Triarchic conceptualization of psychopathy Developmental origins of disinhibition boldness - PDF document

Triarchicconceptualizationofpsychopathy:Developmentaloriginsofdisinhibition,boldness,andmeannessCHRISTOPHERJ.PATRICK,DONC.FOWLES,ROBERTF.KRUEGERUniversityofMinnesota;UniversityofIowa;andWashingtonUniversity–St.LouisAbstract PreparationofthisarticlewassupportedbyGrants Thetraditionalcounterparttopsychopathyinthegeneralchildpsychopathologyliterature,precedingtheintroductionofspecificinventor-iesfortheassessmentofpsychopathyinyouth,hasbeentheconceptof“externalizing”psycho-pathology(cf.Achenbach&Edelbrock,1978).Thephenomenonofpsychopathycanbecon-sidereddistinctfromtheconceptofexternaliz-inginthatitentailsadeficiencyratherthananexcessofaffectivereactivity.Thatis,psychop-athyisdistinguishedfromgeneralexternalizingby“emotionaldetachment,”whichisalackofnormalemotionalsensitivityandsocialrelated-ness(Cleckley,1976;Lykken,1995;McCord&McCord,1964;Patrick,Bradley,&Lang,1993).Fromthisperspective,understandingthephenomenonofpsychopathyrequireseluci-dationoffactorsthatgiverisetodisinhibitedbehaviorinthecompanyofemotionaldetach-ment(i.e.,distinctivemanifestationsofexter-nalizingdeviancyinwhichemotionaldetach-mentissalient).Towardthisend,considerableefforthasbeendevotedoverthepast15yearstothestudyofpsychopathyinchildhoodandadolescence.Themajorfocusofworkinthisareahasbeenonso-called“downwardextensions”oftheadultpsy-chopathyconstruct(e.g.,Forth,Kosson,&Hare,1996;Frick&Hare,2001;Lynam,1997).Thisworkhasyieldedimportantadvances,butun-certaintiesremainregardingwhatpsychopathyinyouthentails,howitshouldbemeasured,andhowitintersectswithnormalandabnormaldevelopment.Wearguethatworkinthisareacanbeadvancedbyconceptualizingpsychopathyintermsofmoreelementalphenotypicconstructswithclearerpsychologicalandneurobiologicalreferents.Further,webelievethatprogressinthisareacanbeadvancedbyconsideringhowestablishedconceptsandfindingsfromthegen-eraldevelopmentalliteraturewithpotentialrele-vancetothesekeyphenotypicconstructscanbe“upwardlyextended”toinformthepsychopathyliterature.Thus,oneobjectiveofthecurrentreviewistodescribecontemporaryresearchpertainingtotheassessmentofpsychopathyinadultsaswellasyouthasabasisfordefiningcorepheno-typicconstructsofdisinhibition,and.Asecondmajorobjectiveistodis-cusshowestablishedconceptsandfindingsfromthegeneraldevelopmentalliteraturecanbetiedtothesecorephenotypicconstructs.HistoricalPerspectivesonPsychopathyEarlyaccountsofthesyndromeofpsychopathyassignedprominentemphasistoviolentandan-tisocialbehavior,presumablyowingtothesa-lienceofsuchbehaviorinotherwiserational-appearingindividuals.Explosive,impulsive,reckless,andirresponsibleactions,whichwereoftenaccompaniedbyalcoholordrugproblems(e.g.,Partridge,1928a,1928b;Prichard,1835)andsometimesbysuicidalbehavior(e.g.,Par-tridge,1928a;Pinel,1962),emergedrepeatedlyasthemes.Asdescribedfurtherbelow,thesefeaturesreflectthedisinhibitory(Gorenstein&Newman,1980)orexternalizing(Kruegeretal.,2002;Patrick,Hicks,Krueger,&Lang,2005)componentofpsychopathyincludedinmodernconceptualizations.ForPinel(1962),explosiveviolence(“abstractandsanguinaryfury”)wasthemostsalientclinicalfeature.Par-tridge’s(1928a,1928b)descriptionofthe“so-ciopathic”individualinparticularemphasizedtendenciestowardemotionalinstability,feel-ingsofinadequacyorinferiority,alienation,andangryaggression.Thispatternofemotionalvolatilityandimpulsive–reactiveviolenceap-pearscharacteristicofhighexternalizingindi-viduals(cf.Patrick&Bernat,2009)ratherthanindividualswhowouldbeconsideredpsycho-pathicaccordingtocontemporarydefinitions.Asecondsetofattributesemphasizedintheseearlyaccounts,whichappearssomewhatatoddswiththefeaturesjustmentioned,consistsofcharm,self-assurance,interpersonaldominance,attentionseeking,persuasiveness,andaffectiveshallowness.Forexample,asubgrouplabeled“swindlers”byKraepelin(1904)werecharacter-izedasglibandcharmingbutlackinginbasicmoralityorloyaltytoothers;theytypicallyspe-cializedinfraudulenceandconartistryandin-variablyaccumulatedlargedebtsthatwentun-paid.“Self-seeking”psychopathsasdescribedbySchneider(1934)weredescribedaspleasantandaffable,butegocentric,demandingofatten-tion,andsuperficialintheiremotionalreactionsandtheirrelationswithothers.LikeKraepelin’sswindlers,Schneider’sself-seekingtypeswerepathologicallydeceitfulandpronetofraudulentC.J.Patrick,D.C.Fowles,andR.F.Krueger behavior.Asdescribedbelow,thissetoffeatureswascentraltoCleckley’s(1976)conceptionofpsychopathicpersonality.Athirdprominentemphasisinearlyhistori-calaccountsconsistsoffeaturesrelatingtobru-tality,emotionalcoldness,andcallousexploi-tationofothers.Forexample,oneofthreeillustrativecasespresentedbyPinel(1962)wascharacterizedasefficaciousandsuccessfulinhisfinancialdealingsbutself-centeredandviciouslyantagonisticinhisinteractionswithothers.Rush(1812)emphasizedcrueltyandvicious-nessinhisaccountofthepsychopathandpos-itedthatadeep-rooted“moraldepravity”layatthecoreofthedisorder.Schneider’s(1934)“activeaffectionless”typewascharacterizedasunscrupulous,cold,andunfeeling.Schnei-derattributedthesetendencies,whichhesawasemergingearlyinlife,toacoredeficitinemotionalsensitivityratherthantoaweaknessinmoraljudgment.Cleckley’sclassictreatiseTheMaskofSanity(1976)servedasthefoundationformoderncon-ceptualizationsandmeasuresofpsychopathy.CentraltoCleckley’saccount,whichwasbasedonhisdirectexperienceswithpsychopathicindividualsinalargeinpatientpsychiatricfacil-ity,wastheideathatpsychopathyentailsthepre-senceofsevereunderlyingpathologymaskedbyanoutwardappearanceofrobustmentalhealth.Incontrastwithotherpsychiatricpatientswhopresentasirrational,agitated,dysphoric,sociallywithdrawn,orotherwisedisturbed,psy-chopathsimpressasconfident,personable,andpsychologicallywelladjustedonfirstcontact.Itisonlythroughcontinuedobservationacrossarangeofsettingsthatthepsychopath’sunder-lyingpathologyrevealsitself.Toprovideabasisfordiagnosticclarityandspecificity,Cleckleysetforthalistof16specificcriteriaforthedis-order,whichcanbegroupedintothreecategor-ies(Patrick,2006):(a)positiveadjustmentindi-cators(goodintelligenceandsocialadeptness,absenceofdelusionsorirrationality,absenceofnervousness,andlowincidenceofsuicide);(b)behavioraldevianceindicators(“unreliabil-ity,”i.e.,irresponsibility,sexualpromiscuity,impulsiveantisocialacts,failuretolearnfromexperience,absenceofanyclearlifeplan,andenhancedrecklessnesswhenintoxicated);and(c)indicatorsofemotionalunresponsivenessandimpairedsocialrelatedness(lackofremorseorshame,povertyinaffectivereactions,ego-centricityandinabilitytolove,deceitfulnessandinsincerity,absenceofloyalty,anddeficientinsight).Notably,Cleckley(1976)didnotdescribepsychopathicpatientsasantagonistic,violent,orcruel,andfew(only3of15)ofhisclinicalcaseexamplesshowedstrongindicationsofinterpersonalaggressiveness.Indeed,Cleckleymaintainedthatthecharacteristicemotionalunre-sponsivenessofpsychopathsmitigatesagainstangry,vengefulreactions.Furthermore,Cleck-ley’sconceptofpsychopathyextendedbeyondindividualswhoengagedrepeatedlyinantisocialactsthatcausedthemproblems.Cleckleyalsodescribedexamplesof“successfulpsychopaths”whoestablishedcareersasphysicians,scholars,orbusinessmen.Hisperspectiveontheetiologyofpsychopathywasthatitreflectedadeep-rootedimpairmentinemotionalprocessingakintose-manticaphasia(intherealmoflanguagepro-cessing)orcolorblindness(intherealmofpercep-tualprocessing;cf.Maudsley,1874).Fromthisperspective,itwastheoccurrenceofthiscoreunderlyingimpairmentthatdefinedthepresenceofthedisorder,asopposedtoaparticularovertbe-havioralexpression.However,incontrast,otherwritersofCleck-ley’stimeconcernedwithpsychopathyincrim-inaloffendersamplespresentedasomewhatdifferentpictureofthedisorder.McCordandMcCord’s(1964)volumeThePsychopath:AnEssayontheCriminalMindemphasizedfea-turesofemotionalcoldness,socialdetachment,anddangerousness,alongwithbehavioraldis-inhibition.LikeCleckley,McCordandMcCordconsideredpsychopathstobedeficientinanxi-etyandemotionalresponsiveness.However,intheirview,theseaffectiveimpairmentswereareflectionofprofoundsocialdisconnected-ness(“lovelessness”and“guiltlessness”)ratherthanofaglobaldeficitinaffective-motivationalcapacity.Inparticular,McCordandMcCordmaintainedthatpsychopathicindividuals,lack-inginsocialconscienceandinhibitionsagainstaggression,characteristicallyrespondedwithrageasopposedtofearinfrustratingorthreaten-ingsituations.Thus,incontrastwithCleckley,whodescribedpsychopathicinpatientsasneither“deeplyvicious”nor“volcanicallyexplosive,”Triarchicconceptualizationofpsychopathy McCordandMcCordcharacterizedpsychopathiccriminalsascold,vicious,andpredatory.WritersofCleckley’seraconcernedwithpsy-chopathyincriminalsamplesalsohighlightedcrueltyandaggressivenessasfeatures.Lindner(1944)characterizedcriminalpsychopathsastruculentandantagonistic.Craft(1966)iden-tifieda“vicious”criminalpsychopathicsubtype,whomhedescribedas“affectionless,impulsive,andpersistentlyaggressive.”(p.212).Robins(1966,1978)likewiseemphasizedearlyandper-sistentaggressiveantisocialityinherempiricalaccountsofmaladjustedyouthwhodevelopedintoadult“sociopaths.”Robins’workservedasthecornerstoneforthemodernnotionofantiso-cialpersonalitydisorder(APD)includedinthethirdandfourtheditionsoftheDiagnosticandStatisticalManualofMentalDisordersDSM-IIIDSM-IV;AmericanPsychiatricAssociation,1980,2000),whichemphasizesaggression,de-structiveness,andotherformsofdelinquencyinchildhoodandbehavioralevidenceofimpul-sivity,deception,recklessness,aggressiveness,andcriminaldeviancyinadulthood.Intermsofcorephenotypicconstructsdis-cussedindetailbelow,Cleckleyandhiscon-temporariessimilarlyhighlighted(pronenesstoexternalizingbehavior)intheiraccountsofpsychopathy,butdifferedintheemphasistheyassignedtoboldnessversusinconceptualizingthedisorder.ThemostobviousexplanationforthisdifferenceisthatCleckley’spsychopathiccaseexamplesconsistedofpsychiatricinpatientsratherthanincarceratedcriminaloffenders.Theantisocialactstheyperpetratedweregenerallyofalesser,nonviolentnatureandappearedirrational(“un-motivated”)inwayssuggestiveofanunderly-ingmentaldisorder.Inaddition,Cleckley’spatientstendedtocomefromhigherratherthanlowersocioeconomicbackgroundsandinmanycasespossessedfamilialandothersourcesofsocialsupportthatbufferedthemagainstlegalconsequences.Incontrast,writersofCleckley’stimeconcernedwithyouthfulandadultcrim-inalssoughttodelineateaspecificsubgroupwhoseantisocialdeviancywasdistinguishedbyitsamorality,severity,persistence,andrecalcitrancetotreatment.Individualsofthiskindwereno-tablefortheiraggressiveness,emotionalcold-ness,indifferencetothefeelingsandwelfareofothers,andpredatoryvictimization.Theytendedtocomefromimpoverished,abusiveback-grounds(e.g.,McCordandMcCordidentifiedparentalabuseandneglectasdistinctivelypatho-genicforcriminalpsychopathy)andengagedinseriousformsofantisocialbehaviorthatpro-vokedharshlegalpenalties.Differingconceptualizationsofpsychopathyareevidentinhistoricaccountsofthedisorder.Oneperspective,advancedbyCleckleyinhisaccountofhospitalinpatientsconsideredtobepsycho-pathic,portraysthedisorderasaparadoxicalconditioninwhichanoutwardveneerofpositiveadjustment(absenceofobviousmentaldistur-bance,highsocialefficacy,emotionalresiliency)masksasevereunderlyingpathologymanifestedbypersistentimpulsive,irresponsiblebehaviorwithoutregardforconsequencestooneselforothers.Asdiscussedinthenextsection,thiscon-ceptualizationappearstobeoperationalizedlesseffectivelybyassessmentinstrumentsthatindexpsychopathyasaputativelyunitary(unidimen-sional)construct,andmoreeffectivelybyinstru-mentsthatmeasurepsychopathyintermsofsepa-ratecomponents.Incontrastwiththis,theothermajorperspectiveevidentinhistoricwritingsisofpsychopathyasadistinctlyaffectionlessandpredatoryformofcriminaldeviancy(cf.McCord&McCord,1964).IncontrastwithCleckley’sportrayalofpsychopathicpatientsaspersonableandostensiblywellmeaningbutfecklessandun-trustworthy,thislatterperspectiveconceptualizespsychopathicindividualsascold,abrasive,andaggressivelyexploitativeintheirinteractionswithothers.Asdiscussedinthenextsectionbelow,contemporaryclinicaldiagnosticinstru-mentsfortheassessmentofpsychopathyinyouthandadultsreflectthisconceptualizationofpsy-chopathymoreso.Assessmentinstrumentsofthiskind,althoughdesignedtoassesspsychop-athyasaunitaryconstruct,nonethelessevidencedistinguishableaffective–interpersonalandbe-havioraldeviancefactors.ContemporaryApproachestoConceptualizingandAssessingPsychopathyTable1providesasummaryofmajorcurrentinventoriesfortheassessmentofpsychopathyC.J.Patrick,D.C.Fowles,andR.F.Krueger inadultandyouthfulparticipantsamples.Rel-evantempiricalfindingsforeacharereviewedbelow.PsychopathyinadultoffendersamplesCurrently,thedominantinstrumentforassess-ingpsychopathyinadultcriminaloffendersamplesisHare’s(2003)PsychopathyCheck-list—Revised(PCL-R).BeforethePCL-Rwasdeveloped,Hare’sempiricalresearchem-ployedaglobalratingapproachinwhichadiag-nosticratingfrom1to7wasassignedtoindi-catetheparticipant’sdegreeofresemblancetoCleckley’sdescriptionoftheprototypicpsy-chopath(1clearlynonpsychopathicinitelypsychopathic).TheoriginalPCL,whichconsistedof22items,wasdevelopedtoclarifyandsystematizetheassessmentofpsychopathyincorrectionalandforensicsamplesbasedonCleckley’sconceptualization.TheitemsofthePCLweredistilledfromalargercandidatepoolbyselectingthosethatbestdiscriminatedbetweenhighversuslowscorersonthe1–7CleckleyGlobalScale.Twoitemswereomittedfromtherevisedversion(Hare,1991,2003)andthescoringcriteriafortheremaining20itemsweremodifiedinvariousways.RegardingtheitemcontentofthePCL-R,theaffective–inter-personalandbehavioralmaladjustmentfeaturesdescribedbyCleckleyarewellrepresented.However,thepositiveadjustmentfeaturesarenot.Inparticular,absenceofnervousness/neu-roticismisnotpartofthePCL-R,noris“ab-senceofdelusionsorirrationality”orimmunitytosuicide.Further,althoughostensiblysimilartoCleckley’s“superficialcharmandgoodin-telligence,”“glibnessandsuperficialcharm”inthePCL-R(Item1)isdefinedinamorede-viantmanner,thatis,reflectinganexcessivelytalkative,slick,andinsinceredemeanor.Patrick(2006)attributedthisomissionofpos-itiveadjustmentindicatorstothestrategythatwasusedtoselectitemsfortheoriginalPCL.Itemswerechosentoindexpsychopathyasauni-taryconstructincriminaloffendersusingoverall Table1.SummaryofinventoriesfortheassessmentofpsychopathyindifferingparticipantSample/InventoryRatingFormatTotalItemsFacets/FactorsAssessedPCL-RInteviewer20Interpersonal,affective,lifestyle,PPISelf-report187Fearlessdominance,impulsiveYouthPCL:YVInterviewer18Interpersonal,affective,lifestyle,APSDParent/teacher20Impulsive/conductproblems,CPSParent/teacher41Affective–interpersonal,behavioraldevianceYPISelf-report53Grandiose–manipulative,impulsive–irresponsiblePCL-R,PsychopathyChecklist—Revised(Hare,2003);PPI,PsychopathicPersonalityInventory(Lilienfeld&An-drews,1996);PCL:YV,PsychopathyChecklist:YouthVersion(Forthetal.,2003);APSD,AntisocialProcessScreeningDevice(Frick&Hare,2001);CPS,ChildPsychopathyScale(Lynam,1997);YPI,YouthPsychopathicTraitsInventory(Andershedetal.,2002).Self-reportversionavailablealso.Separatesintodistinct“impulsive”and“narcissistic”subfactorsinsomework(e.g.,Frick,Boden,&Barry,2000).Triarchicconceptualizationofpsychopathy Cleckleyprototyperatingsasthecriterion,anditemswereretainedthatdemonstratedhighinter-nalconsistencywithoneanotheraswellaseffec-tivediscriminationbetweenlowandhighCleck-leygroups(Hare,1980).BecausemoreofCleckley’scriteriareflectdeviancy(12of16)asopposedtopositiveadjustment(4of16)andbecauseparticipantsinthePCLdevelop-mentsamplewerecriminalsratherthannon-incarceratedpatientsornonpatients,itseemslikelythattheinitialcandidatepoolincludedmanymoredeviance-relateditems,suchthatpositiveadjustmentindicatorsdroppedoutintheselectionprocess.TheresultisthatthePCL-R,comparedwithCleckley’soriginaldi-agnosticcriteria,containsitemsthatareuni-formlyindicativeofdeviancyandpsychologi-calmaladjustment.Inaddition,theoverallscoresonthePCL-Rshowrobustpositiverela-tionswithvaryingmeasuresofdeviancyandmaladjustmentincludingextentandseverityofcriminalacts,antagonismandaggression,andalcoholanddrugproblems,butnegligibleasso-ciationswithmeasuresofpositiveadjustmentsuchasverbalability,anxiousness,internaliz-ingsymptoms,andsuicideimmunity(Hall,Benning,&Patrick,2004;Hare,2003;Lynam&Derefinko,2006;Smith&Newman,1990;Verona,Patrick,&Joiner,2001).However,despitethefactthatthePCL-Rwasdevelopedtoindexpsychopathyasauni-tarysyndrome,factoranalyticandcorrela-tional-validationresearchindicatesthatitnone-thelesstapsdistinguishablecomponentfactors.Thebest-knownstructuralmodelofthePCL-Risthetwo-factormodel(Harpur,Hakstian,&Hare,1988;Hareetal.,1990),inwhichFactor1encompassestheinterpersonalandaffectivefeaturesofpsychopathyandFactor2encom-passestheantisocialdeviancyfeatures.How-ever,CookeandMichie(2001)proposedanal-ternativethree-factormodelinwhichFactor1isparsedintotwocomponents(“arrogantandde-ceitfulinterpersonalstyle,”markedbycharm,grandiosity,deceitfulness,andmanipulation;and“deficientaffectiveexperience,”consistingofabsenceofremorse,callousness,shallowaf-fect,andfailuretoacceptresponsibility)andFactor2ispareddowntoan“impulsive–irre-sponsiblebehavioralstyle”factorconsistingoffiveitems(boredomproneness,parasitism,impulsivity,irresponsibility,andabsenceofgoals)consideredtoreflectunderlyingtraitsasopposedtobehavioraloutcomesassociatedwiththosetraits.Inaddition,HareandNeu-mann(2006)advancedafour-factormodelinwhichFactor1isparsedintotwo“facets”mirror-ingCookeandMichie’sinterpersonalandaffec-tivefactors,andFactor2isdividedintoa“life-style”facetidenticaltoCookeandMichie’simpulsive–irresponsiblefactorandan“antisocial”factorencompassingaggressiveness,earlybehav-iorproblems,juveniledelinquency,revocationofconditionalrelease,andcriminalversatility.Reflectingtheunitaryconceptionofpsy-chopathythatguidedthePCL-R’sdevelop-ment,constituentfactorswithineachofthesefactormodelsshowmoderate(.5)correlationswithoneanother.Nonetheless,theseseparablefactorsalsoshowdivergingrelationswithvar-iousexternalcriterionmeasures.Inthetwo-factormodel,highscoresonFactor1areassoci-atedwithhigherscoresonindicesofselfishnessandexploitativenesssuchasnarcissismandMachiavellianism(Harpur,Hare,&Hakstian,1989;Hare,1991;Veronaetal.,2001),height-eneduseofproactive(instrumental/premedi-tated)aggression(Patrick&Zempolich,1998;Porter&Woodworth,2006),andlowerscoresonmeasuresofempathy(Hare,2003).Inaddi-tion,scoresonFactor1(inparticular,thevar-ianceinFactor1thatisunrelatedtoFactor2)showsomerelationshipwithadaptivetenden-cies.Forexample,Factor1showspositivecor-relationswithmeasuresofsocialdominance(Hare,1991;Harpuretal.,1989;Veronaetal.,2001)andnegativecorrelationswithmeasuresoffearfulness,distress/anxiety,anddepression(Harpuretal.,1989;Hicks&Patrick,2006).Evidenceofdiminishedphysiologicalrespon-sivenesstofearfulandaversivestimulihasalsobeenreportedspecificallyinrelationtoFactor1ofthePCL-R(cf.Patrick,1994,2007).Incontrast,Factor2ofthePCL-Rshowsselectivepositiverelationswithtraitmeasuresofaggression,impulsivity,andgeneralsensa-tionseeking(Harpuretal.,1989;Hare,1991),aswellaschildsymptomsofAPD,andiscorrelatedtoamarkedlyhigherdegreethanFactor1withadultAPDsymptomsandvari-ablesreflectingfrequencyandseverityofcrim-inaloffending(Hare,2003;Veronaetal.,2001).C.J.Patrick,D.C.Fowles,andR.F.Krueger IncontrastwithFactor1,Factor2isassociatedmorewithangry-reactiveformsofaggression(Patrick&Zempolich,1998;Porter&Wood-worth,2006).Factor2alsoshowsrobustpositiveassociationswithmeasuresofalcoholanddrugdependence,whereasFactor1showsnegligiblerelations(Hare,2003;Smith&Newman,1990).Studiesoftheexternalcorrelatesofcompo-nentsofthePCL-Ridentifiedbythethree-andfour-factormodelshavealsobeguntoappear.Skeem,Mulvey,andGrisso(2003)reportedthattheimpulsive–irresponsible(“Lifestyle”)factorwasmostrelatedtooverallfrequencyandseverityofcriminaloffending,incidenceofpropertycrimes,andsubstance-relateddisor-ders.TheAffectivefactorwasmostrelatedtohistoricandfutureviolenceandcrimesagainstpeople,andtheInterpersonalfactorwasassoci-atedtoalesserdegreewithpastandfuturecrim-inaldeviancythaneithertheAffectiveorLife-stylefactors.Halletal.(2004)reportedthattheInterpersonalfactoraccountedforaforemen-tionedassociationsbetweenPCL-RFactor1andmeasuresofsocialefficacyandemotionalresilience.TheuniquevarianceintheInterper-sonalfactor(i.e.,thatunrelatedtotheAffectiveandLifestylefactors)wasassociatedpositivelywithfive-factormodel(FFM)extraversion,openness,andconscientiousness,andnega-tivelywithFFMneuroticism.Thisfactoralsoshoweddistinctivepositiveassociationswithverbalintelligenceandpersonalandparentalsocioeconomicstatus.Incontrast,scoresontheLifestylefactorshowedselectiverelationswithvaryingmeasuresofexternalizingde-viancyandmaladjustmentincludingtraitsofimpulsivity,sensationseeking(disinhibitionandboredomfacets,inparticular),anger,alie-nation,highneuroticismanddysphoria/dis-tress,andlowconscientiousnessandachieve-mentmotivation;fightinginchildhoodandadulthood;drugandalcoholproblems;andlowpersonalsocioeconomicstatus.ReplicatingSkeemetal.(2003),scoresontheAffectivefac-torwereassociatedselectivelywithviolentcriminaloffending(includingincidenceofas-sault,weaponspossession,kidnapping,andmurder).Themostsalientpersonalitycorrelatesofthisfactorwereaggressiveness,lowagree-ableness,andlowaffiliation(lowsocialclose-ness/communality).Scoresonthisfactoralsopredictedareducedincidenceofspecificfears.TheantisocialfacetofthePCL-R(cf.Hare&Neumann,2006),althoughgenerallyparallel-ingthelifestylefacetinitsassociationswithcri-terionmeasures,showedhighercorrelationswithaggression-relatedthanimpulsivity-re-latedpersonalitytraitsandstrongerassociationswithviolentcriminalcharges.Inotherworkwithfemaleoffenders,Verona,Hicks,andPat-rick(2005)reportedtheantisocialand(toalesserdegree)lifestylefacetsofthePCL-Rtobepositivelyassociatedwithpastsuicidalat-tempts,whereastheinterpersonalfacetshowedaselectivenegativeassociationwithsuicidality.SimilarresultswerereportedbyDouglasetal.(2008)foramaleoffendersample.Summary.Hare’sPCL-Rwasdevelopedtoas-sessthesyndromeofpsychopathyasdescribedbyCleckleyinadultcriminaloffendersamples.ThedevelopmentstrategyforthePCL-Rem-phasizedmeasurementofpsychopathyasauni-taryconstruct,resultinginagenerallyinterre-latedsetofbehavioralindicators.Nonetheless,factoranalysesofthePCL-Ritemsindicatethepresenceofdistinctive(albeitcorrelated)af-fective–interpersonalandbehavioraldeviancefactors.Intermsofconceptsdiscussedbelow,theitemcontentofthePCL-Rappearstotapdisinhibitionandmeannessprimarily,andboldnessonlysecondarily.Inparticular,thepositiveadjustmentfeaturesofpsychopathyemphasizedbyCleckley(e.g.,absenceofpsy-choticsymptoms;lackofanxietyornervous-ness;immunitytosuicide)areweaklyrepre-sentedinthePCL-R.Themeannessanddisinhibitioncomponentsofpsychopathy(preferentiallyreflectedinFac-tors1and2ofthePCL-R,respectively)areimportanttodistinguishbecauseresearchonpsy-chopathyinyouth(cf.Frick&Marsee,2006;Frick&Morris,2004;seebelow)indicatesthatthesecomponentshavedifferentetiologicsub-strates,withtheformertheorizedtoderive(atleastinpart)fromdiminishedfearcapacity,andthelatterfromimpairmentsininhibitorycontrol.PsychopathyinadultnoncriminalsamplesTodate,onlyafewstudieshavebeenconductedinwhichadultsfromthecommunityhavebeenTriarchicconceptualizationofpsychopathy assessedforpsychopathyusingclinicaldiag-nosticprocedures(Ishikawa,Raine,Lencz,Bihrle,&lacasse,2001;Raineetal.,2004;Van-man,Mejia,Dawson,Schell,&Raine,2003;Widom,1977).However,participantsidentifiedaspsychopathicinthesestudiesevidencedhighlevelsofantisocialdeviancyandthuscouldmoreaccuratelybelabeled“subclinical”than“noncriminal”or“successful”(cf.Hall&Ben-ning,2006).Someotherpublishedstudieshaveassessedpsychopathyinstudent(e.g.,Forthetal.,1996),civilpsychiatric(e.g.,Skeem,Miller,Mulvey,Tiemann,&Monahan,2005),orat-riskcommunitysamples(e.g.,Farringtonetal.,2006)usingascreeningversionofthePCL-R(PCL:SV;Hart,Cox,&Hare,1995).However,therangeofPCL:SVscoresingeneralcommunitysamplestendstobehighlyrestricted,andconcernshavebeenraisedregardingthesen-sitivityofPCL-basedratingsforassessingcorefeaturesofpsychopathyinnonincarceratedindi-viduals,particularlyinviewofthestrongem-phasisoncriminaldeviancyinthescoringofmostPCLitems(Skeem&Cooke,inpress;Wi-diger,2006;seealsoWidigeretal.,1996).Theothermajorassessmentapproachthathasbeenusedtoidentifypsychopathicindividualsinnonincarceratedadultsamplesisself-report.Avarietyofself-reportmeasureshavebeende-velopedandutilizedovertheyears(Lilienfeld&Fowler,2006),butforthemostpartthesein-dexmainlytheantisocialdeviance(Factor2)componentofpsychopathy(Hare,1991,2003;Harpuretal.,1989;Lilienfeld&Fowler,2006).AnotableexceptionisthePsychopathicPersonalityInventory(PPI;Lilienfeld&An-drews,1996;Lilienfeld&Widows,2005),whichwasdevelopedtoassesspsychopathyasde-scribedbyCleckleyinnonincarceratedsamples.UnlikethePCL-R,thePPIwasnotdevelopedtoindexpsychopathyasaunitaryconstruct.In-stead,aninclusivepersonality-basedapproachwastakenwiththeaimofcapturingthefullspectrumoftraitconstructsembodiedinCleck-ley’sdescription.Eightunidimensionalsub-scalesweredevelopedtoassessthesevaryingconstructs,andexploratoryfactoranalysesofthesesubscaleshaverevealedtwodistincthigherorderfactors(Benning,Patrick,Hicks,Blonigen,&Krueger,2003;Benning,Patrick,Salekin,&Leistico,2005;Ross,Benning,Pat-rick,Thompson,&Thurston,2009).Socialpo-tency,stressimmunity,andfearlessnesssub-scalesloadpreferentiallyononefactor(PPI-Iandimpulsivenonconformity,blameexternali-zation,Machiavellianegocentricity,andcare-freenonplanfulnesssubscalesloadonasecondfactor().Benning,Patrick,Blonigen,Hicks,andIacono(2005)labeledthesefactorsfearlessdominanceimpulsiveantisocialityUnlikePCL-RFactors1and2,whicharemod-eratelycorrelated,thetwohigherorderfactorsofthePPIareuncorrelated.TheeighthPPIsub-scale,coldheartedness(reflectinglowsenti-mentalityandimaginativecapacity,andlowre-sponsivenesstoothers’distress),doesnotloadappreciablyoneitherPPIfactorbutinsteadde-finesaseparatefactorinanexpandedthree-fac-torsolution(Benningetal.,2003).LikethetwoPCL-Rfactors,thehigherorderfactorsofthePPIshowmeaningful,divergingre-lationswithavarietyofexternalcriterionvari-ables(Benningetal.,2003;Benning,Patirck,Bloigen,etal.,2005;Benning,Patrick,Salekin,etal.,2005;Blonigenetal.,2005;Douglasetal.,2008;Patrick,Edens,Poythress,&Lilien-feld,2006;Rossetal.,2009).Ingeneral,thecor-relatesofPPIFactors1and2mirrorthoseoftheuniquevarianceinPCL-RFactor1(itsinterper-sonalcomponent,inparticular)andofFactor2,respectively.Thatis,highscoresonPPI-Iareas-sociatedwithpositivepsychologicalandsocialadjustmentaswellaswithtendenciestowardnar-cissism,thrillseeking,andlowempathy,whereasscoresonPPI-IIaremoregenerallyindicativeofpsychologicalandbehavioralmaladjustment,in-cludingimpulsivityandaggressiveness,childandadultantisocialbehavior,alcoholanddrugprob-lems,highanxiousnessandsomaticcomplaints,andsuicidalideation.ThetwohigherorderfactorsofthePPI,despitetheirindependencefromoneanotheranddifferentialrelationswithexternalcriteria,showcomparablerobustasso-ciationswithscoresonMiller,Lynam,Widiger,andLeukefild’s(2001)FFMpersonality-basedpsychopathyprototype(Rossetal.,2009),indi-catingthatthePPIfactorscapturedifferingele-mentsoftheprototypicpsychopathdefinedintermsofFFMconstructs:PPI-Iisassociatedwithlowneuroticism(N)andagreeableness(A)andhighextraversion(E)andopenness(O);PPI-IIisassociatedwithhighN,lowA,andC.J.Patrick,D.C.Fowles,andR.F.Krueger lowconscientiousness(C).Notably,thecold-heartednesssubscaleofthePPI(which,asmen-tioned,isrelativelyindependentofPPI-IandII)alsoevincesarobustpositiveassociationwithFFMprototypescores,thebasisoftheassocia-tionbeinglowN,lowE,lowA,andlowO(Rossetal.,2009).Despiteshowingparallelassociationswithcriterionmeasures,thetwofactorsofthePPIdifferinessentialwaysfromPCL-RFactors1and2(e.g.,theyareassessedviaself-reportvs.clinicalrating;theyareuncorrelatedvs.moder-atelycorrelated;theyshowstronger,moredirect,i.e.,zeroorder,associationswithadjustment-relatedvariables),anddirectcomparisonsofthePPIandPCL-Rfactorshaverevealedonlymodestandsomewhatasymmetriccorrespon-dence.PPI-Iisrelatedmainlytotheinterper-sonalcomponentofthePCL-R,toamodestde-gree(.3;Benning,Patrick,Blonigen,etal.,2005).ScoresonPPI-IIshowasomewhatstrongerrelationshiptoPCL-RFactor2scoresasawhole(.4;Benning,Patrick,Blonigen,etal.,2005).RegardingthePPIColdhearted-nessscale,whichasnotedappearstotapsome-thingdistinctfromPPI-IandII,availabledataindicatethatthisscaleshowsmoderateandmodestassociations(.37and.21),respectively,withPCL-RFactors1and2(Poythress,Edens,&Lilienfeld,1998).Summary.Historically,measuresofpsychopa-thydevelopedforuseinadultnonoffendersam-pleshavefocusedmainlyonthesalientbehav-ioraldeviancycomponentofthesyndrome(Lilienfeld&Fowler,2006).AnotableexceptionisthePPI,whichwasdesignedtocomprehen-sivelyassesstraitconstructsembodiedinCleck-ley’sdescriptiveaccountofthedisorder.Incon-trastwiththePCL-R,thesubscalesofthePPIweredevelopedwithoutassumingorrequiringcoherencearoundaunitaryhigherordercon-struct.ConsistentwithCleckley’sportrayalofpsychopathyasaconfigurationofdisparateten-dencies,structuralanalysesofthePPIsubscalesrevealtwobroad,largelyuncorrelatedfactors:onereflectingsocialefficacy,imperturbability,andtoleranceofdanger,andtheotherreflectingimpulsivity,rebelliousness,alienation,andag-gression.Intermsofconceptsdiscussedbelow,PPI-I(theFearlessDominancefactor)predomi-nantlyreflectsboldness,whereasPPI-II(theIm-pulsiveAntisocialityfactor)reflectsdisinhibitionandtoalesserextentmeanness.AneighthPPIsubscale,Coldheartedness,doesnotloadprefer-entiallyoneitherofthesebroadfactors;thissub-scalecanbeviewedastappingelementsofmean-nessnotcapturedbyPPI-II(i.e.,elementsreflectingalackofempathicconcern).Theboldnesscomponentofpsychopathy,whichistappedweaklyandincompletelybytheitemsofthePCL-R,isimportanttodistin-guishinturnfromthemeannesscomponent,whichiswellrepresentedinthePCL-R.OnereasonisthatthedistinctionbetweenboldnessandmeannessiscrucialtoreconcilingCleck-ley’sconceptionofpsychopathywiththatad-vancedbymorecriminologicallyorientedtheor-ists(e.g.,McCord&McCord,1964;Robins,1966).Anotheristhatboldness,althoughphe-notypicallydistinctfrommeanness,appearstoshareakeyetiologicsubstrate(i.e.,diminishedfearcapacity).Thisraisestheimportantdevel-opmentalquestion,discussedinthelastmajorsectionbelow,ofwhatintersectingetiologicfac-torsgiverisetomeannessasopposedtobold-nessintemperamentallyfearlessindividuals.Yetanotherreasonisthattheconstructofbold-nessislikelytobeofuniqueimportanceinun-derstandingso-called“successfulpsychopaths”:individualsexhibitinghighlevelsofcharm,per-suasiveness,imperturbability,andventuresome-nesswhoachievesuccessinsocietyasmilitary,political,orcorporate-industrialleaders(cf.Lykken,1995).Psychopathyinconduct-disorderedyouthHistorically,researchonpsychopathyinchild-hoodandadolescence(e.g.,Robins,1966,1978)hasemphasizedthebehavioraldeviance(externalizing)featuresofpsychopathymoresothanthecoreaffective–interpersonalfeatures.However,researchersoverthepast15yearshavedevotedsystematicefforttoindexingthesecorefeaturesinordertoidentifyadistinctsub-groupofconduct-disorderedyouthwhoqualifyaspsychopathic.Muchofthisworkhasem-ployedyouth-adaptedversions(or“downwardextensions”;Salekin,2006)ofHare’sPCL-R.TheearliestofthesewasthePCLYouthVer-sion(PCL:YV;Forth,Brown,Hart,&Hare,Triarchicconceptualizationofpsychopathy 2003;Forthetal.,1996),amodified18-itemvariantofthePCL-Rdevelopedforusewithadolescentoffendersages13–18.ResearchfindingstodateindicatethatthePCL:YVlargelyparallelsthePCL-Rintermsofitsfactorstructureandassociationswithexternalcriter-ionmeasures(Forthetal.,2003).Frickandcolleagues(Frick&Hare,2001;Frick,O’Brien,Wooten,&McBurnett,1994)developedtheAntisocialProcessScreeningDe-vice(APSD)toassesspsychopathictendenciesinyoungerchildren(ages6–13years)withcon-ductproblems.TheAPSDconsistsofa20-itemratingscalecompletedbyparentsorteachers.(Anewerself-reportversionforusewithadoles-centsaged13–18isalsoavailable;Loney,Frick,Clements,Ellis,&Kerlin,2003.)ItsitemcontentwaspatternedafterthePCL-Rwiththegoalofrepresentingallfeaturesofpsy-chopathyembodiedinthePCL-Rthatcouldbeassessedmeaningfullyinchildren(Fricketal.,1994).AninitialstructuralanalysisoftheitemsoftheAPSD(Fricketal.,1994)revealedtwodistinctivefactors:anImpulsive/ConductProb-lems(I/CP)factorreflectingimpulsiveness,be-havioraldeviancy,andinflatedself-importance;andaCallous–Unemotional(CU)factorreflect-ingtendenciestowardemotionalinsensitivityandinterpersonalcallousness.Scoresonthesetwofactorswerecorrelatedmoderately(.5).Sub-sequentworkbyFrick,Boden,andBarry(2000)suggestedthattheI/CPfactorcouldbeparsedintodistinctive“impulsive”(e.g.,boredeasily,actswithoutthinking,failstoplan)and“narcissistic”(e.g.,highself-importance,brags,uses/consoth-ers)subfactors.Anextensiveliteraturehasaccumulatedre-gardingpsychologicalandbehavioraldiffer-encesbetweenimpulsiveconduct-disordered(i.e.,highI/CP)childrenexhibitinglowversushighlevelsofCUtendencies(forrecentre-views,seeFrick&Dickens,2006;Frick&Marsee,2006;Frick&White,2008).Com-paredwithnoncliniccontrolchildrenandhighCUclinic-referredyouth,highI/CPchildrenwithlowlevelsofCUfeaturesshowevidenceofintellectual(inparticular,verbalIQ)impair-mentanddifficultyinregulatingtheiremotions(e.g.,enhancedreactivitytonegativeemotionalstimuliofvaryingtypesandhigherreportedlevelsoftraitanxiety).Inaddition,theyarepronetoreactive(angry–impulsive)aggression,butnotproactive(instrumental–strategic)ag-gression.Bycomparison,childrenhighinCUaswellasI/CPtendenciesscoreloweronself-reportmeasuresofanxietyandneuroticism,areattractedtoactivitiesentailingnoveltyandrisk,showreducedbehavioralresponsivenesstothreateningoraffectivelydistressingstimuliofvarioustypes,andexhibitimpairmentsinpassiveavoidancelearning(i.e.,reducedabilitytoinhibitbehaviorthatresultsinpunishment).Inaddition,comparedwithcontrolchildren,highCUconduct-problemchildrenexhibithighlevelsofproactiveaswellasreactiveag-gression.Relatedly,thereisevidencethatthepresenceofCUtraitsprospectivelypredictsla-terincidenceofaggressionandviolenceoverandaboveI/CPtendencies(Frick,Stickle,Dan-dreaux,Frrrell,&Kimonis,2005).AthirdapproachtocapturingthePCL-RconceptofpsychopathyinyouthwithconductproblemsisthatofLynamandcolleagues.Ly-nam’s(1997)ChildPsychopathyScale(CPS)wasdevelopedbyidentifyingitemsfromtwoestablishedchildbehaviorprobleminventoriesthatappearedtotapfeaturessimilartoitemsofHare’sPCL-R.Itemanalyticprocedureswereusedtonarrowthesecandidateindicatorsdowntoasetof41thatprovidedcoverageof13ofthe20PCL-Ritemswithhighinternalcon-sistency.AfactoranalysisoftheseitemsintheCPSdevelopmentsample(430boysfromthePittsburghyouthstudy,acohortthatin-cludedahighproportionofindividualsatriskfordelinquency;Lynam,1997)revealedevi-denceoftwodistinguishableitemsubsetsthatparalleledtheaffective–interpersonalandbe-havioraldeviancefactorsofthePCL-R.How-ever,incontrastwiththePCL-Rfactorswhicharecorrelatedonlymoderately(.5),thetwofactorsoftheCPSwerecorrelatedveryhighlyLynam(1997)reportedthathighoverallscoresontheCPSdistinguishedasubgroupofstable,seriouslydelinquentboys.OverallCPSscoreswereassociatedpositivelywithscoresonvariousself-report,other-report,andbehavioralmeasuresofimpulsivity,andwithself-andteacher-reportedlevelsofaggression,delinquency,andexternalizingproblems.Inad-dition,controllingforlevelsofexternalizingC.J.Patrick,D.C.Fowles,andR.F.Krueger psychopathology,higherscoresontheCPSwereassociatedwithlowerlevelsofanxiety,withdrawal,andinternalizingproblems.Morerecently,Lynametal.(2005)examinedrela-tionsofself-andmother-reportedscoresonarevised55-itemversionoftheCPSwithFFMpersonalitytraits.ThetwofactorsoftherevisedCPSwerenotsohighlyinterrelatedinthisstudysample(whichconsistedoftwoseparateco-hortsfromthePittsburghYouthStudy),andthuscorrelationswerereportedseparatelyforCPSfactorscores(affective–interpersonal,be-havioraldeviance)andtotalscores.OverallscoresontheCPS(whetherbasedonself-ormotherreport)showedmarkednegativeassocia-tionswithFFMAandC,andmodestpositiveandnegativeassociations,respectively,withNandopenness.Inoneofthetwostudycohorts,overallCPSscoresbasedonmotherreportshowedasig-nificantnegativeassociationwithextraversion(E).Inaddition,hierarchicalregressionanalysesrevealedthat,acrossinformantsandcohorts,theuniquevarianceintheaffective–interpersonalfactoroftheCPS(i.e.,thatunrelatedtothebehav-ioraldeviancefactor)wasassociatednegativelywithAand(consistently,buttoalesserdegree)N.Incontrast,theuniquevarianceintheantiso-cialdeviancefactoroftheCPSwasassociatedpositivelywithN,andnegativelywithCand(consistently,buttoalesserdegree)A.Summary.Thebest-knowninventoriesforas-sessingpsychopathictendenciesinchildrenandadolescents(PCL:YV,APSD,CPS)wereconstructedtoemulatetheitemcontentofthePCL-R.LikethePCL-R,theseyouth-orientedpsychopathyinventoriesappeartotapcon-structsofdisinhibitionandmeannessprimarily,withlimitedrepresentationofboldness;thesamecanbesaidoftheself-reportbasedYouthPsychopathyinventory,describedinthenextsubsection.ThegrowingliteratureondistinctexternalcorrelatesoftheFearlessDominancefactorofthePPI(PPI-I),whichincludeaspectsofpositiveadjustment(e.g.,reducedincidenceofinternalizingdisordersandsuicidalbehav-ior)aswellasdeviancy(e.g.,narcissism,thrillseeking,anddeficientempathicconcern),pointtoassessmentofdispositionalboldnessasaripeareaofopportunityinthechildpsychopathyliterature.Somekeyquestionsofinterestthatmightbeaddressedthroughtheconstructionofdevelopmentallyappropriatemeasuresofboldnessare:whatfactorsearlyinlifecontrib-utetotheemergenceofdispositionalboldnessversusmeannessintemperamentallyfearlessindividuals?Whatdevelopmentalinterplayex-istsbetweeneachofthesedistinctphenotypicstylesanddisinhibitory(externalizing)tenden-cies?Whatmoderatingfactorscontributetosuccessfulversusunsuccessfuloutcomesinhighboldindividuals?Istherealate-onsetformofpersistentcriminalityassociatedselec-tivelywithhighdispositionalboldness?Theyouthpsychopathymeasurethathasbeeninvestigatedmostextensivelytodate,theAPSD,includesdistinguishableI/CPandCUfactors.Youthhighonbothofthesefactorsshowreducedemotionalreactivity,greaterphysicaldaring,andhighlevelsofproactiveag-gressioncomparedwithyouthwhoscorehighontheI/CPfactoralone.Asdiscussedinthenextmajorsectionbelow,theuniquevarianceintheCUfactoroftheAPSDcanbeconceptu-alizedastappingmeanness,whereastheI/CPfactorcanbeconsideredanindexofgeneraldisinhibition.Thefinalmajorsectionconsidersdevelopmental–etiologicprocessesthatgiverisetothesetwodistinctivecomponentsofpsy-chopathy,alongwithfactorsthatmaycontrib-utedistinctivelytotheboldnesscomponent.PsychopathyinnondelinquentyouthAsistrueofresearchtodateonpsychopathyinadults,thestudyofpsychopathyinchildrenandadolescentshasfocusedpredominantlyonindividualswithconductproblems,andthephe-nomenonofpsychopathyinnondelinquentyouthremainsunderstudied.Aninventorydevelopedquiterecentlyforassessingpsychopathictenden-ciesinnondelinquentaswellasdelinquentyouthisthe50-item,self-reportbasedYouthPsycho-pathicTraitsInventory(YPI;Andershed,Kerr,Stattin,&Levander,2002).TheitemcontentoftheYPIwasdesignedtocapturethecoherenttraitdomainsrepresentedinCookeandMichie’s(2001)three-factormodelofthePCL-R:arro-gant–deceitfulinterpersonalstyle,deficientaf-fectiveexperience,andimpulsive–irresponsiblebehavior.LiketheitemsofthePCL-R,theitemsoftheYPIarelargelyindicativeofdeviancy(i.e.,Triarchicconceptualizationofpsychopathy dishonesty,grandiosity,lying,manipulation;cal-lousness,unemotionality,remorselessness;im-pulsivity,thrillseeking,irresponsibility),withfactoranalysisrevealingdistinctbutmoderatelyinterrelatedinterpersonal(“grandiose–manipula-tive”),affective(“callous–unemotional”),andbehavioral(“impulsive–irresponsible”)factors(Andershedetal.,2002).Aninitialinvestigationofnondelinquentyouthrevealedsignificantasso-ciationsforallthreeYPIfactorswithvariouscri-terionmeasuresofexternalizingdeviancy.Re-searchwithclinic-referredyouth(Andershed,Hodgins,&Tengstrom,2007)hasdemonstratedmoderatestatisticalconvergencebetweenthefac-torsoftheYPIandthecorrespondingfactorsofthePCL:YV.Otherworkwithdelinquentyouth(Poythress,Dembo,Wareham,&Greenbaum,2006)hasreplicatedthefindingofrobustassocia-tionsforallthreeYPIfactorswithmeasuresofexternalizingdeviancy.ParallelingresultsforthePCL-R(Hicks&Patrick,2006),thisworkalsorevealedevidenceofsuppressoreffectsfortheinterpersonal(andtoalesserdegree,affec-tive)factoroftheYPIinrelationswithinternal-izingproblems.ConceptualintegrationThePCL-R,whichwasdevelopedtoassesspsychopathyasaunitaryconstructincriminaloffendersamples,indexesadistinctlydifferentphenotypicvariantofpsychopathythanthatemphasizedbyCleckleyinhisclinicaldescrip-tionsofpsychopathichospitalinpatients(cf.Patrick,2006).HighscoresonthePCL-Rasawholeareassociatedwithaggressiveexternal-izingtendenciesincludinglowFFMagree-ableness(highantagonism),lowaffiliation/communality,lowempathy,Machiavellianism,impulsivesensationseeking,andpersistentvio-lentoffending(Hare,2003;Harpuretal.,1989;Lynam&Derefinko,2006;Veronaetal.,2001).ThisdescriptivepictureismoreinlinewiththeconceptionofcriminalpsychopathyadvancedbyCleckley’scontemporariesthanwithCleckley’sownportrayalofpsychopathicinpatientsascharmingne’er-do-wellswhoharmothersincidentallyratherthandeliber-ately.Atthesametime,factoranalyticstudiesindicatethatthePCL-Ritemsettapsdistin-guishableinterpersonal,affective,andimpul-sive–irresponsiblecomponents(Cooke&Mi-chie,2001;Hare&Neumann,2006;Patrick,Hicks,Nichol,&Krueger,2007)thatexhibitdivergingrelationswithexternalcriterionTheuniquevarianceintheinterper-sonalcomponent(thatassociatedwiththe“glibness/charm”and“grandioseself-worth”itemsinparticular;Patricketal.,2007)appearstocapturesomeoftheadaptiveelementsofpsychopathyemphasizedbyCleckley.Fur-thermore,subtypingstudies(Hicks,Markon,Patrick,Krueger,&Newman,2004;Skeem,Johansson,Andershed,Kerr,Eno,&Louden,2007)haverevealedthathighPCL-Rscorerscomprisetwodistinctsubgroups:a(smaller)lowanxious,surgentsubgroupakintothetypedescribedbyCleckleyanda(larger)aggres-sive,unconstrained,sociallydetachedsubgroupmoreakintothatdescribedbyMcCordandMcCord.Thebest-knowninstrumentsforassessingpsychopathyinchildrenandadolescents,whichweredevisedforusewithadjudicatedandclinic-referredpopulations,wereconstructedtomirrortheitemcoverageofthePCL-R.Accordingly,overallscoresontheseinventoriesappeartotapthesameaggressive–externalizingvariantofpsychopathyindexedbyoverallscoresonthePCL-R.Again,however,theseinstrumentscontaindistinctivesubsetsofitemsthatexhibitdivergingrelationswithexternalcriterionmea-sures.ThechildpsychopathyinventorythathasbeenstudiedmostextensivelyintermsofitsdistinctivefactorsisFrick’sAPSD.WhereastheI/CPfactoroftheAPSD(parallelingFactor2ofthePCL-R;Patricketal.,2005)appearstoin-dexgeneralexternalizingtendencies,theCUfactorisassociateduniquelywithalackofanx-ietyandnegativeemotionalreactivityandwithventuresomeness,thrillseeking,anduseofpro-active(strategic,goal-oriented)aggression.Inaddition,researchwiththeAPSDhasreliablydemonstratedthatconductproblemchildrenwithhighlevelsofCUtraitsarelessresponsive 1.ItemsassociatedwiththeantisocialcomponentofthePCL-RincludedinHareandNeumann’s(2006)four-factormodelappeartotapthebroadaggressive–external-izingdimensionunderlyingthePCL-Rasawhole,asopposedtoadistinctivesubdimension(Patricketal.,C.J.Patrick,D.C.Fowles,andR.F.Krueger totreatmentandmorelikelytopersistintheirdeviantbehavior;inparticular,behaviorentail-ingviolencetowardothers(Frick&Dickens,2006).BasedontheemotionalandbehavioralcorrelatesoftheCUfactor,Frickandcolleagueshavepostulatedthatthisphenotypiccomponentofchildpsychopathyreflectsthepathologicex-pressionofanunderlyingfearlesstemperament.IncontrastwiththePCL-Randitsyouth-adaptedvariants,thePPI,whichwasdevelopedtocomprehensivelyassesstraitconstructsem-bodiedinCleckley’sconceptualization,indexespsychopathyintermsoftwoorthogonalhigherorderfactors:onereflectingsocialdominance,stressimmunity,andfearlessness,andtheotherreflectingexternalizingdeviancy.Asdiscussedinthenextsectionbelow,thefirstPPIfactorap-pearstoreflectapurer,morebenignexpressionofunderlyingtemperamentalfearlessness(termed“boldness”)thanFactor1ofthePCL-RortheCUfactoroftheAPSD,whichcanbeviewedastapping“meanness”moresothanboldness.TheconstructofboldnessindexedbyPPI-Iislikelytobeparticularlyrelevanttotheconceptu-alizationandmeasurementofpsychopathyinnon-criminalsamples,includingidentificationofindi-vidualswithpsychopathictendencieswhoascendtopositionsofleadershipandinfluenceinsociety(cf.Cleckley,1976;Lykken,1995).DistinctPhenotypicComponentsofPsychopathy:Disinhibition,Boldness,andMeannessTheforegoingreviewofhistoricandcontempo-raryeffortstoconceptualizethesyndromeofpsychopathyrevealsthreeprominentrecurringthemes,whichforeaseofreferencecanbedesig-nateddisinhibition,boldness,andmeanness.Considerationofthebroaderpersonality,psy-chopathology,andneurobiologicalliteraturesin-dicatesthatthesethreeconstructs,althoughinter-relatedatsomelevelsempiricallyandintermsoftheirmutualconnectionswiththephenomenonofpsychopathy,havedistinctivephenotypiciden-titiesandcanbeconceptualized,measured,andunderstoodseparately.Ourviewisthatthesethreephenotypicconstructsrepresentthekeytounderstandingpsychopathyinitsvaryingmanifestations:criminalandnoncriminal,pri-mary,andsecondary(cf.Karpman,1941;Lykken,1957,1995;Skeemetal.,2007),stableandag-gressive(Hicksetal.,2004),unsuccessfulandsuccessful(Hall&Benning,2006).Below,weconsidereachofthesekeyconstructsinturn.DisinhibitionTheterm“disinhibition”isusedheretodescribeageneralphenotypicpropensitytowardimpulsecontrolproblemsentailingalackofplanfulnessandforesight,impairedregulationofaffectandurges,insistenceonimmediategratification,anddeficientbehavioralrestraint.Relatedcon-ceptsincludeexternalizing(Achenbach&Edel-brock,1978;Kruegeretal.,2002),disinhibitorypsychopathology(Gorenstein&Newman,1980;Sher&Trull,1994),andlowinhibitorycontrol(Kochanska,Murray,andCoy,1997).Inper-sonalityterms,disinhibitioncanbeviewedasthenexusofimpulsivityandnegativeaffectivity(Krueger,1999a;Sher&Trull,1994).Promi-nentbehavioralmanifestationsofdisinhibitionincludeirresponsibility,impatience,impulsiveactionleadingtonegativeconsequences,aliena-tionanddistrust,aggressiveactingout(inpartic-ular,angry–reactiveaggression),untrustworthi-ness,pronenesstodrugandalcoholproblems,andengagementinillicitorothernorm-violatingactivities(Krueger,Markon,Patrick,Benning,&Kramer,2007).Historicconceptualizationsofpsychopathyhaveemphasizedthisexternalizingcomponenttovaryingdegrees,andtoanimportantextent,differencesofopinionregardingtheappropriatedefinitionandboundariesofthepsychopathyconstructcanbetracedtothiscomponent.Exter-nalizingencompassesabroadrangeofpatho-logicbehavioralphenomenaincludingchildcon-ductproblems,adultcriminaldeviance,angryaggression,andaddictivebehaviorsofvaryingsorts(Kruegeretal.,2002,2007;Young,Stal-lings,Corley,Krauter,&Hewitt,2000).Somehistoricwritersdefinedpsychopathybroadlyto 2.ThetermdisinhibitionasusedherediffersfromKagan’s(1994)conceptionofdisinhibitedtemperamentinchildren,whichconnotesalackoftimidityinnovelsituationsandisassociatedprospectivelywithareducedincidenceofanxi-ety-relatedproblems(Kagan&Snidman,1999).Thiscon-ceptionismoresimilartotheconstructofboldnessde-scribedhere.Triarchicconceptualizationofpsychopathy includesubstance-relatedaddictionsandothernonnormativebehaviors(e.g.,sexualdeviancyofvaryingkinds)thatintersectwiththeexter-nalizingspectrum(e.g.,Prichard,1835);otherwriterscharacterizedpsychopathyintermsthatappearmoreapplicabletoexternalizingindi-viduals(e.g.,Arieti,1963,1967;Partridge,1928a,1928b);andothersdescribedsubtypesofpsychopathswhowouldmoreaptlybeclassifiedashighexternalizers(e.g.,Craft,1966;Kraepelin,1915).Thetraditionalnotionofthe“symptomatic”orsecondarypsychopath(Karpman,1941;Lykken,1957)appearsconsis-tentwiththeclinicalpresentationofthehighexternalizingindividual.Contemporaryresearchdemonstratesthatthedistinctvarianceasso-ciatedwiththeantisocialdeviance(Factor2)componentofthePCL-Rlargelyreflectstheexternalizingfactor(Patricketal.,2005)andtheimpulsiveantisocialitycomponentofthePPI(PPI-II)exhibitsarobustgeneticassociationwithscoresontheexternalizingfactor(Blonigenetal.,2005).Basedonitsknowncorrelates,theI/CPcomponentofFrickandHare’s(2001)APSDalsoappearstoindextheexternalizingfactor.However,contemporaryresearchersinthefieldwouldgenerallynotviewdisinhibitionorexternalizingasequivalenttopsychopathy.Inparticular,asmentioned,externalizingisassoci-atedwithheightenednegativeaffectivityasop-posedtoanabsenceofanxietyorfear.Highexternalizingisalsoassociatedwithanin-creasedratherthanreducedincidenceofinter-nalizing(anxiety,mood)problemsinchildhoodandadulthood(Achenbach&Edelbrock,1978;Krueger,1999b)andwithahigherratherthanlowerincidenceofsuicidalbehaviorinadultoffendersandcommunityparticipants(Verona&Patrick,2000;Verona,Sachs-Ericsson,&Joiner,2004).Itiswhenexternalizingtenden-ciesarecoupledwithdispositionalboldnessormeannessthatadiagnosisofpsychopathywouldbeconsideredapplicable.Thetermboldisusedheretodescribeapheno-typicstyleentailingacapacitytoremaincalmandfocusedinsituationsinvolvingpressureorthreat,anabilitytorecoverquicklyfromstress-fulevents,highself-assuranceandsocialeffi-cacy,andatoleranceforunfamiliarityanddan-ger.Termsrelatedtoboldnessincludefearlessdominance(Benning,Patrick,Blonigen,etal.,2005),daringness,audacity,indomitability,re-siliency(Block&Block,1980),andhardiness(Kobasa,1979).Inpersonalityterms,boldnesscanbeviewedasthenexusofsocialdominance,lowstressreactivity,andthrill–adventureseek-ing(Benningetal.,2003;Benning,Patrick,Blo-nigen,etal.,2005).Prominentbehavioralman-ifestationsofboldnessincludeimperturbability,socialpoise,assertivenessandpersuasiveness,bravery,andventuresomeness.Asusedhere,boldnessisnotconsideredsynonymouswiththeterm“fearless.”Rather,fearlessnessisconceptualizedasanunderlyingconstitutionallybased(genotypic)dispositionentailingreducedsensitivityofthebrain’sdefen-sivemotivationalsystemtocuessignalingthreatorpunishment(Fowles&Dindo,2006;Patrick&Bernat,2006,inpress).Boldnessisonewayinwhichgenotypicfearlessnesscanbeex-pressedphenotypically.However,asdiscussedinthenextsubsection,genotypicfearlessnessmayalsocontributetophenotypicmeanness.Cleckley’sconceptualizationofpsychopathyemphasizedphenotypicboldnesstogetherwithdisinhibitory(externalizing)tendencies.Bold-nesswasevidentinhiscasedescriptionsanddi-agnosticcriteriaintermsofpoiseandhighsocialefficacy,absenceofanxietyorneuroticsymp-toms,diminishedemotionalresponsiveness,im-perviousnesstopunishment(“failuretolearnbyexperience”),andlowsuicidality.Otherhistoricwritersconcernedwithpsychopathyinpsychiat-ricpatientsasopposedtocriminalsamples(e.g.,Kraepelin,Schneider)alsoidentifiedboldexter-nalizingtypes.Morecontemporaneously,fear-lessness,andunresponsivenesstopunishmentcueswereemphasizedprominentlyinHare’sclas-sicpsychophysiologicalstudiesofthe1960sand1970s(cf.Hare,1978)ininfluentialtheoriesofpsychopathyadvancedbyFowles(1980)andLykken(1995).Lilienfeld’sself-reportPPI,whichwasde-velopedtoindextraitsembodiedinCleckley’sconception,includesabroadfactor(PPI-I)thatdirectlyreflectstheconstructofboldness.Thesubscalesthatdefinethisfactorarestressimmu-nity,socialpotency,and(toalesserdegree)C.J.Patrick,D.C.Fowles,andR.F.Krueger Notably,thisfactorofthePPIisuncorrelatedwithtendenciestowardimpulsiveantisocialdeviancetappedbyPPI-II.Inthisre-spect,theconstructofboldnesstappedbyPPI-Icanbeviewedasindexingamorebenignex-pressionofdispositionalfearlessness:onethatisphenotypicallydistinctfromaggressiveex-ternalizingdevianceandlikelyofimportancetoconceptualizingpsychopathyinnonviolent,noncriminalsamples(cf.Lykken,1995).TheconstructofboldnessalsoappearstobetappedsomewhatbyFactor1ofthePCL-R(Benning,Patrick,Blonigen,etal.,2005),inparticular,byitemscomprisingitsinterpersonalfacet,mostnotablyItems1(charm/glibness)and2(gran-diosesenseofself-worth;Patricketal.,2007).However,thePCL-Rinterpersonalfacetover-lapswiththePCL-R’sAffective,Lifestyle,andAntisocialfacets,indicatingthatthePCL-Rin-dexestheconstructofboldnesslessdirectlyandlessdistinctivelythanthePPI-I.Asde-scribednext,Factor1ofthePCL-Rasawholeap-pearstoindexmeannessmoresothanboldness.Thetermmeandescribesaconstellationofphenotypicattributesincludingdeficientempa-thy,disdainforandlackofcloseattachmentswithothers,rebelliousness,excitementseeking,exploitativeness,andempowermentthroughcruelty.Termsrelatedtomeannessincludecal-lousness(Fricketal.,1994),coldheartedness(Lilienfeld&Widows,2005),andantagonism(Lynam&Derefinko,2006).Withrespecttoba-sicdimensionsofinterpersonalbehavior(Leary,1957;Wiggins,1982),meannesscanbeviewedasoccupyingapositionmidwaybetween(high)dominanceand(low)affiliation(Blackburn,2006;Harpuretal.,1989).Consistentwiththis,Saucier(1992)identifiedaconstructakintomeanness(representedbyadjectivedescriptorssuchasrough,tough,unemotional,andinsensi-tive)asthenexusofhighdominance,lowaf-filiation,andlowneuroticism(highemotionalstability);notably,thisconfigurationoftraitsmirrorstheFFMcorrelatesofPPIcoldhearted-ness,whichincludelowA,lowE,andlowN(aswellaslowO;Rossetal.,2009).Fromthisperspective,meannesscanbeviewedasagenticdisaffiliation,whichisamotivationalstyleinwhichpleasureandsatisfactionareac-tivelysoughtwithoutregardforandattheex-penseofothers(cf.Schneider’s,1934,“activeaffectionless”type).Incontrastwithsocialwithdrawal,whichentailspassivedisengage-mentfromothers(“movingawayfrompeople”;Horney,1945),meannessentailsactiveexploi-tativenessandconfrontation(“movingagainstpeople”;Horney,1945).Characteristicbehav-ioralmanifestationsincludearroganceandver-balderisiveness,defianceofauthority,lackofclosepersonalrelationships,aggressivecom-petitiveness,physicalcrueltytowardpeopleandanimals,predatory(proactive,premeditated)aggression,strategicexploitationofothersforgain,andexcitementseekingthroughdestruc-tiveness.Thenotionofmeannessiscentraltoconcep-tionsofpsychopathyincriminalanddelinquentsamples.McCordandMcCord(1964)identifiedlovelessnessandguiltlessnessascentraltocrim-inalpsychopathy.Quay(1964)listedlackofconcernforothers,anabsenceofnormalaffec-tionalbonds,anddestructiveandassaultivebe-haviorascharacteristicfeaturesofpsychopathy(laterdubbed“undersocializedaggressivedelin-quency”;Quay,1986)injuvenileoffenders.TheaffectivefacetofHare’sPCL-RconsistsofitemsthatcoverMcCordandMcCord’slovelessness(Item7,“shallowaffect,”whichincludesrefer-encetoalackofgenuineattachments/loverela-tionshipswithothers;andItem8,“callous/lackofempathy,”whichencompassescruel/sadistictreatmentofothers,contemptuousness,andde-structiveness)andguiltlessness(Item6,“lackofremorseorguilt,”andItem16,“failuretoac-ceptresponsibilityforownactions”).Notably,theinterpersonalitemsofthePCL-Ralsoin-cludeelementsofmeannessintheirdefinitions: 3.InadditiontoloadingtoalesserdegreethaneitherstressimmunityorsocialpotencyonPPI-I,thefearlessnesssubscaleofthePPIalsocross-loadsreliablyonPPI-II.ThelikelyexplanationappearstobethatPPIfearless-nesscontainsvariancerelatedtoboredomsusceptibilityanddisinhibitionfacetsofsensationseeking,aswellasthrill–adventureseekingandexperience-seekingfacets(cf.Zuckerman,1979);thethrill–adventureseekingcomponentofPPIfearlessnessinparticularaccountsforitsassociationwithPPI-I,whereastheboredomsus-ceptibilityanddisinhibitioncomponentsaccountforitsassociationwithPPI-II(cf.Benning,Patrick,Blonigen,etal.,2005).Triarchicconceptualizationofpsychopathy Item1(“glibnessandsuperficialcharm”)in-cludesreferencetoexcessiveslicknessandisas-signedascoreof1(outof2)incaseswheretheexamineeexhibitsa“macho”or“toughguy”de-meanor;Item2(grandiosesenseofself-worthincludesreferencetoarroganceandasenseofsuperiorityoverothers;thecriteriaforItem4pathologicallying)describeanindividualwhoisroutinelydeceptiveininterpersonalinter-actionsandwhoenjoysdeceivingothers;Item5conning/manipulative)referstopredatoryex-ploitationofothersforpersonalgainwithoutconcernforthewelfareofvictims.Thebest-knowninstrumentsforassessingpsychopathyinyouth(PCL:YV,CPS,andAPSD)weremod-eledafterthePCL-Randlikewiseemphasizemeanness(socialandemotionaldetachment,callousness,andexploitativeness)intheiraffec-tive–interpersonalitems.Akeyquestioniswhethermeannesscanbemeasuredseparatelyfromcriminalorantisocialbehavior.InthecaseofthePCL-R,ahierarchical(bifactor)analysisrevealedthatthemajorityofitsitemsareprimarilyindicatorsofageneraloverarchingfactorthatreflectsaggressiveexter-nalizingdeviancy(Patricketal.,2007).Thestrongestandpurestindicatorsofthisfactorwereitemsreflectingaggressivecriminalbehav-ior(i.e.,itemsassociatedwiththeantisocialfacetofthePCL-R):earlybehavioralproblems,poorbehavioralcontrols,criminalversatility,andjuveniledelinquency.Inaddition,mostoftheaffectiveandinterpersonalitemsofthePCL-Ralsoloadedappreciablyonthisgeneralfactorwithtwooffouritemsfromeachfacetloadingmorestronglyonthegeneralfactorthanondistinguishableaffectiveorinterpersonalsubfactors.Specifically,thepathologicallyingandconning/manipulativeitemsloadedmorestronglyonthegeneralfactorthanontheinter-personalsubfactor(onwhichglibness/charmandgrandiosityshowedtheirprimaryloadings),andtheshallowaffectandcallous/lackofempa-thyitemsloadedmorestronglyonthegeneralfactorthanontheaffectivesubfactor(onwhichlackofremorseandfailuretoacceptresponsibil-ityshowedtheirprimaryloadings).Asnotedear-lier,theheavysaturationofmostPCL-Ritemswithexternalizingdeviancyreflectsthefactthatthescoringcriteriaformostofitsitemsin-cludereferencetoantisocialbehavior.However,recentresearchonthescopeandstructureoftheexternalizingspectrumsuggeststhatthemeannesscomponentofpsychopathycanbedisaggregatedfromitsdisinhibitory(ex-ternalizing)component.Specifically,usingdatacollectedacrossmultipleiterativewavesfromsamplesincludingmaleandfemaleprisonersaswellasnonincarceratedmenandwomen,Krue-geretal.(2007)developedself-reportscalestocomprehensivelyindexthedomainofexternaliz-ingproblemsandtraitsintermsofelementalcon-structs.Unidimensionalscalesweredevelopedtomeasure23separateconstructsincluding:vary-ingfacetsofimpulsivity,differingformsofag-gression(physical–reactive,relational–proactive,anddestructive),irresponsibility,rebelliousness,excitementseeking,blameexternalization,andalcohol,drug,andmarijuanause/problems.Con-firmatoryfactoranalysesofthese23scalesyieldedevidenceofasuperordinatefactor(exter-nalizing)onwhichallsubscalesloadedsubstan-tially(.45orhigher),andtwosubordinatefactorsthataccountedforresidualvarianceinparticularsubscales.Thestrongestandpurestindicatorsoftheoverarchingexternalizingfactorwerescalesindexingirresponsibilityandproblematicimpul-sivity(i.e.,pronenesstoimpulsiveactsresultinginharmtooneselforothers).Oneofthetwosub-ordinatefactorswasdefinedbyresidualvarianceinsubscalesmeasuringcallousness,aggression(relational/proactiveanddestructive,inparticular;physical/reactiveaggressionloadedmoresub-stantiallyonthesuperordinateexternalizingfac-tor),excitementseeking,rebelliousness,and(low)honesty.Theothersubfactorwasdefinedbyresidualvarianceinsubscalesindexingalco-hol/druguseandsubstance-relatedproblems.Itisimportanttonotethatthevariancedefiningeachofthesesubfactorsconsistedofvarianceincommonamongspecificscalesthatwasunrelated(orthogonal)tothebroadexternalizingfactor.Thesefindingsindicatethataseparatepro-pensityentailinglowempathyandstimulation-seekingtendencies,distinguishablefromthegeneralexternalizingfactor,contributesinde-pendentlytoaggressivebehavior,particularlyaggressionthatinvolvesinstrumentalcoercionandabuseofothers.Othervariablesthatloadedtosomeextentonthiscallous–aggressionsub-factorincludeddishonestyandrebelliousness.Notably,theseindicatorvariablescloselyparallelC.J.Patrick,D.C.Fowles,andR.F.Krueger theitemcontentandknowncorrelatesoftheCUfactoroftheAPSD.Specifically,(a)theitemsoftheAPSDCUfactorreflectlackofconcernforthefeelingsofothers,disregardforformalre-sponsibilities(schoolwork),shallowaffectandinsincerity,lackofguilt,andlying/conning(Fricketal.,1994);and(b)amongyouthexhibit-ingsymptomsofconductdisorder(CD),thosehighinCUtraitsshowincreasedlevelsofproac-tiveaggression(alongwithcomparablelevelsofreactiveaggression)andenhancedthrill-seekingtendenciescomparedwiththoselowinCUtraits(Frick&Dickens,2006;Frick&White,2008).Inturn,theknownexternalcorrelatesoftheAPSDCUfactorpointtolowdispositionalfearasonecontributortophenotypicmeanness.Specifically,asnotedearlier,higherscoresonthisfactoroftheAPSDareassociatedwithlowerscoresonmeasuresofanxietyandneurot-icism,diminishedresponsivenesstothreateningandaffectivelydistressingstimuli,andheight-enedtoleranceofunfamiliarityandrisk(Blair,2006;Frick&Dickens,2006;Frick&White,2008;Marshetal.,2008).However,totheex-tentthatmeannessconstitutesaphenotypicex-pressionofunderlyingfearlessness,itisama-lignantexpressionoflowfearincomparisonwithboldness.EstablishedDevelopmentalConstructsRelevanttoanUnderstandingofTheseDistinctivePsychopathyComponentsAssuggestedabove,itispotentiallyvaluabletoexamineestablishedconceptsandfindingsfromthedevelopmentalpsychopathologylitera-turethatbearonthephenotypicconstructsofdis-inhibition,boldness,andmeanness.Insodoing,onemustexpectcomplexityratherthansimplerelationships.Theconstructsofequifinalityandmultifinality(Cicchetti&Rogosch,1996),fun-damentaltodevelopmentalpsychopathology,underscorethatmultiplepathwaysleadtoagivenphenotype(equifinality)andthatearlyetiologi-calriskfactorsinteractwithotherinfluencesincomplexcausalchainstoyieldvariedpheno-types(multifinality)(e.g.,Hinshaw,2008).Sim-ilarly,etiologicalpathwaysinvolveahostofcomplexmechanismssuchasgene–environmentinteractions,gene–geneinteractions,reciprocalormutuallyinteractiveindividual–environmentprocesses,gene–environmentcorrelations,ge-neticandenvironmentalinfluencesongeneex-pression,geneticeffectsonenvironments,andenvironmentalinfluencesonbraindevelopment(plasticity),makingitmoreappropriatetothinkintermsofriskfactorsthancausalfactorsandtoexpectmodestcontributionsfromanygivenriskfactor(Hinshaw,2008;Rutter,2006).AnimportantcontextforthisliteratureisMoffittandLynam’s(e.g.,Moffitt,1993;Ly-nam,1998;Moffitt&Lynam,1994)distinctionbetweenearly-onsetandadolescent-onsetanti-socialbehaviorinwhichearlyonsetisassoci-atedwithariskoflife-coursepersistentantiso-cialbehavior,includingsomeindividualswhomeetadultcriteriaforpsychopathy.Theearly-onsettrajectoryinvolvesoppositionaldefiantdisorderthat“matures”intoCDaroundage10andisassociatedwithcomorbidattention-deficit/hyperactivitydisorder(ADHD)involv-inghyperactivity(i.e.,notthepredominantlyinattentivesubtype).Oneverylargeandonesmallerliteratureattemptstoarticulatetwotem-perament-basedpathwaystosevereconductproblemsinchildren.FrickandMorris(2004)provideacomprehensivereviewoftheselitera-tures,andthecurrentsummaryisadaptedfromtheirreviewunlessotherwisenoted.Thelargerliteratureencompassesthenotionof“difficulttemperament”ininfants,andsomewhatinterre-lateddevelopmentalconceptsof“failureofse-cureattachment”and“coerciveexchanges.”Theseconcepts,discussedinthefirstsubsec-tionbelow,appearmostrelevanttophenotypicconstructsofdisinhibitionandmeanness.Thesmaller,morerecentliteraturefocusesondispo-sitionalfearlessnessasapathwaytopsycho-pathy.Thisconceptappearsmostrelevanttophe-notypicconstructsofboldnessandmeanness.FactorscontributingtodisinhibitionandDifficulttemperament.Thedevelopmentalcon-ceptof“difficulttemperament”isacomplexoneinvolvinghighnegativeaffectandirritabil-ity,highactivity,withdrawalfromnovelstim-uli,poorperformancewheresustainedattentionisrequired,anddifficultyadaptingtochangesintheenvironment,characteristicsfoundtobeassociatedwithariskofconductproblemsTriarchicconceptualizationofpsychopathy thatbeginearlyinchildhoodwithariskoflife-longantisocialbehavior.FrickandMorris(2004)suggestthattheintensenegativeemo-tionalreactionsofangerandfrustrationarethecoreriskfactor,consistentwiththeclinicalpictureofirritability,lowtoleranceforfrustra-tion,andangryoutburstsinoppositionaldefiantdisorder,theearlychildhoodsyndromeassoci-atedwithahighriskofearlyonsetconductproblemsandchronicantisocialbehavior.Al-mostbydefinition,theseexcessivenegativeemotionalreactionspointtodifficultiesinemo-tionregulation,ormorespecificallyregulationofanger.Thedevelopmentofemotionregula-tionabilitiesinvolvesbothchildcharacteristicsandtheeffortsofparentsandothersocializingagentstohelpthechildlearntomanageemo-tions(e.g.,Cole&Hall,2008;Frick&Morris,2004;Thompson,2001).Animportant,relativelyrecentdistinctionbe-tweenautomaticandeffortfuldimensionsofemo-tionalresponsivenessisimportanttoappreciatingthemultipleinfluencesonemotionregulation.Automaticreactivityreferstoinvoluntaryorpas-sivereactionstoemotionalstimuliwithseparatedimensionsforreactionstocuesforpositive(re-wards)andnegative(punishment,threateningemotionalstimuli)events.Effortfulorvoluntarycontrolreferstoinhibitingdominantorprepotentbehavioralandemotionalresponsesandtodirect-ingattentioninadaptivewaysinordertoregulatebehaviorandemotions.Giventhateffortfulcon-trolhelpstoinhibitatendencytostrongautomaticnegativereactivity,bothdimensionsarerelevanttoemotionregulation.Themostseveredifficulttemperamentwillinvolveacombinationofstrongautomaticnegativereactivitywithweakeffortfulcontrol.Theseparateassessmentofautomaticandeffortfulresponsivenessisnotwelldeveloped,althoughFrickandMorrisoffersuggestionsastohowtoachieveit.Becauseeffortfulcontrolstrategiesoftenareseenascomponentsofthebroaderconceptofexecutivefunctions,itisnotclearwhetherdifficultyinregulatingangerandhostilityisthecoreriskfactorforconductprob-lemsorwhetherabroaderdeficitinexecutivefunctionsisthecriticalriskfactor.Thedeficitinemotionregulationincreasestheriskofconductproblemsinavarietyofways:in-terferingwiththeacquisitionofappropriateso-cialcognitionsandbehavior,increasingpeerre-jectionwithsubsequentreductioninpositivesocializingexperiencesandincreaseddeviantpeerassociation,facilitatingthedevelopmentofreactiveaggressionregardingpeers,producingexcessivelystrongnegativeaffecttopunishmentthatunderminestheefficacyofskilledmaternalgentlediscipline,andincreasingtheprobabilityofmutuallycoerciveexchangeswithparents.Thus,difficulttemperamentinvolvingpooremo-tionregulationand/orpoorexecutivefunctions(attributesembodiedintheconstructofdisinhibi-tion)increasestheriskofsevereantisocialbehav-iorandaversiveinteractionswithcaretakersandpeers,settingthechildonapathwaythatmayde-velopintobehaviorthatmeetsthecriteriaforpsy-chopathyasdefinedbythePCL-Rinadulthood.Failureofsecureattachment.Asecondrelevant(andoverlapping)literatureconcernsthedevelop-mentalconceptof“secureattachment”(Camp-bell,1998),assessedat1yearofageandviewedasprovidingtheinfantwithasecurebaseforex-ploringtheenvironmentandamajorsourceofcomfortwhendistressed,fearful,orill.Thislitera-ture,too,focusesondifficulttemperamentasariskfactor,buttheissueofsecureattachmentisap-plicabletoanyfactorsthataffectearlyparentingandithasdirectimplicationsforrelationshipswithothers.Thebasicmodelsuggeststhatadiffi-culttemperamentisachallengefortheparent,re-quiringmuchgreaterparentingskillthaninfantswithapleasant,happy,andeasilysoothabletem-perament.Absentsuchunusuallygoodparentingskillorstrongsocialsupport,adverseeffectsonparent–infantinteractionsarelikelytoresultinaninsecureor“anxiousorambivalentattachmentcharacterizedbyexcessiveanger,clinging,and/oravoidancebehavioronthepartoftheinfant”(Campbell,1998,p.13).Contextualfactorsofpovertyandstressfullifeeventsincreasetheriskofinsecureattachment(probablybydisruptingparenting).Extremeenvironmentssuchasabuseandneglectorchronicmaternalpsychopathologycanproduceinsecureorevendisorganizedattach-ments(moreseverethaninsecureattachment),quiteapartfromtheinfant’stemperament.Thereissome,butmixed,evidencethatat-tachmentproblemsatageoneyeararepredic-tiveoflaterinternalizingandexternalizingproblems(Campbell,1998).TheprimarypointinthepresentcontextisthattemperamentalandC.J.Patrick,D.C.Fowles,andR.F.Krueger otherfactorsthatchallengeordisruptoptimalparent–childinteractionsduringthefirstyearlikelyhaveanadverseimpactontheinfant’sat-tachmenttotheprimarycaregiver.Thisdevel-opmentishypothesizedtoproduce“internalworkingmodels”ofsocialinteractionsthatarelessadaptive,coloringtheinfant’ssubse-quentsocialinteractions.Optimalenviron-mentsprobablyeffectivelyreverseorattenuatethiseffect,butthedevelopmentofpoorattach-mentsininfancysetsthestageforfurtherfail-urestodeveloppositiverelationshipswithoth-ers.Therangeofnegativeorientationstoothersinpsychopaths(i.e.,hostile,angry,callous,ex-ploitive)canbearguedtoreflectatleastinpartafailuretodeveloppositiveattachments.Ifso,thefailureofsecureattachmentconstitutesariskfactorforsomeoftheaffective–interper-sonalaspectsofpsychopathy,thatis,thoseem-bodiedintheconceptofmeanness.Coerciveexchanges.AmajorlineofresearchonthedevelopmentofantisocialbehaviorbyPatter-sonandhiscolleagues(e.g.,Dishion,French,&Patterson,1995;Patterson,Reid,&Dishion,1992;Patterson,Reid,andEddy,2002;Snyder,Reid,Patterson,2003)focusedonthe“coercionhypothesis.”Accordingtothisnowwell-estab-lishedmodel,whenthereisconflictbetweenpar-entandchild(e.g.,theparenturgesthechildtostopsomethingthechildwantstodoortodosomethingthechilddoesnotwanttodo),ifthechild’scoerciveresponse(e.g.,noncompliance,tempertantrums,generallyaversivebehavior)causestheparenttogivein,thechild’scoercivere-sponseisnegativelyreinforced.Similarly,whentheparentgivesinandthechildterminatesthecoercion,theparentisnegativelyreinforced.InPatterson’ssociallearningmodel,thousandsofthesecoerciveexchangesproducearesponsere-pertoireinwhichcoercionisadominantandstronglyreinforcedbehavior.Coerciveexchangesgeneralizetopeersandteachers,withsubsequentimmediaterewardsbutdelayednegativeconse-quencesintheformofrejection.Thecombinationofcoercivebehaviorandrejectionbynormalpeersfacilitatesassociationwithdeviantpeersandsub-sequentsocializationintoawiderangeofantiso-cialbehaviors.Theseinvestigatorsviewaninfanttempera-mentassociatedwithariskfordevelopingADHDinvolvinghyperactivityasariskfactorforcoerciveexchanges(Patterson,DeGarmo,&Knutson,2000).Intheactualstudy,astructuralequationmodelwaspresentedtosupporttheirhy-pothesisthatthecomorbidityofADHDandCDreflectsanearly(ADHD)andlate(CD)manifes-tationofasharedprocess.Althoughtheirownresearchhasinvolvedolderchildren,theseauthorshypothesizethatthecombinationofanextremelyactiveanddifficult(irritable)infantandanonre-sponsive(noncontingent)caretakerinitiatethisprocess,whichprobabilisticallyresultsincoerciveandsociallyunskilledbehaviorbyage24months,consistentwithadiagnosisofhyperactivitybe-tweentheagesof2and4years.Thus,theliteratureoncoercionpointstoatemperamentstronglysim-ilartothatdescribedabovefordifficulttempera-mentandforpooremotionregulation,anditfo-cusesontheetiologyofcoercive,antagonisticsocialinteractions,followedbysocializationintoanantisocialsubculturebydeviantpeers.LiketheFrickandMorrisreview,Pattersonandcol-leagueslinkthisdevelopmentalmodeltoearly-on-set,chronicsevereantisocialbehavior.Insummary,thisdevelopmentalapproachcombinesahyperactive,irritabletemperament,parentingthatisnotuptothechallengeofsuchatemperament,familyinteractionsthatfacili-tatethecharacteristicsofhyperactivity,comor-bidityofADHDandantisocialbehavior,andtheearly-onsetofantisocialbehaviorassociatedwithlaterpsychopathybyMoffittandLynam.LowfearasasubstrateformeannessandboldnessGiventheemphasisonaffective–interpersonal(Factor1)featuresinclassicviewsofpsychop-athyandtheassociationofthosefeatureswithlowfearintheadultpsychopathyliterature,thereshouldbeanadditionaletiologicalpath-wayformoreclassic,emotionallydetachedpsychopathsinthechildhoodliterature.Asde-scribedearlier,theAPSDdevelopedbyFrickandcolleaguescanbeusedtoidentifyyouthhighonCUtraits,whichcapturemanyoftheaf-fective–interpersonalfeaturesofpsychopathyandarecharacterizedbysuchlowfearattributesaslowscoresonanxietyandneuroticismscales,reducedsensitivitytostressfulstimuliandsituations,andadominanceofreward-seekingTriarchicconceptualizationofpsychopathy approachoverpassiveavoidanceofpunishmentinconflictsituations(cf.Frick&Morris,2006).HighCUyoutharecharacterizedbyhighlevelsofinstrumental,premeditated,orproactiveag-gression(directedtowardacquisitionofgoods,services,ordominance)aswellasbyhighlevelsofreactive,hostile,orimpulsiveaggres-sion(usuallyanangryresponsetothreatorprovocation),whereasantisocialyouthlowonCU(thosewith“difficulttemperaments,”asde-scribedabove)showpredominantlyreactiveag-gression.Ofinterestinthepresentcontext,Frick(Frick&Marsee,2006;Frick&Morris,2004)citesresearchonthedevelopmentofinternalizedconscienceinchildrenbyKochanskaandhercolleagues(1993,1995,1997;Kochanska,Gross,Lin,&Nichols,2002)asrelevanttothelowfearpathwayforpsychopathy.Basedoninitialclassificationsoffearfultemperamentattoddlerage,Kochanskaiden-tifiedtwopathwaystothedevelopmentofinter-nalizedconsciencebyage4.Usingamediansplitforfearfultemperament,maternalgentlediscipline(“good”discipline:parentalgentledisciplinedeemphasizingpowerandcapitaliz-inginsteadoninternaldiscomfort)predictedinternalizedconscienceforfearfulbutnotfear-lesschildren.Thus,thisdiscipline-basedpath-waywasineffectiveforfearlesschildren,con-sistentwiththehypothesisthatpoorfearconditioningimpairsmildpunishment-basedsocialization.Incontrast,securityofattachment(astand-inforaclose,mutuallypositivepar-ent–childrelationship)predictedinternalizedconscienceforfearlesschildren.Theseresultsdemonstratethatalowfeartemperamentdoesnotinevitablyleadtoafailureofconsciencede-velopment.Withsufficientskillonthepartoftheparent,amutuallypositiverelationshipcapitalizesonthechild’sfullyfunctionalre-ward-basedlearningtopromotesocialization,aprocesslikelytofosterboldnessasopposedtomeanness(seenextsection).Quitepossibly,however,extremelylowfearmaymakethechildmoredifficulttocontrolwithapotentialforconflictthatwouldinterferewiththedevel-opmentofamutuallypositiverelationship.Combinedwithotherriskfactors(e.g.,lowge-notypicaffiliativeness;parentalabuseorne-glect),thismaypushgenotypicfearlessnessinthedirectionofphenotypicmeanness.ImplicationsforConceptualizingPathwaystoPsychopathyAlthoughthedevelopmentalpsychopathologyliteraturedoesnotdirectlyaddresstheimplica-tionsoftheaforementionedetiologicfactorsfordistinctivephenotypiccomponentsofadultpsy-chopathy(disinhibition,boldness,meanness),somereasonableextrapolationsfromexist-ingdatacanbeadvanced.Figure1providesagraphicdepictionofinterrelationsamongthesedistinctphenotypicconstructs,andillustratesaforementionedideasastohowfactorsofdiffi-culttemperamentandlowdispositionalfearpresumablycontributetothesephenotypicout-comes.Theremainderofthissectionelaboratesfurtheroncontributoryprocesses/pathways.Onenotablepoint,impliedintheforegoingsection,isthatboththeattachmentandcoerciontrajectoriesprobablycontributetopsychopathicoutcomesinlowfearaswellasdifficulttem-peramentyouth,bypromotingtendenciestowardantagonismandcallousness(i.e.,meanness).Totheextentthatalowfeartemperamentcreatesachallengeforparents,theremaywellbeinterfer-encewiththedevelopmentofpositive(secure)at-tachmentsandemergenceofcoerciveprocesseswithinthefamilythatthengeneralizetopeersandteachersandresultindeviantpeerassociation,consistentwiththeprincipleofequifinality.Thus,thesedevelopmentalinfluenceswillbecommontothetwotemperament-basedriskfactors,andwilltendtoproduceoverlappingphenotypesinimportantrespects(i.e.,individualsexhibitingtendenciestowardinterpersonalantagonismandexploitativebehavior).Tobesure,theaffectivecomponentswilldifferinclearcases,butpoorat-tachments,coerciverepertoires,andexploitativeattitudeswouldcharacterizebothgroups.Asecondpoint,alsoalludedtoearlier,isthatthedifficulttemperamentinvolvingpooremotionregulation/poorexecutivefunctionsmapsmostclearlyontothephenotypeofdisinhibitionorex-ternalizing.Theineptorunskilledimpulsivityandtheirritablehighnegativeaffectcombinewithde-velopmentalexperiencesofadversarialinterac-tionswithcaregivers,peers,andteacherstopro-motehighlevelsofanger,hostility,fighting,drugandalcoholproblems,academicandoccupa-tionalfailure,andsoforth,inthecontextofhighscoresonanxietyandneuroticism.TodistinguishC.J.Patrick,D.C.Fowles,andR.F.Krueger theconceptofdifficulttemperamentfromthatoffearlesstemperament,whichasnotedcanalsobeconstruedas“difficult,”andtohighlightitsrele-vancetothephenotypicconstructofdisinhibitiondescribedearlier,weadvocateuseofthealterna-tiveexpression“disinhibitedtemperament.”Althoughtherearefewdirectdatainthedevel-opmentalliteraturethatspeakstoalternativephe-notypicoutcomesofboldnessversusmeanness,therecanbereasonablespeculation.Consistentwithaforementionedsuggestions,onehypothesisisthatboldnessreflectsaphenotypicorientationthatevolvesmorenaturallyfromthelowfearge-notype(“apurer,morebenignexpressionofun-derlyingtemperamentalfearlessness”),whereasmeannesslikelyreflectsanoverlaybecauseofdevelopmentalexperiencesgoneawry.Thelowstressreactivityelementofboldnesscanbeviewedasadirectmanifestationoflowdefense-systemsensitivity,withhighsocialdominanceandthrill–adventureseekingrepresentingaffili-atedphenotypicexpressionsofrewardseekingunrestrainedbyfearandanxiety.Incontrast,themeannessattributesofdeficientempathy,disdainforandlackofcloseattachmentswithothers,rebel-liousness,exploitativeness,andempowermentthroughcrueltycanbeviewedasoutcomesofalowfeartemperament(fearlessgenotype)inwhichtheprocessesofsocializationhavefailed.Assuggestedabove,thefailureofpositiveattach-mentcombinedwiththeexperienceofcoerciveinteractionswithothersislikelytopromoteacal-lous,exploitiveattitudetowardothers,andtheseattitudesarelikelytobesupportedandstrength-enedthroughdeviantpeerassociation.However,thesefeaturesmayalsobeassociatedwiththe Figure1.Aschematicdepictionofhypothesizedinterrelationsamongphenotypicconstructsofdisinhibi-tion,boldness,andmeanness(circles)andcontributionsmadetoeachbyunderlyingetiologic-dispositionalfactorsofdifficulttemperamentandlowfear(arrows),asdescribedinthedevelopmentalliterature.Disin-hibitionandmeannessaredepictedasmoderatelyinterrelated,basedonfindingsforvariousexistingpsy-chopathyinventoriesthatincludecoverageoftheseconstructs.Difficulttemperamentisdepictedascontrib-utingtoeachoftheseconstructs,asdiscussedinthefinalsectionofthemaintext.Disinhibitionandboldnessaredepictedasminimallyinterrelated,basedonfindingsforthePsychopathicPersonalityInventory,inwhichfearlessdominance(boldness)representsaseparatefactorfromimpulsiveantisociality.Meannessandboldnessaredepictedassomewhatinterrelated,basedonevidenceforacontributionoflowdisposi-tionalfeartoeach(seetext).Thetriarchicmodelconceivesofpsychopathyasencompassingthesethreedis-tinctphenotypicdispositions.Thesyndromeofpsychopathyasdefinedclinicallyentailsdisinhibitioninconjunctionwitheitherboldnessormeanness.Cleckley’s(1941,1976)conceptualizationofpsychopathemphasizedboldnessmoresothanmeanness.Criminologicconceptions,andinstrumentsdevelopedtoas-sesspsychopathyinadultcriminalsanddelinquentyouth,emphasizemeannessmoresothanboldness.Lyk-ken’s(1995)conceptionofthesuccessful(highachieving,or“heroic”)psychopathplacespredominantem-phasisonboldness.Triarchicconceptualizationofpsychopathy 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