Moral responsibility in psychopathy: A clinicophilosophical case discussion

This article examines the concept of moral responsibility in psychopathy. In doing so it shows how philosophical ideas can be used to help approach a complex issue in psychiatry. Building on a fictitious case, we explore two arguments: the exempting view, which proposes that psychopaths lack any ability to function as moral agents; and the mitigating view, which concedes that there are impairments in moral understanding in psychopathy, but takes these to be insufficient to be completely exempting, instead concluding that such individuals are at least partially morally responsible. Typically, clinicians (and the courts) are more comfortable with a mitigating view, whereas philosophers tend to extol an exempting view. Through discussion of the case, we illustrate the value that philosophy brings to clinical psychiatry and the ways in which psychiatry can enrich philosophical debate. Learning Objectives • Appreciate the diversity of views about moral responsibility in psychopathy, ranging from mitigation to exemption • Understand the philosophical arguments used to support both the mitigating and exempting views • Consider the benefits of philosophical reasoning in explicating a complex problem in psychiatr

Structural, item, and test generalizability of the psychopathology checklist - revised to offenders with intellectual disabilities

The Psychopathy Checklist–Revised (PCL-R) is the most widely used measure of psychopathy in forensic clinical practice, but the generalizability of the measure to offenders with intellectual disabilities (ID) has not been clearly established. This study examined the structural equivalence and scalar equivalence of the PCL-R in a sample of 185 male offenders with ID in forensic mental health settings, as compared with a sample of 1,212 male prisoners without ID. Three models of the PCL-R’s factor structure were evaluated with confirmatory factor analysis. The 3-factor hierarchical model of psychopathy was found to be a good fit to the ID PCL-R data, whereas neither the 4-factor model nor the traditional 2-factor model fitted. There were no cross-group differences in the factor structure, providing evidence of structural equivalence. However, item response theory analyses indicated metric differences in the ratings of psychopathy symptoms between the ID group and the comparison prisoner group. This finding has potential implications for the interpretation of PCL-R scores obtained with people with ID in forensic psychiatric settings

Callous-unemotional traits and anxiety in a community sample of 7-year-olds

In forensic samples of adults and adolescents, there is evidence to suggest that there may be distinct variants of psychopathy marked by the presence/absence of significant levels of anxiety. Callous-unemotional (CU) traits can be used to characterize children who share behavioural and neurocognitive features with adult psychopaths. The aims of this paper are to (a) investigate the genetic and environmental influences on CU traits with/without anxiety and (b) explore differences in terms of concurrent and early parenting and adjustment. Discrete groups were formed on the basis of scores in the top 10% of the sample on CU and anxiety scales at age 7. Estimates of group heritability were calculated using a Defries-Fulker (DF) extremes regression model. Follow back analyses of early parenting and adjustment were conducted using multivariate analyses of covariance. There was high group heritability for CU traits with/without anxiety. Children with both high CU and anxiety showed greater levels of adjustment problems than those with CU only at age 7. The two groups did not differ in parenting characteristics. In this general population sample, evidence did not support differences in etiology for the two groups high on CU traits differing in level of anxiety