آیا اختلالات فکری و روانی نوجوانان همراه با اضطراب و ترس در مجرمین مرد مبتلا به اختلال سلوک پایین است؟

Although the traditional conceptualization of psychopathy suggests that this construct is negatively associated with anxiety the literature has produced mixed findings. The present study examined the relationship between self-report measures of anxiety/fear and psychopathy assessed using the Psychopathy Checklist: Youth Version in 110 adolescent male offenders with conduct disorder. In line with the literature in children, we found that measures of anxiety and fearfulness exhibited differential associations with different elements of psychopathy. Specifically, we found that trait anxiety was negatively correlated with the affective components of the psychopathy construct and that fearfulness was negatively correlated with the more antisocial components of the construct. The findings are discussed in the context of growing literature on psychopathy assessment in younger cohorts.

The antisocial personality disorders (conduct disorder, antisocial personality disorder, and psychopathy) are a group of overlapping disorders of personality that are associated with significant intra and interpersonal dysfunction across the lifespan. There is increasing recognition that these disorders are complex constructs and comprise a constellation of symptoms and behaviors (Blackburn, 1998, Frick, 1998 and Hare, 1998). The last decade has seen a growing interest in the assessment of psychopathy in children and adolescents and a number of reviews have highlighted the need to demonstrate that psychopathy is a stable construct with similar external correlates across the lifespan (Dolan, 2004; Edens, Skeem, Cruise, & Cauffman, 2001; Farrington, 2005). There has been longstanding debate in the literature concerning the nature of the association between antisocial behavior in these disorders and fear and anxiety, particularly in relation to the psychopathy construct. Several theories have focused on the low fear hypothesis of antisocial behavior (Cloninger, 1987, Cloninger, 1994, Gray, 1982 and Lykken, 1957) or the absence of anxiety (Cleckley, 1976). However, several researchers have noted that antisocial personality disorders can be associated with relatively high levels of negative affect including anxiety as a secondary consequence of their antisocial behavior (Blackburn, 1998, Fowles, 1988, Frick, 1998, Lilienfeld, 1992 and Lilienfeld, 1994). It has been suggested that there are subgroups of antisocial individuals with varying degrees of anxiety and neuroticism. Those with low levels of anxiety are described as primary psychopaths (Blackburn, 1998) or undersocialized delinquents (Quay, 1987). Those with high levels of anxiety are described as secondary psychopaths (Blackburn, 1998) or neurotic delinquents (Quay, 1987). Some support for this distinction comes from studies showing that low anxious psychopaths have deficits on passive avoidance learning tasks compared to high anxious psychopaths (Newman, Widom, & Nathan, 1985). Cleckley, 1941 and Cleckley, 1976 original conceptualization of psychopathy emphasized deficient emotional processes, including impoverished emotional reactions, lack of anxiety, and a disjunction between the lexical and experiential components of emotion as key components of the disorder. Several studies provide evidence of attenuation of physiological responses to emotional information processing in psychopathic subjects with marked callous-unemotional traits (Patrick, 1994). In addition, there is evidence of discordance between linguistic and experiential components of emotion in both fear imaging (Patrick, Cuthbert, & Lang, 1994) and memory paradigms (Christianson et al., 1996). The behavior and physiological anomalies associated with psychopathy are thought to arise because the psychological processes that would normally function to motivate adaptive behavior and emotional responding, in response to cues for punishment, do not occur. Thus subjects who are characterized as having low anxiety and an inability to empathize with others may have significant difficulties learning from the previous adverse consequences of their behavior either on themselves or their victims. Low anxiety may also be associated with a degree of fearlessness that results in repeated engagement in antisocial activities and a failure to learn from experience. In recent years there have also been attempts to distinguish between anxiety and fear constructs, with fearfulness seen as a sensitivity to cues of impending danger (Gray, 1982 and Tellegen, 1982) while trait anxiety is viewed as the distress that results from the feeling that negative consequences are inevitable (Tellegen, 1982). Although anxiety and fear are overlapping constructs they do appear to have distinct neural underpinnings (Dien, 1999). Early empirical studies testing the hypothesis that psychopathy is associated with a reduced capacity for fear/anxiety has produced inconsistent findings. While Lykken (1957) reported that primary psychopaths had lower fear, but not anxiety scores compared with non-criminal comparisons, others (Schmauk, 1970 and Widom, 1976) have not been able to replicate this finding. More recent studies assessing psychopathy using the Psychopathy Checklist-Revised (PCL-R) devised by Hare (1991) have focused on the relationship between anxiety and fear and the two-factor model of psychopathy outlined by Harpur, Hare, and Hakstian (1989) in which Factor 1 reflects affective and interpersonal traits and Factor 2 consists of the social deviance/behavioral items. To address the issue that these factors may have a differential relationship with anxiety/fear, a number of studies have looked at the unique relationships with each factor by controlling for the influence of the other factor. Thus, Patrick (1994) found that self-report measures of emotional distress and fear were negatively related to PCL-R Factor 1 scores after controlling for PCL-R Factor 2 and positively correlated with Factor 2 after controlling for Factor 1. This finding was not replicated by Schmitt and Newman (1999) where controlling for Factor 2 did not affect correlations between fear and anxiety and PCL-R total scores. Hale, Goldstein, Abramowitz, Calamari, and Kosson (2004) examined the relationship between three measures of anxiety and psychopathy (assessed using the PCL-R) in a sample of incarcerated adult males. The anxiety measures included the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the State Trait Anxiety Inventory (STAI; Speilberger, 1983) and the Welsh Anxiety Scale (WAS; Welsh, 1956). In line with previous studies (Barry et al., 2000, Frick, 1998 and Patrick, 1994) they examined relationships between anxiety measures and specific dimensions of the PCL-R after controlling for the other factor. They found that neither overall psychopathy score nor the affective/interpersonal aspects of these disorders were significantly associated with abnormally low anxiety sensitivity or trait anxiety. Overall, the empirical evidence for an inverse relationship between psychopathy and self-reported anxiety in adults is mixed and inconsistent. In child and adolescent literature the findings are also unclear. Several reviews suggest that rates of anxiety disorders are higher in clinic-referred and institutionalized conduct-disordered samples than community samples of children (Russo & Beidel, 1993; Zoccolillo, 1992) and adolescents (Krueger et al., 1994). There have also been reports of positive correlations between anxiety and measures of externalizing behavior on childhood rating scales (Fergusson & Horwood, 1993). There are a limited number of studies assessing psychopathy and its relationship to anxiety/fear in younger cohorts and the findings are mixed. Thus Brandt, Kennedy, Patrick, and Curtin (1997) reported no significant correlations between measures of negative affect or anxiety and modified PCL-R ratings for adolescents. However, the latter study did not examine differential relationships with the two psychopathy factors. Frick, Lilienfeld, Ellis, Loney, and Silverthorn (1999) studied the relationship between anxiety and psychopathy dimensions measured by the Psychopathy Screening Device (now the Antisocial Process Screening Device, APSD; Frick, 1998) in a sample of 143 clinically referred children with conduct problems. They found that measures of trait anxiety and fearlessness did not correlate with each other but trait anxiety correlated positively, but not significantly, with conduct problems after controlling for callous-unemotional traits. Callous-unemotional traits tended to be negatively correlated with trait anxiety when conduct problems were controlled for. By contrast, they found that correlations between fearlessness and psychopathy factor scores were less striking, but fearlessness was correlated with callous-unemotional traits after controlling for conduct problems, while fearlessness was negatively correlated with the two conduct problem measures. A recent study in adolescent males (Kosson, Cyterski, Steuerwald, Neumann, & Walker-Matthews, 2002) reported that Psychopathy Checklist: Youth Version (PCL: YV; Forth, Kosson, & Hare, 2003) score was positively correlated with the Welsh Anxiety Scale; a measure of neuroticism or negative affect leading them to speculate that juvenile psychopaths may have not yet developed the same “mask of sanity” that is seen in adults. Inconsistencies in this literature in this field may be due to a combination of factors including inconsistency in the anxiety/fear assessments, variable reliability of psychopathy measures across the lifespan and, heterogeneity in the characteristics of the samples studied. For example many previous studies of anxiety in conduct-disordered youth included mixed gender samples and few have screened for psychopathology including anxiety/depressive disorders. In this study we attempted to address these methodological limitations by restricting our sample to male conduct-disordered youths who had been screened for co-morbid psychopathology in light of reports that high levels of anxiety have been reported in antisocial young people. We also examined the relationship between anxiety/fear and psychopathy in adolescents using a measure of juvenile psychopathy (PCL: YV) that has now been validated in a number of international settings and has been shown to have similar external correlates to the adult construct (Forth et al., 2003). On the basis of previous research, we predicted that measures of anxiety and fearlessness would exhibit differential associations with different elements of psychopathy. Specifically, based on traditional theories, we hypothesized that trait anxiety would be negatively correlated with the affective components of the psychopathy construct and that fearfulness would be negatively correlated with the more antisocial components of the construct. In line with previous studies (Frick et al., 1999, Hale et al., 2004 and Patrick, 1994) we examined the unique associations between anxiety/fear and each psychopathy dimension.