Hare Psychopathy Checklist
In contemporary research and clinical practice, Robert D. Hare's Psychopathy Checklist, Revised (PCL-R) is the psycho-diagnostic tool most commonly used to assess psychopathy. Because an individual's score may have important consequences for his or her future, and because the potential for harm if the test is used or administered incorrectly is considerable, Hare argues that the test should only be considered valid if administered by a suitably qualified and experienced clinician under controlled and licensed conditions. Hare receives a royalty on licensed use of the test.
 PCL-R model of psychopathy
The PCL-R is a clinical rating scale (rated by a psychologist or other professional) of 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and a semi-structured interview. A value of 0 is assigned if the item does not apply, 1 if it applies somewhat, and 2 if it fully applies. In addition to lifestyle and criminal behavior the checklist assesses glib and superficial charm, grandiosity, need for stimulation, pathological lying, conning and manipulating, lack of remorse, callousness, poor behavioral controls, impulsivity, irresponsibility, failure to accept responsibility for one's own actions and so forth. The scores are used to predict risk for criminal re-offence and probability of rehabilitation.
The current edition of the PCL-R officially lists three factors (1.a, 1.b,, and 2.a), which summarize the 20 assessed areas via factor analysis. The previous edition of the PCL-R listed two factors. Factor 1 is labelled "selfish, callous and remorseless use of others". Factor 2 is labelled as "chronically unstable, antisocial and socially deviant lifestyle". There is a high risk of recidivism and currently small likelihood of rehabilitation for those who are labelled as having "psychopathy" on the basis of the PCL-R ratings in the manual for the test, although treatment research is ongoing.
PCL-R Factors 1a and 1b are correlated with narcissistic personality disorder and histrionic personality disorder. They are associated with extraversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).
PCL-R Factors 2a and 2b are particularly strongly correlated to antisocial personality disorder and criminality and are associated with reactive anger, criminality, and impulsive violence. The target group for the PCL-R is convicted criminals. The quality of ratings may depend on how much background information is available and whether the person rated is honest and forthright.
 The two factors
Factor 1: Personality "Aggressive narcissism"
- Glibness/superficial charm
- Grandiose sense of self-worth
- Pathological lying
- Lack of remorse or guilt
- Shallow affect (genuine emotion is short-lived and egocentric)
- Callousness; lack of empathy
- Failure to accept responsibility for own actions
Factor 2: Case history "Socially deviant lifestyle".
- Need for stimulation/proneness to boredom
- Parasitic lifestyle
- Poor behavioral control
- Lack of realistic long-term goals
- Juvenile delinquency
- Early behavior problems
- Revocation of conditional release
Traits not correlated with either factor
- Promiscuous sexual behavior
- Many short-term marital relationships
- Criminal versatility
- Acquired behavioural sociopathy/sociological conditioning (Item 21: a newly identified trait i.e. a person relying on sociological strategies and tricks to deceive)
Early factor analysis of the PCL-R indicated it consisted of two factors. Factor 1 captures traits dealing with the interpersonal and affective deficits of psychopathy (e.g. shallow affect, superficial charm, manipulativeness, lack of empathy) whereas Factor 2 dealt with symptoms relating to antisocial behaviour (e.g. criminal versatility, impulsiveness, irresponsibility, poor behaviour controls, juvenile delinquency).
The two factors have been found by those following this theory to display different correlates. Factor 1 has been correlated with narcissistic personality disorder, low anxiety, low empathy, low stress reaction and low suicide risk but high scores on scales of achievement and social potency. In addition, the use of item response theory analysis of female offender PCL-R scores indicates factor 1 items are more important in measuring and generalizing the construct of psychopathy in women than factor 2 items.
In contrast, Factor 2 was found to be related to antisocial personality disorder, social deviance, sensation seeking, low socio-economic status and high risk of suicide. The two factors are nonetheless highly correlated and there are strong indications they do result from a single underlying disorder. However, research has failed to replicate the two-factor model in female samples.
Recent statistical analysis using confirmatory factor analysis by Cooke and Michie indicated a three-factor structure, with those items from factor 2 strictly relating to antisocial behaviour (criminal versatility, juvenile delinquency, revocation of conditional release, early behavioural problems and poor behavioural controls) removed from the final model. The remaining items are divided into three factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience and Impulsive and Irresponsible Behavioural Style.
In the most recent edition of the PCL-R, Hare adds a fourth antisocial behaviour factor, consisting of those Factor 2 items excluded in the previous model. Again, these models are presumed to be hierarchical with a single unified psychopathy disorder underlying the distinct but correlated factors.
The Cooke & Michie hierarchical ‘three’-factor model has severe statistical problems—i.e., it actually contains ten factors and results in impossible parameters (negative variances)—as well as conceptual problems. Hare and colleagues have published detailed critiques of the Cooke & Michie model. New evidence, across a range of samples and diverse measures, now supports a four-factor model of the psychopathy construct, which represents the Interpersonal, Affective, Lifestyle, and overt Antisocial features of the personality disorder.
 Other mental disorders
Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder.
The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are misnomers. The World Health Organization takes a different stance in its ICD-10 by referring to psychopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.
Among laypersons and professionals, there is much confusion about the meanings and differences between psychopathy, sociopathy, antisocial personality disorder, and the ICD-10 diagnosis, dissocial personality disorder. Hare takes the stance that psychopathy as a syndrome should be considered distinct from the DSM-IV's antisocial personality disorder construct, even though ASPD and psychopathy were intended to be equivalent in the DSM-IV. However, those who created the DSM-IV felt that there was too much room for subjectivity on the part of clinicians when identifying things like remorse and guilt; therefore, the DSM-IV panel decided to stick to observable behaviour, namely socially deviant behaviours.
As a result, the diagnosis of ASPD is something that the "majority of criminals easily meet." Hare goes further to say that the percentage of incarcerated criminals that meet the requirements of ASPD is somewhere between 80 to 85 percent, whereas only about 20% of these criminals would qualify for a diagnosis of what Hare's scale considers to be a psychopath. This twenty percent, according to Hare, accounts for 50 percent of all the most serious crimes committed, including half of all serial and repeat rapists. According to FBI reports, 44 percent of all police officer murders in 1992 were committed by psychopaths.
Another study using the PCL-R to examine the relationship between antisocial behaviour and suicide found that suicide history was strongly correlated to PCL-R Factor 2 (reflecting antisocial deviance) and was not correlated to PCL-R factor 1 (reflecting affective functioning). Given that ASPD relates to Factor 2, whereas psychopathy relates to both factors, this would confirm Hervey Cleckley's assertion that psychopaths are relatively immune to suicide. People with ASPD, on the other hand, have a relatively high suicide rate.
Since psychopaths frequently cause harm through their actions, it is assumed that they are not emotionally attached to the people they harm; however, according to the PCL-R Checklist, psychopaths are also careless in the way they treat themselves. They frequently fail to alter their behavior in a way that would prevent them from enduring future discomfort.
In practice, mental health professionals rarely treat psychopathic personality disorders as they are considered untreatable and no interventions have proved to be effective. In England and Wales the diagnosis of dissocial personality disorder is grounds for detention in secure psychiatric hospitals under the Mental Health Act if they have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment this alternative to prison is not often used.
Because an individual's scores may have important consequences for his or her future, the potential for harm if the test is used or administered incorrectly is considerable. The test can only be considered valid if administered by a suitably qualified and experienced clinician under controlled conditions.
Hare wants the Diagnostic and Statistical Manual of Mental Disorders to list psychopathy as a unique disorder, saying psychopathy has no precise equivalent in either the DSM-IV-TR, where it is most strongly correlated with the diagnosis of antisocial personality disorder, or the ICD-10, which has a partly similar condition called dissocial personality disorder. Both organizations view the terms as synonymous. But only a minority of those in institutions who Hare and his followers would diagnose as psychopaths are violent offenders.
The manipulative skills of some of the others are valued for providing audacious leadership. It is argued psychopathy is adaptive in a highly competitive environment, because it gets results for both the individual and the corporations or, often small political sects they represent. However, these individuals will often cause long-term harm, both to their co-workers and the organization as a whole, due to their manipulative, deceitful, abusive, and often fraudulent behaviour.
Hare describes people he calls psychopaths as "intraspecies predators who use charm, manipulation, intimidation, sex and violence to control others and to satisfy their own selfish needs. Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."
 See also
- Levenson Self-Report Psychopathy Scale
- Robert Hare (psychologist)
- Diagnostic classification and rating scales used in psychiatry
- Voight-Kampff machine
- Leam Craig, Kevin Browne, Anthony R. Beech (2008) Assessing Risk in Sex Offenders p. 117 John Wiley and Sons, ISBN 0-470-01898-4
- Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.
- Hare, R. D., & Neumann, C. N. (2006). The PCL-R Assessment of Psychopathy: Development, Structural Properties, and New Directions. In C. Patrick (Ed.), Handbook of Psychopathy (pp. 58-88). New York: Guilford.
- Carey, Benedict (June 11, 2010). "Legal Fight Delays Paper on Psychopathy Scale 3 Years". The New York Times. http://www.nytimes.com/2010/06/12/health/12psych.html.
- The Hare Psychopathy Checklist-Revised by Robert D. Hare, 1991. Multi-Health Systems, 908 Niagara Falls Blvd, North Tonawanda, New York, USA, 14120-2060
- Harpur, T. J., Hare, R. D., & Hakstian, A. R. (1989). "Two-factor conceptualization of psychopathy: Construct validity and assessment implications.". Psychological Assessment 1 (1): 6–17. DOI:10.1037/1040-35184.108.40.206.
- Zagon, I. K., & Jackson, H. J. (1994). "Construct validity of a psychopathy measure.". Personality and Individual Differences 17 (1): 125–135. DOI:10.1016/0191-8869(94)90269-0.
- Verona, E., Patrick, C. J., & Joiner, T. E. (2001). "Psychopathy, Antisocial Personality, and Suicide Risk". Journal of Abnormal Psychology 110 (3): 462–470. DOI:10.1037/0021-843X.110.3.462. PMID 11502089.
- Hare, R.D. (2003). Psychopathy checklist-revised technical manual, 2nd ed. Toronto: Multihealth Systems, Inc.
- Cooke, D. J., Kosson, D. S., & Michie, C. (2001). "Psychopathy and ethnicity: Structural, item and test generalizability of the Psychopathy Checklist-Revised (PCL-R) in caucasian and African American participants". Psychological Assessment 13 (4): 531–542. DOI:10.1037/1040-35220.127.116.111. PMID 11793896.
- Salekin, R. T., Rogers, R., & Sewell, K. W. (1997). "Construct validity of psychopathy in a female offender sample: A mutlitrait-multimethode evaluation". Journal of Abnormal Psychology 106 (4): 576–585. DOI:10.1037/0021-843X.106.4.576. PMID 9358688.
- Cooke, D. J., & Michie, C. (2001) (2001). "Refining the construct of psychopathy: Towards a hierarchical model". Psychological Assessment 13 (2): 171–188. DOI:10.1037/1040-3518.104.22.168. PMID 11433793.
- Hare, R. D. (2003). Manual for the Hare Psychopathy Checklist - Revised.. Multi-Health Systems.
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- Hare, R. D., & Neumann, C. S. (2008). "Psychopathy as a clinical and empirical construct". Annual Review of Clinical Psychology 4 (1): 217–246. DOI:10.1146/annurev.clinpsy.3.022806.091452. PMID 18370617.
- Neumann, C. S. (2007). "Psychopathy". British Journal of Psychiatry 191 (Oct): 357–358. DOI:10.1192/bjp.191.4.357a. PMID 17906249.
- Hare, R. D. Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion, Psychiatric Times, February 1996, XIII, Issue 2 Accessed June 26, 2006
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- Rutherford MJ, Cacciola JS, Alterman AI (1999). "Antisocial personality disorder and psychopathy in cocaine-dependent women". The American Journal of Psychiatry 156 (6): 849–56. PMID 10360122.
- Hare, Robert D. Without Conscience: The Disturbing World of Psychopaths Among Us, (New York: Pocket Books, 1993) pg 25-30.
- Verona E, Patrick CJ, Joiner TE (2001). "Psychopathy, antisocial personality, and suicide risk". Journal of Abnormal Psychology 110 (3): 462–70. DOI:10.1037/0021-843X.110.3.462. PMID 11502089.
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- Babiak, P. From darkness into the light: Psychopathy in industrial and organizational psychology. In Herve, H. & Yuille, J.C. (Eds.), The Psychopath: Theory, Research and Practice. Mahwah, NJ: Lawrence Erlbaum Associates. 2007
- Ochberg FM, Brantley AC, Hare RD, et al. (2003). "Lethal predators: psychopathic, sadistic, and sane". International journal of emergency mental health 5 (3): 121–36. PMID 14608825.
- Simon, R. I. Psychopaths, the predators among us. In R. I. Simon (Ed.) Bad Men Do What Good Men Dream (pp. 21-46). Washington: American Psychiatric Publishing, Inc.1996
- D. J. Cooke, A. E. Forth, & R. D. Hare (Eds.), Psychopathy: Theory, research, and implications for society Dordrecht, The Netherlands: Kluwer
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 Further reading
- Hare, R. D. (2003). "The Psychopathy Checklist—Revised, 2nd Edition." Toronto: Multi-Health Systems.
- Hare, R.D. (1980). "A research scale for the assessment of psychopathy in criminal populations". Personality and Individual Differences 1 (2): 111–120. DOI:10.1016/0191-8869(80)90028-8.
- Hill, C. D.; Neumann, C. S.; Rogers, R. (2004). "Confirmatory Factor Analysis of the Psychopathy Checklist: Screening Version (PCL:SV) in Offenders with Axis I Disorders". Psychological Assessment 16 (1): 90–95. DOI:10.1037/1040-3522.214.171.124. PMID 15023097.
- Vitacco, M. J.; Neumann, C. S.; Jackson, R. (2005). "Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence". Journal of Consulting and Clinical Psychology 73 (3): 466–76. DOI:10.1037/0022-006X.73.3.466. PMID 15982144.
- Vitacco, M. J.; Rogers, R.; Neumann, C. S.; Harrison, K.; Vincent, G. (2005). "A comparison of factor models on the PCL-R with mentally disordered offenders: The development of a four factor model". Criminal Justice and Behavior 32 (5): 526–545. DOI:10.1177/0093854805278414.
- Babiak, P., & Hare, R. D. (2006). "Snakes in suits: When psychopaths go to work.", New York: Harper Collins.
- Generality of Psychopathy Checklist—Revised Factors Over Prisoners and Substance-Dependent Patients.
- This American Life radio documentary on the PCL-R and its use