Alexithymia and Psychopathy

[loveoforganic]

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I was looking through some articles on psycinfo and came across a study attempting to correlate psychopathy and alexithymia, but they didn't find statistical significance (http://psycnet.apa.org/index.cfm?fa=search.searchResults). Given the almost complete overlap of the symptoms of alexithymia on those of psychopathy, plus the fact that alexithymia and psychopathy seem to present the same way biologically (http://linkinghub.elsevier.com/retrieve/pii/S002239990200466X, http://www.ncbi.nlm.nih.gov/pubmed/9220088 ***<=Those two citations talk about the biological presentation of alexithymia, but I believe that's how psychopathy presents too, right?), it seems like there might have been a flaw in the research that lead to the results. I'm not familiar with the Toronto Alexithymia Scale (TAS), but I searched for it online and came across a self-report adaption of it (http://oaq.blogspot.com/). It feels to me like, based on the questions I read, that there's a fairly good possibility a psychopath would not report accurately on this type of interview, as some of the questions might seem to be deprecating to a psychopath, while they'd be more honest/boastful on the questions of the PCL. Anyway, it seems like psychopathy could be a condition of comorbid antisocial personality disorder or lifespan persistent conduct disorder and alexithymia, especially given that alexithymia is often comorbid with other personality disorders, e.g. schizotypal, dependent, and avoidant (taken off wikipedia, reference listed is Taylor (1997), pp. 162–165).

Anyway, I could be way off base, so I'm just wondering if you all have any thoughts about this.

 

[aGill]

Full disclosure: I'm just an undergrad, but am currently writing my senior honors thesis on the development of emotional deficits characteristic of psychopaths, and have been an active RA (ie administering PCL-R, not just data entry stuff) in a big psychopathy/personality disorder lab since my sophomore year. So, to that degree, I'm hardly foreign to the topic. Anyway, two thoughts:

1) While there seems to be a ton of overlap between the two on the surface, alexithymia doesn't really take into account pscyhopathy's Factor 2 issues...that is, the extreme antisocial lifestyles of these individuals. While alexithymics may score decently on Factor 1 items, there's a whole lot more to being a psychopath. Your samples are a big factor here: are you evaluating individuals from the community and assessing for each disorder? Or are you taking alexithymics and giving them the PCL? Either way, it would probably be very different than if you went to a jail, screened with the PCL, and then assessed for alexitymia.

2) When I think of alexithymia (and this is where my lack of expertise may show), I tend to think of more developmental disorders, autism, and the such where there is just such an distinct lack of emotional understanding. Psychopathy doesn't seem to really stem from this kind of a deficit...remember the classic descriptions of psychopaths as "knowing the words but not the music" of emotions or "knowing the difference from right and wrong, but not caring?" Their emotional deficits seem to be more localized in the areas of guilt and empathy.

 

[73BARMYPgsp]

Full disclosure: I'm just an undergrad, but am currently writing my senior honors thesis on the development of emotional deficits characteristic of psychopaths, and have been an active RA (ie administering PCL-R, not just data entry stuff) in a big psychopathy/personality disorder lab since my sophomore year. So, to that degree, I'm hardly foreign to the topic. Anyway, two thoughts:

1) While there seems to be a ton of overlap between the two on the surface, alexithymia doesn't really take into account pscyhopathy's Factor 2 issues...that is, the extreme antisocial lifestyles of these individuals. While alexithymics may score decently on Factor 1 items, there's a whole lot more to being a psychopath. Your samples are a big factor here: are you evaluating individuals from the community and assessing for each disorder? Or are you taking alexithymics and giving them the PCL? Either way, it would probably be very different than if you went to a jail, screened with the PCL, and then assessed for alexitymia.

2) When I think of alexithymia (and this is where my lack of expertise may show), I tend to think of more developmental disorders, autism, and the such where there is just such an distinct lack of emotional understanding. Psychopathy doesn't seem to really stem from this kind of a deficit...remember the classic descriptions of psychopaths as "knowing the words but not the music" of emotions or "knowing the difference from right and wrong, but not caring?" Their emotional deficits seem to be more localized in the areas of guilt and empathy.

Bless you young Jedi. These are both excellent points and you are thinking like a well-informed researcher. I think you are probably right on in that the disconnect probably has to do with [sophisticated] psychopaths being able to outsmart an alexithymia measure.

 

[loveoforganic]

Thanks for registering to share your insight aG. To disclose some information about myself, I'm an undergrad in a psychopathy lab as well - not doing data entry, but still with significant less experience than you on the subject (second semester in lab).

To your first point - I recognize that there isn't a complete overlap between alexithymia and psychopathy. What I was wondering about was the possibility of psychopathy being more of comorbid alexithymia with either antisocial personality disorder or conduct disorder. I wasn't really planning on getting into discussing how to actually conduct an experiment to determine this, but if you'd want to, we could. I was more just speculating about the possibility.

To your second point, that's the vibe I get about alexithymia too, but my knowledge about the disorder is incredibly limited, which is part of the reason I came here. Alexithymics can express a lack of empathy though.

Thanks again 🙂

 

[psychnic]

I believe that the diagnosis of psychopathy was re-named antisocial pd in the DSM-III; I am not an expert in the field, but they seem to be closely related, if not synonymous, constructs?

Thanks for registering to share your insight aG. To disclose some information about myself, I'm an undergrad in a psychopathy lab as well - not doing data entry, but still with significant less experience than you on the subject (second semester in lab).

To your first point - I recognize that there isn't a complete overlap between alexithymia and psychopathy. What I was wondering about was the possibility of psychopathy being more of comorbid alexithymia with either antisocial personality disorder or conduct disorder. I wasn't really planning on getting into discussing how to actually conduct an experiment to determine this, but if you'd want to, we could. I was more just speculating about the possibility.

To your second point, that's the vibe I get about alexithymia too, but my knowledge about the disorder is incredibly limited, which is part of the reason I came here. Alexithymics can express a lack of empathy though.

Thanks again 🙂

 

[73BARMYPgsp]

I believe that the diagnosis of psychopathy was re-named antisocial pd in the DSM-III; I am not an expert in the field, but they seem to be closely related, if not synonymous, constructs?

Close. APD is a hybrid or compromise on the issue. Some posit that psychopathy is at the extreme end of a spectrum that looks more or less like this:

Histrionic-->Borderline-->Narccicistic-->Antisocial-->Psychopath

While others would call it a completely different construct.

 

[HopefulStudent8]

Close. APD is a hybrid or compromise on the issue. Some posit that psychopathy is at the extreme end of a spectrum that looks more or less like this:

Histrionic-->Borderline-->Narccicistic-->Antisocial-->Psychopath

While others would call it a completely different construct.

Do you have any articles about this idea of a spectrum of personality disorders, with one necessarily being "more extreme" than the others? I've never seen anything to suggest that this is the case. In fact, I could see many people arguing the borderlines could end up suffering more than narcissists in the greater scheme of things, especially given the prevalence of borderlines in psychiatric hospitals. Your argument would suggest that most individuals with personality disorders tend to present with the same severity, which is far from the case. A histrionic with a severe presentation could end up functioning at a lower level than a narcissist with a mild presentation.

 

[cara susanna]

Millon thinks that the most severe personality disorders are schizotypal, borderline, and paranoid because they involve structural deficits.

 

[aGill]

I believe that the diagnosis of psychopathy was re-named antisocial pd in the DSM-III; I am not an expert in the field, but they seem to be closely related, if not synonymous, constructs?

It is true that the APA has chosen not to differentiate between APD and psychopathy...though I still haven't heard any good reason why. Whether you believe that psyschopathy falls within a spectrum of other PDs or is its own separate construct (you'll find a lot of support within this argument), it is clear to those who have researched psychopathy or are familiar with its modern literature that it is not synonymous with APD. There are many things that are specific to psychopaths alone, such as blunted or absent physiological responses to aversive stimuli, usually higher verbal intelligence, very superficial and charming personalities, parasitic lifestyles without any realistic life-goals, etc. Furthermore, for a grand generalization, psychopathy has been associated with far more concrete biological factors than I think APD ever could.

Anyway, the whole matter amazes me. From what I know, psychopathy seems like one of the more distinct and clinically separate disorders, meaning that I'd expect that a trained specialist could identify a psychopath from a group of antisocial individuals with greater certainty than he/she could identify someone with GAD from a group of people with MDD. Despite this, the DSM still disregards it all and just lumps the two together

 

[loveoforganic]

I've heard through the pipeline that they're considering putting psychopathy into the DSM-V. Not necessarily as a diagnosis, however. Maybe just a subset of APD.

 

[Psych528]

I've heard through the pipeline that they're considering putting psychopathy into the DSM-V. Not necessarily as a diagnosis, however. Maybe just a subset of APD.

At least that would be a step in the right direction. Psychopathy and APD have marked differences that, for practitioners/researchers, clear distinctions (i.e. symptoms and treatment) must be made between the two. As it stands the DSM doesn't even recognize psychopathy as an actual disorder. When current researchers write about it, you don't know if they're using Hare or Cleckley's definitions or referring to APD. Especially since APD does not have to include "lack of remorse" in order to guarantee a diagnosis.

 

[coronzon]

The two symdromes may or may not be related, but the relationship, if existent would be weak. in regard to the other question, not all Psychopaths meet the criteria for ASPD. I've argued that the PCL can be used to determine not only if one is a Psychopath, but what kind. I've divided the PCL scores into 3 groups: Psychopaths (High-Functioning, Socialized, non-Violent, Atypical), Sociopaths (Low-Functioning, Antisocial, Violent, Typical) and Antisocial (Criminal or sub-Criminal).

These types are found by higher scores in
Factor 1: Psychopath
Factor 2: Antisocial
Factors 1 and 2: Sociopath

a side note, some Psychopaths are not compulsive liars, but still very talented ones. Factor 1 Psychopaths are more likely to be Opportunistic liars and Compulsive ones, whereas Factor 2 Sociopaths have no such distinction. I will investigate further in due time.

 

[CriminalPsych]

I believe that the diagnosis of psychopathy was re-named antisocial pd in the DSM-III; I am not an expert in the field, but they seem to be closely related, if not synonymous, constructs?

Close. APD is a hybrid or compromise on the issue. Some posit that psychopathy is at the extreme end of a spectrum that looks more or less like this:

Histrionic-->Borderline-->Narccicistic-->Antisocial-->Psychopath

While others would call it a completely different construct.

Many argue that criminal and violent behavior are not among the core features of psychopathy, in contrast to the PCL-R. The problem is that the PCL-R uses past criminal behavior to predict future criminal behavior and masks it as psychopathy, creating a criterion contamination when criterion behavior is in the predictor. This works in a forensic context where it is mainly used as a risk assessment tool (and this is a whole other can of worms), but not so great when trying to decipher a personality construct. The Triarchic model looks at the phenotypic constructs, as measured by the PPI, where psychopathy consists of boldness, disinhibition, and meanness. Criminal and violent behavior would be a by product of these traits, particularly disinhibition and meanness. At least, this is my understanding of all this mumbo jumbo.

 

[cara susanna]

Rereading this thread... So some researchers consider Narcissistc PD and ASPD to be more pathological than BPD? Really? I would actually argue the opposite given how maladaptive BPD is at its core. Narcissists can often flourish in life in the right circumstances and situations. ASPD is certainly maladaptive for some people but if you're in a situation where those kinds of behavioral patterns are adaptive (such as running a corporation), it's not necessarily less adaptive. Whereas with BPD it is at its core maladaptive--the person has clear wants and desires, but acts in a way that prevents them from happening (e.g., wanting close relationships but acting in ways that come across as manipulative and push the person away--and not to mention the self harm/destructive behavior).

I'd also LOVE to hear one of the ASPD/psychopathy researchers on here discuss the differences between ASPD and psychopathy more in depth. Reading the list of differences already mentioned was fascinating and it'd be great to hear more.

 

[CSOPP]

It is true that the APA has chosen not to differentiate between APD and psychopathy...though I still haven't heard any good reason why. Whether you believe that psyschopathy falls within a spectrum of other PDs or is its own separate construct (you'll find a lot of support within this argument), it is clear to those who have researched psychopathy or are familiar with its modern literature that it is not synonymous with APD. There are many things that are specific to psychopaths alone, such as blunted or absent physiological responses to aversive stimuli, usually higher verbal intelligence, very superficial and charming personalities, parasitic lifestyles without any realistic life-goals, etc. Furthermore, for a grand generalization, psychopathy has been associated with far more concrete biological factors than I think APD ever could.

Anyway, the whole matter amazes me. From what I know, psychopathy seems like one of the more distinct and clinically separate disorders, meaning that I'd expect that a trained specialist could identify a psychopath from a group of antisocial individuals with greater certainty than he/she could identify someone with GAD from a group of people with MDD. Despite this, the DSM still disregards it all and just lumps the two together

This. Maybe making a distinction between ASPD and Psychopathy will gain more steam now that they have discovered structural differences between the brains of psychopaths versus those with ASPD. Of course, this matter could be further complicated as some, like coronzon, have argued that there is a difference between psychopathy and being a sociopath (I'm currently on the fence in this debate).