Distinguishing Psychopathy in Adolescents – Promising Avenues

Distinguishing Psychopathy in Adolescents – Promising Avenues

Psychopathy presents a challenging construct to measure, particularly in youth. The MMPI-A-RF shows promising evidence to tap into the Triarchic model of Psychology in adolescents. This is the bottom line of a recently published article in Psychological Assessment. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | Psychological Assessment | 2021, Advanced Online Publication

Operationalizeing the Triarchic Model of Psychopathy in Adolescents Using the MMPI-A-RF (Restructured Form)

Authors

Robert A. Semel, Private Practice
Terry B. Pinsoneault, Cuyahoga County Juvenile Court Diagnostic Clinic
Laura E. Drislane, Sam Houston State University
Martin Selbom, University of Otago

Abstract

The triarchic model is an increasingly influential multidimensional model of psychopathy that focuses on three distinct phenotypic domains of boldness, meanness, and disinhibition. Although originally operationalized through the Triarchic Psychopathy Measure (TriPM), the triarchic model has also been operationalized through items of existing psychopathy and personality measures that provide sufficient content coverage of the triarchic dimensions. The current study aimed to provide a means for enhancing understanding of psychopathic features in adolescents through the development and validation of triarchic scales using items from the Minnesota Multiphasic Personality Inventory Adolescent-Restructured Form (MMPI-A-RF). The MMPI-A-RF normative sample and a large sample of juveniles undergoing court ordered evaluations were used for formal scale development and the juvenile-court sample was also used for validation analyses. The MMPI-A-RF triarchic scales demonstrated adequate internal consistency in both the normative and juvenile offender samples, and were largely related to criterion variables, including measures of personality, psychopathology, interpersonal functioning, and adolescent concerns as predicted based on the triarchic model. Canonical correlation analyses revealed unexpected and novel findings of (variable-centered) patterns of associations between our predictor triarchic scales and criterion variables that resemble “primary” and “secondary” psychopathy variants or subtypes. Overall, findings suggest that the triarchic model as indexed by the MMPI-A-RF scales can be useful for understanding how psychopathy may manifest in youth and for identifying youth at risk for severe and persistent antisocial behavior.

Keywords

triarchic psychopathy model, psychopathy, MMPI-A-RF, antisocial behavior

Summary of the Research

“There is growing evidence that behaviors resembling psychopathy—typically referred to as callous-unemotional (CU) traits or “limited prosocial emotions” (LPE; American Psychiatric Association, 2013)—can manifest early in development and designate a particularly severe subgroup of antisocial youth. The presence of CU/LPE traits is associated with a pattern of severe and persistent conduct problems, delinquency, violence, aggression, and deficits in empathy and guilt. As such, it is imperative to enhance our understanding of psychopathic features in adolescents, and to develop means for accurately assessing psychopathic traits in youth to curtail the persistence of severe antisocial behavior into adulthood and diminish the impact of psychopathy on members of society. Few measures are available for routine clinical and forensic use, however, particularly in youth.” (p.1)

“Continuing to assess youth psychopathic traits from a multidimensional perspective may provide more nuanced insights into the complex, multiply determined nature of conduct problems, and other externalizing outcomes in youth and adults. In this regard, a number of empirically validated assessment instruments have already been developed to assess psychopathic traits in children and adolescents, including the Psychopathy Checklist: Youth Version (PCL: YV; Forth et al., 2003), the Antisocial Process Screening Device (APSD; Frick & Hare, 2001), the Inventory of Callous-Unemotional Traits (ICU; Frick, 2004), and the Youth Psychopathic Traits Inventory (YPI; Andershed et al., 2002). However, most of the aforementioned inventories are research scales and none derive from broad-band, comprehensive assessment measures of personality psychopathology in adolescents, such as the MMPI-A-RF, which are more widely used in routine clinical and forensic practice.” (p.2)

“One increasingly influential multidimensional model of psychopathy is the triarchic model, which was developed as an integrative model to reconcile different historical theories and contemporary measurement models of psychopathy through a focus on three distinct phenotypic domains of boldness, meanness, and disinhibition. An advantage of the triarchic model is that dimensions of the model are conceived of as neurobehavioral trait constructs, having correlates both in behavior and core neurobiological systems, which is consistent with research initiatives to integrate neuroscience-based approaches to understanding, and ultimately treating and preventing psychiatric disorders. From a developmental perspective, the focus on neurobehavioral trait constructs may also be advantageous to identify putative brain-based deficits that emerge early in life which could confer biological risk for the development of adult psychopathy.” (p.2)

The current study had two principal aims. First, we undertook to develop item-based MMPI-A-RF scales for indexing boldness, meanness, and disinhibition, using a consensus-based rating approach which has been employed in the development of triarchic scales from other measures (e.g., Brislin et al., 2015; Drislane, Patrick, & Arsal, 2014; Hall et al., 2014; Sellbom et al., 2016). Internal psychometric analyses of data from a large community and juvenile forensic samples were used to refine the scales. The second aim was to validate the MMPI-A-RF-Tri scales in relation to criterion measures that were administered concurrently with the MMPI-A, i.e., the Jesness Inventory-Revised (JI-R; Jesness, 2003), and the Millon Adolescent Clinical Inventory (MACI; Millon, 1993) during the course of court-ordered forensic evaluations. The JI-R is a revision of a self-report personality inventory developed to assess salient characteristics of youth involved in the juvenile justice system. The MACI was designed to assess a broad range of psychological problems experienced by adolescents and includes scales assessing three significant areas of adolescent functioning, that is, personality patterns, self-reported concerns, and clinical symptoms.” (p.3)

Translating Research into Practice

“The pattern of bivariate associations with criterion measures suggests that boldness, as indexed by the MMPI-A-RF, can be manifested through both adaptive, or at least nonpathological, traits (i.e., an absence of psychological distress and seriously problematic externalizing behavior) as well as maladaptive personality characteristics (i.e., narcissism). Previous research with adults has likewise indicated that boldness is associated with narcissistic features, antagonism, exploitativeness, and the interpersonal features of psychopathy as measured by the PCL-R. Boldness was not significantly associated overall with externalizing, antisocial, acting-out behavior patterns, and was not significantly correlated with the MACI psychopathy Egocentricity/Grandiosity indices. However, as will be discussed shortly, high boldness, in conjunction with even low-to-moderate disinhibition and meanness in CCAs, was associated with high levels of antisocial personality pattern and delinquent predisposition” (p.10)

“Our resulting triarchic scales, developed from a construct- and consensus based item rating approach, with refinements based on psychometric considerations, demonstrated adequate internal consistency reliabilities in both community and juvenile-court samples. Within a juvenile-court sample, scores on these triarchic scales generally demonstrated patterns of convergent and discriminant validity with available criterion measures that were consistent with our hypotheses, which were based on theory and past empirical findings with the triarchic model. As such, our study results extend further support for the applicability of the triarchic model of psychopathy in youth.” (p.10)

“The constellations of triarchic scale associations that resemble primary and secondary psychopathy subtype patterns in delinquent youth may also show meaningful differences on other important outcomes, such as violent and nonviolent offending, and treatment responsiveness. The potential of identifying youth whose personality and behavior patterns are consistent with the secondary psychopathy subtype may have particular relevance for detection of possible future antisocial and psychiatric disturbances. In juvenile justice involved youth the presence of comorbid internalizing and externalizing psychopathology has been associated with significantly increased risk (compared with non-disordered peers) for young adult recidivism. Furthermore, whereas psychopathy is known to have a pronounced association with severe antisocial behavior which has a costly impact on society, secondary psychopathic traits, as compared to primary psychopathic traits, in prison inmates has been associated with greater frequency of suicide attempts and also was found to strengthen the relationship between depressive symptoms and suicidal ideation. Thus, identification of youth with high levels of secondary psychopathy traits has important behavioral and mental health implications.” (p.11)

Other Interesting Tidbits for Researchers and Clinicians

“Although it was not planned for, our study appeared to have contributed novel findings concerning patterns of associations between variables that resemble psychopathy subtypes. Whereas previous studies generally distinguished between psychopathy subtypes based largely on trait anxiety or multiple indices of internalizing problems, the current study, albeit variable-centered rather than person-centered, and thus indicating the need for further study, suggests that primary and secondary subtypes might be distinguished based on varying triarchic scale configurations, and also strongly supports the role of boldness in distinguishing between primary and secondary subtypes. Boldness, as indexed by the MMPI-A-RF, and consistent with the nomological network of triarchic boldness, appeared to be associated with a personality style that is highly confident and expressive, with an elevated sense of self-worth, and with manipulative and potentially hostile features. Boldness, in conjunction with even mild-to-moderate levels of meanness and disinhibition may manifest through callousness, domineering behavior with very high inclination to break the law or violate the rights of others. The current findings, then, appear to contradict the criticism (e.g., Miller & Lynam, 2012; Vize et al., 2016) that triarchic boldness (and fearless dominance) are not meaningfully associated with maladaptive outcomes, and is not essential to the psychopathy construct.” (p.11)

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Authored by Leila N. Wallach

Leila N. Wallach is a clinical psychology doctoral student at Palo Alto University. Her research and clinical interests focus on alternatives to incarceration, culture and trauma-informed care, policy in the juvenile justice system, and risk assessment for community offender management.

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