Disentangling Psychopathy From Antisocial Personality Disorder An Australian Analysis

Journal of Forensic Psychology Practice
ISSN: 1522-8932 (Print) 1522-9092 (Online) Journal homepage: http://www.tandfonline.com/loi/wfpp20
Disentangling Psychopathy from Antisocial

Personality Disorder: An Australian Analysis
James R. P. Ogloff PhD, JD, Rachel E. Campbell DPsych & Stephane M.

Shepherd PhD
To cite this article: James R. P. Ogloff PhD, JD, Rachel E. Campbell DPsych & Stephane M.
Shepherd PhD (2016) Disentangling Psychopathy from Antisocial Personality Disorder:
An Australian Analysis, Journal of Forensic Psychology Practice, 16:3, 198-215, DOI:
10.1080/15228932.2016.1177281
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JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE
2016, VOL. 16, NO. 3, 198–215
http://dx.doi.org/10.1080/15228932.2016.1177281
Disentangling Psychopathy from Antisocial Personality

Disorder: An Australian Analysis
James R. P. Ogloff, PhD, JD, Rachel E. Campbell, DPsych,
and Stephane M. Shepherd, PhD
Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of
Forensic Mental Health Forensicare, Clifton Hill, Victoria, Australia
ABSTRACT KEYWORDS
Downloaded by [Orta Dogu Teknik Universitesi] at 14:10 16 May 2016
The relationship between psychopathy and antisocial personality antisocial personality

disorder (APD) was explored in a sample of Australian mentally disorder; forensic
disordered offenders. Two Hare adult psychopathy measures, the psychology; PCL-R;
Psychopathy Checklist–Revised (PCL-R) and the Psychopathy psychopathy; violence risk
assessment
Checklist: Screening Version (PCL: SV) were employed and a
diagnosis of APD was measured for 136 participants in a secure
forensic psychiatric inpatient facility. Results revealed clear dis-
tinctions between measurements of psychopathy and APD. Over
65% of patients high in psychopathic traits received a diagnosis
of APD while only 5.5% of patients with APD were high in
psychopathic traits, denoting an asymmetric relationship.
Implications for the assessment and treatment of mentally dis-
ordered offenders with psychopathic traits are discussed.
Psychopathy is a personality disorder with historical and clinical significance

that has been the subject of extensive inquiry. In contemporary times it is
often understood to be synonymous with antisocial personality disorder
(APD). Indeed, in the description for APD, the Diagnostic and Statistical
Manual of Mental Disorders, fifth edition (DSM-V) even states that “this
pattern has also been referred to as psychopathy” (American Psychiatric
Association [APA], 2013, p. 659). Although encompassing antisocial beha-
viors, what distinguishes psychopathy from APD is a poverty of empathic
responding and shallow affect. Some experts have maintained a clear distinc-
tion between psychopathy and cognate personality disorders, namely APD
(i.e., Ogloff, 2006). In contrast, others have used a variety of labels to refer to
the same personality construct, and even argue that “despite fine distinctions,
for practical purposes psychopathic personality and antisocial personality can
be regarded as largely synonymous descriptions of the same condition”
(Lynn, 2002, p. 274).
After undergoing classification alterations over the past 60 years (see
Arrigo & Shipley, 2001), the contemporary diagnostic criteria for APD
CONTACT Stephane Shepherd sshepherd@swin.edu.au Centre for Forensic Behavioural Science,

Swinburne University of Technology, 505 Hoddle Street, Clifton Hill, VIC 3068, Australia.
© 2016 Taylor & Francis
JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 199
require that an individual exhibit a persistent pattern of disregard for and

violation of the rights of others (American Psychiatric Association, 2013).
The items are predominantly behavioral and include a failure to adhere to
social norms, deceitfulness, impulsivity, irritability, irresponsibility, remorse-
lessness, and neglect for the safety of others. The disorder also necessitates
evidence of conduct disorder prior to the age of 15. Practically speaking, the
incidence of APD in criminal and forensic settings is unsurprisingly high
given the reliance on behaviors relating to criminality. This has elicited
concern over the lack of discriminative ability and diagnostic ubiquity in
criminal populations (Hart & Hare, 1997; Ogloff, 2006).
Psychopathy, as it came to be known, was among the disorders first
categorized in psychiatric nosology. What differentiates psychopathy from
other personality disorders is a penchant for callousness, narcissism, manip-

ulation, and absence of empathy. Following early accounts of the disorder
complied by Hervey Cleckley, Robert Hare devised a research tool aimed at
operationalizing the construct of psychopathy. Often referred to as the gold
standard of measurement for psychopathy within clinical and forensic settings
(Edens, Skeem, Cruise, & Cauffman, 2001), the Psychopathy Checklist–Revised
(PCL-R) has become the most widely used measure of psychopathy. Interest in
the construct of psychopathy can, in part, be attributed to the utility of the
Hare Psychopathy instruments to predict recidivism and other problem
behaviors.
Diagnostic comparisons
APD is diagnosable in up to 3% of the population (APA, 2013; Lenzenweger,
Lane, Loranger, & Kessler, 2007). The rate of APD is much higher in clinical
and forensic settings. Approximately 30% of civil psychiatric patients are
diagnosed with APD, and up to 80% of individuals in forensic or correctional
settings are given the diagnosis (American Psychiatric Association, 2013;
Côté & Hodgins, 1990; Douglas, Ogloff, Nicholls, & Grant, 1999; Hare,
1996, 2003). By contrast, the prevalence of psychopathy is low. It is estimated
that less than 1% of the population will score within the range indicative of a
prototypical psychopath (Forth, Brown, Hart, & Hare, 1996; Hare, 2003;
Monahan et al., 2001). On the other hand, approximately 15.7% of male
offenders, 10% of forensic-psychiatric patients and 7.4% of female offenders
in North America achieve PCL-R scores above 30 (Hare, 2003). These
estimates are modest compared to those for APD.
Research has reliably found an asymmetric association between APD and
psychopathy. While most psychopathic offenders meet criteria for APD, the
majority of offenders with APD will not achieve instrument scores indicative of
psychopathy (Hare & McPherson, 1984; Hart & Hare, 1989; Hildebrand & de
Ruiter, 2004; Meloy, 1988; Pham & Saloppe, 2010). Poythress et al. (2010)
200 J. R. P. OGLOFF ET AL.
discovered a sizable (n = 195) cluster of individuals with very low psychopathy

scores in a sample of 691 offenders who met the criteria for APD. Additionally,
in a breakdown of PCL-R and APD criteria, Ogloff (2006) showed that APD
criteria tap into only three of the eight (37.5%) PCL-R Factor 1 items, which
relate to affective and interpersonal symptoms. Unsurprisingly, the behaviorally
based APD diagnosis correlates more meaningfully with the PCL-R Factor 2,
which comprises socially deviant behavior (Frick, O’Brien, Wootton, &
McBurnett, 1994). This evidence suggests that an APD criterion is not encom-
passing key psychopathic characteristics. What is more, DSM’s have not pro-
vided any means of specifically classifying psychopathic personality traits,
despite decades of empirical evidence attesting to psychopathy’s unique exis-
tence (Arrigo & Shipley, 2001; Hare & Neumann, 2010; Widiger, 2006).
Alternatively, not all experts agree that APD and psychopathy represent two
different disorders. Skilling, Harris, Rice, and Quinsey (2002) argue that they are
underlined by the same natural class. Widiger (2006) proffers that APD and
psychopathy, as measured by PCL-R criteria, are similar and may capture the
same disorder. A study by Coid and Ullrich (2010) discovered substantial over-
lap between the PCL-R and APD, advancing that psychopathy is essentially at
the severe end of the APD spectrum. The DSM-V makes no distinction about
the degree of severity of the disorder, although a dimensional APD model with
an additional psychopathy specifier is now included in Section III as an “emer-
ging measure or model.” Yet psychopathy as a discrete diagnosis remains absent
from the new DSM-V. Given the prevalence of APD in correctional settings and
the therapeutic nihilism associated with psychopathy (see Gacono, Neiberding,
Owen, Rubel, & Boldholt, 2000), the continued interchangeability of these
disorders is potentially harmful, and can preclude appropriate treatment
schemes for offenders suffering either disorder (Ogloff & Wood, 2010;
Shipley & Arrigo, 2001). Recent investigations show that the new trait-based
APD diagnostic approach found in Section III of the DSM-V provides greater
coverage of psychopathic traits (Anderson, Sellbom, Wygant, Salekin, &
Krueger, 2014; Few, Lynam, Maples, MacKillop, & Miller, 2015; Strickland,
Drislane, Lucy, Krueger, & Patrick, 2013). Yet other studies have found that
unique psychopathic items are still unaccounted for (Crego & Widiger, 2014;
Venables, Hall, & Patrick, 2014). With few other exceptions (i.e., Ogloff, 2006;
Poythress et al., 2010), there is still an underwhelming body of empirical
research differentiating the two constructs. This is acutely apparent outside
North America. To address this issue, this study explores the constructs of
APD and psychopathy in an Australian sample of mentally disordered offenders
(MDOs). It examines the prevalence of each disorder and determines if distinc-
tions between measures of APD and psychopathy reflect theoretical differences
in the literature.
It was hypothesized that psychopathy would be predictive of a diagnosis of
APD, while APD would not predict psychopathy. Given the overlap between
APD and psychopathy, it was expected that the behavioral components of

both constructs would be highly correlated. Specifically, APD would correlate
strongly with the behavioral aspects of the PCL-R (Factor 2), but less so with
the affective and interpersonal features (Factor 1).
Methodology
Sample
The current study drew a random sample of 136 patients (men n = 98; women
n = 38) from a larger sample of all 265 forensic-psychiatric patients from
Thomas Embling Hospital (TEH) in Melbourne, Australia, between August
2000 and November 2003
The hospital is operated by the Victorian Institute of Forensic Mental Health

(Forensicare) and is Victoria’s only secure forensic mental health facility. TEH
provides assessment and treatment to men and women with serious mental
illnesses requiring secure inpatient psychiatric hospitalization. Most patients
who go through TEH are transferred from prison when they require involuntary
psychiatric hospitalization, and are returned to prison once stabilized. The
largest number of patients held long-term in the TEH are those found not guilty
by reason of mental impairment and who require hospitalization.
Demographics
Almost three quarters of the sample were male (72.1%), and the mean age at
discharge was 32.2 years (SD = 9.4; Mdn = 30.2; range 17–62). The majority
of patients in the sample were Caucasian (78.7%, n = 107). The vast majority
of patients were admitted to TEH from prison (87.5%). In the study sample,
72% had been diagnosed with either psychotic or affective disorders (with
psychotic features) at discharge. In contrast, few patients received a primary
diagnosis of personality disorder at admission or discharge (7.4% and 8.8%
respectively). A considerable number of patients (64.7%; n = 88) had been
previously hospitalized in a civil psychiatric facility. Just over half (54.4%)
had a previous conviction for a violent offense, while the large majority had
been convicted of a past nonviolent offense (73.5%, n = 100). The most
frequent index offense category was theft or robbery (47.1%), followed by
assault (33.1%), possessing or carrying a weapon (19.9%), and property
damage (19.1%).
Ethics
The research project was approved by the Victorian Institute of Forensic
Mental Health, the Ethics Committee of the Department of Human Services,
the Research Coordinating Committee of the Victoria Police, and the

Monash University Standing Committee on Ethics in Research Involving
Humans (SCERH).
Measures
Psychopathy Checklist–Revised (PCL-R)
The PCL-R (Hare, 1991, 2003) was developed as a measure of psychopathic
personality traits. The PCL-R has traditionally been divided into two mod-
erately correlated factors (r = .50; Hare et al., 1990; Harpur, Hakstian, &
Hare, 1988). Factor 1 represents the affective or interpersonal features and
Factor 2 captures the behavioral aspects of psychopathy. Factor analyses have
shown that Factors 1 and 2 may be further divided into two facets each: Facet
1 (Interpersonal) and Facet 2 (Affective) fall under the original Factor 1, and
Facet 3 (Lifestyle) and Facet 4 (Antisocial) are aligned with Factor 2. The 20
PCL-R items and Hare’s four-facet structure are presented in Figure 1
(Hare, 2003).
Each of the 20 items are scored on a 3-point scale (0 = item does not apply,
1 = item applies to a certain extent, 2 = item definitely applies). Although the
PCL-R total score may best be described as dimensional, a score of 30 and
above is considered an appropriate categorical diagnostic cutoff, though
indicative of the prototypical psychopath (Hare, 2003).
The psychometric properties of the PCL-R are well established (Forth,
Kosson, & Hare, 2003; Fulero, 1995; Hare, 2003). A high level of reliability
has been established across varied samples and countries when used by
trained raters; intraclass coefficients (ICC1) around .80 for the single rater
and .90 for the average of raters (ICC2) have been reported.
Figure 1. Scale structure of the PCL-R: Second edition (Hare, 2003).

Psychopathy Checklist: Screening Version (PCL: SV)

The original 20-item measure was condensed into a shorter 12-item version,
the Psychopathy Checklist: Screening Version (PCL: SV, Hart, Cox, & Hare,
1995). The screening measure has been validated with populations beyond
the criminal justice system (e.g., civil psychiatric; Doyle & Dolan, 2006;
Skeem & Mulvey, 2001). For research purposes, a score of 18 and above is
considered indicative of the presence of psychopathy.
The measure demonstrates acceptable internal consistency for the total
score, and parts 1 and 2 (weighted mean alphas of .84, .81, and .75, respec-
tively), good item construct validity (Rogers et al., 2000), and adequate
interrater reliability (mean weighted ICC1 for Total scores .84; Hart et al.,
1995). The PCL: SV total and part scores show high concurrent validity with
the PCL-R total and factor scores.
Antisocial personality disorder

Antisocial personality disorder (APD) was assessed using the criteria from
the DSM-IV-TR (American Psychiatric Association, 2000), which remain
unchanged in the DSM-V (American Psychiatric Association, 2013). The
criteria required for a diagnosis of APD are displayed in Table 1.
Based on extensive information available in the clinical files (e.g., docu-
mented past history, inpatient behavior, staff reports, criminal records, etc.),
a diagnosis of APD was made by raters using the above DSM-IV-TR criteria.
Each of the four criteria were coded Yes, No, or Don’t Know. The seven
sub-items that make up Criterion A were also coded Yes, No, or Don’t Know.
Furthermore, an overall diagnosis (i.e., whether collectively all four APD
criteria were met) was coded Yes, No, or Not Enough Information to Make a
Diagnosis. This diagnosis was independent of any preexisting APD diagnosis
Table 1. DSM-IV-TR criteria for antisocial personality disorder (American Psychiatric Association, 2000).
(A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age
15 years, as indicated by three or more of the following:
(1) failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly
performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or
pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or
honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or
stolen from another
(B) The individual is at least 18 years
(C) There is evidence of conduct disorder with onset before age 15 years
(D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic
episode
or traits that had been documented in the file (i.e., in past reports, case notes
from prior services).
This information generated three APD variables labeled (a) APD-Met, (b)
APD adult-symptoms, and (c) APD-8. The first of these variables, APD-Met,
is a dichotomous variable comprising patients who clearly met the APD
criteria, and those who did not (1 = APD Yes; 0 = APD No). The second
APD variable, APD adult-symptoms, is a dimensional variable comprising
the sum of the seven Criterion A (adult) items (0–7), prorated for the
number of Don’t Know responses. Finally, a third variable, APD-8, is also a
dimensional variable that comprises the sum of Criterion A (adult) symp-
toms (0–7), plus Criterion C (evidence of conduct disorder, coded Yes, No, or
Don’t Know). This produces an 8-item score encompassing all eight child and
adult items featured in the DSM-IV APD criteria.

Information was also collected pertaining to whether patients, at any point
in the past, had been diagnosed with APD or APD traits. This information
was categorically coded (Diagnosis = 2, Traits = 1, No APD = 0), and created
the fourth APD variable, labeled APD-Past.
Procedure
Each of the patients’ files was retrospectively coded using a broad range of
information collected from clinical and legal files about a patient’s back-
ground. The file information and assessment instruments were coded prior
to the collection or entry of recidivism data.
The file information was used to code the PCL-R (Hare, 2003), the PCL:
SV (Hart et al., 1995), and the APD criteria (APA, 2000) as required by the
test manuals. Where insufficient file information precluded a PCL-R Total
score rating, the patient’s PCL: SV score was used. Due to the quality of file
information available, it was not always possible to complete the study
measures; therefore, the number of participants included in analyses may
vary. The coding of instruments was completed by doctoral-level clinical
forensic-psychology raters. Both coders were trained on the administration of
the PCL measures during a three-day workshop conducted by the measures’
author, Robert Hare, and the third author.
Data handling and analysis

Statistical analyses were performed using the Statistical Package for the Social
Sciences (SPSS, 1999). Interrater reliability for the PCL-R/SV measures was
considered by means of an intraclass correlation coefficient (ICC) with a
one-way (rater) random effect model. For APD variables, a raw percentage of
total agreement and kappa coefficients were employed. Descriptive statistics
were used to establish the base rates of psychopathy and APD in the sample.
The level of measurement agreement between the PCL-R and PCL: SV was
examined using a median split (above the median and below or equal to the
PCL median). The chi-square test was used to determine differences in
frequency distributions between the measures. In addition, odds ratio and
kappa coefficients were calculated to indicate the association between the
measures.
The level of agreement between the PCL-R and APD variables was evaluated
using a number of statistical methods. First, Pearson’s r was used to perform
intercorrelations between the continuous APD and PCL-R/SV total and sub-
scale scores; point-biserial correlations were employed to compare the con-
tinuous measures with the categorical and dichotomous APD variables.
Second, simple cross-tabulations were used to determine the level of agree-
ment between the measures, and the chi-square test of independence was used
to determine differences in the frequency distributions between the measures.
Results
Interrater reliability
Interrater reliability of file coding was assessed by having the primary rater
and another rater code a randomly chosen subset of 20 (14.7%) files. The
ICC coefficients for the PCL-R total, Factor 1 and 2 scores were high: .94, .81,
and .97, respectively. The PCL: SV Total, Parts 1 and 2 score coefficients,
were also high: .95, .84, and .86 respectively.
The two raters demonstrated a high level of agreement in determining
which patients met the APD DSM-IV criteria. A kappa coefficient value
of .69 and a total percentage agreement of 80% were achieved. Agreement
pertaining to the presence of past APD diagnoses or APD traits was high,
generating a kappa value of .92 and achieving 95% total agreement. The four
APD criteria were compared through evaluation of the total percent of
agreement between raters. Overall, the level of agreement between raters on
the APD variables was high (80–100%).
PCL-R/SV measurement agreement

The PCL-R and PCL: SV were compared to evaluate the extent to which
these two related measures identified the same individuals as above or
below the median (high or low). A strong association was gleaned,
χ2(1, N = 128) = 72.14, p < .0001, κ = .75, OR = 52. Of the 58 people who
scored above the PCL-R median, 52 also scored above the PCL: SV median.
Of the 70 people who scored below the median on the PCL-R, 60 also scored
below the median on the PCL: SV. The PCL-R and PCL: SV total scores were
also highly correlated (r = .91, p < .01)
Base rate of psychopathy and APD

Valid data were obtained to complete PCL-R Total scores for over 90% of the
study sample. The mean PCL-R Total score was 15.0 (SD = 6.8; Mdn = 15.6;
range 1–34). Three patients (2.4%) received a PCL-R score of 30 and above.
Three quarters of the sample’s PCL-R scores placed them in the low range of
psychopathy (PCL-R < 20), while 21.1% (n = 26) scored in the moderate
range (PCL-R score 20–29).
As expected given its role as a screening measure, the PCL: SV produced a
slightly higher base rate of psychopathy than did the full PCL-R. It was
possible to generate PCL: SV Total scores for 94.9% (n = 129) of the sample.
The mean PCL: SV score was 10.9 (SD = 4.8; Mdn = 11; range 1–24). The
cutoff score used by the PCL: SV authors (PCL: SV score ≥ 18; Hart et al.,
1995) identified seven individuals (5.4%). More than 60% of the sample fell
in the low range of psychopathy (PCL: SV < 13); 30% in the moderate range
(PCL: SV score 13–17).
The prevalence of APD (diagnosed using DSM-IV criteria) was 27.2%
(n = 37). There was not enough information to make a definitive diagnosis in
almost one third of patient cases (31.6%; n = 43). This was predominantly due to
the lack of information required to fulfill criteria C and D. Using the dimen-
sional APD variable (APD adult-symptoms), the mean number of DSM-IV
adult symptoms was 5.23 (SD = 2.1; Mdn = 5.83; range 0–7). When the conduct
disorder criteria were also considered (i.e., APD-8), the mean number of child
and adult symptoms combined (7 + 1) was 5.8 (SD = 2.4; Mdn = 6.7; range 0–8).
The incidence of past APD diagnoses (APD-Past) was 23.5%.
Intercorrelations between APD and the PCL-R/SV

Although some variability was apparent, as is evidenced in Table 2, many of
the correlations were significant and large in magnitude. The dimensional
APD adult-symptom score yielded large and significant correlations with the
PCL-R (r = .75, p < .01) and PCL: SV Total scores (r = .76, p < .01). A
breakdown of the subscale scores revealed particularly strong correlations
with the PCL-R/SV Factor/Part 2 and Facets 3 and 4 subscales, ranging from
.64 to .75. Inclusion of the conduct disorder item (Criterion C) produced
slightly higher correlations with the PCL-R and PCL: SV Total scores
(.78 and .79, respectively), but yielded a similar trend where the smallest
correlations observed were with Factor/Part 1 and Facets 1 and 2 (i.e., APD-8
correlated at .79 with Factor 2, compared to just .40 with Factor 1). The
correlations with the dichotomous (APD-Met) and categorical (APD-Past)
APD variables were comparable; stronger and larger correlations were
observed with Factor/Part 2 and the associated facets than with Factor/Part
1 and its facet derivatives.
Table 2. Intercorrelations of APD variables and PCL measures.

APD-Past rpb APD adult-sx APD-8 PCL:SV Total Part 1 Part 2 PCL-R Total Factor 1 Factor 2 Facet 1 Facet 2 Facet 3 Facet 4
APD-Met rpb .42** .39** .45** .52** .30** .53** .56** .34** .58** .21* .34** .41** .61**
APD-Past rpb .45** .48** .56** .33** .55** .50** .26** .53** .06 .38** .47** .47**
APD adult-sx .98** .76** .44** .75** .75** .39** .74** .20* .47** .64** .70**
APD-8 .79** .45** .79** .78** .40** .79** .19* .47** .68** .75**
PCL:SV Total .78** .84** .91** .74** .78** .51** .76** .68** .74**
Part 1 .35** .68** .94** .32** .75** .91** .26** .33**
Part 2 .80** .34** .90** .16 .38** .81** .84**
PCL-R Total .70** .88** .50** .71** .80** .80**
Factor 1 .32** .83** .94** .27** .34**
Factor 2 .15 .38** .91** .88**
Facet 1 .60** .13 .20*
Facet 2 .31** .37**
Facet 3 .65**
Note. n ranges 110–136. **p < .01 (2-tailed). *p < .05 (2-tailed). All correlations are significant unless bold. rpb is a point-biserial correlation coefficient. APD-Met = APD DSM-IV
criteria met; APD-Past = past APD diagnosis or APD traits; APD adult-sx = DSM-IV APD adult-symptoms (Criterion A); APD-8 = DSM-IV APD child and adult symptoms; PCL:
SV = Psychopathy Checklist: Screening Version; PCL-R = Psychopathy Checklist–Revised.
JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE
207
Measurement agreement between the PCL-R and APD variables

A good level of agreement was revealed between the PCL-R and the APD-8
variable, χ2(1, N = 131) = 54.6, p < .0001, κ = .62, OR = 33. Of the 60 (48.8%)
people who scored above the median on the PCL-R, 56 (45.5%) also scored
above the median on the APD-8 (see Table 3). Four of the 60 patients scoring
above the median on the PCL-R scored low on the APD-8. Of the 71 people
who scored below the median on the PCL-R, 50 also scored below the
median on the APD-8. Interestingly, 21 individuals who scored high on the
APD-8 scored low on the PCL-R.
To further determine the probability of psychopathy, given the presence of
APD, the PCL-R was compared with the two remaining APD categorical and
dichotomous variables (i.e., APD-Met and APD-Past). Using the dichoto-
mous APD-Met variable and a PCL-R cutoff score of 30 (See Table 4),
analyses revealed that 66.6% of individuals with high PCL-R scores met the
criteria for a diagnosis of APD, while only 5.6% of those who met the criteria
for APD were psychopathic, Fisher’s p = .0001. The small sample size for this
analysis engendered the employment of a lower cutoff score. Using the
second grouping (i.e., based on the sample’s mean and SD scores), 75% of
those with moderate to high PCL-R scores (PCL-R score ≥ 22) had a
diagnosis of APD, while 41.7% of those with APD had scores in the high
psychopathy range; χ2(2, N = 123) = 29.11, p < .000. Thus, most individuals
with moderate to high PCL-R scores received a diagnosis of APD, while a
smaller proportion of individuals with APD achieved moderate to high
PCL-R scores. Odds ratio analysis revealed that moderate to high
Table 3. Measurement agreement between PCL-R and APD-8 as a function of high and low
scores on the median.
PCL-R
Low High Total
APD-8 Low 50 (70.4%) 4 (6.7%) 54
High 21 (29.6%) 56 (93.3%) 77
Total 71 60 131
Table 4. Measurement agreement between PCL-R groupings and APD-Met.

APD-Met
PCL-R Group No Yes Total
Conventional score categories Low < 20 76 18 94
Medium 20–29 10 16 26
High ≥ 30 1 2 3
Total 87 36 123
Study-derived cutoff scores Low < 8 20 0 20
Medium ≥ 8–< 22 62 21 83
High ≥ 22 5 15 20
Total 87 36 123
Table 5. Measurement agreement between PCL-R groupings and APD-Past diagnosis and traits.
APD-Past
PCL-R Group No APD Traits Diagnosis Total
Conventional score categories Low < 20 58 16 20 94
Medium 20–29 5 11 10 26
High ≥ 30 1 0 2 3
Total 64 27 32 123
Study-derived cutoff scores Low < 8 18 0 2 20
Medium ≥ 8–< 22 44 17 22 83
High ≥ 22 2 10 8 20
Total 64 27 32 123
psychopathy scores (PCL-R ≥ 22) were significantly associated with APD,

χ2(1, N = 123) = 24.13, OR = 11.71, p < .000. Patients with moderate to high
psychopathy scores were almost 12 times more likely to receive a diagnosis of

APD than those with low psychopathy scores.
In the second set of analyses, the APD-Past variable was cross-tabulated
with the PCL-R grouping variable (high, medium, and low). A similar trend
emerged (see Table 5); 66.7% of those with high PCL-R scores (PCL-R
score ≥ 30) received a diagnosis of APD, while only 6.3% of those with
APD Diagnoses achieved scores in the high psychopathy range, Fisher’s
exact, p = .000. Using the study-derived cutoff scores, 40% (n = 8) of those
with moderate to high PCL-R scores (PCL-R score ≥ 22) received a diagnosis
of APD, while a quarter (n = 8) of those with an APD diagnosis had scores in
the high psychopathy range, Fisher’s exact, p = .000.
Using conventional cutoff scores, around 60% of individuals who had been
diagnosed or displayed traits of APD (62.5%, n = 20; 59.3%, n = 16, respec-
tively) achieved PCL-R scores that placed them in the low score range (see
Table 5). Similarly, for those who met APD criteria using the dichotomous
variable, APD-Met, 50% (n = 18) received scores that placed them in the low
range of PCL-R scores (PCL-R score < 20; see Table 4).
Discussion
Base rates of psychopathy and APD
It was hypothesized that the base rate of psychopathy would be lower than
that observed in criminal offenders, but higher than civil psychiatric samples
(Hare, 2003). The base rate of psychopathy in the current sample (using a
cutoff score of ≥ 30) was lower than the rate observed in criminal offenders;
however, distinct from previous research (see Hare, 1991; Hart, Hare, &
Forth, 1994), the base rate of psychopathy (2.2%, M = 15, SD = 6.8) was
also lower than typically found in civil-psychiatric settings. It is important to
note that PCL-R scores, derived from both interview and file review in male
forensic-psychiatric patients, produce higher scores (pooled mean 21.5,
SD = 6.9) than studies where the score is based on file review alone (pooled
mean = 17.4, SD = 9.3) (Hare, 2003). Although the PCL-R manual generates
a pooled average for the file review approach from just two samples (mean
scores of 15.5 and 20.1), the trend is consistent with the broader state of
research that has since emerged. Hart and Hare (1989) also found that high
PCL total scores tend to be associated with the absence of an Axis I principal
diagnosis. Douglas, Strand, Belfrage, Fransson, and Levander (2005) also
reported that psychopathy was significantly and negatively correlated with
diagnoses of psychosis. Thus, the observed base rate of psychopathy may be a
function of the high number of individuals with psychotic disorders in the
current sample.
Psychometric properties of APD and PCL-R/SV

The current study similarly revealed that individuals with high psychopathy
scores (PCL-R ≥ 22) were 11.71 times more likely than those with low scores to
meet the criteria for a diagnosis of APD. Although this trend did not hold true
when a higher PCL-R cutoff score was utilized (PCL-R ≥ 26), it is likely that
when the cutoff score was increased, the base rate fell below the number
necessary to satisfy assumptions of normality. Similarly, although employing a
cutoff of 30, Hart and Hare (1989) found that the likelihood of being diagnosed
with APD was 11.32 times greater for those with high psychopathy scores.
It was hypothesized that the relationship between APD and psychopathy
would be asymmetric. Specifically, a comparison of the dichotomous APD
variable and the PCL-R found that 66.6% of individuals with high PCL-R
scores (≥ 30) received a diagnosis of APD, while only 5.5% with APD
achieved high psychopathy scores. Although this result is unconvincing
given the small number of participants with PCL-R scores above 30, a similar
trend emerged when a lower PCL-R cutoff score was employed. Hildebrand
and de Ruiter (2004) found that more than 80% of patients diagnosed as
psychopathic met the criteria for APD, while only 38% of those with APD
scored above 30 on the PCL-R. Hart and Hare (1989) also found that
psychopathy was diagnostic of APD (PPP = .90), but that APD was not
predictive of psychopathy (PPP = .23). Another important finding is the
notable proportion of individuals with APD diagnoses who obtain low scores
on the PCL measures. It is likely that this asymmetry is the product of
differences in the base rate of the two disorders in the sample, but also a
function of the strong and robust relationship shared between APD and
Factor 2 (Hare, 2003; Hart & Hare, 1989). That is, while most psychopaths
engage in the type of behavior that defines the APD criteria (e.g., early
behavioral problems, irresponsibility, impulsivity), the large majority of indi-
viduals with APD do not show sufficient evidence of interpersonal or affec-
tive deficits characteristic of the psychopath (Hart & Hare, 1989).
Consistent with previous research, the results of the current study revealed
strong correlations between the PCL-R/SV Total scores and the dichotomous
and categorical APD variables (Frick et al., 1994; Hart & Hare, 1989). As
predicted, APD was strongly and positively correlated with Factor/Part 2, but
less so with Factor/Part 1. Similarly, the dimensional APD variables also
shared large and significant correlations with the PCL-R/SV Total scores.
This is consistent with findings reported by Skilling et al. (2002), who found
large, positive, and significant correlations between a dimensionally coded
APD variable and the PCL-R total and factor scores. While Skilling and
colleagues argue that the two constructs share the same natural class, there
are a number of reasons why this is unlikely.
Factor 2 was found to contribute to a diagnosis of APD more than Factor
1. Notably, the Factor/Part 2 correlations were similar to those of the PCL-R

Total score. This suggests that that antisocial and irresponsible lifestyle traits
(i.e., scores on Factor/Part 2) account for as much of the variance toward a
diagnosis of APD as does the PCL-R/SV Total score. Of note were the
correlations between the APD variables and the facet scores. In particular,
Facet 4 (Antisocial) produced large and strong correlations of a similar level
to those between APD and the PCL-R/SV Total score. This suggests that a
diagnosis of APD can, more specifically, be attributed to antisocial traits such
as poor behavioral controls and criminal versatility. Corroborating this,
Facets 1 and 2 were weakly correlated with APD, suggesting that interperso-
nal and affective features have little bearing on a diagnosis of APD. These
results confirm APD as a function of behavior, and not the interpersonal or
affective features considered the core of the psychopathy construct.
Limitations
A number of limitations and methodological issues must be taken into
account when drawing conclusions from the above research findings. First,
a larger study sample may have increased the base rate of psychopathy as well
as the power to detect effects. It is possible that low power arising from the
small number of individuals identified as psychopathic, plus the low base rate
of violence, obscured any true trends.
A second limitation relates to the postdictive design of the study. As with
most studies of this kind, there are certain limitations associated, one of
which pertains to the reliance on file information. Although a number of
research studies using archival data have observed significant effects
(Douglas & Ogloff, 2003; Harris, Rice, & Quinsey, 1993; Menzies &
Webster, 1995; Nicholls, Ogloff, & Douglas, 2004), the coding of diagnostic
tools or risk measures from files is nevertheless limiting. For example,
research has demonstrated that PCL-R file ratings may underestimate high
scores and overestimate low scores (Grann, Långström, Tengström, &
Stålenheim, 1998; Hare, 2003). Despite this restriction, the analyses were able
to meaningfully distinguish both disorders—a distinction that perhaps may
have been more pronounced with direct access to the clientele. A third
limitation is the absence of gender comparisons. The smaller female sample
precluded the conducting of meaningful analyses by gender; however, the
inclusion of women in psychopathy research is presently minimal and there-
fore warranted.
Implications for clinical practice

The current findings provide evidence for a clear distinction between psy-
chopathy and APD. Put simply, APD does not wholly measure the same
symptoms as psychopathy. There is an overlap of behavioral markers

between the disorders; however, psychopathy—as operationalized by the
Hare Checklists—uniquely encompasses pervasive affective and interpersonal
deficits. This characterization of psychopathy has demonstrated associations
with recidivism in the literature. Although this association is with the beha-
vioral aspects of psychopathy (Olver & Wong, 2015), it is incumbent upon
clinicians to undertake an assessment of psychopathy following a diagnosis of
APD. The repercussions of failing to assess psychopathy in these circum-
stances are not only negligent but also potentially harmful (Shipley & Arrigo,
2001). While MDOs with either APD or psychopathic traits present a treat-
ment challenge (their offending unlikely to be ameliorated by traditional
antipsychotic medication), the psychopathic offender presents a particularly
difficult challenge. For instance, interpersonal and affective-related psycho-
pathic characteristics (i.e., narcissism, manipulation, remorselessness) can
inhibit the development of a therapeutic alliance, while behavioral factors
often disrupt group therapy, rendering conventional treatments ineffective.
As such, the identification of offenders high in psychopathic traits—particu-
larly Facets 1 and 2—is essential to ensure responsivity concerns are ther-
apeutically accommodated. Treatment strategies for psychopathic offenders
differ from offenders with an APD diagnosis in this regard, underscoring the
conceptual distinctions confirmed in this study (Ogloff & Wood, 2010).
Despite continuing uncertainty over the treatability of psychopathic offen-
ders, developing initiatives targeting the minimization of problem behaviors,
in preference to altering immutable personality traits, has generated cautious
optimism (see, e.g., Wong & Burt, 2007; Wong, Gordon, & Gu, 2007). It is
hoped that this investigation has provided a stronger understanding of the
diagnostic differences between APD and psychopathy and the complications
that arise if these disorders are deemed clinically interchangeable. Additions
to the international body of research working toward the development of
effective treatment initiatives for psychopathic offenders are strongly
encouraged.
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Disentangling Psychopathy From Antisocial Personality Disorder An Australian Analysis

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Journal of Forensic Psychology Practice

ISSN: 1522-8932 (Print) 1522-9092 (Online) Journal homepage: http://www.tandfonline.com/loi/wfpp20

Disentangling Psychopathy from Antisocial

James R. P. Ogloff PhD, JD, Rachel E. Campbell DPsych & Stephane M.

To link to this article: http://dx.doi.org/10.1080/15228932.2016.1177281

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Disentangling Psychopathy from Antisocial Personality

The relationship between psychopathy and antisocial personality antisocial personality

Psychopathy is a personality disorder with historical and clinical significance

CONTACT Stephane Shepherd sshepherd@swin.edu.au Centre for Forensic Behavioural Science,

require that an individual exhibit a persistent pattern of disregard for and

other personality disorders is a penchant for callousness, narcissism, manip-

discovered a sizable (n = 195) cluster of individuals with very low psychopathy

APD and psychopathy, it was expected that the behavioral components of

The hospital is operated by the Victorian Institute of Forensic Mental Health

the Research Coordinating Committee of the Victoria Police, and the

Figure 1. Scale structure of the PCL-R: Second edition (Hare, 2003).

Psychopathy Checklist: Screening Version (PCL: SV)

the PCL-R total and factor scores.

Antisocial personality disorder

adult items featured in the DSM-IV APD criteria.

Data handling and analysis

PCL-R/SV measurement agreement

Base rate of psychopathy and APD

Intercorrelations between APD and the PCL-R/SV

Table 2. Intercorrelations of APD variables and PCL measures.

Measurement agreement between the PCL-R and APD variables

Table 4. Measurement agreement between PCL-R groupings and APD-Met.

psychopathy scores (PCL-R ≥ 22) were significantly associated with APD,

psychopathy scores were almost 12 times more likely to receive a diagnosis of

Psychometric properties of APD and PCL-R/SV

1. Notably, the Factor/Part 2 correlations were similar to those of the PCL-R

Implications for clinical practice

symptoms as psychopathy. There is an overlap of behavioral markers

psychopathy. Comprehensive Psychiatry, 51, 426–433. doi:10.1016/j.comppsych.2009.09.006

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