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Development and validation of a new scale for the assessment of psychopathy Hart, Stephen D. 1992

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DEVELOPMENT AND VALIDATION OF A NEW SCALEFOR THE ASSESSMENT OF PSYCHOPATHYbySTEPHEN DAVID HARTB.A., The University of British Columbia, 1984M.A., The University of British Columbia, 1987A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFDOCTOR OF PHILOSOPHYinTHE FACULTY OF GRADUATE STUDIES(Department of Psychology)We accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIANovember 1992© Stephen David Hart, 1992In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of ^PsychologyThe University of British ColumbiaVancouver, CanadaDateDE-6 (2/88)ABSTRACTA review of the construct of psychopathy suggested that procedures for assessing the disordershould take into account its two-facet structure, its chronicity, its association with criminality, andits association with deceitfulness. A review of the five most popular assessment procedurescurrently in use indicated that none of them was completely satisfactory; the Hare PsychopathyChecklist-Revised (PCL-R) appeared to be superior to the other measures in most respects, but itwas not well-suited for use outside of forensic settings. It was therefore decided to develop anew scale, based on the PCL-R, that would be suitable for both forensic and nonforensic settings.Pilot testing resulted in a 12-item symptom construct rating scale, named the PsychopathyChecklist: Screening Version (PCL:SV). The PCL:SV was validated in 11 samples (N = 586)from forensic/nonpsychiatric, forensic/psychiatric, civil/psychiatric, and civil/nonpsychiatricsettings. Results indicated that the PCL:SV had good internal consistency, interrater reliability,and temporal stability. The scale also appeared to have a two-factor structure, at least in sampleswith an appreciable base rate of psychopathy. The PCL:SV was highly correlated with otherpsychopathy-related measures, including the PCL-R, antisocial personality disorder symptomcounts, and several self-report scales. It also had a pattern of convergent and discriminantvalidities that was consistent with both theory and previous research that used the PCL-R. It wasconcluded that the PCL:SV holds considerable promise as a measure of psychopathy; areasrequiring further research were identified.iiTABLE OF CONTENTSABSTRACT^ iiLIST OF TABLES^ vACKNOWLEDGMENTS^ viiPREFACE^ viiiCHAPTER 1: INTRODUCTION^ 1A. Assessment Issues: The Nature of the Construct ^ 21. Two-Facet Structure^ 22. Chronicity^ 43. Association with Criminality^ 54. Association with Deceitfulness 6B. Evaluation of Existing Procedures^ 71. DSM-III-R Criteria for Antisocial Personality Disorder (APD)^ 82. Hare Psychopathy Checklist-Revised (PCL-R)^ 163. Minnesota Multiphasic Personality Inventory (MMPI-2)^ 224. California Psychological Inventory (CPI)^ 275. Millon Clinical Multiaxial Inventory (MCMI-II) 31C. Summary of Chapter 1 ^ 35CHAPTER 2: SCALE DEVELOPMENT AND VALIDATION^ 36A. Development of the PCL:SV^ 361. First Draft: The Clinical Version of the PCL-R (CV)^ 372. Final Draft: The Psychopathy Checklist: Screening Version (PCL:SV)^ 41iiiB. Validation of the PCL:SV^ 431. Overview^ 432. Samples 443. Procedure^ 464. Results 48C. Summary of Chapter 2^ 82CHAPTER 3: DISCUSSION^ 83A. Implications for Clinical Practice^ 831. The PCL:SV as a Measure of Psychopathic Traits^ 832. The PCL:SV as a Screening Test^ 843. Psychopathy in Future DSMs 85B. Implications for Research^ 851. Norms^ 852. Large Samples^ 863. Test-retest Reliability 864. Predictive Validity^  865. Laboratory Studies 876. Psychopathy and the Big 5^ 87C. Conclusion^ 89REFERENCES^ 90APPENDIXES^ 101A. PCL:SV Administration and Scoring Details^  101B. Supplementary Tables^  108ivLIST OF TABLESCHAPTER 11: The DSM-III-R Criteria for Antisocial Personality Disorder^ 92: Items in the PCL-R^ 17CHAPTER 23: Items in the PCL:SV^ 424: Demographic Characteristics of Subjects^ 475: Descriptive Statistics for PCL:SV Total, Part 1, and Part 2 Scores^ 496: Mean Weighted Interrater Reliabilities and Corrected Item-Total Correlationsfor the PCL:SV Items in the 11 Samples^ 517: Internal Consistency (Chronbach's Alpha) of PCL:SV Total, Part 1, andPart 2 Scores^ 528: Item Homogeneity (Mean Inter-Item Correlation) of PCL:SV Total, Part 1,and Part 2 Scores^ 539: Interrater Reliability (ICC) of PCL:SV Total, Part 1, and Part 2 Scores^ 5510: Correlation Between PCL:SV Part 1 and Part 2 Scores in the 11 Samples^ 5711: Coefficients of Congruence Between Factor Loadings for the Oblique,Two-Factor Solution Across the 11 Samples^ 5812: Coefficients of Congruence Between Factor Loadings for the Oblique,Two-Factor Solution in 7 Samples with Appreciable Base Rates of Psychopathy^ 6013: Concurrent Validity: Correlations With PCL-R Total and Factor Scores^ 6214: Concurrent Validity: Correlations With APD Adult Symptoms^ 6415: Concurrent Validity: Correlations With Self-Report Measures of Psychopathy/APD 6516: Convergent Validity: Correlations With PDE Ratings in Sample 6^ 6817: Convergent Validity: Correlations With MCMI-II Personality Disorder Scalesin Sample 3^ 6918: Convergent Validity: Correlations With IAS-R B5 Domain Self-Ratings in Sample 6 ^ 7219: Convergent Validity: Correlations With IAS-R B5 Octant Self-Ratings in Sample 6 ^ 7320: Convergent Validity: Correlations With IASR-B5 Domain Observer Ratings inStudents and Inmates^ 7521: Convergent Validity: Correlations With IAS-R B5 Octant Observer Ratings inStudents and Inmates^ 7622: Convergent Validity: Correlations With Measures of Alcohol and Drug Abuse^ 7823: Discriminant Validity: Correlations With Self-Reported Depression (BeckDepression Inventory) and Anxiety (State-Trait Anxiety Inventory) at theTime of Assessment^ 8024: Discriminant Validity: Correlations With Age, Sex, and Race^ 81APPENDIXESB-1: Interrater Reliability (r) of PCL:SV Items in 7 Samples^  108B-2: Corrected Item-Total Correlations for PCL:SV Total Scores in the 11 Samples^ 109B-3: Corrected Item-Total Correlations for PCL:SV Parts 1 and 2 Scores in the11 Samples^  110B-4: Loadings for Oblique, 2-Factor Solution in Samples 1 to 4^  111B-5: Loadings for Oblique, 2-Factor Solution in Samples 5 to 8  112B-6: Loadings for Oblique, 2-Factor Solution in Samples 9 to 11^  113viACKNOWLEDGEMENTSI would like to thank David Cox, David Crockett, Don Dutton, and Ron Roesch for theirsupport and encouragement of my graduate training, and to Lynn Alden, David Crockett, DimitriPapageorgis, and Jerry Wiggins for their help in guiding my Master's and Doctoral research.Special thanks also to Addle Forth, my dear friend and valued colleague over the past ten years.Finally, and most importantly, my deepest thanks go to Robert Hare, whose guidance,loyalty, and companionship I have come to value so highly. Any scholarly virtues evident in thiswork are due entirely to Bob's influence; any flaws, due to the fact that I still have much to learnfrom him.I dedicate this thesis to Tammy and Kenzie.viiPREFACEIn accordance with University guidelines, I would like to clarify the roles played by othersin the research described herein.All my research has been conducted under the supervision of Dr. Robert Hare. Many ofthe ideas were developed in collaboration with Drs. Hare and David Cox, Department ofPsychology, Simon Fraser University. However, I must bear sole responsibility for the analysesand comments in this thesis.There is no way that I could have collected the data without financial and logisticalsupport. Financial support came in the form of a grant to Dr. Hare from the John D. andCatherine T. MacArthur Foundation's Research Network on Mental Health and the Law, underthe direction of Dr. John Monahan, School of Law, University of Virginia. I wish to express mygratitude to Dr. Monahan and the MacArthur Foundation for this support. Logistical supportcame primarily from Dr. Adelle Forth, Department of Psychology, Carleton University, who waslargely responsible for administering the MacArthur Foundation grant on behalf of Dr. Hare. Asrequired by the granting agency, we submitted a brief report on the development and validation ofthe PCL:SV to Dr. Monahan upon completion of the research; this report will soon be publishedby the University of Chicago Press as a chapter in an edited volume (Hart, Hare, & Forth, inpress).A number of people administered the PCL:SV as part of independent research projects,and kindly allowed me access to their data. Specifically, I would like to thank Dr. HenrySteadman and Ms. Pamela Clark Robbins of Policy Research Associates, Delmar, NY, for accessto the MacArthur Risk Study data; Ms. Catherine Strachan, Department of Psychology,University of British Columbia, for access to her doctoral research data; and Ms. Shelley Brown,Department of Psychology, Carleton University, for access to her undergraduate honor's thesisdata. Ms. Brown presented some preliminary analyses of the PCL:SV data for university studentsat the Annual Meeting of the Canadian Psychological Association (Brown, Forth, Hart, & Hare,1992).While the data for this project were still being collected, we pilot-tested a procedure forhaving naive observers make ratings of normal personality. The results of this pilot test, whichare described in Chapter 2, were also submitted to a peer-reviewed journal. The paper has sincebeen accepted for publication, and is referred to below as "in press" (Hart & Hare, in press).I apologize in advance for quoting Eliot out of context.viiiWe are the hollow menWe are the stuffed menLeaning togetherHeadpiece filled with straw. Alas!Our dried voices, whenWe whisper togetherAre quiet and meaninglessAs wind in dry grassOr rats' feet over broken glassIn our dry cellarShape without form, shade without colour,Paralysed force, gesture without motion;Those who have crossedWith direct eyes, to death's other KingdomRemember us--if at all--not as lostViolent souls, but onlyAs the hollow menThe stuffed men...from T.S. Eliot, The Hollow Men (1925)ixCHAPTER 1: INTRODUCTIONObservers of human behavior have long argued that people can be classified into "types"on the basis of their personality (Tyrer & Ferguson, 1988). In modern clinical psychology andpsychiatry, we refer to abnormal types as personality disorders: characteristic ways of perceivingand relating to the world that result in social dysfunction or disability (e.g., American PsychiatricAssociation, 1987; Millon, 1981).Psychopathy, or psychopathic personality disorder, can be differentiated from otherpersonality disorders on the basis of its characteristic pattern of interpersonal, affective, andbehavioral symptoms (e.g., Cleckley, 1976; Hare, 1991; McCord & McCord, 1964).Interpersonally, psychopaths are grandiose, egocentric, manipulative, dominant, forceful, andcold-hearted. Affectively, they display shallow and labile emotions, are unable to form long-lasting bonds to people, principles, or goals, and are lacking in empathy, anxiety, and genuineguilt or remorse. Behaviorally, psychopaths are impulsive and sensation-seeking, and tend toviolate social norms; the most obvious expressions of these predispositions involve criminality,substance abuse, and a failure to fulfill social obligations and responsibilities.The assessment of psychopathic personality disorder has been a topic of growing interestover the past decade. There are probably two main reasons for this. The first is the success ofdiagnostic criteria for psychopathy--specifically, the Psychopathy Checklist (PCL; Hare, 1980)and its recent revision (PCL-R; Hare, 1991). There is now a considerable literature attesting tothe reliability and validity of PCL and PCL-R in forensic settings; of particular importance is theirpredictive validity with respect to criminal behavior (for reviews, see Hare, 1991; Hare, Forth, &Strachan, 1992; Hare & Hart, 1993).The second reason for the growing interest in psychopathy is disappointment with thediagnostic criteria for antisocial personality disorder (APD) contained in the third edition of theAmerican Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) and its recent revision (DSM-III-R; AmericanPsychiatric Association, 1987). The APD criteria consist largely of a list of overt delinquent andcriminal behaviors, and they have been severely criticized for their neglect of interpersonal and1affective symptoms historically associated with the construct of psychopathy, such assuperficiality, grandiosity, callousness, manipulativeness, lack of remorse, and so forth (e.g., Hare,1983; Hare, Hart, & Harpur, 1991; Millon, 1981; Rogers & Dion, 1992; Widiger & Corbett, inpress). Interestingly, the American Psychiatric Association made a token attempt to include suchsymptoms in the criteria for APD in the DSM-III-R, and has just completed field trials inanticipation of DSM-IV that may result in a radical swing back towards the traditional constructof psychopathy (Widiger et al., 1992).This dissertation reports the results of an effort to develop and validate a new, PCL-basedscale for the assessment of psychopathy. To demonstrate the need for such a scale, in theremainder of this Chapter, I will identify some crucial theoretical issues in the assessment ofpsychopathy and review existing assessment procedures.A. Assessment Issues: The Nature of the ConstructIt is quite easy to construct a test or measure and establish that it is more or less reliable(e.g., is internally consistent) and has reasonable criterion-related validity (e.g., is moderatelycorrelated with other measures of the same construct); it is quite another matter to more fullyevaluate its construct-related validity. One reason that establishing construct-related validity is sodifficult is that it requires a reasonably thorough understanding of the construct being measured(e.g., American Psychological Association, 1985). Thus, any discussion or evaluation ofprocedures for assessing psychopathy must be guided by theory and research concerning thenature of the disorder. In this section, I will make four fundamental assertions concerningpsychopathy and discuss their implications for assessment.1. Two-Facet StructureMy first assertion is that two oblique dimensions are both necessary and reasonablysufficient to provide a comprehensive description of psychopathic symptomatology. The evidencesupporting this assertion comes from two sources: first, clinical and empirical studies identifyingthe key symptoms of psychopathy; and second, research indicating that these key symptoms formtwo natural clusters. The major clinical description of the psychopath is found in Cleckley'sclassic text, The Mask of Sanity (1976). He described sixteen characteristics of the disorder:2superficial charm and good intelligence; absence of delusions and other signs of irrationalthinking; absence of nervousness or psychoneurotic manifestations; unreliability; untruthfulness orinsincerity; lack of remorse or shame; inadequately motivated antisocial behavior; poor judgmentand failure to learn from experience; pathological egocentricity and incapacity for love; generalpoverty in major affective relations; specific loss of insight; unresponsiveness in generalinterpersonal relations; fantastic and uninviting behavior with drink (and sometimes without);suicide rarely carried out; sex life impersonal, trivial, and poorly integrated; and failure to followany life plan. (Note that this list includes characteristics that in the DSM-III (-R) would beconsidered symptomatic of antisocial, narcissistic, histrionic, and borderline personality disorder.)Other clinicians (before and after Cleckley) have described longer or shorter lists ofcharacteristics, yet their conceptualization of the disorder is remarkably similar (e.g., Buss, 1961;Craft, 1965; Karpman, 1961; McCord & McCord, 1964; Millon, 1981). Reviews and contentanalyses of the empirical literature (e.g., Albert, Brigante, & Chase, 1959; Fotheringham, 1957)and surveys of mental health and criminal justice professionals (e.g., Davies & Feldman, 1981;Gray & Hutchinson, 1964; Livesley, 1986; Tennent, Tennent, Prins, & Bedford, 1990) suggestthat researchers and practicing clinicians are in close agreement with Cleckley.Several studies indicate that when a reasonably comprehensive set of psychopathicsymptoms is factor-analyzed, the resulting structure yields two correlated factors. For example,Harpur, Hakstian, and Hare (1988) factor analyzed the 22 items of the PCL. These items wereheavily influenced by Cleckley's list of 16 features (Hare, 1980). Harpur et al. attempted toidentify a factor structure underlying the items that was stable across samples, sites, andinvestigators. They had PCL ratings from six samples, with a total N of 1,119. For each sample,they extracted between 2 and 8 factors, and then subjected the factors to a variety of orthogonaland oblique rotations. The stability of various solutions both within and across samples wasdetermined using split-half cross-validation and congruence. The results strongly supported anoblique, two-factor solution. Factor 1, labeled the "selfish, callous and remorseless use ofothers," comprised items tapping egocentricity, superficiality, deceitfulness, callousness, and alack of remorse, empathy, and anxiety--all features that the APD criteria have been criticized for3neglecting. On the other hand, Factor 2, labeled a "chronically unstable and antisocial lifestyle,"or "social deviance," comprised items tapping impulsivity, sensation-seeking, irresponsibility,aggressiveness, and criminality. The two factors were correlated about r = .50. An identicalfactor structure has been reported for the 20 items of the PCL-R (Hare et al., 1991). The twofactors are differentially correlated with important external variables, such as violence, substanceuse, and interpersonal style (Harpur, Hare, & Hakstian, 1989; Hare, 1991). In another study,Livesley, Jackson, and Schroeder (1989, 1992) developed self-report scales to measure symptomsof personality disorder (identified via literature review, so as not to limit the domain of traits tothose found in DSM-III-R). They conducted factor analyses of the scales in both patient andnonpatient samples. With respect to the prototypical psychopathy/APD symptoms, Livesley et al.found a two-factor structure isomorphic to that reported by Hare and colleagues; they labeled thefactors "interpersonal disesteem" and "conduct problems." Finally, Harpur, Hare, Zimmerman, &Coryell (1990) conducted a factor analysis of DSM-III Cluster 2 (Dramatic-Erratic-Emotional)personality disorder symptoms in a large sample of community residents (relatives of psychiatricpatients and a control group, consisting of relatives of nonpatients). All subjects were assessedusing the Structured Interview for DSM-III Personality (Stangl, Pfohl, Zimmerman, Bowers, &Corenthal, 1985), a reliable and well-validated instrument. Several factors emerged, includingtwo that comprised symptoms of antisocial and narcissistic personality disorder and wereisomorphic to the PCL factors.In sum, considerable research suggests that the construct of psychopathy has anunderlying structure consisting of two correlated factors. A corollary of this first assertion is thatany procedure designed to measure psychopathy should assess both facets of the disorder.2. ChronicityThe second assertion is that psychopathy is a chronic disorder. There is researchindicating that the disorder is first evident in early childhood and persists into adulthood (e.g.,Livesley and Schroeder (1991) have also identified these same two factors in a study of thefactorial structure of the existing DSM-III-R APD symptoms.4Hare, McPherson, & Forth, 1988; Robins, 1966). Indeed, these characteristics are necessarysymptoms in the DSM-III (-R) criteria for APD criteria and contributory symptoms in the PCLcriteria for psychopathy; they were also seen as highly prototypical of the disorder in the reviewsand surveys described above. Further evidence of chronicity comes from studies indicating thateven treatment does little to alter the behavior of criminal psychopaths (Harris, Rice, & Cormier,1991; Ogloff, Wong, & Greenwood, 1991; Rice, Harris, & Cormier, 1992). 2 There may be adecrease in the frequency of some type of overt antisocial behavior in psychopaths after age 45 orso, particularly property offending (Hare, McPherson, & Forth, 1988); however, there is noevidence that this "burnout" phenomenon (as it is sometimes misleadingly referred to)encompasses a wide range of behavioral symptoms, and no evidence at all that it extends tointerpersonal or affective symptoms.One corollary of the assertion that psychopathy is a chronic disorder is that assessmentprocedures for psychopathy should have high test-retest reliability, at least over relatively briefperiods of time. A second is that measurement procedures should be relatively immune to theeffects of state variables, such as mood at the time of assessment.3. Association with CriminalityMy third assertion is that psychopathy and criminality are distinct but related constructs.(If they are not next-door neighbors, at least they reside on the same conceptual block.) As Harehas remarked, given the characteristics of psychopathy (callousness, remorselessness, impulsivity,and so forth), there is every reason to expect that psychopaths are particularly likely to engage incriminal behavior (Hare & Hart, 1993). This statement should not be interpreted to mean that allpsychopaths are criminals (i.e., have official criminal records) or that all criminals arepsychopaths; if this was the case, the construct of psychopathy loses its distinctiveness. Rather,we should expect offender populations to have a high base rate of psychopathy relative to otherpopulations, such as community residents or civil psychiatric patients. In addition, within any2 In fact, the study by Rice et al. (1992) suggests that treatment may even increase the likelihoodof recidivism in psychopaths.5particular population, psychopaths should be at an increased risk for antisocial behavior (e.g.,Hart, Kropp, & Hare, 1988). Two main lines of evidence support this assertion. First, thesurveys and reviews cited earlier indicate that repeated antisocial behavior is considered to be ahighly prototypical symptom of psychopathy, and indeed is included in the DSM-III (-R) and PCL(-R) criteria. Second, considerable research indicates that psychopathic criminals have a higherdensity of offending than do nonpsychopaths, even when controlling for previous criminalbehavior to avoid circularity in prediction (see reviews cited earlier).To reiterate, psychopathy is related to, but distinct from, criminality. The most importantcorollary of this assertion is that procedures for the assessment of psychopathy should havesignificant predictive and/or convergent validity vis-a-vis measures of criminality. A second isthat assessment procedures should be suitable for use in both forensic and nonforensic settings.4. Association with DeceitfulnessThe fourth and final assertion is that deceitfulness--lying, deception, and manipulation--isclosely associated with psychopathy. As was the case with criminality, deceitfulness is consideredto be a prototypical symptom of psychopathy and is included in most diagnostic criteria for thedisorder. There is also some empirical evidence that psychopaths are more likely thannonpsychopaths to engage in dissimulation, at least in certain contexts (e.g., Kropp, 1992; Hart,Dutton, & Newlove, 1992). The major corollary of this assertion is that assessment proceduresfor psychopathy should directly assess deceitfulness; a second is that assessment procedures mustcontrol for deceitfulness, as this symptom may interfere with the assessment of other features ofthe disorder.6B. Evaluation of Existing ProceduresIn this section, I will review and critically evaluate the major procedures for assessingpsychopathy. In order to identify those procedures, I conducted a computer search of articlesindexed in Psychological Abstracts between 1980 and 1992, using "antisocial personality" as thekeyword. The result was a list of 442 abstracts. The elimination of dissertations, non-Englishpublications, and non-empirical studies (case histories, reviews, theoretical papers, letters, and soforth) from this list left a total of 183 abstracts. Next, I went through the remaining abstracts andattempted to group them according to the assessment procedure(s) they used. I was able to makeconcrete determinations concerning 113 (61.7%) of the abstracts; the others did not containinformation specific enough to permit their classification.' Among the classifiable abstracts, themost common assessment methods still in use were as follows: the DSM-III or DSM-III-Rcriteria for antisocial personality disorder, cited in 38 abstracts; the PCL or PCL-R criteria forpsychopathy, 30 abstracts; the Psychopathic Deviate (Pd) scale from the Minnesota MultiphasicPersonality Inventory (MMPI; Hathaway & McKinley, 1940) and its recent revision (MMPI-2;Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 17 abstracts; and the Socialization(So) scale from the original and revised California Psychological Inventory (CPI; Gough, 1957,1987), 5 abstracts.Two procedures used with some degree of frequency were excluded from this review:medico-legal status according to the Mental Health Act of England and Wales, 6 abstracts(excluded as this does not constitute a psychiatric diagnosis in the usual sense of the word); andthe Research Diagnostic Criteria (Spitzer, Endicott, & Robins, 1978) and Feighner criteria(Feighner et al., 1972), 12 abstracts (excluded as they have been superseded by the DSM-III andDSM-III-R).Procedures used in fewer than five studies were excluded from this review, with oneimportant exception: the Antisocial scale (6A) of the revised Millon Clinical Multiaxial Inventory,3 Probably 25% to 50% of these studies used the DSM-III or DSM-III-R criteria for APD,judging from their authorship and/or date of publication.7or MCMI-II (Millon, 1987). This inventory was cited in only one abstract that contained thekeyword antisocial personality; however, it is currently among the most commonly-used adultassessment devices in clinical practice, and it is also the focus of considerable research in the lastfew years looking at personality disorders in general, including antisocial personality.In sum, the assessment procedures selected for review included two "clinical-behavioral"measures (the DSM-III-R criteria for APD and the PCL-R criteria for psychopathy) and threeself-report measures (the MMPUMMPI-2 Pd scale; the CPI So scale; and the MCMI-II 6A scale).When discussing format, reliability, and norms, I will focus on the most recent version of eachprocedure. 4 When discussing validity, however, I will also review studies that used earlierversions, as empirical evidence suggests that the most recent and earlier versions of eachprocedure are highly correlated (Butcher et al., 1989; Gough, 1987; Hare, 1991; Millon, 1987;Morey, 1988b).1. DSM-III-R Criteria for Antisocial Personality Disorder (APD)Format. The DSM-III-R criteria for APD are fixed and explicit psychiatric diagnosticcriteria. There are four criteria, two of which contain multiple subcriteria: (1) current age at least18; (2) conduct disorder before age 15; (3) antisocial behavior since age 18; and (4) symptoms ofthe disorder are not limited to periods of active schizophrenia or mania. The criteria aremonothetic in nature: each one is necessary, and together they are jointly sufficient, to diagnoseAPD. The criteria and subcriteria are presented in Table 1.The content of the DSM-III APD criteria was decided by a committee of the AmericanPsychiatric Association's DSM-III Task Force, and was revised slightly by another committee forthe DSM-III-R (Widiger et al., 1991). In drafting their criteria, these committees were heavilyinfluenced by the clinical and research traditions at the Washington University in St. Louis, whicheschewed the use of inferred personality traits for the diagnosis of APD in favor of the use ofspecific behavioral indicators of those traits (Robins, 1978).4 In each case, the revision represents a minor modification of the original procedure; thus, anycriticisms of the revision also apply to the original procedure, mutatis mutandis.8Table 1The DSM-III-R Criteria for Antisocial Personality DisorderCriterion/SubcriterionA. Current age at least 18B. Conduct disorder before age 15, as indicated by at least three of the following:1. Truant 7. Cruel to people2. Ran away 8. Destroyed property3. Fought 9. Set fires4. Used weapons 10. Lied5. Forced sex on others 11. Stole6. Cruel to animals 12. RobbedC. Antisocial behavior since age 15, as indicated by four or more of the following:1. Poor employment record 6. Lies2. Repeated criminal acts 7. Reckless3. Irritable and aggressive 8. Irresponsible parenting4. Poor financial record 9. No monogamous relationships5. Impulsive 10. Lacks remorseD. Occurrence of antisocial behavior not exclusively during the course of Schizophrenia or manicepisodes9The APD criteria do not constitute a scale or test. Their development was not guided bypsychometric principles, they do not have a response format per se, and they do not yield a score.Rather, the assessor determines if each (sub-) criterion is present/true or absent/false. The finaldecision is dichotomous: If the criteria are all present, then a lifetime diagnosis of APD is made; ifone or more is absent, no such diagnosis is made. 5 Despite this, many researchers (e.g., Hart,Forth, & Hare, 1991) and some diagnostic interviews (e.g., Loranger, 1988) use the criteria toobtain dimensional APD "scores," such as symptom counts.The DSM-III-R also does not specify a particular method for assessing APD. In theempirical literature, researchers have employed methods ranging from structured interview tosemi-structured interview plus a review of case history information to file review alone.Structured interviews should probably be avoided, unless the interviews are supplemented withcase history information, as they may be highly susceptible to the effects of deceitfulness.Depending upon the method employed, assessment of APD probably takes 30 to 60 minutes.Reliability. In some respects, it may be unfair to evaluate the APD criteria according tostandard psychometric principles, as their construction was not guided by these principles and asdiagnostic criteria in general cannot be equated with test items (Blashfield & Livesley, 1991).With this caveat in mind, let us examine the reliability of the APD criteria.Criterion A is typically not analyzed in studies, as it is a simple decision regarding thesubject's age. It presumably has near-perfect interrater and short-term test-retest reliability inadults, with the only errors being due to assessor error or deceitfulness on the part of the subject.Criterion B of APD has moderate to high interrater reliability. Kappa coefficients ofinterrater agreement for the presence versus absence of this criterion, using the interviewer-observer method, have ranged from .34 to .69 (e.g., Hart, Forth, & Hare, 1992; Widiger et al.,1992). Its temporal stability is unknown but must be moderate to high, given the stability of5 The DSM-III-R does allow the assessor to use certain modifiers to clarify the diagnosis. Forexample, APD can be diagnosed as present but not currently active (i.e., in full or partialremission), or as probably present (i.e., provisionally diagnosed). Some researchers also structuretheir assessment methods to yield probabilistic diagnoses (e.g., Loranger, 1988).10overall APD diagnoses (see below). Problems have been identified with specific subcriteria,however. Coolidge, Merwin, Wooley, & Hyman (1990) examined APD symptom self-reports incollege students and their family members. They found that several subcriteria had extremely lowprevalence rates and/or low item-total correlations; overall, the internal consistency of thesubcriteria was moderate (alpha = .63). Using the Spearman-Brown prophecy formula, I estimatethat item homogeneity was also low to moderate (mean inter-item correlation = .12). It could beargued that the poor performance of the subcriteria directly resulted from the low prevalence ofAPD diagnoses in the sample (less than 10%); however, similar results were reported by Hart,Forth, & Hare (1992), who used an interview plus file review procedure in samples ofincarcerated male offenders, forensic psychiatric patients, and college students. Despite a muchhigher prevalence of APD, at least in the two forensic samples (64.2% and 15.7%, respectively), anumber of symptoms had low prevalence, low item-total correlations, or low interrater reliability.The internal consistency of the subcriteria was moderate (median alpha = .66), as was the itemhomogeneity (median value of mean inter-item correlation = .12). Symptoms identified asproblematic in both studies included Used weapons, Forced Sex, Cruel to animals, Cruel topeople, and Robbed. 6Criterion C has adequate interrater reliability, with researchers reporting kappas of about.50 (Hart, Forth, & Hare, 1992; Stangl et al., 1985). Like criterion B, its temporal stability isunknown but presumably high. In addition to the Coolidge et al. (1990) and Hart, Forth, andHare (1992) studies, data concerning the C subcriteria comes from the DSM-IV APD field trials(Widiger et al., 1992). All three studies indicate that several subcriteria have low prevalence,poor interrater reliability, or low item-total correlations in both forensic and civil samples. Thesubcriteria that performed poorly in at least two studies were Irresponsible parenting, Nomonogamous relationships, and Poor financial record. Internal consistency of the C subcriteria6 Morey (1988a,b,c) examined the internal consistency of the 1985 draft DSM-III-R APDsubcriteria. Results were not reported separately for B and C subcriteria. The overall alpha was.82 (Morey, 1988a,c); none of the B subcriteria had a corrected item-total correlation of less than.30 (Morey, 1988c).11was low to moderate in the Hart, Forth, and Hare (1992) study (median alpha = .55); itemhomogeneity was low (median value of mean inter-item correlation = .10). 7Criterion D, like Criterion A, has not been analyzed in studies of the APD criteria. This isunfortunate, as its reliability may be substantially lower than that of Criterion A: first, the assessormust diagnose schizophrenia and manic syndrome--diagnoses which themselves are of imperfectreliability--in addition to APD; and second, the assessor must determine whether all the APDsymptoms occurred during active periods of schizophrenia or mania.Irrespective of any problems with its constituent criteria, there is general agreement thatAPD was the most reliable of the DSM-III Axis II disorders; the same appears to be true forDSM-III-R (Widiger, 1992; but cf. Rogers & Dion, 1991). Interrater agreement, using theinterviewer-observer method, was moderate in Hart, Forth, and Hare's (1992) inmate sample(kappa = .63) and low to moderate in the DSM-IV field trials (median kappa = .50). Higherinterrater reliability has been reported in studies that used structured diagnostic interviews (e.g.,Jackson et al., 1991; kappa = 1.00). APD diagnoses also have acceptable test-retest reliability, atleast over brief periods of time (e.g., Alterman, Cacciola, & Rutherford, 1992). 8 APDassessments appear to be relatively unaffected by state variables, such as subjects' mood at thetime of assessment (Widiger et al., 1992).Norms. There are no systematic norms concerning the prevalence of DSM-III-R APDsymptoms or diagnoses. The recent DSM-IV field trials for APD (Widiger et al., 1992) reportedprevalence rates in five different settings, each with approximately 100 subjects. The settings andprevalence rates were as follows: outpatient substance abusers attending a VA clinic, 17%; maleprison inmates, 70%; psychiatric and substance abuse inpatients, 36%; adopted-away offspring,1%; and psychiatric inpatients, 34%. Other research confirms a high prevalence rate (typicallyIn Morey (1988c), the only C subcriterion that had a corrected item -total correlations less than.30 was Impulsive (.27).8 Given the monothetic nature of the criteria, their internal consistency is irrelevant; however, it isof interest to note that the association between the presence versus absence of Criteria B and Cwas only moderate in the Hart, Forth, & Hare (1992) study, with kappas of .15, .32, and .67 inthe inmate, forensic patient, and student samples.1250% to 75%) in forensic populations using either DSM-III or DSM-III-R criteria (CorrectionalService of Canada, 1990; Hare, 1983, 1985; Hart, Forth, & Hare, 1992; Hart & Hare, 1989;Roesch, 1992).We can draw some inferences about the prevalence of APD from the results of theEpidemiologic Catchment Area (ECA) project (Robins & Regier, 1991), which used the DSM-IIIcriteria. In the ECA, a structured interview, the Diagnostic Interview Schedule (DIS; Robins,Helzer, Croughan, & Ratcliff, 1981), was administered to a stratified random sample comprisingnearly 20,000 adults residing in five large geographic centers in the United States. Therespondents included community residents, as well as those institutionalized in psychiatrichospitals, geriatric homes, prisons, and residential substance use programs. According to Robins,Tipp, & Przybeck (1991), the lifetime prevalence of APD was 2.6% (SE = 0.16%). APDprevalence rates were significantly higher in men versus women (by a factor of about 5), in urbanversus rural residents (by a factor of about 2), and in those below age 30 versus those above age64 (by a factor of about 10). There were no significant racial differences in prevalence.Validity. The content-related validity of the APD criteria has been heavily criticized on anumber of grounds. First, the content of the criteria and subcriteria is thought by many writers tobe too long, overly-specific, and arbitrary--in the words of Millon (1981), "picayunish." Theircomplexity may give rise to a number of problems, including an over-reliance on retrospectiveself-reports for assessment, a failure to adhere to the actual criteria in clinical practice, andextreme heterogeneity among those meeting the criteria (Hare, Hart, & Harpur, 1991; Morey &Ochoa, 1989; Rogers & Dion, 1991). Second, the criteria appear to assess primarily the socialdeviance facet of psychopathy, ignoring many affective and interpersonal symptoms (Hare, 1985;Hare, Hart, & Harpur, 1991; Millon, 1981). Even in their assessment of social deviance, theymay focus too much on rare, violent symptoms (Rogers & Dion, 1991). Thus, they may bevirtually synonymous with severe and persistent criminality (Hare, 1991). As Widiger (1992)notes, such criticism has led to speculations that the criteria are at once both too broad,overdiagnosing APD in criminal populations, and too narrow, failing to identify true psychopaths13in noncriminal populations. 9 Third, some of the criteria can be criticized on logical grounds. Forexample, Criterion A may be unnecessary; DSM-III-R makes clear in the overview to Axis II thatpersonality disorders persist into adulthood; thus, no APD diagnosis should be made in the case ofsomeone whose antisocial behavior spontaneously remits after adolescence. No other Axis IIcriteria include an age criterion. Similarly, Criterion B itself may be redundant: DSM-III-R statesthat symptoms of a personality disorder are usually first evident in childhood, and no other Axis IIcriteria have specific childhood symptoms that are necessary for the diagnosis. Finally, CriterionD, like other exclusionary criteria in the DSMs, is of unknown validity (Boyd et al., 1984).With respect to concurrent validity, APD diagnoses are correlated about .55 with PCL-Rtotal scores, and have moderate to high levels of agreement with the PCL-R (Hare, 1983, 1985,1991). Similar levels of agreement were observed between APD and the ICD-10 criteria fordyssocial personality and criteria for psychopathic personality disorder (based on the PCL-R) inthe DSM-IV APD field trials (Widiger et al., 1992). Turning to self-report measures, APDdiagnoses have low to moderate correlations, typically around .30, with MCMI-II Antisocial/-Aggressive (6A) and Sadistic (6B) scales, MMPI Psychopathic Deviate (Pd) and Hypomania (Ma)scales, and the CPI Socialization (So) scale (Hare, 1985; Hart, Forth, & Hare, 1992). Of course,when dimensional measures of APD (e.g., symptom counts) are used, the correlations aresomewhat higher, but still only moderate in magnitude (Hart, Forth, & Hare, 1992; Widiger et al.,1992). These relatively low correlations may reflect a problem with the self-report scales ratherthan with the APD criteria, however.There has been little research looking at the predictive validity of APD. There is limitedevidence that APD is associated with poor response to treatment in substance abuse andcorrectional treatment programs (e.g., Woody & McLellan, 1985; Harris et al., 1991). However,9 Interestingly, Morey (1988a) found that symptoms of APD tended to covary with certainsymptoms of other personality disorders (e.g., narcissistic, passive-aggressive) to form a clusterthat he labelled "psychopathic." This tends to support the view that, although the APD symptomsmay be internally consistent, they fail to provide adequate coverage of the domain of thepsychopathy construct.14its predictive efficiency appears to be weak both in absolute terms and relative to that of othermeasures, such as the PCL-R (e.g., Hare, 1991; Hart et al., 1988; Harris et al., 1991).With respect to construct-related validity, there is a rather large body of literature lookingat the association between APD and substance use. In fact, this one topic accounts for over athird of the recent research (14 of 38 abstracts) identified by the computer search. Probably themost common findings are that APD is significantly comorbid with substance use disorders andthat substance use patients with APD are more socially deviant or have worse treatment outcomesthan other patients (e.g., Liskow & Powell, 1990, 1991; Stabenau, 1990; Woody & McLellan,1985). Another common finding in the personality disorder literature is that APD is frequentlycomorbid with other Axis II, Cluster B (Dramatic-Erratic-Emotional) disorders, particularlyborderline personality disorder (e.g., Gunderson, Zanarini, & Lisiel, 1991). These findings are notinconsistent with clinical views of psychopathy, and can thus be considered evidence supportingthe concurrent validity of APD (although the comorbidity with substance use may be greatenough to impede differential diagnosis; Gerstley, Alterman, McLellan, & Woody, 1990).However, there is also evidence of unexpected or theoretically inconsistent comorbidity, such asoverlap with schizophrenia and mania when the exclusion criterion (D) is ignored (Boyd et al.,1984; Robins et al., 1991).There is no systematic experimental evidence to support the construct-related validity ofthe APD criteria. Other reviewers (e.g., Widiger, 1992; Widiger & Corbett, in press) havereferred to a body of supportive evidence that includes biochemical, genetic, and adoption studies;but as many (if not most) of the studies cited did not use the actual DSM-III or DSM-III-Rcriteria, and as the equivalence of DSM-III(-R) and other (e.g., RDC or Feighner) criteria isquestionable (Widiger et al., 1992), the relevance of these studies is unclear. 10Summary. The DSM-III-R criteria for APD have adequate interrater reliability andtemporal stability, although some of the subcriteria have extremely low prevalence, poor interrater10 It is worth noting that in 5 of the 38 abstracts citing APD, the primary focus of the researchwas actually psychopathy as assessed by the PCL(-R); in another one, the PCL was used tovalidate the APD criteria.15reliability, and/or low item-total correlations. There are no normative data for DSM-III-R APDsymptoms or diagnoses. DSM-III (-R) APD diagnoses have adequate concurrent and convergentvalidity, but the remaining facets of its validity are questionable.Much of the criticism discussed above suggests that the APD criteria focus too much onantisocial behavior, lack a clear two-facet structure, and may be indistinguishable from severe orpersistent criminality. These are serious weaknesses that make the APD criteria problematic forresearch and clinical practice in forensic populations. On the other hand, they do have twostrengths. First, with respect to chronicity, they appear to measure a construct that is relativelystable over time. Second, at least when the assessment is based on collateral information inaddition to interview data, they may be relatively immune to the effects of deceitfulness.2. Hare Psychopathy Checklist-Revised (PCL-R)Format. The PCL-R is a 20-item symptom construct rating scale. To control for theeffects of deceitfulness, ratings are made on the basis a semi-structured interview and a review ofcollateral information (although they can also be based on collateral information alone, ifnecessary).. Each item consists of a one-page description of a rather complex, high-level trait(e.g., "Shallow Affect" or "Criminal Versatility"); the summary labels of the items are presented inTable 2. The response format is a 3-point scale (0 = item does not apply, 1 = item appliessomewhat, 2 = item definitely applies); items can also be omitted under certain conditions.Individual items are summed (and prorated, if items were omitted) to yield dimensional scoresranging from 0 to 40 that reflect the severity of psychopathic traits; a cutoff score can also beused to yield lifetime diagnoses of psychopathy (< 29 = nonpsychopath; > 30 = psychopath). Inaddition, the PCL-R yields factor scores reflecting the two facets of psychopathy. Administrationand scoring of the PCL-R takes about 2 1/2 to 3 hours.The PCL-R was constructed using a mixture of methods. First, more than a hundreditems were generated through a literature review and clinical experience. Second, these itemswere piloted; those that were redundant or could not be scored reliably were dropped. Third, theshortened item pool was used on a sample of adult male inmates for whom clinical global ratingsof psychopathy were available; items were dropped if they did not discriminate between those16Table 2Items in the PCL-RItem Description Factor Loading1. Glibness/Superficial Charm 12. Grandiose Sense of Self-Worth 13. Need for Stimulation/Proneness to Boredom 24. Pathological Lying 15. Conning/Manipulative 16. Lack of Remorse or Guilt 17. Shallow Affect 18. Callous/Lack of Empathy 19. Parasitic Lifestyle 210. Poor Behavioral Controls 211. Promiscuous Sexual Behavior12. Early Behavioral Problems 213. Lack of Realistic, Long-Term Goals 214. Impulsivity 215. Irresponsibility 216. Failure to Accept Responsibility for Own Actions 117. Many Short-Term Marital Relationships18. Juvenile Delinquency 219. Revocation of Conditional Release 220. Criminal Versatilityidentified as psychopaths and nonpsychopaths according to the global ratings or if they did notcorrelate with the other items.The original target population of the PCL-R was incarcerated adult male offenders (Hare,1991), and most research using the scale has focused on White, North American offenders infederal or state/provincial prisons. However, the PCL-R has also proved useful in research onforensic psychiatric patients (Hart & Hare, 1989; Rice et al., 1992), and has been used withfemale offenders, young offenders, a variety of ethnic minority groups, offenders in Britain andEurope, and even noncriminals (see Hare, 1991).Reliability. In the PCL-R manual, Hare (1991) presents summary reliability data from 11forensic samples (N = 1,632). Unlike the APD criteria, construction of the PCL-R was guided bypsychometric principles, so it is no surprise that it has superior psychometric properties.The individual PCL-R items have acceptable prevalence, interrater reliability, and item-total correlation. The internal consistency reliability is quite high: the median alpha coefficientacross the 11 samples was .87, and the median MIC (mean inter-item correlation) was .25.The interrater reliability of total scores is acceptable: the median intraclass correlationcoefficient for PCL-R total scores (ICC1; Bartko, 1976) in 6 samples that used multiple raterswas .88. For clinical purposes, it is probably best to average two independent ratings; theeffective interrater reliability using this procedure (ICC 2) was .94. PCL-R diagnoses ofpsychopathy also have acceptable interrater reliability. Kappa coefficients of agreement betweenindependent raters reported in various studies range between .50 and .80 (e.g., Hart, Forth, &Hare, 1991; Hart & Hare, 1989)."Only one study has looked at the temporal stability of the PCL-R (Alterman et al., 1992).In that study, which looked at 88 adult men attending a methadone maintenance program, theone-month test-retest reliability (r) of total scores was .89. This estimate is similar to thatreported for the PCL over a 10-month interval in 42 adult male inmates (Schroeder, Schroeder, &11 All the interrater reliability data described here were obtained using the interviewer-observermethod.18Hare, 1983). There is considerable evidence that PCL-R scores are uncorrelated with subjects'emotional states (state anxiety or dysthymia) at the time of assessment (Hare, 1991).The PCL-R factors are less reliable than total scores. This is to be expected, given thatthe factor scales are shorter in length than the total scale (8 items for Factor 1 and 9 items forFactor 2, versus 20 items for the full scale). Nevertheless, the factor scores are sufficientlyreliable for research purposes (Alterman et al., 1992; Hare, 1991).Norms. The PCL-R presents normative data for total and factor scores from 7 samples ofadult male prisoners (N = 1192) and 4 samples of adult male forensic psychiatric patients (N =440). The distribution of scores varies little within the two settings, despite differences betweenthe samples in principle investigator, country of origin, security level of the institution, legal statusof subjects, and sampling technique employed. Demographic variables such as age and raceappear to have a small but statistically significant association with PCL-R scores; similar resultshave been reported for the PCL (Hare, 1991).Although the PCL-R has been used with female offenders, young offenders, andnoncriminals, no norms are available for these populations at the present time.Validity. The PCL and PCL-R have good content-related validity, as evidenced by theirclear two-facet structure. Perhaps the only weakness here is that the items were developed andintended for use in forensic populations. This creates two possible problems for their use withnoncriminals. First, the base rate of psychopathy or psychopathic symptoms probably differsgreatly from that of the PCL and PCL-R validation samples; consequently, the reliability andvalidity of the items may be diminished. Second, three items from the PCL and PCL-R are scoredon the basis of formal criminal records, making them difficult to score and possibly extremely rarein noncriminals. (Alternatively, these items can be omitted in noncriminals and total scoresprorated.) There are preliminary indications that these problems do not render the PCL-R invalidfor use with noncriminals, although they may decrease its utility somewhat.The concurrent validity of the PCL and PCL-R is good. They are moderately to highlycorrelated with clinical global ratings of psychopathy, ratings made using Cleckley's 16 criteria,and APD diagnoses and ratings, typically in the range of .55 to .85 (Hare, 1980, 1985, 1991).19Their correlations with the MMPI Pd, MCMI-II 6A, and CPI Pd scales are rather low, averagingabout r = .30 in magnitude; however, as noted earlier, this probably reflects problems with theself-report measures (Hare, 1985, 1991; Hart, Forth, & Hare, 1991).The predictive validity of the PCL scales is good, particularly given the rather poorperformance of most psychological tests and diagnoses in the prediction of criminal behavior.More than a dozen studies conducted in Canada and the United States indicate that PCL/PCL-Rscores are correlated with antisocial and violent behavior both inside and outside of correctionalinstitutions, including recidivism following conditional release from prison, response tocorrectional treatments, and institutional misconduct (see Hare, 1991; Hare & Hart, 1993).Psychopaths also have criminal careers--patterns of violent and nonviolent offending across thelife span--that are quite different from those of nonpsychopaths (Hare, McPherson, & Forth,1988; Williamson, Hare, & Wong, 1987). In studies that have compared the ability of variousmeasures to predict criminal behavior, the PCL and PCL-R scales perform as well as or betterthan both other measures of psychopathy (such as APD or the MMPI) and actuarial riskassessment scales (Hare, 1991; Rice et al., 1992; Serin, Barbaree, & Peters, 1990; Simourd,Bonta, Andrews, & Hoge, 1990).The PCL and PCL-R have a clear pattern of convergent and discriminant validities, theinterpretation of which is greatly clarified by analysis of the two factors. Like APD, the PCLscales are significantly associated with substance use disorders; however, this association is dueentirely to Factor 2 (Hart & Hare, 1989; Hemphill, Hart, & Hare, 1992; Smith & Newman, 1990).Similarly, the PCL and PCL-R correlate positively with DSM-III-R Cluster B personalitydisorders and negatively with several Cluster C disorders; in this case, however, the association isdue primarily to Factor 1 (except for the correlation with APD, which is due primarily to Factor2; Hare, 1991; Hart & Hare, 1989). The factors also have distinct patterns of correlations withself-report measures of personality: Factor 1 correlates negatively with anxiety and empathy, andpositively with narcissism and dominance; Factor 2 correlates positively with sensation-seekingand impulsivity, and negatively with nurturance (Harpur et al., 1989; Hart, Forth, & Hare, 1991;Hare, 1991). Similar results have been found using projective measures (e.g., Gacono, Meloy, &20Heaven, 1990). The PCL-R has good clinical specificity with respect to DSM-III-R Axis I andAxis II Cluster C disorders, both in absolute terms (Hart & Hare, 1989; Raine, 1986) and relativeto other measures such as the MMPI (Howard, Bailey, & Newman, 1984; but cf. Howard, 1990).Finally, there are more than 20 published experimental investigations supporting theconstruct validity of the PCL and PCL-R. Although they have no apparent brain damage (at leastas measured by standard neuropsychological measures; see Hare, 1984; Hart, Forth, & Hare,1991), psychopaths have linguistic functions that are abnormal and/or weakly lateralized in thecerebral hemispheres and they give unusual behavioral and physiological responses to affectivestimuli (see Hare, Williamson, & Harpur, 1988; Williamson, Harpur, & Hare, 1991). In addition,psychopaths show little physiological arousal in anticipation of noxious stimuli; together with theresults of many studies on learning and attentional processes in psychopaths, this has beeninterpreted as evidence of an adaptive coping response that helps them to selectively ignore cuesof impending punishment but that also makes them susceptible to over-focusing on reward cues(for a review, see Harpur & Hare, 1991).It is worth noting here that the construct validity of psychopathy does not seem to beunduly affected by race (Kosson, Nicholls, & Newman, 1990; Wong, 1984).Summary. The PCL-R has excellent psychometric properties, although there has beenrelatively little research looking at its temporal stability. It has good normative data for maleforensic populations. There is considerable research supporting all facets of the PCL-R's validity.Like APD, the PCL-R appears to measure a chronic disorder. As a measure that is basedin large part on file review, it also appears to be relatively immune to deceitfulness. Unlike APD,however, the PCL-R has a clear two-facet structure. In addition, it predicts crime but its contentis not too focused on criminality.Perhaps the biggest weakness of the PCL-R is that its target population is adult maleoffenders. It has been used with female offenders, young offenders, and noncriminals, but nonormative data are available for these groups. Also, some of the PCL-R items may not berelevant for use with noncriminals. Another problem is that completion of the PCL-R is a ratherlengthy process that requires access to collateral information (at least in clinical settings). These21factors may decrease the PCL-R's attractiveness to clinicians working in civil psychiatric and othernoncriminal settings.3. Minnesota Multiphasic Personality Inventory (MMPI-2)Format. The MMPI-2 is very familiar to most psychologists as a broad-band, self-reportinventory of personality and psychopathology. It contains 567 true-false items, all declarativestatements phrased in the first person singular. The items yield scores on 10 basic clinical scales,4 basic validity (response style) scales, and a number of supplementary scales. In the standardscoring procedure, raw scores are first adjusted for defensiveness (as measured by one of thevalidity scales, K) and then converted to T-scores; T-scores > 65 are considered to be high. Thetarget population of the MMPI-2 is adults (age 18 or older) who have Grade 8 reading ability orbetter. The entire MMPI-2 usually takes between 1 and 1 1/2 hours to complete, although patientswith serious psychopathology may take 2 hours or longer. Scoring and interpreting the MMPI-2by hand can be a lengthy process, taking and hour or longer; fortunately, computer scoring andinterpretation are available.The MMPI was originally constructed using the criterion groups method, and the itemsincluded in the Pd scale were those that reliably discriminated a heterogeneous sample ofdelinquent adolescents and young adults from normal controls. The MMPI-2 Pd scale contains50 items that, according to Graham (1990, pp. 61-62), "cover a wide array of topics, includingabsence of satisfaction in life, family problems, delinquency, sexual problems, and difficulties withauthorities. Interestingly, the keyed responses include both admissions of social maladjustmentand assertions of social poise and confidence." When the MMPI was revised, 4 Pd items wererephrased to modernize, clarify, or simplify their content. Because of the wide range of itemsincluded in the Pd scale, interpretation of high and low scores can be difficult. To aidinterpretation, Harris and Lingoes (1955, 1968) constructed five Pd subscales using a rationalapproach (i.e., based on the apparent content of the items). They labeled the subscales FamilialDiscord (Pdl), Authority Problems (Pd2), Social Imperturbability (Pd3), Social Alienation(Pd4), and Self Alienation (Pd5).22There are actually several ways in which the MMPI-2 can be used to assess psychopathy,including use of the Pd scale alone, Pd in combination with Ma, profile analysis (i.e., two- andthree-point code types, such as 4-9 or 4-8-9), or research scales (e.g., Morey, Waugh, &Blashfield, 1985). I will focus on the Pd scale, as it is the most common MMPI-based measure ofpsychopathy and because its items are a central component of all the other measures. Also, thePd scale is probably equal or superior to other MMPI-based measures of psychopathy in terms ofits reliability and validity (e.g., Foreman, 1988; Hare, 1985).Reliability. The Pd scale has low internal consistency. In the MMPI-2 normative sample,alpha was .60 for men and .62 for women. The scale's item homogeneity is extremely poor; usingthe Spearman-Brown formula, I estimate that it has a MIC of about .03. The Harris-Lingoessubscales have better item homogeneity, but their internal consistency (alpha) is still quite low dueto their brevity.The Pd scale has acceptable temporal stability. The MMPI-2 manual reports a one-weektest-retest reliability (r) of .81 for 82 male college students and .79 for 111 female collegestudents. The Harris-Lingoes subscales have similar temporal stability (Graham, 1990). Theseresults are consistent with previous research using the 1VIIVIPI, where the typical range of test-retest reliability coefficients was .70 to .85 over one day, .60 to .85 over one to two weeks, and.35 to .60 over periods of a year or longer (Graham, 1990); interestingly, temporal stability waslower in criminals than in psychiatric patients or normals. One factor that may limit the temporalstability of the Pd scale is its susceptibility to state variables. Evidence supporting this hypothesiscomes from the MMPI-2 manual, which notes that in the normative sample the Pd scalecorrelated .37 with the Depression (D) scale and .51 with the Psychasthenia (Pt) scale; thesescales reflect dysthymic and anxious mood states, respectively.Because the MMPI-2 is a self-report inventory, interrater reliability is not an issue. It hasno parallel form.Norms. The MMPI-2 has excellent norms. The normative sample comprised 1,138 adultmen and 1,462 adult women residing in U.S. communities, and was representative of the 1980national census with respect to sex, age, race, and geographic region of residence. Separate23norms are available for men and women. Because the MMPI-2 Pd scale scores are transformedinto T-scores, the average T-score for men and women is, by definition, 50. For eight of theMMPI-2 clinical scales, including Pd, a process called "uniform" T-score transformation wasemployed instead of the usual linear transformation, to insure that the percentile rank for a givenT-score was the same on each scale. Because of this innovation, we know with thatapproximately 8% of both sexes have T-scores > 65 on Pd. 12 Graham (1990) presents norms forthe Pd sub scales based on linear T-scores.No normative data are available for forensic populations at the present time, although theyalmost certainly will appear in the psychological literature over the next few years. Such data arecritical in order to determine if the MMPI-2 is able to make meaningful discriminations amongoffenders. This may be a problem, as reviews of the use of the MMPI in correctional settingshave concluded that "the MMPI profiles of prisoners have seemed remarkably homogeneous.Numerous studies show that scale 4 usually is the most elevated scale in mean profiles ofprisoners and identify the 4-2 and 4-9 code types as those most frequently occurring forprisoners" (Graham, 1990, p.196).Validity. The content-related validity of the Pd scale appears to be poor: first, the itemsfocus primarily on the social deviance facet of psychopathy; second, it includes some items whosecontent is of questionable relevance (e.g., sexual maladjustment); and third, it has poor itemhomogeneity. A good indication of the heterogeneous content of the Pd scale comes fromexamination of the correlations among the Harris-Lingoes subscales (Graham, 1990). For men,they range from -.22 to .71, and average about .22; 30% are negative in direction. For women,the range is -.26 to .69, and the average is .21; once again, 30% of the correlations are negative. Ishould note that these criticisms may be unfair in some respects, as content-related validity wasnot a concern during the construction and revision of the MMPI.12 Note that the test authors do not assume that the actual prevalence of psychopathy in men andwomen is 8%. The cutoff was selected to identify people with relative, rather than absolute,elevations on the scale; it was not selected because of its efficiency for predicting psychopathydiagnoses.24The concurrent validity of the Pd scale is low. It correlates about r = .30 with otherclinical and self-report measures of psychopathy, including APD, the PCL-R, and the So scalefrom the CPI (Hare, 1985). Its predictive validity with respect to criminal behavior is also poor,both in absolute terms and in comparison to other psychopathy measures (e.g., Simourd et al.,1990).There is a voluminous research literature on the MMPI and MMPI-2, including a largenumber of studies that have used the Pd scale to define psychopathy for laboratory research. Ingeneral, the evidence supporting the construct-related validity of the Pd scale is notoverwhelming. For example, with respect to convergent and discriminant validity, spouse ratingsof behavior were collected for 1,644 normals (822 men and 822 women) as part of the MMPI-2restandardization research; Graham (1988) collected similar ratings, made by attendingpsychologists and psychiatrists, for 423 patients (232 men and 191 women). The behaviors ratedincluded several dozen symptoms of psychopathology (e.g., "Has trouble sleeping," "Wearsunusual clothing"). In normal men, the Pd scale had substantial correlations only with the items"Trouble with the law" (r = .21) and "Uses nonprescription drugs" (r = .16). In normal women,the Pd scale correlated with "Angry, yells" (r = .25), "Cooperative" (r = -.24), and "Irritable,grouchy" (r = .23). In male patients, it correlated with "Guilt feelings" (r = .17) and "Grandiosity"(r = .17); in female patients, it correlated with "Grandiosity" (r = -.21), "Depressive mood" (r =.21), and "Emotional withdrawal" (r = .20). Although the correlations for normals aretheoretically consistent, they are different for men and women. The correlations for patients alsodiffer for the sexes; furthermore, most of them are theoretically inconsistent (e.g., negativecorrelations with grandiosity, positive correlations with depression and guilt).The results of the computer search indicated that recent research on Pd and crime hasyielded mixed evidence concerning the construct validity of the scale. On the positive side,Pavelka (1986) and Bayer and Bonta (1985) found that Pd and its subscales were significantlyassociated with several indexes of criminality (e.g., recidivism) in adult males. Similarly, Walters(1985) found that military offenders diagnosed as APD scored higher on Pd than did non-APDoffenders. In contrast, Roger and Gillis (1989) found that Pd scores were not associated with25ICD-9 diagnoses of sociopathy in a sample of 470 forensic psychiatric patients. Howard, Bailey,& Newman (1984) found that MMPI scales (including Pd) discriminated better than chancebetween various groups of mentally disordered offenders, although they performed less well thandid the PCL.Two studies looking at learning also yielded somewhat mixed results. Newman andWidom (1985) found that high Pd subjects showed the same deficits on passive avoidancelearning deficits tasks that extraverts did, consistent with a disinhibition model of psychopathy.Brown and Gutsch (1985) examined preference for delayed versus immediate reward and thecognitions associated with each preference. They divided high Pd scorers into "primarypsychopaths" (high Pd and low self-reported anxiety) and "secondary psychopaths" (high Pd andhigh anxiety). Primary psychopaths did not differ from nonpsychopaths; however, secondarypsychopaths differed from both primary psychopaths and nonpsychopaths.Several studies found results that are inconsistent with theoretical views of psychopathy.A study of community residents found that Pd scores were negatively correlated with measures ofsocially desirable responding (Ray & Ray, 1982) and positively correlated with anxiety (Ray,1983). Sutker and Allain (1983) reported that medical students with high Pd scores were moreimpulsive and reported greater delinquency as juveniles than did matched controls with lowscores; however, they were just as empathic on self-report and interview measures. Eisenman(1980) found high school students with high Pd who abused drugs were better liked by teachersthan other students (although the author tried to account for this by characterizing the high-Pddrug abusers as better manipulators).Summary. The MMPI-2 Pd scale has excellent general population norms and acceptabletemporal stability. However, possibly as a consequence of the manner in which it wasconstructed, it has poor internal consistency, item homogeneity, and content-related validity.Both facets of its criterion-related validity are also poor. Its convergent and discriminant validityare questionable, especially in psychiatric populations. It has not proven to be of use in laboratoryor experimental research on psychopathy.26With respect to the four specific assessment issues discussed earlier, the Pd scale appearsto measure a reasonably chronic construct; unfortunately, the identity of that construct is unclearat this time. One thing is clear: The Pd scale is a poor measure of the two-facet model ofpsychopathy, and is biased towards measurement of social deviance. Although the content of theitems is not too closely associated with criminality, the Pd scale may be unable to makemeaningful discriminations among offenders.One strength of the MMPI-2 is that it provides a direct appraisal of deceitfulness and test-taking attitude (via the validity scales). One form of deceitfulness--psychologically sophisticateddefensiveness--is even corrected for during the scoring process. However, other forms (e.g.,malingering, unsophisticated defensiveness) are not controlled; thus, valid completion of theMMPI-2 still requires considerable cooperation from subjects.4. California Psychological Inventory (CPI)Format. The revised CPI (Gough, 1987) is self-report inventory designed to assess "folkconcepts" of personality--"concepts that arise from and are linked to the ineluctable processes ofinterpersonal life, and that are to be found everywhere that humans congregate into groups andestablish social functions" (Gough, 1987, p. 1). The CPI contains 462 true-false items that takethe form of declarative statements (not necessarily phrased in the first person). The items form 20folk concept scales and three "structural" scales (which reflect higher-order factors); a number ofspecial research scales have also been developed. The CPI does not contain scales to assess orcorrect for response styles, although the manual presents several methods for determining thevalidity of protocols. Raw item scores on each scale are summed and then transferred into"standard scores" (actually, T-scores); different norms are available for men and women. Thetarget population of the CPI is adolescents and adults (age 13 and older) who have at least Grade7 reading ability. The test typically takes about 45 to 60 minutes to complete. Computer scoringand interpretation are available.The So scale is intended to measure the internalization of social norms and values, so thatthose with "very strong rule-breaking and norm-violating proclivities" would receive high scores(Gough, 1987; p. 45). In its original form (Gough & Peterson, 1952), the scale was designed to27measure psychopathy as conceptualized in Gough's role-taking theory (Gough, 1948). Later, withthe publication of the CPI, the scoring for the scale was reversed to make it consistent with theother scales. Like the MMPI Pd scale, the So scale was constructed using an empirical approach:Items were selected for inclusion in the scale according the magnitude of their correlations withnon-test criteria, not on the basis of internal consistency. The current So scale consists of 46items (some of which were taken from the MIVIPI item pool) that tap such characteristics asdelinquency and rejection of traditional values. Some items are intentionally subtle in content.Six items from the original So scale were dropped during the CPI revision process. Given theratio of items to scales, there must be item overlap on the CPI; however, the manual does notpresent any information on this subject. Gough has recently developed four subscales for So,based on factor analyses: Optimism, self-confidence, and positive affect (12 items); Self-disciplineand cathexis of social norms (15 items); Good memories of home and parents (10 items); andInterpersonal awareness and sensitivity (9 items).' 3Reliability. The internal consistency reliability of the CPI is moderate. In 400 collegestudents, coefficient alpha was .67 for 200 male college students and .76 for 200 female collegestudents (.71 for the combined sample). Due to the length of the scale, this reflects very low itemhomogeneity: Using the Spearman-Brown formula, I estimate that MIC in this sample was .05.As was the case with the Pd scale, however, it must be emphasized that Gough does not considerinternal consistency to be an important criterion by which to judge the So scale.The So scale has moderate temporal stability. The one-year test-retest reliability was .69in a sample of 85 high school boys and .74 in 38 high school girls. No information is available inthe manual concerning the So scale's susceptibility to state variables.Norms. Gough based the CPI norms on archival data. He selected a total of 1,000 malesand 1,000 females from diverse groups--for example, high school students, mathematicians,nurses, prisoners, psychiatric patients, and "San Francisco area residents"--so that thedemographic characteristics of the normative sample were similar to those of the general13 H.G. Gough, personal communication to R.D. Hare, October 19, 1992.28population.^Raw scores are apparently converted into standard scores using a lineartransformation procedure.The CPI manual does not recommend a specific cutoff score for the So scale. Throughoutthe manual, though, Gough appears to consider T-scores greater than 65 or 70 to be high, at leastin a relative sense. It is likely that somewhere between 5% and 15% of males and females wouldreceive scores at or above these cutoffs.Validity. The content-related validity of the So scale is low to moderate. The manifestcontent of some So items is of questionable relevance to psychopathy (e.g., "I think Lincoln wasgreater than Washington" or "My table manners are not quite as good at home as when I am outin company"). Also, the items appear to tap mainly the social deviance facet of psychopathy.Finally, the scale has low to moderate internal consistency and item homogeneity. Recall,however, that these may not be fatal flaws in a scale constructed using the empirical approach.The concurrent validity of the So scale is also low. It is correlated about -.30 with PCL(-R) scores (e.g., Hare, 1985, 1991) and with APD diagnoses (Hare, 1985). Its correlations withother self-report measures, such as the Pd scale, are also typically in the range of -.30 to -.40(Hare, 1985).One strength of the So scale may be its predictive validity. In a meta-analysis, the So scalewas robustly related to antisocial behavior (Simourd et al., 1990). It performed significantlybetter than did the Pd scale, and at about the same level as the PCL(-R). (However, most of thestudies supporting the "predictive" validity of So involved differentiating samples of juveniledelinquents from normal adolescents, whereas those supporting the PCL-R involved thepostdiction and prediction of criminal convictions, including violent crime and recidivism afterrelease from prison, in adult male offenders.)With respect to construct-related validity, the CPI manual presents data on the associationbetween So and the results of personality assessments conducted over a period of years at theInstitute for Personality Assessment and Research at Berkeley. These personality assessmentsincluded three types of ratings (Q-sorts, adjective checklists, and psychosocial history checklists)from three different sources (peers, spouses, and trained staff). Gough presents the items from29each assessment method that had the highest positive and negative correlations with each CPIscale. The pattern of results appears to be theoretically consistent, although it is hard to makeabsolute judgments concerning validity, as Gough does not give the actual magnitude of thecorrelations. Peers, spouses, and staff were consistent in rating the following adjectives amongthe 20 strongest correlates of the So scale: reckless (negatively correlated), rebellious (negative),and organized (positive).The results of the computer search found little evidence supporting the construct validityof So in the past 12 years. Barbour-McMullen and Coid (1988) found that So could differentiateAPD forensic patients from other patients and from normals. O'Mahony and Murphy (1991) alsofound that So could differentiate between students and prisoners when the groups were asked torespond honestly; however, the scale was very susceptible to response styles when subjects wereasked to fake good. Gorenstein (1982, 1987) found that So-diagnosed psychopaths hadperformance deficits on neuropsychological tests relative to psychiatric and normal controls;however, this finding contradicts several much larger studies that used other measures ofpsychopathy (Hare, 1984; Hart, Forth, & Hare, 1990; Sutker, Moan, & Allain, 1983).Summary. The CPI So scale has many of the same strengths and weaknesses as does theMMPI-2 Pd scale. On the plus side, it has general population norms and moderate temporalstability; on the down side, it has poor internal consistency, item homogeneity, and content-relatedvalidity. The criterion-related validity of the So scale may be slightly better than the Pd scale;however, its construct-related validity is just as questionable.With respect to the four specific assessment issues discussed earlier, the So scale appearsto measure a reasonably chronic construct; once again, however, the identity of that construct isunclear. The So scale is a poor measure of the two facets of psychopathy, and is biased towardsmeasurement of social deviance. Its content is not unduly associated with criminality. The CPIallows for a limited appraisal of deceitfulness and test-taking attitude, but does not correct forthese; thus, valid completion of the inventory requires the cooperation of subjects.305. Millon Clinical Multiaxial Inventory (MCMI-II)Format. The MCMI-II is a self-report inventory of psychopathology intended for use withclinical populations. It contains 175 true-false items, all declarative statements phrased in the firstperson singular. It yields scores on 4 validity scales, 13 scales analogous to the DSM-III-R AxisII personality disorders, and 9 clinical syndrome scales analogous to DSM-III-R Axis I disorders.The MCMI scales were constructed using a three-stage procedure. In the first ("theoretical-substantive"), Millon's theory of psychopathology was used to identify the relevant constructs tobe measured and to generate scale items to measure those constructs. In the second phase("internal-structural"), the initial item pool was administered to a sample of patients in order todetermine the psychometric properties of items and scales; items with poor properties weresubsequently dropped. Finally, in the third stage ("external-criterion"), the revised item pool wasagain administered to a large sample of patients to determine the predictive, convergent, anddiscriminant validity of scales and items with respect to clinical ratings and diagnoses; theseresults were used to develop item weights that maximized the MCMI-II's predictive efficiency.Each MCMI-II scale comprises a relatively small number of items (usually between 8 and10) that are unique to that scale, as well as other items that are shared with other scales. Scaleitems are given a weight (1, 2, or 3) according to their theoretical importance and empiricalvalidity. Raw scores on some scales are then adjusted according to scores on the validity scalesand on two "hidden" (i.e., unreported) correction indexes. Finally, scale scores are transformedinto base rate (BR) scores. The BR transformations are complex, and differ according to the sexand race of patients. Their interpretation is also complex: briefly, for the severe personalitypathology scales and the clinical syndrome scales, BR scores > 75 indicate that the disorder orsyndrome measured by a scale is "present," and scores > 85 that it is "prominent" (Millon, 1987).For the clinical personality pattern scales, Millon recommends a more sophisticated configuralanalysis that takes into account both absolute and relative scale elevations (although thisprocedure does not appears to improve significantly over the more simple cutoff method;Rennenberg, Chambless, Dowdall, Fauerbach, & Gracely, 1992). Not surprisingly, computerscoring and interpretation are available (and recommended; Millon, 1987) for the MCMI-II.31In the MCMI-I, psychopathy was assessed by the Antisocial/Aggressive (6) scale. Thecontent of that scale was akin to APD in DSM-III-R in many respects, but also included elementsof sadism and of the Cleckleyan concept of psychopathy. In the MCMI-II, scale 6 was split intotwo separate scales: the Antisocial (6A) scale, a more pure measure of APD; andAggressive/Sadistic (6B) scale, a more focused measure of DSM-III-R sadistic personalitydisorder traits. Scale 6A contains 45 items: 10 are unique or prototypal (weight factor = 3); 21are secondary (weight = 2); and 14 are tertiary (weight = 1). Raw scores can range from 0 to 86.6A has the highest item overlap with scales measuring drug abuse (T; percent overlap = 50),narcissistic personality disorder (5; percent overlap = 38), and sadistic personality disorder (6B;percent overlap = 38).Reliability. According to the MCMI-II manual, the internal consistency of the 6A scalewas high (KR20 = .88) in a sample of 825 adult psychiatric patients. As was the case with theMMPI-2, however, this is an overestimate of the scale's item homogeneity, due to the scalelength. According to my calculations, item homogeneity is somewhat low (MIC = .14), althoughMillon does not expect the MCMI-II scales to be unifactorial on theoretical grounds (Millon,1987).Millon (1987) reports the temporal stability of the MCMI-II scales in six different samples,including a nonclinical sample, two outpatient samples, and three inpatient samples. The stabilityestimates (r) were moderate, ranging from .64 to .88 (median = .71) over a period of 3 to 5weeks. Temporal stability may be limited by undue susceptibility to state factors; the MCMI-IImanual notes that scale 6A is correlated with scales that reflect mood states, including hypomania(scale N; r = .55) and depression (scale CC; r = .22).Norms. The MCMI-II was normed in two large samples (total N = 1,292) of adultpsychiatric patients drawn from a number of clinical settings, including inpatient, outpatient,college guidance, and forensic clinics. (As noted above, it was not intended for use outside suchsettings, so "normal" norms are not available.) The settings included in the first sample (N = 825)were selected from among those that regularly used the MCMI-I; the degree to which they arerepresentative of patients in general is unknown. Attending clinicians completed a diagnostic32checklist, comprising the draft DSM-III-R criteria for the major adult disorders, for each subject.The second sample (N = 467) sampled from settings where clinicians were known to Millon; theseclinicians made DSM-III-R Axis I and II diagnoses for each subject. The DSM-III-R diagnosticdata were used to construct the MCMI-II BR transformation tables, so that the prevalence of anMCMI-II-diagnosed disorder (according to the decision-making rules outlined in the test manual)was identical to that of the corresponding DSM-III-R disorder. In the combined samples, scale6A was the most elevated of the 10 clinical personality scales (scales 1 to 8B) for 6% of men and2% of women; it was the highest or second-highest of the clinical personality scales for 12% ofmen and 4% of women. At the present time, there are no separate norms for correctionalpatients.Note that the MCMI-II, unlike the MMPI-2 and CPI, selected cutoff scores so that ascale's selection ratio (the percentage of people that score at or above the cutoff) matches the baserate of the criterion (the prevalence of psychopathy/APD as diagnosed by clinicians) in thenormative sample. Put another way, the cutoff identifies people with absolute, rather thanrelative, elevations. The cutoff for scale 6A had acceptable predictive efficiency characteristicswith respect to the criterion diagnoses in the normative sample.Validity. The content-related validity of the 6A scale appears to be acceptable. Althoughit does not have an explicit two-factor structure, its underlying theory (Millon, 1981) and themanifest content of the items that make up the scale include both social deviance symptoms (e.g.,"As a teenager, I got into lots of trouble because of bad school behavior") and affective-interpersonal symptoms (e.g., "Pm the kind of person who can walk up to anyone and tell him orher off'). However, recall that the item homogeneity of the scale is somewhat low.The concurrent validity of scale 6A appears to be low to moderate. Hart, Forth, and Hare(1992) looked at the MCMI-II in a sample of 119 adult male offenders who had also beendiagnosed using PCL-R and DSM-III-R APD criteria. They reported that scale 6A correlated .45with PCL-R Total scores, .24 with Factor 1 scores, and .51 with Factor 2 scores; it also33correlated .33 with APD diagnoses and .51 with the number of adult APD symptoms. 14 Thesecorrelations, although moderate in magnitude, actually reflected relatively poor diagnosticagreement between the measures. For example, agreement between high scores on scale 6A andPCL-R psychopathy diagnoses was poor, regardless whether a BR cutoff of > 74 or > 84 wasused (kappa = .08 and .14, respectively); agreement between 6A and APD diagnoses was slightlyhigher, but still low (kappa = .25 and .23, respectively). In a sample of 34 court- and self-referredwife assaulters, Hart, Dutton, & Newlove (1992) found a correlation of .53 between 6A anddimensional ratings of APD made using a structured diagnostic interview. In the DSM-IV APDfield trials, 6A had generally moderate correlations (around .35 to .40) with symptom counts usingthe DSM-III-R APD, ICD-10 dyssocial personality disorder, and PCL-R-based psychopathicpersonality disorder criteria sets.There are apparently no data as yet concerning the predictive validity of 6A with respectto criminal behavior; neither are there data concerning the construct-related validity (e.g.,experimental or factorial validity) of the scale.Summary. Scale 6A of the MCMI-II holds some promise as a measure of psychopathy. Itappears to have somewhat better content-related validity than the Pd and So scales; at least, itsitems have better face validity and are more homogeneous. Its concurrent validity is also as goodas or better than other self-reports. Unlike the other self-reports, it has a cutoff that wasdetermined empirically to identify people with absolute, rather than relative, elevations in clinicalsettings. Finally, the MCMI-II contains scales that attempt to assess and control for responsestyle.Despite its promise, the MCMI-II does have weaknesses. It lacks a clear two-facetstructure, and is still biased towards measurement of the social deviance facet of psychopathy. Itsconcurrent validity is still only moderate in absolute terms; its predictive and construct validity are14 This pattern of correlations suggests that the items of scale 6A are biased towards measurementof the social deviance facet of psychopathy, despite appearances to the contrary (Hart et al.,1992).34unknown. There is no evidence that its controls for response styles are effective. Finally, it hasno general population or correctional norms.C. Summary of Chapter 1Several conclusions can be drawn from the review presented above. First, and mostgeneral, it appears that none of the existing assessment procedures for psychopathy is withoutsignificant limitations with respect to reliability, validity, or clinical utility. This is important, as itsuggests that there is a need for new measures that may complement the existing procedures.Second, we can conclude, as Hare (1985) did, that "clinical-behavioral" procedures (i.e., thosethat employ expert ratings based on interview and case history data) appear superior to self-reportprocedures, particularly in terms of validity and ability to control for deceitfulness. Therefore, thedevelopment of a new scale may have maximal chance for success if it uses an expert rater format,as opposed to a self-report format. Third, of the procedures reviewed, only the PCL-R has aclear two-facet structure, and this structure has proven extremely useful for clarifying researchresults. Consequently, new measures should start with an explicit two-facet structure, takingadvantage of research on the PCL-R. In Chapter 2, I describe the results of an attempt developand validate a new scale for the assessment of psychopathy that takes into account the aboverecommendations.35CHAPTER 2: SCALE DEVELOPMENT AND VALIDATIONIn this Chapter, I will first describe out efforts to develop a new scale for the assessmentof psychopathy. Next, I will present the results of efforts to validate the scale in a number ofdifferent settings.A. Development of the PCL:SVSeveral key decisions were made concerning the design of the new scale. First, the scalemust be developed according to psychometric theory and evaluated according to standardpsychometric criteria. Second, the scale must be conceptually and empirically related to the PCL-R. This would help to maximize the scale's chances for success (as discussed in Chapter 1) andwould also allow the scale to tap into the extensive empirical literature supporting the validity ofthe PCL-R. And third, to maximize its utility, the scale must be suitable for use in a wide range ofsettings (including civil and forensic psychiatric populations) and require relatively little time,effort, and training to administer and score.In order to meet the first two requirements, the new scale retains the format that provedso successful with the PCL-R--namely, an expert-rater, symptom-construct rating scale. Like thePCL-R, the new scale yields both dimensional and categorical indexes of psychopathy. It also hasan explicit two-facet structure.Fulfilling the third requirement did not appear to be problematic, as previous research hadindicated that psychopathy, as defined by the PCL-R, could be measured reliably in forensicpsychiatric patients (e.g., Harris et al., 1991; Hart & Hare, 1989). One concern was that all theprevious research on the PCL (-R) had been conducted in forensic settings; we needed to revisethe content of some items to make them appropriate for use with noncriminals. Also, it appearedrelatively easy to fulfill at least part of the third requirement--brevity--merely by decreasing thenumber of items in the new scale, as the high internal consistency of the PCL-R suggested thatthere was a degree of redundancy among the original items. The main concern here was thatdecreasing the number of items would decrease interrater reliability. The issue of training was notperceived to be a major problem, as experience suggested that even undergraduates could betaught to make reliable PCL-R assessments of psychopathy.361. First Draft: The Clinical Version of the PCL-R (CV)The first attempt to develop a new, shorter version of the PCL-R resulted in the ClinicalVersion of the PCL (CV; Cox, Hart, & Hare, 1989). One purpose of the CV was for use inscreening jail remands. Because initial assessment interviews in a jail are typically very brief(perhaps 20 to 30 minutes) and because there is often limited access to case history information,the CV consisted of items that were rated primarily on the basis of interview (i.e., stylistic orinterpersonal) data. Another purpose was for use in treatment outcome studies, which requiremeasures that may be sensitive to changes in symptom severity over time. It was hoped that thetime frame for scoring the CV items could be changed from lifetime to a shorter period (say, thepast month). The CV contained only six items: Superficial, Grandiose, Manipulative, LacksRemorse, Lacks Empathy, and Doesn't Accept Responsibility. The content of these items wasderived directly from the PCL-R, but the item descriptions were short, presented in point form,and scored on the basis of a brief interview (10 to 20 minutes). As in the PCL-R, items werescored on a 3-point scale; total scores ranged from 0 to 12. The CV was tested in three differentstudies.Cox, Hart, and Hare (1989). We tested the CV at the Vancouver Pretrial Services Centre(VPSC), a maximum security jail in Vancouver, Canada. Subjects in this study were 100 malesremanded in custody (awaiting trial or a bail hearing) who were referred to staff psychologists formedical, psychological, or security reasons. We did not collect systematic data on thedemographic characteristics of these men; however, they ranged in age from 18 to over 60 years,most were White and English-speaking, and most were charged with violent or other seriousoffenses. Almost all the men had a previous criminal record. Although the sample was notrepresentative of all inmates at VPSC, it was probably very representative of inmates who aremonitored or screened by psychologists after admission.One of the researchers was employed as a consulting psychologist at the VPSC. He andanother researcher conducted a series of 100 joint assessments following the usual institutionalprocedures. Interviews covered the following areas: current charges and past criminal history;educational, occupational, and marital status; and current medical/psychological complaints. Brief37counseling followed some interviews. All available case history information was reviewed.Assessments lasted from 5 to 30 minutes in length, and averaged about 20 minutes. After eachassessment, both raters independently scored the CV and reviewed any scoring differences. Alldata were kept confidential and were not released to VPSC medical or security staff.The mean CV score (averaged across the two raters) was 6.24 (SD = 2.45). Theintraclass correlation coefficient interrater reliability for the single ratings (ICC j) was .86; thereliability of the averaged ratings (ICC2) was .92. The interrater reliability (r) of the individualitems ranged from .52 to .73. Reliability analyses based on the averaged ratings revealed a meaninter-item correlation (MIC) of .51 (range = .40 to .69); internal consistency, as measured byCronbach's alpha, was .86.The MIC and alpha coefficients observed indicated that the CV could be considered aunidimensional measure. To investigate this issue further, we conducted a principal componentsanalysis (PCA) of the averaged ratings. The PCA yielded one large component (eigenvalue =-3.54) accounting for 59% of the common item variance; all other components were much smaller(eigenvalues < .71) and accounted for less than 12% of the remaining variance each. All the CVitems had high loadings (> .69) on the first principal component; Item 1 (Superficial) had thehighest loading (.84).The cutoff score for a research diagnosis of psychopathy on the PCL-R is 30, a score thatis approximately 1 SD above the mean in most samples of male inmates (Hare, 1990). Thecomparable cutoff score for the CV was 9. We used this cutoff score to divide the two originalsets of CV ratings into two groups: those with a score of 9 or above were defined as psychopaths,and those with a score of 8 or less were considered to be nonpsychopaths. Using thesecategories, the kappa coefficient of diagnostic agreement between the two raters was .93.Applying the above cutoffs to the averaged CV ratings, the base rate of psychopathy in the samplewas 15%.Roy (1988). Roy examined the utility of "present-state" CV ratings, those made in theabsence of case history information. He determined the concurrent validity of these ratings in asample of 60 male federal inmates. All subjects previously had been assessed by independent38researchers using PCL(-R) and DSM-III(-R) criteria; Roy reassessed them between 1 and 24months later, and made CV ratings on the basis of a 30 to 40 minute interview. Subjects rangedin age from 20 to 58 years (mean = 30.5, SD = 8.7); they were serving aggregate sentences oftwo years or longer, mostly for violent offenses.The mean CV score in the sample was 6.7 (SD = 2.2), the mean PCL score was 26.6 (SD= 7.7), and the mean PCL-R score was 23.6 (SD = 8.2). Using DSM-III criteria, 35% of thesubjects met the criteria for APD; for DSM-III-R criteria, the figure was 41.7%. Roy (1988)reported that the interrater reliability of the PCL-R in his sample was r =.74; he did not reportreliabilities for the other measures.CV scores were correlated r = .42 with PCL Total scores and r = .38 with PCL-R Totalscores. Correlations with Factor 1 scores on the PCL and PCL-R were somewhat higher (r = .54and .47, respectively), whereas correlations with Factor 2 were lower (r = .23 and .22,respectively). Interestingly, the CV was uncorrelated with DSM-III and DSM-III-R diagnoses ofAPD (r = -.08 and -.09, respectively). Multiple regression analyses indicated that CV scores incombination with APD diagnoses predicted PCL and PCL-R Total scores significantly better thandid either CV scores or APD diagnoses alone (multiple Res ranging between .38 and .51). (Itshould be noted that none of the above correlations was disattenuated for the unreliability of thevarious measures across time or raters.)Roesch (1992). Roesch used the CV in another study of pretrial remands at VPSC.Subjects were a random sample of 861 men admitted to the jail over a 12-month period. Thesubjects ranged from 18 to 71 years in age (M = 30.4, SD = 9.2), and most (82.3%) had a priorcriminal record as an adult. Of these subjects, 684 (79.4%) completed an interview-based mentalhealth screening battery that included, in addition to the CV, the following instruments: the BriefPsychiatric Rating Scale (BPRS; Overall & Gorham, 1962), a 19-item symptom construct ratingscale of general psychopathology; the Referral Decision Scale (RDS; Teplin & Swartz, 1989), abrief structured interview for major mental disorders; and the Diagnostic Profile (Hart &Hemphill, 1989), a 7-item syndrome construct rating scale. Standard cutoffs were applied to theBPRS and the DP: Subjects with a "hit" on at least one scale were classified as mentally39disordered offenders (MDOs); subjects with no hits were designated as non-MDOs. A randomsubsample of 192 subjects, stratified according to MDO status, were subsequently administeredthe Diagnostic Interview Schedule (DIS; Robins, Helzer, Croughan, & Ratcliff, 1981). Also,conjoint screening interviews were conducted with 45 subjects to determine the interraterreliability of the rating scales.Complete CV ratings were available for 651 subjects. The mean CV total score was 4.58(SD = 3.16); using a cutoff of > 9, the base rate of psychopathy was 13.1%. These figures aresimilar to, although slightly lower than, those reported by Cox et al. (1989); the difference isprobably due to the sampling methods employed in the two studies. The internal consistency anditem homogeneity of the CV were high (alpha = .88; MIC = .56). In the subsample of 45subjects, the interrater reliability of the CV was acceptable (ICC1 = .80, ICC2 = .90), as wasinterrater agreement for psychopathy diagnoses (kappa = .73).A principal components analysis of the CV items once again yielded a single largecomponent (eigenvalue = 3.79) accounting for 63.2% of the common item variance; all othercomponents were much smaller (eigenvalues < .72) and accounted for 12% or less of theremaining variance each. All the CV items had high loadings (> .74) on the first principalcomponent; Item 4 (Lacks Remorse) had the highest loading (.83).With respect to validity, CV scores were negatively correlated with status as a MDO (r =-.11, p = .004). Looking at the DP, the CV was negatively correlated with scores on theDepressed and Organic syndrome scales (r = -.13 and -.12, respectively, both p < .002). On theBPRS, the CV was correlated positively with factors related to grandiosity (r = .43, p < .001) andhostility (r = .30, p < .001), and negatively correlated with factors of dysthymia (r = -.30, p <.001) and psychomotor retardation (r = -.12, p < .002). In the subsample assessed with the DIS,CV scores were positively correlated with APD diagnoses (made ignoring the exclusion criterion)(r = .16, p = .032) and negatively correlated with diagnoses of sexual disorders (r = -.19,p = .008).Summary. The results of these three studies were encouraging, and suggested that it wasindeed possible to shorten the PCL assessment procedure. However, two major problems were40apparent with the CV. First, factor analyses of the PCL and PCL-R conducted subsequent to theconstruction of the CV (Harpur et al., 1988; Hare et al., 1990) revealed that all six CV itemsreflected only Factor 1 of the PCL scales. That is, the CV neglected the social deviancecomponent of psychopathy. The CV's relatively low correlations with PCL(-R) Factor 2 (Roy,1988) and APD diagnoses (Roesch, 1992; Roy, 1988) support this view. The second problemwas that the CV allowed ratings to be made in the absence of case history information. There wassome evidence that such a procedure might result in a drop in reliability or validity (Roy, 1988); inaddition, it might make the CV unduly susceptible to deceitfulness. Given the arguments I putforward in the Introduction, it is clear that the CV must be considered flawed as a measure ofpsychopathy.2. Final Draft: The Screening Version of the Psychopathy Checklist (PCL:SV)Rather than develop a second scale de novo, it was decided to retain the CV's format andexpand its content. The six CV items were re-labeled "Part 1," analogous to Factor 1 of thePCL-R. Six new items were then added to tap Factor 2 symptoms: Impulsivity, Poor BehavioralControls, Lacks Goals, Irresponsibility, Childhood/Adolescent Antisocial Behavior, and AdultAntisocial Behavior. These were labeled "Part 2." In order to make the last two items moresuitable for use outside of forensic settings, their content was significantly altered from theoriginal PCL-R descriptions to include actions that did not result in formal contact with thecriminal justice system. It was also decided to make the use of case history information arequirement for scoring (at least for clinical purposes). The result of these efforts was a 12-itemscale, named the Screening Version of the Psychopathy Checklist (PCL:SV). The scale items arepresented in Table 3; details concerning item descriptions, administration, and scoring arepresented in Appendix A.The PCL:SV's name is an explicit recognition of its derivation from the PCL-R in contentand format. Items are scored using the same 3-point scale as in the PCL-R. Also, raters have theoption of omitting as many as three items if they feel there is insufficient information with whichto score it; scores are prorated to adjust for the missing items. The PCL:SV yields threedimensional scores. Total scores (the sum of Items 1 through 12) can range from 0 to 24, and41Table 3Items in the PCL:SVPart 1^ Part 21. Superficial2. Grandiose3. Manipulative4. Lacks Remorse5. Lacks Empathy6. Doesn't Accept Responsibility7. Impulsive8. Poor Behavior Controls9. Lacks Goals10. Irresponsible11. Adolescent Antisocial Behavior12. Adult Antisocial Behavior42reflect the degree of overall psychopathic symptomatology exhibited by the individual. Part 1 scores (sum of Items 1 through 6) can range from 0 to 12, and reflect the severity of theinterpersonal and affective symptoms of psychopathy (i.e., PCL-R Factor 1). Part 2 scores (sumof Items 7 through 12) can also range from 0 to 12, and reflect the severity of the social deviancesymptoms of psychopathy (i.e., PCL-R Factor 2). A Total score of at least 18 (equivalent to ascore of at least 30 on the PCL-R) is considered indicative of psychopathy.With respect to ease of administration, scoring, and training, note that the 12-itemPCL:SV represents a 40% reduction in length relative to the 20-item PCL-R. In addition, thePCL:SV excludes PCL-R items that are scored on the basis of detailed, highly specific, ordifficult-to-confirm information (e.g., marital or sexual history). Pilot testing revealed that thePCL:SV interview could be completed in 30 to 60 minutes, with the case history review andscoring requiring a further 20 to 30 minutes--a 50% reduction in administration time relative tothe PCL-R. Also, raters with varied educational and professional backgrounds, fromundergraduates to clinical psychologists, were easily trained with a program consisting of a 3-hourlecture and 10 practice ratings; the usual training program for the PCL-R involves 8 to 16 hoursof lecture plus the practice ratings.B. Validation of the PCL:SV1. OverviewResearch on the validation of the PCL:SV was funded by the MacArthur Risk Study (seePreface). I have collected data from 11 different samples comprising more than 500 subjects.Rather than treat each sample as an independent study, I will present results from all the samplescontemporaneously whenever practical. This should facilitate direct comparisons among thesamples and reduce redundancy in the descriptions of procedures and results. Certain results areunique to individual samples, however, and will be addressed separately.The validation research focused on several specific issues, not all of which wereinvestigated in each sample. First, I looked at the psychometric properties (distribution andreliability) of the PCL:SV. The facets of reliability examined included internal consistency, itemhomogeneity, and interrater reliability. Second, I looked at the factor structure of the PCL:SV.43Because it was derived from the PCL-R, which has two underlying factors correlated about r = .5,we expected that the PCL:SV would have a parallel structure. Third, I examined the concurrentvalidity of the PCL:SV with respect to PCL-R scores and adult symptoms of DSM-III-R APD. Iexpected the correlations among these measures to be high. In order to keep the PCL:SV ratingsindependent from the PCL-R and APD, different raters assessed them in different sessions,separated by a break of 2 to 7 days. PCL-R data were collected primarily in forensic settings toavoid ambiguity in the interpretation of the results. (Because the PCL-R was not designed for usein civil settings, a low correlation with the PCL:SV might well reflect problems with the PCL-Rrather than with the PCL:SV). I also examined concurrent validity with respect to self-reportquestionnaires related to psychopathy; however, based on past research (e.g., Hare, 1985; Hart,Forth, & Hare, 1991), I expected that self-reports would be only moderately correlated with thePCL:SV. Finally, I examined the convergent and discriminant validity of the PCL:SV. Indifferent samples, the PCL:SV was administered along with interview-based and self-reportmeasures of DSM-III-R Axis II disorders, as well as with measures of normal personality andstate measures of psychological distress at the time of assessment.2. SamplesThe 10 samples were drawn from four different settings--forensic/nonpsychiatric,forensic/psychiatric, civil/psychiatric, and civil/nonpsychiatric--with a total N of 586.Sample 1. Subjects were 50 adult male inmates at Matsqui Institution, a federal prison inBritish Columbia. Their average age was 29.0 years (SD = 7.7); 92.0% were White. All wereserving aggregate sentences of two years or longer, mostly for violent offenses.Sample 2. Subjects here were 32 adult female inmates at the Burnaby Correctional Centrefor Women (BCCW), a provincial prison in British Columbia. This sample included offendersserving provincial sentences (aggregate length of less than two years) and federal sentences (twoyears or longer). Their average age was 30.0 years (SD = 9.1); 81.3% were White. These datawere collected under the supervision of Ms. C. Strachan.Sample 3. Subjects were 67 adult male inmates at various federal prisons in Pacific(British Columbia) Region of the Correctional Service of Canada. Their average age was 33.744years (SD = 7.6); 90.9% were White. All were serving aggregate sentences of two years orlonger, mostly for violent offenses. These data were collected under the supervision of Dr. DonDutton as part of a larger study looking at the correlates of family violence in offenders (Dutton& Hart, 1992a, 1992b).Sample 4. This sample comprised 71 adult offenders (67 men and 4 women) attending theForensic Psychiatric Outpatient Clinic (FPOC), operated by the British Columbia ForensicPsychiatric Services Commission in Vancouver. Their average age was 37.4 years (SD = 10.0);90.1% were White. All were on probation or provincial parole and ordered to attend the FPOCfor psychiatric treatment (usually medications). Most had a diagnosis of a serious mental disorder(schizophrenia or some other psychotic disorder).Sample 5. Subjects were 49 adult male inpatients at the Kirby Forensic Psychiatric Centerin New York, NY. Their average age was 33.9 years (SD = 8.2); 16.3% were White. All wereinvoluntarily hospitalized due to incompetence to stand trial or insanity acquittal. These datawere collected under the supervision of Drs. R. Wack and D. Martel.Sample 6. Subjects were 48 adult psychiatric patients (21 men and 27 women) at theUniversity Hospital, UBC Site in Vancouver. Their average age was 32.8 years (SD = 14.7);93.8% were White. The sample included both inpatients and outpatients who were referred to thePsychology Department for psychodiagnostic assessment.Sample 7. This sample comprised 49 adult psychiatric patients (26 men and 23 women)attending the Western Psychiatric Institute and Clinic at Pittsburgh, PA. Their average age was34.0 years (SD = 9.9); 63.5% were White. These data were collected under the supervision ofDr. E. Mulvey.Sample 8. Subjects were 80 adult psychiatric patients (54 men and 26 women) at theGreater Kansas City Mental Health Center at Kansas City, MO. Their average age was 31.2 years(SD = 8.8); 66.3% were White. These data were collected under the supervision of Dr. D.Klassen.Sample 9. Subjects were 40 adult psychiatric patients (20 men and 20 women) at theWorcester State Hospital in Worcester, MA. Their average age was 32.6 years (SD = 8.9);4591.8% were White. These data were collected under the supervision of Drs. P. Appelbaum andT. Grisso.Sample 10. Subjects were 50 adult undergraduate students (25 men and 25 women)attending various faculties at the University of British Columbia in Vancouver. Their average agewas 24.8 years (SD = 6.7); 66.0% were White.Sample 11. Subjects in this sample were 50 adult psychology undergraduates (25 men and25 women) attending Carleton University in Ottawa, Ontario. Their average age was 20.2 years(SD = 2.2); 86.0% were White. These data were collected by Ms. S. Brown and Dr. A. Forth(Brown, Forth, Hart, & Hare, 1992).The composition of the samples is summarized in Table 4.3. ProcedureSubject recruitment procedures varied from site to site; subjects at some sites were paid,whereas those at others were voluntary. In each case, however, subjects gave informed consent,and all experimental procedures were given ethical approval by the appropriate university and/orinstitutional committees.The assessment battery completed by subjects also varied from site to site. The singlecommon element in the batteries was the PCL:SV, which was completed on the basis of a semi-structured interview and case history information. The interview was similar in structure, but notidentical, across the sites. The nature and quantity of case history information varied greatlyacross settings; indeed, no such information was available in Sample 10, and in Sample 11 itconsisted of telephone interviews with a collateral informant (usually a close friend or familymember) nominated by the subject. To allow the determination of interrater reliability, PCL:SVinterviews were videotaped at several sites, and the case history information was synopsized. Anindependent rater then completed the PCL:SV on the basis of this information. Where two sets ofratings were available, they were averaged for subsequent analyses.As noted earlier, several sites examined the concurrent validity of the PCL:SV withrespect to the PCL-R and DSM-III-R APD. At these sites, the PCL-R and APD ratings weremade on the basis of an independent interview, that is, not on the basis of the same interview that46Table 4Demographic Characteristics of Subjects^N^Age (yrs.)RaceSetting and Sample^M^F^All^M (SD)^(% White)Forensic!Nonpsychiatric1. Federal inmates 50 50 29.8 (7.7) 92.02. Provincial inmates 32 32 30.0 (9.1) 81.33. Federal inmates 67 --- 67 33.7 (7.6) 90.9Forensic/Psychiatric67 4 71 37.4 (10.0) 90.14. Outpatients5. Inpatients 49 --- 49 33.9 (8.2) 16.3Civil/Psychiatric6. Vancouver, BC 21 27 48 32.8 (14.7) 93.87. Pittsburgh, PA 20 20 40 34.0 (9.9) 63.58. Kansas City, MO 54 26 80 31.2^(8.8) 66.39. Worcester, MA 26 23 49 32.6 (8.9) 91.8Noncriminal/Nonpsychiatric10. UBC undergrads 25 25 50 24.8 (6.7) 66.011. Carleton undergrads 25 25 50 20.2 (2.2) 86.0Note. M = males; F = females. See text for a more detailed description of the samples andsettings.47was used to score the PCL:SV. To avoid undue contamination of the assessment interviews, theywere conducted by different interviewers, blind to each other's ratings, separated by a break of 2to 7 days. Note that the concurrent validity coefficients are thus attenuated both by temporalunreliability and by unreliability due to raters. From the concurrent validity of the PCL:SVobserved in these samples, then, we can estimate the lower bound of its test-retest reliability.All procedures included in the assessment batteries were administered and scoredaccording to the standard instructions, unless otherwise noted.4. ResultsDistribution of scores. Table 5 presents the mean and standard deviation of PCL:SVTotal, Part 1, and Part 2 scores in the 11 samples. The Table also presents the base rate ofpsychopathy (i.e., percent of subjects with a PCL:SV Total score > 18) in each sample. It is clearfrom the Table that PCL:SV scores varied significantly as a function of setting: the two forensicsettings had the highest scores, followed by the civil/psychiatric and the civil/nonpsychiatricsettings. The base rate of psychopathy in civil settings was very low--10% or less--in five of sixsamples, and only Sample 8 had a base rate greater than 10%. (Note that these results can beconsidered preliminary evidence of the concurrent validity of the PCL:SV.)It is interesting that in every sample, the mean Part 2 score was about 2 points higher thanthe mean Part 1 score. The reason for this is unclear. It may be that Part 1 items are slightlymore "difficult" than Part 2 items. That is, Part 1 items may be phrased conservatively, so thateven in the case of individuals who exhibit psychopathic symptoms that are all of equal severity,raters are constrained by the framework of the PCL:SV to give them higher scores on Part 1items than on Part 2 items. Alternatively, it may be that symptoms of psychopathy associatedwith Part 1 of the PCL:SV are, in general, less severe or less prevalent than symptoms associatedwith Part 2.There was considerable dispersion of PCL:SV scores within each sample, even in sampleswhere the base rate of psychopathy was very low. This is an important finding, as it suggests thatpsychopathic traits may prove useful for research or in predicting behavior even in settings whereno-one fulfills the diagnostic criteria for psychopathy.48Table 5Descriptive Statistics for PCL:SV Total, Part 1, and Part 2 ScoresSampleForensic/NonpsychiatricTotalPCL:SV ScorePart 1 Part 2BaseRate1. Federal inmates 15.77 (4.34) 6.95 (2.71) 8.82 (4.99) 34.02. Provincial inmates 16.41 (3.49) 7.30 (2.35) 9.11 (2.27) 37.53. Federal inmates 12.97 (4.92) 5.16 (2.91) 7.81 (2.94) 17.9Forensic/Psychiatric13.72 (4.05) 6.01 (2.43) 7.70 (2.19) 19.74. Outpatients5. Inpatients 16.56 (3.28) 7.55 (2.22) 9.01 (1.73) 34.7Civil/Psychiatric6. Vancouver, BC 5.18 (4.34) 2.01 (2.33) 3.17 (2.64) 2.17. Pittsburgh, PA 8.68 (5.92) 3.53 (2.83) 5.15 (3.66) 10.08. Kansas City, MO 13.14 (5.71) 5.33 (3.39) 7.81 (2.99) 23.89. Worcester, MA 9.63 (4.90) 3.35 (2.72) 6.29 (2.63) 6.1Noncriminal/Nonpsychiatric10. UBC undergrads^3.09 (3.43) 1.41 (1.83) 1.68 (1.85) 0.011. Carleton undergrads 2.88 (2.58) 1.02 (1.33) 1.86 (1.83) 0.0Note. SD in parentheses. Base rate is percent of subjects with a PCL:SV Total score > 18.49PCL:SV items. Appendix B contains the corrected item-total correlations of the PCL:SVitems with respect to Total, Part 1, and Part 2 scores in each of the 11 samples; Table 6 presentsthe mean weighted corrected item-total correlations across the 11 samples. As the Tableindicates, the item validities were all acceptable, with none lower than .40.Two independent sets of PCL:SV ratings were collected in seven samples. Appendix Bcontains the interrater reliability (r) of all 12 items in each of the seven samples; Table 6 alsopresents the mean weighted interrater reliability of the items across the seven samples. The meanweighted reliabilities were acceptable for all the items, ranging from .50 to .79 and averagingabout .60.Although I have not presented the descriptive statistics for the items across the samples, itis clear from the above results that none of the items has an extreme endorsement frequency, atleast not one extreme enough to adversely affect its reliability or validity.Internal consistency. Table 7 presents the internal consistency (Chronbach's alpha) of thePCL:SV Total, Part 1, and Part 2 scores across each of the 11 samples. Overall, the internalconsistency of PCL:SV Total scores was acceptable for a clinical scale, averaging about .84. Thisis particularly encouraging given the PCL:SV's relatively short length. Alphas for Part 1 and 2scores were somewhat lower (mean weighted alphas of .81 and .75, respectively), although this isto be expected as alpha is partially dependent upon scale length. Also, note that alphas for Part 1were generally higher than those for Part 2; interestingly, the same pattern holds true for PCL-RFactor 1 and 2 scores.Item homogeneity. Table 8 presents the item homogeneity (MIC) of the PCL:SV Total,Part 1, and Part 2 scores across each of the 11 samples. Recall that MIC is not dependent uponscale length; thus, the MICs for the Total and Parts are more directly comparable than are thealphas.The mean weighted MIC for the PCL:SV Total score was .32, indicating a high degree ofitem homogeneity. Indeed, this value exceeds the cutoff of .20 that is generally interpreted toreflect a unidimensional scale. DeSpite this, the division of the scale into two subscales appears to50Table 6Mean Weighted Interrater Reliabilities and Corrected Item-Total Correlations for the PCL:SVItems in the 11 SamplesItemInterraterReliabilityItem-Total CorrelationTotal^Part 1^Part 21. .60 .50 .572. .65 .50 .633. .62 .48 .474. .59 .65 .645. .57 .63 .636. .57 .55 .587. .59 .54 .588. .69 .43 .419. .60 .47 .4410. .53 .56 .5811. .79 .45 .5412. .50 .52 .53Median: .60 .51 .61 .54Mean: .61 .53 .59 .5251Table 7Internal Consistency (Chronbach's Alpha) of PCL:SV Total, Part 1, and Part 2 ScoresSampleForensic/NonpsychiatricTotalPCL:SV ScorePart 1 Part 21. Federal inmates .88 .89 .802. Provincial inmates .77 .82 .773. Federal inmates .81 .78 .76Forensic/Psychiatric4. Outpatients .83 .81 .705. Inpatients .72 .73 .52Civil/Psychiatric.88 .87 .846. Vancouver, BC7. Pittsburgh, PA .87 .78 .808. Kansas City, MO .88 .86 .809. Worcester, MA .83 .77 .67Noncriminal/Nonpsychiatric10. UBC undergrads .91 .84 .8111. Carleton undergrads .69 .58 .66Median: .83 .82 .77Weighted Mean: .84 .81 .7552Table 8Item Homogeneity (Mean Inter-Item Correlation) of PCL:SV Total Part 1, and Part 2 ScoresSampleForensic/NonpsychiatricTotalPCL:SV ScorePart 1 Part 21. Federal inmates .41 .57 .452. Provincial inmates .24 .44 .403. Federal inmates .27 .37 .35Forensic/Psychiatric.30 .42 .304. Outpatients5. Inpatients .17 .30 .16Civil/Psychiatric6. Vancouver, BC .40 .54 .467. Pittsburgh, PA .36 .38 .418. Kansas City, MO .39 .51 .409. Worcester, MA .30 .36 .26Noncriminal/Nonpsychiatric10. UBC undergrads .42 .49 .4011. Carleton undergrads .17 .18 .23Median: .30 .44 .35Weighted Mean: .32 .42 .3553be justifiable, as the mean weighted MICs for Parts 1 and 2 are even higher (.42 and .35,respectively).Interrater reliability. Table 9 presents the interrater reliability (ICC) of Total, Part 1, andPart 2 scores in the seven samples that collected two independent sets of PCL:SV ratings. TheTable presents both ICC 1, the reliability of ratings made by one rater, and ICC2, the reliability ofratings averaged across two independent raters. The mean weighted ICC 1 and ICC2 for Totalscores were quite high (.84 and .92, respectively) and adequate for research purposes. However,the ICC I may be too low for clinical purposes; those who wish to use the PCL:SV for makingimportant clinical decisions may wish to base such decisions on scores averaged across twoindependent raters.Note that although Part 1 scores are more internally consistent and have greater itemhomogeneity than do Part 2 scores, the latter have slightly higher interrater reliability. Onceagain, the results parallels those found using PCL-R Factor 1 and 2 scores. It may be thatpsychopathic symptoms related to Part 1 form a cluster that is naturally more cohesive than doPart 2 symptoms, but one that requires greater inference on the part of raters. Alternatively, itmay be that ratings of Part 1 symptoms are subject to a "halo effect" that increases their(apparent) internal consistency while decreasing their interrater reliability.The results presented so far in this section focus on the PCL:SV as a dimensional measure;however, the PCL:SV was also intended for use as a diagnostic instrument. I therefore examinedthe interrater agreement for PCL:SV diagnoses in those samples that had > 5 cases ofpsychopathy." Kappas were as follows: Sample 1, .70; Sample 2, .36; Sample 4, .36; and Sample5, .40. The mean weighted kappa across samples was .48, indicating moderate or fair agreement;this is very similar to the figure of .51 that is obtained by calculating kappa on the basis ofagreement data that is pooled across samples.15 Inclusion of the other samples would have skewed the results, as interrater agreement in themwas perfect. However, this agreement was due primarily to the total absence of psychopaths inSamples 10 and 11, and a near-total absence in Sample 6.54Table 9Interrater Reliability (ICC) of PCL:SV Total, Part 1, and Part 2 ScoresSampleForensic/NonpsychiatricN TotalPCL:SV ScorePart 1 Part 21. Federal inmates 50 .82 / .91 .84 / .92 .79 / .892. Provincial inmates 32 .70 / .85 .66 / .83 .81 / .90Forensic/Psychiatric59 .81 / .91 .81 / .90 .72 / .864. Outpatients5. Inpatients 26 .67 / .83 .59 / .80 .76 / .88Civil/Psychiatric28 .86 / .93 .80 / .90 .88 / .946. Vancouver, BCNoncriminal/Nonpsychiatric10. UBC undergrads 50 .92 / .96 .67 / .83 .82 / .9111. Carleton undergrads 50 .88 / .94 .80 / .90 .90 / .95Median: .82 /.91 .80 / .90 .81 / .90Weighted Mean: .84 / .92 .77 / .88 .82 / .91Note. ICC = intraclass correlation. Numbers before the oblique stroke are the ICC for singleratings (ICC1); numbers after, the ICC for averaged ratings (ICC2).55Correlation between Part 1 and 2 scores. Table 10 presents the correlation between Part 1and 2 raw scores in the 11 samples. These correlations varied considerably, ranging from .14 to.73. However, the mean weighted correlation, .53, is very much in line with expectations basedon research with the PCL-R (Hare, 1991).Factor structure of the PCL:SV. The PCL:SV is based on an explicit model ofpsychopathy that posits 2 oblique factors. The results discussed above offer some limited supportfor this model. A better test would involves the use of factor analytic methods; however, the useof multiple samples, all quite small in factor analytic terms, makes the use of these methodsproblematic.There are several possible strategies that could be used to investigate the factor structureof the PCL:SV. Given that there is an explicit theoretical structure underlying the items (i.e., twooblique factors correlated about .50), a confirmatory factor analysis makes good sense. However,because this is the first empirical investigation of the PCL:SV, the use of exploratory strategiescan also be justified.In light of the above discussion, I decided to use exploratory methods to conduct apreliminary investigation of the factor structure of the PCL:SV. Readers are cautioned not todraw firm conclusions from the following analyses; rather, they should be used to generatehypotheses for future research. I experimented with a variety of methods and found that anoblique two-factor solution, with unweighted least squares extraction and oblimin rotation of thefactors, was optimal. Appendix B contains the matrix of rotated factor loadings for each of the11 samples, as well as the eigenvalues and percentage of variance accounted for by each factor,that were obtained using this procedure.It is difficult to judge the comparability of the factor solutions across samples. To clarifythis issue, I calculated Coefficients of Congruence (CCs; Harman, 1976) for correspondingfactors in a pairwise manner across the 11 samples. That is, CCs were calculated for each of thetwo factors, comparing each sample with all of the others. This yielded a total of 110 CCs (55 foreach factor), which are presented in Table 11. (The Table does not present CCs between non-corresponding factors.) CCs for the factor that best reflected Part 1 of the PCL:SV are presented56Table 10Correlation Between PCL:SV Part 1 and Part 2 Scores in the 11 SamplesSampleForensic/Nonpsychiatric1. Federal inmates .522. Provincial inmates .143. Federal inmates .42Forensic/Psychiatric4. Outpatients .535. Inpatients .37Civil/Psychiatric6. Vancouver, BC .537. Pittsburgh, PA .668. Kansas City, MO .609. Worcester, MA .68NoncriminaUNonpsychiatric10. UBC undergrads .7311. Carleton undergrads .33Median: .53Weighted Mean: .53Table 11Coefficients of Congruence Between Factor Loadings for the Oblique, Two-Factor SolutionAcross the 11 SamplesSample 1 2 3 4 5 6 7 8 9 10 111. (.54) .98* .87* .94* .91* .94* .72 .94* .74 .64 .732. .95* (.09) .86* .91* .89* .91* .77 .91* .73 .61 .753. .85* .79 (.35) .91* .82 .82 .54 .83 .62 .48 .374. .89* .78 .90* (.50) .93* .95* .70 .94* .63 .58 .635. .69 .53 .75 .89* (.16) .89* .79 .88* .78 .72 .726. .95* .91* .86* .93* .73 (.39) .65 .97* .87* .54 .687. .86* .87* .82 .81 .62 .76 (.35) .62 .69 .62 .838. .88* .79 .84 .89* .66 .70 .73 (.53) .82 .66 .679. .67 .70 .70 .52 .23 .55 .75 .51 (.47) .47 .6110. .68 .76 .65 .67 .50 .64 .90* .56 .62 (.60) .6411. .82 .90* .74 .69 .38 .68 .92* .68 .79 .89* (.05)Note. Congruence coefficients for the factor corresponding to Part 1 are above the diagonal;those for the factor corresponding to Part 2 are below the diagonal; correlations between the twofactors are on the diagonal.58above the diagonal; those for the factor that best reflected Part 2, below. The correlation betweenthe rotated factors within each sample appear along the diagonal. In general, CCs greater than orequal to .85 are seen to reflect identical (or highly similar) factor structures; in the Table, these aremarked with an asterisk.As a gross index of a sample's overall comparability with the other 10 samples, I simplysummed the number of CCs > .85 for both factors. The maximum possible value for this indexwas 20. The value for the samples was as follows: Sample 1 = 12; Sample 2 = 9; Sample 3 = 6;Sample 4 = 11; Sample 5 = 6; Sample 6 = 10; Sample 7 = 4; Sample 8 = 7; Sample 9 = 1; Sample10 = 2; and Sample 11 = 3. Clearly, a few of the samples had factor solutions that did notcorrespond well with the others. To further investigate this issue, I correlated the comparabilityindex described above with several characteristics of the samples. For example, the indexcorrelated r = .16 with sample size, -.23 with the percentage of women in the sample, -.23 withthe percentage of non-Whites in the sample, and .41 with the mean age of subjects in the sample.All of these correlations were nonsignificant (df = 9, p > .10, two-tailed test), suggesting that thesize and demographic characteristics of the sample had little impact on the replicability of itsfactor structure. On the other hand, the level of psychopathic traits had a significant impact: Theindex correlated r = .55 with the mean PCL:SV Total score in the sample, .59 with the mean Part1 score, and .51 with the mean Part 2 score. These correlations approached statistical significance(df = 9, p < .10, two-tailed), and suggested that the two-factor structure of the PCL:SV could notbe recovered in samples with a relative absence of psychopathic symptomatology. Consistentwith this hypothesis, the index correlated r = .59 with the base rate of psychopathy in the sampleand .71 with the presence versus absence of an extreme base rate of psychopathy (i.e., prevalence< 10%). The latter correlation was highly significant (df = 9, p < .01, two-tailed). 16If the four samples in which the base rate of psychopathy was extreme (Samples 7, 9, 10,and 11) are excluded, the factor solution replicated quite well across samples, as Table 1216 In those samples with an extreme base rate, the two factors appeared to collapse into a singlefactor.59Table 12Coefficients of Congruence Between Factor Loadings for the Oblique, Two-Factor Solution in 7Samples with Appreciable Base Rates of PsychopathySample 1 2 3 4 5 6 81. (.54) .98* .87* .94* .91* .94* .94*2. .95* (.09) .86* .91* .89* .91* .91*3. .85* .79 (.35) .91* .82 .82 .834. .89* .78 .90* (.50) .93* .95* .94*5. .69 .53 .75 .89* (.16) .89* .88*6. .95* .91* .86* .93* .73 (.39) .97*8. .88* .79 .84 .89* .66 .70 (.53)Note. Congruence coefficients for the factor corresponding to Part 1 are above the diagonal;those for the factor corresponding to Part 2 are below the diagonal; correlations between the twofactors are on the diagonal.60indicates. Out of 21 pairwise CCs for the factor corresponding to PCL:SV Part 1, 18 were > .85,and the three others were > .82. For the factor corresponding to Part 2, 11 of 21 CCs were > .85;the others ranged from .53 to .79. The observed factor structures also corresponded quite well tothe theoretical structure of the PCL:SV, with most items having high and/or unique loadings onthe predicted factor.To summarize this section of the results, factor analysis offers tentative support for thetheoretical structure of the PCL:SV, although the oblique two-factor solution is not recovered insamples with an extreme base rate of psychopathy.Concurrent validity: PCL-R. The PCL:SV was correlated with independent PCL-Rratings in five samples; these correlations are presented in Table 13. As discussed earlier, byindependent I mean that different individuals made ratings on the basis of different interviewsconducted on different occasions, blind with respect to each other's results. Two sets ofindependent PCL:SV ratings were available for about 75% of the subjects in Table 13; however,only a single PCL-R rating was available for the vast majority of the subjects.The mean weighted correlation between Total scores on the two scales was .80 (range =.55 to .84). PCL:SV Total scores correlated about the same with PCL-R Factor 1 and 2 scores(mean weighted correlations = .67 and .68, respectively), whereas PCL-R Total scores correlatedhigher with PCL:SV Part 2 scores than with Part 1 scores (mean weighted correlations = .78 and.61, respectively). This latter result is not surprising, given that the content of the PCL-R isslightly biased towards Factor 2 (9 of 20 items, versus 8 of 20 items for Factor 1).The Table also supports the concurrent validity of the PCL:SV subscales. Part 1 scorescorrelated higher with PCL-R Factor 1 scores than they did with Total or Factor 2 scores (meanweighted correlations of .68 versus .61 and .40, respectively). Similarly, Part 2 scores correlatedhigher with PCL-R Factor 2 scores than they did with Total or Factor 1 scores (.81 versus .78and .48, respectively).Diagnostic agreement between the PCL:SV and PCL-R was examined in samples that had> 5 cases of psychopathy according to either scale. Kappas were as follows: Sample 1, .54;Sample 2, .37; Sample 4, .45; and Sample 5, .37. The mean weighted kappa across the four61Table 13Concurrent Validity: Correlations With PCL-R Total and Factor ScoresSamplePCL:SVScore TotalPCL-R ScoreFactor 1 Factor 21. Federal inmates Total .78** .62** .64**(N = 50) Part 1 .62** .64** .38*Part 2 .77** .43** .79**2. Provincial inmates Total .81** .50** .73**(N = 32) Part 1 .45* .57** .24Part 2 .77** .18 .88**4. Outpatients Total .84** .76** .71**(N = 65) Part 1 .72** .79** .49**Part 2 .75** .52** .76**5. Inpatients Total .55** .45** .39*(N = 47) Part 1 .44** .52** .17Part 2 .47** .18 .52**10. UBC undergrads Total .81** .78** .78**(N = 49) Part 1 .63** .68** .57**Part 2 .88** .77** .88**Median: Total .81 .62 .71Part 1 .62 .64 .38Part 2 .77 .43 .79Weighted Mean: Total .80 .67 .68Part 1 .61 .68 .40Part 2 .78 .48 .81Note. PCL-R = Revised Psychopathy Checklist (Hare, 1991). * Test-wise p < .05, ** column-wise p < .05 (both one-tailed).62samples was .44, indicating moderate or fair agreement; the kappa calculated on the agreementdata pooled across the samples was .46. If we consider PCL-R diagnoses to be the criterion, thenthe pattern of PCL:SV diagnostic errors was asymmetric: false positive decisions outnumberedfalse negatives by a factor of 5 to 1. (Of course, it could just as easily be argued that the PCL-Runderdiagnoses psychopathy.)These concurrent validities are surprisingly high, given that they are attentuated by severalsources of unreliability, and suggest that the PCL:SV could be considered a parallel form of thePCL-R. Also, because the two instruments were administered about a week apart, we canconclude that the short-term temporal stability of the PCL:SV must be high (for Total scores, atleast r > .81, and probably r > .85).Concurrent validity: APD. The PCL:SV was correlated with independent APD ratings insix samples; these correlations are presented in Table 14. The APD ratings were actually a countof the number of adult (Criterion C) APD symptoms that the subject exhibited. Two sets ofindependent PCL:SV ratings were available for about 65% of the subjects in Table 14; however,only a single APD rating was available for the vast majority of the subjects. (Note that althoughindependent of PCL:SV ratings, the APD assessments were not necessarily independent of PCL-Rratings.)The mean weighted correlation between PCL:SV Total scores and APD ratings across thesix samples was .70 (range = .52 to .85). As expected, Part 1 scores correlated lower with theAPD ratings than they did with Part 2 scores (mean weighted correlations of .49 and .72,respectively). Once again, these concurrent validities were surprisingly high in light of theirattenuation due to several sources of unreliability, and were very similar to results found using thePCL-R.Concurrent validity: Self-report measures. The association between PCL:SV scores andself-report measures of psychopathy and/or APD was examined in five samples. The self-reportsincluded the CPI So scale, the MCMI-II 6A scale, and Hare's unpublished Self-ReportPsychopathy scale (SRP; see Hare, 1985). The concurrent validities are reported in Table 15.63Table 14Concurrent Validity: Correlations With APD Adult SymptomsSample N TotalPCL:SV ScorePart 1 Part 21. Federal inmates 50 .62** .46** .64**2. Provincial inmates 24 .52** .06 .68**4. Outpatients 52 .61** .51** .56**6. Vancouver, BC 27 .85** .73** .85**10. UBC undergrads 49 .67** .51** .74**11. Carleton undergrads 50 .78** .49** .75**Median: .65 .51 .72Weighted Mean: .70 .49 .72Note. APD = DSM-III-R antisocial personality disorder (American Psychiatric Association,1987). * Test-wise p < .05, ** column-wise p < .05 (both one-tailed).64Table 15Concurrent Validity: Correlations With Self-Report Measures of Psychopathy/APDPCL-SV ScoreSample N Total^Part 1 Part 2CPI Socialization ScaleSample 2 28 -.29^-.14 -.32*Sample 10 48 -.47**^-.27* -.59**Self-Report Psychopathy ScaleSample 2 27 .69**^.41* .70**Sample 4 63 .53**^.45** .48**Sample 10 49 .63**^.48** .58**Sample 11 50 .64**^.48** .56**MCMI-II Antisocial ScaleSample 3 40 .68**^.53** .67**Note. CPI = California Psychological Inventory (Gough, 1987); MCMI-II = Millon ClinicalMultiaxial Inventory-II (Millon, 1987). * Test-wise p < .05, ** test-wise p < .001 (both one-tailed).65The correlations between the PCL:SV and the three self-reports were moderate to large inmagnitude. Indeed, the correlations with 6A and the SRP were larger than those typicallyreported between clinical-behavioral and self-report measures of psychopathy, as reviewed in theIntroduction, a finding that may bode well for the use self-reports in future research. There was aconsistent tendency for the self-reports to have higher correlations with Part 2 than with Part 1.This parallels the results of research conducted using the PCL-R factors, and supports the viewthat the content of self-reports is somewhat biased towards the social deviance facet ofpsychopathy.Convergent validity: DSM-III-R personality disorders. In past research, the PCL-R hasshown an interesting pattern of association with various measures of the DSM-III (-R) personalitydisorders. In a study that used clinical ratings of the personality disorders in a sample of 80forensic psychiatric patients (Hart & Hare, 1989), PCL-R Total scores were positively correlatedwith antisocial, narcissistic, and histrionic personality disorder ratings; and uncorrelated ornegatively correlated with ratings of other disorders. Factor 1 scores had a pattern of correlationsvery similar to that of Total scores, whereas Factor 2 correlated only with APD ratings. Inanother study that used the MCMI-II in a sample of 119 prison inmates (Hart, Forth, & Hare,1991), Total scores were positively correlated with scales measuring antisocial, sadistic, paranoid,narcissistic, borderline, passive-aggressive, and schizotypal personality disorder; and uncorrelatedor negatively correlated with scales measuring the other disorders. In that study, all the MCMI-IIscales correlated higher with Factor 2 than with Factor 1. On the basis of this research, I decidedto test the PCL:SV's convergent validity vis-a-vis the DSM-III-R personality disorders in twosamples; I predicted that Total scores would be positively correlated with the Cluster B(Dramatic-Erratic-Emotional) antisocial, narcissistic, histrionic, and borderline disorders, as wellas with sadistic personality disorder.In Sample 6, we tested the PCL:SV against the Personality Disorder Examination (PDE;Loranger, 1988), a clinical-behavioral measure of the DSM-III-R personality disorders. Evidenceis accumulating supporting the PDE's reliability and validity (e.g., Loranger, Susman, Oldham, &Russakoff, 1987; Standage & Ladha, 1988). Although the PDE is not the "gold standard" for66personality disorder assessment, it is widely recognized as one of the best available measures, asevidenced by its inclusion in the World Health Organization's International Pilot Study onPersonality Disorders (Loranger, Hirschfeld, Sartorius, & Regier, 1991). The PDE is scored onthe basis of a semi-structured interview and file review. In the present study, it was administeredby graduate students in clinical psychology separately from the PCL:SV assessment procedures;however, these assessments were not blind. That is, in the majority of cases, the researcher whoadministered the PDE also rated the same subject on the PCL:SV. (The plan was to have a leastone set of independent PDE and PCL:SV ratings for each subject; however, a large number ofvideotaped interviews were accidentally damaged by a research assistant before they could bedouble-rated.) The PDE interview is used to rate 126 separate items on a 3-point scale (0 —absent, 1 = subclinical, 2 = present). Item ratings are then transformed to yield a score for eachDSM-III-R personality disorder symptom, using the same 3-point scale. The symptoms ratingscan then be used to make dimensional ratings (the sum of symptom ratings), symptom counts (thenumber of symptoms rated present), and diagnoses (according to DSM-III-R diagnostic rules) foreach personality disorder. I analyzed dimensional ratings, as the base rate of diagnoses wasextremely low (i.e., < 10%) for most disorders. The correlations between the PCL:SV and thePDE dimensional ratings are presented in Table 16. As predicted, Total scores were correlatedwith the ratings of Cluster B disorders and sadistic personality disorder, as well as with passive-aggressive personality disorder. Part 1 scores were correlated more highly with narcissistic andhistrionic ratings than were Part 2 scores, whereas Part 2 scores were more highly correlated withantisocial, borderline, passive-aggressive, and sadistic ratings than were Part 1 scores.The PCL:SV was correlated with the MCMI-II, a self-report measure of psychopathology,in Sample 3. I analyzed base rate (BR) scores on the MCMI-II, rather than raw scores. Thepattern of correlations observed, presented in Table 17, was similar in many ways to that obtainedusing the PDE, although there were some interesting differences. For example, in addition to thepredicted correlations, Total scores were also correlated with MCMI-II scales measuringschizotypal, paranoid, and self-defeating personality disorder. The latter results are, in somerespects, theoretically incongruous, but consistent with previous research (Hart et al., 1991); they67Table 16Convergent Validity: Correlations With PDE Ratings in Sample 6PDE Rating TotalPCL:SV ScorePart 1 Part 2Paranoid .12 .07 .13Schizoid .04 -.04 .11Schizotypal -.16 -.23 -.06Antisocial .74** .46** .83**Borderline .48** .24 .59**Histrionic .45** .45* .36*Narcissistic .58** .63** .41*Avoidant .06 .03 .07Dependent .20 .11 .24Obsessive-Compulsive -.03 -.12 .06Passive-Aggressive .54* * .37* .57**Sadistic .47** .39* .44*Self-Defeating .18 .12 .20Note. N = 38. PDE = Personality Disorder Examination (Loranger, 1988). * Test-wise p < .05,** column-wise p < .05 (both one-tailed).68Table 17Convergent Validity: Correlations With MCMI-II Personality Disorder Scales in Sample 3 PCL:SV ScoreMCMI-II Scale Total Part 1 Part 2Schizoid (1) .23 .26 .14Avoidant (2) .22 .02 .35*Dependent (3) -.23 -.26 -.16Histrionic (4) .16 .14 .14Narcissistic (5) .44** .48** .30*Antisocial (6A) .68** .53** .67**Aggressive/Sadistic (6B) .44** .50** .29*Compulsive (7) .08 .23 -.09Passive-Aggressive (8A) .48** .43** .42**Self-Defeating (8B) .28* .13 .37*Schizotypal (S) .50** .32* .55*Borderline (C) .45** .34* .46**Paranoid (P) .40* .39* .33*Note. N = 40. MCMI-II = Millon Clinical Multiaxial Inventory-II (Millon, 1987). * Test-wise p< .05; ** column-wise p < .05 (both one-tailed).69may reflect problems with the content-related validity of the MCMI-II, or sophisticateddissimulation or image-management on the part of respondents (Hare, Forth, & Hart, 1989; Hart,Forth, & Hare, 1991). Part 1 scores were correlated more highly than Part 2 scores with thescales measuring sadistic, narcissistic, and paranoid personality disorder; Part 2 scores werecorrelated more highly than Part 1 scores with scales related to antisocial, schizotypal, borderline,self-defeating, and avoidant personality disorder. None of the PCL:SV scales correlatedsignificantly with the MCMI-II histrionic personality disorder scale.To summarize the results of this section, across two samples and two methods ofassessment, PCL:SV Total scores were positively correlated with the Cluster B (Dramatic-Erratic-Emotional) antisocial, narcissistic, and borderline personality disorders; they were alsopositively correlated with passive-aggressive and sadistic personality disorder. Correlations withother personality disorders were either small, negative, or inconsistent across methods.Convergent validity: Normal personality. There have been several studies looking at theassociation between psychopathy and various models of normal personality, most notably the fivefactor (or Big 5) and interpersonal circumplex models (for a review, see Harpur, Hart, & Hare, inpress). Most research has used the PCL-R to assess psychopathy and self-reports such as theNEO Personality Inventory (NEO-PI; Costa & McCrae, 1985) or the revised InterpersonalAdjective Scales (IAS-R; Wiggins, Trapnell, & Phillips, 1988) to measure normal personality;however, some research has also used observer ratings of normal personality (e.g., Foreman,1988). In studies of the five factor model, psychopathy was generally negatively correlated withthe dimensions of Agreeableness and Conscientiousness; correlations with Extraversion,Openness, and Neuroticism were smaller in magnitude and inconsistent. In studies of theinterpersonal circumplex model, psychopathy was generally positively correlated with Dominanceand negatively correlated with Love (or Nurturance).I looked at the association between the PCL:SV and the five-factor model of personalityin Sample 6. Patients completed a self-report version of the IAS-R that was expanded to includedomain markers for the Big 5 dimensions of Neuroticism, Conscientiousness, and Openness (IAS-R B5; Trapnell & Wiggins, 1991). The IAS-R B5 is a 124-item adjective rating scale. In the70present study, subjects indicated the degree to which each adjective was characteristic of themusing an 8-point scale (1 = very uncharacteristic, 8 = very characteristic). Sixty-four items weresummed to yield scores for eight octants of the interpersonal circumplex (8 items per scale), andthe octant scores were then standardized using norms derived from research with collegestudents. Scores for the interpersonal circumplex dimensions of Dominance and Love werecalculated from standardized octant scores using the geometric algorithm recommended byWiggins et al. (1988). Research suggests that Dominance and Love are equivalent to the Big 5dimensions of Extraversion and Agreeableness, merely rotated clockwise by about 30° (McCrae &Costa, 1989). Scores for the other three Big 5 dimensions were obtained by summing theremaining items (20 items per scale); these scores were also standardized using college studentnorms. Based on past research and clinical theory, I predicted that PCL:SV Total scores wouldbe positively correlated with Dominance and negatively correlated with Love, Neuroticism,Conscientiousness, and Openness. The observed correlations are presented in Tables 18 and 19.As predicted, Total scores were negatively correlated with Conscientiousness andOpenness. Also, Part 2 scores were more strongly correlated than Part 1 scores with thesedimensions. However, Total scores were uncorrelated with the domains of Dominance and Love,and had only a small and marginally significant negative correlation with Unassured-Submissiveoctant scores. The reasons for the lack of strong results are unclear, but may include thefollowing. First, there was a little variability in the range of self-reported scores on the latterscales, with most subjects rating themselves as very low on Dominance, very high on Neuroticism,and somewhat above average on Love. (This description is not surprising given the compositionof the sample, which consisted entirely of civil psychiatric patients.) Second, it appeared thatseveral subjects rated themselves inaccurately on these dimensions. For example, one subject witha high score on the PCL:SV--in fact, the only one in this sample to exceed the cutoff forpsychopathy--rated himself as very low on Dominance and very high on Love. These self-ratingsappeared to contradict his behavior prior to hospitalization, as revealed in his PCL:SV and PDEinterviews and hospital records. Such (apparently) inaccurate ratings may be the result ofconscious attempts to manipulate assessors or of deficits in self-awareness (Hare, Forth, & Hart,71Table 18Convergent Validity: Correlations With IAS-R B5 Domain Self-Ratings in Sample 6PCL-SV ScoreIASR-B5 Domain^Total^Part 1^Part 2Dominance^.12^.07^.13Nurturance .04 -.04 .11Neuroticism^-.16^-.23^-.06Conscientiousness^-.74** -.46** -.83**Openness^-.48**^-.24^-.59**Note. N = 42. IASR-B5 = Revised Interpersonal Adjective Scales, Big 5 Version (Trapnell &Wiggins, 1991). * Test-wise p < .05; ** column-wise p < .05 (both one-tailed).72Table 19Convergent Validity: Correlations With IAS-R B5 Octant Self-Ratings in Sample 6PCL:SV ScoreIAS-R Octant Rating Total Part 1 Part 2PA: Assured-Dominant .07 .16 -.04BC: Arrogant-Calculating .22 .15 .24DE: Cold-Hearted .10 -.03 .20FG: Aloof-Introverted .09 -.00 .16HI: Unassured-Submissive -.30* -.24 -.30*JK: Unassuming-Ingenuous -.15 -.10 -.16LM: Warm-Agreeable .01 .06 -.03NO: Gregarious-Extraverted .00 .03 -.03Note. N = 42. IAS-R B5 = Revised Interpersonal Adjective Scales, Big 5 Version (Trapnell &Wiggins, 1991). * Test-wise p < .05, ** column-wise p < .05 (both one-tailed).731989; Hart, Forth, & Hare, 1991). Finally, it may be that the PCL:SV was truly unassociatedwith Dominance, Love, and Neuroticism.It was my intention to have naive observers make IAS-R B5 ratings of all the subjects inSample 6. This would have allowed us to determine whether observer ratings of normalpersonality yielded stronger correlations with the PCL:SV than did self-ratings. Unfortunately,the damage to the videotaped interviews made this impossible. We were able to test this observerrating procedure using 24 videotaped interviews, 12 with male students from Sample 10 and 12with male inmates from Sample 1 (Hart & Hare, in press). We used a mixed sample to insure thatthe sample was heterogeneous with respect to personality pathology; however, this also had theundesired effect of making Part 1 and 2 scores highly correlated in the sample, so we analyzedonly Total scores. Observers were two female undergraduate students who rated subjects on theIAS-R B5 with only a minor variation in the standard instructions (i.e., "Rate the degree to whichthe following adjectives are characteristic of the individual..."). The observers were blind toPCL:SV scores, IAS-R B5 scoring, and the experimental hypotheses. Interrater reliability of theIAS-R B5 observer ratings was moderate, but adequate for research purposes. PCL:SV Totalscores were then correlated with (unstandardized) scores on the Big 5 domain markers and theinterpersonal circumplex octants; these correlations are presented in Tables 20 and 21.As the Table indicates, the results were quite strong and statistically significant, despite thesmall sample size: Total scores were positively with Dominance and negatively with the remainingdomains. The smallest correlation was with Neuroticism (-.44), which may be due to the fact thatthis is the least publicly observable dimension (Paunonen, 1989). (Alternatively, it may be thatpsychopathy is negatively associated with most facets of Neuroticism, such as depression, anxiety,and a sense of vulnerability, but positively associated with other facets, such as irritability.) Totalscores also correlated most positively with the Arrogant-Calculating octant and most negativelywith the Unassuming-Ingenuous octant (.90 and -.92, respectively). Interestingly, much the samepattern of correlations was found within the student and inmate subsamples, suggesting that thefindings were not due to stereotyped perceptions of inmates or students. The results of this pilotresearch lead me to conclude that there may indeed be substantial correspondence between74Table 20Convergent Validity: Correlations With IASR-B5 Domain Observer Ratings in Students andInmates SampleDomain Students Inmates CombinedDominance .60* .52* .64**Love -.07 -.64* -.83**Neuroticism -.57* -.41 -.44*Conscientiousness -.36 -.79** -.82**Openness .14 -.54* -.77**N 12 12 24Note. IAS-R B5 = Revised Interpersonal Adjective Scales, Big 5 Version (Trapnell & Wiggins,1991). * Test-wise p < .05, ** column-wise p < .05 (both one-tailed).75Table 21Convergent Validity: Correlations With IAS-R B5 Octant Observer Ratings in Students andInmatesSampleDomain Students Inmates CombinedPA: Assured-Dominant .19 .39 .53**BC: Arrogant-Calculating .81** .76** .90**DE: Cold-hearted -.04 .73** .86**FG: Aloof-Introverted -.32 .08 .41*HI: Unassured-Submissive -.38 -.47 -.66**JK: Unassuming-Ingenuous -.66* -.84** -.92**LM: Warm-Agreeable -.11 -.69* -.83**NO: Gregarious-Extraverted .39 .07 -.18N 12 12 24Note. IASR-B5 = Revised Interpersonal Adjective Scales, Big 5 Version (Trapnell & Wiggins,1991). * Test-wise p < .05, ** column-wise p < .05 (both one-tailed).76psychopathy and the Big 5, and that the failure to find such an association in Sample 6 was theresult of problems assessing personality pathology via self-report.Convergent validity: Substance use. The PCL-R has been associated with substance use--more specifically, measures of alcohol and drug abuse and dependence--in four different studies(Hart, Forth, & Hare, 1991; Hart & Hare, 1989; Hemphill, Hart, & Hare, 1992; Smith &Newman, 1991). A recent meta-analysis indicated that, across all these studies, Factor 2 hadsignificantly larger correlations with measures of substance use than did Factor 1 (Hemphill et al.,1992).Well-validated self-report measures of substance use were administered to subjects inSamples 3, 10, and 11. Alcohol use was assessed using the Michigan Alcoholism Screening Test(MAST; Selzer, 1971) in all three samples and the Alcohol Dependence (B) scale of the MCMI-IIin Sample 3 only. Drug use was assessed using the Drug Abuse Screening Test (DAST; Skinner,1982) in all three samples and the Drug Dependence (/) scale of the MCMI-II in Sample 3 only.Correlations between these measures and the PCL:SV are presented in Table 22. As expected,correlations with Total and Part 2 scores were moderate to high in magnitude, and all werestatistically significant. A few correlation with Part 1 scores were also significant; however, ineach instance, the correlations with Part 2 scores were much larger.Discriminant validity: Mood state at assessment. As discussed in the Introduction,psychopathy is a chronic disorder; therefore, psychopathy measures should be stable over timeand relatively immune to the effects of state variables, such as mood at the time of assessment.Research indicates that this pattern holds true for the PCL-R (e.g., Harpur et al., 1989). I havealready presented some evidence suggesting that the short-term test-retest reliability of thePCL:SV is high; below, I examine the impact of mood states on assessment.The two mood states most often seen as possibly interfering with the assessment ofpersonality disorder are anxiety and depression (e.g., Reich, 1987). Self-report measures of thesemood states were administered to subjects in Samples 2, 4, 6, 10, and 11, on the day that theycompleted the PCL:SV interview. Anxiety was assessed using the State and Trait forms of theState-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970); depression was77Table 22Convergent Validity: Correlations With Measures of Alcohol and Drug AbusePCL-SV ScoreSample Scale N^Total Part 1 Part 2Alcohol AbuseSample 3 MCMI-II 40^.50** .23 .65**MAST 61^.35* .06 .50**Sample 10 MAST 48^.39** .27* .47**Sample 11 MAST 50^.51** .13 .63**Drug AbuseSample 3 MCMI-II 40^.64** .47** .70**DAST .37* .07 .52**Sample 10 DAST 48^.62** .47** .73**Sample 11 DAST 50^.59** .20 .68**Note. MCMI-II = Millon Clinical Multiaxial Inventory-II (Millon, 1987); MAST = MichiganAlcoholism Screening Test (Selzer, 1971); DAST = Drug Abuse Screening Test (Skinner, 1982).* Test-wise p < .05, ** test-wise p < .001 (both one-tailed).78assessed using the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh,1961). The correlations are presented in Table 23. As expected, PCL:SV Total scores did notcorrelate significantly with the BDI, STAI-State, or STAI-Trait in any of the samples; the meanweighted correlations across samples were .05, .06, and .06, respectively. Although they are notpresented in the Table, correlations with Parts 1 and 2 scores were also small and nonsignificant.I conclude that PCL:SV ratings were not unduly influenced by subjects' mood states at the time ofassessment.Discriminant validity: Age, sex, and race. There are few data available concerning theassociation between psychopathy and demographic variables such as age, sex, and race. ThePCL-R manual (Hare, 1991) summarizes some published and unpublished studies suggesting thatrace differences within samples appear to be small in terms of effect size, although on occasionthey are statistically significant. With respect to age, cross-sectional analyses suggest that PCL-RTotal scores have a small, negative correlation with age. There are no systematic data as yetconcerning sex differences on the PCL-R; there is no compelling theoretical reason to expect sucha difference, although epidemiological research on APD suggests that the prevalence rate in menis higher than that in women (Robins et al., 1991).I examined the association between PCL:SV Total scores and basic demographiccharacteristics in all 11 samples; the results are presented in Table 24. Consistent with researchon the PCL-R, correlations with age were generally small (reaching statistical significance only inSample 2) and mostly negative in direction (in 8 of 11 samples). The mean weighted correlationwith age across samples was -.07. Similarly, the correlations between Total scores and race(dummy coded, 1 = White, 2 = non-White) were mostly small, negative in direction, andnonsignificant; the mean weighted correlation across 8 samples was -.08." However, correlationsbetween Total scores and sex (dummy coded, 1 = male, 2 = female) were significant and negative17 Subject-by-subject race data were not available for Samples 7, 8, and 9.79Table 23Discriminant Validity: Correlations with Self-Reported Depression (Beck Depression Inventory)and Anxiety (State-Trait Anxiety Inventory) at the Time of AssessmentSample Depression StateAnxietyTrait2. Provincial inmates -.22 -.124. Outpatients .06 .06 .206. Vancouver, BC .12 .21 .2110. UBC undergrads .14 -.02 -.0411. Carleton undergrads -.16Median: .09 .02 .08Weighted Mean: .05 .06 .06Note. Ns are as follows: Sample 2, 29; Sample 4, 62 for Depression and 64 for Anxiety; Sample6, 44 for Depression, 41 for State Anxiety, and 43 for Trait Anxiety; Sample 10, 49; and Sample11, 50. Anxiety scores are percentiles corrected for setting, age, and sex. None of the test-wisecorrelations are significant at p < .05 (two-tailed).80Table 24Discriminant Validity: Correlations with Age, Sex, and RaceSetting and SampleForensic/NonpsychiatricAge-.22-.37*-.12Sex Race-.26.00-.071. Federal inmates2. Provincial inmates3. Federal inmatesForensic/Psychiatric-.10 .054. Outpatients5. Inpatients .17 .01Civil/Psychiatric6. Vancouver, BC .15 -.43** -.217. Pittsburgh, PA -.07 -.35*8. Kansas City, MO -.05 -.27**9. Worcester, MA -.26 -.23Noncrhninal/Nonpsychiatric10. UBC undergrads .17 -.39** -.1411. Carleton undergrads -.09 -.33** -.06Median: -.09 -.34 -.07Weighted Mean: -.07 -.33 -.08Note. Coding is as follows: Age, age in years; Sex, 1 = female, 2 = male; and Race, 1 = White,2 = non-White. * Test-wise p < .05, ** column-wise p < .05 (two-tailed).81in 5 of 6 samples's, with a mean weighted correlation of -.33. This suggests that there mayindeed be a small but significant sex difference in the prevalence of psychopathic symptoms, withmen having more symptoms than women, although possible methodological artifacts such as aselection bias, a sex bias in the content of the PCL:SV items, or a Sex of rater by Sex of subjectinteraction will need to be ruled out in future research.To summarize the results of this section, PCL:SV Total scores did not appear to be undulyinfluenced by subjects' age or race; sex appeared to have a modest but robust impact on ratings,with women receiving lower scores than men. Although these findings may have importantclinical implications for the use of the PCL:SV, any general conclusions about the associationbetween psychopathy and demographics must await the results of large-scale epidemiologicalstudies.C. Summary of Chapter 2At the beginning of this Chapter, I set out three requirements for the development andvalidation of a new scale for the assessment of psychopathy, which in turn were based on theliterature review in Chapter 1. If we use these requirements as criteria for judging the resultsdescribed in the remainder of this Chapter, then it appears that the PCL:SV must be considered asuccess. First, the PCL:SV has good psychometric properties, and it is clearly reliable enough foruse in research (although for clinical purposes, which require a higher standard of reliability, itmay be necessary to use PCL:SV scores averaged across two or more independent raters).Second, the scale is conceptually and empirically related to the PCL-R. Like the PCL-R, thePCL:SV appears to have a two-facet structure, and PCL:SV scores correlate highly with theirPCL-R counterparts. Indeed, the degree of convergence between the scales is so high that, inmany respect, the PCL:SV can be considered a parallel form of the PCL-R. And third, despite itssimilarity to the PCL-R, the PCL:SV requires less time, effort, and training to administer, and it issuitable for use outside of forensic settings.18 No correlation was computed for Sample 4 because so few subjects were female; the remainingsamples were either all male or all female.82CHAPTER 3: DISCUSSIONIn the final Chapter, I will discuss the implications of this study for research and clinicalpractice. As I have already summarized and discussed many aspects of the results, I will focus onwhat is not known about or what remains to be done with the PCL:SV.A. Implications for Clinical PracticeIs the PCL:SV ready for clinical use? There is no simple answer to this question. On theone hand, there is a need for more basic information on the PCL:SV's psychometric properties,including its standard errors of measurement, its factor structure, and interrater agreement forpsychopathy diagnoses (these will be discussed in detail below). On the other hand, there isconsiderable evidence that the scale is reliable (internally consistent, stable across time and raters)and valid (appropriate content, associated with other measures of the same construct, theoreticallyconsistent pattern of associations with other constructs). In fact, there is now probably as muchor even more evidence supporting the reliability and validity of the PCL:SV than there issupporting that of other psychopathy-related scales, such as 6A of the MCMI-II (which iscurrently one of the most popular and widely-used psychopathology inventories). Perhaps itwould be most appropriate to make a few specific recommendations concerning the clinical use ofthe PCL: S V.1. The PCL:SV as a Measure of Psychopathic TraitsThe available evidence supports the use of PCL:SV Total scores to make statementsconcerning the relative strength of psychopathic traits in correctional, forensic psychiatric, andcivil psychiatric settings. However, there is not enough evidence at present to support the use ofPCL:SV diagnoses or subscale scores as the sole criterion by which to make important clinicaldecisions. This begs the question, what is the utility of PCL:SV scores? High scores should alertclinicians to the possible presence of comorbid disorders, such as substance use or Axis II ClusterB personality disorders. Clinicians could also use high PCL:SV scores to alert them to furtherevaluate issues such as potential for violence towards others (i.e., dangerousness), potential fordisruptive behavior on hospital wards, poor suitability for interpersonal psychotherapy, potentialfor abusing prescription medications, and possible malingering of psychiatric or physical83symptoms, all of which appear to be associated with psychopathy in forensic settings (seeChapter 1).2. The PCL:SV as a Screening TestThere is evidence that the PCL:SV could be used as a screening test for psychopathy incorrectional or forensic psychiatric populations (as its name suggests). That is, the standardPCL:SV cutoff (> 18) can be used to make decisions about further evaluation, rather than actualdiagnoses. This conclusion is based on the diagnostic agreement between the PCL:SV and PCL-R, and on the pattern of diagnostic errors made by the PCL:SV (designating the PCL-R as acriterion measure). Recall that agreement between the scales was fair, but that the PCL:SVoverpredicted psychopathy relative to the PCL-R while making virtually no false negative errors:about half of individuals with high scores on the PCL:SV will also get a high score on the PCL-R,but almost no-one with a low PCL:SV score will get a high score on the PCL-R. Therefore,individuals with a high PCL:SV score could be re-evaluated using the PCL-R, which is a morereliable and better-validated measures of psychopathy, whereas those with low PCL:SV scorescould be safely diagnosed as nonpsychopaths. This procedure can results in a significant savingsof resources in settings that routinely screen for psychopathy. Let us take the hypotheticalexample of a forensic psychiatric hospital that receives referrals from local prisons and wants toidentify psychopaths among those referrals for the purpose of institutional classification andmanagement decision-making. Let us further assume that 100 prison transfers are evaluated eachyear, and that the base rate of PCL-R psychopathy in these transfers is 10%. If every transfer wasevaluated using the PCL-R, which typically requires about 2'/2 to 3 hours to complete, then thepsychopathy assessments would require a total of 275 hours. On the other hand, if the sametransfers were evaluated using the PCL: S V, the routine screening would require only 1 to 11/2hours per transfer, or a total of about 125 hours. About 20% of the transfers would then be givenfollow-up PCL-R assessments, requiring an additional 11/2 to 2 hours per person, for a total of 35hours. Thus, using the PCL-R alone would require 275 clinician-hours, whereas using thePCL:SV + PCL-R procedure would require 160 clinician-hours--an annual savings of 115clinician-hours (about 15 clinicians days) or over 40% in clinical labour costs.843. Psychopathy in Future DSMsThe present results have some implications for current and future revisions to the DSM.Perhaps most important implication is that, contrary to previous assumptions (e.g., Robins, 1978),it appears that psychopathic traits can be reliably and validly inferred in both forensic andnonforensic settings. As a result, there is no need to continue using the DSM-III-R's "behavioralchecklist" format for the diagnosis of APD; the current criteria can be readily revised to moreclosely resemble the other Axis II criteria sets without a substantial reduction in reliability. Such arevision would probably result in something that closely resembles Part 2 of the PCL:SV.Another implication concerns the content of the APD criteria, which, as noted in Chapter1, currently focus on the social deviance facet of psychopathy. The present results suggest thatsymptoms such as superficiality and grandiosity could easily be included in diagnostic criteria forAPD. This would increase the content-related validity of the criteria without significantlyreducing their internal consistency. Unfortunately, such expansion also may lead to increasedoverlap between APD and near-neighbour disorders, such as narcissistic and histrionic personalitydisorder, unless the criteria for these latter disorders are also revised.B. Implications for ResearchIn validating the PCL:SV, the current study clearly sacrificed depth for breadth. That is, itexamined a several facets of validity in a variety of small samples, rather than looking in detail atone or two facets of validity in a large sample. This strategy is a logical one in the early stages ofa test's development. In future research, however, greater depth of information will be needed.1. NormsA priority in future research should be the collection of systematic normative data. This isessential if the PCL:SV is to be maximally useful in research and clinical settings. A majordecision that must be made concerns the sampling techniques to be used. For example, onepossibility is to collect random-sample norms within specific settings (adult male prisoners, femaleyoung offenders, forensic psychiatric outpatients, and so forth). This procedure is relativelysimple and inexpensive for any given setting; however, the number of possible settings in which tocollect norms is almost limitless. Given that the PCL:SV is intended for use in the general85population, not just forensic settings, a stratified random sample of community residents may bemore appropriate. Although more expensive and time-consuming, this procedure would yieldnorms for a reference group that is of general interest. It would also allow the calculation ofstandard errors of measurement, a determination of the PCL:SV's factor structure (including theuse of confirmatory factor analysis), and a determination of the "true" association betweenpsychopathy and demographic characteristics such as age, sex, and race.2. Large SamplesEven if systematic, random-sample norms are not collected, the use of the PCL:SV in alarge sample (say, > 100 or 200 subjects) within a given setting would still yield useful data forconducting factor analyses. If two independent raters were used, it would also allow a morerobust estimate of interrater agreement for PCL:SV diagnoses. Finally, if other psychopathy-related measures were administered to the same subjects, diagnostic agreement between thePCL:SV and alternative measures could be determined.3. Test-retest ReliabilityThe temporal stability of PCL:SV scores was not directly assessed in this study. It will beimportant to examine this issue further, in both forensic and nonforensic settings, over timeperiods ranging from short (i.e., one week, one month) to long (one year or longer). An efficientway to examine both interrater and test-retest reliability of PCL:SV dimensional scores anddiagnoses would be to conduct a generalizability study based on G- and D-theory (e.g., Schroederet al., 1983). Unreliability due test items, raters, time, and settings--as well as the interactions ofthese factors--could be quantified in a single study.4. Predictive ValidityThe PCL:SV's predictive validity was not examined in the present study. Of course,development of the PCL:SV was motivated in part by the MacArthur Risk Study, which willexamine the scale's ability to predict violence among civil and forensic psychiatric patientsreleased into the community (Hart, Forth, & Hare, in press). It might also be useful to examinethe PCL:SV's ability to predict institutional violence in civil or forensic psychiatric hospitals, or in86correctional facilities. Of course, predictive validity with respect to variables other than violence,such as general recidivism or property offending, could also be examined.Another type of study that might be of more general interest would look at the predictivevalidity of PCL:SV scores in job applicants--for example, police, military, or corrections officerrecruits. The PCL:SV would be easily administered in such settings, where all applicants undergopersonal interviews, criminal record checks, interviews with collateral informants, and even drugscreenings. If psychopathy is to be a useful construct outside of forensic settings, then it shouldpredict poor occupational adjustment in employees (negative evaluations by co-workers, lowproductivity, disciplinary infractions, and so forth). The predictive validity of psychopathic traitsshould even be observed in settings with a zero or near-zero base rate of psychopathy; that is,employees with significant psychopathic traits should do more poorly than people with few or nopsychopathic traits. A study of this sort might receive considerable financial and/or logisticalsupport from large employers.5. Laboratory StudiesAs noted in Chapter 1, there is a large and growing literature on the cognitive andpsychophysiological correlates of psychopathy. To date, the vast majority of these studies havebeen conducted with inmates, and the generalizability of the results outside of criminalpopulations has been questioned. The construction of the PCL:SV may facilitate the replicationof key studies (e.g., Williamson et al., 1991) in community residents. If large numbers of "trulypsychopathic" community residents cannot be identified (a mixed blessing), it may still be thatpeople with significant psychopathic traits show a pattern of responses similar to those ofpsychopaths, and that they can therefore serve as analog subjects in laboratory research.Regardless of whether the community subjects are true or analog psychopaths, their use couldgreatly reduce the costs of future research, as well as increasing confidence in the generalizabilityof research findings.6. Psychopathy and the Big 5The results of the pre-test looking at observer ratings of normal personality wereintriguing and deserve further study. Initially, of course, simple replication in a larger sample is87required; if the primary findings replicate, then subsequent research should examine the nature ofthe association between psychopathy and the Big 5.I should emphasize here that it would not be surprising to find a significant associationbetween psychopathy and the Big 5; indeed, several recent studies suggest that omnibus measuresof personality pathology have a factor structure highly similar to the Big 5 in both clinical andnonclinical samples (e.g., McCrae & Costa, 1989; Trull, 1992; Wiggins & Pincus, 1989). Thereal surprise in the present study was magnitude of the association. To be sure, shared methodvariance may be partly responsible for the magnitude, but the possibility still remains thatpsychopathy, as measured by the PCL:SV, is simply an additive combination of Big 5 personalitydimensions (or, put another way, simply a vector in the Big 5's five-dimensional space). If true,this hypothesis has important implications. For example, it would no longer be valid to treatpsychopathy as a categorical construct, to make "diagnoses" of psychopathy or posit etiologicmechanisms underlying the "disorder" (e.g., Livesley et al., 1992). Instead, psychopathy could bedecomposed into its constituent Big 5 elements, each of which is dimensional in nature and eachof which has its own psychobiological underpinnings. On the other hand, it may be thatpsychopathy, although composed of Big 5 building blocks, is an emergent construct (one whosewhole is greater than the sum of the parts). If this hypothesis is true, then psychopathy can indeedbe considered a disorder or taxon. Note that both the summative and multiplicative models areconsistent with the correlational results observed here. A comparison of the models could involvemultiple regression, using Big 5 ratings to predict PCL:SV scores using either main effects ormain effects plus interactions; or taxonometric methods, to investigate whether there is adiscontinuity in Big 5 ratings that more-or-less corresponds to PCL:SV psychopathy diagnoses. 1919 There is some evidence of a psychopathy taxon underlying the PCL-R (Rice, Harris, &Quinsey, 1992).88C: ConclusionAlthough a great deal of basic research remains to be done, the PCL:SV is a promisingnew measure of psychopathy. There is reason to hope that the scale will help to significantlyreduce the costs of psychopathy-related research in forensic settings and facilitate the extension ofthis research into nonforensic settings. 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An interview is one of the two key data sources on which the PCL:SV israted (the other being charts or collateral informants). We use the interview to collect historio-demographic data and to sample the individual's interpersonal style. The former is used primarilyto score items in Part 2 of the PCL:SV, whereas the latter is used primarily to score Part 1 items.We recommend the use of semi-structured, rather than a structured, interviews. Somestructure aids the interviewer in collecting necessary content-related information, but too muchstructure can hinder rapport-building and obscure interactional style. For example, with a semi-strutured interview, interviewers can use their clinical skills to elicit evidence of emotional bonds,or they can permit an individual to "ramble" and tell stories.In our own research, we use an interview that covers the following areas: presentingproblem/current legal status, educational history and goals, vocational history and goals, medicaland psychiatric history, family background, marital history, juvenile conduct problems, and adultantisocial behavior (including substance use). Within each area, recommended general questionsand follow-up probes are listed; however, interviewers are free to rephrase or even omitquestions, or to ask additional questions as they see fit. It is not necessary to complete theinterview at one sitting; in fact, multiple interviews may actually be an asset, as they help to insurethat the rater obtains a representative sample of the individual's interpersonal style.It should be obvious from the above description that our semi-structured interview is verysimilar in structure to any reasonably comprehensive clinical interview. Consequently, if theindividual has already completed a clinical interview, it may be unnecessary to re-interview thatperson in order to make PCL:SV ratings. If the clinical interview administered was notsufficiently comprehensive, the rater may wish to ask only selected questions from the PCL:SVinterview.100In rare instances, it may be impossible to complete an interview due to mental illness,discharge or elopement from the institution, and so forth. In such cases, so long as there isadequate detail in the institutional files, the PCL:SV can be completed on the basis of fileinformation alone. File data can also be supplemented by any limited contacts with orobservations of the individual.Charts and collateral informants. As noted above, the second major source of data forscoring the PCL:SV is charts and collateral informants. We do not accept data obtained in theinterview at face value. Rather, we attempt to confirm or deny important claims made by theindividual. Hospital charts, correctional files, and criminal records may all be used for thispurpose, as can interviews with friends or relatives. Of course, interviewers must use their clinicaljudgement to evaluate the reliability of this collateral information; in general, however, conflictingreports concerning an individual's personality or behavior should alert the interviewer to thepossibility that the individual is engaging in impression management.In rare cases, there may be abolsutely no file or collateral information available. ThePCL:SV should not be completed on the basis of interview information alone; every attemptshould be made to collect at least some file information (e.g., requesting a criminal record for theindividual, interviewing a family member, friend, or previous employer). If this is not possible,then PCL:SV ratings should be delayed until collateral information in the form of progress notes,consultant reports, and so forth become available. (In most institutions, such collateralinformation will be available within two or three weeks.)B. PCL:SV ScoringItem descriptions. The item descriptions are listed on the PCL:SV scoresheet. Thesedescriptions are brief and in point form. The individual statements under each item are roughlyordered in descending order of importance and frequency (prototypicality). However, ratersshould not use these item descriptions as a simple checklist. Instead, they should use the entireitem description to form an impression (prototype) in their minds and then compare the individualbeing rated to the prototype. Once raters have assessed someone who matches an item101description very well--an exemplar for that item--it may also be helpful to conjure up a mentalimage of that person while rating the item in question.Item scores. Each of the PCL:SV items is scored using a 3-point ordinal scale (0, 1, or 2),based on the degree to which the individual matches the item description. Clearly, the scoring issubjective; however, our research indicates that experienced raters can be highly reliable whenmaking judgements of this kind. Scores of 2, 1, and 0 are defined as follows:2 The item applies to the individual; a reasonably good match inmost essential respects; his/her behavior is generally consistentwith the flavor and intent of the item.1 The item applies to a certain extent but not to the degreerequired for a score of 2; a match in some respects but with toomany exceptions or doubts to warrant a score of 2; uncertainabout whether or not the item applies; conflicts betweeninterview and file information that cannot be resolved in favorof a score of 2 or 0.0 The item does not apply to the individual; s/he does not exhibitthe trait or behavior in question, or s/he exhibits characteristicsthat are the opposite of, or inconsistent with, the intent of theitem.In brief: Yes (2); In some respects/maybe (1); No (0). We note again that raters shouldnot use the item description statements as a simple checklist. An individual could receive a scoreof 2 on an item by displaying one or two of the characteristics to a great degree, or by displayingseveral of the characteristics to a moderate degree. Take the intensity, frequency, and duration ofthe individual's symptoms into account when scoring the item. Also, keep in mind that the102timeframe for scoring the PCL:SV is the individual's entire life: each item is supposed to reflect apersonality trait, rather than a symptom that is present only during brief or rare episodes.Conflicting information regarding the individual can be handled in different ways. If asource of information is deemed to be totally noncredible by the rater, it can be ignored. If asource is seen as less credible than others, information obtained from it can be given less weight.If the sources are equally credible, then the rater can attempt to seek out new information orconsider giving the individual a score of 1 on the relevant item(s). Finally, if all informationpertaining to an item comes from sources that lack credibility, the item can be omitted.An item may also be omitted if there is insufficient information with which to score it. Upto three items can be omitted for any one subject; assessments requiring more than three itemomissions should be considered invalid.Once all the items have been scored, the Part 1, Part 2, Total scores should be calculatedand entered on the scoresheet. Where items are omitted, the Part and Total scores should beprorated on the basis of the remaining item scores. If more than two items were omitted on eitherPart 1 or Part 2, the score for that subscale should be considered invalid.III. PCL:SV Training ProgramWe have found that many raters benefit from formal training program in the use of thePCL:SV, although such training is neither necessary nor sufficient to insure reliable ratings. Inour own training, we cover three main topic areas:1. The nature and assessment of psychopathy. A review of the concept of psychopathy,problems in assessing the disorder, the development of the PCL and PCL:SV, and preliminaryresearch regarding the psychometric properties and validity of the PCL:SV.2. The PCL:SV assessment procedure. A discussion of interviewing techniques, chartreviews, and collateral informants.3. PCL:SV scoring. A review of scoring procedures. We also give raters a chance towatch several videotaped interviews with real prisoners to help them establish a set of "internalnorms" for scoring individual PCL:SV items.103IV. Supplementary Item Scoring DescriptionsBelow we discuss the individual PCL:SV item descriptions. This section should not beused as an alternative to the descriptions on the PCL:SV; rather, it is intended to clarify theinterpretation of these descriptions.Item 1: Superficial. This item describes an individual whose interactional style appearssuperficial (i.e., glib) to others. Usually, the individual tries to make a favorable impression onothers by "shamming" emotions, telling stories that portray him/her in a good light, and makingunlikely excuses for undesirable behaviors. S/he may use unnecessary--and, frequently,inappropriate--jargon. Despite its superficiality, the individual's style may be considered engaging.Alternatively, the individual may try to impress others by appearing sullen, hostile, or "macho."Still, the key aspect is that this presentation appears affected and superficial. Both types ofindividuals are "slippery" in conversation: when challenged with facts that contradict theirstatements or with inconsistencies in their statements, they simply change their story.Item 2: Grandiose. Individuals who score high on this item are often described asgrandiose or as braggarts. They have an inflated view of themselves and their abilities. Theyappear self-assured and opinionated in the interview situation (a situation where most people aresomewhat reticient or deferential). If they are in hospital or prison, they attribute theirunfortunate circumstances to external forces (bad luck, the "system") rather than to themselves.Consequently, they are relatively concerned about their present circumstances and worry littleabout the future. (Note that psychotic delusions are irrelevant to the scoring of this item, unlessthey are accompanied by the other characteristics listed.)Item 3: Manipulative. People with this characteristic commonly engage in lying,deception, and other manipulations in order to achieve their own personal goals (money, sex,power, etc.). They lie and deceive with self-assurance and no apparent anxiety. They may admitthat they enjoy conning and deceiving others; they may even label themselves "fraud artists."Item 4: Lacks Remorse. High scores on this item are given to individuals who appear tolack the capacity for guilt. It is normal to feel justified in having hurt someone on at least a fewoccasions; however, high scorers on this item appear to have no conscience whatsoever. Some of104these latter individuals will verbalize remorse, but in an insincere manner; others will display littleemotion about their own actions or the impact they had on others, and will focus instead on theirown suffering. (In scoring this item, it is necessary to take the nature of the individual's harmfulbehaviors into account. Clearly, a lack of remorse concerning relatively trivial acts may not bepathological.)Item 5: Lacks Empathy. This item describes individuals who have little affective bondingwith others and are unable to appreciate the emotional consequences (positive or negative) oftheir actions. As a result, they may appear cold and callous, unable to experience strong emotionsand indifferent to the feelings of others. Alternatively, they may express their emotions, but theseemotional expressions are shallow and labile. The verbal and nonverbal aspects of their emotionmay appear inconsistent.Item 6: Doesn't Accept Responsibility. People who score high on this item avoid takingpersonal responsibility for their harmful actions by rationalizing their behavior, greatly minimizingthe consequences for others, or even denying the actions altogether. Most of their rationalizationsinvolve the projection of blame (or at least partial blame) onto the victim or onto circumstances.Minimizations usually involve denying that the victim suffered any serious or direct physical,emotional, or financial consequences. Denial usually involves claiming innocence, that is, that thevictim lied or the individual was framed; alternatively, s/he may claim amnesia due to substanceuse or to physical or mental illness.Item 7: Impulsive. This item describes people who act without considering theconsequences of their ations. They act on the spur of the moment, often as the result of a desirefor risk and excitement. They may be easily bored and have a short attention span. Consquently,they lead a lifestyle characterized by instability in school, relationships, employment, and place ofresidence.Item 8: Poor Behavioral Controls. This item describes people who are easily angered orfrustrated; this may be exacerbated by the use of alcohol or drugs. They are frequently verballyabusive (i.e., they swear, insult, or make threats) and physically abusive (i.e., they break or throw105things; push, slap, or punch others). The abuse may appear to be sudden and unprovoked. Theseangry outbursts are often short-lived.Item 9: Lacks Goals. High scores on this item are given to those who do not have realisticlong-term plans and commitments. Such people tend to live their lives "day-to-day," not thinkingof the future. They may have relied excessively on family, friends, and social assistance forfinancial support. They often have poor academic and employment records. When asked abouttheir goals for the future, they may describe far-fetched plans or schemes.Item 10: Irresponsible. This item describes people who exhibit behavior that frequentlycauses hardship to others or puts others risk. They tend to be unreliable as a spouse or parent:they lack commitment to relationships, fail to care adequately for their children, and so forth.Also, their job performance is inadequate: they are frequently late or absent without good reason,etc. Finally, they are untrustworthy with money: they have been in trouble for such things asdefaulting on loans, not paying bills, or not paying child support.Item 11: Adolescent Antisocial Behavior. People who score high on this item had seriousconduct problems as an adolescent. These problems were not limited to only one setting (i.e.,occurred at home, at school, and in the community) and were not simply the result of childhoodabuse or neglect (e.g., running away to avoid beatings; stealing food when it wasn't available athome). Such people frequently were in trouble with the law as a youth or minor, and theirantisocial activities were varied, frequent, and persistent.Item 12: Adult Antisocial Behavior. This item describes people who frequently violateformal, explicit rules and regulations. They have had legal problems as an adult, including chargeswith or convictions for criminal offenses. Their antisocial activities are varied, frequent, andpersistent.106APPENDIX BSupplementary TablesTable B-1Interrater Reliability (r) of PCL:SV Items in 7 SamplesSampleItem 1 2 4 5 6 10 111. .52 .33 .48 .41 .72 .17* .942. .49 .56 .63 .64 .70 .33 .893. .55 .53 .61 .36 .40 .70 .784. .68 .53 .66 .08* .56 .55 .675. .43 .56 .66 .51 .40 .41 .776. .67 .57 .21* .53 .39 .78 .637. .38 .72 .42 .55 .69 .60 .768. .71 .68 .61 .57 .65 .37 .899. .57 -.01* .72 .19* .44 .67 .8010. .24 .20* .52 .41 .21* .74 .8011. .83 .76 .73 .87 .60 .62 .8312. .23 .46 .27 .59 .65 .42 .80Note. Ns are as follows: Sample 1, 50; Sample 2, 32; Sample 4, 59; Sample 5, 26; Sample 6, 28;Sample 10, 50; and Sample 11, 50. * p > .05 (one-tailed).107Table B-2Corrected Item-Total Correlations for PCL:SV Total Scores in the 11 SamplesSampleItem 1 2 3 4 5 6 7 8 9 10 111. .58 .18* .59 .51 .58 .52 .55 .53 .51 .55 .10*2. .66 .29 .40 .57 .56 .40 .39 .65 .55 .56 .14*3. .45 .23* .35 .46 .50 .55 .53 .59 .50 .58 .294. .79 .73 .51 .61 .38 .69 .67 .63 .70 .82 .435. .77 .74 .62 .50 .13* .72 .42 .69 .56 .78 .626. .65 .52 .41 .63 .38 .74 .64 .65 .40 .56 .247. .59 .48 .37 .51 .39 .70 .50 .53 .57 .76 .458. .38 .29 .33 .50 .36 .71 .50 .52 .36 .33 .19*9. .67 .37 .58 .31 .23* .29 .48 .53 .49 .63 .3410. .58 .36 .43 .53 .30 .77 .60 .65 .54 .72 .3911. .52 .42 .59 .35 .13* .39 .65 .49 .35 .53 .3612. .55 .49 .44 .50 .29 .64 .71 .54 .41 .49 .58Note. Ns are as follows: Sample 1, 50; Sample 2, 32; Sample 3, 67; Sample 4, 71; Sample 5, 49;Sample 6, 48; Sample 7, 40; Sample 8, 80; Sample 9, 49; Sample 10, 50; and Sample 11, 50. * p> .05 (one-tailed).108Table B-3Corrected Item-Total Correlations for PCL:SV Parts 1 and 2 Scores in the 11 SamplesSampleItem 1 2 3 4 5 6 7 8 9 10 11Part 11. .65 .54 .62 .56 .62 .59 .63 .61 .56 .51 .262. .76 .65 .53 .65 .70 .59 .52 .64 .58 .65 .453. .52 .44 .30 .37 .37 .64 .45 .59 .47 .55 .374. .80 .72 .59 .64 .42 .71 .57 .68 .64 .78 .21*5. .81 .67 .56 .55 .24 .74 .51 .74 .45 .73 .616. .67 .51 .58 .68 .42 .81 .52 .67 .41 .59 .04*Part 27. .69 .67 .44 .51 .41 .82 .52 .45 .59 .76 .498. .47 .51 .38 .43 .34 .68 .35 .52 .21* .32 .17*9. .62 .46 .54 .22 .06* .23* .57 .48 .47 .65 .3910. .56 .42 .57 .57 .49 .77 .67 .61 .51 .67 .3011. .59 .54 .64 .49 .19* .62 .63 .65 .33 .49 .4712. .60 .68 .47 .48 .20* .63 .65 .64 .33 .52 .53Note. Ns are as follows: Sample 1, 50; Sample 2, 32; Sample 3, 67; Sample 4, 71; Sample 5, 49;Sample 6, 48; Sample 7, 40; Sample 8, 80; Sample 9, 49; Sample 10, 50; and Sample 11, 50. * p> .05 (one-tailed).109Table B-4Loadings for Oblique, 2-Factor Solution in Samples 1 to 4Sample 11^2Sample 21^2Sample 31^2Sample 41^21. .73 -.05 -.27 .70 .32 .42 .55 .072. .90 -.12 -.17 .78 .06 .50 .75 -.033. .55 -.01 -.11 .51 .38 .08 .23 .354. .76 .18 .37 .73 -.01 .84 .72 .045. .83 .08 .44 .71 .41 .43 .69 -.076. .63 .14 .30 .52 -.17 .90 .77 .027. -.03 .79 .71 -.01 .46 .01 .10 .588. -.06 .56 .67 -.14 .56 -.13 .25 .409. .29 .54 .56 .00 .46 .29 .23 .1610. .20 .51 .54 .06 .71 -.14 .04 .6511. .01 .68 .60 .02 .73 .08 -.21 .7512. -.01 .71 .71 -.04 .53 .06 .18 .46Eigenvalue: 5.17 1.19 3.40 2.31 3.54 1.39 3.84 0.96% Variance: 43.1 9.9 28.3 19.3 29.5 11.5 32.0 8.0Factor r: .54 .09 .35 .50110Table B-5Loadings for Oblique, 2-Factor Solution in Samples 5 to 8Sample 51^2Sample 61^2Sample 71^2Sample 81^21. .77 .18 .60 .04 .21 .73 .67 -.082. .79 .10 .73 -.21 -.01 .86 .67 .083. .30 .51 .73 -.04 .48 .18 .60 .084. .61 -.19 .70 .18 .68 .12 .77 -.055. .36 -.26 .74 .18 .36 .24 .86 -.076. .38 .09 .84 .12 .60 .17 .76 -.037. .14 .57 .12 .80 .57 -.05 .42 .228. .16 .47 .27 .63 .43 .21 .22 .449. .34 .02 .22 .14 .73 -.29 .33 .3210. -.02 .56 .32 .69 .74 -.15 .36 .4511. -.12 .40 -.30 .89 .69 .06 -.12 .8812. .27 .15 .24 .60 .74 .11 -.01 .79Eigenvalue: 2.61 1.16 5.25 1.55 4.51 1.15 4.84 1.06% Variance: 21.8 9.7 43.7 12.9 37.6 9.6 40.4 8.8Factor r: .16 .39 .35 .53111Table B-6Loadings for Oblique, 2-Factor Solution in Samples 9 to 11 Sample 91^2Sample 101^2Sample 111^21. .51 .15 -.16 .93 -.12 .532. .58 .13 .25 .45 -.05 .853. .61 .01 .50 .16 .16 .494. .38 .52 .93 -.00 .64 .005. .12 .61 .45 .48 .67 .476. .65 -.14 .63 .01 .37 -.157. .29 .43 .36 .56 .45 .108. .52 -.07 .28 .11 .17 .069. -.14 .87 .30 .48 .47 -.1010. .39 .28 .95 -.13 .51 .0911. -.03 .52 .34 .28 .51 -.2012. .31 .21 .59 -.05 .81 -.03Eigenvalue: 3.76 0.87 5.35 0.78 2.73 1.51% Variance: 31.3 7.3 44.5 6.5 22.8 12.6Factor r: .47 .60 .05

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