بازگشت به جرم به اختلالات فکری و روانی (PCL-R) در یک گروه از مردان متهم به قتل مرتبط است

It is well known that psychopaths are a group with high risk for criminality. Despite that, researchers and clinicians have not yet agreed on a general cause of psychopathy. However Raine [Raine, A. (2002). Biosocial studies of antisocial and violent behavior in children and adults: A review. Journal of Abnormal Child Psychology, 30, 311-326.] advocated a biosocial model of violent behaviour where the greatest risk for criminal behaviour occurred when both heredity and environmental risk factors (e.g., social class, childhood history) were present. In this follow-up study, 35 men convicted of homicide were assessed retrospectively for psychopathy according to the Psychopathy Checklist-Revised (PCL-R). Information on personal history, as well as from legal documents and records of offences committed by the subjects was also obtained. Fourteen of the 35 men were classified as psychopaths. Two men, both rated as psychopaths, had criminal parents. Twenty-seven of the men had a social relationship with their victim, and eleven out of these were rated as psychopaths. There was no difference in PCL-R scores between those who had a social relationship with their victim and those who did not. The psychopaths relapsed more frequently than the nonpsychopaths into criminality after their prison term. This result confirms previous research indicating that psychopathy is a risk factor for recidivism. It is, therefore, very important that psychopaths get the best possible treatment, aftercare, and supervision.

Definitions of the term psychopath have historically been diverse, but most clinicians and researchers are generally in quite good agreement with each other and with the description of psychopathy provided by Harvey Cleckley (1941/1988) in his book The Mask of Sanity. Robert Hare and his collaborators have been involved during almost the past 20 years in the development of, and in studies regarding the validity and reliability of a rating scale, the Psychopathy Checklist–Revised (PCL-R) (Hare, 1991 and Hare, 2003), which assesses symptoms of psychopathy. Traditionally, PCL-R has been divided into two factors: classical interpersonal and affective characteristics (Factor 1, e.g., lack of empathy, manipulativeness, glibness or superficial charm, shallow affect), and behavioural features (Factor 2, e.g., early problem behaviours, impulsiveness, juvenile delinquency) (Harpur, Hare, & Hakstian, 1989). 1.1. Why do we need to identify criminal psychopaths? It is important to be able to identify psychopaths so that we can protect ourselves from the harm they can cause. One of the main characteristics of a psychopath is his or her unusual charm and amazing success in lying, and it is easy for such a person to obtain extraordinary advantages during the period of custody, including, for example, early release. The next step, then, is for the psychopath to relapse into another serious crime. It is also very important that the judicial system is capable of identifying psychopaths, principally with respect to various decisions concerning verdicts, treatment, and release (Hare, 1997). The ability to identify psychopathy gives us, to a certain extent, the ability to predict serious crime. Identification of psychopaths also allows us to attempt to prevent them from committing crimes. Psychopaths commit considerably more crimes than nonpsychopaths. Hare also states that psychopaths commit more than 50% of the most serious crimes. 1.2. Psychopathy and relapse into criminality Several studies have shown that psychopaths are more liable to relapse into criminality than non-psychopaths. Långström and Grann (2002) investigated psychopathy and violent crime recidivism in a group of young people who underwent forensic psychiatric assessment. The young offenders had, in a first stage, been rated according to PCL-R. They were then followed during their prison term and for two years afterwards in society, until being convicted for a further violent crime. The study found a positive significant relationship between psychopathy and recidivism of violent crime. Hare (1999) has shown that psychopathy is an accurate predictor of recidivism, principally with respect to violent crime. Woodworth and Porter (2002) describe how Serin and Amos (1995) found that recidivism within five years after release was five times more likely in psychopaths than in nonpsychopaths. Gretton (1999) found that psychopaths ran a greater risk of committing violent crimes after release than nonpsychopaths. Furthermore, psychopaths relapsed into criminality earlier after release than nonpsychopaths. 1.3. Psychopathy and aggression Myers and Monaco (2000) found a significant negative association between scores on a scale that measures control of aggression and psychopathy scores on PCL-R. Woodworth and Porter (2002) claim that it is possible to distinguish between two types of aggression: instrumental aggression and reactive aggression. Instrumental aggression is intentional and directed at a specific target. This target is more important than any injury that the aggressive behaviour may cause. In contrast to reactive aggression, instrumental aggression is not produced by a major emotional reaction. Reactive aggression, in comparison, is more spontaneous, impulsive, and driven by emotion. Homicides committed by psychopathic offenders are more likely to be primarily instrumental whereas homicides committed by nonpsychopaths are often described as crimes of passion (Woodworth & Porter, 2002). Cornell et al. (1996) found that instrumental aggression was associated with a lack of arousal. Persons who are not known to the perpetrator are most often the targets of instrumental violence, whereas reactive violence is most often committed with a high emotional arousal involving a person known to the perpetrator. 1.4. The family backgrounds and biological risk factors in violent offenders and psychopaths Raine (2002) proposed a biosocial model of violent behaviour, based on research regarding social risk- and protective factors for antisocial and criminal behaviour. Previous research indicates that social (e.g., social class, childhood history) and biological (e.g., genes, skin conductance, neurological factors, brain structure and functions) factors interact. For example, several adoption studies showed that the greatest risk of criminal behaviour occurred when both heredity and environmental risk factors were present. Raine also indicated a relationship between psychophysiological factors and antisocial behaviour, and concluded that the relationship was strongest for antisocial persons with benign backgrounds (high social class and intact homes). According to Raine, empirical research shows that reduced skin conductance characterises antisocial persons from a high social class. An explanation of this pattern may be provided by a theory of “social push.” According to this theory, antisocial persons who, as children, had not been “pushed” (predisposed) into criminality by their social situation were instead characterized by several biological risk factors (e.g., reduced skin conductance), which, according to Raine, may explain their antisocial behaviour. One factor that is protective against antisocial behaviour, in spite of deprived psychosocial background, could be high autonomic activity (high level of arousal). Low levels of arousal in turn, according to the fearlessness theory (Raine, 2002) are indicators for low level of fear. Low level of fear in childhood leads to poor socialisation and may also influence antisocial behaviour at the late stage. According to Raine, pregnancy and birth complications could as well, in interaction with poor parenting, predispose for antisocial behaviour. Raine proposed that in cases of clear adverse social background, such as a broken home, the link between antisocial behaviour and biological risk factors might be weaker because the social causes of crime may be over-interpreted. Therefore, he has highlighted a need for a biological research in antisocial persons without adverse early home conditions. Raine and his collaborators have performed a series of biologically oriented studies in murderers and focused on the presence or absence of adverse social backgrounds. In a study of Raine, Stoddard, Bihrle, and Buchsbaum (1998), a sample of 41 persons (39 men and 2 women) who had been charged with homicide (labelled as murderers), pleading not guilty by reason of insanity, were assessed for psychosocial deprivation and divided into two groups: those with and without deprivation, respectively. Matching each murderer with a normal participant of the same sex and age formed a control group. In the murderers, the degree of evidence of significant psychosocial deprivation was measured using a 5-point Likert scale (0 = none, 1 = minimal, 2 = partial, 3 = substantial, 4 = extreme). The following variables were rated on the scale: physical abuse, sexual abuse, neglect, extreme poverty, foster home placement, having a criminal parent, severe family conflict, and a broken home. Twelve out of the 41 murderers were identified as having evidence of significant psychosocial deprivation with ratings between 2 and 4. The murderers lacking psychosocial deprivation were characterised by lower prefrontal glucose metabolism compared with the controls. The authors hypothesise that because deprived murderers lack prefrontal dysfunction, their violent acts may be a result of some kind of psychosocial deficit. Murderers without deprived backgrounds who were characterised by prefrontal dysfunction do not have the history of the “social push” into violence and therefore the prefrontal deficits provide a stronger inclination to violence in this group. These findings indicate that those biological risk factors, when interacting with psychosocial risk factors, may influence antisocial and violent behaviour. Hare (1997) believes that unstable and criminal parents do not primarily cause psychopathy in a person, but that this factor plays a major role. He showed that the family backgrounds of psychopaths did not differ from those of other criminals, nor did family background influence the age at which the psychopath began his/her criminal career. On the other hand the study showed that criminal psychopaths from disadvantaged family backgrounds committed more violent crimes than psychopaths from stable family backgrounds. A dissertation by Mcbride (1999) showed that psychopathy was associated with physical abuse by the father, psychopathy of the mother, and ineffectual parental strategies. Farrington (2000) investigated psychosocial factors in childhood that may predicate antisocial personality disorder (DSM-III-R) in adult age. Antisocial personality disorder is, according to Harpur, Hakstian, and Hare (1988), correlated to a degree of .40 with Factor 1 of PCL-R, and to a degree of .60 with Factor 2. Farrington's study showed that the items that most strongly predicted antisocial personality disorder were having at least one parent convicted of crime, and having grown up in a family with many members. Marshall and Cooke (1999) investigated whether social experiences and environmental experiences during childhood influenced psychopathy diagnosed at a later stage. They found that the experiences of psychopathy during childhood were significantly different from those of nonpsychopaths with respect to ten variables investigated. These variables were: lack of parental discipline for the child, malevolence of the parents against the child, neglect of the child by the parents, surveillance of the child by the parents, malevolence of the child against the parent, mental abuse of the child by the parents, poor experience in institutions, poor social experiences, poor school performance, and poor experience of school. Two factors could be extracted by factor analysis from all of the variables related to childhood. These factors were given the names “familial” and “social.” The study showed that the higher the score received on PCL-R, the greater was the likelihood that the person had both familial and social difficulties. The study also showed that the familial factor was principally linked to Factor 1 of PCL-R, and that the social factor was principally linked to Factor 2. 1.5. Neurodevelopment in murders and psychopaths Raine, Buchsbaum, and LaCasse (1997) showed, with the help of PET scans, in an initial study that murderers had prefrontal deficits (among other things, a reduced glucose metabolism in both lateral and medial cortical areas) compared to age- and sex-matched controls (cf. Raine et al., 1998, and the characteristics of previous mentioned groups regarding social deprivation). There were no significant differences in the PET measures between murderers with and without a history of head injury. Damage to the prefrontal region can result in impulsivity, loss of self-control, immaturity, altered emotionality, and a lack of ability to modify behaviour. All of these characteristics can all in turn facilitate aggressive acts. Another important finding was that murderers had low activity in their left, and high in their right amygdala. It is known that the amygdala plays an important roll in control of aggressive behaviour and the expression of emotions and also in the recognition of affective and socially significant stimuli. Together with the hippocampus and thalamus the amygdala plays an important roll in learning, memory, and attention. Following the previously mentioned ideas of Raine (2002) concerning the importance of studies in antisocial persons with relatively good social characteristics, Raine et al. (2003) studied a group of 15 psychopathic antisocial persons with no convictions, that is, successful, uncaught psychopaths. This group had a mean score in PCL-R of 30.3, range 23–40, and all fulfilled the diagnostic criteria of antisocial personality disorder. Compared to controls, the psychopaths had a more frequent occurrence of substance dependence (81% vs. 18%) and of schizophrenia spectrum disorder (40% vs. 12%). Using a structural MRI scan, Raine et al. found that the corpus callosum of the psychopaths was abnormal and showed an increased functional connectivity between the two hemispheres. The study thus suggests a relationship between callosal structural abnormalities and psychopathy. Abnormalities in the corpus callosum could have profound implications for cognition, affect, and emotion and for psychopathology. In this study, an increased callosal volume has been shown to be associated with blunted affect, lack of remorse, no close friends, lack of social closeness, and reduced skin conductance and heart rate activity during the presence of the stressor. All of these characteristics account for characteristic features of psychopaths. The structural abnormalities suggest the possibility that psychopathy may be partly neurodevelopmental. Because the hippocampus is involved in contextual fear conditioning, persons with impairment of this region could become insensitive to signals that predict punishment and arrest and as a result be more likely to be detained (Raine et al., 2004). It has been indicated that unsuccessful psychopaths, compared to successful psychopaths and control persons, have an exaggerated structural asymmetry in the anterior hippocampus, that is, the right half is larger than the left (Raine et al., 2004). Atypical brain asymmetries are considered to reflect an abnormality of the neurodevelopment process, which probably occurs early in life. This abnormality disrupts hippocampal–prefrontal circuitry and results in affect dysregulation, poor contextual fear conditioning, and insensitivity to signals predicting capture. In summary, studies have shown that there are several social factors during childhood as well as biological factors that may influence antisocial and violent behaviour at a later stage. The link between previous adverse social experiences and different biological factors in psychopaths convicted of homicide is still an open issue. 1.6. Aim We have recently examined the prevalence of psychopathy in a sample of men convicted of homicide (Laurell & Dåderman, in press). We found that 40% of the men were rated as psychopathic when a cut-off point of 27 on the PCL-R was used, and 31.4% when a cut-off point of 30 was used. The aim of the present investigation was to investigate whether psychopathy in this sample is associated with any of the following variables: a) recidivism following the conviction of homicide, b) at least one criminal parent, and c) the existence of a social relationship with the homicide victim. Previous research led us to expect a significant difference between groups with low and high scores for psychopathy, respectively, with respect to the above selected variables.