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Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  12:   Personality  Disorders     Introduction   • Personality  disorders  are  “enduring  patterns  of  perceiving,  relating  to,  and   thinking  about  the  environment  and  oneself  that  are  exhibited  in  a  wide   range  of  social  and  personal  context”   • They  are  also  “inflexible  and  maladaptive,  and  cause  significant  functional   impairment  or  subjective  distress   • Its  all  the  characteristic  ways  a  person  behaves  and  thinks   • We  tend  to  type  people  as  behaving  in  one  way  in  many  different  situations   • We  usually  consider  a  way  of  behaving  as  part  of  a  person’s  personality  only   if  it  occurs  many  ties  in  many  places     An  Overview   • Personality  disorders  are  chronic   • Individuals  with  personality  disorders  may  not  feel  any  subjective  distress;   indeed,  it  may  be  acutely  felt  by  others  because  the  individual  may  show  a   blatant  disregard  for  the  rights  of  others  yet  exhibit  no  remorse   • Many  people  who  have  personality  disorders  in  addition  to  other   psychological  problems  tend  to  do  poorly  in  treatment   • The  personality  disorders  are  included  in  Axis  II   • In  the  Axis  system,  a  patient  can  receive  a  diagnosis  on  only  Axis  I,  Axis  II,  or   on  both  axes   • A  diagnosis  on  both  Axis  I  and  Axis  II  indicates  that  a  person  has  both  a   current  disorder  (Axis  I)  and  a  more  chronic  problem     Categorical  and  Dimensional  Models   • People  with  personality  disorders  display  problem  characteristics  over   extended  periods  and  in  many  situations,  which  can  cause  great  emotional   pain  for  them  or  others   • Their  difficulty,  then,  can  be  seen  as  one  of  degree  rather  than  kinds   • The  problems  of  people  with  personality  disorders  may  just  be  extreme   versions  of  the  problems  many  of  us  experience  on  a  temporary  basis,  such   as  being  shy  or  suspicious   • The  distinction  between  problems  of  degree  and  problems  of  kind  is  usually   described  in  terms  of  dimensions  instead  of  categories   • Most  people  in  the  fields  see  personality  dimensions,  yet  because  of  the  way   people  are  diagnosed  with  the  DSM,  the  personality  disorders  end  up  being   viewed  in  categories   • No  in-­‐between  is  possible  when  it  comes  to  personality  disorders   • Using  categorical  models  of  behaviour  has  advantages,  the  most  important   being  convenience     • Problems  are  that  the  mere  act  of  using  categories  leads  clinicians  to  reify  the   disorders,  that  s,  to  view  disorders  as  real  “things”  comparable  to  the   realness  of  an  infection  or  a  broken  arm   • Some  have  proposed  that  the  DSM  personality  disorders  section  be  replaced   or  at  least  supplemented  by  a  dimensional  model  in  which  individuals  would   not  only  be  given  categorical  diagnoses  but  also  would  be  rated  on  a  series  of   personality  dimensions   • Widger  believer  such  a  system  would  have  at  least  three  advantages  over  a   purely  categorical  system:   1. It  would  retain  more  information  about  each  individual   2. I  would  be  more  flexible  because  it  would  permit  both  categorical  and   dimensional  differations  among  individuals   3. It  would  avoid  the  often  arbitrary  decisions  involved  in  assigning  a   person  to  a  diagnostic  category   • “Big  Five”  or  five-­‐factor  model  of  personality,  people  can  be  rated  on  a  series   of  personality  dimensions,  and  the  combination  of  five  components  describes   why  people  are  so  different   • The  five  factors  or  dimensions  are  extraversion,  agreeableness,   conscientiousness,  neuroticism,  and  openness  to  experience   • On  each  dimensions,  people  are  rated  high,  low  or  somewhat  in  between   • We  can  see  how  the  five-­‐factor  model  helps  us  distinguish  between  people   with  avoidant  personality  disorder  versus  schizoid  personality  disorder     Personality  Disorder  Clusters   • DSM  divides  the  personality  disorders  into  3  groups  or  “clusters”   • Cluster  A  is  called  the  “odd”  or  “eccentric”  cluster;  it  includes  paranoid,   schizoid,  and  schizotypal  personality  disorders   • Cluster  B  is  the  “dramatic”,  “emotional”  or  “erratic”  cluster;  it  consists  of   antisocial,  borderline,  histrionic,  and  narcissistic  personality  disorders   • Cluster  C  is  the  “anxious”  or  “fearful”  cluster;  it  includes  avoidant,  dependent,   and  obsessive-­‐compulsive  personality  disorders   • More  recent  work  shows  that  the  proposed  three-­‐cluster  structure  only   holds  when  the  personality  disorders  are  assessed  by  clinicians,  and  not   when  they  are  assessed  via  patient  self-­‐reports     Statistics  and  Development   • Personality  disorders  are  found  0.5-­‐2.5%  of  the  general  population   • Schizoid,  narcissistic,  and  avoidant  personality  disorders  are  relatively  rare,   occurring  in  less  than  1%  of  the  general  population   • Paranoid,  schizotypal,  histrionic,  dependent,  and  obsessive-­‐compulsive   personality  disorders  are  found  in  1-­‐4%  of  the  general  population   • Personality  disorders  are  thought  to  originate  in  childhood  or  adolescence   and  continue  into  the  adult  years  and  to  be  so  ingrained  it  is  difficult  to   pinpoint  an  onset   • Many  individuals  do  not  seek  treatment  in  the  early  developmental  phases  of   their  disorder,  but  only  after  years  of  distress   • This  delay  makes  it  difficult  to  study  people  wit  personality  disorders  from   the  beginning   • People  with  borderline  personality  disorders  are  characterized  by  their   volatile  and  unstable  relationships;  they  tend  to  have  persistent  problems  in   early  adulthood,  with  frequent  hospitalizations,  unstable  personal   relationships,  severe  depression,  and  suicidal  gestures   • People  with  antisocial  personality  disorder  display  a  characteristic  disregard   for  the  rights  and  feelings  of  others;  they  tend  to  continue  their  destructive   behaviours  of  lying  and  manipulation  through  childhood     Gender  Differences   • Borderline  personality  disorder  is  diagnosed  much  more  frequently  in   females,  who  make  up  about  75%   • According  to  recent  studies  of  their  prevalence  in  the  general  population,   equal  numbers  of  males  and  females  may  have  histrionic  and  dependent   personality  disorders   • Some  have  argued  that  histrionic  personality  disorder,  like  several  of  the   other  personality  disorders,  is  biased  against  females   • Many  of  the  features  of  histrionic  personality  disorder,  such  as   overdramatization,  vanity,  seductiveness,  and  overconcern  with  physical   appearance,  are  characteristic  of  the  Western  “stereotypical  female”   • Just  because  certain  disorders  are  observed  more  in  men  or  in  women   doesn’t  necessarily  indicate  bias   • The  criteria  for  the  disorder  may  themselves  be  biased  or  the  assessment   measures  and  the  way  they  are  used  may  be  biased     Specific  Personality  Disorders   • Paranoid,  schizoid,  schizotypal,  antisocial,  borderline,  histrionic,  narcissistic,   avoidant,  dependent,  and  obsessive-­‐compulsive     Cluster  A  Disorders:  Paranoid  Personality  Disorder   • People  with  paranoid  personality  disorder  are  excessively  mistrustful  and   suspicious  of  others,  without  any  jurisdiction   • They  assume  other  people  are  out  to  harm  or  trick  them,  and  therefore  they   tend  not  to  confide  in  others     Paranoid  Personality  Disorder:  Clinical  Description   • The  defining  characteristic  of  people  with  paranoid  personality  disorder  is  a   pervasive  unjustified  distrust   • People  with  paranoid  personality  disorder  are  suspicious  in  situations  in   which  most  other  people  would  agree  that  their  suspicions  are  unfounded   • Even  events  that  have  nothing  to  do  with  them  are  interpreted  as  personal   attacks   • People  with  paranoid  personality  disorder  may  be  argumentative,  may   complain,  or  may  be  quiet,  but  they  are  obviously  hostile  toward  others   • These  individuals  are  very  sensitive  to  criticism  and  have  an  excessive  need   for  autonomy     • Paranoid  personality  disorder  bears  relationship  to  two  disorders  we   1. The  paranoid  type  of  schizophrenia     2. Delusional  disorder   • Although  individuals  are  very  suspicious  of  others,  their  suspiciousness  does   not  reach  delusional  proportions   • Another  difference  between  the  paranoid  type  of  schizophrenia  and  paranoid   personality  disorder  is  that  the  former  also  involves  other  psychotic   symptoms  like  hallucinations,  whereas  paranoid  personality  disorders  does   not     Paranoid  Personality  Disorder:  Causes   • Evidence  for  biological  contributions  to  paranoid  personality  disorder  is   limited   • Relatives  of  individuals  with  schizophrenia  may  be  more  likely  to  have   paranoid  personality  disorder  than  people  who  do  not  have  a  relative  with   schizophrenia   • Psychological  contributions  to  this  disorder  are  even  less  certain   • Maladaptive  way  to  view  the  world,  yet  it  seems  to  provide  every  aspect  of   the  lives  of  these  individuals   • Parents  may  teach  them  to  be  careful  about  making  mistakes  and  to  impress   on  them  that  they  are  different  from  other  people   • This  vigilance  causes  them  to  see  signs  that  other  people  are  deceptive  and   malicious   • Cultural  factors  have  also  been  implicated  in  paranoid  personality  disorder   • People  such  as  prisoners,  refuges,  people  with  hearing  impairments,  and  the   elderly  are  thought  to  be  particularly  susceptible  because  of  their  unique   experiences   • Cognitive  and  cultural  factors  may  interact  to  produce  the  suspicious   observed  in  some  people  with  paranoid  personality  disorder     Paranoid  Personality  Disorder:  Treatment   • Unlikely  to  seek  professional  help  when  they  need  it,  and  they  also  have   difficulty  developing  the  trusting  relationships  necessary  for  successful   therapy   • When  they  do  seek  therapy,  the  trigger  is  usually  a  crisis  in  their  lives  or   other  problems  such  as  anxiety  or  depression,  and  not  necessarily  their   personality  disorder   • Therapists  try  to  provide  an  atmosphere  conductive  to  developing  a  sense  of   trust   • They  often  use  cognitive  therapy  to  counter  the  persons’  mistaken   assumptions  about  others,  focusing  on  changing  the  persons’  beliefs  that  all   people  are  malevolent  and  most  people  cannot  be  trusted   • No  confirmed  demonstrations  that  any  form  of  treatment  can  significantly   improve  the  lives  of  people  with  paranoid  personality  disorder     Cluster  A  Disorders:  Schizoid  Personality  Disorder   • Schizoid  personality  disorder  show  a  pattern  of  detachment  form  social   relationships  and  a  very  limited  range  of  emotions  in  interpersonal  situations   • They  seem  “aloof”,  “cold”,  and  “indifferent”  to  other  people     Schizoid  Personality  Disorder:  Clinical  Description   • Individuals  with  schizoid  personality  disorder  seem  neither  to  desire  nor   enjoy  closeness  with  others,  including  romantic  or  sexual  relationships   • Unfortunately,  homelessness  appears  to  be  prevalent  among  people  with  this   personality  disorder   • The  social  deficiencies  of  people  with  schizoid  personality  disorder  are   similar  to  those  of  people  with  paranoid  personality  disorder,  although  the   deficiencies  are  more  extreme   • People  with  paranoid  and  schizotypal  personality  disorders  often  have  ideas   of  reference,  mistaken  beliefs  that  meaningless  events  relate  just  to  them   • Those  with  schizoid  personality  disorder  share  the  social  isolation,  poor   rapport,  and  constricted  affect  seen  in  people  with  paranoid  personality   disorder   • Distinction  among  psychotic-­‐like  symptoms  in  important  to  understanding   people  with  schizophrenia,  some  of  whom  show  the  “positive”  symptoms  and   others  only  the  “negative”  symptoms     Schizoid  Personality  Disorder:  Causes  and  Treatment   • Research  o  the  genetic,  neurobiological,  and  psychosocial  contributions  to   schizoid  personality  disorder  remains  to  be  conducted   • Preference  for  social  isolation  resembles  aspects  of  autism   • Research  over  the  past  several  decades  has  pointed  to  biological  causes  of   autism,  and  it  is  possible  that  a  similar  biological  dysfunction  combines  with   early  learning  or  early  problems  with  interpersonal  relationships  to  produce   with  social  deficits  hat  define  schizoid  personality  disorder   • People  with  a  lower  density  of  dopamine  receptors  scored  higher  on  a   measure  of  detachment   • Dopamine  may  contribute  to  the  social  aloofness  of  people  with  schizoid   personality  disorder   • Rare  for  a  person  with  this  disorder  to  request  treatment,  except  in  response   to  a  crisis  such  as  extreme  depression  or  losing  a  job   • Therapists  often  begin  treatment  by  pointing  out  the  value  I  social   relationships   • The  person  with  the  disorder  may  even  need  to  be  taught  the  emotions  felt   by  others  in  order  to  learn  empathy   • The  therapist  takes  the  part  of  a  friend  or  significant  other  in  a  technique   known  as  role-­‐playing,  and  helps  he  patient  practice  establishing  and   maintaining  social  relationships     Cluster  A  Disorders:  Schizotypal  Personality  Disorder   • People  with  schizotypal  personality  disorder  are  typically  socially  isolated,   like  those  with  schizoid  personality  disorder   • They  behave  in  ways  that  would  seem  unusual  to  many  of  us  and  they  tend  to   be  suspicious  and  to  have  odd  beliefs     Schizotypal  Personality  Disorder:  Clinical  Description   • People  given  a  diagnosis  of  schizotypal  personality  disorder  are  often  “odd”   or  “bizarre”  because  of  how  they  relate  to  other  people,  how  they  think  and   behave,  and  even  how  they  dress   • They  have  ideas  of  reference,  which  means  they  think  insignificant  events   relate  directly  to  them   • People  with  schizophrenia  also  have  ideas  of  reference,  but  they  are  usually   not  able  to  “test  reality”  or  see  the  illogic  of  their  ideas   • They  report  unusual  perceptual  experiences,  including  such  illusions  as   feeling  the  presence  of  another  person  when  they  are  alone   • Only  a  small  proportion  of  individuals  with  schizotypal  personality  disorder   go  on  to  develop  schizophrenia   • Tend  to  be  suspicious  and  have  paranoid  thoughts,  express  little  emotion,   and  may  dress  or  behave  I  unusual  ways   • Children  who  later  develop  schizotypal  personality  disorder  found  that  they   tend  to  be  passive  and  unengaged  and  are  hypersensitive  to  criticism   • Mental  health  workers  have  to  be  particularly  sensitive  to  cultural  practices   that  may  differ  from  their  own  and  can  distort  their  view  of  certain   seemingly  unusual  behaviours     Schizotypal  Personality  Disorder:  Causes   • Some  people  are  thought  to  have  “schizophrenia  genes”  and  yet,  because  of   relative  lack  of  biological  influences  or  environmental  stresses,  some  will   have  the  less  severe  schizotypal  personality  disorder   • Family,  twin,  and  adoptions  studies  have  shown  an  increased  prevalence  of   schizotypal  personality  disorder  among  relatives  of  people  with   schizophrenia  who  do  not  also  have  schizophrenia  themselves   • Environment  can  strongly  influence  schizotypal  personality  disorder   • Cognitive  assessment  of  persons  with  this  disorder  point  to  mild  to  moderate   decrements  in  their  ability  to  perform  on  tests  involving  memory  and   learning,  suggesting  some  damage  in  the  left  hemisphere   • Abnormalities  in  semantic  association  abilities  may  contribute  to  the   thinking  oddities  displayed  by  schizotypal  personality  disorder     Schizotypal  Personality  Disorder:  Treatment   • 30-­‐50%  of  the  people  with  this  disorder  who  request  clinical  help  also  meet   the  criteria  for  MDD   • Treatment  will  obviously  include  some  of  the  medical  and  psychological   treatments  for  depression   • One  general  approach  has  been  to  teach  social  skills  to  help  them  reduce   their  isolation  from  and  suspicion  of  others   • A  rather  unusual  tactics  goal  is  to  help  the  person  accept  and  adjust  to  a   solitary  lifestyle   • Medical  treatment  has  seem  similar  to  that  for  people  who  have   schizophrenia   • Haloperidol,  often  used  with  schizophrenia,  was  given  to  individuals  with   schizotypal  personality  disorder   • Some  improvements  in  the  group,  especially  with  ideas  of  reference,  odd   communication,  and  social  isolation   • Negative  side  effects  of  the  medication,  including  drowsiness,  many  stopped   taking  their  medication  and  dropped  out  of  the  study     Cluster  B  Disorders:  Antisocial  Personality  Disorder   • People  with  antisocial  personality  disorder  are  among  the  most  dramatic  of   the  individuals  a  clinician  will  see  in  a  practice  and  are  characterized  as   having  a  history  of  failing  to  comply  with  social  norms   • The  perform  actions  most  of  us  would  find  unacceptable   • They  also  tend  to  be  irresponsible,  impulsive,  and  deceitful   • About  3%  of  adults  meet  criteria  for  antisocial  personality  disorder     Antisocial  Personality  Disorder:  Clinical  Description   • Individuals  with  antisocial  personality  disorder  tend  to  have  long  histories  of   violating  the  rights  of  others   • They  are  often  described  as  being  aggressive  because  they  take  what  they   want,  indifferent  to  the  concerns  of  other  people   • Lying  and  cheating  seem  to  be  second  nature  to  them,  and  often  they  appear   unable  to  tell  the  difference  between  the  truth  and  the  lies  they  make  up  to   further  their  own  goals   • They  show  no  remorse  or  concern  over  the  sometimes  devastating  effects  of   their  actions   • Substance  abuse  is  common  and  appears  to  be  a  lifelong  pattern  among  these   individuals   • The  long-­‐term  outcome  for  people  with  antisocial  personality  disorder  is   often  poor,  regardless  of  gender   • Pinel  identified  what  he  called  manie  sans  delire  to  describe  people  with   unusual  emotional  responses  and  impulsive  rages  but  no  deficits  in   reasoning  ability   • Other  labels  have  included  “moral  insanity”,  “egopathy”,  “sociopathy”,  and   “psychopathy”   • We  focus  on  the  two  that  have  figured  more  prominently  in  psychological   research:  psychopathy  and  DSM’s  antisocial  personality  disorder   • Checkley,  identified  a  constellation  of  16  major  characteristics,  most  of  which   are  personality  traits  and  are  sometimes  referred  to  as  the  “Cleckley  criteria”   (pg.  439)   • Six  f  the  criteria  that  Hare  includes  in  his  Revised  Psychopathy  Checklist   (PCL-­‐R)  on  page  440   • High  scores  indicate  psychopathy   • The  DSM  criteria  for  antisocial  personality  focus  almost  entirely  o  observable   behaviours   • Cleckly/Hare  criteria  focus  primarily  on  underlying  personality  traits   • DSM  and  previous  versions  chose  to  use  only  observable  behaviours  so   clinicians  could  reliably  agree  on  a  diagnosis   • Some  psychopaths  are  not  criminals  and  some  do  not  display  the   aggressiveness  that  is  a  DSM  criterion  for  antisocial  personality  disorder   • Although  the  relationship  between  psychopathic  personality  and  antisocial   personality  disorder  is  uncertain,  the  two  syndromes  clearly  do  not  overlap   perfectly   • Characteristics  of  psychopathy  as  described  by  Cleckley  and  Hare,  antisocial   personality  disorder  as  outlined  in  DSM,  and  criminality,  which  includes  all   people  who  get  into  trouble  with  the  law   • Although  psychopathy  and  antisocial  personality  disorder  are  both  related  to   criminality,  not  everyone  who  has  psychopathy  or  antisocial  personality   disorder  becomes  involved  with  the  legal  system   • What  separates  many  in  this  group  from  those  who  get  into  trouble  with  the   law  may  be  IQ   • Finding  suggest  that  having  a  higher  IQ  may  help  protect  some  people  from   developing  more  serious  problems,  or  may  at  least  prevent  them  from   getting  caught   • Some  individuals  with  psychotic  personality  traits  avoid  repeated  contact   with  the  legal  system  and  may  even  function  successfully  in  society   • One  study  found  that  criminals  who  scored  high  on  Hares  PCL-­‐R  put  in  less   effort  and  showed  fewer  improvements  in  a  therapy  program  than  did   criminals  who  ere  not  psychopaths   • Other  studies  have  shown  that  psychopathic  criminals  are  more  likely  than   nonpsychopathic  criminals  to  repeat  their  criminal  offences,  especially  those   that  are  violent  or  sexual  in  nature   • Incarcerated  youth  offenders  who  were  classified  as  instrumentally  violent   scored  higher  in  psychopathy  than  those  who  were  not   • The  homicides  committed  by  psychopaths  contained  significantly  higher   levels  of  both  gratuitous  and  sadistic  violence   • Study  illustrates  the  importance  of  assessing  an  inmates  levels  of   psychopathy  then  predicting  the  types  of  crimes  he  is  likely  to  commit  in  the   future   • DSM  provides  a  separate  diagnosis  for  children  who  engage  in  behaviours   that  violate  society’s  norms:  conduct  disorder   • Tremblay  supports  a  stable,  lifelong  pattern  of  antisocial  behaviour  in  a   subgroup  of  antisocial  children   • The  most  important  personality  characteristic  that  distinguished  the  boys   who  showed  a  stable  and  persistent  pattern  of  physical  aggression,  theft,  and   vandalism,  was  “psychoticsm”   • Many  adults  with  antisocial  personality  disorder  or  psychopathy  had  conduct   disorder  as  children   • The  likelihood  increases  if  the  child  has  both  conduct  disorder  and  ADHD     Antisocial  Personality  Disorder:  Genetic  Influences   • Family,  twin,  and  adoption  studies  all  suggest  a  genetic  influence  on  both   antisocial  personality  disorder  and  criminality     • Crowe  points  out  gene-­‐environment  interaction;  in  other  words,  genetic   factors  may  be  important  only  in  the  presence  of  certain  environmental   influences   • Genetic  factors  may  present  a  vulnerability,  but  actual  development  of   criminality  may  require  environmental  factors,  such  as  a  deficit  in  early,   high-­‐quality  contact  with  parents  or  parent-­‐surrogates   • Genetic  influence  does  not  necessairily  mean  certain  disorders  are  inevitable   • Personality  characteristic  called  dissocial  behaviour  has  large  genetic   component   • We  must  remember  several  limitations  when  we  interpret  findings  on  the   genetics  of  criminality   o First,  “criminality”  is  an  extremely  heterogeneous  category  that   includes  people  with  and  without  antisocial  personality  disorder  and   psychopathy    Genetics  may  influence  one  or  more  subtypes  of  criminality     o Second,  it  is  clear  that  environment  factors  play  a  substantial  role  in   many,  if  not  all,  cases  of  criminality   o Finally,  the  interaction  between  genes  and  environment  may  be   important  in  the  genesis  of  criminality     Antisocial  Personality  Disorder:  Neurobiological  Influences   • A  great  deal  of  research  has  focused  on  neurobiological  influences  that  may   be  specific  to  antisocial  personality  disorder   • Relative  to  controls,  psychopaths  evidenced  deficits  in  their  abilities  to   maintain  a  plan  and  to  inhibit  irrelevant  information  suggesting  executive   cognitive  function  deficits  in  psychopaths   • Two  major  neurobiological  theories  have  attracted  a  great  deal  of  attention   in  the  area  of  psychopathy:   1. The  underarousal  hypothesis   2. The  fearlessness  hypothesis   • According  to  the  underarousal  hypothesis,  psychopaths  have  abnormally  low   levels  of  cortical  arousal   • There  appears  to  be  an  inverted  U-­‐shaped  relation  between  arousal  and   performance   • Yerkes-­‐Dodson  curve  suggests  that  people  with  either  very  high  or  very  low   levels  of  arousal  tend  to  experience  negative  affect  and  perform  poorly  in   many  situations,  whereas  individuals  with  intermediate  levels  of  arousal   tend  to  be  relatively  content  and  perform  satisfactorily  in  most  situations   • According  to  the  underarousal  hypothesis,  the  abnormally  low  levels  of   cortical  arousal  characteristic  of  psychopaths  are  the  primary  cause  of  their   antisocial  and  risk-­‐taking  behaviours   • They  seek  stimulation  to  boost  their  chronically  low  levels  of  arousal   • Low-­‐frequency  theta  waves  are  found  in  brain  wave  measures  of  children   and  largely  disappear  in  adulthood;  their  specific  purpose  is  unknown   • Evidence  suggests  that  many  psychopaths  have  excessive  theta  waves  when   they  are  awake   • Cortical  immaturity  hypothesis  of  psychopathy  holds  that  the  cerebral  cortex   of  psychopaths  is  at  a  relatively  primitive  stage  of  development   • This  hypothesis  may  help  explain  why  the  behaviour  of  psychopaths  is  often   childlike  and  impulsive   • Their  cerebral  cortices,  which  play  such  a  key  role  in  the  inhibition  and   control  of  impulses,  may  be  insufficiently  developed   • Because  theta  waves  also  indicate  states  such  as  drowsiness  or  boredom,   psychopaths  higher  levels  of  theta  waves  may  simply  reflect  their  relative   lack  of  concern  regarding  being  hooked  up  to  psychphysiological  equipment   • Excessive  theta  waves  of  psychopaths  may  simply  reflect  their  relative   absence  of  anxiety   • According  to  the  fearlessness  hypothesis,  psychopaths  possess  a  higher   threshold  for  experiencing  fear  than  most  other  individuals   • The  fearlessness  of  the  psychopath  gives  rise  to  all  the  other  major  features   of  the  syndrome   • Psychopaths  may  have  difficulty  associating  certain  sues  or  signals  with   impending  punishment  or  dange
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