Explicating the Construct of Psychopathy: Development and Validation of a Conceptual Model, the Comprehensive Assessment of Psychopathic Personality (CAPP)

Abstract

Psychopathic personality disorder (PPD) has important clinical and forensic implications. But much more effort has been devoted to assessing or diagnosing PPD than to explicating or defining it. In the first part of this paper, we describe the development of a conceptual model or “concept map” of PPD. Based on a systematic review of descriptions of PPD in the clinical and research literature, as well as consultation with subject matter experts, we identified key features of the disorder and translated them into 33 symptoms, presented as natural language (i.e., non-technical) trait descriptive adjectives or adjectival phrases. Each symptom in turn was defined by three synonymous adjectives or adjectival phrases. The 33 symptoms were grouped rationally to reflect six domains of personality functioning. In the second part of the paper, we discuss research completed and in progress intended to validate the CAPP conceptual model.

Keywords:

• psychopathy
• antisocial personality disorder
• dissocial personality disorder
• Comprehensive Assessment of Psychopathic Personality
• CAPP

Notes

We have heard some people argue that psychopathic, antisocial, dissocial, and sociopathic personality disorder are distinct entities, and others that PPD “does not exist” insofar as it doesn't appear in the Fourth Edition, Text Revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) or the 10th edition of the International Classification of Diseases and Related Health Problems (ICD-10). Such arguments confuse the map with the terrain. As Hart and Cook (in press) pointed out:

As a concept, PPD is indeed synonymous with antisocial, dissocial, and sociopathic personality disorder. They are simply different terms for the same disorder. This is explicitly recognized in the DSM-IV-TR (p. 703). So PPD is included in the DSM-IV-TR, where it is referred to as antisocial personality disorder, and in the ICD-10, where it is referred to as dissocial personality disorder. At an operational level, however, the various procedures for assessing and diagnosing PPD definitely are not equivalent. But, of course, even diagnostic criteria with the same name may differ markedly in content.

We recognize that the ICD-10, DSM-IV-TR, PCL:SV, and PCL-R criteria are not concept maps—they are intended to measure or diagnose rather than define PPD. But as the content of a concept map should be more comprehensive than that of a measure, comparing the CAPP to existing diagnostic criteria yields a conservative evaluation of its efficiency. For example, if one considers the full text entry for a disorder in the DSM-IV-TR to function as a concept map, then the DSM-IV-TR requires more than 2,000 words to define antisocial personality disorder—more than 10 times as many words used in the CAPP.