Brain Development of the Psychopath

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Brain Development of the Psychopath Session 5
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Phineas gage
The strange case of Phineas Gage

• Gage was a railroad construction supervisor in
  1848 when a tamping rod was driven through his
  skull by an explosion
• The tamping rod severed the connections in the
  frontal area
• Prior to the accident he was a moral,
  hardworking, sensitive, conscientious,
  intelligent, and well liked
• Following the accident, his personality changed
  lying, swearing, fighting, drinking,
  extravagance, seizure prone,
  and antisocial

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MRI pix
Functional Magnetic Resonance Imagery (FMRI)
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Stroop color word test
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Pruning MRI
Time-lapse imagery of brain age 5 to 20
Use it or lose it!
Note red shows more gray matter while blue shows
less gray matter. Gray matter wanes as the brain
matures and neurons are pruned. Areas for basic
function mature early higher executive functions
later.
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Brain serotonin
Antisocial behavior the brain

• Impulsive, violent emotions appears to be a
  failure of emotional regulation
• ASP shows impairment in the orbito-frontal cortex
  (impulse control, judgment, tact) and its
  connections with anterior cingulate cortex
  (conflict coping) amygdala (fear anger)
• Abnormalities in serotonin function
• Early neglect (sensory deprivation) trauma
  abuse affects the development of the brain
• During 1st three years the brain grows rapidly,
  later prunes unused areas
• Result poor impulse control, lack of
  socialization, poor empathy, reactivity

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Lykken study startle
Normal people show fear, startle, and avoidance
reactions to painful stimuli psychopaths dont
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Non-reactivity to Emotional Stimulation
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Frontal brain
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Stress
Effects of Stress Trauma on the Brain

• Long term exposure to stress violence produces
  high level
  of fear hormone, cortisol (reduces
  connections may shrink
  hippocampus)
• High stress homes, multitasking technology
  (computer games)
  more often produce short attention (ADHD)
• Verbal abuse (repeated yelling, scolded,
  criticized) has adverse
  effects on the limbic
  (emotional) system, likely through stress
  pathways
• Physical and/or sexual abuse increases limbic
  system dysfunction including olfactory
  hallucinations, visual disturbances, déjà vu,
  jamais vu
• Repeated recollection and obsessing can intensify
  the stress effects
• Physical/sexual abuse or neglect is associated
  with decrease in the size of the hippocampus
  (working memory) in adulthood
• Stress tends to short-circuit frontal lobe
  processing (what little there is) and switch to
  emotional processing (resulting in
  over-sensitivity)
• Such impairments may make the challenges of
  school even more stressful a vicious cycle

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Drugs
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Reading emotion
Reading Emotion Normal Youth

• Youth seem to do nothing but socialize, yet are
  poor readers of emotion
• Undeveloped prefrontal cortex plays role in
  assessment of social relations, planning, and
  impulse control in social relations
• Compared with adults (100), teens (50) have
  greater difficulty correctly identifying
  emotional facial expression
• This confusion may lead to misinterpretation
  inappropriate reaction
• Girls somewhat more accurate than boys boys
  misinterpret cues
• Deep emotional relationships comes from ability
  to read subtle cues
• When one observes a close friend receiving a
  shock, although the sensory cortex does not
  activate, the emotional one does

When reading emotion, teens (left) rely more on
the amygdala, while adults (right) rely more on
the frontal cortex.

• Conduct Disordered Youth
• Errors in evaluating motive and intent
• Misinterpret social cues
• Attribute hostile intentions
• Tease others but respond negatively to others
• Abnormal standards and expectations regarding own
  behavior

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Treatment considerations for the
psychopath Session 6
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Practical Hands On Interventions
Or-- when you just cant use duct tape
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PCL-YV
Psychopathy Checklist Youth Version
Factor 1
Factor 2
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System map of traits
Possible pathways among traits
Stimulation seeking
Low fear, anxiety
High pain threshold
Low motivation to anticipate consequences
Opportunist (versatility)
Inability to anticipate, learn, insight
Poor planning, present orientation, unrealistic
Predatory
Limited cognitive capacity, inattention
Impulsiveness
Early behavior problems
Poor identification with others
Parasitic Irresponsible Aggressive Callous
No remorse, shame, guilt, embarrassment
Narcissism grandiosity
Poor social attachment
Superficiality Promiscuity Short term relations
Charm glibness
Verbal fluency
Manipulation Lying
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Rules of the road

• Be calm
• Be respectful even when they are not
• Have a few clear rules
• Give clear, direct, simple messages
• Be consistent
• Avoid confrontations in front of others
• Start fresh every day
• Give choices
• Use positive reinforcers whenever possible
• Dont sweat the small stuff

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Practical In-class Interventions

• Anger Management
• Where and How my Body Feels Anger
• Defining the actual feeling
• Anger management workbooks
• Swearing worksheet / identify alternatives to
  swear words

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Parental contribution to empathy
Parental contribution to empathy

• Secure attachment nurturing responsiveness to
  infant, available,
  sensitivity, consistency
• Take children seriously respect feelings,
  preferences, questions
• Practice cooperating demonstrating collaboration
  rather
  than competition
• Guiding explaining value sharing, caring,
  helping, explain why prosocial behaviors are
  important and appreciated, how aggressive and
  selfish behaviors harms others, intervening when
  child is selfish or cruel, explain how others
  feel
• Modeling generosity, charitable to others,
  practice what preached, small acts of kindness
• Promoting and praising prosocial self image
  encourage opportunities to experience caring
  helping, view self as caring and helping,
  volunteering, internal rather than external locus
  of control for altruism

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Components of Empathy Enhancement for Juvenile
Offenders

• Ability to identify and express emotions
  Identification of
  feelings prior to, during and after offenses
• Development of good listening skills in order to
  be able to identify feelings of others may need
  to break this down into nonverbal cues, voice
  tone, etc. depending extent of deficit
• Constructing a series of apologies to his victims
• Dealing with own victimization
• Comprehension of how anger, stress and values
  influence his reactions to others
• Modification of behavior out of concern for
  others feelings
• Used to address the lack of awareness of the
  devastating short and long term emotional impact
  that the assault had on the victim(s)
• To reduce the consistent pattern of blaming the
  victim for the assault address the lack of
  remorse for the assault
• Increase ability to understand how others feel
  and how intimate relationships are based on
  empathy and trust
• To reduce inappropriate behaviors and increase
  boundary awareness

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Examples of Empathy Techniques

• Practice reading the nonverbal cues of
  
  others in order to assess emotions
• Describe feelings experienced by
  
  fictional people pictures, movies, etc
• List ways of demonstrating empathy
• Write an account of the assault from the victims
  perspective
• Identify emotions that the victim felt before,
  during and after the assault
• Outline the consequences of the lack of empathy
  in relationships

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Time bomb tactics
Time-Bomb Tactics
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Thinking errors (1) errors
Thinking Errors Irresponsibility is fostered by
ten thinking errors. These errors exist in
varying degrees in various individuals. The more
extreme the degree of
irresponsibility the more thinking errors are
involved.

• Closed Thinking
• is not receptive
• is not self critical
• makes no self disclosures
• lies by omission
• is good at pointing out and giving feedback on
  the faults of others
• Victim stance
• views self as a victim (but not as the
  victimizer)
• Blames others (his/her family, childhood, social
  conditions, the past, etc.)
• Viewing Self As A Good Person
• focuses only on own positive attributes
• fails to acknowledge own destructive behavior
• builds self up at the expense of others
• Lack of Effort
• is unwilling to do anything found boring or
  disagreeable
• uses I cant which really means I wont

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Thinking errors (2)

• 5. Lack of interest in Responsible Performance
• finds responsible living to be unexciting and
  unsatisfying
• responds only if netting an immediate payoff
• no sense of obligation
• 6. Lack Of Time Perspective
• does not use the past as a learning tool
• expects others to act immediately on demand
• decisions are made on assumptions, not facts
• 7. Fear Of Fear
• has irrational fears but refuses to admit them
• has a fundamental fear of injury or death
• has a profound fear of put downs
• experiences "zero state" (feels worthless when
  held accountable)
• 8. Power Thrust
• has a compelling need to be in control of every
  situation
• uses manipulation and deceit
• refuses to be dependent unless someone can be
  taken advantage of

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Thinking errors (3)

• 9. Uniqueness
• thinks of self as different and better than
  others
• expects of others that which s/he fails to do
• cuts fear of failure with super optimism
• quits at the first sign of failure
• 10. Ownership Attitude
• perceives all people, places, and things as
  objects to possess
• has no concept of the ownership rights of others
• uses sex for power and control, not intimacy

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Criteria for successful treatment

• the criminal must hit "bottom" before the program
  
  can work
• the criminal must accept that he is and always
  will be a
  criminal. He will always need habilitative
  practice
• the change agent must make an effective
  presentation to the criminal at a time when the
  criminal is vulnerable and willing to change
• the change agent must have a detailed knowledge
  of the criminal's thinking process. It is
  imperative that the agent know specifically with
  whom he is dealing
• the change agent must apply the knowledge
  appropriately to the change process
• the offender is receptive to criticism if he is
  employed,
• responsible and reliable is drug-free
• responsible with time and money
• receptive to constructive criticism and is
  constantly striving to improve

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Effectiveness of corrective thinking
Effectiveness of Corrective Thinking

• High risk clients
• 66 reduction in crime for those who completed
  the program.
• 33 reduction in crime for those who entered but
  did not complete.
• 48 of all clients pursued no new crime.
• 29.4 exhibited a decrease in crime.
• 6.4 showed no change.
• 15.6 exhibited an increase in crime.

• Average number of criminal charges
• Reduced by slightly over 50 for all clients who
  entered the program.
• Reduced approximately 66 for those who completed
  the program.
• Reduced by approximately 33 among clients
  terminated before completion.
• Reduced 79.17 for those who completed and had no
  previous arrests.
• Reduced 36.36 for those who terminated prior to
  completion with no prior arrests.

Truthought's Corrective Thinking Treatment Model
includes four studies done by University of
Wisconsin, US Department of Justice National
Institute on Corrections, US Department of
Justice Bureau of Justice Assistance (1988-1993)
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Relapse Prevention
Family support Supervision Structure Consistency N
urturance

• Stress
• Peer influence
• Vulnerability
• Substance compromise

Scapegoating Continued conflict Poor role
modeling Lack supervision
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