Psychopathic Check Lists

Click on image above to enlarge the psychopathic check list adapted by Gary Rosenthal.

One consideration DSM-3’s personality disorder work group had in mind was an important one—the previous lack of guidelines around criteria, and specifically, the requirements that should be necessary for each to be considered valid. But the way they went about it became limiting in its own right. For the criterion of recklessness that had been central to the construct of psychopathy became burdened and less useful by having to show “driving while intoxicated, or recurrent speeding.” (What if a psychopathic client doesn’t own or drive a car?).

Relationship infidelity became predicated upon evidence of “two or more divorces and/or separations (whether legally married or not).” While the related trait of promiscuity required ten or more partners within a single year. (If you only had 9, sorry, you don’t make the cut). Though by this accounting, the members of almost any rock band over the past two decades would already have 2 strikes against them on an ASPD rap.

Meanwhile in 1980, as the DSM was struggling to successfully launch a personality disorder it could call its own, another significant figure came on the scene—the Canadian-born psychologist, Robert D. Hare. Hare had briefly worked as a prison psychologist in British Columbia, after getting his M.A. in 1960. In the ensuing 3 years while researching his PhD thesis, he encountered Cleckley’s The Mask of Sanity. It was a pivotal encounter. For in Cleckley’s pioneering book, Hare had found the field that was to be his life work, a field he was soon to lead...

But Hare found the other workers in the field to be few, and with the exception of Cleckley—whom he was to correspond with until Cleckley died in 1984—not having much to offer. Finally, frustrated with the lack of decent research or insight by others, Hare developed the first version of his own Psychopathy Check List (PCL). In 1980—the same year that the DSM formally adopted ASPD—Hare released his PCL to a limited circulation.

It was based on and “wished to retain the essence of psychopathy embodied in Cleckley’s work.” Hare worked from his mentor’s 16-item list while noting, as had Robins earlier, that some of them were “vague,” requiring “a considerable degree of subjective interpretation.” And when a 22-item version of PCL (in 1986) was released, it was way more aligned with Cleckley than the DSM-3. For it included Cleckley’s superficial charm, lack of remorse, egocentricity, and lack of emotional depth—none of which were included in the DSM-3.

Plus it had eliminated a number of Cleckley’s more questionable items: Absence of delusions, good intelligence, fantastic behavior when drunk (!) and suicide rarely carried out. Though Hare’s elimination of Cleckley’s impersonal sex life, and absence of nervousness were two swings at psychopathy that failed to make better contact at the plate. Yet I found it interesting that the absence of nervousness (anxiety) that Hare had banished, was a feature of Cleckley that continues to live in the DSM-5’ s Alternate model: lowered level of anxious withdrawal, combined with heightened attention seeking.

But Hare’s PCL was reflective of more than a mere regurgitation of the best of Cleckley, and a deletion of the more questionable. Hare’s own clinical vision is astute; and it added: proneness to boredom, parasitic lifestyle, poor probation risk, and previous diagnosis as a psychopath. ( Parenthetically, proneness to boredom also found a home in the DSM5’s Alternative model, which is supposed to be more “trait based.” When I first encountered it there, it struck me as one of the more deeply observed of the traits in the DSM’s portrayal of ASPD, like a really striking image in an otherwise unmemorable poem—though I had no idea at the time, of Hare as its source).

Successive editions of Hare’s PCL became—like Hare himself, a go-to source for assessing cases involving psychopathy. He’s been an advisor to the FBI, and consultant to various North American and British prison systems.

And since 1980 onward, the DSM construct (ASPD) and Hare’s PCL and its subsequent PCLR became somewhat like Ford and Ferrari—foils and competitors with each other.