial file drawer effects in the projectives literature, as the effect sizes from published studies markedly exceeded those from unpublished studies. We conclude with recommendations regarding the (a) construction of projective techniques with adequate validity, (b) forensic and clinical use of projective techniques, and (c) education and training of future psychologists regarding projective techniques.

The association between anxiety and psychopathy dimensions in children.

Although several theoretical models posit that low levels of anxiety are a risk factor for psychopathy and antisocial behavior, a number of studies have reported elevated levels of anxiety among antisocial individuals. Nevertheless, most investigators in this literature have not distinguished between fearfulness and trait anxiety or attempted to separate the antisocial lifestyle dimension from the callous and unemotional dimension of psychopathy. In a study of clinically referred children (N = 143), we found that (a) measures of trait anxiety and fearlessness (low fearfulness) exhibited low correlations; (b) conduct problems tended to be positively correlated with trait anxiety, whereas callous and unemotional traits tended to be negatively correlated with trait anxiety; and (c) controlling statistically for the effects of one dimension increased the divergent correlations of the other dimension with both trait anxiety and fearful inhibition. These findings bear potentially important implications for the diagnosis and etiology of psychopathy and antisocial behavior and suggest that distinctions between trait anxiety and fearful inhibition, as well as between the two dimensions of psychopathy, may help to clarify longstanding confusion in this literature.

Psychopathic, not psychopath: Taxometric evidence for the dimensional structure of psychopathy.

Although psychopathy is frequently regarded as qualitatively distinct from other conditions, relatively little research has examined whether psychopaths represent a distinct class of individuals. Using a sample of 876 prison inmates and court-ordered substance abuse patients who were administered the Psychopathy Checklist-Revised (R. D. Hare, 2003), the authors examined the latent structure of psychopathy using several taxometric procedures developed by Meehl and colleagues (P. E. Meehl & L. J. Yonce, 1994; N. G. Waller & P. E. Meehl, 1998). The results across these procedures offer no compelling support for the contention that psychopathy is a taxonic construct and contradict previous reports that psychopathy is underpinned by a latent taxon. The authors discuss the theoretical, public policy, and practice-level implications of these findings.

Neural Correlates of Social Cooperation and Non-Cooperation as a Function of Psychopathy

BACKGROUND Psychopathy is a disorder involving a failure to experience many emotions that are necessary for appropriate social behavior. In this study, we probed the behavioral, emotional, and neural correlates of psychopathic traits within the context of a dyadic social interaction. METHODS Thirty subjects were imaged with functional magnetic resonance imaging while playing an iterated Prisoners Dilemma game with human confederates who were outside the scanner. Subjects also completed two self-report psychopathy questionnaires. RESULTS Subjects scoring higher on psychopathy, particularly males, defected more often and were less likely to continue cooperating after establishing mutual cooperation with a partner. Further, they experienced more outcomes in which their cooperation was not reciprocated (cooperate-defect outcome). After such outcomes, subjects scoring high in psychopathy showed less amygdala activation, suggesting weaker aversive conditioning to those outcomes. Compared with low-psychopathy subjects, subjects higher in psychopathy also showed weaker activation within orbitofrontal cortex when choosing to cooperate and showed weaker activation within dorsolateral prefrontal and rostral anterior cingulate cortex when choosing to defect. CONCLUSIONS These findings suggest that whereas subjects scoring low on psychopathy have emotional biases toward cooperation that can only be overcome with effortful cognitive control, subjects scoring high on psychopathy have an opposing bias toward defection that likewise can only be overcome with cognitive effort.

Psychopathic personality or personalities? Exploring potential variants of psychopathy and their implications for risk assessment

Although psychopathy typically has been construed as a relatively uniform construct, seminal theories and contemporary research suggest that it may be heterogeneous. In this article, the most promising literature is distilled to distinguish among potential variants of antisocial personality disorder (APD) that can be derived from, and informed by, modern conceptions of psychopathy. This analysis suggests that there are primary and secondary variants of psychopathy, which may be distinguished based on the extent to which they are heritable and are characterized by affective deficits, impulsivity, trait anxiety, and characteristics of borderline and narcissistic personality disorders (NPD). These variants also may differ in their patterns of violence and responsivity to treatment. If variants of psychopathy can be identified reliably and supported empirically, psychopathy may be transformed from a global label to a set of more specific constructs that improve our ability to understand, manage, and treat individuals who have largely been regarded as dangerous and untreatable.

Sex differences in psychopathy and antisocial personality disorder: A review and integration

Although the correlates and causes of psychopathy and antisocial personality disorder (ASPD) have been the subject of extensive investigation, researchers in this area have until recently focused almost exclusively on males. As a consequence, relatively little is known about psychopathy and ASPD in females. In this paper, we review the empirical literature on sex differences in the base rates, mean symptom levels, correlates, and factor structure of psychopathy and ASPD. In addition, we discuss the potential sex-differentiated phenotypic expressions of psychopathy and ASPD (e.g., somatization disorder [SD]) as well as sex differences in the developmental trajectories of these conditions. There is suggestive evidence that these conditions may be differentially expressed across biological sex, although further investigation of this issue is warranted. We conclude with recommendations for future research in this area, including suggestions for embedding the study of sex differences in psychopathy and ASPD within a construct validational framework.

Posttraumatic stress disorder: An empirical evaluation of core assumptions

The diagnosis of posttraumatic stress disorder (PTSD) rests on several core assumptions, particularly the premise that a distinct class of traumatic events is linked to a distinct clinical syndrome. This core assumption of specific etiology ostensibly distinguishes the PTSD diagnosis from virtually all other psychiatric disorders. Additional attempts to distinguish PTSD from extant conditions have included searches for distinctive markers (e.g., biological and laboratory findings) and hypothesized underlying mechanisms (e.g., fragmentation of traumatic memory). We review the literature on PTSDs core assumptions and various attempts to validate the construct within a nomological network of distinctive correlates. We find that virtually all core assumptions and hypothesized mechanisms lack compelling or consistent empirical support. We consider the implications of these findings for conceptualizing PTSD in the forthcoming edition of the American Psychiatric Associations diagnostic manual.

Comorbidity Between and Within Childhood Externalizing and Internalizing Disorders: Reflections and Directions

The term and concept of “lcomorbidity” has been mired in controversy, although there is little question that the existence of covariation among psychiatric diagnoses poses significant challenges to current models of psychiatric classification and diagnosis. The papers in this Special Section underscore a number of important issues relevant to the comorbidity between and within childhood externalizing and internalizing disorders, and illustrate both methodological and substantive reasons for such comorbidity. Weiss, Susser, and Catrons distinction among common, broad-band specific, and narrow-band specific features provides a helpful framework for understanding the comorbidity of childhood externalizing and internalizing disorders (B, Weiss, K. Susser, & T. Catron, 1998). Hierarchical models of psychopathology help to dissolve the distinction between “splitters” and “lumpers” and point to variables that may elucidate the etiology of externalizing and internalizing disorders.