Running head: PSYCHOPATHY IN WOMEN

Psychopathy in Women
Erin Weaver
Loras College

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Psychopathy in Women

Psychopathy is a psychological disorder that has been studied in great detail, particularly
focusing on criminal populations, for many years. Historically, the majority of research on this
psychological disorder has been focused on psychopathy in men and male inmates. Psychopathy
research is important in these populations because many of the most heinous and violent
criminalsserial killers like Ted Bundy and John Wayne Gacyhave been male psychopaths
and the need to understand these criminals has been great in order to stop and catch them from
killing again. However, in more recent years, some focus has shifted toward researching
psychopathy in women. Topics that have been researched in this area include comorbid disorders
common in female inmates who display psychopathic personality traits, common personality
traits present in female psychopaths, commonalities and differences between men and women in
the expression of psychopathy, and abnormal brain activity of female psychopaths.
What is Psychopathy?
Psychopathy is a psychological disorder that was first officially described by Hervy M.
Cleckley, a psychiatrist at the Medical College of Georgia. Traits of psychopathy described by
Cleckley (1941) include being overly charming but making a good first impression on most
people to the extent that they may seem normal, being egocentric, being a liar, being unreliable,
and engaging in risky or dangerous behavior simply because they can and they enjoy it. A
psychopath will usually blame others for their dangerous and risky behaviors instead of taking
responsibility for their own actions. Impulse control, learning from disapproving reactions to
their actions, and feelings of guilt, empathy, and love are all lacking in individuals who have
psychopathic tendencies. These personality traits are generally grouped into three different

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categories: interpersonal/relational, affective/emotional, and impulsive/criminal (Lillienfeld &

Arkowitz, 2007).
In previous literature, psychopathy has been divided into two subgroups: primary
psychopaths and secondary psychopaths. A study conducted by Hicks, Vaidyanathan, and
Patrick (2010) focused primarily in determining whether the subtypes of psychopathy identified
in menprimary and secondarywere also distinguishable in women. These two subtypes were
both distinguishable in female inmates (Hicks, Vaidyanathan, & Patrick, 2010). Secondary
psychopaths tended to have intense negative emotionality, low constraint in behavior, more
antisocial and criminal behavior related to more impulsive behavior which sometimes results
from reactive anger and aggression leading to violence. The onset of these behaviors tended to be
in childhood. Secondary psychopaths tended to be more likely to heavily use drugs like alcohol,
nicotine, and marijuana which leads to dependence or abuse. Primary psychopaths, however, do
not display such extreme traits, as their onset of antisocial behavior was usually in adulthood,
and tended to limit their drug use and possible abuse to barbiturates or tranquilizers (Hicks et al.,
2010).
Psychopathy and antisocial personality disorder are frequently grouped together in
everyday language. However, while these two disorders share many common characteristics,
they also have several significant differences. An individual being impulsive, irresponsible and
aggressive and acting antisocially are characteristics of both psychopathy and antisocial
personality disorder (Anton, Baskin-Sommers, Vitale, Curtin & Newman, 2012). Psychopathy
differs from antisocial personality disorder by the presence of callous-unemotional traits which
include pathological lying and lack of empathy (Anton et al., 2012). Lower levels of other types

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of psychopathologies, particularly depression and anxiety, are also characteristic of psychopathy

rather than antisocial personality disorder (Anton et al., 2012)
Common Comorbid Disorders
Many studies have been done in order to determine if there are comorbid disorders
common among female inmates displaying psychopathic inmates. Several different disorders
have been investigated in previous studies including posttraumatic stress disorder (PTSD),
borderline personality disorder, and histrionic personality disorder. Psychopathy has also been
studied in relationship with suicidality among female inmates.
Blonigen and colleagues (2012) studied the relationships between antisocial behavior,
posttraumatic stress disorder, traumatic experiences and borderline personality disorder in 226
female inmates using a 20 item PCL-R interview, a self-report Life Events Checklist, a PTSD
Checklist (Civilian version), and a Minnesota Borderline Personality Disorder scale composed of
19 times from the Multidimensional Personality Questionnaire. The Antisocial and Lifestyle
aspects of psychopathy were found to be related to traumatic experiences, but only the Antisocial
aspect was found to be related to PTSD. Borderline personality disorder traits in female inmates
was found to almost completely explain the relationships between Antisocial and Lifestyle
aspects of psychopathy and PTSD. The researchers believed that the differing relationships
between Antisocial and Lifestyle aspects of psychopathy, PTSD, and traumatic events could be
due to differing times of abuse with the Antisocial aspects being linked more to childhood abuse
while the Lifestyle aspects being linked more to adulthood abuse (Blonigen, Sullivan, Hicks, &
Patrick, 2012).
A study by Hicks, Vaidyanathan, and Patrick (2010) also examined the relationship
between psychopathy and PTSD, but expanded this idea by examining the relationship between

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primary or secondary psychopathy and PTSD using 226 female inmate participants. Also using
the PCL-R, Life Events Checklist, PTSD Checklist plus the Survey of Alcohol and Drug Use and
gathering information from the institution that they women were incarcerated, this study found
that secondary psychopaths exhibited higher prevalence rates of PTSD and its causing factors
than both primary psychopaths and control inmates (Blonigen et al., 2012). Hicks and colleagues
(2010) also found that secondary psychopathy was very similar to borderline personality
disorder. While secondary psychopathy was more related to PTSD, primary psychopathy was
found to be related to more resilience psychologically which in turn is related to fewer suicide
attempts and lower rates of PTSD in these inmates (Blonigen et al., 2012). This study extends the
work of Verona, Hicks, and Patrick (2005) which found that lower suicide risk was associated
with higher levels of affective/interpersonal aspects of psychopathy. However, a higher suicide
risk was associated with higher levels of antisocial/impulsive behavioral aspects of psychopathy
(Verona, Hicks, & Patrick, 2005).
Personality Traits
Another important area of research concerning female psychopaths has been exploring
which personality traits are common among female psychopaths. Common personality traits
include narcissism, impulsive behavior, antisocial behavior, violent behavior, negative
emotionality, and dominant behavior.
Salekin, Rogers, and Sewell (1997), earlier researchers of female psychopaths, suggested
that this disorder is characterized by aggressiona common trait among several studieslack of
empathy, lack of guilt, significant amounts of social deception, a tendency toward adventure
seeking due to boredom, and behavioral problems in both childhood and adulthood (Salekin,
Rogers, & Sewell, 1997). Additionally, Salekin and colleagues (1997) hypothesized that mania,

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expressed through impulsivity and adventure seeking due to boredom is also a significant
personality trait common among female psychopaths.
Phillips, Sellbom, Ben-Porath, and Patrick (2014) extended the research done on female
psychopaths and their common personality traits. Two aspects of psychopathy
fearlessness/dominance and impulsive/antisocialitywere studied in depth to determine traits
that were commonly associated with female psychopathy in general. Fearlessness and dominance
were related to good social effectiveness, lower emotionality, and thrill seeking while
impulsivity and antisociality were related to maladjustment traits in female psychopaths
including disinhibition, Machiavellianism, and general meanness (Phillips, Sellbom, BenPorath, & Patrick, 2014). Other common traits found in female psychopaths in this study
included narcissism, lack of empathy, and high levels of aggression (Phillips et al., 2014).
Comparing Men and Women
Male psychopaths have received most of the attention in research for a long time. As the
focus has shifted more toward including women or exclusively using female participants in
research of psychopathy, it has become important to compare men and women who show
significant psychopathic features. There seems to be some debate among researchers in this area
as to whether male and female psychopaths present symptoms similarly or differently.
The study by Salekin and colleagues (1997) posited that gender plays a significant part in
psychopathic features. While they conceded that the overall theoretical model of psychopathy
based on male psychopaths is applicable to female psychopaths, there seemed to be significant
differences between the genders in the presentation of the disorder. In men, narcissistic
personality disorder and unstable, socially deviant and antisocial lifestyles seem to be
characteristic of psychopathy. However, in women, psychopathy tends to be presented more in

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traits consistent with histrionic personality disorder (attention/adventure seeking, promiscuity,

etc.) and borderline personality disorder (Salekin et al., 1997; Sprague, Javdani, Sadeh, Newman,
& Verona, 2012). Further research conducted by Wennberg (2012) in determining differences
between men and women in the presentation of psychopathy found that women displayed more
impulsiveness and self-harming behaviors meaning their aggression was internal rather than
external while men displayed more externally aggressive behaviors like violent criminal
offenses. These traits displayed in female psychopaths are connected to borderline personality
disorder suggesting that these disorders may be strongly related in this population of individuals
(Wennberg, 2012).
Later research by Phillips and colleagues (2014) showed that there may not be as much
difference between male and female psychopaths as originally thought. Findings for traits
common in female psychopaths were comparable to male psychopaths. Some of these traits
include narcissist behavior, Machiavellianism, antisocial behavior, and impulsive behavior
meaning that physical expression of psychopathic traits are more similar than originally thought
(Phillips et al., 2014). These authors suggested that findings indicating significant differences in
the presentation of psychopathic traits between men and women could be a result of societys
typical gender roles influencing the evaluation of the participants personality traits (Phillips et
al., 2014). Phillips and colleagues only found significant differences between the genders in
expression of fear and empathy, where women scored higher in tests, and narcissistic and
extroverted behavior, where men scored higher in tests. All other traits were similar across
genders when analyzed (Phillips et al., 2014) which means that there may be fewer differences
between men and women in the presentation of psychopathy than originally thought by Salekin
and colleagues (1997).

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However, recent research by Sprague and colleagues (2012) investigated whether there
was a difference between men and women in the presentation of psychopathic and borderline
personality traits and whether displaying interpersonal-affective and impulsive-antisocial
characteristic clusters of psychopathy was differentially correlated to borderline personality
disorder in men and women. Using the Psychopathic Personality Inventory and the Borderline
Features Scale of the Personality Assessment Inventory, features of both pathologies were
measured in undergraduate students (51% female, 49% male) (Sprague et al., 2012). Consistent
with previous research, the men scored higher in psychopathic characteristics of personality
while borderline personality disorder scores were higher in the women (Sprague et al., 2012). In
women, higher scores for the interpersonal-affective cluster of characteristics of psychopathy
was negatively related to borderline personality traits while impulsive-antisocial scores were
positively related to borderline personality traits (Sprague et al., 2012). However, the association
was found to be stronger between the impulsive-antisocial scores and borderline personality
traits in women who also scored higher in the interpersonal-affective trait cluster while there was
no such change in the relationship when accounting for the interpersonal-affective trait scores
among the men participating in the study (Sprague et al., 2012).
Abnormal Brain Activity and Cognitive Processing
Several researchers have examined the brain activity of female psychopaths. Brain
activity in the amygdala and other regions have been seen to be abnormal in female psychopaths.
Other studies have investigated selective attention and fear reactivity/startle response in female
psychopath processing in comparison with control women in prisons. Rorschach testing has also
been used to evaluate cognitive functioning in incarcerated female psychopaths.

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Abnormal functioning in several brain regions has been implicated in psychopathic

tendencies. Abnormal reactivity to negative stimuli, particularly threats, has been negatively
related to psychopathy (Hyde, Byrd, Votruba-Drzal, Hariri, & Manuck, 2014). Regions in the
dorsal amygdala are the primary parts of the brain that control behavioral and physiological
stimulation so abnormal activities in these areas of the brain can help explain psychopathic
behavior and personality traits related to reduced negative emotionality for self-threatening
stimuli (Hyde et al., 2014).
Another deficit in brain functioning common to female psychopaths is in selective
attention to stimuli. In a study by Vitale, Brinkley, Hiatt, and Newman (2007), it was found that
female psychopaths displayed a substantial deficit in responding whether two picture-word
stimuli were related or not in both situations in which the stimuli were emotionally charged and
neutral (Vitale, Brinkley, Hiatt, & Newman, 2007). In other words, women displaying
psychopathic characteristics were less affected by contradictory information when they were
focusing on a goal than women who did not display psychopathic characteristics.
Anton and colleagues (2012) expanded the work by Vitale. These researchers
investigated the differences in cognitive and fear processing/startle response between
psychopathic women and nonpsychopathic women displaying characteristics of antisocial
personality disorder. Using three different conditions (one with focus on threat and two with
focus not on threat) it was found that women displaying psychopathic characteristics showed
more fear startle response in the trials when they were attending to the threat stimuli (red letters
vs green letters) and less fear startle response in the trials when they were focused on stimuli not
related to the threat (upper vs lower case letters and whether the letter matched two letters
previously) (Anton, Baskin-Sommers, Vitale, Curtin, & Newman, 2012).

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Other brain regions experiencing abnormal activity implicated in psychopathic behavior

included those involved in the feeling of pain and empathy: the medial cingulate cortex, the
frontal and parietal cortices (mirror neurons), the limbic system, and the
ventromedial/orbitofrontal and dorsolateral cortices (Verona, Bresin, & Patrick, 2013). Verona
and colleagues (2013) found that abnormal activity in these brain regions caused deficits in the
startle response to pictures depicting victims rather in comparison to pictures depicting a direct
threat to the participant in those women who display higher levels of psychopathic traits which
was thought to partly explain why psychopaths struggled to feel empathy for others. These
researchers also suggested that in order to activate a psychopaths defense mechanisms built into
the brain, one must present a direct threat to her rather than a threat to another person because of
the abnormal brain activity (Verona et al., 2013).
Rorschach testing addresses several aspects of cognitive functioning such as interpersonal
abilities, self-perception, and effectiveness of available cognitive resources (Baird, 2009). Baird
(2009) used this test to determine if the scores on the total Rorschach and its specific dimensions
correlated with scores of psychopathy using the Psychopathic Personality Inventory-Revised
(PPI-R). Interestingly, the form dimension of the Rorschach measure, the tendency for
introspection and self-examination and the capacity for psychological mindedness was
positively correlated with psychopathy scores (Baird, 2009). This means that as the number of
introspective thoughts increased, so did scores of psychopathy which is opposite of what has
been demonstrated in studies of male psychopaths. Number of aggressive thoughts and number
of cooperative interaction thoughtsto achieve a self-serving goalwere also found to be
positively related to psychopathy scores (Baird, 2009).
Present Study

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The present study seeks to investigate the physiological causes for alternative fear
processing and startle response in female psychopaths. This study aims to determine if those
classified as primary psychopaths differ in brain activity from those classified as secondary
psychopaths and whether both of these groups differ in brain activity from those classified as
having borderline personality disorder (BPD). Differences in brain activity between these three
groups and those not classified as any of the above will also be examined. I hypothesize that
brain activity in the primary psychopathy, secondary psychopathy, and BPD groups will all be
different from participants that do not meet the characteristics for any of these disorders when
presented with threat stimuli within and outside of their focus. I also hypothesize that the
secondary psychopathy and BPD groups will have similar brain activity patterns when exposed
to threat stimuli.
Method
Participants
Participants will be randomly selected from a womens high security prison and college
campus in order to collect data from both the criminal and noncriminal. Twenty participants in
all four categories (primary psychopath, secondary psychopath, BPD, no classification) will be
randomly selected from the available participant pool.
Materials
Psychopathy checklist-revised. The PCL-R is based on 20 items administered through
an interview of the participant and review of official files from either the prison or college. These
items are scored as 0: not at all present, 1: moderately present, or 2: significantly present.
The possible scores for this measure range from 0 to 40 with higher scores implying higher

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levels of psychopathy. Interviews and files will be scored by two independent raters for
reliability.
MPQ-BF. The MPQ-BF is a self-report measure consisting of 155 items that evaluates
agentic-positive emotionality, communal-positive emotionality, negative emotionality, and
constraint (Hicks et al., 2010). Scores on this scale will be used to divide individuals into
primary psychopathy and secondary psychopathy groups.
Borderline Features Scale of the Personality Assessment Inventory. The PAI-BOR is
based includes 24 items. These items evaluate affective instability, identity problems, negative
relationships, and self-harmfour aspects of BPDusing a scale from one to four (Sprague et
al., 2012). Six items assess each of the four characteristics. Scores can range from 0 to 72 on this
measure, with higher scores implying higher levels of BPD.
Procedure
On one day, potential participants will come to a private office in the prison or on the
college campus and complete the PCL-R, MPQ-BF, and PAI-BOR to determine which group
they would be assigned to for data analysis if randomly selected.
On a second day, participants would return to complete the shock sensitivity protocol and
instructed fear-conditioning task while being monitored by functional magnetic resonance
imaging (fMRI) for the second task. Shock sensitivity will be tested using a range of shocks from
0-7 mA. Shocks of increasing intensity will be administered in this range until the participant
first states that the shock is considered uncomfortable and then the maximum shock that they can
tolerate. The task will be completed when the participant states that they have reached their
maximum level of shock that is tolerable. During the instructed fear-conditioning task, a shock
that falls in the middle of the uncomfortable shock and maximum shock will be used. Using

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subjective shock levels for each participant will help to control for any differences between
individuals.
The instructed fear-conditioning task will consist of three conditions composed of 100
trials per condition. All participants will complete all three conditions. A red font or green font
letter that is either uppercase or lowercase will appear on the screen for 400-ms in each trial.
There will be 2-2.8 s in between each trial that will vary randomly. Corresponding with the
instructions given for each of the three unique conditions, participants will press one of two
buttons available to them. Shocks will given to the fingers on the participants left hand 1,400ms after the stimulus appears on the screen for 20% of the trials presenting a letter in red font but
for 0 of the trials presenting a letter in green font in order to differentiate threat stimuli (red) from
non-threat stimuli (green). For 16 of the 100 trials in each of the conditions, a noise lasting 50ms at 102-dB will be presented 1,400-ms after the stimulus appears on the screen. These noises
will never occur on the same trial as an electric shock and will occur equally between threat and
non-threat stimuli in each condition.
In the first condition, the threat-focused condition (TF), participants will be asked to pay
attention to the color of the letter that appears on the screen and push the button that corresponds
with the color of the letter: threat (red) or non-threat (green). To make sure that the participants
will be focused on the threat of the red letters, participants will be told that the speed and
accuracy of their responses will affect the number of shocks they will receive during the
condition even though the same number of shocks will be given to each participant regardless of
performance. In the second condition, the alternative-focus/low-load condition (AF/LL),
participants will be asked to pay attention to whether the letter on the screen is uppercase or
lowercase and press the corresponding button with their right hand. In the third and final

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condition, the alternative-focus/high-load condition (AF/HL), participants will be asked to

determine whether the letter present on the screen matches the letter that appeared on the screen
two letters before the current one and press the corresponding button with their right hand. In the
second and third conditions, the threat of the stimulus (the color) was not central to the task.

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Blonigen, D. M., Sullivan, E. A., Hicks, B. M., & Patrick, C. J. (2012). Facets of psychopathy in
relation to potentially traumatic events and posttraumatic stress disorder among female
prisoners: The mediating role of borderline personality disorder traits. Personality
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