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Authors: Kent A. Phd Kiehl
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17. Many Short-Term Marital Relationships
18. Juvenile Delinquency
19. Revocation of Conditional Release
20. Criminal Versatility
----
Psychopathy and the Diagnostic and Statistical Manual (DSM) of Mental Disorders
While almost everyone recognized the importance of the affective traits Cleckley and Hare articulated, some psychiatrists had doubts about average clinicians’ abilities to reliably detect affective criteria, such as lack of empathy, guilt, or remorse.
One common mistake that leads to overrating some of the affective items, such as
Lack of Empathy
, is to focus on a single bad thing that the person did, such as the index crime the individual committed that prompted his or her assessment and scoring. For example, if an individual commits a sex offense against a child, many trainees in the room will raise their hands when asked if this behavior merits a high score on
Lack of Empathy
. But they are wrong. 24 The sex offense is only one piece of evidence suggesting impairment in empathy. To score high on
Lack of Empathy
, an individual must have evidence of the trait from multiple life domains and for the majority of his or her life—echoing Koch’s seminal contribution to the assessment of personality (disordered) traits. So the individual who committed a sex offense against a child may very well deserve a high score on
Lack of Empathy
but if they do, it will be because the person has demonstrated impaired empathy for a long time in other areas of his or her life as well—the single offense alone does not automatically warrant the high score.
One trick we teach clinicians when rating items on the Psychopathy Checklist is to ignore the index offense—the offense for which a client is convicted or incarcerated. The individual should get the same psychopathy item scores regardless of the crime that leads to his or her imprisonment. This avoids the common issue whereone monstrous deed leads raters to score the individual high on all traits.
Without proper training, the average clinician will likely have trouble producing valid ratings of psychopathy. The simple fix to this problem is that clinicians who need to perform psychopathy assessments as part of their practices or jobs should participate in a special professional training session. This is one of the reasons why continuing education is a required part of being licensed for any practitioner in psychology or psychiatry.
However, it was this tension—between those who did and did not think the affective traits could be reliably diagnosed—that drove the swinging pendulum of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM)
classification of psychopathy over successive iterations.
The
DSM
is the “bible” of mental illnesses in the United States. It provides a template for how clinicians assess and classify patients into various categories of mental illness. Determining a patient’s diagnosis is usually the first step toward determining the best course of treatment. However, defining
mental illness
is a complicated process, and I always teach my students that they need to go beyond the
DSM
. That is, the
DSM
is a good starting point, but if you really want to be on the cutting edge of the science of mental illness or developing new treatments, you must educate yourself about the strengths and weaknesses of any psychiatric diagnosis. Moreover, the
DSM
is an evolving document that is shaped by science, economics, and politics (not necessarily in that order). Thus, it is incumbent upon researchers that they understand the history of the mental illness they are studying and learn how the illness has been assessed in previous iterations of the
DSM
.
There was widespread dissatisfaction 25 , 26 with early versions of the
DSM
treatment of antisocial personality disorder/psychopathy. This led the American Psychiatric Association to conduct field studies in an effort to improve the coverage of the
17. Many Short-Term Marital Relationships
18. Juvenile Delinquency
19. Revocation of Conditional Release
20. Criminal Versatility
----
Psychopathy and the Diagnostic and Statistical Manual (DSM) of Mental Disorders
While almost everyone recognized the importance of the affective traits Cleckley and Hare articulated, some psychiatrists had doubts about average clinicians’ abilities to reliably detect affective criteria, such as lack of empathy, guilt, or remorse.
One common mistake that leads to overrating some of the affective items, such as
Lack of Empathy
, is to focus on a single bad thing that the person did, such as the index crime the individual committed that prompted his or her assessment and scoring. For example, if an individual commits a sex offense against a child, many trainees in the room will raise their hands when asked if this behavior merits a high score on
Lack of Empathy
. But they are wrong. 24 The sex offense is only one piece of evidence suggesting impairment in empathy. To score high on
Lack of Empathy
, an individual must have evidence of the trait from multiple life domains and for the majority of his or her life—echoing Koch’s seminal contribution to the assessment of personality (disordered) traits. So the individual who committed a sex offense against a child may very well deserve a high score on
Lack of Empathy
but if they do, it will be because the person has demonstrated impaired empathy for a long time in other areas of his or her life as well—the single offense alone does not automatically warrant the high score.
One trick we teach clinicians when rating items on the Psychopathy Checklist is to ignore the index offense—the offense for which a client is convicted or incarcerated. The individual should get the same psychopathy item scores regardless of the crime that leads to his or her imprisonment. This avoids the common issue whereone monstrous deed leads raters to score the individual high on all traits.
Without proper training, the average clinician will likely have trouble producing valid ratings of psychopathy. The simple fix to this problem is that clinicians who need to perform psychopathy assessments as part of their practices or jobs should participate in a special professional training session. This is one of the reasons why continuing education is a required part of being licensed for any practitioner in psychology or psychiatry.
However, it was this tension—between those who did and did not think the affective traits could be reliably diagnosed—that drove the swinging pendulum of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM)
classification of psychopathy over successive iterations.
The
DSM
is the “bible” of mental illnesses in the United States. It provides a template for how clinicians assess and classify patients into various categories of mental illness. Determining a patient’s diagnosis is usually the first step toward determining the best course of treatment. However, defining
mental illness
is a complicated process, and I always teach my students that they need to go beyond the
DSM
. That is, the
DSM
is a good starting point, but if you really want to be on the cutting edge of the science of mental illness or developing new treatments, you must educate yourself about the strengths and weaknesses of any psychiatric diagnosis. Moreover, the
DSM
is an evolving document that is shaped by science, economics, and politics (not necessarily in that order). Thus, it is incumbent upon researchers that they understand the history of the mental illness they are studying and learn how the illness has been assessed in previous iterations of the
DSM
.
There was widespread dissatisfaction 25 , 26 with early versions of the
DSM
treatment of antisocial personality disorder/psychopathy. This led the American Psychiatric Association to conduct field studies in an effort to improve the coverage of the
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