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Psychopathy, alexithymia and affect in female offenders Louth, Shirley May 1994

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PSYCHOPATHY, ALEXITHYMIA AND AFFECT IN FEMALE OFFENDERSbySHIRLEY MAY LOUTHB.A., The University of British Columbia, 1992A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF ARTSinTHE FACULTY OF GRADUATE STUDIESDEPARTMENT OF PSYCHOLOGYWe accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIASeptember 1994©Shirley May Louth, 1994In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Ubrary 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.Department of fsyC?zo/off/The University of British ColumbiaVancouver, CanadaDate 4 /3/T4L(Signature)DE-6 (2/88)iiAbstractPsychopathy and alexithymia are disorders with manyconceptual similarities. For example, Factor 1 of thePsychopathy Checklist - Revised (PCL-R; Hare, 1991) containsitems like shallow affect and lack of empathy, which seem to mapon to the construct of alexithymia. Additionally, bothpsychopaths and alexithymics display striking differences fromothers in their use of language, especially affective language.The two areas of interest in the present study were (a)occurrence and co—occurrence of psychopathy and alexithymia in asample of female inmates, and (b) the relationship betweenaffective language and these two disorders.Psychopathy and alexithymia were assessed in 37 womenoffenders incarcerated in a Burnaby Correctional Centre, usingthe PCL-R and the Toronto Alexithymia Scale (TAS; Taylor, Ryan &Bagby, 1985). Each subject was presented with a short writtenscenario designed to elicit an emotional response, and asked todescribe the feelings of the characters in the story. Their tapedresponses were analyzed for measures of affect.Base rates of both disorders were comparable to those insimilar samples, (30% of the inmates were diagnosed aspsychopathic; 33% as alexithymic) but the coxnorbidity rate wasonly 8%. There was a significant correlation between alexithymiascores and PCL—R Factor 2 scores — the factor assessingantisocial behaviour. Multiple regression analysis revealed thatiiithe TAS and PCL-R were both predictive of violence. Thisrelationship between the PCL-R and violence is wellsubstantiated; that the TAS also predicts violence is a newerfinding.Alexithymics spoke more slowly, used fewer total wordsoverall and fewer affective words, and displayed less emotion intheir voices than did nonalexithymics. Psychopaths could not beidentified by any vocal measures except a slight tendency tospeak faster than nonpsychopaths. Although both disorders arecharacterized’ by affective impoverishment, the verbal expressionsof affect were very different in psychopaths and alexithymics.The psychopaths were adept at convincing raters of an emotionalinvestment they did not feel; alexithymics could not disguisetheir lack of appropriate emotional response.ivTABLE OF CONTENTSAbstract iiTable of Contents ivList of Tables viAcknowledgement viiINTRODUCTION iPsychopathy, Language and Emotion - aReview of the Literature 1The Relationship between Psychopathyand Alexithymia 5Assessment of Psychopathy 10Assessment of Alexithymia 11Rationale for Proposed Study -Psychopathy and Alexithymia 12Occurrence and Co—occurrence ofPsychopathy and Alexithymia 12Relationship between AffectiveLanguage, Psychopathy and Alexithymia 15MethodSubjects 18Measures 19Procedures 24- Psychopathy 25— Voice Analyses 25Results 28Descriptive Statistics andIntercorrelations between the PCL-Rand the TAS 28Relationship of the PCL-R and the TASto Violence 31Voice Analyses 38VDiscussionPsychopathy and Alexithymia 44Criminality and Violence 48Psychopathy, Aexithyrnia, and AffectiveLanguage 49Conclusion 53References 55Appendices 61viList of TablesTable 1 Descriptive statistics of the PCL-R for samples of 29female and male offendersTable 2 Descriptive statistics of the TAS for different samples 30Table 3 Subject variables 32Table 4 Correlations between PCL-R and TAS factors33Table 5 Correlations of the PCL-R and the TAS with violence36Table 6 Standard multiple regression of PCL-R and TAS variableson violence 37Table 7 Correlations between PCL—R scores and vocal analysisratings 39Table 8 Correlations between TAS Scores and vocal analysisratings 40Table 9 Correlations between TAS scores, prediction of empathy,and content analysis of subjects’ responses to question 42regarding own feelingsviiAcknowledgementI would like to thank my committee members, Drs. WolfgangLinden and Janet Werker for their time and constructive comments.I would like to thank my thesis advisor, Dr. Robert Hare, for hisvaluable feedback and support during the course of this research.I would also like to recognize my fellow lab members who gave oftheir time to assist with ratings, data collection, and helpfulcomments.This research was made possible by the cooperation of theinmates and staff of British Columbia Correctional Centre forWomen, particularly Beverly Roest who consistently facilitatedthe implementation of this project.I would also like to thank the many volunteers whounstintingly gave of their time to bring this project tocompletion.The contribution of my family - their patience, help andunderstanding, is also gratefully acknowledged.1IntroductionThough many lawbreakers may be described as cold andcalculating towards their victims, they usually experience somedegree of emotional committment to friends, family, or otherloved ones. For the psychopathic criminal, however, poverty ofaffect is pervasive.Psychopathy is a personality disorder marked by a particularpattern of interpersonal, affective, and behavioural symptoms. Itis similar to antisocial personality disorder (APD), but alsoincorporates some features of narcissistic and histrionicpersonality disorders. While APD, according to the DSM-IVdescription (American Psychiatric Association, 1994), isdiagnosed primarily by a collection of antisocial and criminalbehaviours, which certainly characterizes psychopaths, thepsychopath also displays a cluster of personality traits andaffective symptoms not considered necessary for a diagnosis ofAPD. Interpersonally, psychopaths are manipulative, egocentric,grandiose and dominant. Affectively, they display shallow andlabile emotions, have no capacity for compassion or remorse, andare unable to form lasting bonds with others.Psychopathy, Language and Emotion - a Review of the LiteratureThis striking pattern of affective “deviance” has shown uptime and again in clinical impressions of psychopaths, leading toresearch into their appreciation of different forms of emotionalmaterial. Christianson, Forth, Hare, Strachan, Lidberg & Thorell,2(1993) demonstrated that nonpsychopaths recall more salientdetails about emotionally harrowing colour slides than they dowhen presented with slides of neutral content. Psychopaths’recall, however, was unrelated to the emotional polarity of theslides. Patrick, Cuthbert, and Lang, (1990), found thatpsychopaths failed to show physiological signs of fear when theyimagined a fearful event; in an earlier study, (Patrick et al,1989) these authors had concluded that subject fearfulness was asignificant predictor of affective normality.Language has often served as a stimulus in studies designedto show psychopaths’ insensitivity to affective valence.Williamson, Harpur, and Hare, (1990) found that psychopaths wereless likely than nonpsychopaths to group words by emotionalpolarity. These researchers also showed that althoughpsychopaths could identify emotional scenes, they had difficultymatching phrases and pictures on the basis of affective valence.Differences between psychopaths and nonpsychopaths also emergedduring a study (Williamson, Harpur, & Hare, 1991) in whichsubjects were required to distinguish between words and nonwordsin a lexical decision task. Nonpsychopaths were clearly able touse the information contained in the emotional words tofacilitate their decision as to whether the letter string was aword or a nonword. In sharp contrast, psychopaths failed to showreaction time or electrocortical differences between emotionaland neutral words. Cleckley (1976) proposed that psychopaths3cannot appreciate the emotional significance of language, andthat they suffer from a deep—seated semantic disorder in whichthe affective and semantic components of words are dissociated.Others have made similar observations, including Grant (1977) whoconsidered psychopaths to know “only the book meaning of words”(p.50), and Gilistrom who suggested that emotion is “like asecond language to the psychopath” (reported in Hare, 1993).While widely cited, demonstrating evidence of these emotionaldeficiencies has sometimes proven surprisingly difficult. Forexample, traditional empathy questionnaires of the self—reporttype do not discriminate psychopaths from nonpsychopaths (Wrightand Wong, 1988; Day and Wong, 1993; Strachan, 1993), and in astudy by Strachan, Harpur, and Hare (1991), psychopaths were ableto select the appropriate affect when writing about an emotionalevent.Similarly, evidence for the causes of emotional\linguisticdifferences between psychopaths and normal individuals has beensparse; Hare and McPherson (1984) and Raine et al (1990) foundweak cerebral lateralization in psychopaths, with psychopathsdemonstrating less left-hemisphere dominance than normals whenprocessing language. Day and Wong (1993) concluded that while theright side of the brain generally plays a central role inemotion, the psychopathic brain does not show this hemisphericspecialization. In fact, for psychopaths, neither side of thebrain may be proficient in processing emotional material. No4consistent evidence has been found for other clinicallysignificant neuropsychological or intellectual differencesbetween psychopaths and non-psychopaths.One expression of such emotional/linguistic detachment wouldinvolve difficulty in the interpersonal arena. It is certainlytrue that prototypical psychopaths cannot form long-lasting bondsto people and are profoundly lacking in compassion and empathy,yet their affective poverty does not seem to warn prospectivevictims of their insincerity. Psychopaths are often described ascharming, and a key feature of psychopathy is the ability to uselanguage to deceive, manipulate and con, while seeming to beperfectly sincere. Even when caught out in an obvious lie,psychopaths use language for their own ends, talking their wayout of trouble with no embarrassment or discomfiture.Of course, words are not the exclusive domain ofpsychopaths, and there is no evidence they have a larger lexiconthan other people. While the same world of words is availablefor the use of us all, certain words exert a power over mostpeople because of their evocative or connotative content. Thisis the basis of literature and poetry; poets often exhort us toread their works aloud for full effect, and authors labour forjust the right word to evoke the emotional reaction they seek --be it negative or positive. The power of words to elicit feelingsis well known. For most people, words have a power to controlthe speaker as well as exerting an effect on the listener. The5words can lead to an unconscious cognition that is almostinstantly transformed into a feeling.One can sense, then, the power imbalance occurring if thereare people who use words to affect others, yet who remainthemselves unaffected by words. These people would be especiallydangerous if their affective deficiency was subtle, covert, noteasily detected by others. Freed from the negative emotionaleffect of language, members of this group could painstakinglysearch their lexicon for words to achieve the desired emotionaleffect on listeners, not, like poets, in order to enrich andastound, but for less prosocial purposes.The Relationship Between Psychopathy and AlexithymiaAnother disorder that has at its base a fundamentaldifficulty in language and emotion is alexithymia. Believed bysome to affect about 10% of the general population, the conceptof alexithymia was introduced in the early 1970’s as apersonality disorder linked to an inadequacy in experiencing andexpressing emotions (Taylor, 1984; Apfel & Sifneos, 1979). Theterm (“a” = without; “lexia” = words; “thymus” = feelings) wascoined by Sifneos (1973) to designate a specific disturbance inthe capacity to recognize, describe and label feelings. Perusalof the literature reveals a picture of the alexithymic as anindividual with constricted emotional functioning, unable to useaffects as signals of inner conflict or responses to externalsituations, impoverished in imaginative processes, and whose6thought content is dominated by trivial environmental detailsrather than true feelings, dreams, or fantasies. Freedman andSweet (1954) referred to such people as “emotional illiterates,”and researchers tend to agree that the disorder represents agenuine inability to verbalize emotions, rather than denial orrepression of feelings (Wise et al, 1990).There are several theoretical, scientific bases forinvestigating possible connections between alexithymia andpsychopathy. Some of the similarities in research directions arestriking, and a few of them are are outlined here. Lateralitystudies conclude that the limited access to verbal expression inalexithymics is suggestive of abnormal hemispheric processing(Flannery & Taylor, 1981; Tucker, D.M., 1981; Buchanan,Waterhouse & West, 1980; Zeitlin, Lane, & O’Leary, 1989),especially increased hemispheric lateralization (Taylor, 1984).Alexithymia seems to have a higher prevalence in men, a findingcited as evidence to support lateralization theories, in thatwomen are considered to possess greater hemispheric plasticitythan men (Taylor, 1984). Past research suggests thatalexithymia, like psychopathy, is not significantly correlatedwith age, race, or sociodemographic/socioeconomic variables(Parker, Taylor & Bagby, 1989; Taylor, Ryan & Bagby, 1985; Wise,Janni, Kass, Sonnenschein & Mann, 1988; Apfel & Sifneos, 1979).Alexithymia has been linked to interpersonally insensitivebehaviours such as having multiple sexual partners (Thome, 1990),7and impaired capacity for empathy (Krystal, 1979), as well assubstance abuse (Haviland, Shaw, MacMurray & Cummings, 1988;Taylor, Parker & Bagby, 1990), personality disorders such asnarcissism (Taylor, 1984), and psychopathy itself (Apfel &Sifneos, 1979) —- especially violent psychopathy (KeltikangasJarvinen, 1982). von Rad et al (1979) depicted alexithymics asexpressing —— and appearing to experience —— less guilt and shamethan nonalexithymics. Alexithymia has also been reported inpatients with sexual perversions (Taylor, 1984). Inappropriateaffect, impulsiveness, boredom, and frustration characterize theprototypical alexithymic (Apfel & Sifneos, 1979). One studysuggests that their emotional conflicts cannot be resolved byfantasy, so they resort to action (Legorreta et al, 1980). Taylorand Bagby (1988) concur, stating that they discharge tensionthrough exacerbated physiological responses to stress, viaphysical action. Possessing restricted imaginations, they areunable to formulate realistic goals, have poor attentionalcontrol, and are easily bored. Wise et al found thatalexithymics can easily become irritable and bad-tempered (1990).Finally, alexithymics, like psychopaths, are unresponsive toinsight-based psychological treatment (Sifneos, 1975; Gage &Egan, 1984)Lacking insight to feelings and other inner experiences,alexithymic individuals tend to focus on and amplify thephysiological component of emotional arousal, leading to8confusion and difficulty in naming feelings. This is thought toexplain their tendency to somatisation, to compulsive activitieslike substance abuse, to impulsive behaviour, and their pronenessto psychosomatic illnesses. This latter tendency is largelyputative, however, and many studies have found no suchrelationship between alexithymia and psychosomatic disorders(Gage & Egan, 1984; Fava, Baldaro & Osti, 1980; Wise et al,1988).While there are undisputed similarities between thedisorders of psychopathy and alexithymia, there are also manydifferences. For example, alexithymics are known to bore, notcharm, their listeners, and they tend to score highly on socialconformity measures (Gage & Egan, 1984, Taylor, Ryan & Bagby,1985). It is not the intention to argue that the two disordersare identical, but rather that they may occur together, or sharea common biological predisposition. The idea ofpsychopathologies being linked by a common diathesis was proposedby Gorenstein and Newman (1980), who studied disorders involvingimpulsiveness. They present an accumulation of evidencesuggesting that the core of such disorders could be geneticallybased disinhibitory processes. The authors see this disinhibitorypsychopathology as a broad constellation including psychopathy,hyperactivity, alcoholism, and antisocial personality disorder.They propose that such disorders involve a biologicallydetermined, common diathesis, and suggest that the expression of9a particular disorder may depend upon differential experience.For the psychopathy construct, for example, this might mean thatan individual born into a supportive, psychologically healthyfamily, could be merely bad-tempered and interpersonallyambivalent, while another person, exposed to abusive and criminalinfluences, may become a full—blown psychopath. The similaritiesbetween some features of psychopathy and alexithymia, one ofwhich is impulsivity (Apfel & Sifneos, 1979), would support atheory such as Gorenstein and Newman’s.Another possibility is that there is a subgroup ofpsychopaths with a particular pattern of symptoms, who are bothpsychopathic and alexithymic. If coinorbidity between the twodisorders is shown to be common, assessment of alexithymia in aninmate population could have implications for the measurement,identification and management of psychopaths. Since there aremany similarities between alexithymia and psychopathy, evidenceof overlap between the two could result in some inflation of anindividual’s score on a psychopathy measure such as thePsychopathy Checklist (PCL-R, Hare, 1991). Inflation may occuron interpersonal/affective symptoms (items such as lack ofremorse, shallow affect, and lack of empathy) as well asbehaviourally antisocial symptoms (proneness to boredom,impulsivity). Both clusters of symptoms (personality traits andbehavioural symptoms) are considered vital to the assessment ofpsychopathy, and are fundamental to the PCL-R.10Assessment of PsychopathyMeasurement of psychopathy has acquired a highly reliableand valid status with the use of Hare’s PCL-R, which has beenwell tested with criminal populations, including males andfemales (Strachan, 1993, Tien et al, 1993), mentally disorderedoffenders, and substance abusers. The PCL-R requires both asemi—structured interview and an intensive review of subjects’institutional files. Impressive alpha coefficient and interraterreliability scores have been achieved (Hare, Harpur, Hakstian,Forth, Hart & Newman, 1990; Hare, 1991; Hart, Hare & Harpur,1992). The PCL—R consists of two stable, correlated factors(Harpur, Hakstian and Hare, 1988). While the factors themselvesare correlated, they have different external correlates. Factor1 reflects interpersonal and affective characteristics consideredfundamental to the clinical conception of psychopathy, whileFactor 2 assesses social deviance and characteristics related tothe DSM-IV diagnosis of Antisocial Personality Disorder. ThePCL—R contains 20 items in total, each scored on a 3—point scale(0, 1, 2) according to the extent to which it characterizes thesubject (see Appendix A). The maximum possible score of 40represents the prototypical psychopath, and subjects’ scorescorrespond to the degree that they match this prototype.Previous research in male forensic populations has establishedthat a PCL-R score of 30 is a useful cutoff for a diagnosis ofpsychopathy (Hare, 1991).11Assessment of AlexithymiaMeasurement of alexithyinia has been more contentious thanthat of psychopathy, with many scales being criticized for poorpsychometrics and insufficient or contradictory researchfindings. Linden, Wen & Paulhus (in press) conducted extensivereviews of several popular measures, and concluded that the Beth—Israel Questionnaire (BIQ; Sifneos, 1973) and the TorontoAlexithymia Scale (TAS; Taylor, Ryan & Bagby, 1985) are the best-supported instruments for assessment of alexithymia. The BIQ hasbeen criticized elsewhere as lacking validity (Bagby et al, 1988;Taylor, 1987), and for having low interrater reliability -especially when raters are not fully trained (Shipko & Noviello,1984). It also requires lengthy administration and scoring, andconsiderable training is needed to administer it. Someinvestigators have found that scoring may depend upon experience,bias, and the style of the interviewer (Taylor & Bagby, 1988).Linden et al (in press) report that the BIQ may reflect changingsituational variables during the interview, and describe it asconfounded with denial tendencies.While the TAS is a self-report scale and thus may be suspectfor pathological liars such as psychopaths, it is free fromsocial desirability responses (Bagby, Taylor & Ryan, 1986). TheTAS has been validated for use with clinical and non-clinicalpopulations, substance abusers (Haviland et al, 1988), and isequally valid for men and women (Taylor & Bagby, 1988). It is12relatively quick to administer, and its favourable test—retestreliability suggests that it is successful at differentiatingbetween trait and state alexithymia. Test-retest reliability hasbeen demonstrated over as long as three months (Bagby, Taylor &Ryan, 1986). While alexithymia, like psychopathy, isconceptualized to be an enduring personality trait, unlikepsychopathy it may also be a temporary condition in reaction to atraumatic event or situation. Incarceration might represent sucha situation (Thome, 1990), so it is important to use aninstrument that differentiates between state and traitalexithymia, and also between alexithymia and depression. TheTAS seems to fit this description better than other measures. Itis important to recognize, however, the many warnings ofresearchers about secondary, or reactive alexithymia, versusprimary alexithymia (Thome, 1990, Gage & Egan, 1984, and others).It is possible that the TAS does not always discriminate betweenthese two conditions.Rationale for Proposed Study - Psychopathy and AlexithvmiaThere are two areas of interest in the present study: (a)the occurrence and co—occurrence of psychopathy and alexithymiain a female prison population; and (b) the relationship betweenaffective language and these two disorders.(a) Occurrence and Co—occurrence of Psychopathy andAlexithvmiaThe rate of psychopathy in female inmates, in contrast to13that of male inmates, has rarely been investigated. In a studyfinanced by the B.C. Institute of Family Violence, Tien et al(1993) assessed 74 women incarcerated in a multi—level securityprison, and found 23% to be strongly psychopathic. Strachan’s1992 study resulted in 31% of 75 women inmates being rated aspsychopathic. In both cases, the PCL—R was used to assesspsychopathy. In contrast, the rate of psychopathy found inincarcerated males is lower, ranging from 15-21% (Hare, 1991).Judicially, there may be greater tolerance of milder forms offemale criminality, because of a reluctance to imprison women,especially if they have childrearing responsibilities. This biaswould contribute to lower levels of incarceration for women, butmay also mean that the women who are imprisoned would possess agreater criminal versatility or commit crimes of greaterseriousness than those not sentenced to prison. In other words,to receive a jail sentence, they must be really “bad.” Mednickand Kandel (1988) make just this point to explain the lowernumber of convictions for females compared with males, and theyhypothesize additionally that criminal behaviour in men may bemore socially or environmentally induced than it is in women.Women, they speculate, are environmentally conditioned to behaveprosocially.Assessment of trait alexithymia would enhance our knowledgeabout the prevalence of affective disorders among femaleprisoners, and add to the psychological profile others have14already compiled (Tien et al, 1993; Strachan, 1993).There are also several reasons to assess the co—occurrence ofalexithymia with psychopathy. In representing an inmate’spsychopathy score on the PCL-R, the presence of alexithymia mightresult in slightly higher scores on both factors. Because of therigorous investigation of institutional files that is part of aPCL-R diagnosis, it is unlikely that such inflation could resultin a categorical misdiagnosis of psychopathy, but there are otherimplications of the presence of alexithymia among inmates.Treatment is one salient issue. While the treatment of bothdisorders is difficult, assessment of alexithymia in psychopathswould at least mean that forensic clinicians could tap into thetreatment research data for alexithymia and be aware of any newdevelopments. Neither psychopaths nor alexithymics respond toempathy training or to dynamically or cognitively basedtherapies. As Legorreta, Bull & Kiely (1988) remarked in theirstudy of eating—disordered alexithymics, treatment programs whichhave a behavioural orientation should be the treatment of choicefor such individuals.Another implication is that different behaviours may berelated to the degree of affective abnormality present inpsychopathy, and affective abnormality in psychopaths may best beassessed by a measure of alexithymia administered concurrentlywith the PCL-R. Consistent with this idea, Patrick, Bradley andLang (1993) found that emotional detachment in psychopaths15(measured by Factor 1 of the PCL-R) was the factor most relatedto their unusual startle reactions to emotional stimuli. Patricket al (1993) found that the eye-blink response of nonpsychopathswould change according to the emotional valence of the stimulus.This effect was not found in psychopaths with high Factor 1scores.Similarly, presence or absence of alexithymia may predictdifferent behaviours in psychopaths.It was hypothesized that alexithymia would be significantlyrelated to psychopathy, especially to Factor 1 of the PCL-R, andthat comorbidity between the two disorders would be common.(b) Relationship between Affective Language, Psychopathyand AlexithymiaThis study extends the research previously conducted onpsychopathy and language, by exploring the effect on listenerswhen psychopaths speak about emotional subjects. On the onehand, since many psychopaths seem to possess the ability toconvince the casual listener of their sincerity and charm, theyare able to deceive and manipulate. Yet on the other hand, ifpsychopaths have no emotional investment in the words they use,their language —- especially when talking about highly emotivematerial -- might be expected to sound flat and insincere. Ifso, their charm must come from elsewhere. There is evidence thatpsychopaths have developed a repertoire of nonverbal techniques,like unusual hand gestures (Gilistrom & Hare, 1988), and16impressive facial expressions -- people often describe theriveting stare and ready smile of the psychopath. Perhaps thesekinetic features of communication are used as a front, blindingprospective victims to the callous personality that lies beneaththe veneer. Without the distracting influence of nonverbalbehaviour, it may become clear that what is being heard is notsincerity, but mere pseudo affect. Hearing psychopaths’ recordedvoices, without being exposed to the impact of their visualpresence, might allow listeners to detect a lack of emotion andlack of sincerity in their speech.Distinguishing and assessing emotion from speech is areliable and valid procedure (Scherer, 1986; Taylor et al, 1981).Scherer has found that judges can accurately decode emotions fromvocal cues, and after examining the results of other techniques,he concluded that “accuracy for the recognition of emotion fromvocal cues is far better than chance and seems to be somewhatbetter than the accuracy reported for facial emotion recognition”(Scherer 1986, p.144).The taped speeches will also be rated by word count, using aparadigm modeled after research conducted by Taylor andassociates (Taylor, Doody & Newman, 1981; Taylor and Doody,1985). Another paradigm, the Gottschalk-Gleser method of contentanalysis (Gottschalk and Gleser, 1969) is frequently used toanalyze speech. This method was considered, but I rejected itbecause it has been shown to perform poorly with alexithymics,17partly because the scales were developed to measure immediate,labile emotional stages rather than stable traits (Gottschalk,1974; Taylor & Doody, 1985). Furthermore, considerable trainingis needed to use the Gottschalk-Gleser method, and it alsorequires an element of subjective interpretation which makesreliability difficult to attain. In contrast, Taylor and Doody’sAffect Vocabulary Score (AVS) is a straightforward scoringprocedure based upon a count of the number of different affectivewords used. They defined as affect words “words that clearlyand unambiguously expressed emotional feeling” (p.471). In theirearlier study (1981), Taylor and Doody performed a total wordcount and an affect word count for each subject. In the 1985study, however, they expanded upon this paradigm by discountingall repetitions of the same affect. Since alexithymia involves alimited vocabulary for describing emotions, and psychopathyinvolves a constricted range of emotions, the more recentprocedure seems preferable for the current study. Rather thanscoring the number of affective words used, this method resultsin a count of the number of emotions mentioned.My hypothesis was that the voices of psychopaths wouldsound unemotional and insincere, and that any emotion which wasexpressed was likely to be inappropriate. I further hypothesizedthat the speech of alexithymics would contain fewer appropriateemotional words, and that their voices would sound flatter, withless affective quality, than those of nOn-alexithymics.18MethodSubj ectsBurnaby Correctional Centre for Women is a medium—securityfacility, housing both federally and provincially convictedfemale offenders, as well as women remanded in custody andawaiting sentencing. There is a maximum security wing and aminimum security open—living unit, and occupancy during theresearch period ranged from 89-102 women, including those onremand. The study sample consisted of 37 females who responded toan information letter mailed to all inmates. For those whovolunteered, informed consent was obtained before their inclusionin the study, and each was paid $10.00 for her participation.Separate consent forms were used for agreeing to be video— andaudio-taped, for participating in the study and for allowing usaccess to their institutional files. To be included, subjectswere required to meet a minimum reading requirement and to speakEnglish fluently and relatively accent-free. No subjects whovolunteered needed to be excluded based on these criteria.The age of the subjects ranged from 19 to 50, with anaverage of 31.68 years (standard deviation 8.35). The majority(76.5%) were Caucasian; 13.5% were Native Indian, 5% were Black,and 5% were Oriental.Twenty—seven percent were housed in the Open Living Unit;the remainder were incarcerated in a maximum or medium securityunit; 10% of these were still on remand.19MeasuresApproximately one-third of the subjects were firstinterviewed for the purpose of a psychopathy assessment. Thequestionnaires and emotional scenarios were then administered ina second session; for the other subjects the order of sessionswas reversed. Psychopathy was assessed using the HarePsychopathy Checklist Revised (PCL-R), which includes avideotaped, semi—standardized interview and intensive examinationof subjects’ institutional files.Subjects were presented with the following typed scenario:Please read the following true account of a recent event. Readit to yourself.A woman was shopping. She had her little two-year old boywith her. While she was shopping, the boy wandered off. He wasled away by two 11 year old youths who persuaded the little boyto go with them. They beat him up and then took him across townto a train crossing. He screamed and cried, begging them toreturn him to his family, but they just laughed. After beatinghim with an iron bar, they threw his body on the train line, andhe was cut in two when a trainS-passed.When she realized her little boy was missing, the woman wasfrantic. She ran around asking everyone if they had seen him,and soon went to the police for help. When his body was found,she collapsed.After providing adequate time for the subject to read thisaccount, she was asked to respond, into a tape recorder, to thefollowing questions:1. Briefly describe this event in your own words. (This was acomprehension, memory, and attention check. All subjects wereable to recap at least the salient events —— e.g. (i) the woman’s20little boy was taken away by two youths; and (ii) they killedhim).2. How well do you think you can describe the feelings of thepeople involved in this event? (1) Not at all well; (2)Moderately well; (3) Extremely well. (Adapted from Dobson andMothersill, 1979, Table 3). This question was included in orderto measure each subject’s ability to predict her empathic powers.While alexithymics were expected to demonstrate a realisticassessment of their empathic abilities, psychopaths, whogenerally tend to exaggerate their abilities, were expected toprovide an inflated score.3. Describe in your own words the feelings of the victim fromthe time he was first separated from his mother, to the time ofhis death.4. Describe in your own words the feelings of the killers fromthe time they first saw the child to the time of his death.5. Describe in your own words the feelings of the little boy’smother from the time she first realized the boy was missing tothe time she learned of his death.6. Describe in your own words the feelings of the killers’parents when they found out what their sons had done.7. Describe in your own words the feelings of the dead littleboy’s father when he found out what had happened that day.8. How does this make YOU feel?Subjects answered question 2 in writing and the rest21required verbal replies. The order of questions 3—8 wasrandomized for each subject, and the answers to these sixquestions were audiotaped.Visual and auditory modalities were separated by recordingthe voices of subjects on audiotape only. By capturing the vocalqualities independently of the visual features, I gauged theeffect of listening to psychopaths and alexithymics, neither ofwhom are thought to have much direct experience of emotion,describing their reactions to an emotional event. Listeners wereexposed to speech only, unconfounded with any effects of thephysical presence of the speakers. I would have liked to testraters reactions under a second condition —— sound plus video,but obtaining prison approval of videotape exposure for thispurpose has, at this point, proved impossible.The following battery of measures was administered:1. The Toronto Alexithymia Scale (TAS; Taylor, Ryan & Bagby,1985) consists of 26 5—point Likert scales for subjects toindicate their degree of agreement/disagreement with each self—rating statement. The 26 item version of the TAS covers fouraspects of alexithymia: (a) the ability to identify anddistinguish between feelings and bodily sensations; (b) theability to describe feelings to others; (c) the extent to whichdaydreaming is experienced; and (d) externally-oriented thinking.Ongoing research into these factors and into the individual itemsin the TAS, has led to several changes by the authors and others.22As a result of reliability and scale validation studies, theinstrument was revised in 1992. The TAS-R consists of 23 items;some of the original ones were discarded, others rewritten, andthe daydreaming factor was eliminated. Factors 1 and 2 (abilityto discriminate feelings from bodily sensations, and ability tocommunicate feelings) were combined; thus the TAS—R contains onlytwo scales. Linden and Paulhus (in press) examined this version,and concluded it added little to the original. The originalauthors collaborated with others, and published a secondrevision, with only 20 items (Parker, Bagby, Taylor, Endler andSchmitz, 1993) but with three factors. The daydreaming scale wasomitted, but the first two factors were once again included asseparate scales. According to the authors, this very recentversion still requires evaluation of convergent, discriminant,and criterion validity in diverse cultural groups.For this study, I decided to use the original TAS, but withan amendment developed by Haviland et al (1988). Theseresearchers analyzed the TAS subscales, and their factor analyticstudies suggested the following three subscale derivations:Factor 1, Feelings (this represents a combination of the originalfirst two factors); Factor 2, Daydreaming; and Factor 3, ExternalThinking.All but one of the 37 subjects completed the TAS; she didnot feel like completing the session and was released on anelectronic monitoring program (house arrest) before she could be23re-contacted. The 26 item TAS is included as Appendix B.2. The Beck Depression Inventory (BDI; Beck, Ward, Mendelson,Mock & Erbaugh, 1961) is a 21-item self-report instrument used toassess state depression (mood). It is widely used and hasadequate validity and reliability. The BDI was used to discountthe alternative hypothesis that mood could be responsible foremotional/speech differences between subjects. (See Appendix C).3. The Wide Range Achievement Test - Revised (WRAT-R; Jastak &Jastak, 1978) was administered to ensure that a minimum standardof reading ability was met by all subjects, and that differencesin emotional responses were not due to inability to read thewritten scenario presented by the researcher. The WRAT has beenresearched continuously on many samples of all ages and mentalabilities, and impressive reliability measures have been reportedfor all three WRAT subtests (Reading, Spelling and Arithmetic).The Reading Test has been externally validated in educational andclinical trials. One of its uses is the accurate diagnosis ofreading ability, and the degree and nature of reading disabilityas a result of brain injury and other disturbances. The Level IIReading Test (for people aged 12 years and up) asks subjects toread aloud a list of 74 words; they have a limit of 10 secondsper word, and the test is halted after 12 consecutive failures.This is the only part of the WRAT-R that was used in the presentstudy. (See Appendix D).4. The Wechsler Adult Intelligence Scale - Revised (WAIS-R;24Wechsler, 1981) was used to assess verbal intelligence. (SeeAppendix E). Use of an IQ measure allows us to discount IQ as analternative explanation of any verbal differences betweensubjects. The WAIS-R contains five subtests used to assign aPerformance IQ Score; the Verbal and Performance scores areadded to provide a Full Scale IQ Score. In this study, Iadministered only the six subtests necessary to compile a VerbalIQ Score, using a shortened version of the WAIS-R administrationinstructions, a version developed by Satz and Mogel in 1962 whichcorrelates .99 with the complete version for Verbal IQ in anormal population. Subsequent studies have reported comparablyhigh correlation coefficients between the Satz-Mogel short formand the full form in other populations, including brain-damagedpopulations (Goebel & Satz, 1975) and the elderly (Osato, VanGorp, Kern, Satz & Steinman, 1988). The advantage of this shortform is that it takes only about one-third of the time requiredfor administration of the complete WAIS-R. Answers wereprorated, and an equivalent Verbal IQ score was thus obtained.ProceduresAll sessions were conducted on site at the prison’s mainunit or at the open living unit, in private offices provided byCorrections Staff. Subjects were tested individually, in twosessions. The PCL—R interview lasted approximately two hours;administration of the test battery and voice taping requiredapproximately one hour.25Psychopathy: A graduate student of psychology, with adiploma in criminology, was trained to administer and rate thePCL-R. She completed her training by rating ten “practice” tapes(videotaped interviews with inmates who agreed to serve astraining sources), at which point acceptable interraterreliability was achieved. A second, independent rating wasobtained for 25 of the subjects by a trained research assistant.PCL—R interviews were videotaped, and ratings were based on theinterview material and file information. Information aboutoffspring was recorded separately to assess any effect ofmotherhood or number of children on the experimental results.Under circumstances where information was unavailable to score aPCL-R item, it was omitted and the total score prorated. Threeof the subjects were unavailable for interview although they hadsigned consent forms for access to their file material; theirpsychopathy ratings were obtained by exhaustive perusal of theirinstitutional files. File-only ratings have proven reliable andvalid in other settings (Lewis et al, 1994). Interraterreliability coefficients were calculated for all 25 double-ratedfiles, including 2 of the 3 file-only ratings.Voice Analyses: Two female psychology undergraduatestudents, blind as to the identity or characteristics of thesubjects, volunteered to rate subjects’ audiotaped responses.They were trained on the following list of measures by discussingand jointly rating practice tapes until acceptable interrater26reliability was achieved:1. Using a 5-point Likert-type scale with 3 anchors (not at allemotional, moderately emotional, extremely emotional) they ratedeach subject for intensity of emotion (Dobson & Mothersill,1979). These ratings were designed to reflect impressions ofwhether subjects’ voices displayed any feelings at all, or ifthey seemed flat, expressionless, bored, or disengaged, as heardby a lack of cadence and low variability of tone. This item wasrated on voice quality, not content.2. Using a 5-point Likert-type scale with 3 anchors (not at allappropriate, moderately appropriate, extremely appropriate), theyrated subjects for appropriateness of emotion (Dobson &Mothersill, 1979). Here, if there was judged to be any emotionexpressed, raters assessed whether it was appropriately sad,angry, distraught, and so forth, or if it seemed inappropriatelyexcited, aroused, happy, or was judged to drasticallyunderestimate the appropriate depth of emotion (e.g. responseslike “the mother was probably glad her son was dead,” or “thefather was quite sorry his boy was killed,” would beinappropriate). This item was rated on content rather than voicequality.3. Using a 5-point Likert-type scale with 3 anchors (not at allsincere, moderately sincere, extremely sincere), they rated thedegree of sincerity (Dobson & Mothersill, 1979). They assessedwhether the words matched the affect. If there was appropriate27emotion expressed verbally, did it seem genuinely sincere or didit come across as mere pretense? This item was rated on bothvoice quality and the actual words used (i.e. the subject mayhave said appropriately emotive words, but sounded either too“theatrical,” histrionic, or flat, or else used words that werejudged to lack sincerity. An example of this would have been if asubject expressed appropriate emotions, but embellished herresponses with jokes).Interrater reliability coefficients were calculated for alltape ratings.One of the volunteers also transcribed the tapes, andperformed word counts based on Taylor and Doody’s (1985)paradigm. A total word count was obtained for each subject, andeach different emotion was tallied to form an affect word count.Separate total word counts and affect word counts were calculatedfor the question “How does this make YOU feel,” in order toobtain a measure of subjects’ ability to describe their ownfeelings in contrast to those of others. All affect word countswere checked by a second volunteer, and 10 total word counts wererandomly selected and checked.28ResultsThe results are presented in three sections: (a) descriptivestatistics and intercorrelations between the PCL-R and the TASand their subscales; (b) relationships of the PCL-R and the TASto violence, and (c) vocal analyses.(a) Descriptive Statistics and Intercorrelations between thePCL-R and the TASTable 1 presents the descriptive and psychometric statisticsfor the PCL-R for this sample. It also contains similar datafrom other female offender studies described in Strachan (1993)and Tien et al (1993) and, for comparative purposes, data from apooled sample of male offenders (Hare, 1991).Interrater reliability for the present study was assessedusing Pearson’s r coefficient.The distribution of Total and Factor scores in this samplewas similar to that obtained with the Strachan, Tien, and Haresamples. Correlations were calculated on the full range ofalexithymia and psychopathy scores. For all correlational data,scatterplots were obtained; none revealed significant outliers.Table 2 contains the descriptive statistics for the TAS forthis sample. Also included are similar data for two othersamples, one female and one male. The mean score for the currentstudy was higher than the female sample and lower than the malesample. The base rate in this study was lower than that found ina sample of male alcoholic inpatients.29Table 1Descriptive statistics of the PCL-R for samples of female andmale offendersFemales MalesStrachan Tien et al Present Haresample sample sample sampleN 75 74 37 1192Total ScoreM 24.49 23.0 24.09 23.63SD 7.45 NR 7.7 7.92Base rate 31% 23% 30% 15—20%Interraterreliability .96 NR .95 .91Factor 19.95 MR 8.65 8.93SD 3.25 NR 2.85 3.93Factor 2M 10.90 MR 11.63 11.69SD 4.14 MR 4.09 3.90Note. Base rate refers to the percentage of subjects scoring 30or higher on the PCL-R. A score of 30 (one standard deviationabove the mean) was determined to represent the optimum cut—offscore for research purposes (Hare, 1991). In practice, however,it is found that subjects who score 27 or more usually exhibitthe behaviours associated with psychopaths.PCL—R Factor 1 refers to the cluster of characteristicsassociated with interpersonal deviance; Factor 2 refers tosocially deviant behaviours.NR = statistic not reported30Table 2Descriptive statistics of the TAS for different samplesTaylor et al Hendryx et al Current sample(1988) sample (1992) sampleN 26 130 37M 64.8 72.1 69.72SD 13.7 10.8 13.56Base rate NR 51% 33%NR: Not Reported.Note. Taylor’s sample consisted of female outpatients at abehavioural medicine clinic; the Hendryx sample were maleinpatients at an alcohol abuse treatment centre.31Table 3 presents the subject variables: age, Verbal IQ, BDIand Wide Range Achievement Test (WRAT) scores. The TAS wasnegatively correlated with Verbal IQ ( = -.37, p <.05), and bothTAS and PCL-R scores were positively correlated with BDI scores(r = .50, p <.01; = .33, p =.05). Additionally, PCL-R and agewere negatively associated ( = —.33, p <.05). There was norelationship between reading ability (the WRAT) and eitheralexithymia or psychopathy.Table 4 contains a correlation matrix between psychopathyand alexithymia ratings. There was no relationship between PCL-Rand TAS total scores, but significant positive associationsemerged between the TAS and PCL-R Factor 2 (social deviance) andespecially between TAS Factor 1 (inability to distinguish anddescribe feelings) and PCL-R Factor 2.PCL-R Factor 2 scores were significantly correlated with TASTotal Scores and TAS Factor 1. Obviously, there was someconnection, in this sample, between criminality and alexithymia.(b) Relationships of the PCL-R and the TAS to ViolenceTo explore further the relationship between PCL-R Factor 2and alexithymia, I examined the subjects’ institutional files forclues as to which Factor 2 behaviours might be common to bothpsychopaths and alexithymics. Violence appeared a strongpossibility. I then coded the subjects according to presence or32Table 3Subiect variablesVariable M SD Mm. Max.BDI Score 15.54 8.78 2.00 35.00Age 31.68 8.35 19 50Verbal IQ 87.56 11.67 68 113WRAT 98.53 13.84 72 133Note. WRAT scores represent standard scores calculated accordingto the WRAT scoring manual.33Table 4Correlations between PCL-R and TAS factorsTAS TAS TAS TASTotal Factor 1 Factor 2 Factor 3Score (Feelings) (Dreaming) (External)PCL—R .26 .32 —.24 .19PCL-RFactor 1 .01 .11 -.13 -.06PCL-RFactor 2 •33* .38* —.24 .22*p<.05.Note. TAS Factor 1 = Ability to distinguish and describefeelings; TAS Factor 2 = Lack of daydreaming; TAS Factor 3 =Externally-oriented thinking.Higher scores on all factors relate to higher dysfunction levels.34absence of violence. Extensive research has been carried out toexamine the association between psychopathy and violence (e.g.Hart and Hare, 1989; Kosson, Newman and Smith, 1990; Serin,1991), but there has been very little research examining apossible linkage between violence and alexithymia. Even wheredata exist, most are concerned with male offenders. Forinstance, Keltikangas-Jarvinen (1982) found a high rate ofalexithymia among males convicted of violent crimes. In hersample of 75 female offenders, Strachan (1993) found the PCL—Rcorrelated .35 (significant at p<.002) with a record of violence.In this study, the subjects were coded as violent if theyhad ever been charged with a violent crime (i.e. murder,manslaughter, assault). According to this criterion, 25 of the37 subjects (60%) were considered violent and 12 (32*) were nonviolent. Because of the imbalance in subjects between groups,Levene’s test for equality of variances was conducted, revealingthe difference to be non-significant for -tests involvingviolence and the PCL-R, F = 2.108, p .155, and violence and theTAS, = .389, p =.537.The violent group had a higher mean PCL-R score (N = 27.2)than did the non-violent group ( = 17.6), (35) = 3.84, p<.OOl.Clearly, female violence, like male violence, was highlyassociated with psychopathy.The mean TAS score was higher for the violent sample ( =74.4) than for the non-violent group ( = 60.5), (34) = 3.43,35p<.OOl. In this sample, there was obviously a connection betweenfemale violence and alexithymia.Table 5 presents the correlations of the PCL-R and the TASwith violence. PCL—R and TAS total scores were each correlatedwith violence. Both Factors of the PCL-R were significantlyassociated with violence. Only Factors 1 and 3 of the TAS werecorrelated with violence. Since the TAS and PCL-R had nostatistical relationship with each other, a multiple regressionanalysis was performed to see to what extent violence could bepredicted by these two instruments. A standard multipleregression (SPSS—X) was performed between violence as thedependent variable and TAS and PCL-R scores as the independentvariables. The distribution of scOres for the two independentvariables was approximately normal (skewness = —.43 for PCL—R and.16 for TAS scores); consequently, no transformations werenecessary. Table 6 displays the regression coefficients, R (themultiple correlation), and R2. Both TAS and PCL-R variables weresignificant predictors of violence; altogether, 47% of thevariability in violence was attributable to these scores.36Table 5Correlations of the PCL-R and the TAS with violencePCL-RTotal .60**Factor 1Factor 2 .52**TASTotalFeelings .36*Dreaming -.03External*p<.05. **p<.O137Table 6Standard multiple regression of PCL-R and TAS variables onviolenceVariable T pPCL—R .031 3.83 .0005TAS .012 2.70 .011R2 = .472, (2,33) 14.78, p<.O0l; Multiple R = .687.38(c) Vocal AnalysesAppendix F lists the means, standard deviations and inter-correlations of all vocal measures. Table 7 contains thecorrelations between PCL—R scores and vocal analyses of subjects’audiotaped responses to the emotional scenario. None of thefindings was significant. No clear affective impoverishment couldbe detected in the voices of psychopaths, either by rating theirspeech for signs of affect, or by counting the number of wordsand number of emotions spoken.The same pattern emerged when ratings for the question “Howdoes this make YOU feel?” were correlated with PCL—R scores.There was no relationship between psychopathy and emotionalquality of the voices, appropriateness of emotions expressed,raters’ impressions of sincerity, total word count, or number ofaffective states mentioned by subjects.I next looked at subjects’ self-ratings of empathic ability(“How well do you think you will be able to describe the feelingsof the people involved in this event?”). Again, there was norelationship with psychopathy.Table 8 contains the same analyses performed for TAS scoresand vocal ratings. All correlations were negatively associatedwith the TAS and its factors, seven significantly so. Total TASscores were negatively associated with appropriateness of39Table 7Correlations between PCL—R scores and vocal analysis ratingsEmotion Appropri- Sincerity Total Totalateness Word AffectCount CountPCL—R .09 .16 .13 .02 .17Factor 1 .01 .12 .06 .09 .32Factor 2 .01 .11 .05 —.01 .09Note. Interrater reliability was computed for the two independentratings of Amount of Emotion, Appropriateness of Emotion, andSincerity, and the results are reported as Pearson’s r: Amount ofEmotion: =.8; Appropriateness of Emotion: r =.77; Sincerity:=78.40Table 8Correlations between TAS scores and vocal analysis ratingsEmotion Appropri- Amount of Total Totalateness Sincerity Word AffectCount CountTAS —.20 —.40* —.22 —. 44**Feelings —.09 —.25 —.13 —.21 —.08Dreaming —.13 —.25 —.13 —.22 —. 55***External —.28 —35* —.28 —. 56*** —.33**p<.0S. **p<.Ol. ***<.00141emotional content, total words, and number of affects mentioned.Factor 2, inability to daydream, was negatively correlated withtotal affect count, and Factor 3 —— an externally—oriented,concrete thinking style, was negatively associated withappropriateness of emotions, total word count, and total affectcount. The higher subjects’ scores on measures of alexithymia,the lower their ratings on normal affective expression.Table 9 shows the relationship between TAS factors and ratedability to predict degree of empathic ability, as well as therelationship between alexithyrnia and affective content ofresponses to the question “How does this make YOU feel?”All results were in the negative direction. Alexithyiniccharacteristics were associated with lower predictions ofempathic ability and fewer words/affective states, but only fourof these reached statistical significance. Total TAS scores werenegatively correlated with number of affective states mentioned,as were Factor 2 scores; Factor 3 scores were negativelycorrelated both with prediction of empathy and with total wordcount. Alexithymics appeared to be realistic in theirexpectations about their impaired ability to correctly assess anddescribe others’ emotions, and alexithyrnia was associated withsubjects’ inability to verbalize emotional reactions to thescenario presented in this study.In case the experience of motherhood contributed to the42Table 9Correlations between TAS scores, prediction of empathy, andcontent analysis of subiects’ responses to question regarding ownfeelingsPrediction of Total Word Total AffectEmpathy Count CountTAS —.29 —.23Feelings —. 11 —.08 —. 16Dreaming -.03 -.11 -. 4Q*External —47** •33* -.16*p<.05. **p<.0l.43degree of emotion expressed in response to the scenario, Iexamined each subject’s file for number of children, andcorrelated this variable with all affective measures. Most of thewomen had at least one child (range: 0 — 4). Presence or absenceof children, or number of offspring, was unrelated to any of thespeech measures.An earlier study examining the speech of male psychopaths(Louth et al, 1994) found a significant tendency for incarceratedmale psychopaths to speak more quickly than their non-psychopathic counterparts. The vocal patterns in that study wereanalyzed using a sophisticated software package which tracks theacoustic signals of speech, and measures the duration ofutterances and internal pauses. The raters in the present studywere asked to assess the audiotapes of subjects’ responses andscore them for rate of speech, using a continuous scale where 1 =slow, and 3 = fast.While no association emerged between rate of speech andpsychopathy (r = -.04), there was a significant negativerelationship between rate of speech and alexithymia (r = -.57, p<.001). In case the slow speech of alexithymics could beobscuring the faster speech of psychopaths, the data werereanalysed with alexithymics (TAS > 70) filtered out. With aremaining p of 16, there was still no significant relationshipbetween psychopathy and speed of speech, but the results were nowin a slightly positive direction (r = .34, p =.19).44DiscussionPsychopathy and AlexithymiaI had expected to find some connection betweenalexithymia and the PCL-R factor which measures interpersonalimpoverishment — Factor 1. No such relationship emerged.Instead, there was a modest but significant positive correlationbetween the TAS and Factor 2 — the factor assessing behaviouralindices of psychopathy such as impulsiveness, proneness toboredom, poor behavioural controls, and criminality. Thesignificant correlation between PCL—R Factor 2 and the “Feelings”subscale of the TAS, rather than the anticipated relationshipbetween “Feelings” and Factor 1, prompted a closer examination ofindividual items on the two instruments. Items on the “Feelings”scale include: “When I cry I always know why,” “I often getconfused about what emotion I am feeling,” and “I find it hard todescribe how I feel about people.” Factor 1 of the PCL-Rincludes such characteristics as glibness, grandiosity,pathological lying, tendency to con and manipulate others, andshallow affect. Psychopaths who are glib and grandiose would bedisinclined to admit confusion about their feelings. Theirinflated sense of their own abilities, plus a tendency to lie andgloss over personal inadequacies, would lead them to make non—alexithymic responses to these TAS items. Their superficialityand restricted affective range could result in a feeling ofconfidence about how they feel about people —— perhaps there are45simply those who can be manipulated and those who cannot.Psychopaths scoring highly on Factor 1 of the PCL-R may betotally unaware of any emotional deviance on their part.The descriptive statistics and interrater reliability of thePCL-R in this sample were similar to those reported by otherresearchers. Consistent with other research, the base rate forpsychopathy, however, was higher than typically found for malesample groups -- a finding that lends support to Mednick andKandel’s view (1988) of differential sentencing practices. Itwould be worthwhile, in this regard, to compare the criminalbackgrounds of incarcerated men and women. We might surmise thatprison sentences of women represent something of a last resort,whereas for men, prison is recommended for less serious, orfewer, criminal offences. Only two of our subjects had noprevious criminal records; most had extensive criminalhistories.In this sample, the only correlates of psychopathy weredepression and age. The relationship with depression, asmeasured by the Beck Depression Inventory, is unusual. Strachan(1994) found no such relationship, and indeed, negativecorrelations are most commonly found with male samples (Hare,1991). In the Tien et al (1990) assessment of female inmates,they found that 32% of the women suffered from depressivedisorders, but the report did not include mean Beck DepressionInventory scores, nor did it report correlations between BDI and46PCL-R scores. Given the high rate of depression and psychopathyin their sample, it is likely that BDI scores were alsoassociated with PCL—R scores.When the BDI was administered to the current sample of womenno special instructions were issued about how to deal with item 6(“I feel I am being punished”). Out of a range of 0 to 3, veryfew women chose the lowest selection (“I don’t feel I am beingpunished”); many chose the highest scoring statement. Possibly,in this sample, the women concluded that this item referred tothe fact that they were being punished by the law, aninterpretation not intended by the authors of the BDI. It is notknown if other researchers in prison environments give theirsubjects any instructions about completing this item.The negative correlation between age and psychopathy (-.33)shows that, in this group of women, the younger inmates were themost likely to be psychopaths. Though some researchers havereported a reduction in antisocial behaviours as psychopaths age(Hare et al, 1988; Hare & Forth, 1992), this negative associationis not normally seen within a given psychopathy study, and mayonly reflect the particular sample incarcerated during the timeof this study.The descriptive statistics of the TAS found in this studywere in line with other reported research in the area ofalexithymia. The mean score was higher than that found in asample of 26 female outpatients at a behavioural medicine clinic47(Taylor et al, 1988), but slightly lower than the mean of 130male alcoholic inpatients (Hendryx et al, 1992). Over fiftypercent of the alcoholic sample were considered alexithymic,compared to one—third of our female inmates. Given thatincarceration could be considered a stressful condition for manyoffenders, the fact that two—thirds of our sample were notalexithymic provides support for the idea that the TAS assessesprimary, or trait alexithymia, as contrasted with secondary, orreactive alexithymia.The high correlation between TAS and depression echoes arelationship commonly found in alexithymia studies (Taylor et al,1990, and others). Most researchers report that although the twoare highly correlated, depression is not a significant predictorof alexithymia. Haviland et al (1988) explored this relationshipfurther, and found that while BDI scores fluctuated TAS scoreswere relatively static, which they interpreted as supportingconceptual independence of the two constructs.One purpose of this study was to assess the co—occurrence ofalexithymia and psychopathy. The base rates of psychopathy andalexithymia were similar. Using the recommended cutoff scores of74 for the TAS and 30 for the PCL-R, eleven of the women werepsychopaths and twelve were alexithymic, but only three subjectscould be considered both psychopathic and alexithymic. It seemsunlikely then, that alexithymia scores inflated PCL-R ratings toa point where misdiagnosis was a threat.48Criminality and ViolenceThough social conformity has been associated withalexithymia, the characteristics of alexithymics in prison may bedifferent from those of non—incarcerated populations.Alexithymia is also connected with impulsivity and substanceabuse. Apparently, in these alexithymic inmates, thesetendencies overcome the desire to conform. This would explainthe correlation of the TAS with Factor 2 of the PCL-R.Kroner (1994), in a study of 104 male sex offenders, alsofound a connection between PCL—R Factor 2 and the “Feelings”subscale of the TAS, although he used a different version of theTAS, one with 20 items and four factors. While my sample was toosmall to permit individual item correlations, Kroner performed adetailed item analysis, and found this subscale to correlatepositively with PCL-R Items 3 (proneness to boredom), 14(impulsivity), 15 (irresponsibility), and 20 (criminalversatility).Kroner’s sample was quite different from mine; he used adifferent version of the TAS, and his group of male offenders hada mean PCL-R score of only 17.2; yet, like Keltikangas-Jarvinen(1982), we both found an association between alexithymia andcriminality. Keltikangas-Jarvinen’s sample consisted of 68violent offenders from a Helsinki Penitentiary. All were maleand all were recidivists. Although no psychopathy assessment wasused, it is reasonable to speculate that this group would score49highly on Factor 2 of the PCL-R. Keltikangas-Jarvinen reported ahigh rate of alexithymia in her sample.It would be interesting to investigate the relationshipbetween alexithylnia and violence in a non—incarcerated sample.Until this is attempted we can only conclude that in an inmatepopulation the characteristic of being unable to experience ordescribe emotions is predictive of violence.It has long been known that psychopathy, as measured by thePCL-R, is strongly associated with, and predictive of, violencein male inmates (e.g. Hare & McPherson, 1984; Serin, 1991; Riceet al, 1992). The present study indicates that there is also aPCL-R/violence relationship in female offenders. As Strachan(1994) pointed out, the concept of femininity has traditionallybeen considered antithetical to violence, but as women’s sex—rolestereotypes disappear society may begin to view femalecriminality more realistically. If further research confirms theassociation between psychopathy, alexithymia, and violence inwomen, parole boards and corrections staff will have additionalmeans at their disposal for assessing offenders’ suitability forearly release.Psychopathy, Alexithymia, and Affective LanguageAlthough psychopaths appear to experience a restrictedrange of affect, those in this study were judged the same asothers on amount of expressed emotion, appropriateness of emotionand sincerity. It seems that psychopaths may not experience50normal emotions, but are as adept as others at using appropriatewords to describe emotional states. Even though the raters knewthat some of the subjects were psychopaths, they were unable todetect any group differences in the taped voices. Perhaps thepsychopaths went out of their way to convince the interviewers oftheir normalcy in the areas of empathy and affect. There was noevidence they were aware of affective impoverishment in theirpredictions of self-empathic ability. Psychopaths rated theirown empathic powers in the same way as did the other subjects.A different picture emerged in the analysis of alexithymicspeech samples. In line with the theoretical construct ofalexithymia, high TAS scores were associated with low total wordproduction and a low number of affective states mentioned. Thiswas true whether subjects were trying to describe others’feelings or their own. Alexithymics were also rated as talkingsignificantly more slowly than others. If this finding isreplicated, rating the speed of speech may prove to be a usefulsignal to alert professionals to the possible presence ofalexithymia.Although all results were in the negative direction, thehighest significant correlations were with the “Dreaming” and“External Cognitive Style” scales of the TAS. Alexithymics wererated as less appropriate than others in the type and depth ofemotions they talked about. Alexithymics also seemed much morerealistic appraisers of their poor empathic ability than did51psychopaths. Again, an externally oriented cognitive style seemedto predispose subjects to rate their own empathic powers as quitelow. This represents a fundamental difference betweenpsychopaths and alexithymics. Although neither group wouldlikely attach any great significance to their affectivedifficulties, at least the alexithymic seems more likely to admittheir existence — a vital first step before any treatment couldeven be contemplated.Although detailed speech analyses were not conducted in thisstudy, and only affective words were singled out for attention, amore careful examination of some of the speech samples revealedsome trends worthy of future research. For example, alexithymicstended to use an excessive number of qualifiers, such as“probably, maybe, I imagine,” and often simply, “I don’t know,”or “I don’t have a clue.” They also tended to change theirminds, as “When he died, she probably felt guilty, no angry, nosorry.” They sometimes showed their concrete ways of thinkingquite dramatically., as “But the story doesn’t say anything abouta husband,” and “The story didn’t say what her feelings were,angry, scared, or what.” Psychopaths often produced strange nonsequiturs in their speech, for example: “How would the kid feel?Well, in a store he is curious about what’s in the store.Macaroni cheese, whatever,” and “Anyway, it’s different in themthird world countries. No respect for life, with the IRS or IRAor whatever.” These rather odd verbalizations only appeared when52the transcripts were examined, and did not affect raters’assessments of sincerity, appropriateness, and so forth. Hare(1993) has remarked upon this tendency for strange verbalrambling by psychopaths.Psychopaths also showed a preoccupation with legal conceptsand with mitigating factors; for instance, the following examplesare all excerpted from psychopaths’ responses:“They must have been abused children themselves,”“The kids that killed him must obviously have had terriblelives,”“The father might have wanted to take legal action,”“Maybe they had poor backgrounds, no concept of right orwrong,”“What kinds of homes were they brought up in?”“Must be because of something they’d watched on TV; at theirage they couldn’t stick them in jail.”Psychopaths in prison are often the offenders who are mostskilled at manipulating the system. With an almost obsessiveknowledge of the law and their rights, they are adept at playingthe system to their advantage. These examples supply interestingevidence of this preoccupation with ways to gain sympathy andleniency from the legal system.There are several limitations to the speech analyses in thisstudy. Firstly, rating speech for emotional measures is adifficult and subjective task. The interrater reliability levels53achieved by our raters, while acceptable for research purposes,were far from perfect. Secondly, the scenario provided to thesubjects was a true story, but reading a short paragraph, howevercarefully chosen to elicit emotion, is still an artificialsituation. Realistically, the subjects were probablyparticipating because of the payment we offered them, or as analternative to prison routine. There is no guarantee they tookthis study seriously, or that their behaviour during the sessionswas representative of their normal behaviour.ConclusionThis study suggests that alexithymia, like psychopathy, is asignificant construct in institutions. Both disorders have ahigh base rate among female inmates, ahd there seems to be asmall subgroup of psychopaths, high on PCL-R Factor 2, who arealso alexithymics. Given their propensity for violent action andtheir poor response to treatment, such individuals would be athorny management problem for those responsible for designing andconducting rehabilitation programs. Presumably, treatmentprograms designed to teach empathy to these individuals would notbe very useful.For the alexithymic client in clinical practice, anyinterventions dependent upon emotional insight would probably bedestined to fail. As. Legorreta (1980) recommended, the besttreatment paradigm for such individuals might be interventionswith a strong behavioural focus.54If there is a common link between alexithymia andpsychopathy, it may lie in the characteristic of impulsivity,which both groups experience in excess —— so much so inalexithymics that it seems to overcome their natural reluctanceto break social conventions. A study by Lee and Menna (1994)found that aggressive (and probably impulsive) children as youngas 3 years had an impaired ability to predict others’ emotions.We could speculate that these traits might foreshadow thedevelopment of disorders such as psychopathy or alexithymia, andthat environmental issues would be crucial in affecting theoutcome for children such as these. Very young psychopaths maynot yet have learned to make up for their affective impairments;their glibness and manipulative skills would yet be unhoned.Research into psychopathy has been aided by the developmentof the PCL-R; with the ongoing validation of the TAS, the way isbeing paved for future research combining both constructs. Inpsychopaths, affective impairment and antisocial behaviours arewoven together to form a potentially dangerous personality. 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Promiscuous sexual behavior12. Early behaviour problems13. Lack of realistic long-term plans14. Impulsivity15. Irresponsibility16. Failure to accept responsibility for own actions17. Many marital relationships18. Juvenile delinquency19. Poor risk for conditional release20. Criminal versatilityVALIDITY RATING0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omit0 1 2 omitAppendix APCL-R SCORESHEETTOTAL SCORE: /Prorated score: /40Prototypicality:____________(#of 2’s)On the basis of the quality of the interview and collateral information, indicate your confidencein the validity ofyour PCL rating:/ / / /Low Moderate High1 2 3 4 5©Copyright 1989 by Robert D. Hare, University ofBntish Columbia62Appendix BTAS Subject No.Please read each statement carefully and circle the number which best describes how much youagree or disagree with each statement.Strongly Moderately Neither Moderately StronglyDisagree Disagree Disagree Agree Agreenor agree1. When I cry I always know why. 1 2 3 4 52. Daydreaming is a waste of time. 1 2 3 4 53. I wish I were not so shy. 1 2 3 4 54. I often get confused about whatemotion I am feeling. 1 2 3 4 55. I often daydream about the future. 1 2 3 4 56. I seem to make friends as easily asothersdo. 1 2 3 4 57. Knowing the answers to problems ismore important than knowing thereasons for the answers. 1 2 3 4 58. It is difficult for me to find the rightwords, 1 2 3 4 59. I like to let people know where Istand on things. 1 2 3 4 510. I have physical sensations that evendoctors don’t understand. 1 2 3 4 511. It’s not enough for me to know thatsomething gets the job done; I needto know why and how it works. 1 2 3 4 512. I am able to describe my feelingseasily. 1 2 3 4 513. I prefer to analyze problems ratherthan just to describe them. 1 2 3 4 563TAS Page 2.Strongly Moderately Neither Moderately StronglyDisagree Disagree Disagree Agree Agreenor agree14. When I’m upset, I don’t know if Iam sad, frightened or angry. 1 2 3 4 515. I use my imagination a great deal. 1 2 3 4 516. I spend much time daydreaming 1 2 3 4 5whenever I have nothing else to do.17. I am often puzzled by sensation inmybody. 1 2 3 4 518. Idaydream rarely. 1 2 3 4 519. I prefer to just let things happenrather than to understand why 1 2 3 4 5they turned out that way.20. I have feelings that I can’t quite 1 2 3 4 5identify.21. Being in touch with emotions is 1 2 3 4 5essential.22. I find it hard to describe how I feel 1 2 3 4 5about people.23. People tell me to describe myfeelings more. 1 2 3 4 524. One should look for deeperexplanations. 1 2 3 4 525. I don’t know what’s going on insideme. 1 2 3 4 526. I often don’t know why I’m angry. 1 2 3 4 5This questionnaire consists of 21 groups of statements. After reading each group of statements carefully,circle the number (0, 1 • 2 or 3) next to the one statement in each group which best describes the way youhave been feeling the past week, Including today. If several statements within a group seem to apply equallywell, circle each one. Be sure to read all the statements In each group before making your choice._____SubtotalPage 1,THE PS’tDHctOGlCAL ODRPcS.i’310N*j,’HATtfXuRrBR ‘ANCYs’IGi. R’.Copyright © 1978 by Aaron T. Beck. All rights reserved. Printed in the U.S.A.CONTINUED ON BACKIrriDLI64Appendix CDate:° Idonotfeelsad.I feel sad.2 Iamsadallthetimeandlcan’tsnapoutofit.I am so sad or unhappy that I can’t stand it.2 ° I am not particularly discouraged about thefuture.1 I feel discouraged about the future.2 I feel I have nothing to look forward to.I feel that the future is hopeless and thatthings cannot improve.3 ° Idonotfeellikeafailure.I feel I have failed more than theaverage person.2 As I look back on my life, all I can see isa lot of failures.I feel I am a complete failure as a person.4 ° I get as much satisfaction out of things as Iused to.I don’t enjoy things the way I used to.2 I don’t get real satisfaction out of anythinganymore.lam dissatisfied or bored with everything.5 ° I don’t feel particularly guilty.1 I feel guilty a good part of the time.2 I feel quite guilty most of the time.I feel guilty all of the time.6 ° I don’t feel I am being punished.I feel I may be punished.2 expect to be punished.‘ I feel lam being punished.7 ° I don’t feel disappointed in myself.lam disappointed in myself.2 1am disgusted with myself.Ihatemyself.8 ° I don’t feel I am any worse thananybody else.I am critical of myself for my weaknessesor mistakes.2 blame myself all the time for my faults.I blame myself for everything badthat happens.8 0 I don’t have any thoughts of killing myself.I have thoughts of killing myself, but Iwould not carry them out.2 Iwouidliketokillmyself.I would kill myself if I had the chance.10 0 don’t cry any more than usual.1 I cry more now than I used to.2 I cry all the time now.Iusedtobeabletocry,butnowlcan’tcryeven though I want to.11 ° lam no more irritated now than lever am.I get annoyed or irritated more easily thanIusedto.2 I feel irritated all the time now.Idon’tgetirritat.edatallby thethingsthatused to irritate me.12 ° I have not lost interest in other people.1 I am less interested in other people thanIusedtobe.2 I have lost most of my interest Inother people.S I have lost all of my interest in other people.13 0 I make decisions about as well asI ever could.I I put off making decisions more thanIusedto.2 I have greater difficulty in makingdecisions than before.3 I can’t make decisions at all anymore.65BDI page 2_____SubtotalPage 2Subtotal Page 1_‘ibtalScore14 o I don’t feel I look any worse than I used to.i I am worried that I am looking old orunattractive.2 I feel that there are permanent changesin my appearance that make me lookunattractive.I believe that I look ugly.1518 o I haven’t lost much weight, if any, lately.I have lost more than 5 pounds.2 Ihavelostmorethan lOpounds.I have lost more than 15 pounds.o I can work about as well as before.Ittakesanextraefforttogetstartedatdoing something.I have to push myself very hard to doanything.I can’t do any work at all.I am purpo8ely trying to lose weight byeating less. Yes No_____1829 o I am no more worried about my healththan usual.a I am worried about physical problemssuch as aches and pains; or upsetstomach; or constipation.2 1am very worried about physicalproblems and it’s hard to think ofmuch else.s I am so worried about my physicalproblems that I cannot think aboutanything else.o I can sleep as well as usual.I don’t sleep as well as I used to.2 I wake up 1-2 hours earlier than usualand find it hard to get back to sleep.I wake up several hours earlier than Iused to and cannot get back to sleep.17 o I don’t get more tired than usual.i I get tired more easily than I used to.2 I get tired from doing almost anything.Jam too tired to do anything.21 o I have not noticed any recent changein my interest in sex.a lam less interested in sex than I usedtobe.2 I am much less interested in sex now.a I have lost interest in sex completely.18 o My appetite is no worse than usual.a My appetite is not as good as it used to be.2 My appetite is much worse now.I have no appetite at all anymore.TPC 0528-001 1819 BCOEI66Appendix DWIDE RANGE ACHIEVEN’lENT TEST JASTAKPage 4Reading, Level I AR Z H I Q S E B 0Two letters in name 2 A B 0 S E R T H P I U Z Qcat see red tothen open letterweather should lipapprove plot hugebulk exhaustrecession thresholdbig workjar deepfinger trayqualityabusehorizonbook eateven spellfelt stalksour implycollapsewas himawake blockcliff lamehumiditygluttonhowsizestruckurgeclarifyluxurious rescinded emphasis aeronauticputative endeavor heresy discretionaryresidence participate036465664707682889400miscreantspuriousrudimentaryseismographLevel I,Raw Scores (RS)and Grade Ratings(GR)SEE MANUAL FOR NORMSusurpidiosyncrasyintriguepersevereaudaciouspseudonymnoviceitineraryquarantinerepugnantanomalymitosisaboriginesRS CR RS GR RS CR RS CR RS GR RS CR RS CR RS CR RS CR PS CR PS CR0 N.7 9 P.6 18 <.6 I 27 1 5 36 23 45 2.8 54 3.8 63 5 1 72 6.6 SI 76 91 8.81 N.8 10 P.7 19K.7281.6 3724 162.8553.9.5.75.3 736.7 3277:92932N.9nP8I2OK.8291.713824 472.91564.05555i7469I537.9. 939.23 P.O 12 P9 21 K9 30 1.8 39 25 18 30 I 4.1 i 66 5.7 75 70 84 80 9.7 9.31 P.1 13 KO 22 1.0 31 19 40 25 19 31 58 42 76 7.1 85 81 5 945 P.2 14 KI 23 11 3220 1126 5032 5944 68 6.0 77 72 5663 95 956P3’5K.2j2412 5221422.6I513.3I604,56962 7873 8784’9967 P.416K.4j251.3,3422432.7 523.4 614.7:7064 7974 8583 65978 P.5 17 K.5 I 26 1.3 35 2.2 44 2.7 53 36 62 49 1 6.5 80 7.5 89 86 99 9890 87 7G 99Reading, Level IITwo letters in name (2) A B 0 S E R T H P 1 U Z Q- Imilk city in tree animal himself between chin split formgrunt stretch theory contagious grieve toughen aboard triumphcontemporary escape eliminate tranquillity conspiracy image ethicsdeny rancid humiliate bibliography unanimous predatory alcovescald mosaic municipal decisive contemptuous deteriorate stratagembenign desolate protuberance prevalence regime irascible peculiaritypugilist enigmatic predilection covetousness soliloquize longevity abysmalingratiating oligarchy coercion vehemence sepulcher emaciated evanescencecentrifugal subtlety beatify succinct regicidal schism ebulliencemisogyny beneficent desuetude egregious heinous internecine synecdocheII40475475Level II,Raw Scores (RS)and Grade Ratings(GR)SEE MANUAL FOR NORMSPS CR RS CR RS CR RS CR RS CR PS CR RS CR PS GR RS GR RS CR PS CR RS OR0 K 1 7 1.3 14 2.3 21 33 I 28 43 35 54 32 6.4 50 7 58 89 66 100 74 112 52 1251 K31 6 14 15 2.4 22 34 29 4.5 36 5.6 43 6.6 51 7.8 59 90167 10.275 113 53 12.72 KS 9 15 16 251 23 3:6 30 47 37 5.7 34 68 52 8.0 60 9268 103 76 ‘1.5 54 1293 K.6.10 1.7117 2.7124 37 31 48 38 59115 69153 Bli&l 9.3169 10.5 77 ‘17 05 13.0I K.811 18 18 2.9125 39 32 5,039 6.0’46 7.1 54 8.3 62 9.470 10.6.76 11566 1315 K.9 12 1.9 19 3.0 26 4.0 33 5.2 40 6.2 47 7.3 55 8.4 63 9.6 71 10.7’7912.0 87 1336 1.1 13 2.1 20 3.1 27 4.1 34 5.3 41 6.3 48 7.4 56 8.6 64 9.7 72 10.9 80 12.2 88 13549 76 57 8.7 65 9.9 73 11.1 81 121 69 13.767Appendix EWAIS-R RECORDWECHSLER ADULTINTELLIGENCE SCALE—REVISEDOCCUPATION__________________________ EDUCATION_________PLACE OF TESTING TESTED BYNAME_ADDRESSMARITALSEX_____ AGE______ RACE__________ STATUS_________TABLE OF SCALED SCORE EQLJIVALENTS*RAW SCOREVERBAL TESTS PERFORMANCE TESTS0 ————— 02 c Uv 2.0C cC C a>.2 a> a> •2 .2 .!? E .? —(0. 5 a> a, a,a> — 5E ‘° .o E o. ca CL tE 0a> E E a> (3 0 a>. .o> g E o o .2 a> 3’ a> .2>>..E (5 > ( 0 co Q0 o< ma 0< 00)Year Month DayDate Tested______ ______ ______Date of BirthAgeSUMMARY191817‘16,1514121110987654321292827262523-242219-2117-1815-1613-149-126-85430-2282726252422-2320-2118-191715-161412-13119-108763-50-270696866-676563-6460-6255-5952-5447-5143-4637-4229-3620-2814-1911-139-106-80-5191817161513-141211108-96-75431-203231302927-28262523-2421-2219-2017-1814-1611-138-106-74-52-30-12827262524232220-2118-1916-1714-1511-137-105-62-40201918171615141311-128-105-73-420-12019181715-16141311-128-105-73-42051504947-4844-4642-4338-4135-3731-3427-3023-2620-2214-198-133-720414039383735-363432-3330-3128-2924-2721-2316-2013-159-126-80-59391-9289-9084-8879-8375-7870-7466-6962-6557-6153-5648-5244-4737-4330-3623-2916-228-150-719181716151413121110987654321Raw ScaledScore ScoreVERBAL TESTSlnformatiors ———Digit SpanVocabularyArithmetic — —Comprehension ——SimilaritiesVerbal ScorePERFORMANCE TESTSPictureCompletionPictureArrangement ——Block Design ———ObjectAssemblyDigit Symbol — —Performance Score—Sum ofScaledScores 10VERBAL ——PERFORMANCE —FULL SCALE‘Ctinicians wico wish to draw a profile maydo so by locating the subjects raw scores on the table above and drawing a line toconnect them. See Ohapter 4 in the Manual for a discussion of the significance of differences between scoces on the tests.9-991829WAIS:R page 21. INFORMATION Discontinue after 5 consecutIve faIlures.1. Flag2. BaIl3. Months4. Thermometer5. Sun6. Presidents7. Weeks- 8. Armstrong9. Panama10. Labor Day11. Brazil12. Hamlet13. Civil War14. Earhart15. Clothes16. Italy17. King18. Genesis19. Sahara20. Relativity21. Yeast22. Senators23. Paris24. Blood vessels25. Temperature26. Curie• 27. Population28. Koran29. Faust2. PICTURE COMPLETION Scrn.DIscontinue after 5 1 or 0consecutive failures.1. Door2. Tennis3. Frog4. Playing card5. Car6. Pitcher7. Glasses8. Pliers9. Boat10. Beach11. Mirror12. Crab13. Violin14. Sun15. Watch16. Leaf17. Man18. Horse19. Female profile20. WoodpileTotal BackwardMax=2(/I 11 Max=28 ]Forward •ackward Total68rNote: Be sure to include scores for Items 1-4 In Total. Max29TotalTotal3. DIGIT SPAN Discontinue afterfailure on BOTH TRIALS of any Item.Administer BOTH TRIALS of each Item, even If subject passes first trial. 1DIGITS FORWARD PaSS- Score DIGITS BACKWARD* PaSS- ScoreFail 2, 1, or 0 Fail 2, 1, or 015-8-2- 12-4 —6-9-4 — 5-8 —6-4-3-9 — 6-2-9 —2.7-2-8-6— 2.4-1-5 —4-2-7-3-1 — 3-2-7-9 —7-5-8-3-6 4-9-6-8 —6-1-9-4-7-3 — 1-5-2-8-6 —‘ 3-9-2-4-8-7 6-1-8-4-3 —55-9-1-7-4-2-8 5-3-9-4-1-8 —. 4-1-7-9-3-8-6 — ‘ 7-2-4-8-5-6 —65-8-1-9-2-6-4-7 — 8-1-2-9-3-6-5 —. 3-8-2-9-5-1-7-4 — 6. 4-7-3-9-1-2-8 —72-7—5—8-6—2—5—8—4 — 9—4—3—7—6—2—5—8 —. 7-1-3-9-4-2-5-6-8 — 7-2-8-1-9-6-5-3 —Total ForwardMax=14 Max=14Administer DIGITS BACKWARD even if subject scores 0 on DIGITS FORWARD.69Appendix FDescriptive statistics of vocal analysis measuresVariable M SD Mm. Max.All questionsEmotion 3.10 1.12 1.00 5.00Appropriateness 2.90 1.11 .90 4.75Sincerity 3.01 1.27 .75 5.00Total WordCount 303.00 195.47 30.00 757.00Total Affect Count 10.41 4.30 4.00 21.00questions regardingown feelingsTotal Word Count 59.03 48.62 5.00 197.00Total Affect Count 1.73 1.15 0.00 5.00Intercorrelations between vocal measuresEmotion Appropriateness Sincerity Affect WordCount CountEmotion .752 .942 .268 .469Appropriateness -- .815 .593 .639Sincerity -- .332 .524Affect Count .633Note. N37.

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