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SYCHOPATHY AND THE RELATION WITH ATTACHMENT
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NIVERSITY OF
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MSTERDAM
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ACULTYOFS
OCIAL ANDB
EHAVIOURALS
CIENCESM
ASTERC
LINICALF
ORENSICP
SYCHOLOGYM
ASTERTHESIS
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AME:
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IGNEH
OFSTRAS
TUDENTNUMBER:
10558705
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ASTER:
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RUNOV
ERSCHUERE2
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NDEX
PREFACE ... 3 ABSTRACT ... 4 INTRODUCTION ... 5 Ps ychopa thy ... 5Ps ychopa thy – Etiology ... 5
Ps ychopa thy – Prevalence ... 6
Ps ychopa thy - Overlap Antisocial Pers onality Disorder... 6
Ps ychopa thy – Dimensional cons truct... 6
Atta chment ... 6
Ps ychopa thy – Atta chment ... 7
The present s tudy ... 8
Main Hypothesis ... 8 Sub hypothesis ... 8 METHOD ... 9 Design ... 9 Ins truments... 9 Ps ychopa thy ... 9 Atta chment ... 10 Procedure ... 10 RESULTS ... 11
Prelimi nary a nal yses ... 11
Des cripti ve cha racteris ti cs ... 11
Internal consistency ... 11
Rela tionship between ps ychopathy and a ttachment ... 12
Bi va ria te correlations ... 12
Pa rtial correlati ons... 12
DISCUSSION ... 13
Limi ta tions of the s tudy ... 15
Small sample size ... 15
Reliability... 15
Interventions ... 17
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P
REFACE
“I didn’t want to hurt them, I only wanted to kill them ”. Door deze quote van David Berkowitz, een
seriemoordenaar uit de VS die beter bekend is onder de naam ‘Son of Sam’, werd mijn interesse gewekt voor psychopaten tijdens mijn studie psychologie. Ik hoopte door het volgen van de mastertrack Klinische Forensische Psychologie aan de UvA, antwoord te krijgen op de vraag wat mensen beweegt om te gaan moorden. Dankzij mijn scriptiebegeleider, Bruno Verschuere, heb ik onderzoek kunnen doen naar psychopaten en heb ik daarnaast een kijkje kunnen nemen in de wereld van de TBS. Hierdoor heb ik mijn kennis omtrent psychopathie en
aanzienlijk kunnen uitbreiden, dank daarvoor.
Deze masterthese draag ik verder op aan mijn vriend, Eric, mijn ouders en mijn beste vrienden (Annie, Yorick en Melissa). Al deze mensen hebben mij gesteund, geadviseerd en een luisterend oor geboden tijdens het schrijven van mijn these. De combinatie van het schrijven van de masterthese met het hebben van mijn fulltime
(droom)baan viel eerlijk gezegd wel wat tegen. Dankzij mijn doorzettingsvermogen en steun van mijn omgeving is het mij wel gelukt om mijn scriptie te voltooien net voor het eind van het jaar 2014. Het jaar 2015 zal voor mij dan ook in het teken staan van het krijgen van mijn diploma.
Ik wens jullie veel leesplezier. Signe Hofstra
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A
BSTRACT
The goal of the present study is to explore the relationship between the two factors of psychopathy and attachment, following Hare’s two-factor model. We expect that (1) factor 1 relates positively to Attachment Avoidance and negative to Attachment anxiety and (2) that factor 2 relates positively to Attachment Avoidance and to Attachment Anxiety. We also look more specific at psychopathy with use of the three factor model of Cooke and Michie (2001). The YPI and the PCL-R are used to measure psychopathy and the ECR-2010 to measure attachment. The 41 participants that participated in this study all came from two forensic psychiatric clinics in Holland. Results of the PCL-R scores were not significant. However, results of the YPI scores show that CU-traits are positive related to Attachment avoidance, that II-traits are positive related to Attachment Anxiety and that GM-traits are positive related to Attachment Anxiety. Findings are only partly in line with previous research. Therefore it is recommended to further explore the relationship between psychopathy and attachment.
Suggestions for further research and treatment- and intervention programs are given.
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I
NTRODUCTION
It is important to study the relationship between psychopathy and attachment, because of the possibility to identify high risk groups for developing a psychopathic personality disorder. These risk factors, for example having an unhealthy attachment style, are already present in puberty. Baardewijk et al. (2008) even found that psychopathic traits can be measured reliably and meaningfully through self-report in 9 to 12 year olds. Therefore it is possible to intervene and help them to develop a healthy attachment style. This will decrease the risk o f developing a
psychopathic personality disorder (Kosson, Cyterski, Neumann, Steuerwald, & Walker-Matthews, 2002). A number of authors believe that attachment disruptions during childhood (e.g. abuse, neglect) are associated with the development of a psychopathic personality disorder during adulthood (Gao, Raine, Chan, Venables, & Mednick, 2010; Saltaris, 2002). However, other researchers claim that there is no significant association between childhood victimization and psychopathy (Lang, af Klinteberg, & Alm, 2002). Brennan and Shaver (1998) even say that psychopathy is the only personality disorder which is not related to attachment.
Because of the lack of clarity on this matter, the goal of the present research is to explore the relationship between the two factors of psychopathy and attachment, following Hare’s two-factor model (Harpur, Hakistan, & Hare, 1988). We expect that factor 1 relates positively to Attachment Avoidance and negatively to Attachment Anxiety. However, we expect that factor 2 relates positively to Attachment Avoidance and Attachment Anxiety.
PSYCHOPATHY
One of the first researchers who made a clear definition of ‘psychopathy’ was Cleckley (1988). He described 16 characteristics of a psychopathic personality disorder (e.g. superficial charm and good intelligence, lack of remorse or shame, unreliability and untruthfulness) (Cleckley, 1988, p. 338-339). This definition of ‘psychopathy’ influenced Hare for developing his ‘two-factor model’ of psychopathy. The first factor includes the interpersonal and affective traits, the so called “core features” of psychopathy (e.g. glibness, lack of empathy). The second factor includes the chronically unstable antisocial lifestyle (e.g. irresponsible, impulsivity) (Harpur et al., 1988). Hare also developed an instrument to measure the level of psychopathy, the Psychopathy Checklist (Hare, 2003). Cooke and Michie (2001) found that there were some items of the PCL which did not load with one of the two factors. Therefore they developed a ‘three-factor’ model of psychopathy, by dividing the first factor into two different factors ‘Arrogant and Deceitful Interpersonal Style’ (e,g, glibness, grandiose sense of self-worth) and ‘Deficient Affective Experience’ (e.g. lack of remorse and lack of empathy) (Cooke, Michie, & Kosson, 2001). Hare eventually developed the ‘four-factor’ model of psychopathy. He kept the first two factors of Cooke et al. (2001) but he split the third factor into two different factors, ‘Lifestyle’ (e.g. impulsivity) and ‘Antiso cial’ (e.g. juvenile delinquency) (Hare & Neumann, 2008).
PSYCHOPATHY –ETIOLOGY
Research on the etiology of psychopathy indicates that there are different ways of developing a psychopathic personality disorder. Marshall and Cooke (1999) say that the two factors of psychopathy (Harpur et al., 1988) have two different types of etiology; biological influences and societal influences (e.g. childhood abuse). This finding is confirmed by an earlier study of Karpman (1948) who found two different types of psycho pathy; primary psychopathy with biological influences and secondary psychopathy with environmental influences (as cited in
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Skeem, Poythress, Edens, Lilienfeld, & Cale, 2003). Fowles and Dindo (2009) supported this two factor view by devlopping the ‘Dual Process Model. This model says that factor 1 is associated with the ‘Low Fear Hypothesis’ of Lykken (1996), which means that “psychopaths” are fearless because of their low fear conditioning. The model also says that factor 2 is associated with a deficit in the cognitive processing system located in the prefrontal cortex, which results in a poor regulation of emotions and behavior and a poor ability to generate fear imagery (Fowles & Dindo, 2009).PSYCHOPATHY –PREVALENCE
The prevalence of psychopathy remains unclear. Some researchers claim that the prevalence of psychopathy among non-criminals is substantially lower compared to the prevalence among criminals (Forth, Brown, Hart, & Hare, 1996; Hare, 2003; Hare et al., 2008). On the contrary, there are researchers who believe that psychopathy is more prevalent among the general society than among the forensic society (Kosson et al., 2002; J. Blair, Mitchell and K. Blair, 2005, as cited in Mack, Hackney, & Pyle, 2010). These differences of prevalence rates can be due to the different cut-off points that had been used. For example, the widely used cut-off score in America is 30 while the most used cut-off score in Europe is 25 (Cooke & Michie, 1999). In summary, it can be said that the prevalence rate of psychopathy in the forensic society lays between the 15 and 32 percent. The prevalence rate of psychopathy among the general society lays between the 3 and 30 percent (Forth et al., 1996; Cooke et al., 1999; Kosson et al., 2002; Hare; 2003; Blair et al., 2005; Laurell, & Dåderman, 2007; Hare et al., 2008).
PSYCHOPATHY -OVERLAP ANTISOCIAL PERSONALITY DISORDER
There is some overlap between the Psychopathic Personality Disorder and the Antisocial Personality (APD) Disorder. However, they are two different types of personality disorders with different criteria. The DSM-criteria for APD are almost exclusively based on behavioral characteristics (e.g. antisocial behavior), while the DSM-criteria for Psychopathy are based on both behavioral and personality characteristics (e.g. lack of empathy and antisocial behavior) (APA, 1994). The relationship between both personality disorders is asymmetric; most offenders with a high PCL-R score meet the criteria for APD, but most offenders diagnosed with APD do not meet the criteria for psychopathy (Hare, 2003; Decyper, De Fruyt, & Buschman, 2008).
PSYCHOPATHY –DIMENSIONAL CONSTRUCT
Historically, with regard to psychopathy, the research focus has shifted over the years from supporting a categorical view to a more dimensional view. Earlier research of Harris, Rice and Quinsey (1994) supported the categorical view by seeing psychopathy as a distinct group. However, this was only the case for psychopathy factor 2. Now there is more evidence pointing in the direction of a dimensional view of psychopathy, indicating that there are no fundamental, qualitative differences between psychopaths and non-psychopaths, which supports the dimensional view (Blackburn & Coid, 1998; Edens, Lilienfeld, Marcus, & Poythress, Lilienfeld, & Skeem 2006).
ATTACHMENT
Attachment is the capacity to form relationships with others (Bowlby, 1977). Attachment develops during the first nine months of life and is based on an individual’s experiences with his caregiver. There are different ways of
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forming these bonds, the so called attachment styles. Attachment styles can be either secure (self-reliant,trusting, co-operative) or insecure. Insecure attachment styles can be caused by a history of abuse or parental rejection. According to Bowlby (1977), there are four different types of insecure attachment; ‘Anxious’ (constant fear of abandonment, over-conscientious), ‘Compulsive Self-reliance’ (distrustful of close relationships, avoiding contact by fear of rejection), ‘Compulsive Care-giving’ (always in the role of caregiver, never in the role of receiver) and ‘Emotionally Detached’ (incapable of maintaining a stable affectional bond, the so called “psychopathic”) (Bowlby, 1977).
Bartholomew and Horowitz (1991) developed a different ‘four-dimensional’ model. Their model uses combinations of a person’s self-image and an image of others, which can be either positive or negative. The four different types of attachment styles following this model are: ‘Secure’, characterized by a positive image of the self and others, ‘Preoccupied’, characterized by a negative self image and a positive image towards others, ‘Fearful -Avoidant’, characterized by a negative view towards the self and others, and ‘Dismissive-Avoidant’, characterized by a positive view of the self and a negative view towards others.
Although there is some support for the ‘four-dimensional’ model of Bartholomew et al. (1991) (Mikulincer, & Shaver, 2005), in this current study we choose for the more widely used ‘two-dimensional’ model of attachment developed by Brennan and Shaver (1998). This model says that individual differences between adult attachment are caused by a variation among only ‘Attachment Anxiety’, characterized by anxiety about being abandoned or rejected by others, and ‘Attachment Avoidance’, characterized by a discomfort with close relationships and dependence on others (Brennan & Shaver, 1998; Hansen, Waage, Eid, Johnsen, & Hart, 2011).
PSYCHOPATHY –ATTACHMENT
Research indicates that there is a relationship between psychopathy and attachment (Westen, Thomas, Nakash, & Bradley, 2006). Rosenstein and Horowitz (1996) believe that persons with a dismissing (i.e. avoidant)
attachment style are more likely to have a narcissistic or antisocial personality disorder (psychopathic like -traits). IJzendoorn et al., (1997) found an association between early negative experiences (e.g. separation from an attachment figure), having an insecure attachment style and a personality disorder (in particular Cluster B). An interesting finding is that many researchers found an over-representation of insecure attachment styles, in particular avoidance, and an absence of secure attachment in forensic settings (Rosenstein et al., 1996; IJzendoorn et al., 1997; Frodi et al., 2001; Hansen et al., 2011).
Other research focused more on psychopathy and the relationship with family bonding. For example, Frodi, Dernevik, Sepa, Philipson and Bragesjö (2001) found an association between a high psychopathy score and a family history of a rejecting father and a very warm (idealized) mother. This finding is also confirmed by Flight and Forth (2007), who found an association between psychopathic traits in adolescent offenders and a lack of attachment with their father, but not with their mother of peers.
There are also studies that looked more specific at the relationship between different types of psychopathy and Attachment Avoidance and Attachment Anxiety. Pasalich, Dadds, Hawes and Brennan (2010) found an association between high levels of Callous-Unemotional traits (psychopathic like-traits) in children and insecure attachment styles. However, this was not the case for an Avoidant Attachment style. A possible explanation for this is their small sample of children with an Avoidant Attachment style who participated in this study. Mack et al. (2011) found that individuals with a high score of Attachment Avoidance and Attachment Anxiety also show high
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scores on primary psychopathic traits. Individuals who score high on secondary psychopathic traits showed only high scores on Attachment Avoidance or Attachment Anxiety but not both. Schimmenti et al. (2014) believed that individuals with high PCL-R scores, show more indicators of Attachment Avoidance and Attachment Anxiety and have experienced more severe abuse during childhood. Boertien (2014) also found this connection between high scores on factor 2 with both Attachment Avoidance and Attachment Anxiety. However, factor 1 was only positive related to Attachment Avoidance and negative related to Attachment Anxiety.In summary, it can be said that there is a relationship between psychopathy and attachment. However, it still remains unclear if this relationship is different or if it’s the same for both psychopathy factors.
THE PRESENT STUDY
MAIN HYPOTHESIS
The present study examines the two factors of psychopathy, factor 1 (core personality traits) and factor 2 (chronically unstable and antisocial lifestyle) (Harpur et al., 1988) and their relationship with Attachment Avoidance and Attachment Anxiety. We hypothesize that factor 1 relates positively to Attachment Avoidance, because individuals with high scores on factor 1 are characterized as cold, without a conscience, lack of empathy and being manipulative. These people don’t seek comfort of proximity to others, they even try to avoid contact. We also hypothesize that factor 1 relates negatively with Attachment Anxiety, following the theory of the ‘Dual Process Model’ (Fowles et al., 2009) which says that people who score high on factor 1 are considered “fearless”. Conversely, we expect a positive relation of factor 2 with Attachment Avoidance. At the same time we expect that factor 2 relates positively to Attachment Avoidance. This is due to the fact that factor 2 is influenced by
environmental factors, like abuse or rejection by a parental figure. Therefore, these people could develop an Avoidant Attachment style because of the ‘fear of rejection’. However, they could also develop an Anxious Attachment style because of the ‘fear of abandonment’ (Fowles et al., 2009). The PCL-R will be used to examine this relation (Harpur et al.,1988).
SUB HYPOTHESIS
We also use the ‘three-factor model’ of Cooke et al. (2001) to look more specific at the three factors of psychopathy and their relationship with Attachment Avoidance and Attachment Anxiety. The three factors are: factor 1: Arrogant and Deceitful Interpersonal Style, factor 2: Deficient Affective Experience and factor 3: Impulsive and Irresponsible behavioral style. The YPI will be used to examine the relationship s. It is based on a similar ‘three-factor model’ but it uses different factor labels; factor 1: Grandiose-Manipulative (GM-traits), factor 2: Callous-Unemotional (CU-traits) and factor 3: Impulsive-Irresponsible (II-traits) (Dutch version: Hillege, Das, & De Ruiter, 2010).
The ‘three-factor model is comparable with the originally ‘two-factor’ model, by combining the GM-traits and CU-traits into one factor which is the same as factor 1. The II-CU-traits are comparable to factor 2. Therefore, we hypothesize that GM traits relates positively to Attachment Avoidance. We also expect that GM-traits relates negatively to Attachment Anxiety. With respect to the CU-traits, we hypothesize that they relates positively with Attachment Avoidance. But we also expect a negative relation between CU-traits and Attachment Anxiety. Finally, we expect II-traits to relate positively with Attachment Avoidance and also to relate positively with Attachment Anxiety.
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M
ETHOD
PARTICIPANTS
Our sample consisted of 43 patients admitted to two different Dutch forensic psychiatric clinics; the TBS clinic Oldenkotte and the FPC Oostvaarders. The exclusion criteria that we used for our study were; blindness, acute psychotic disorder, people who are illiterate and whom did not sufficiently master the Dutch language, and a minimum IQ score of 81 (M = 99,92, SD = 11,40). From the total of 43, there were 41 men (95,3%) and 2 women (4,7%). Due to the low number of female participants, and our wish to control for gender effects, only male inmates were included in this present study. Their ages (N = 41) ranged from 23 to 67, with a mean age of 44.59 (SD = 11,59).
To estimate if the sample size was large enough we used the program G*Power 3.1.7. G*Power is a general stand-alone power analysis program for statistical tests (Faul, Erdfelder, Lang, & Buchner, 2007). We used it to calculate the minimum amount of participants needed to get a medium effect size (r = .5) with a conventional value of 0.8. Because our hypothesis are pointed in one direction we choose one-tailed correlations (P < 0,05). The program calculated a minimum amount of participants per group of 64. Our total of 41 participants makes this study slightly underpowered. It is important to take this into account while looking at the results of this study.
DESIGN
We used a cross-sectional correlational design to look into the relationship between psychopathy (independent variable) and attachment (dependent variable).
INSTRUMENTS
PSYCHOPATHY
The Youth Psychopathic Traits Inventory (YPI) (Dutch version; Hillege et al., 2010) is a self-report instrument to measure psychopathic traits, originally developed for adolescents. The YPI can also be used with adults because of the overlap in character traits measured by adult male offenders and male adolescent offenders (Andershed, Kerr, Levander, & Statting, 2000). This has been done before by Uzieblo, Verschuere, Van Den Bussche and Crombez (2010) who used the YPI for a community based sample of adults. The test consists of 50 items on a 4-point Liker-Scale, from 1 (Does not apply at all) to 4 (Applies very well). The YPI measures the ‘three-factor model’ of psychopathy with Grandiose-manipulative (GM), Callous-unemotional (CU), and Impulsive-Irresponsible (II) traits. More specifically, GM-traits consists of ‘Dishonest charm’ (“When I need to, I use my smile and my charm to use others”), ‘Grandiosity’ (“I am more important and valuable than other people”), ‘Lying’ (“Sometimes I lie for no reason, other than because it’s fun”) and ‘Manipulation’ (“To get people to do what I want, I often find it efficient to con them”). The CU-traits consists of the sub dimensions: ‘Remorselessness’ (“I Seldom regret things I do, even if other people feel that they are wrong”), ‘Un-emotionality’ (“What scares others usually doesn’t scare me”) and ‘Callousness’ (“When other people have problems, it is often their own fault, therefore, one should not help them”). The II-traits consists of ‘Thrill seeking’ (“I get bored quickly by doing the same thing over”), ‘Impulsiveness’ (“I prefer to spend my money right away rather than save it”) and ‘Irresponsibility’ (“I have cut classes more than most other people”) (Hillege et al., 2010). Research have shown acceptable internal
consistencies for the three main dimensions and the YPI total scores of boys (Cronbach’s alpha: GM = 0.84, CU = 0.66, II = 0.71 and Total = 0.70) and girls (Cronbach’s alpha: GM = 0.82, CU = 0.60, II = 0.78 and Total = 0.74).
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Internal consistencies for the sub dimensions were largely acceptable except for Un-emotionality (0,51) and Callousness (0.32) in boys and Callousness in girls (0.52) (Hillege et al., 2010; Poythress et al., 2006).The Psychopathy Checklist-Revised (PCL-R) is a 20-item rating scale that uses a semi-structured interview, case-history information and specific scoring criteria to rate each item on a three-point scale (0 to 2) according to the extent to which it applies to a given individual. In the current study, only PCL-R scores scored by well trained and experienced therapists from both the clinics were used. These scores were based on case-history information (criminal records, psychiatric records and prison records) and semi-structured interviews with questions like; “Where you ever physically, sexually, or emotionally abused?”. The minimum score is zero and the maximum score is 40. In America, the most used cut-off score of psychopathy is 30 (Hare et al., 2008). However, Cooke, Michie, Hart and Clark (2005) suggested to use a cut-off score of 28 in Europe. Research shows that the PCL-R contains good intra-class correlations (0.80 for a single rater, 0.90 for two raters), a good inter internal
consistency (Cronbach’s alpha of 0.80), a good inter-item correlation (0.22), a good cross-cultural generalizability and a good construct validity (Hare, Clark, Grann, & Thornton, 2000). In summary, the PCL-R is a well-validated instrument.
ATTACHMENT
The Experiences in Close Relationships Questionnaire (ECR-2010) is a self-report questionnaire which measures the adult attachment in partner relationships in the past and present, with questions like: “I tell my partner almost everything.” or “I don’t worry a lot about being left alone.” . The questionnaire consists of 36 items on a 7-point Likert-scale, from 1 (Extremely disagree) to 7 (Extremely agree). The ECR-2010 has two dimensions: ‘Attachment Avoidance’ and ‘Attachment Anxiety’. Each dimension consists of 18 items. How higher the score on the
Avoidance dimension, how more the participants tend to avoid emotional intimacy and proximity. In addition, how higher the score on the Anxiety dimension, how higher the fear of rejection and feelings of jealousy. Research supports a good external and internal consistency of the ECR-2010 with Cronbach’s Alpha of 0.91 for the Anxiety dimension and 0.94 for the Attachment dimension (Conradi, Gerlsma, Van Duijn, & De Jonge, 2006).
PROCEDURE
The participants of this study were all admitted to either one of the two Dutch forensic clinics, Oldenkotte or the Oostvaarders. These clinics are for the mentally disturbed, hospitalized criminal offenders. In the Netherlands it is possible for a judge to decide that someone who commit a severe crime (physical abuse, rape, child molestation, homicide) should get an involuntary treatment in a forensic psychiatric institution, which is called ‘Ter Beschikking Stelling’ (TBS). The patients of these institutions have a combination of a mental disorder and committing a crime, which is interesting for our research (IJzendoorn, et al., 1997).
Participants were approached in the clinics to participate in the study. They were given a leaflet with information about the study (e.g. the purpose and durtation) and they were told that they could stop their participation at any time. They were also asked to sign an informed consent and a form that gave us permission to look into their records which hold information about their demographic information and their PCL-R scores. You have to follow a special training before you are able to take a PCL-R. The researchers of this study weren’t qualified but the therapists of the clinics were. At the end, there was made an appointment for their participation. The participants received an amount of money when they finished their participation, with a minimum of €10,- and a maximum of €15,- (depending on performance in a task not related to the present study).
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R
ESULTS
PRELIMINARY ANALYSES
DESCRIPTIVE CHARACTERISTICS
The participant’s responses on the three different questionnaires are presented in table 1. The PCL-R total scores are comparable to those found by Schimmenti et al. (2014); average total score of 21.69 (SD = 8.18), factor 1 mean score of 10.09 (SD = 4.08) and factor 2 mean score of 9.92 (SD = 4.81). The YPI scores are comparable to those of Hillege et al. (2010); average total score of 21.24 (SD = 4.12), GM-traits mean score of 7.72 (SD = 2.28), CU-traits mean score of 6.66 (SD = 1.28) and II-traits a mean score of 6.86 (SD = 1.44). Also the ECR scores compared well to the ones found in the study of Mack et al. (2011); attachment Avoidance scores ranged from 1 to 5.06 (M = 2.75, SD = .84) and attachment Anxiety scores ranged from 1.22 to 5.61 (M = 3.22, SD = .98).
Table 1
Descriptive Statistics for the total scores and sub dimensions of the PCL-R, YPI and ECR
Questionnaires Mean St. deviation Min. score Max. score
PCL-R Total (N = 38) 23.27 7.43 7 37 Factor 1 9.84 3.14 3 16 Factor 2 10.56 4.17 2 16 YPI Total (N = 41) 84.51 18.88 52 142 GM-traits 29.27 7.87 20 51 CU-traits 26.44 6.10 16 42 II-traits 28.80 7.99 16 49 ECR Total (N = 41) 109.83 32.47 47 201 Avoidance 49.27 20.05 20 101 Anxiety 60.56 19.27 18 100
To assess for potential violations to normality all variables were evaluated for skewness and kurtosis using the Kolmogorov-Smirnov’s test. Factor 1, II-traits, Attachment Avoidance and Attachment Anxiety scores proved normally distributed at p > .05. Although the scores of factor 2 (D(38) = 0.19, p < 0.001.), GM-traits (D(41) = 0.20,
p <.001) and CU-traits (D(41) = 0.20, p <.001) were all significant non-normal, it was considered acceptable. Because of the great range of scores within the small sample size.
PCL-R total scores were not significantly correlated with age (r =.05, p =.38) or with total IQ scores (TIQ) (r =-.22,
p =.11). This was the same for the YPI total scores (age: r =-.07, p = .34; TIQ: r =.08) and the ECR total scores (age: r =.11, p =.24; TIQ: r =-.05, p =.38). Therefore, we did not control for age or IQ in the subsequent analyses.
INTERNAL CONSISTENCY
Because we only had PCL-R total and factor scores (from the participants file in the forensic clinic), it was not possible to assess the internal consistency of the PCL-R scores. Inter-correlations between the two factors were moderate (r = .37, p <.05).
According to Field (2013) a Cronbach’s alpha between 0.7 and 0.8 is considered good and an alpha lower than 0.3 is considered bad. The Cronbach’s alpha’s of the YPI subscales indicated good reliabilities; ‘Dishonest
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Charm’ (α = .73), ‘Lying’ (α = .80), ‘Manipulation’ (α = .77), ‘Remorselessness’ (α = .74), ‘Un-emotionality’ (α = .75), ‘Thrill-Seeking’ (α = .79), ‘Impulsiveness’ (α = .72) and ‘Irresponsibility’ (α = .73). However, the subscales ‘Grandiosity’ (α = .42) and ‘Callousness’ (α = .29) showed low reliabilities. The Cronbach’s alpha’s coefficients of the three factors showed acceptable internal consistencies; ‘GM-traits’ (α = 79), ‘CU-traits’ (α = .50) and ‘II-traits’ (α = .66). Finally the Cronbach’s alpha of the total YPI score was .92 which indicates a good internal consistency of the YPI. The YPI factors showed high inter-correlations (r’s between = .51 to = .66, all p <.001) which were higher than the inter-correlations found by Boertien (2014) (r’s between = .31 to = .47, all p <.001).The ECR dimensions ‘Attachment Avoidance’ (α =.93) and ‘Attachment anxiety’ (α =.91) showed good internal consistencies. The Cronbach’s alpha of the total ECR score was .93, which indicate a good internal consistency of the ECR. These Cronbach’s alpha’s are comparable with the ones found by Unger et al. (2014); Cronbach’s alpha of 0.91 for the entire scale, 0.92 for the avoidance dimension and 0.90 for the anxiety dimension . The correlation between the ECR dimensions is moderate and significant, which indicate a statistically significant relationship between them (r =.36, p < .01). This inter-correlation is slightly higher than the correlation found by Boertien (2014) (r = .11, p < .001).
RELATIONSHIP BETWEEN PSYCHOPATHY AND ATTACHMENT
BIVARIATE CORRELATIONS
It was hypothesized that factor 1, GM-traits and CU-traits will relate positively to attachment avoidance. But, as can be seen in Table 2, findings only support a positive relationship for the CU-traits with attachment avoidance. However, there was found an unexpected positive relationship between GM-traits and attachment anxiety. It was also hypothesized that factor 2 and II-traits will relate positively with attachment avoidance and with attachment anxiety. Pearson correlations revealed that only II-traits relate positively with attachment anxiety.
Table 2
Pearson's correlations coefficients
Attachment Avoidance Anxiety PCL-R Total .11 .01 Factor 1 .12 .11 Factor 2 .05 -.08 YPI Total .25 .44** GM-traits .08 .42** CU-traits .39** .16 II-traits .22 .49**
Note. *p < .05, one-tailed. **p < .01, one-tailed.
PARTIAL CORRELATIONS
Because of the moderate inter-correlations of psychopathy, which indicate that the variations of the variables overlap, computed we partial correlations to control for possible suppressor effects (see table 3). With partial
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correlations the portion of variance that is also shared by other psychopathy factors is removed, leaving only the unique relationship between one variable of psychopathy with attachment (Field, 2013). Most of the results were similar to the bivariate correlations. But there were some differences. The positive correlation between GM-traits and Attachment Anxiety became non-significant. This means that the II-traits mediates the relationship between GM-traits and Attachment Anxiety (it decreases the validity coefficient of the initial predictor) (Hicks & Patrick, 2006).However, there is also some evidence for possible suppressor effects. This is the case if a suppressed relation is present at partial level but not at zero-order level (Hicks et al. 2006). For example, the relationship between GM-traits and Attachment Avoidance almost became significant (r =-.25, p = .06) while controlling for CU-traits. And when we conducted a ‘second-order-partial correlation’ with GM-traits controlled for both CU-traits and II-traits, the negative relationship between GM-traits and Attachment Avoidance became significant. Finally, another interesting finding was that the negative relationship between CU-traits and Attachment Anxiety almost became significant (r =-.23, p = .08) when we conducted a ‘second-order-partial correlation’ with CU-traits controlled for both GM-traits and II-traits. These findings suggest that there are some complex relationships between the YPI factors indicating possible suppressor effects. However, the interpretation of partial correlations is very difficult, especially if the Cronbach’s alpa’s are lower than previously observed (e.g. Callousness) or if the inter-correlations are high (Lynam, Hole & Newman, 2006). Therefore, we only use the bivariate inter-correlations, which leaves the original scales intact.
Table 3
Partial correlations coefficients
Attachment YPI traits Controlled for Avoidance Anxiety
GM-traits CU-traits -.25 .42**
II-traits -.09 .16
CU-traits and II-traits -.31* .25
CU traits GM-traits .45** -.17
II-traits .33* -.11
GM-traits and II-traits .43** -.23
II-traits GM-traits .22 .32*
CU-traits .03 .48**
GM-traits and CU-traits .18 .35* Note. *p < .05, one-tailed. **p < .01, one-tailed.
D
ISCUSSION
The purpose of this study was to identify the relationship of the two factors of psychopathy and attachment, following Hare’s ‘two-factor model’, in a forensic sample. We expected a positive relation between factor 1 and Attachment Avoidance and a negative relation with Attachment Anxiety. This hypothesis was not confirmed.
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We also expected that factor 2 related positively with Attachment Avoidance and with Attachment Anxiety. This hypothesis was also not confirmed.We took a closer look at the relationship between psychopathy and attachment with use of the ‘three -factor model’ of Cooke and Michie (2001). We expected for the GM-traits to relate positively to Attachment Avoidance and negatively to Attachment Anxiety. However, we found the opposite; an unexpected relationship between GM-traits and Attachment Anxiety. This finding is consistent with an previous study of Boertien (2014) who found this for women, but not for men. She suggested that there is a link between GM-traits and an experience of fear of abandonment. Individuals who score high on GM-traits tend to hide their insecurity behind a mask of grandiosity and manipulation to keep their partner from leaving them. Another possible explanation is that GM-traits are more compatible with the description of factor 2 instead of factor 1 (Boertien, 2014).
Next, we expected that CU-traits related positively with Attachment Avoidance and negatively with Attachment Anxiety. Our findings confirmed only the positive relationship between CU-traits and Attachment Avoidance. This indicates that individuals who score high on CU-traits are characterized as cold and avoid contact and proximity to others (Brennan & Shaver, 1998). These findings are partly in line with previous research (Boertien, 2014). A possible explanation for the unfound relationship with Attachment Anxiety could be due to the fearlessness of the individuals who score high on CU-traits (Lykken, 1996). Because if these individuals can’t feel fear, they also can’t report it in self-report measurements. At the same time, it could be possible that the participants chose ‘socially desirable’ answers because they don’t want to be labeled as ‘fearless’ or ‘psychopath’. Therefore they could have faked their responses and have reported fear while they didn’t felt it. This could explain why we haven’t found evidence for the negative relationship with Attachment Anxiety.
Finally, we expected II-traits to relate positively with Attachment Avoidance and with Attachment Anxiety. Our results showed only a positive relationship between II-traits and Attachment Anxiety but not with Attachment Avoidance. It appears that participants with high scores on II-traits developed an Anxious Attachment style because of the fear of abandonment instead of an Avoidant Attachment style because of the fear of rejection (Fowles et al., 2009). This finding is in line with the previous study of Mack et al. (2010), who argued that individuals who score high on secondary psychopathic traits (i.e. factor 2) will only show high scores on Attachment Avoidance or Attachment Anxiety but not on both.
The differences in the relationships between the different factors of psychopathy and Attachment Avoidance and Attachment Anxiety can be explained by the etiology of psychopathy (Marshall & Cooke, 1999). It appears that the CU-traits are more influenced by biological factors (for example fearlessness), compared to the GM-traits and II-traits who seem to be more influenced by environmental factors.
As mentioned before, is attachment formed by the bond between the child and their parents. Therefore it is very likely to assume that there is a causal relationship from attachment to psychopathy (Mack et al., 2010). An example of this is the passive gene-environment, which says that parents who are abusive to their children have a genetic predisposition towards violence and impulsivity (i.e. psychopathic trait) which they then transfer onto their children. However, there is also evidence for a causal relationship in the opposite direction, which is called the reactive gene-environment. This pathway explains that children with psychopathic-like traits are at high risk for abuse by their parents because of their challenging and difficult temperament (Poythress et al ., 2006). Because
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our study didn’t provide enough evidence for one of the pathways, draw we the conclusion that there is a bi -directional relationship between psychopathy and attachment. Further research is recommended.LIMITATIONS OF THE STUDY
The results of our study were not all significant or in line with previous research. This can be the result of several limitations.
SMALL SAMPLE SIZE
The major limitation of this study is the small sample size. It was very hard to recruit participants from the forensic clinics. Most of them had a IQ below 80 or a acture psychotic disorder which are both exclusion criteria of our study. With use of the power analysis program 3.1.7. G*Power, we calculated a minimum amount of participants of 64. However, we only had 41 participants. This means that the sample is too small to detect a minimal effect and that we need more participants to find significant results.
The small sample size also complicates generalization to the whole population because our sample only used incarcerated offenders. We can change this by including a control group of non-criminal offenders. This will increase our external validity and generalization to the general population and also the effect size by enlarging the sample size.
RELIABILITY
While we were checking the reliability of the YPI subscales, we found some very low alpha’s for ‘Grandiostiy’ (α = .42) and ‘Callousness’(α = .29). The Cronbach’s alpha of ‘Callousness’ is comparable with the ones found by Hillege et al. (2010); α = .32, by Poythress et al. (2006); α = .36, and Campbell, Doucette and French (2009); α = .40-56. However we couldn’t find any research that confirmed a low alpha for ‘Grandiosity’. This is probably caused by item 41 (‘I am destined to become a famous , important and influential person’). This item correlates only positive with item 30, and this correlation is very low (r =.22). Item 41 correlates negative with all the other items in the subscale with a maximum of r = -.10. We did not deleted this item because this can influence the validity. But further research is needed to confirm this finding.
SELF-REPORT MEASUREMENTS
We used self-reported measurements in this study. Some researchers indicate that this can increase the possibility of fake responses in forensic populations, especially with individuals who score high on psychopathy (Hillege et al., 2010). Researchers who support this pessimistic view argue that psychopaths are lacking insight into their psychological problems and that they never have experienced certain affective states (e.g. guilt and empathy) which makes them unable to report certain feelings (Patrick, 2007). Research also found a positive correlation between lying frequency and psychopathic tendencies (Halevy, Shalvi and Verschuere, 2014). However, in the last 10 to 15 year there is a more optimistic view with growing support for self-report assessment of psychopathy because of significant advances in this field (Patrick, 2007). New instruments that were developed also assess the personality components next to the psychopathic traits. Lynam, Caspi, Moffit, Loeber, and Stouthamer-Loeber (2007) believe that the traditional distrust of self-report inventories of psychopathy is misplaced, especially when it comes to non-institutionalized psychopaths. The pressure to present oneself in a good light is much reduced outside prisons were decisions will not be made for an individual on the basis of his
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responses to certain instruments. Findings of an earlier study of forth et al. (1996) showed that there is a relative strong correlation (r=.60) between the PCL-R and the self-report psychopathy scale (Lynam, et al.2007). Nevertheless, we decided to partially correct for this sort bias by using the PCL-R to measure psychopathy as well. However, we only used a self-report measurement for measuring attachment. In the future we could also include the Adult Attachment Interview (AAI) to strengthen the results.METHOD VARIANCE
This study is also limited by the choice of instruments. Because the ECR-2010 and the YPI are self-report measurements and the PCL-R is not, is it predictable that the correlation between the ECR-2010 and the YPI is higher compared to the correlation between ECR-2010 and the PCL-R. This is due to the fact of method variance. Method variance is the variance that measures the method instead of the construct. Which mean s that
questionnaires who use the same form of measurement will show higher correlations because they have more similarities.
RECOMMENDATIONS FOR FUTURE RESEARCH
The current study looked at the current level of attachment. However, it is also important to look more at the history and etiology of attachment during the participant’s childhood, for example the type of parenting style and possible abuse. Research indicates that parental supervision and rejection by the father figure play a significant role in developing psychopathy, especially in male offenders (Flight and Forth, 2007). Unfortunately these information was not present at our study.
Environmental influences during childhood, for example childhood abuse, neighborhood, institutionalization and interactions with peers, are also important factors that can increase or reduce the risk of developing psychopathy and an unhealthy attachment style. Research on this topic shows very different results (IJzendoorn et al., 1997). However, research that focus on environmental factors should consult more than one source, like siblings or grand-parents. It is a well known fact that individuals who score high on psychopathy are very likely to have antisocial personality tendencies, for example externalization of blame and hostile attributional biases (Poythress et al., 2010). These characteristics could lead to an over report of a history of abuse or abandonment as an excuse for their bad behavior (Poythress, Lilienfeld & Skeem, 2006).
Our final suggestion is to not only focus on the risk factors of psychopathy but also look at the protective factors of psychopathy. A disturbing fact is that in many forensic psychiatric institutions secure attachment styles are virtually absent (Rosenstein et al., 1996; IJzendoorn et al., 1997; Frodi et al., 2001; Hansen, Waage, Eid,
Johnsen, & Hart, 2011). But it is possible that there are individuals who score high on psychopathy and also have a secure attachment style. These individuals should be studied to highlight protective factors which can be used in interventions.
TREATMENT AND INTERVENTION PROGRAMS
TREATMENT
Research of Skeem, Polaschek, Patrick and Lilienfeld (2011) shows that youth and adults with high scores on psychopathy can show improved behavior after intensive treatment. A Remarkable fact is that most research psychopaths still portray as “untreatable”, despite evidence of to the contrary. For example, Hughes, Hogue,
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Hollin and Champion (1997) say that different types of therapy (i.e. psychodynamic therapy, cognitive therapy and group therapy) have been proven unsuccessful. This pessimistic view is probably based on misconceptions of psychopathy. It is well known that psychopathic offenders are “challenging to treat” because they are often angry, irritable, suspicious of other’s motives, aggressive, untrustworthy, egocentric, noncompliant and have a history of school failing. Psychopaths also often show no motivation for treatment because they view their problems as externally caused and have a lack of insight. This all makes these psychopathic individuals “difficult to treat”, but not “untreatable”. Another misconception is that psychopathy traits almost make it impossible to built a therapeutic alliance. However, this assumption has no empirical evidence. On the contrary, there is empirical evidence that shows that alliances scores are not significant related to psychopathy scores. It is therefore recommended to create new intensive therapy programs, were the most “difficult to treat” persons should work hardest with. A lot is to learn about the treatment of psychopaths and therefore more research is needed. A study of Felthous (2011) suggest to treat co-morbid conditions because some conditions might be regarded as expressions of psychopathy (i.e. impulsive aggression) and have demonstrated improvement with treatment. But, treatment must continue after the individual has reentered the community. Polaschek and Daly (2013) recommend programs that focus on reducing the criminal behavior. Overall, the untreatability assumption of psychopathic individuals is overly pessimistic. It is too early to implicate that treatment of psychopathy should focus on attachment. Therefore more research is needed to discover intensive treatment programs for psychopathic disorders which also focus on attachment. This could help the patient to change his or her ways of interacting with significant others and develop a healthy attachment style.INTERVENTIONS
Early identification is essential before the severe and entrenched patters of emotional insensitivity became irreversible (Saltaris et al., 2002). Research of Lynam et al. (2009) shows that juvenile psychopathy could be reliably assessed beginning in childhood, because there are no large changes in personality pathology across childhood and adolescence (Lynam, Charnigo, Moffitt, Raine, Loeber, & Stouthamer-Loeber, 2009). Polaschek & Daly (2013) suggested to intervene by changing dynamic risk factors. Our findings suggest that a targeted intervention that focus on unhealthy attachment patterns, for those children who are at high risk for developing a psychopathic personality disorder, could reduce the risk of a psychopathic outcome (Marschall & Cooke, 1999). Longitudinal studies are needed to test this assumption.
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