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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 OFFENDERS by SHIRLEY MAY LOUTH  B.A.,  The University of British Columbia,  1992  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES DEPARTMENT OF PSYCHOLOGY  We accept this thesis as conforming to the required standard  THE UNIVERSITY OF BRITISH COLUMBIA September 1994 ©Shirley May Louth,  1994  In presenting this thesis in partial fulfilment of the requirements for degree at the University of British Columbia, I agree that the Ubrary freely available for reference and study. I further agree that permission copying of this thesis for scholarly purposes may be granted by the department  or  by  his  or  her  representatives.  It  is  understood  that  an advanced shall make it for extensive head of my copying  or  publication of this thesis for financial gain shall not be allowed without my written permission.  (Signature)  Department of  fsyC?zo/off/  The University of British Columbia Vancouver, Canada  Date  DE-6 (2/88)  4  /3/T4L  ii  Abstract Psychopathy and alexithymia are disorders with many For example,  conceptual similarities. Psychopathy Checklist  -  Revised  Factor 1 of the  (PCL-R; Hare,  1991)  items like shallow affect and lack of empathy, on to the construct of alexithymia.  contains  which seem to map  Additionally,  both  psychopaths and alexithymics display striking differences from others 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 a sample of female inmates,  the relationship between  and (b)  affective language and these two disorders. Psychopathy and alexithymia were assessed in 37 women offenders incarcerated in a Burnaby Correctional Centre, the PCL-R and the Toronto Alexithymia Scale Bagby,  1985).  (TAS; Taylor,  using Ryan &  Each subject was presented with a short written  scenario designed to elicit an emotional response,  and asked to  describe the feelings of the characters in the story.  Their taped  responses were analyzed for measures of affect. Base rates of both disorders were comparable to those in similar samples, psychopathic; only 8%.  (30% of the inmates were diagnosed as but the coxnorbidity rate was  33% as alexithymic)  There was a significant correlation between alexithymia  scores and PCL—R Factor 2 scores antisocial behaviour.  —  the factor assessing  Multiple regression analysis revealed that  iii  the TAS and PCL-R were both predictive of violence.  This  relationship between the PCL-R and violence is well substantiated; that the TAS also predicts violence is a newer finding. Alexithymics spoke more slowly, used fewer total words overall and fewer affective words,  and displayed less emotion in  their voices than did nonalexithymics.  Psychopaths could not be  identified by any vocal measures except a slight tendency to speak faster than nonpsychopaths.  Although both disorders are  characterized’ by affective impoverishment,  the verbal expressions  of affect were very different in psychopaths and alexithymics. The psychopaths were adept at convincing raters of an emotional investment they did not feel; alexithymics could not disguise their lack of appropriate emotional response.  iv  TABLE OF CONTENTS  Abstract  ii  Table of Contents  iv  List of Tables  vi  Acknowledgement  vii  INTRODUCTION  Psychopathy, Language and Emotion Review of the Literature  i 1 5  Assessment of Psychopathy  10  Assessment of Alexithymia  11 -  12  Occurrence and Co—occurrence of Psychopathy and Alexithymia  12  Relationship between Affective Language, Psychopathy and Alexithymia  15  Subjects  18  Measures  19  Procedures  24  -  —  Results  a  The Relationship between Psychopathy and Alexithymia  Rationale for Proposed Study Psychopathy and Alexithymia  Method  -  Psychopathy  25  Voice Analyses  25  Descriptive Statistics and Intercorrelations between the PCL-R and the TAS  28 28  Relationship of the PCL-R and the TAS to Violence  31  Voice Analyses  38  V  Discussion  Psychopathy and Alexithymia  44  Criminality and Violence  48  Psychopathy, Aexithyrnia, Language References Appendices  Conclusion  and Affective  49 53 55 61  vi  List of Tables  Table 1  Descriptive statistics of the PCL-R for samples of female and male offenders  29  Table 2  Descriptive statistics of the TAS for different samples  30  Table 3  Subject variables  32  Table 4  Correlations between PCL-R and TAS factors  Table 5  Correlations of the PCL-R and the TAS with violence  Table 6  Standard multiple regression of PCL-R and TAS variables on violence  37  Table 7  Correlations between PCL—R scores and vocal analysis ratings  39  Table 8  Correlations between TAS Scores and vocal analysis ratings  40  Table 9  Correlations between TAS scores, prediction of empathy, and content analysis of subjects’ responses to question regarding own feelings  33  36  42  vii  Acknowledgement I would like to thank my committee members,  Drs. Wolfgang  Linden and Janet Werker for their time and constructive comments. I would like to thank my thesis advisor,  Dr. Robert Hare,  for his  valuable feedback and support during the course of this research. I would also like to recognize my fellow lab members who gave of their time to assist with ratings,  data collection,  and helpful  comments. This research was made possible by the cooperation of the inmates and staff of British Columbia Correctional Centre for Women, particularly Beverly Roest who consistently facilitated the implementation of this project. I would also like to thank the many volunteers who unstintingly gave of their time to bring this project to completion. The contribution of my family understanding,  -  their patience, help and  is also gratefully acknowledged.  1  Introduction Though many lawbreakers may be described as cold and calculating towards their victims, they usually experience some degree of emotional committment to friends, loved ones.  family, or other  For the psychopathic criminal, however, poverty of  affect is pervasive. Psychopathy is a personality disorder marked by a particular pattern of interpersonal, affective, and behavioural symptoms. It is similar to antisocial personality disorder  (APD), but also  incorporates some features of narcissistic and histrionic personality disorders.  While APD,  according to the DSM-IV  description (American Psychiatric Association,  1994),  is  diagnosed primarily by a collection of antisocial and criminal behaviours, which certainly characterizes psychopaths,  the  psychopath also displays a cluster of personality traits and affective symptoms not considered necessary for a diagnosis of APD.  Interpersonally, psychopaths are manipulative, egocentric,  grandiose and dominant.  Affectively, they display shallow and  labile emotions, have no capacity for compassion or remorse,  and  are unable to form lasting bonds with others. Psychopathy, Language and Emotion  -  a Review of the Literature  This striking pattern of affective “deviance” has shown up time and again in clinical impressions of psychopaths,  leading to  research into their appreciation of different forms of emotional material.  Christianson, Forth, Hare,  Strachan, Lidberg & Thorell,  2  (1993)  demonstrated that nonpsychopaths recall more salient  details about emotionally harrowing colour slides than they do when presented with slides of neutral content. Psychopaths’ recall, however, was unrelated to the emotional polarity of the slides. Patrick,  Cuthbert, and Lang,  (1990),  found that  psychopaths failed to show physiological signs of fear when they imagined a fearful event; in an earlier study, 1989)  (Patrick et al,  these authors had concluded that subject fearfulness was a  significant predictor of affective normality. Language has often served as a stimulus in studies designed to show psychopaths’ Williamson, Harpur,  insensitivity to affective valence. and Hare,  (1990)  found that psychopaths were  less likely than nonpsychopaths to group words by emotional polarity.  These researchers also showed that although  psychopaths could identify emotional scenes,  they had difficulty  matching phrases and pictures on the basis of affective valence. Differences between psychopaths and nonpsychopaths also emerged during a study (Williamson, Harpur,  & Hare,  1991)  in which  subjects were required to distinguish between words and nonwords in a lexical decision task. Nonpsychopaths were clearly able to use the information contained in the emotional words to facilitate their decision as to whether the letter string was a word or a nonword.  In sharp contrast, psychopaths failed to show  reaction time or electrocortical differences between emotional and neutral words.  Cleckley (1976)  proposed that psychopaths  3  cannot appreciate the emotional significance of language,  and  that they suffer from a deep—seated semantic disorder in which the affective and semantic components of words are dissociated. Others have made similar observations,  including Grant  (1977) who  considered psychopaths to know “only the book meaning of words” (p.50),  and Gilistrom who suggested that emotion is “like a  second language to the psychopath”  (reported in Hare,  1993).  While widely cited, demonstrating evidence of these emotional deficiencies has sometimes proven surprisingly difficult.  For  example, traditional empathy questionnaires of the self—report type do not discriminate psychopaths from nonpsychopaths and Wong,  1988; Day and Wong,  1993; Strachan,  1993),  (Wright  and in a  study by Strachan, Harpur, and Hare (1991), psychopaths were able to select the appropriate affect when writing about an emotional event. Similarly,  evidence for the causes of emotional\linguistic  differences between psychopaths and normal individuals has been sparse;  Hare and McPherson (1984)  and Raine et al  (1990)  found  weak cerebral lateralization in psychopaths, with psychopaths demonstrating less left-hemisphere dominance than normals when processing language. Day and Wong (1993)  concluded that while the  right side of the brain generally plays a central role in emotion,  the psychopathic brain does not show this hemispheric  specialization.  In fact,  for psychopaths, neither side of the  brain may be proficient in processing emotional material.  No  4  consistent evidence has been found for other clinically significant neuropsychological or intellectual differences between psychopaths and non-psychopaths. One expression of such emotional/linguistic detachment would involve difficulty in the interpersonal arena.  It is certainly  true that prototypical psychopaths cannot form long-lasting bonds to people and are profoundly lacking in compassion and empathy, yet their affective poverty does not seem to warn prospective victims of their insincerity. charming,  Psychopaths are often described as  and a key feature of psychopathy is the ability to use  language to deceive, manipulate and con, while seeming to be perfectly sincere.  Even when caught out in an obvious lie,  psychopaths use language for their own ends, talking their way out of trouble with no embarrassment or discomfiture. Of course, words are not the exclusive domain of psychopaths,  and there is no evidence they have a larger lexicon  than other people.  While the same world of words is available  for the use of us all, certain words exert a power over most people because of their evocative or connotative content.  This  is the basis of literature and poetry; poets often exhort us to read their works aloud for full effect, and authors labour for just the right word to evoke the emotional reaction they seek  --  be it negative or positive. The power of words to elicit feelings is well known.  For most people, words have a power to control  the speaker as well as exerting an effect on the listener.  The  5  words can lead to an unconscious cognition that is almost instantly transformed into a feeling. One can sense, then, the power imbalance occurring if there are people who use words to affect others, yet who remain themselves unaffected by words. These people would be especially dangerous if their affective deficiency was subtle,  covert,  not  easily detected by others. Freed from the negative emotional effect of language, members of this group could painstakingly search their lexicon for words to achieve the desired emotional effect on listeners, not, astound,  like poets,  in order to enrich and  but for less prosocial purposes.  The Relationship Between Psychopathy and Alexithymia Another disorder that has at its base a fundamental difficulty in language and emotion is alexithymia.  Believed by  some to affect about 10% of the general population,  the concept  of alexithymia was introduced in the early 1970’s as a personality disorder linked to an inadequacy in experiencing and expressing emotions term (“a”  =  without;  coined by Sifneos  (Taylor, “lexia”  (1973)  1984; Apfel & Sifneos, =  words;  “thymus”  =  1979).  The  feelings) was  to designate a specific disturbance in  the capacity to recognize, describe and label feelings.  Perusal  of the literature reveals a picture of the alexithymic as an individual with constricted emotional functioning,  unable to use  affects as signals of inner conflict or responses to external situations,  impoverished in imaginative processes,  and whose  6  thought content is dominated by trivial environmental details rather than true feelings, Sweet  (1954)  dreams,  or fantasies.  Freedman and  referred to such people as “emotional illiterates,”  and researchers tend to agree that the disorder represents a genuine inability to verbalize emotions, repression of feelings  (Wise et al,  There are several theoretical,  rather than denial or  1990). scientific bases for  investigating possible connections between alexithymia and psychopathy. striking,  Some of the similarities in research directions are  and a few of them are are outlined here.  Laterality  studies conclude that the limited access to verbal expression in alexithymics is suggestive of abnormal hemispheric processing (Flannery & Taylor, Waterhouse & West,  1981; Tucker, 1980;  Zeitlin,  D.M.,  1981; Buchanan,  Lane,  & O’Leary,  especially increased hemispheric lateralization  1989),  (Taylor,  1984).  Alexithymia seems to have a higher prevalence in men,  a finding  cited as evidence to support lateralization theories,  in that  women are considered to possess greater hemispheric plasticity than men  (Taylor,  alexithymia, with age, (Parker,  1984).  like psychopathy,  race,  is not significantly correlated  or sociodemographic/socioeconomic variables  Taylor & Bagby,  Janni, Kass,  Past research suggests that  1989; Taylor,  Sonnenschein & Mann,  Ryan & Bagby,  1985; Wise,  1988; Apfel & Sifneos,  1979).  Alexithymia has been linked to interpersonally insensitive behaviours such as having multiple sexual partners  (Thome,  1990),  7  and impaired capacity for empathy substance abuse Taylor,  (Haviland,  Sifneos,  1979)  —-  1982).  Jarvinen, expressing  ——  as well as  Shaw, MacMurray & Cummings,  1988;  1990), personality disorders such as  Parker & Bagby,  narcissism (Taylor,  1979),  (Krystal,  1984),  and psychopathy itself  especially violent psychopathy von Rad et al  (1979)  (Apfel & (Keltikangas  depicted alexithymics as  and appearing to experience  ——  less guilt and shame  than nonalexithymics. Alexithymia has also been reported in patients with sexual perversions affect,  impulsiveness,  boredom,  prototypical alexithymic  1984).  (Taylor,  Inappropriate  and frustration characterize the  (Apfel & Sifneos,  1979).  One study  suggests that their emotional conflicts cannot be resolved by fantasy, and Bagby  so they resort to action (1988)  concur,  (Legorreta et al,  1980).  stating that they discharge tension  through exacerbated physiological responses to stress, physical action.  Possessing restricted imaginations,  unable to formulate realistic goals, control,  and are easily bored.  via they are  have poor attentional  Wise et al found that  alexithymics can easily become irritable and bad-tempered Finally,  alexithymics,  like psychopaths,  insight-based psychological treatment Egan,  Taylor  (1990).  are unresponsive to  (Sifneos,  1975; Gage &  1984) Lacking insight to feelings and other inner experiences,  alexithymic individuals tend to focus on and amplify the physiological component of emotional arousal,  leading to  8  confusion and difficulty in naming feelings.  This is thought to  explain their tendency to somatisation, to compulsive activities like substance abuse, to impulsive behaviour, to psychosomatic illnesses.  and their proneness  This latter tendency is largely  putative, however, and many studies have found no such relationship between alexithymia and psychosomatic disorders (Gage & Egan,  1984; Fava, Baldaro & Osti,  1980; Wise et al,  1988). While there are undisputed similarities between the disorders of psychopathy and alexithymia, there are also many differences.  For example,  alexithymics are known to bore,  not  charm, their listeners, and they tend to score highly on social conformity measures 1985).  (Gage & Egan,  1984, Taylor, Ryan & Bagby,  It is not the intention to argue that the two disorders  are identical,  but rather that they may occur together,  a common biological predisposition.  or share  The idea of  psychopathologies being linked by a common diathesis was proposed by Gorenstein and Newman (1980), who studied disorders involving impulsiveness. They present an accumulation of evidence suggesting that the core of such disorders could be genetically based disinhibitory processes. The authors see this disinhibitory psychopathology as a broad constellation including psychopathy, hyperactivity,  alcoholism, and antisocial personality disorder.  They propose that such disorders involve a biologically determined,  common diathesis, and suggest that the expression of  9  a particular disorder may depend upon differential experience. For the psychopathy construct,  for example, this might mean that  an individual born into a supportive, psychologically healthy family,  could be merely bad-tempered and interpersonally  ambivalent, while another person,  exposed to abusive and criminal  influences, may become a full—blown psychopath.  The similarities  between some features of psychopathy and alexithymia, which is impulsivity (Apfel & Sifneos,  one of  1979), would support a  theory such as Gorenstein and Newman’s. Another possibility is that there is a subgroup of psychopaths with a particular pattern of symptoms, who are both psychopathic and alexithymic.  If coinorbidity between the two  disorders is shown to be common,  assessment of alexithymia in an  inmate population could have implications for the measurement, identification and management of psychopaths.  Since there are  many similarities between alexithymia and psychopathy,  evidence  of overlap between the two could result in some inflation of an individual’s score on a psychopathy measure such as the Psychopathy Checklist  (PCL-R, Hare,  on interpersonal/affective symptoms remorse,  1991).  Inflation may occur  (items such as lack of  shallow affect, and lack of empathy)  behaviourally antisocial symptoms impulsivity).  psychopathy,  (proneness to boredom,  Both clusters of symptoms  behavioural symptoms)  as well as  (personality traits and  are considered vital to the assessment of  and are fundamental to the PCL-R.  10  Assessment of Psychopathy Measurement of psychopathy has acquired a highly reliable and valid status with the use of Hare’s PCL-R,  including males and  well tested with criminal populations, (Strachan,  females  1993,  Tien et al,  and substance abusers.  offenders,  which has been  1993), mentally disordered  The PCL-R requires both a  semi—structured interview and an intensive review of subjects’ institutional files.  Impressive alpha coefficient and interrater  reliability scores have been achieved Forth,  Hart & Newman,  1990; Hare,  (Hare,  1991; Hart,  The PCL—R consists of two stable,  1992).  Hakstian and Hare,  (Harpur,  are correlated,  Harpur,  Hakstian,  Hare & Harpur,  correlated factors  1988). While the factors themselves  they have different external correlates.  Factor  1 reflects interpersonal and affective characteristics considered fundamental to the clinical conception of psychopathy, while Factor 2 assesses social deviance and characteristics related to the DSM-IV diagnosis of Antisocial Personality Disorder. PCL—R contains 20 items in total, (0,  1,  subject  2)  The  each scored on a 3—point scale  according to the extent to which it characterizes the  (see Appendix A).  The maximum possible score of 40  represents the prototypical psychopath,  and subjects’  scores  correspond to the degree that they match this prototype. Previous research in male forensic populations has established that a PCL-R score of 30 is a useful cutoff for a diagnosis of psychopathy  (Hare,  1991).  11  Assessment of Alexithymia Measurement of alexithyinia has been more contentious than that of psychopathy, with many scales being criticized for poor psychometrics and insufficient or contradictory research findings.  Linden,  Wen & Paulhus  (in press)  reviews of several popular measures, Israel Questionnaire Alexithymia Scale  (BIQ; Sifneos,  conducted extensive  and concluded that the Beth— 1973)  and the Toronto  (TAS; Taylor, Ryan & Bagby,  1985)  are the best-  supported instruments for assessment of alexithymia. been criticized elsewhere as lacking validity Taylor,  1987),  (Bagby et al,  and for having low interrater reliability  especially when raters are not fully trained 1984).  The BIQ has 1988;  -  (Shipko & Noviello,  It also requires lengthy administration and scoring,  considerable training is needed to administer it.  and  Some  investigators have found that scoring may depend upon experience, bias,  and the style of the interviewer (Taylor & Bagby,  Linden et al  (in press)  1988).  report that the BIQ may reflect changing  situational variables during the interview,  and describe it as  confounded with denial tendencies. While the TAS is a self-report scale and thus may be suspect for pathological liars such as psychopaths, social desirability responses  it is free from  (Bagby, Taylor & Ryan,  1986).  The  TAS has been validated for use with clinical and non-clinical populations,  substance abusers  equally valid for men and women  (Haviland et al, (Taylor & Bagby,  1988), 1988).  and is It is  12  relatively quick to administer,  and its favourable test—retest  reliability suggests that it is successful at differentiating between trait and state alexithymia.  Test-retest reliability has  been demonstrated over as long as three months Ryan,  1986).  While alexithymia,  (Bagby,  like psychopathy,  Taylor &  is  conceptualized to be an enduring personality trait,  unlike  psychopathy it may also be a temporary condition in reaction to a traumatic event or situation. a situation  (Thome,  1990),  Incarceration might represent such  so it is important to use an  instrument that differentiates between state and trait alexithymia, and also between alexithymia and depression.  The  TAS seems to fit this description better than other measures.  It  is important to recognize, however, the many warnings of researchers about secondary, or reactive alexithymia, versus primary alexithymia  (Thome,  1990, Gage & Egan,  1984,  and others).  It is possible that the TAS does not always discriminate between these two conditions. Rationale for Proposed Study  -  Psychopathy and Alexithvmia  There are two areas of interest in the present study:  (a)  the occurrence and co—occurrence of psychopathy and alexithymia in a female prison population; and (b)  the relationship between  affective language and these two disorders. (a)  Occurrence and Co—occurrence of Psychopathy and  Alexithvmia The rate of psychopathy in female inmates,  in contrast to  13  that of male inmates, has rarely been investigated. financed by the B.C. (1993) prison,  In a study  Institute of Family Violence, Tien et al  assessed 74 women incarcerated in a multi—level security and found 23% to be strongly psychopathic.  Strachan’s  1992 study resulted in 31% of 75 women inmates being rated as psychopathic. psychopathy.  In both cases, the PCL—R was used to assess In contrast, the rate of psychopathy found in  incarcerated males is lower, ranging from 15-21%  (Hare,  1991).  Judicially, there may be greater tolerance of milder forms of female criminality, because of a reluctance to imprison women, especially if they have childrearing responsibilities.  This bias  would contribute to lower levels of incarceration for women, but may also mean that the women who are imprisoned would possess a greater criminal versatility or commit crimes of greater seriousness than those not sentenced to prison.  In other words,  to receive a jail sentence, they must be really “bad.” and Kandel  (1988)  Mednick  make just this point to explain the lower  number of convictions for females compared with males,  and they  hypothesize additionally that criminal behaviour in men may be more socially or environmentally induced than it is in women. Women,  they speculate, are environmentally conditioned to behave  prosocially. Assessment of trait alexithymia would enhance our knowledge about the prevalence of affective disorders among female prisoners, and add to the psychological profile others have  14  already compiled  (Tien et al,  1993; Strachan,  1993).  There are also several reasons to assess the co—occurrence of alexithymia with psychopathy.  In representing an inmate’s  psychopathy score on the PCL-R, the presence of alexithymia might result in slightly higher scores on both factors.  Because of the  rigorous investigation of institutional files that is part of a PCL-R diagnosis,  it is unlikely that such inflation could result  in a categorical misdiagnosis of psychopathy,  but there are other  implications of the presence of alexithymia among inmates. Treatment is one salient issue. disorders is difficult,  While the treatment of both  assessment of alexithymia in psychopaths  would at least mean that forensic clinicians could tap into the treatment research data for alexithymia and be aware of any new developments.  Neither psychopaths nor alexithymics respond to  empathy training or to dynamically or cognitively based therapies.  As Legorreta, Bull & Kiely  (1988)  remarked in their  study of eating—disordered alexithymics, treatment programs which have a behavioural orientation should be the treatment of choice for such individuals. Another implication is that different behaviours may be related to the psychopathy,  degree of affective abnormality present in  and affective abnormality in psychopaths may best be  assessed by a measure of alexithymia administered concurrently with the PCL-R. Lang (1993)  Consistent with this idea,  Patrick,  Bradley and  found that emotional detachment in psychopaths  15  (measured by Factor 1 of the PCL-R)  was the factor most related  to their unusual startle reactions to emotional stimuli. et al  (1993)  Patrick  found that the eye-blink response of nonpsychopaths  would change according to the emotional valence of the stimulus. This effect was not found in psychopaths with high Factor 1 scores. Similarly, presence or absence of alexithymia may predict different behaviours in psychopaths. It was hypothesized that alexithymia would be significantly related to psychopathy,  especially to Factor 1 of the PCL-R,  and  that comorbidity between the two disorders would be common. (b)  Relationship between Affective Language,  Psychopathy  and Alexithymia This study extends the research previously conducted on psychopathy and language, by exploring the effect on listeners when psychopaths speak about emotional subjects. hand,  On the one  since many psychopaths seem to possess the ability to  convince the casual listener of their sincerity and charm,  they  are able to deceive and manipulate. Yet on the other hand,  if  psychopaths have no emotional investment in the words they use, their language material  --  —-  especially when talking about highly emotive  might be expected to sound flat and insincere.  If  so, their charm must come from elsewhere. There is evidence that psychopaths have developed a repertoire of nonverbal techniques, like unusual hand gestures  (Gilistrom & Hare,  1988),  and  16  impressive facial expressions  --  people often describe the  riveting stare and ready smile of the psychopath.  Perhaps these  kinetic features of communication are used as a front,  blinding  prospective victims to the callous personality that lies beneath the veneer.  Without the distracting influence of nonverbal  behaviour,  it may become clear that what is being heard is not  sincerity,  but mere pseudo affect. Hearing psychopaths’  recorded  voices, without being exposed to the impact of their visual presence, might allow listeners to detect a lack of emotion and lack of sincerity in their speech. Distinguishing and assessing emotion from speech is a reliable and valid procedure (Scherer,  1986; Taylor et al,  1981).  Scherer has found that judges can accurately decode emotions from vocal cues,  and after examining the results of other techniques,  he concluded that “accuracy for the recognition of emotion from vocal cues is far better than chance and seems to be somewhat better than the accuracy reported for facial emotion recognition” (Scherer 1986, p.144). The taped speeches will also be rated by word count,  using a  paradigm modeled after research conducted by Taylor and associates 1985). analysis  (Taylor, Doody & Newman,  1981; Taylor and Doody,  Another paradigm, the Gottschalk-Gleser method of content (Gottschalk and Gleser,  analyze speech.  1969)  is frequently used to  This method was considered, but I rejected it  because it has been shown to perform poorly with alexithymics,  17  partly because the scales were developed to measure immediate, labile emotional stages rather than stable traits 1974; Taylor & Doody,  1985).  (Gottschalk,  Furthermore, considerable training  is needed to use the Gottschalk-Gleser method,  and it also  requires an element of subjective interpretation which makes reliability difficult to attain. Affect Vocabulary Score (AVS)  In contrast,  Taylor and Doody’s  is a straightforward scoring  procedure based upon a count of the number of different affective words used.  They  defined as affect words “words that clearly  and unambiguously expressed emotional feeling”  (p.471).  In their  earlier study (1981), Taylor and Doody performed a total word count and an affect word count for each subject. study, however,  In the 1985  they expanded upon this paradigm by discounting  all repetitions of the same affect.  Since alexithymia involves a  limited vocabulary for describing emotions,  and psychopathy  involves a constricted range of emotions, the more recent procedure seems preferable for the current study.  Rather than  scoring the number of affective words used, this method results in a count of the number of emotions mentioned. My hypothesis was that the voices of psychopaths would sound unemotional and insincere, and that any emotion which was expressed was likely to be inappropriate.  I further hypothesized  that the speech of alexithymics would contain fewer appropriate emotional words,  and that their voices would sound flatter, with  less affective quality, than those of nOn-alexithymics.  18  Method Subj ects Burnaby Correctional Centre for Women is a medium—security facility,  housing both federally and provincially convicted  female offenders,  as well as women remanded in custody and  awaiting sentencing.  There is a maximum security wing and a  minimum security open—living unit,  and occupancy during the  research period ranged from 89-102 women, remand.  including those on  The study sample consisted of 37 females who responded to  an information letter mailed to all inmates. volunteered, in the study,  For those who  informed consent was obtained before their inclusion and each was paid $10.00 for her participation.  Separate consent forms were used for agreeing to be video— and audio-taped,  for participating in the study and for allowing us  access to their institutional files.  To be included,  subjects  were required to meet a minimum reading requirement and to speak English fluently and relatively accent-free.  No subjects who  volunteered needed to be excluded based on these criteria. The age of the subjects ranged from 19 to 50, average of 31.68 years (76.5%)  were Caucasian;  (standard deviation 8.35). 13.5% were Native Indian,  with an The majority 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 security unit;  10% of these were still on remand.  19  Measures Approximately one-third of the subjects were first interviewed for the purpose of a psychopathy assessment. The questionnaires and emotional scenarios were then administered in a second session; for the other subjects the order of sessions was reversed.  Psychopathy was assessed using the Hare  Psychopathy Checklist Revised (PCL-R), which includes a videotaped, of subjects’  semi—standardized interview and intensive examination institutional files.  Subjects were presented with the following typed scenario: Please read the following true account of a recent event. it to yourself.  Read  She had her little two-year old boy A woman was shopping. He was While she was shopping, the boy wandered off. with her. led away by two 11 year old youths who persuaded the little boy They beat him up and then took him across town to go with them. He screamed and cried, begging them to to a train crossing. After beating return him to his family, but they just laughed. threw his body on the train line, and with an iron bar, they him a trainS-passed. he was cut in two when When she realized her little boy was missing, the woman was frantic. She ran around asking everyone if they had seen him, When his body was found, and soon went to the police for help. she collapsed. After providing adequate time for the subject to read this account,  she was asked to respond,  into a tape recorder, to the  following questions: 1.  Briefly describe this event in your own words.  comprehension, memory,  and attention check.  able to recap at least the salient events  ——  (This was a  All subjects were e.g.  (i)  the woman’s  20  little boy was taken away by two youths; and (ii)  they killed  him). 2.  How well do you think you can describe the feelings of the  people involved in this event? Moderately well; Mothersill,  (3)  (1)  Extremely well.  Not at all well;  (2)  (Adapted from Dobson and  1979, Table 3). This question was included in order  to measure each subject’s ability to predict her empathic powers. While alexithymics were expected to demonstrate a realistic assessment of their empathic abilities, psychopaths, who generally tend to exaggerate their abilities, were expected to provide an inflated score. 3.  Describe in your own words the feelings of the victim from  the time he was first separated from his mother,  to the time of  his death. 4.  Describe in your own words the feelings of the killers from  the time they first saw the child to the time of his death. 5.  Describe in your own words the feelings of the little boy’s  mother from the time she first realized the boy was missing to the 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 little  boy’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 rest  21  required verbal replies.  The order of questions 3—8 was  randomized for each subject,  and the answers to these six  questions were audiotaped. Visual and auditory modalities were separated by recording the voices of subjects on audiotape only.  By capturing the vocal  qualities independently of the visual features,  I gauged the  effect of listening to psychopaths and alexithymics,  neither of  whom are thought to have much direct experience of emotion, describing their reactions to an emotional event. Listeners were exposed to speech only, unconfounded with any effects of the physical presence of the speakers.  I would have liked to test  raters reactions under a second condition  ——  sound plus video,  but obtaining prison approval of videotape exposure for this purpose has,  at this point, proved impossible.  The following battery of measures was administered: 1. 1985)  The Toronto Alexithymia Scale (TAS; Taylor, Ryan & Bagby, consists of 26 5—point Likert scales for subjects to  indicate their degree of agreement/disagreement with each self— rating statement.  The 26 item version of the TAS covers four  aspects of alexithymia:  (a)  the ability to identify and  distinguish between feelings and bodily sensations; ability to describe feelings to others; daydreaming is experienced; and (d)  (c)  (b)  the  the extent to which  externally-oriented thinking.  Ongoing research into these factors and into the individual items in the TAS, has led to several changes by the authors and others.  22  the  As a result of reliability and scale validation studies, The TAS-R consists of 23  instrument was revised in 1992.  others rewritten,  some of the original ones were discarded,  Factors 1 and 2  the daydreaming factor was eliminated.  items;  to discriminate feelings from bodily sensations,  and  (ability  and ability to  communicate feelings) were combined; thus the TAS—R contains only two scales.  Linden and Paulhus  (in press)  examined this version,  and concluded it added little to the original. authors collaborated with others, revision, with only 20 items  The original  and published a second  (Parker,  Bagby,  but with three factors.  Taylor,  Endler and  The daydreaming scale was  Schmitz,  1993)  omitted,  but the first two factors were once again included as  separate scales.  According to the authors,  this very recent  version still requires evaluation of convergent,  discriminant,  and criterion validity in diverse cultural groups. For this study,  I decided to use the original TAS,  an amendment developed by Haviland et al researchers analyzed the TAS subscales,  (1988).  but with  These  and their factor analytic  studies suggested the following three subscale derivations: Factor 1,  Feelings  (this represents a combination of the original  first two factors); Factor 2,  Daydreaming; and Factor 3,  External  Thinking. All but one of the 37 subjects completed the TAS;  she did  not feel like completing the session and was released on an electronic monitoring program (house arrest)  before she could be  23  re-contacted. 2.  The 26 item TAS is included as Appendix B.  The Beck Depression Inventory (BDI; Beck, Ward, Mendelson,  Mock & Erbaugh,  1961)  is a 21-item self-report instrument used to  assess state depression (mood).  It is widely used and has  adequate validity and reliability.  The BDI was used to discount  the alternative hypothesis that mood could be responsible for emotional/speech differences between subjects. 3.  The Wide Range Achievement Test  Jastak,  -  (See Appendix C).  Revised (WRAT-R; Jastak &  1978) was administered to ensure that a minimum standard  of reading ability was met by all subjects, and that differences in emotional responses were not due to inability to read the written scenario presented by the researcher. The WRAT has been researched continuously on many samples of all ages and mental abilities,  and impressive reliability measures have been reported  for all three WRAT subtests  (Reading,  Spelling and Arithmetic).  The Reading Test has been externally validated in educational and clinical trials. One of its uses is the accurate diagnosis of reading ability,  and the degree and nature of reading disability  as a result of brain injury and other disturbances. The Level II Reading Test (for people aged 12 years and up)  asks subjects to  read aloud a list of 74 words; they have a limit of 10 seconds per word, and the test is halted after 12 consecutive failures. This is the only part of the WRAT-R that was used in the present study. 4.  (See Appendix D).  The Wechsler Adult Intelligence Scale  -  Revised (WAIS-R;  24  Wechsler,  1981)  was used to assess verbal intelligence.  (See  Appendix E). Use of an IQ measure allows us to discount IQ as an alternative explanation of any verbal differences between The WAIS-R contains five subtests used to assign a  subjects.  Performance IQ Score;  the Verbal and Performance scores are  added to provide a Full Scale IQ Score.  In this study,  I  administered only the six subtests necessary to compile a Verbal IQ Score, using a shortened version of the WAIS-R administration instructions,  a version developed by Satz and Mogel in 1962 which  correlates .99 with the complete version for Verbal IQ in a normal population.  Subsequent studies have reported comparably  high correlation coefficients between the Satz-Mogel short form and the full form in other populations, populations  (Goebel & Satz,  Gorp, Kern,  Satz & Steinman,  1975)  including brain-damaged  and the elderly  1988).  (Osato, Van  The advantage of this short  form is that it takes only about one-third of the time required for administration of the complete WAIS-R. prorated,  Answers were  and an equivalent Verbal IQ score was thus obtained.  Procedures All sessions were conducted on site at the prison’s main unit or at the open living unit, Corrections Staff. sessions.  in private offices provided by  Subjects were tested individually,  in two  The PCL—R interview lasted approximately two hours;  administration of the test battery and voice taping required approximately one hour.  25  A graduate student of psychology, with a  Psychopathy:  diploma in criminology, was trained to administer and rate the PCL-R. She completed her training by rating ten “practice” tapes (videotaped interviews with inmates who agreed to serve as training sources),  at which point acceptable interrater  reliability was achieved. A second,  independent rating was  obtained for 25 of the subjects by a trained research assistant. PCL—R interviews were videotaped,  and ratings were based on the  interview material and file information.  Information about  offspring was recorded separately to assess any effect of motherhood or number of children on the experimental results. Under circumstances where information was unavailable to score a PCL-R item,  it was omitted and the total score prorated.  Three  of the subjects were unavailable for interview although they had signed consent forms for access to their file material; their psychopathy ratings were obtained by exhaustive perusal of their institutional files.  File-only ratings have proven reliable and  valid in other settings  (Lewis et al,  1994).  Interrater  reliability coefficients were calculated for all 25 double-rated files,  including 2 of the 3 file-only ratings.  Voice Analyses:  Two female psychology undergraduate  students, blind as to the identity or characteristics of the subjects, volunteered to rate subjects’ audiotaped responses. They were trained on the following list of measures by discussing and jointly rating practice tapes until acceptable interrater  26  reliability was achieved: 1.  Using a 5-point Likert-type scale with 3 anchors  emotional, moderately emotional, extremely emotional)  (not at all they rated  each subject for intensity of emotion (Dobson & Mothersill, 1979).  These ratings were designed to reflect impressions of  whether subjects’ voices displayed any feelings at all,  or if  they seemed flat,  as heard  expressionless, bored, or disengaged,  by a lack of cadence and low variability of tone.  This item was  rated on voice quality, not content. 2.  Using a 5-point Likert-type scale with 3 anchors  (not at all  appropriate, moderately appropriate, extremely appropriate), they rated subjects for appropriateness of emotion (Dobson & Mothersill,  1979).  Here,  if there was judged to be any emotion  expressed, raters assessed whether it was appropriately sad, angry, distraught, excited,  and so forth, or if it seemed inappropriately  aroused, happy, or was judged to drastically  underestimate the appropriate depth of emotion  (e.g. responses  like “the mother was probably glad her son was dead,” or “the father was quite sorry his boy was killed,” would be inappropriate). This item was rated on content rather than voice quality. 3.  Using a 5-point Likert-type scale with 3 anchors  sincere, moderately sincere,  (not at all  extremely sincere), they rated the  degree of sincerity (Dobson & Mothersill, whether the words matched the affect.  1979).  They assessed  If there was appropriate  27  emotion expressed verbally,  did it seem genuinely sincere or did  it come across as mere pretense?  This item was rated on both  voice quality and the actual words used (i.e.  the subject may  have said appropriately emotive words, but sounded either too “theatrical,” histrionic, or flat, or else used words that were judged to lack sincerity. An example of this would have been if a subject expressed appropriate emotions, but embellished her responses with jokes). Interrater reliability coefficients were calculated for all tape ratings. One of the volunteers also transcribed the tapes, performed word counts based on Taylor and Doody’s  and  (1985)  paradigm. A total word count was obtained for each subject,  and  each different emotion was tallied to form an affect word count. Separate total word counts and affect word counts were calculated for the question “How does this make YOU feel,” in order to obtain a measure of subjects’  ability to describe their own  feelings in contrast to those of others.  All affect word counts  were checked by a second volunteer, and 10 total word counts were randomly selected and checked.  28  Results The results are presented in three sections:  (a)  descriptive  statistics and intercorrelations between the PCL-R and the TAS and their subscales; to violence, (a)  and (c)  (b)  relationships of the PCL-R and the TAS  vocal analyses.  Descriptive Statistics and Intercorrelations between the  PCL-R and the TAS Table 1 presents the descriptive and psychometric statistics for the PCL-R for this sample.  It also contains similar data  from other female offender studies described in Strachan and Tien et al  (1993)  and,  for comparative purposes,  pooled sample of male offenders  (Hare,  (1993)  data from a  1991).  Interrater reliability for the present study was assessed using Pearson’s  r  coefficient.  The distribution of Total and Factor scores in this sample was similar to that obtained with the Strachan, samples.  Tien,  and Hare  Correlations were calculated on the full range of  alexithymia and psychopathy scores.  For all correlational data,  scatterplots were obtained; none revealed significant outliers. Table 2 contains the descriptive statistics for the TAS for this sample. samples,  Also included are similar data for two other  one female and one male.  The mean score for the current  study was higher than the female sample and lower than the male sample.  The base rate in this study was lower than that found in  a sample of male alcoholic inpatients.  29  Table 1 Descriptive statistics of the PCL-R for samples of female and male offenders  Males  Females  N Total Score M SD Base rate Interrater reliability Factor 1 SD Factor 2 M SD  Strachan sample  Tien et al sample  Present sample  Hare sample  75  74  37  1192  24.49 7.45 31%  23.0 NR 23%  24.09 7.7 30%  23.63 7.92 15—20%  .96  NR  .95  .91  9.95 3.25  MR NR  8.65 2.85  8.93 3.93  10.90 4.14  MR MR  11.63 4.09  11.69 3.90  Note. Base rate refers to the percentage of subjects scoring 30 or higher on the PCL-R. A score of 30 (one standard deviation the mean) was above determined to represent the optimum cut—off score for research purposes (Hare, 1991). In practice, however, it is found that subjects who score 27 or more usually exhibit the behaviours associated with psychopaths. PCL—R Factor 1 refers to the cluster of characteristics associated with interpersonal deviance; Factor 2 refers to socially deviant behaviours. NR  =  statistic not reported  30  Table 2 Descriptive statistics of the TAS for different samples  N M SD Base rate  Taylor et al (1988) sample  Hendryx et al (1992) sample  Current sample  26 64.8 13.7 NR  130 72.1 10.8 51%  37 69.72 13.56 33%  NR: Not Reported. Taylor’s sample consisted of female outpatients at a Note. behavioural medicine clinic; the Hendryx sample were male inpatients at an alcohol abuse treatment centre.  31  Table 3 presents the subject variables: and Wide Range Achievement Test  BDI  scores. The TAS was  (WRAT)  negatively correlated with Verbal IQ  age, Verbal IQ,  (  =  -.37, p <.05),  and both  TAS and PCL-R scores were positively correlated with BDI scores (r  =  .50, p <.01;  =  .33, p =.05).  (  were negatively associated  =  Additionally,  —.33, p <.05).  relationship between reading ability (the WRAT)  PCL-R and age  There was no and either  alexithymia or psychopathy. Table 4 contains a correlation matrix between psychopathy and alexithymia ratings. and TAS total scores,  There was no relationship between PCL-R  but significant positive associations  emerged between the TAS and PCL-R Factor 2 especially between TAS Factor 1 describe feelings)  (social deviance)  and  (inability to distinguish and  and PCL-R Factor 2.  PCL-R Factor 2 scores were significantly correlated with TAS Total Scores and TAS Factor 1. connection, (b)  in this sample,  Obviously,  there was some  between criminality and alexithymia.  Relationships of the PCL-R and the TAS to Violence To explore further the relationship between PCL-R Factor 2  and alexithymia,  I examined the subjects’  institutional files for  clues as to which Factor 2 behaviours might be common to both psychopaths and alexithymics. possibility.  Violence appeared a strong  I then coded the subjects according to presence or  32  Table 3 Subiect variables  Variable  M  SD  Mm.  Max.  BDI Score Age Verbal IQ WRAT  15.54 31.68 87.56 98.53  8.78 8.35 11.67 13.84  2.00 19 68 72  35.00 50 113 133  Note. WRAT scores represent standard scores calculated according to the WRAT scoring manual.  33  Table 4 Correlations between PCL-R and TAS factors  TAS Total Score  TAS Factor 1 (Feelings)  TAS Factor 2 (Dreaming)  TAS Factor 3 (External)  PCL—R  .26  .32  —.24  .19  PCL-R Factor 1  .01  .11  -.13  -.06  PCL-R Factor 2  •33*  .38*  —.24  .22  . 5 *p<.0 Note. TAS Factor 1 = Ability to distinguish and describe feelings; TAS Factor 2 = Lack of daydreaming; TAS Factor 3 Externally-oriented thinking.  =  Higher scores on all factors relate to higher dysfunction levels.  34  absence of violence.  Extensive research has been carried out to (e.g.  examine the association between psychopathy and violence Hart and Hare, 1991),  1989; Kosson, Newman and Smith,  1990;  Serin,  but there has been very little research examining a  possible linkage between violence and alexithymia.  Even where For  data exist, most are concerned with male offenders.  found a high rate of  instance, Keltikangas-Jarvinen (1982)  alexithymia among males convicted of violent crimes. sample of 75 female offenders, correlated .35  Strachan  (significant at p<.002)  In this study,  (1993)  37 subjects  the subjects were coded as violent if they  violent.  (i.e.  murder, 25 of the  According to this criterion,  assault).  (60%)  found the PCL—R  with a record of violence.  had ever been charged with a violent crime manslaughter,  In her  were considered violent and 12  (32*)  were non  Because of the imbalance in subjects between groups,  Levene’s test for equality of variances was conducted,  revealing  the difference to be non-significant for -tests involving violence and the PCL-R, TAS,  =  F  =  2.108, p .155,  and violence and the  .389, p =.537.  The violent group had a higher mean PCL-R score than did the non-violent group Clearly,  female violence,  (  =  17.6), (35)  =  (N  =  3.84,  27.2) p<.OOl.  like male violence, was highly  associated 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,  35  p<.OOl.  In this sample,  there was obviously a connection between  female violence and alexithymia. Table 5 presents the correlations of the PCL-R and the TAS with violence. with violence.  PCL—R and TAS total scores were each correlated Both Factors of the PCL-R were significantly  associated with violence. Only Factors 1 and 3 of the TAS were correlated with violence.  Since the TAS and PCL-R had no  statistical relationship with each other,  a multiple regression  analysis was performed to see to what extent violence could be predicted by these two instruments. regression  (SPSS—X)  A standard multiple  was performed between violence as the  dependent variable and TAS and PCL-R scores as the independent variables.  The distribution of scOres for the two independent —.43 for PCL—R and  variables was approximately normal  (skewness  .16 for TAS scores); consequently,  no transformations were  necessary.  =  Table 6 displays the regression coefficients,  multiple correlation),  . 2 and R  R (the  Both TAS and PCL-R variables were  significant predictors of violence; altogether,  47% of the  variability in violence was attributable to these scores.  36  Table 5 Correlations of the PCL-R and the TAS with violence  PCL-R .60**  Total Factor 1 Factor 2  .52**  TAS Total Feelings  .36*  Dreaming  -.03  External  *p<.05.  **p<.O1  37  Table 6 Standard multiple regression of PCL-R and TAS variables on violence  Variable  T  p  PCL—R  .031  3.83  .0005  TAS  .012  2.70  .011  2 R  =  .472,  (2,33)  14.78,  p<.O0l; Multiple  R  =  .687.  38  (c)  Vocal Analyses Appendix F lists the means,  standard deviations and inter-  correlations of all vocal measures. Table 7 contains the correlations between PCL—R scores and vocal analyses of subjects’ audiotaped responses to the emotional scenario. None of the findings was significant. No clear affective impoverishment could be detected in the voices of psychopaths, either by rating their speech for signs of affect, or by counting the number of words and number of emotions spoken. The same pattern emerged when ratings for the question “How does this make YOU feel?” were correlated with PCL—R scores. There was no relationship between psychopathy and emotional quality of the voices, raters’  appropriateness of emotions expressed,  impressions of sincerity, total word count,  or number of  affective 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 feelings of the people involved in this event?”). Again, there was no relationship with psychopathy. Table 8 contains the same analyses performed for TAS scores and vocal ratings.  All correlations were negatively associated  with the TAS and its factors,  seven significantly so.  Total TAS  scores were negatively associated with appropriateness of  39  Table 7 Correlations between PCL—R scores and vocal analysis ratings  PCL—R Factor 1 Factor 2  Emotion  Appropriateness  Sincerity  Total Word Count  Total Affect Count  .09 .01 .01  .16 .12 .11  .13 .06 .05  .02 .09 —.01  .17 .32 .09  Note. Interrater reliability was computed for the two independent ratings of Amount of Emotion, Appropriateness of Emotion, and Sincerity, and the results are reported as Pearson’s r: Amount of =.8; Appropriateness of Emotion: r =.77; Sincerity: Emotion: =78.  40  Table 8 Correlations between TAS scores and vocal analysis ratings  Total Word Count  Total Affect Count  Emotion  Appropriateness  Amount of Sincerity  TAS  —.20  —.40*  —.22  —.  Feelings  —.09  —.25  —.13  —.21  —.08  Dreaming  —.13  —.25  —.13  —.22  —.  External  —.28  —35*  —.28  —.  *p<.0S.  **p<.Ol.  ***<.001  44**  56***  55***  —.33*  41  emotional content, total words, and number of affects mentioned. Factor 2,  inability to daydream, was negatively correlated with  total affect count,  and Factor 3  ——  an externally—oriented,  concrete thinking style, was negatively associated with appropriateness of emotions, count.  The higher subjects’  total word count,  and total affect  scores on measures of alexithymia,  the lower their ratings on normal affective expression. Table 9 shows the relationship between TAS factors and rated ability to predict degree of empathic ability,  as well as the  relationship between alexithyrnia and affective content of responses to the question “How does this make YOU feel?” All results were in the negative direction. Alexithyinic characteristics were associated with lower predictions of empathic ability and fewer words/affective states, of these reached statistical significance.  but only four  Total TAS scores were  negatively correlated with number of affective states mentioned, as were Factor 2 scores;  Factor 3 scores were negatively  correlated both with prediction of empathy and with total word count.  Alexithymics appeared to be realistic in their  expectations about their impaired ability to correctly assess and describe others’ subjects’  emotions,  and alexithyrnia was associated with  inability to verbalize emotional reactions to the  scenario presented in this study. In case the experience of motherhood contributed to the  42  Table 9 Correlations between TAS scores, prediction of empathy, and content analysis of subiects’ responses to question regarding own feelings  Prediction of Empathy  Total Word Count  —.29  —.23  11  —.08  Dreaming  -.03  -.11  External  —47**  •33*  TAS Feelings  *p<.05.  —.  **p<.0l.  Total Affect Count  —.  -.  16 4Q*  -.16  43  degree of emotion expressed in response to the scenario, examined each subject’s file for number of children,  I  and  correlated this variable with all affective measures. Most of the women had at least one child  0  (range:  —  4).  Presence or absence  or number of offspring, was unrelated to any of the  of children,  speech measures. An earlier study examining the speech of male psychopaths (Louth et al,  1994)  found a significant tendency for incarcerated  male psychopaths to speak more quickly than their nonpsychopathic counterparts.  The vocal patterns in that study were  analyzed using a sophisticated software package which tracks the acoustic signals of speech,  and measures the duration of The raters in the present study  utterances and internal pauses.  were asked to assess the audiotapes of subjects’ score them for rate of speech, slow,  and 3  =  responses and  using a continuous scale where 1  =  fast.  While no association emerged between rate of speech and psychopathy  (r  =  -.04),  there was a significant negative  relationship between rate of speech and alexithymia <.001).  (r  =  -.57, p  In case the slow speech of alexithymics could be  obscuring the faster speech of psychopaths, reanalysed with alexithymics remaining p of 16,  (TAS  >  70)  the data were  filtered out.  With a  there was still no significant relationship  between psychopathy and speed of speech, in a slightly positive direction (r  =  but the results were now  .34, p =.19).  44  Discussion Psychopathy and Alexithymia I had expected to find some connection between alexithymia and the PCL-R factor which measures interpersonal impoverishment Instead,  —  Factor 1.  No such relationship emerged.  there was a modest but significant positive correlation  between the TAS and Factor 2  —  the factor assessing behavioural  indices of psychopathy such as impulsiveness, boredom, poor behavioural controls,  proneness to  and criminality.  The  significant correlation between PCL—R Factor 2 and the “Feelings” subscale of the TAS,  rather than the anticipated relationship  between “Feelings” and Factor 1, prompted a closer examination of individual items on the two instruments. scale include:  Items on the “Feelings”  “When I cry I always know why,” “I often get  confused about what emotion I am feeling,” and “I find it hard to describe how I feel about people.”  Factor 1 of the PCL-R  includes such characteristics as glibness, pathological lying, shallow affect.  grandiosity,  tendency to con and manipulate others,  and  Psychopaths who are glib and grandiose would be  disinclined to admit confusion about their feelings. inflated sense of their own abilities,  Their  plus a tendency to lie and  gloss over personal inadequacies, would lead them to make non— alexithymic responses to these TAS items.  Their superficiality  and restricted affective range could result in a feeling of confidence about how they feel about people  ——  perhaps there are  45  simply those who can be manipulated and those who cannot. Psychopaths scoring highly on Factor 1 of the PCL-R may be totally unaware of any emotional deviance on their part. The descriptive statistics and interrater reliability of the PCL-R in this sample were similar to those reported by other researchers.  Consistent with other research, the base rate for  psychopathy, however, was higher than typically found for male sample groups  --  a finding that lends support to Mednick and  Kandel’s view (1988)  of differential sentencing practices.  would be worthwhile,  in this regard, to compare the criminal  backgrounds of incarcerated men and women.  It  We might surmise that  prison sentences of women represent something of a last resort, whereas for men, prison is recommended for less serious, fewer,  criminal off ences.  previous criminal records;  or  Only two of our subjects had no most had extensive criminal  histories. In this sample, the only correlates of psychopathy were depression and age.  The relationship with depression,  measured by the Beck Depression Inventory, (1994)  found no such relationship,  is unusual.  and indeed,  In the Tien et al  (1990)  Strachan  negative  correlations are most commonly found with male samples 1991).  as  (Hare,  assessment of female inmates,  they found that 32% of the women suffered from depressive disorders, but the report did not include mean Beck Depression Inventory scores, nor did it report correlations between BDI and  46  Given the high rate of depression and psychopathy  PCL-R scores.  in their sample,  it is likely that BDI scores were also  associated with PCL—R scores. When the BDI was administered to the current sample of women no 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,  few women chose the lowest selection punished”);  (“I don’t feel I am being  many chose the highest scoring statement.  in this sample,  very  Possibly,  the women concluded that this item referred to  the fact that they were being punished by the law,  an It is not  interpretation not intended by the authors of the BDI.  known if other researchers in prison environments give their subjects any instructions about completing this item. The negative correlation between age and psychopathy shows that,  in this group of women,  most likely to be psychopaths.  (-.33)  the younger inmates were the  Though some researchers have  reported a reduction in antisocial behaviours as psychopaths age (Hare et al,  1988; Hare & Forth,  1992),  this negative association  is not normally seen within a given psychopathy study,  and may  only reflect the particular sample incarcerated during the time of this study. The descriptive statistics of the TAS found in this study were in line with other reported research in the area of alexithymia.  The mean score was higher than that found in a  sample of 26 female outpatients at a behavioural medicine clinic  47  (Taylor et al,  1988),  but slightly lower than the mean of 130  male alcoholic inpatients  (Hendryx et al,  1992).  Over fifty  percent of the alcoholic sample were considered alexithymic, compared to one—third of our female inmates.  Given that  incarceration could be considered a stressful condition for many offenders, the fact that two—thirds of our sample were not alexithymic provides support for the idea that the TAS assesses primary,  as contrasted with secondary,  or trait alexithymia,  or  reactive alexithymia. The high correlation between TAS and depression echoes a relationship commonly found in alexithymia studies 1990,  and others).  Most researchers report that although the two  are highly correlated, of alexithymia. further,  (Taylor et al,  depression is not a significant predictor  Haviland et al  (1988)  explored this relationship  and found that while BDI scores fluctuated TAS scores  were relatively static, which they interpreted as supporting conceptual independence of the two constructs. One purpose of this study was to assess the co—occurrence of alexithymia and psychopathy. alexithymia were similar.  The base rates of psychopathy and  Using the recommended cutoff scores of  74 for the TAS and 30 for the PCL-R,  eleven of the women were  psychopaths and twelve were alexithymic,  but only three subjects  could be considered both psychopathic and alexithymic. unlikely then,  It seems  that alexithymia scores inflated PCL-R ratings to  a point where misdiagnosis was a threat.  48  Criminality and Violence Though social conformity has been associated with the characteristics of alexithymics in prison may be  alexithymia,  different from those of non—incarcerated populations. Alexithymia is also connected with impulsivity and substance Apparently,  abuse.  in these alexithymic inmates,  these  This would explain  tendencies overcome the desire to conform.  the correlation of the TAS with Factor 2 of the PCL-R. Kroner  (1994),  in a study of 104 male sex offenders,  also  found a connection between PCL—R Factor 2 and the “Feelings” subscale of the TAS, TAS,  although he used a different version of the  one with 20 items and four factors.  While my sample was too  small to permit individual item correlations, detailed item analysis,  and found this subscale to correlate  positively with PCL-R Items 3 (impulsivity),  15  Kroner performed a  (proneness to boredom),  (irresponsibility),  and 20  14  (criminal  versatility). Kroner’s sample was quite different from mine; he used a different version of the TAS,  and his group of male offenders had  a mean PCL-R score of only 17.2; yet, (1982),  like Keltikangas-Jarvinen  we both found an association between alexithymia and  criminality.  Keltikangas-Jarvinen’s sample consisted of 68  violent offenders from a Helsinki Penitentiary. and all were recidivists. used,  All were male  Although no psychopathy assessment was  it is reasonable to speculate that this group would score  49  highly on Factor 2 of the PCL-R. Keltikangas-Jarvinen reported a high rate of alexithymia in her sample. It would be interesting to investigate the relationship between alexithylnia and violence in a non—incarcerated sample. Until this is attempted we can only conclude that in an inmate population the characteristic of being unable to experience or describe emotions is predictive of violence. It has long been known that psychopathy, PCL-R,  is strongly associated with,  et al,  and predictive of,  (e.g. Hare & McPherson,  in male inmates  as measured by the  1984;  Serin,  violence  1991; Rice  The present study indicates that there is also a  1992).  PCL-R/violence relationship in female offenders. As Strachan (1994)  pointed out,  the concept of femininity has traditionally  been considered antithetical to violence,  but as women’s sex—role  stereotypes disappear society may begin to view female criminality more realistically.  If further research confirms the  association between psychopathy,  alexithymia,  women,  and violence in  parole boards and corrections staff will have additional  means at their disposal for assessing offenders’  suitability for  early release. Psychopathy,  Alexithymia,  and Affective Language  Although psychopaths appear to experience a restricted range of affect,  those in this study were judged the same as  others on amount of expressed emotion, and sincerity.  appropriateness of emotion  It seems that psychopaths may not experience  50  normal emotions,  but are as adept as others at using appropriate  words to describe emotional states.  Even though the raters knew  that some of the subjects were psychopaths, they were unable to detect any group differences in the taped voices.  Perhaps the  psychopaths went out of their way to convince the interviewers of their normalcy in the areas of empathy and affect. There was no evidence they were aware of affective impoverishment in their predictions of self-empathic ability.  Psychopaths rated their  own empathic powers in the same way as did the other subjects. A different picture emerged in the analysis of alexithymic speech samples.  In line with the theoretical construct of  alexithymia, high TAS scores were associated with low total word production and a low number of affective states mentioned.  This  was true whether subjects were trying to describe others’ feelings or their own.  Alexithymics were also rated as talking  significantly more slowly than others.  If this finding is  replicated, rating the speed of speech may prove to be a useful signal to alert professionals to the possible presence of alexithymia. Although all results were in the negative direction,  the  highest significant correlations were with the “Dreaming” and “External Cognitive Style” scales of the TAS.  Alexithymics were  rated as less appropriate than others in the type and depth of emotions they talked about.  Alexithymics also seemed much more  realistic appraisers of their poor empathic ability than did  51  psychopaths. Again,  an externally oriented cognitive style seemed  to predispose subjects to rate their own empathic powers as quite This represents a fundamental difference between  low.  psychopaths and alexithymics.  Although neither group would  likely attach any great significance to their affective difficulties,  at least the alexithymic seems more likely to admit  their existence  —  a vital first step before any treatment could  even be contemplated. Although detailed speech analyses were not conducted in this study,  and only affective words were singled out for attention,  a  more careful examination of some of the speech samples revealed some trends worthy of future research.  For example,  tended to use an excessive number of qualifiers, “probably, maybe,  I imagine,” and often simply,  or “I don’t have a clue.” minds,  as  sorry.”  “When he died,  alexithymics  such as “I don’t know,”  They also tended to change their she probably felt guilty,  no angry,  no  They sometimes showed their concrete ways of thinking  quite dramatically., as “But the story doesn’t say anything about a husband,” and “The story didn’t say what her feelings were, angry,  scared,  or what.”  sequiturs in their speech, Well,  Psychopaths often produced strange non for example:  “How would the kid feel?  in a store he is curious about what’s in the store.  Macaroni cheese, whatever,” and “Anyway,  it’s different in them  third world countries. No respect for life, with the IRS or IRA or whatever.”  These rather odd verbalizations only appeared when  52  the transcripts were examined,  and did not affect raters’  assessments of sincerity, appropriateness, and so forth. (1993)  Hare  has remarked upon this tendency for strange verbal  rambling by psychopaths. Psychopaths also showed a preoccupation with legal concepts and with mitigating factors; for instance, the following examples are all excerpted from psychopaths’ responses: “They must have been abused children themselves,” “The kids that killed him must obviously have had terrible lives,” “The father might have wanted to take legal action,” “Maybe they had poor backgrounds, no concept of right or wrong,” “What kinds of homes were they brought up in?” “Must be because of something they’d watched on TV; at their age they couldn’t stick them in jail.” Psychopaths in prison are often the offenders who are most skilled at manipulating the system.  With an almost obsessive  knowledge of the law and their rights, they are adept at playing the system to their advantage.  These examples supply interesting  evidence of this preoccupation with ways to gain sympathy and leniency from the legal system. There are several limitations to the speech analyses in this study.  Firstly, rating speech for emotional measures is a  difficult and subjective task.  The interrater reliability levels  53  achieved by our raters, while acceptable for research purposes, were far from perfect.  Secondly, the scenario provided to the  subjects was a true story, but reading a short paragraph, however carefully chosen to elicit emotion, situation.  is still an artificial  Realistically, the subjects were probably  participating because of the payment we offered them, alternative to prison routine.  or as an  There is no guarantee they took  this study seriously, or that their behaviour during the sessions was representative of their normal behaviour. Conclusion This study suggests that alexithymia, significant construct in institutions.  like psychopathy,  is a  Both disorders have a  high base rate among female inmates, ahd there seems to be a small subgroup of psychopaths, high on PCL-R Factor 2,  who are  also alexithymics. Given their propensity for violent action and their poor response to treatment,  such individuals would be a  thorny management problem for those responsible for designing and conducting rehabilitation programs.  Presumably, treatment  programs designed to teach empathy to these individuals would not be very useful. For the alexithymic client in clinical practice,  any  interventions dependent upon emotional insight would probably be destined to fail.  As. Legorreta  (1980)  recommended,  the best  treatment paradigm for such individuals might be interventions with a strong behavioural focus.  54  If there is a common link between alexithymia and it may lie in the characteristic of impulsivity,  psychopathy,  which both groups experience in excess  ——  so much so in  alexithymics that it seems to overcome their natural reluctance to break social conventions.  A study by Lee and Menna  found that aggressive (and probably impulsive)  (1994)  children as young  as 3 years had an impaired ability to predict others’  emotions.  We could speculate that these traits might foreshadow the development of disorders such as psychopathy or alexithymia, and that environmental issues would be crucial in affecting the outcome for children such as these.  Very young psychopaths may  not 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 development with the ongoing validation of the TAS,  of the PCL-R;  the way is  being paved for future research combining both constructs. psychopaths,  In  affective impairment and antisocial behaviours are  woven together  to form a potentially dangerous personality.  Now  it seems that alexithymia, too, may combine elements of antisocial,  violent behaviour with the more traditional view of  the emotionally barren and interpersonally aloof alexithymic least in incarcerated females.  -  at  Future research should clarify if  this relationship also exists in non—criminals.  55  References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).. Author. Washington, DC: Apfel, R.J., & Sifneos, P.E. (1979). Alexithymia: concept and measurement. Psychotherapy & Psychosomatics, 3, 180-190. Bagby, R.M., Taylor, G.J., & Ryan, D. (1986). 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The relationship between alexithyinia and abnormal illness behaviour. Psychotherapy & Psychosomatics, 54, 18-25. Zeitlin, S.B., Lane, R.D., O’Leary, D.S., et al. (1989). American Interhemispheric transfer decif it and alexithymia. 1434—1439. Journal of Psychiatry,  61  Appendix A PCL-R SCORESHEET Subject: Date: Rater:  TOTAL SCORE: Prorated score: Prototypicality:  -  -  / /40 of 2’s)  1.  Glibness/superficial charm  0  1  2  omit  2.  Grandiose sense of self-worth  0  1  2  omit  3.  Proneness to boredom/need for stimulation  0  1  2  omit  4.  Pathological lying  0  1  2  omit  5.  Conning/manipulative  0  1  2  omit  6.  Lack of remorse  0  1  2  omit  7.  Shallow affect  0  1  2  omit  8.  Lack of empathy  0  1  2  omit  9.  Parasitic lifestyle  0  1  2  omit  10.  Poor behavioral controls  0  1  2  omit  11.  Promiscuous sexual behavior  0  1  2  omit  12.  Early behaviour problems  0  1  2  omit  13.  Lack of realistic long-term plans  0  1  2  omit  14.  Impulsivity  0  1  2  omit  15.  Irresponsibility  0  1  2  omit  16.  Failure to accept responsibility for own actions  0  1  2  omit  17.  Many marital relationships  0  1  2  omit  18.  Juvenile delinquency  0  1  2  omit  19.  Poor risk for conditional release  0  1  2  omit  20.  Criminal versatility  0  1  2  omit  VALIDITY RATING On the basis of the quality of the interview and collateral information, indicate your confidence in the validity of your PCL rating:  1  Low  / 2  / / Moderate 3  / 4  High 5  ©Copyright 1989 by Robert D. Hare, University of Bntish Columbia  62  Appendix B Subject No. TAS Please read each statement carefully and circle the number which best describes how much you agree or disagree with each statement. Strongly Moderately Neither Moderately Strongly Disagree Disagree Disagree Agree Agree nor agree 1.  When I cry I always know why.  1  2  4  5  2.  Daydreaming is a waste of time.  1  2  3  4  5  3.  I wish I were not so shy.  1  2  3  4  5  4.  I often get confused about what emotion I am feeling.  1  2  3  4  5  5.  I often daydream about the future.  1  2  3  4  5  6.  I seem to make friends as easily as othersdo.  1  2  3  4  5  7.  Knowing the answers to problems is more important than knowing the reasons for the answers. 1  2  3  4  5  3  4  5  3  8.  It is difficult for me to find the right words, 1  9.  I like to let people know where I stand on things.  1  2  3  4  5  10.  I have physical sensations that even doctors don’t understand. 1  2  3  4  5  11.  It’s not enough for me to know that something gets the job done; I need to know why and how it works. 1  2  3  4  5  12.  I am able to describe my feelings easily.  1  2  3  4  5  13.  I prefer to analyze problems rather than just to describe them.  1  2  3  4  5  2  63  TAS  14.  Page 2. Strongly Moderately Neither Disagree Disagree Disagree nor agree When I’m upset, I don’t know if I 1 2 3 am sad, frightened or angry.  Moderately Strongly Agree Agree 4  5  15.  I use my imagination a great deal.  1  2  3  4  5  16.  1 I spend much time daydreaming nothing to have else do. whenever I  2  3  4  5  17.  I am often puzzled by sensation in mybody.  1  2  3  4  5  18.  Idaydream rarely.  1  2  3  4  5  19.  I prefer to just let things happen rather than to understand why they turned out that way.  1  2  3  4  5  20.  I have feelings that I can’t quite identify.  1  2  3  4  5  21.  Being in touch with emotions is essential.  1  2  3  4  5  22.  I find it hard to describe how I feel about people.  1  2  3  4  5  23.  People tell me to describe my feelings more.  1  2  3  4  5  24.  One should look for deeper explanations.  1  2  3  4  5  25.  I don’t know what’s going on inside 1 me.  2  3  4  5  26.  I often don’t know why I’m angry.  2  3  4  5  1  I rri  64  Appendix C  DLI  Date:  This 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 you have been feeling the past week, Including today. If several statements within a group seem to apply equally well, circle each one. Be sure to read all the statements In each group before making your choice. ° 2  2  ° 1 2  3  °  2  4  °  2  5  ° 1 2  6  °  2 ‘  7  °  2  8  Idonotfeelsad. I feel sad. Iamsadallthetimeandlcan’tsnapoutofit. I am so sad or unhappy that I can’t stand it.  2  I am not particularly discouraged about the future. I feel discouraged about the future. I feel I have nothing to look forward to. I feel that the future is hopeless and that things cannot improve. Idonotfeellikeafailure. I feel I have failed more than the average person. As I look back on my life, all I can see is a lot of failures. I feel I am a complete failure as a person. I get as much satisfaction out of things as I used to. I don’t enjoy things the way I used to. I don’t get real satisfaction out of anything anymore. lam dissatisfied or bored with everything. I don’t feel particularly guilty. I feel guilty a good part of the time. I feel quite guilty most of the time. I feel guilty all of the time. I don’t feel I am being punished. I feel I may be punished. expect to be punished. I feel lam being punished.  °  8  0 I 2  10  0 1 2  11  °  2  12  ° 1 2 S  13  I don’t feel disappointed in myself. lam disappointed in myself. 1am disgusted with myself. Ihatemyself.  0 I 2 3  I don’t feel I am any worse than anybody else. I am critical of myself for my weaknesses or mistakes. blame myself all the time for my faults. I blame myself for everything bad that happens. I don’t have any thoughts of killing myself. have thoughts of killing myself, but I would not carry them out. Iwouidliketokillmyself. I would kill myself if I had the chance. don’t cry any more than usual. I cry more now than I used to. I cry all the time now. Iusedtobeabletocry,butnowlcan’tcry even though I want to. lam no more irritated now than lever am. I get annoyed or irritated more easily than Iusedto. I feel irritated all the time now. Idon’tgetirritat.edatallby thethingsthat used to irritate me.  I have not lost interest in other people. I am less interested in other people than Iusedtobe. I have lost most of my interest In other people. I have lost all of my interest in other people. I make decisions about as well as I ever could. I put off making decisions more than Iusedto. I have greater difficulty in making decisions than before. I can’t make decisions at all anymore. Page 1  ,THE PS’tDHctOGlCAL ODRPcS.i’310N  *j,’HATtfXuRr BR  ‘ANCYs’IGi. R’.  Copyright © 1978 by Aaron T. Beck. All rights reserved. Printed in the U.S.A.  CONTINUED ON BACK  65 BDI  14  page 2  o i 2  15  18  o  o 2  I don’t feel I look any worse than I used to. I am worried that I am looking old or unattractive. I feel that there are permanent changes in my appearance that make me look unattractive. I believe that I look ugly.  18  I can work about as well as before. Ittakesanextraefforttogetstartedat doing something. I have to push myself very hard to do anything. I can’t do any work at all.  29  I can sleep as well as usual. I don’t sleep as well as I used to. I wake up 1-2 hours earlier than usual and find it hard to get back to sleep. I wake up several hours earlier than I used to and cannot get back to sleep.  o 2  I am purpo8ely trying to lose weight by No_____ eating less. Yes  o a  2  s  21  o a  17  o i 2  18  o  a 2  I don’t get more tired than usual. I get tired more easily than I used to. I get tired from doing almost anything. Jam too tired to do anything.  I haven’t lost much weight, if any, lately. I have lost more than 5 pounds. Ihavelostmorethan lOpounds. I have lost more than 15 pounds.  2  a  I am no more worried about my health than usual. I am worried about physical problems such as aches and pains; or upset stomach; or constipation. 1am very worried about physical problems and it’s hard to think of much else. I am so worried about my physical problems that I cannot think about anything else.  I have not noticed any recent change in my interest in sex. lam less interested in sex than I used tobe. I am much less interested in sex now. I have lost interest in sex completely.  My appetite is no worse than usual. My appetite is not as good as it used to be. My appetite is much worse now. I have no appetite at all anymore. Page 2 Subtotal Page 1 Score  TPC 0528-001  1819  BCOE  I WIDE  66 Appendix D  ACHIEVEN’lENT  RANGE  Page 4 Reading, Level I  cat  red  see  then  A  2  open  should  approve  plot  deep  jar  lip  finger  huge  horizon  luxurious  rescinded  emphasis  putative  endeavor  heresy  seismograph  spurious  H  sour  S  B  E I  P  how  36  block  size  46  lame  struck  56  humidity  urge  64  clarify  70  quarantine  76  repugnant  82  persevere  anomaly  88  audacious  mitosis  94  awake cliff  participate  aeronautic  intrigue  discretionary usurp  novice  idiosyncrasy  itinerary  0  Q  Z  U  glutton  residence  0  him  imply  RS GR 36 23 3724 K.8291.713824  JASTAK  was  stalk  Level I, RS CR RS CR RS GR RS CR 0 N.7 Raw Scores (RS) 18 <.6 I 27 1 5 9 P.6 1 N.8 19K.7281.6 10 P.7 and Grade Ratings(GR) 2N.9nP8I2O SEE MANUAL FOR NORMS  T  collapse  threshold  miscreant  Q  spell  felt  abuse  I eat  even  tray  recession  rudimentary  R  book  quality  exhaust  E  S  work  big  letter  weather  bulk  to  0  B  H  Z  AR  Two letters in name  TEST  pseudonym  aborigines  00  RS CR RS CR RS CR RS CR PS CR PS CR 54 3.8 45 2.8 72 6.6 63 5 1 SI 76 91 8.8 162.8553.9.5.75.3 3277:9293 736.7 472.91564.05555i7469I537.9. 939.2  I  P.O 12 3 P9 21 K9 30 1.8 18 30 4.1 i 66 5.7 39 25 1 P.1 13 KO 31 19 22 1.0 19 31 58 42 40 25 14 KI 5 P.2 5944 23 11 3220 1126 68 6.0 5032 6P3’5K.2j2412 5221422.6I513.3I604,56962 7 P.416K.4j251.3,3422432.7 614.7:7064 523.4 8 17 K.5 I 26 1.3 P.5 35 2.2 44 2.7 62 49 1 53 36 6.5  9.7 9.3 84 80 85 81 5 94 5663 95 95 8784’996  75 70 76 7.1 77 72 7873 7974 80 7.5  8583  89 90  86 87  6597  99 7G  98 99  Reading, Level II  Two letters in name milk  city  grunt  in  I  B  tree  stretch  contemporary  -  A  (2)  humiliate  scald  mosaic  municipal  desolate  pugilist  enigmatic  ingratiating centrifugal misogyny  grieve  covetousness  oligarchy  coercion  vehemence  subtlety  beatify  succinct  desuetude  egregious  SEE MANUAL FOR NORMS  3 I 5 6  K.6.10 11 1 K.8 12 K.9 13 1.1  CR  RS  14 1.3 14 15 16 15 1.7117 18 18 19 1.9 20 2.1  CR  RS  21 2.3 2.4 22 251 23 2.7124 2.9125 3.0 26 27 3.1  CR  RS  33 I 28 34 29 3:6 30 37 31 39 32 4.0 33 4.1 34  CR  aboard  II  ethics  40  alcove  47  deteriorate  stratagem  54  irascible  peculiarity  CR  RS  54 32 5.6 43 34 5.7 59115 6.0’46 6.2 47 6.3 48 49  CR  longevity  abysmal  emaciated  evanescence  schism  ebullience  internecine  synecdoche  regicidal  PS  image  predatory  soliloquize  sepulcher  35 43 36 4.5 37 47 48 38 5,039 5.2 40 5.3 41  form triumph  regime  heinous  Q  Z split  conspiracy  contemptuous  predilection  U  chin  unanimous  bibliography decisive  1  toughen  tranquillity  prevalence  PS CR RS Level II, 7 0 K 1 Raw Scores (RS) 1 1 6 K3 and Grade Ratings(GR) 2 KS 9  P  between  protuberance  beneficent  H  T  himself  eliminate  rancid  R  E  contagious  deny  benign  S  animal  theory escape  0  PS  6.4 50 6.6 51 68 52 69153 7.1 54 7.3 55 7.4 56 76 57  GR  RS  7 58 7.8 59 8.0 60 Bli&l 8.3 62 8.4 63 8.6 64 8.7 65  GR  RS  89 66 90167 9268 9.3169 9.470 9.6 71 9.7 72 9.9 73  CR  PS  100 74 10.275 103 76 10.5 77 10.6.76 79 10.7’ 10.9 80 11.1 81  75  CR  RS  OR  112 113 ‘1.5  52 53 54  125 12.7 129 13.0 131 133 135 13.7  ‘17  05  11566 12.0 87 12.2 88 121 69  67  Appendix E  WAIS-R  RECORD  NAME_  WECHSLER ADULT INTELLIGENCE SCALE— REVISED  ADDRESS MARITAL SEX_____ AGE______ RACE__________ STATUS_________  OCCUPATION__________________________ EDUCATION_________ TESTED BY  PLACE OF TESTING  TABLE OF SCALED SCORE EQLJIVALENTS*  Year  RAW SCORE VERBAL TESTS  0  2 v .  (  C  .2 E  . .E  12  a>  g  •2 a>  E  E  .2  o. E o  .!? ca  co  Q0  o<  32  29  27  69  31  28  26  68  28  25  66-67  30  27  27  24  65  18  29  26  0  E  a,a>  70  (  C a, CL  28  E o  a>  tE  (3  .2  a>  ma  20  19  89-90  40  84-88  16  47-48  39  79-83  15  44-46  38  75-78  14  18  42-43  37  70-74  13  35-36 66-69  12  25  20-21  60-62  16  26  24  23-24 18-19 55-59  15  25  23  18  17  38-41  22  35-37  17-18  19  17  15-16  62-65  11  15-16 47-51  12  21-22 20-21  16  14  31-34 32-33 57-61  10  43-46  11  19-20 18-19  15  13  27-30 30-31  15-16 12-13 37-42  10  17-18 16-17  14  13-14  11  29-36  8-9  14-16 14-15  9-12  9-10  20-28  6-7  11-13 11-13  6-8  8  14-19  5  8-10  7-10  8-10  3-4  5  7  11-13  4  6-7  5-6  5-7  2  4  6  9-10  3  4-5  2-4  3-4  3  3-5  6-8  1-2  2-3  0-2  0-2  0-5  0  0-1  17 14  52-54 13-14 23-24  53-56  9  11-12  23-26 28-29 48-52  13  8-10  11-12  5-7  20-22 24-27 44-47 14-19 21-23 37-43  8 7 6  8-13  16-20 30-36  5  3-7  13-15 23-29  4  9-12  16-22  3  6-8  8-15  2  0-5  0-7  1  2  2 0  34  0-1  0  0  ‘Ctinicians wico wish to draw a profile maydo so by locating the subjects raw scores on the table above and drawing a line to  connect them. See Ohapter 4 in the Manual for a discussion of the significance  Raw  Score  00)  49 19  SUMMARY  .2>>.  93  50  25  9 8 7  5 0  19 18 17  20  Age  —  —  91-92  27-28  22  0 U  41  17  19-21  0<  51  22-23 63-64  10  0 a> 3’ a>  Tested  a>  .?  26  11  6 5 4 3 2 1  .o>  a>  5 .o >  17  ‘16 ,15 14  c 0. ‘° a>  C  Day  Date of Birth  PERFORMANCE TESTS —————  c 2 0  (5  19 18  Date  Month  of differences between scoces on the tests.  Scaled Score  VERBAL TESTS lnformatiors  — —  —  Digit Span Vocabulary Arithmetic  —  —  — —  Comprehension Similarities Verbal Score  PERFORMANCE TESTS Picture Completion Picture Arrangement  — —  Block Design  — — —  Object Assembly Digit Symbol  —  Performance Score  —  —  Sum of Scaled  Scores  10  VERBAL  — —  PERFORMANCE  —  FULL SCALE 9-991829  68  WAIS:R  1. INFORMATION 1. 2. 3. 4.  -  r  page 2  2. PICTURE COMPLETION  Discontinue after 5 consecutIve faIlures.  DIscontinue after 5 consecutive failures.  Flag BaIl Months  1. Door 2. Tennis  Thermometer 5. Sun 6. Presidents 7. Weeks 8. Armstrong 9. Panama 10. Labor Day 11. Brazil 12. Hamlet 13. Civil War  14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.  Scrn. 1 or 0  3. Frog 4. Playing card 5. Car 6. Pitcher 7. Glasses 8. Pliers 9. Boat 10. Beach  Earhart Clothes Italy King Genesis Sahara Relativity Yeast Senators Paris Blood vessels Temperature Curie  11. Mirror 12. Crab 13. Violin 14. Sun 15. Watch 16. Leaf 17. Man 18. Horse 19. Female profile 20. Woodpile Max=2(/  • 27. Population 28. Koran 29. Faust  Total  Max29  Note: Be sure to include scores for Items 1-4 In Total.  Total  3. DIGIT SPAN DIGITS FORWARD 1 2.  ‘  5  6 7  .  5-8-2 6-9-4 6-4-3-9 7-2-8-6 4-2-7-3-1 7-5-8-3-6 6-1-9-4-7-3 3-9-2-4-8-7 5-9-1-7-4-2-8 4-1-7-9-3-8-6  5-8-1-9-2-6-4-7 .  .  1  Discontinue after failure on BOTH TRIALS of any Item. Administer BOTH TRIALS of each Item, even If subject passes first trial.  3-8-2-9-5-1-7-4  2-7—5—8-6—2—5—8—4 7-1-3-9-4-2-5-6-8  PaSS-  Score 2, 1, or 0  Fail  1  -  —  2.  —  —  PaSS-  DIGITS BACKWARD*  —  Fail  2-4 5-8 6-2-9 4-1-5 3-2-7-9 4-9-6-8  — —  — —  — —  1-5-2-8-6  —  —  6-1-8-4-3 5-3-9-4-1-8 —  ‘  6.  —  —  —  —  Total Forward  Max=14  Administer DIGITS BACKWARD even if subject scores 0 on DIGITS FORWARD.  Score 2, 1, or 0  —  —  7-2-4-8-5-6  —  8-1-2-9-3-6-5  —  4-7-3-9-1-2-8 9—4—3—7—6—2—5—8  —  —  7-2-8-1-9-6-5-3  I  —  Total Backward Forward  11  Max=14 Max=28  •ackward  Total  ]  69  Appendix F  Descriptive statistics of vocal analysis measures Variable  M  SD  Mm.  Max.  3.10 2.90 3.01 303.00 10.41  1.12 1.11 1.27 195.47 4.30  1.00 .90 .75 30.00 4.00  5.00 4.75 5.00 757.00 21.00  59.03 1.73  48.62 1.15  5.00 0.00  197.00 5.00  All questions Emotion Appropriateness Sincerity Total WordCount Total Affect Count questions regarding own feelings Total Word Count Total Affect Count  Intercorrelations between vocal measures Emotion Emotion Appropriateness Sincerity Affect Count  Note. N37.  --  --  Appropriateness  Sincerity  Affect Count  Word Count  .752  .942 .815  .268 .593 .332  .469 .639 .524 .633  

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