The Psychopathic Triangle
The relationship between psychopathy, substance use and
antisocial behaviour
Merel van Garderen
Clinical Forensic Psychology Student number: 10182039 Supervision: dr. E. Heynen
Abstract
Since psychopathy is a personality disorder that is highly prevalent in forensic populations and difficult to treat, it is important to know more about risk factors that might influence the disorder and impede treatment outcomes. The current study examines a possible triangular relationship between psychopathy, substance use and antisocial behaviour. The study investigated psychopathic traits, substance use disorder and antisocial behaviour in 75 participants. Results indicate that psychopathy positively predicts aggression. Additional relations between psychopathy, substance use and criminal behaviour have not been found. Distinct features of psychopathy seem to play a role in various results. Limitations and implications were discussed.
The Triangular Relationship Between Psychopathy, Substance Use and Antisocial Behavior Psychopathy is a personality disorder, which is frequently associated with antisocial behaviour like aggression and criminality (Hare, 2003; Leistico, Salekin, DeCoster & Rogers, 2008; Walsh, Swogger, Walsh & Kosson, 2007; Walsh & Walsh, 2006). Due to the severity of the disorder and supposed to the ‘resistance to all manner of treatment’, the disorder has caught a considerable amount of public concern and scientific attention in the past centuries (Kiehl & Hoffman, 2011, p. 355). Psychopathy is characterised by two distinctive features: interpersonal-affective and antisocial features (Cooke & Michie, 2001; Hare, 1991; Hare, 2003, Schadé & Koerselman, 1994; Walsh et al., 2007). This results for example in pathological lying (interpersonal), a lack of empathy and remorse (affective) and poor behavioural control (antisocial). For an overview of the criteria of psychopathy and the modifications through time, see Appendix A.
Already since 1800, doctors and psychiatrists have been writing about psychopathy and there has always been a scientific debate about the measuring of psychopathy. One of the key topics of the debate, on one hand, is related to the fact that the measurement of
psychopathy relies on criminal behaviour. As a consequence, it is hard if not impossible, to meet the criteria for psychopathy if there is no criminal history (Polaschek, 2014; Skeem & Cooke, 2010). On the other hand, scientists postulate that the measurement of psychopathy is not necessarily related to criminal behaviour but it is about antisocial behaviour (Hare & Neumann, 2010, p. 447). In addition, several studies indicate that antisocial behaviour may hold criminal features, but antisocial behaviour cannot be simply divided into ‘antisocial’ and ‘criminal’ as distinct concepts (Krueger & Markon, 2006; Marcus, Lilienfeld, Edens & Poythress, 2006). For a full review of the debate, see Skeem and Cooke (2010) and Hare and Neumann (2010).
In the discussion if criminal behaviour is a component of psychopathy or not, it does strike out that the prevalence of psychopathy is 25 till 30 per cent in forensic populations, against only one per cent in the general population (Hare, 2003; Hart, Cox & Hare, 1995; Strand & Belfrage, 2001). It seems that psychopathy mainly occurs in forensic populations. Furthermore, the disorder is frequently associated with an antisocial personality disorder (APD). An APD is characterised by persistent and progressive antisocial and criminal
behaviour that has been developing from an early age (APA, 2000). Among detainees, almost half of the population meet the criteria for APD (Lindsay, Hogue, Taylor, Mooney, Steptoe et al., 2006; RSJ, 2007). Research of Kosson, Lorenz and Newman (2006) shows that people with psychopathy almost always meet the criteria for APD. On the opposite, most of the people with APD do not meet the criteria for psychopathy. Scientists describe psychopathy as a stronger version of APD (Domes, Mense, Vohs & Habermeyer, 2013; Hare, Hart & Harpur, 1991). The disorders differ from one another in affective and social behaviour (Hare et al. 1991; Dolan & Fullam, 2005). For example, a lack of empathy is one of the key features of psychopathy but not of APD.
Another common disorder in forensic populations is substance use disorder (SUD). About 50 till 70 per cent of the detainees meet the criteria for SUD (Baillargeon, Penn,
Knight, Harzke, Baillargeon, et al., 2010; Chandler, Fletcher & Volkow, 2009; Fazel, Bains & Doll, 2006; RSJ, 2007). Research has shown, SUD to be one of the most important risk
factors for the development of criminal recidivism (Dowden & Brown, 2005). Besides, the use of substances during treatment is a risk factor for therapy drop out, which can lead to criminal recidivism (Hildebrand, Schönberger & Spreen, 2007; Lammers et al., 2014). Furthermore, the relation between SUD and criminal recidivism is moderated by personality traits such as impulsivity, sensation seeking and hostility (Lammers Agnie, de Haan, Bakkum,
Pomp, et al. 2014). It is notable that these traits can also be found in the characteristics for the personality disorder psychopathy (Hare, 2003).
Regarding giving treatment to people with psychopathy, it is well known to be more challenging than giving treatment to people with other mental and personality disorders (Morana, Stone & Abdalla-Filho, 2006; Salekin, Worly & Grimes, 2010). Motivation, interest and compliance during treatment seem to be lower in psychopathic than in non-psychopathic offenders (Hobson, Shine & Roberts, 2000; Polaschek, 2014). In addition, studies indicate that people with higher scores on psychopathy more often prematurely end their treatment, relapse in substance use and sooner reoffend in criminal recidivism than people with lower scores on psychopathy (Berger, Rotermund, Vieth & Hohnhorst, 2012; Cunningham & Reidy 1998). As an explanation scientists postulate that people with psychopathy are more
dangerous than people with other mental disorders: they need intensifying and longer treatments to result in positive outcomes (Berger et al., 2012; Salekin, 2002). Treatment of people with psychopathy primarily focuses on lowering criminal needs. Criminal needs are risk factors for the development of criminal behaviour (Simourd & Hoge, 2000). Research indicates that people with psychopathy have more criminal needs than other detainees, but it still remains unclear which criminal needs change the behavioural characteristics of
psychopathy (Polaschek, 2014). Therefore it is necessary to further investigate which factors might chance the characteristics of psychopathy.
Among forensic populations, psychopathy, APD and SUD are highly prominent. One might consider whether the three co-occur. Several studies tap into a possible relationship. Krueger, Hicks, Patrick, Carlson, Iacono et al. (2002) are even talking about a ‘comorbidity phenomenon’ (p. 411) among mental disorders with a disinhibited personality style (e.g. bipolar disorder, ADHD and APD), antisocial behaviour and SUD. In accordance with other scientists they postulate these three factors often co-occur due to a genetic kinship, which
finds expression within a so-called externalising spectrum (ESM) (Hicks, Krueger, Iacono, McGue & Patrick, 2004; Kendler, Prescott, Myers & Neale, 2003; Krueger et al., 2002; Krueger, Markon, Patrick, Benning & Kramer, 2007; Young, Stallings, Corley, Krauter & Hewitt, 2000). The ESM is an umbrella term for disorders characterised by a disinhibited personality style. The ESM is highly heritable and is defined as the origin of ‘disinhibitory traits’ (e.g. novelty seeking, impulsivity and aggression), which directly influences the development of disorders characterised by a disinhibited personality style.
In a large study conducted by Krueger et al. (2007) students and detainees were measured on the degree of the ESM by measuring a wide range of disinhibitory domains such as aggression, sensation seeking and a lack of remorse. Results revealed that detainees differ from students on the ESM; detainees show more disinhibitory tendencies on all domains compared to students. Besides, there are variances on the ESM within the detainee population as well as within the student population. It remains unclear how these variances are resembled and what causes them (Bloningen, Hicks, Krueger, Patrick & Iacono, 2006).
Yet there are studies investigating the origin of variances of personality traits. A twin study from Bloningen, Carlson, Krueger and Patrick (2003) showed variances in personality traits of people with psychopathy are mainly derived from genetic predispositions. A later twin study from Bloningen et al. (2006) examined the genetic and behavioural pathways of the distinct personality features of psychopathy, categorised into interpersonal-affective and antisocial features. Results showed, in accordance with above-mentioned studies, genes are mainly responsible for the expression of personality traits. An interesting finding was that the interpersonal-affective and antisocial features were genetically uncorrelated. Besides, the researchers found a relation between psychopathic traits and externalising as well as
distinctive behavioural features of psychopathy. According to the researchers the results closely follow the ‘classical view’ about psychopathy from Cleckley (1941). Cleckley stated that people with psychopathy are capable of functioning and behaving psychologically healthy in a society; in such a manner no one will think this person is mentally insane. The actual, severe, disorder is masked underneath a ‘healthy disguise’. According to Bloningen et al. (2005), this is a reflection of the two distinct etiological processes; internalising
behavioural characteristics express themselves in proper functioning in society and externalising behavioural characteristics express themselves in antisocial behaviour.
Above-mentioned studies show genetic kinship can be an indication for the co-occurrence of psychopathology, SUD and antisocial behaviour. There is only a limited amount of studies investigating the reciprocity of these three factors. Since psychopathic personality features are derived from distinct etiological processes, it can be an indication for various interactions. Therefore, the present study will map out the triangular relationship between psychopathy, substance use and antisocial behaviour.
First, it was predicted that psychopathy positively predicts antisocial behaviour (Hypotheses 1a & 1b). Due to the debate about antisocial criminal and antisocial behaviour (Hare & Neumann, 2010; Skeem & Cooke, 2010), we measured antisocial behaviour by separated measures for aggression (a) and for criminal history (b) (see Method section).
Second, it was predicted that psychopathy positively predicts SUD (Hypothesis 2). Third, a positive relation between SUD and antisocial behaviour was expected (Hypotheses 3a & 3b). See Figure 1 in Appendix B for an overview of hypotheses 1, 2 and 3.
In case all relationships are supported, we examined the possibility that the relation between psychopathy and antisocial behaviour is (partially) explained by SUD (Hypotheses 4a & 4b) (see Figure 2). Subsequently, we examined the possibility that the degree of
substance use has an influence on the effect that psychopathy has on antisocial behaviour (Hypotheses 5a & 5b) (see Figure 3).
Method Participants
The data that has been used in the present study, was part of a larger research of ‘Inforsa Forensisch Ambulante Zorg’ (Inforsa Forensic Outpatient Care) in Amsterdam (The Netherlands) and was gathered for the purpose of an extensive target group description of the client population. Clients had a ‘forensic indication’: participants have been in contact or are threatening to come in contact with the Justice Department. Besides, clients had psychiatric, addiction and/or personality issues. Seventy-five participants participated in the present study and were classified on the degree of psychopathy (for a full description, see Measures). Participants did not receive a reward for their participation. Participants were 71 men (94.7%) and 4 women (5.3%) with ages varying from 23 till 60 (M = 39.04, SD = 9.4). Fifty-two per cent was born in The Netherlands (n=39) and 48 per cent was born in other countries (n=36). For an overview of the demographic characteristics of the participants, see Table 1 in
Appendix C.
Research Design
Independent variables
Psychopathy was an independent variable in hypotheses 1, 2, 4 and 5 and was
measured on an interval level. The three subscales of the measurement of psychopathy, were used as three independent predictors, which were internally consistent (see Measures). Intercorrelation between the three factors was examined with the Bartlett’s test of sphericity, p < .001. Substance use was an independent variable in hypothesis three and was measured on an interval level.
Dependent variables
Antisocial behaviour was a dependent variable in hypotheses 1, 3, 4 and 5 and was measured on an interval level. Substance use was a dependent variable in hypothesis two and was measured on an interval level.
Data analyses
Hypotheses 1 and 2 were tested with a multiple regression analysis. Hypothesis three was tested with a one-tailed correlation. Hypotheses 4 and 5 were tested with PROCESS macro from Andrew Hayes, downloaded via: http://processmacro.org/download.html. The mediation-analysis (hypothesis four) was conducted with model 4 and the moderation-analysis (hypothesis five) was conducted with model 1.
Measures
Youth Psychopathic Traits Inventory-Short Version
Psychopathy was measured with the Dutch version of the Youth Psychopathic Traits Inventory-Short Version (YPI, Van Baardewijk, Andershed, Stegge, Nilsson, Scholte et al., 2010). The YPI is an 18 item self-report questionnaire measuring psychopathic traits. The questionnaire is divided into three subscales, which represent three domains of psychopathy: Interpersonal (YPI-I), Affective (YPI-II) and Behavioural (YPI-III). Each subscale contains six items, which are described as propositions whereupon participants can answer on a scale from 1 (‘Does not apply at all’) till 4 (‘Applies very well’). The total score is an indication of the degree of psychopathic traits, with a minimum total score of 18 and a maximum total score of 72. YPI-I is measured by measuring superficial charm, manipulation, lying and grandiosity. An example of a proposition is: “I am capable of misleading people by using my charm and my smile.” YPI-II is measured by measuring callousness, unemotionality and remorselessness. An example of a proposition is: “I don’t understand how people can be so moved by watching television or a movie that they cry.” YPI-III is measured by measuring
impulsivity, irresponsible behaviour and sensational seeking behaviour. An example of a proposition is: “I’ve probably skipped school or work more often than other people.”
Several studies have shown high convergent validity and high reliability. For the total score on the YPI, a Cronbach’s alpha of .85 has been found (Van Baardewijk et al., 2010; Colins & Andershed, 2016; Colins, Noom & Vanderplasschen, 2012; Orue & Andershed, 2015). In the current study, a Cronbach’s alpha of .82 has been found for the total score. Because the subscales are used as independent predictors in the current study, the internal consistencies are calculated: YPI-I, α = .80, YPI-II, α = .72, YPI-III, α = .74. Since the YPI is developed to measure psychopathic traits in adults, the YPI-scores of the current participants were compared with the most similar norm group ‘older adolescents’ from the age of 15 till 19 (n=377). A t-test showed the mean total score of the current participants is significant lower than the norm group, t = -2.56, p <.01. Further analyses revealed the current
participants did not differ from the norm group on YPI-II and YPI-III, but only significantly differed on YPI-I with the norm group, t (74) = -4.49, p <.01.
Antisocial behaviour
Reactive-Proactive Aggression Questionnaire
Aggression was measured with the Dutch version of the Reactive-Proactive Aggression Questionnaire (RPQ; Raine, Dodge, Gatze-Kopp, Lynam, Reynolds et al., 2010). This self-report questionnaire contains 23 items, which are described as propositions. Participants can answer with ‘never’, ‘sometimes’ or ‘often’. The questionnaire is divided into two subscales, which represent Proactive and Reactive aggression. A higher score indicates towards
relatively many aggressive traits, with a minimum score of 23 and a maximum score of 69. An example of a proposition from the Reactive aggression scale is: “How often have you become mad or angry when others were threatening you?” An example of a proposition from
the Proactive aggression scale is: “How often did you force someone to give you money or other things?”
Cross-sectional research, from five independent studies, has shown the RPQ has a good validity (Fossati, Raine, Boronni, Bizzozero, Volpo et al., 2009). Besides, research shows a good internal consistency for the Dutch version, a Cronbach’s alpha of .83 has been found for the total score (Cima, Raine, Meesters & Popma, 2013). In the current study, a Cronbach’s alpha of .93 has been found for the total score. The internal consistency of the subscales turned out to be high: Reactive, α = .90, Proactive, α = .87.
Criminal history
Criminal history was measured by investigating the judicial files of participants. On account of the privacy of clients, not every forensic organisation has access to all the judicial files. The files are present in case they are necessary for treatment or in case they are
requested by the organisation after permission of the client. In most cases in the current study, the number of verdicts was present in the judicial files (n=63). In other cases, (n=12) the number of verdicts was an estimate based on a combination of judicial files and self-reports of the participant.
Measurement in the Addictions for Triage and Evaluation
SUD was measured with the Dutch version of the Measurement in the Addictions for Triage and Evaluation (MATE). The MATE is a structured interview, investigating patient characteristics of addiction. In the current study, section 4 of the MATE was used to measure SUD (dependence of substances and abuse of substances) in the past 12 months according to the DSM-IV-criteria (APA, 2005). The COTAN (2009) rated the reliability of the MATE as insufficient, mainly due to a lack of scientific evidence. Research from clinical practices shows the MATE contributes to diagnostics and treatment (Schippers & Broekman, 2013). In
the current study, 62.7 per cent of the participants met the criteria for SUD (n=47) and 37.3 did not meet the criteria for a SUD (n=28).
Procedure
Clients were registered at Inforsa for an intake. After the intake the researcher approached, in agreement with the psychologist, the client and the researcher introduced herself as ‘researcher of Inforsa’. The researcher explained that Inforsa conducts research among clients to have a better understanding of the client population and therefore being able to treat them better. In case the client wanted to participate in the present study, the researcher explained the obtained information is used for scientific purposes and the improvement and development of treatments of Inforsa. After the informed consent (see Appendix D) was obtained, the researcher conducted the tests (MATE, RPQ and YPI) upon the participant in a fixed order.
Results
To examine the triangular relationship between psychopathy, substance use and antisocial behaviour, several analyses have been executed. Preliminary the degree of psychopathic traits in the current study was investigated. The minimum total score on psychopathic traits was 18 and the maximum total score was 57 (M = 30.92, SD = 8.59). For the ranges of scores on the domains of the YPI and the RPQ see Table 2. In accordance with the expectations, hypotheses 1a was significant: psychopathy positively predicted aggression, F(3,71) = 10.94, p <.001, R2 = .32 (see Table 3).
An explorative multiple regression analysis with a backward method was conducted, which revealed the model with predictors YPI-I and YPI-III as the strongest predictor for aggression, F(2,72) = 15.89, p<.001, R2 = .31. However, the model resulted in a decrease of
Another explorative analysis was conducted to examine the correlation (one-tailed) between psychopathy and proactive aggression and between psychopathy and reactive aggression. The correlations were significant for proactive aggression, r = .45, p <.001, and for reactive aggression, r = .57, p <.001 (see Table 4).
Table 2
Mean Scoring, Standard Deviations (Between Brackets) and Scoring Ranges on the YPI and the RPQ
YPI RPQ
YPI-I YPI-II YPI-III
9.48 (3.93) 9.21 (3.59) 12.23 (4) 38.83 (9.54)
Minimum score 6 6 6 23
Maximum score 21 19 23 69
Against expectations, hypothesis 1b was not significant: psychopathy did not predict criminal history (see Table 5 in Appendix C). Hypothesis 2 was, against expectations, not significant: psychopathy did not predict SUD (see Table 6 in Appendix C). As an exploration, the association between psychopathy and the dependence of substances and the abuse of substances was examined. It showed only YPI-III to have predictive values to the dependence of substances, b = .14, Wald (1) = 3.87, p <.05. The other predictors of psychopathy did not have a predictive value to the dependence of substances and to abuse of substances.
Against expectations there was no support for hypotheses 3a and 3b: there were no correlations between psychopathy and antisocial behaviour (see Table 7 in Appendix C).
Based on the above-mentioned non-significant results, the analyses for hypotheses 4 and 5 were not executed.
Table 3
The Three Dimensions of Psychopathy as Predictors of Aggression (Step 1) and Backwards Exploration (Step 2) B β t p Step 1 Step 2 Constant YPI-I YPI-II YPI-III Constant YPI-I YPI-III 19.96 .74 .29 .75 21.27 .80 .81 .31 .11 .32 .33 .34 5.65 2.83 1.01 2.92 6.47 3.16 3.25 <.001 <.01 .32 <.01 <.001 <.01 <.01 Note. R2 = .32 for Step 1, ∆ R2 = .31 for Step 2
Table 4
Exploration of the Correlations (One-Tailed) Between Psychopathy and Aggression (Proactive and Reactive)
YPI-I YPI-II YPI-III
Proactive Aggression Reactive Aggression YPI-I - YPI-II .32** - YPI-III .36** .32** - Proactive Aggression .45** .26* .29** - Reactive Aggression .4** .31** .54** .74** -
Discussion
The current study investigated the triangular relationship between psychopathy,
substance use and antisocial behaviour in a sample of clients with a forensic indication. Based on previous research a triangular relationship between the three elements was predicted for this population. Hypothesis 1a was supported: psychopathy positively predicts aggression, which is in accordance with previous research (Leisitico et al., 2008; Walsh et al., 2007). The current study indicates that the affective domain of psychopathic traits (callousness,
unemotionality, remorselessness) has no influence on predicting aggression. This is in accordance with the review article from Reidy, Shelley-Tremblay and Lilienfeld (2011), which indicated that not all the characteristics of psychopathy are related to various types of aggression. For instance, the study of Walsh, Swogger and Kosson (2009) only found links between interpersonal psychopathic traits and (proactive) aggression. The result that not all domains of psychopathy predict aggression is also a support for the finding from Bloningen et al. (2006), which indicated that distinctiveness in psychopathic traits are a result of distinct etiological processes.
However, no support was found for all remaining hypotheses. Regarding the debate about psychopathy and criminal behaviour (Hare & Neumann, 2010; Skeem & Cooke, 2010), the current study did not support the relation between psychopathy and criminal behaviour (Hypothesis 1b). Although this finding is in contradiction with previous research (Hare 1991; Hare, 2003; Walsh et al., 2006), scientists further indicate that criminal behaviour is a part of antisocial behaviour: ‘antisocial’ and ‘criminal’ cannot be simply divided (Krueger &
Markon, 2006; Marcus et al., 2006). Therefore, it is possible that the relationship between psychopathy and antisocial behaviour, in the current sample, is not resembled in criminal history but in aggression.
moderated by personality traits as impulsivity, sensation seeking and hostility (Lammers et al., 2014). Although these personality traits seem to resemble some of the criteria for the personality disorder for psychopathy (Hare, 2003), the current study found no indications for a relation between psychopathic traits and SUD (Hypothesis 2). However, explorations did reveal that the behavioural traits of psychopathy (impulsivity, thrill seeking and
irresponsibility), which are similar to the personality traits described by Lammers et al. (2014), conduce to the dependence of substances. The interpersonal and affective traits of psychopathy had no influence on SUD.
Previous research has shown substance use to be an important risk factor for criminal recidivism (Dowden & Brown, 2005). However, in the current study SUD had no effect on antisocial behaviour (i.e. aggression and criminal history) (Hypotheses 3a & 3b). The so-called comorbidity phenomenon from Krueger et al. (2002), regarding the comorbidity among mental disorders with a disinhibited personality style, antisocial behaviour and SUD, does not seem to apply among people with psychopathic traits. This might be in line with the view of Cleckley (1941) and Bloningen et al. (2006), indicating that psychopathic people are capable of masking their disorder and appear as well functioning individuals.
Due to a lack of support for the above-mentioned hypotheses, a SUD was not a partial explanation nor had a SUD influence on the relation between psychopathy and antisocial behaviour (Hypotheses 4 & 5).
Limitations
One of the first limitations is the psychopathy score, which was obtained with an instrument that has been developed to measure psychopathic traits in youth. As described in the measures section, participants in the current study scored lower on psychopathic traits compared to the norm group. Then again analyses revealed there was only a difference
affective and the behavioural domain. Therefore, the scores on the interpersonal domain should be interpreted with caution; scores on the affective and the behavioural domain can be interpreted reliably.
A second limitation is the fact that psychopathic traits were investigated, but participants were not diagnosed with a psychopathic personality disorder by the present criteria of psychopathy (see Appendix A). Therefore it is likely that some outcomes differ from research in which participants were diagnosed with psychopathy. However, research has shown that the YPI is a valid instrument to use in research about psychopathy (Van
Baardewijk et al., 2010). Future research could investigate psychopathic traits by using the original YPI that has more items compared to the short-version that has been used in the current study. As a consequence, distinctions can be made between participants with a low and a high degree of psychopathic traits and compare the two groups with each other. In case higher scores on psychopathic traits are obtained, the discrepancies between previous and current research might be dissolved and it might strengthen the preliminary results.
A third limitation of the current study is the use of self-report measurements. Since people with psychopathy are keen on manipulating and lying, it is questionable if they report in an honest manner. However, research has shown that there is no correlation between
response biases and psychopathy scores (Ray, Hall, Rivera-Hudson, Poythress, Lilienfeld e.a., 2013; Verschuere, Uzieblo, De Schryver, Douma, Onraedt e.a. 2014). Then again, not much is known about response biases on other (non psychopathic) self-report instruments (e.g. RPQ, MATE) among people with psychopathic traits. This could be a risk for the results on these measurements and they should therefore be interpreted with caution.
Implications
The preliminary results would implicate to be cautious with involving criminal history in measuring psychopathy. Regarding the treatment of people with psychopathy, the
preliminary results indicate that SUD does not require priority during treatment: there were no relations between psychopathy and SUD, and no relations between SUD and antisocial
behaviour (e.g. aggression and criminal history). Based on the preliminary findings,
psychopathic traits positively predict aggression: aggression might be considered to be a focus in treatment of people with psychopathy. Further research could incorporate aggression regulation therapy among people with a high degree of psychopathic traits to examine if the psychopathic traits decrease and if, consequently, a possible threat for society (e.g. criminal recidivism) is lowered.
Conclusion
The current study proposed a triangular relationship between psychopathy, substance use and antisocial behaviour. The possibility of a relationship was based on previous research. However, the preliminary results revealed that the three elements are not indissolubly
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Appendix A. Overview of the criteria of psychopathy and the modifications through time.
Item Trait 2 Factor Model
(Hare, 1991) 3 Factor Model (Cooke & Michie, 2001) 4 Factor Model (Hare, 2003)
1 Glib and superficial charm F1 F1 F1
2 Grandiose self-worth F1 F1 F1
3 Seek of stimulation or Prone to boredom F2 F3 F3 4 Pathological lying F1 F1 F1 5 Conning and Manipulativeness F1 F1 F1
6 Lack of remorse or guilt F1 F2 F2
7 Shallow affect F1 F2 F2
8 Callousness and Lack of empathy
F1 F2 F2
9 Parasitic lifestyle F2 F3 F3
10 Poor behavioural control F2 X F4
11 Promiscuous sexual behaviour
X X X
12 Early behaviour problems F2 X F4
13 Lack of realistic, long-term goals
F2 F3 F3
14 Impulsivity F2 F3 F3
responsibility for own actions
17 Many short-term marital relationships X X X 18 Juvenile delinquency F2 X F4 19 Revocation of condition release F2 X F4 20 Criminal versatility X X F4
Appendix B. Figures.
Figure 1. Hypotheses 1a and 1b (H1), hypothesis 2 (H2) and hypotheses 3a and 3b (H3).
Figure 2. Hypotheses 4a and 4b (H4).
Appendix C. Tables. Table 1
Demographic Characteristics of the Participants
Characteristic Frequency (n) % Gender Female 4 5.3 Male 71 Age 20 – 29 11 14.7 30 – 39 32 42.7 40 – 49 18 24 50 – 59 13 17.3 ≥ 60 1 1.7 Native country The Netherlands 39 52 Surinam 10 13.3 Morocco 9 12 Turkey 5 6.7 Curacao 3 4 Yugoslavia 2 2.7 India 1 1.3 Eritrea 1 1.3 Romania 1 1.3 Spain 1 1.3 Germany 1 1.3 Iran 1 1.3 Libia 1 1.3
Table 5
The Three Dimensions of Psychopathy as Predictors of Criminal History
B β t p Constant YPI-I YPI-II YPI-III 13.67 -.38 .06 -.05 .30 .32 .29 3.44 -1.29 .20 .17 <.001 .20 .85 .87 Table 6
The Three Dimensions of Psychopathy as Predictors of Substance Use Disorder
B β t p Constant YPI-I YPI-II YPI-III 1.74 -.08 -.06 .18 .08 .08 .08 1.66 -1.02 -.67 2.44 .10 .31 .50 .02 Table 7
Correlations (One-Tailed) Between Substance Use Disorder and Aggression and Between Substance Use Disorder and Criminal History
Substance Use Disorder
Substance Use Disorder -
Aggression .15
Appendix D. Informed Consent Dutch Version.
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