UBC Theses and Dissertations
Diagnosis of psychopathy in a forensic psychiatric population Hart, Stephen David
Both researchers and clinicians, especially those working in criminal populations, have long suggested that psychopathy (or antisocial personality disorder) and schizophrenia are associated on an etiological or on some other level (e.g., Eysenck and Eysenck, 1976, 1978). Others (Hare, 1984; Hare and Harpur, 1986; Raine, 1985) argue that psychopathy is not associated (or even negatively associated) with other psychiatric disorders, including schizophrenia. To evaluate these competing positions concerning the psychopathy-schizophrenia association, 80 male prisoners remanded to a forensic psychiatric institute for assessment of their fitness to stand trial were diagnosed using both the Psychopathy Checklist (PCL; Hare, 1980, 1985a) and DSM-III Axis I and II criteria. In addition, clinical global ratings and self-report inventories were used to measure the strength of psychopathy- and schizophrenia-related traits. The results indicated that: a) although diagnoses of psychopathy (according to PCL criteria) did not have perfect specificity with respect to schizophrenia-related clinical diagnoses, the overlap was small, and the PCL scales were either not associated or negatively associated with these disorders; b) diagnoses of antisocial personality disorder (APD, according to DSM-III criteria) were generally not associated with schizophrenia-related disorders, but had lower clinical specificity than did the PCL criteria with respect to both schizophrenia-related and other psychiatric disorders; c) there was no association between psychopathy- and schizophrenia-related clinical ratings; d) psychopathy and APD diagnoses and clinical ratings were not related to scores on other standard rating scales of the severity of psychiatric symptomatology; and e) there was no difference between schizophrenic and non-schizophrenic subjects in the strength of psychopathy-related traits, and no difference between psychopaths and nonpsychopaths (or APD versus non-APD subjects) in the strength of schizophrenia-related traits. As well, self-report measures related to psychopathy and schizophrenia did not correlate with each other, or with clinical ratings of the two disorders. The results are interpreted as supporting the view that psychopathy is not positively associated with schizophrenia or with psychiatric disorder in general. The practical utility of various techniques for assessing psychopathy in forensic psychiatric populations is also discussed.
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