Effects of Comorbid Psychopathy on Criminal Offending and Emotion
Processing in Male Offenders With Antisocial Personality Disorder
David S. Kosson
Rosalind Franklin University of Medicine and Science
Amanda R. Lorenz and Joseph P. Newman
University of Wisconsin—Madison
Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct
validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that
ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology;
(b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar
in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy.
Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual
(4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria
for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic
criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with
ASPD and psychopathy were characterized by more criminal activity than were controls. In addition,
ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion
facilitation than ASPD alone. Group differences in the association between emotion dysfunction and
criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic
features may be distinct syndromes.
Keywords: psychopathy, antisocial personality disorder, classification, comorbidity
Since publication of the third edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM–III; American Psy-
chiatric Association, 1980), the relationship between antisocial
personality disorder (ASPD) and psychopathy has been controver-
sial (Hare, Hart, & Harpur, 1991). Whereas the DSM–IV (Amer-
ican Psychiatric Association, 1994) reports that these two diagnos-
tic categories describe similar patterns of long-standing antisocial
behavior, several authors have argued that in the operationalization
of ASPD, DSM–III and its revisions sacrifice validity in the service
of reliability (Kernberg, 1989; Lilienfeld, 1994; Millon, 1981) or
are too nonspecific, at least for use within correctional settings
(MacKay, 1986; Widiger et al., 1996). Indeed, DSM–IV refers
explicitly to the possibility that features of psychopathy “may be
particularly distinguishing of Antisocial Personality Disorder in
prison or forensic settings” (p. 647). Such statements imply that
the combination of ASPD and psychopathy may be particularly
important within prisons. However, no accepted assessment of
ASPD includes this step, and no prior studies have examined
whether the categorical assessment of ASPD is affected by the
assessment of comorbid psychopathic features (see also Hare,
It is unquestionable that the category of ASPD has amassed
considerable construct validity. ASPD diagnoses have been corre-
lated with abuse of controlled substances (Skodol, Oldham, &
Gallaher, 1999), psychophysiological anomalies (Raine, Lencz,
Bihrle, LaCasse, & Colletti, 2000), and neuropsychological defi-
cits (Gillen & Hesselbrock, 1992; Stevens, Kaplan, & Hessel-
brock, 2003). Further, ASPD diagnoses predict treatment failure
(Kranzler, Del Boca, & Rounsaville, 1996) and recidivism (Harris,
Rice, & Cormier, 1991).
Similarly, the psychopathy syndrome as operationalized by the
Psychopathy Checklist—Revised (PCL–R; Hare, 1991) has at-
tained a considerable degree of convergent and discriminant val-
idation. In fact, psychopathy predicts many of the same negative
outcomes as ASPD, including treatment failure (Hobson, Shine, &
Roberts, 2000; Reiss, Grubin, & Meux, 1999), involvement in
violent and nonviolent offenses (Hare & McPherson, 1984), recid-
ivism (Harris et al., 1991; Hemphill, Templeman, Wong, & Hare,
1998), and substance abuse or dependence (Hart & Hare, 1989;
Smith & Newman, 1990). Not only do psychopathic inmates
display prolific criminal behavior, but they also are characterized
by substantial versatility in the kinds of antisocial behavior they
carry out (Brinkley, Schmitt, Smith, & Newman, 2001; Kosson,
Smith, & Newman, 1990).
Because most individuals who meet diagnostic criteria for
ASPD do not meet current criteria for psychopathy (Hare, 2003),
the many parallels between the ASPD and psychopathy literatures
suggest the possibility that ASPD (with or without psychopathy)
and psychopathy reflect the same pathological genetic/biological
and developmental processes. According to this view, contempo-
rary diagnostic criteria for ASPD and psychopathy may differ in
David S. Kosson, Department of Psychology, Rosalind Franklin Uni-
versity of Medicine and Science; Amanda R. Lorenz and Joseph P. New-
man, Department of Psychology, University of Wisconsin—Madison.
This study was supported by National Institute of Mental Health Grants
MH57714 (to David S. Kosson) and MH53041 (to Joseph P. Newman). We
thank the Wisconsin Department of Corrections and especially the staff
members at the Oakhill and Columbia Correctional Institutions for making
this research possible.
Correspondence concerning this article should be addressed to David S.
Kosson, Department of Psychology, Rosalind Franklin University of Med-
icine and Science, 3333 Green Bay Road, North Chicago, IL 60064.
Journal of Abnormal Psychology
2006, Vol. 115, No. 4, 798–806
Copyright 2006 by the American Psychological Association
sensitivity, specificity, and reliability, but they reflect different
methods of assessing the same underlying syndrome (e.g., Amer-
ican Psychiatric Association, 1994; see also Widiger et al., 1996,
for a comparison of the reliability and concurrent validity of ASPD
and PCL–R–based criterion sets). For example, the greater number
of items and higher cutoffs for PCL–R psychopathy than for DSM
ASPD may result in more accurate diagnosis, but the pathophys-
iology of the underlying disorder may be the same.1
In contrast, it could be argued that there are important differ-
ences in the underlying mechanisms associated with ASPD versus
psychopathy. For example, Lykken (1995) proposed that psycho-
pathic personalities represent an etiologically distinct subgroup
within the family of antisocial personalities and suggested that the
majority of individuals with ASPD are not psychopathic. Consis-
tent with this perspective, several researchers have argued that
psychopaths are characterized by a pattern of emotional and, in
some cases, cognitive deficits that do not distinguish inmates with
ASPD from those without ASPD (Harpur, Hare, & Hakstian, 1989;
Patrick, 1994). Further, recent evidence indicates that psychopathy
explains variance in hippocampal volume even among individuals
with ASPD (Laakso et al., 2001). Conversely, individuals with
ASPD display cardiovascular anomalies (Raine et al., 2000) that
are not associated with psychopathy (Raine, 1997). Similarly,
ASPD and life-course persistent offenders have been reported to
exhibit neuropsychological deficits (Moffitt, 1993; Stevens,
Kaplan, & Bauer, 2001; Stevens et al., 2003) that are not seen in
psychopathic offenders (Hare, Hart, & Forth, 1990; Smith, Arnett,
& Newman, 1992). Because most psychopathic offenders meet
diagnostic criteria for ASPD but most ASPD offenders do not meet
diagnostic criteria for psychopathy, findings such as these raise the
possibility that ASPD is heterogeneous and that the syndrome of
ASPD plus psychopathy is essentially distinct from the syndrome
of ASPD without psychopathy (cf. Hare, 1999).2
Because psychopathy appears superior to ASPD in predicting
some outcomes such as recidivism and treatment failure (Cunning-
ham & Reidy, 1998; Hare et al., 1991; Hobson et al., 2000), it is
also important to consider whether much of the predictive value of
ASPD reflects its high comorbidity with psychopathy. According
to this perspective, ASPD has predictive utility primarily because
a substantial minority of individuals diagnosed with ASPD are also
psychopathic. Accordingly, removing the subset of psychopaths
from larger samples of ASPD individuals would be expected to
reduce or eliminate associations between ASPD and the kinds of
criteria of interest to criminologists and mental health profession-
als. Although identifying large numbers of offenders who are
psychopathic but non-ASPD is generally not possible, one could
examine whether previously reported relationships between ASPD
and other constructs are related to the common practice of includ-
ing psychopaths in ASPD groups simply by comparing individuals
with ASPD and psychopathy versus individuals with ASPD but
not psychopathy.3However, no prior studies of these two disorders
have separated individuals with ASPD and psychopathy from
those with ASPD alone.
The purpose of the present study was to evaluate three perspec-
tives. By examining whether individuals with both ASPD and
psychopathy versus those with ASPD without psychopathy exhibit
similar or different performance on real-world and laboratory
indexes prominent in the psychopathy literature, we investigated
three possibilities: (a) that ASPD with psychopathy and ASPD
without psychopathy appear to reflect the same underlying patho-
physiology, (b) that they reflect two distinct patterns of underlying
mechanisms, and (c) that the predictive value of ASPD reflects its
high comorbidity with psychopathy. We chose to examine both
criminal behavior and emotional processing because these are two
of the most extensively validated domains in the nomological
network surrounding the psychopathy construct. Moreover, they
are sufficiently distinct that, in the absence of theoretical con-
structs, one would not expect to see relationships in one domain
generalize to the other. Because both ASPD and psychopathy are
antisocial syndromes, both are expected to be associated with
criminal activity. Thus, if the two disorders reflect the same
underlying pathophysiology, then individuals with both ASPD and
psychopathy versus those with ASPD alone may be expected to
manifest relatively similar propensities in the domains of both
crime and emotion processing. However, because the ASPD diag-
nosis requires criminal behavior, evidence for similarity in a lab-
oratory index of affective pathology would constitute especially
persuasive evidence for similar underlying mechanisms. Alterna-
tively, if ASPD and psychopathy are distinct syndromes of anti-
social behavior, then a different pattern of performance anomalies
would be expected. For instance, analyses may reveal different
patterns of deficits on a laboratory measure of emotional function
and different patterns of relationships between laboratory perfor-
mance and real-world criminal behavior. Third, if the validity of
ASPD largely reflects its overlap with psychopathy, then the
segregation of psychopaths from the remainder of the ASPD group
should substantially reduce or eliminate typical associations be-
tween ASPD and maladaptive behavior.
To provide simultaneous tests of these three hypotheses, we
carefully assessed male samples of inmates for both ASPD and
psychopathy. ASPD diagnoses were based on the methods outlined
in the DSM–IV. Psychopathy diagnoses were made according to
procedures outlined in the manual for the PCL–R (Hare, 1991).
Because there have also been controversies in the psychopathy
literature about the validity of the psychopathy diagnosis among
African American inmates (Kosson et al., 1990; Lorenz & New-
1We are indebted to Scott Lilienfeld for pointing out that the asymmetry
in the percentages of offenders with psychopathy who meet criteria for
ASPD as opposed to the converse may be attributable largely or entirely to
base rates, because there are considerably higher rates of ASPD than of
psychopathy in prison populations. It is entirely possible that this asym-
metry may not extend to nonprison (e.g., community, psychiatric) samples.
2Our recognition of the possibility that ASPD with psychopathy and
ASPD without psychopathy are partially distinct syndromes should not be
construed as a suggestion that they should be listed as separate disorders in
the DSM. As noted above, there is ample evidence that these syndromes
overlap to a great extent. Moreover, as discussed by others, the high
frequency of co-occurring personality disorders and symptoms in general
has resulted in obstacles to understanding and treating the personality
disorders (Lilienfeld, Waldman, & Israel, 1994). We are grateful to Tom
Widiger for raising this issue.
3The difficulty of identifying individuals with psychopathy but not
ASPD may not extend to noninstitutionalized settings. Unfortunately, there
have been very few studies of psychopathy using clinical measures outside
forensic settings (but see Ishikawa, Raine, Lencz, Bihrle, & Lacasse,
COMORBID PSYCHOPATHY IN MALE OFFENDERS WITH ASPD
man, 2002b), analyses conducted for this study were limited to the
available sample of European American male inmates.
To address these issues comprehensively, we conducted several
types of analyses. First, we directly compared groups of inmates
characterized by (a) ASPD plus psychopathy (ASPD ? PSY), (b)
ASPD but not psychopathy (ASPD-only), and (c) neither ASPD
nor psychopathy (controls) on their antisocial behavior and emo-
tional processing performance. We chose to compare these groups
on both indexes of antisocial behavior and on emotional process-
ing because these have been domains of central interest in the
psychopathy literature. Because it could be argued that inmates
with ASPD and psychopathy differ from inmates with ASPD but
not psychopathy simply because PCL–R cutting scores for psy-
chopathy groups require that individuals meet a higher percentage
of criteria (30 of 40 points or 75% of maximum criteria) than do
DSM-IV cutting scores for ASPD (3 of 7 adult criteria or 43% of
maximum criteria), we also conducted supplementary analyses in
which comparable cutting scores were used for both groups.4
Four hundred and seventy-two men participated in this study. All par-
ticipants were European American men between the ages of 18 and 45
years who were incarcerated in a state prison in southern Wisconsin at the
time of the study. Men were excluded if they showed evidence of thought
disorder, were taking psychotropic medication, performed below the
fourth-grade level on achievement tests, or had estimated IQs below 70.
Men were contacted by the researchers, provided with information about
the purposes of the study, and asked to indicate their consent for partici-
pation in writing. Those who agreed to participate were interviewed and
invited back to complete one or more laboratory tasks. To ensure that
analysis procedures were consistent with previous studies of lexical deci-
sion (Steuerwald & Kosson, 2000; Williamson, Harpur, & Hare, 1991), we
retained only data for right-handed men for this task. Of those meeting
inclusion criteria, 88 men completed the affective lexical decision task
(described below). Each inmate was administered a semistructured inter-
view addressing his family, school, work, sexual, and criminal history. In
addition, each inmate’s prison record was examined as a source of collat-
eral information. The combination of interview and file information was
used to diagnose both psychopathy and ASPD.
For the diagnosis of ASPD, we wrote interview questions to obtain
answers to each of the DSM–IV criteria. The DSM–IV criteria require not
only the presence of adult antisocial behavior in multiple domains but also
the presence of conduct disorder prior to age 15 and evidence of antisocial
behavior not attributable to schizophrenia or limited to manic episodes.
Interrater agreement based on observed interviews (n ? 107) was good,
? ? .92.
The PCL–R (Hare, 1991) consists of 20 items, each referring to a
behavioral disposition or trait that is characteristic of the adult psychopath.
Each item is scored 0, 1, or 2 to denote whether the behavior disposition is
not at all present, present to some degree, or definitely present. In the
framework based on recommendations of Hare (1991), inmates who re-
ceive scores of 30 or higher are commonly considered to be psychopaths
and inmates with scores of 20 or lower are commonly considered to be
nonpsychopaths. The diagnostic status of inmates with scores greater than
20 but less than 30 is somewhat ambiguous, and such inmates are com-
monly referred to as a middle or intermediate group. Interrater agreement
for PCL–R scores (based on observed interviews, with file reviews and
ratings conducted independently; n ? 108) was good, average intraclass
r ? .94. In analyses addressing criminal behavior, PCL–R scores were
modified: Scores on two items directly related to criminal conduct (juve-
nile delinquency and criminal versatility) were deleted, and scores were
prorated. This procedure was used to reduce overlap between the measure
of psychopathy and the measures of antisocial behavior; similar procedures
have been used in other studies (Brinkley et al., 2001; Kosson et al., 1990;
Vitale, Smith, Brinkley, & Newman, 2002).
For the purposes of this study, the inmates were divided into three
groups. Individuals with ASPD plus psychopathy (ASPD ? PSY) were 69
men who met all inclusion and exclusion criteria for ASPD and who met
PCL–R criteria for psychopathy (i.e., PCL–R scores of ?30). A second
group consisted of 217 men with ASPD but not psychopathy (ASPD-only).
These individuals met all inclusion and exclusion criteria for ASPD and
had PCL–R scores of less than 30. The final group was 186 men with
neither psychopathy nor ASPD (controls). This group included men with
PCL–R scores below 30 who failed to meet diagnostic criteria for ASPD.
Criminal History Measures
We examined three indexes of criminal activity to address three different
aspects of relationships between study groups and criminal conduct that
have been investigated in prior studies: the number of charges for violent
offenses, the number of charges for nonviolent offenses, and the number of
different types of offenses.
Number of charges for violent and nonviolent offenses.
definitions used in prior studies (Hare & McPherson, 1984; Kosson et al.,
1990), the following offenses were considered violent: robberies, murders,
assaults, sexual assaults, kidnappings, and weapons offenses. Offenses
considered nonviolent included burglaries and thefts, frauds and forgeries,
drug offenses, negligence and major driving offenses, escapes, arsons,
obstructions of justice, and miscellaneous minor offenses. The numbers of
charges for violent and nonviolent offenses were tallied for each inmate.
The number of different categories in which in-
mates were charged with offenses was also calculated. This total provided
an index of the versatility of each participant’s criminal activities.
On the basis of
Laboratory Measure of Emotional Processing
On each of 192 trials, participants were presented with a pronounceable
string of letters and asked to indicate by pressing one of two keys on the
keyboard whether the string constituted an English word. The stimulus list
included 48 words and 48 nonwords. The words were evenly divided into
two groups: 24 were considered neutral, and 24 were affective (Rubin &
Friendly, 1986). Affective and neutral words were matched on concrete-
ness, frequency, imageability, pronounceability, and number of letters and
syllables (see Lorenz & Newman, 2002b, for further detail). Nonwords
closely resembled words, typically differing in two letters.
Past research shows that nonclinical samples are faster to classify
affective words than neutral words, a phenomenon referred to as affective
4Because factor analyses have suggested that several distinct (although
correlated) dimensions underlie PCL–R scores (e.g., Cooke & Michie,
2001; Harpur et al., 1989), it could be argued that the PCL–R factors
should be used to examine relationships between ASPD ? PSY versus
ASPD-only groups. However, the authors of these same studies argued
forcefully that the PCL or PCL–R was homogeneous and that the existence
of factors should not be interpreted as an argument against the use of
psychopathy as a whole (see Hare, 2003; Harpur et al., 1989; see also
Cooke, Kosson, & Michie, 2001). For example, Cooke and Michie (2001)
reported that an analysis of general factor saturation (GFS) “indicated that
the superordinate factor in this model is essentially a coherent construct
explaining more than three quarters of the variance accounted for by the
model” (p. 178).
KOSSON, LORENZ, AND NEWMAN
facilitation. However, in prior studies, psychopathic individuals have ex-
hibited significantly less affective facilitation than controls on lexical
decision tasks (Steuerwald & Kosson, 2000; Williamson et al., 1991).
Lorenz and Newman (2002b) reported that psychopaths exhibited a lack of
affective facilitation when responding with the right hand but not when
responding with the left hand, a finding interpreted as consistent with the
left hemisphere activation hypothesis (Kosson, 1998) and with evidence
that many of psychopaths’ cognitive deficits are observed mainly under
conditions designed to place greater demands on left hemisphere than on
right hemisphere resources (Bernstein, Newman, Wallace, & Luh, 2000;
Kosson, 1996, 1998; Llanes & Kosson, 2006; Suchy & Kosson, 2005).
Because prior studies had also used only right-handed responses for this
task (Steuerwald & Kosson, 2000; Williamson et al., 1991), we used only
right-handed response data in the present analyses.
Overview of Analyses
For each domain of analysis, preliminary analyses identified as
outliers those values within each of the three inmate groups (con-
trol, ASPD-only, or ASPD ? PSY) that differed from group means
by more than three standard deviations. Of 472 inmates with
complete information on classification and antisocial behavior
measures, 3 ASPD ? PSY, 4 ASPD-only, and 7 control inmates
were identified as univariate outliers, and 1 ASPD-only inmate and
1 control inmate were identified as multivariate outliers; their
exclusion left 66 ASPD ? PSY inmates, 212 ASPD-only inmates,
and 178 control inmates for analyses. Of the 88 inmates who
completed the emotional processing task and who could be clas-
sified as belonging to one of these three groups, 1 outlier (1 control
inmate) was identified. After he was eliminated from analyses, 25
ASPD ? PSY inmates, 26 ASPD-only inmates, and 36 control
inmates remained for emotional processing analyses. Then, for
each domain, an analysis of variance (ANOVA) was performed, in
which inmate group (control, ASPD-only, or ASPD ? PSY)
served as the between-subjects variable. Levene’s (1960) test for
homogeneity of variance was examined for each analysis; where
there was evidence for heterogeneity of variance, the Welch F? and
t? tests were used in ANOVAs and in tests comparing group
To examine real-world behavior, we performed ANOVAs to
examine the number of different kinds of criminal offenses with
which an individual was charged and the number of charges he
received for nonviolent and for violent offenses (as defined above).
To examine emotional processing, we used ANOVAs to determine
the amount of emotion facilitation in the lexical decision task. The
magnitude of facilitation was computed as the difference between
the mean response latency to affective words and the mean re-
sponse latency to neutral words. Although this task was completed
with both the right hand and the left hand (in separate blocks),
Lorenz and Newman (2002b) reported that psychopathic offenders
exhibited emotional deficits only when using the right hand.
Therefore, analyses were limited to trial blocks involving right-
handed responses. Finally, regressions were conducted to examine
relationships between emotional processing and crime for partic-
ipants with ASPD alone versus those with ASPD ? PSY.
Relationships Between Diagnosis and Antisocial Behavior
in the number of different offense categories in which charges had
been registered, F(2, 453) ? 51.40, p ? .001. Both ASPD ? PSY
inmates and ASPD-only inmates committed more types of crimes
than did controls: t(242) ? 9.87, p ? .001, d ? 1.27, for ASPD ?
PSY inmates versus controls, and t(388) ? 6.65, p ? .001, d ?
0.68, for ASPD-only inmates versus controls. In addition,
ASPD ? PSY inmates committed more types of crimes than
ASPD-only inmates, t(276) ? 4.94, p ? .001, d ? 0.59.
Charges for violent offenses.
charges for violent offenses, F?(2, 160) ? 17.76, p ? .001.
ASPD ? PSY offenders were charged with more violent offenses
than were controls, t?(79) ? 5.50, p ? .001, d ? 1.24, and with
more violent offenses than ASPD-only inmates, t?(80) ? 3.95, p ?
.001, d ? 0.88. The difference between ASPD-only and control
inmates was also significant, t?(386) ? 3.48, p ? .001, d ? 0.35
(see Table 1).
Charges for nonviolent offenses.
effects for group, F?(2, 172) ? 31.58, p ? .001. As shown in Table
1, comparisons examining group differences revealed that all three
groups differed in the number of charges for nonviolent offenses:
The ANOVA revealed group differences
The groups also differed in
The ANOVA revealed main
Group Means and Standard Deviations for Criminal Conduct and for Affective Facilitation of
Control ASPD-onlyASPD ? PSY
M SDM SDM SD
No. of charges for violent offenses
No. of charges for nonviolent offenses
No. of different types of crimes committed
Affective facilitation of lexical decision (ms)
conduct analyses; sample sizes were 36, 26, and 25 for control, ASPD-only, and ASPD ? PSY groups in lexical
decision analyses. Means with different subscripts differ significantly, p ? .05. Control ? neither antisocial
personality disorder (ASPD) nor psychopathy; ASPD-only ? ASPD but not psychopathy; ASPD ? PSY ?
ASPD plus psychopathy.
Sample sizes were 178, 212, and 66 for control, ASPD-only, and ASPD ? PSY groups in criminal
COMORBID PSYCHOPATHY IN MALE OFFENDERS WITH ASPD
t?(90) ? 6.82, p ? .001, d ? 1.44, for ASPD ? PSY inmates
versus controls; t?(375) ? 5.61, p ? .001, d ? 0.58, for ASPD-
only inmates versus controls; and t?(276) ? 2.97, p ? .003, d ?
0.36, for ASPD ? PSY versus ASPD-only inmates.
In summary, inmates characterized by ASPD only were signif-
icantly different from control inmates on all three measures of
criminal behavior. Nevertheless, inmates with ASPD ? PSY were
significantly more antisocial than inmates with ASPD only.
Re-Examining Relationships Between Diagnosis and
Antisocial Behavior Using More Comparable Cutting
Scores on ASPD and Psychopathy
In light of the different base rates of ASPD versus psychopathy
in correctional settings, at least two potential explanations exist for
observed group differences. One relates directly to qualitative
differences between the ASPD and psychopathy criteria, and the
other relates to the greater deviance or, in other words, the greater
selectivity of the psychopathy criteria. To examine whether the
greater antisociality of the ASPD ? PSY group derives from their
meeting a more strict selection criterion, we repeated the above
analyses with the following change: Instead of comparing
ASPD ? PSY inmates and controls with ASPD-only inmates, we
compared the first two groups with a group with severe ASPD but
not psychopathy (severe ASPD-only). Because individuals in the
ASPD ? PSY group must exhibit PCL–R scores of at least 30 of
40 points or 75.0% of maximum criteria, men were classified as
severe ASPD-only if they met full diagnostic criteria for ASPD
and 5 or more of the 7 DSM–IV adult criteria or at least 71.4% of
maximum criteria for ASPD and if their PCL–R scores were below
30. One hundred eight men met these stringent criteria for severe
ASPD only; the mean number of DSM–IV adult criteria for this
group was 5.60 of 7 criteria or 80.0% of the maximum criteria.
The pattern of results for antisocial behavior indexes was gen-
erally similar to that reported above. There were significant effects
for group for criminal versatility, F(2, 292) ? 64.91, p ? .001; for
violent charges, F(2, 292) ? 26.76, p ? .001; and for nonviolent
charges, F(1, 292) ? 47.03, p ? .001. Independent t tests repli-
cated the pattern of significant differences reported above for
criminal versatility. The severe ASPD-only group committed more
different types of offenses than did controls, t(285) ? 8.59, p ?
.001, d ? 1.02, and fewer different types of offenses than ASPD ?
PSY, t(172) ? 2.62, p ? .01, d ? 0.40. For violent charges, the
pattern of group differences was stronger for the severe ASPD-
only group than that reported above in principal analyses: the
severe ASPD-only group was charged with more violent offenses
than were controls, t?(203) ? 4.83, p ? .001, d ? 0.68, and with
fewer violent offenses than were ASPD ? PSY inmates, t?(98) ?
2.48, p ? .015, d ? 0.50. Finally, results were different from
primary analyses for nonviolent charges. Severe ASPD-only in-
mates were charged with more nonviolent offenses than were
controls, t(169) ? 6.74, p ? .001, d ? 1.04, but were not charged
with significantly fewer nonviolent offenses than ASPD ? PSY
inmates, t(172) ? 1.07, p ? .29, d ? 0.16. These analyses suggest
that the difference in the severity of the diagnostic criteria may
have contributed to the difference between the ASPD ? PSY and
ASPD-only groups in charges for nonviolent offenses but do not
account for the differences in charges for violent offenses and
criminal versatility reported above.
Relationships Between Diagnosis and Emotional
Consistent with findings reported in Lorenz and Newman
(2002a), the ANOVA revealed a significant effect of group on
amount of affective facilitation, F(2, 84) ? 3.53, p ? .034. Simple
t tests revealed group differences similar to those reported in the
psychopathy literature for trials completed with the right hand:
ASPD ? PSY inmates displayed less affective facilitation than did
control inmates, t(59) ? 2.48, p ? .016, d ? 0.65, and less
affective facilitation than ASPD-only inmates, t(49) ? 2.32, p ?
.024, d ? 0.66, but ASPD-only inmates did not differ from
controls, t(60) ? 1, ns. Means and standard deviations are shown
in Table 1.
Relationships Between Emotional Processing and
Given the evidence that ASPD ? PSY and ASPD-only inmates
differed in their emotional processing, we also conducted regres-
sions to examine whether emotional processing as measured by a
laboratory paradigm would correlate with real-world antisocial
behavior and whether the nature of this relationship would be
similar for ASPD-only and ASPD ? PSY inmates. This series of
regressions included only these two groups; on successive steps,
we entered a coding for group, the magnitude of affective facili-
tation on right-handed trials, and their interaction. Because a
preliminary inspection of residuals for nonviolent and violent
charges suggested that these were not normally distributed we also
conducted parallel ordinal regression for this criterion variable.
The results of the ordinal regressions were very similar to those of
the linear regression.5
When group and affective facilitation were examined as predic-
tors of the total number of charges for nonviolent offenses, neither
the effect of group nor the effect of degree of affective facilitation
achieved statistical significance, Fchange(1, 48) ? 2.32, p ? .135,
for group; Fchange(1, 47) ? 2.36, p ? .131, for degree of affective
facilitation (both increments in R2? .046). However, the Group ?
Affective Facilitation interaction was significant, Fchange(1, 46) ?
5.38, p ? .025, ? ? ?.94, increment in R2? .095. The significant
interaction is depicted in Figure 1. For ASPD ? PSY inmates,
reduced affective facilitation was associated with a greater number
of charges for nonviolent offenses, r(24) ? ?.61, p ? .001,
whereas for ASPD-only inmates, reduced affective facilitation was
unrelated to the number of nonviolent charges, r(26) ? .02, ns.
The difference between these correlations was significant, Z ?
2.42, p ? .016. In contrast, only group was a significant predictor
5In the ordinal regression, the numbers of charges for nonviolent of-
fenses were recoded to one of five different levels corresponding to very
low, low, moderate, high, and very high levels of nonviolent offending.
The ordinal regression showed that the Group ? Affective Facilitation
interaction was significant, Wald’s ?2(1, N ? 50) ? 3.87, p ? .049. The
ordinal regression differed from the linear regression in that the main
effects for group and affect facilitation were also significant, Wald’s ?2(1,
N ? 50) ? 4.31, 4.53, both ps ? .05, whereas group only approached
significance for the linear regression. A parallel ordinal regression for
number of charges for violent offenses yielded significant prediction only
for group, Wald’s ?2(1, N ? 50) ? 5.35, p ? .021.
KOSSON, LORENZ, AND NEWMAN
of the number of charges for violent offenses, Fchange(1, 48) ?
10.18, p ? .003, ? ? .42, R2? .175. Neither the degree of
affective facilitation nor the interaction proved significant, both
Fchanges? 1, ns.
Finally, for criminal versatility, the group variable was signifi-
cant, Fchange(1, 48) ? 26.77, p ? .001, ? ? .60, explaining 35.8
% of the variance. Although the degree of affective facilitation was
not a significant predictor, Fchange(1, 47) ? 1, the Group ?
Affective Facilitation interaction again explained unique variance
in criminal versatility, Fchange(1, 46) ? 4.71, p ? .035, ? ? ?.74,
increment in R2? .060. Inspection of correlations revealed that
among ASPD ? PSY inmates, the negative correlation between
degree of affective facilitation and criminal versatility approached
significance, r(24) ? ?.35, p ? .095; in contrast, among ASPD-
only inmates, there was a nonsignificant positive correlation be-
tween degree of affective facilitation and criminal versatility,
r(26) ? .26, p ? .20. The difference between these correlations
was significant, Z ? ?2.09, p ? .037.
Both classifications of ASPD without psychopathy and
ASPD with comorbid psychopathy showed reliable links to
important real-world criteria. Even after we removed all in-
mates with psychopathy from the ASPD group, ASPD diag-
noses remained a significant predictor of the number of charges
that men received for violent and nonviolent offenses as well as
for criminal versatility. At the same time, the findings that
offenders with ASPD ? PSY exhibited greater criminal activity
and criminal versatility than inmates with ASPD alone are
consistent with claims that in examining inmates with antisocial
features, psychopathy also makes a unique contribution to the
understanding of criminal behavior. Moreover, because we had
removed the PCL–R items most directly related to antisocial
behavior (Items 18 and 20) prior to conducting these ANOVAs,
the greater antisociality of the ASPD ? PSY individuals is not
easily attributed to the use of this information in assessing
psychopathy. In fact, it is likely that predictor–criterion overlap
was greater with respect to the ASPD diagnosis than to the
psychopathy diagnosis because overt antisocial behavior is cen-
tral to several of the childhood and adult criteria for ASPD.
Nevertheless, because it remains possible that scoring of several
PCL–R items and diagnostic judgments regarding ASPD were
influenced by information about participants’ criminal histo-
ries, relationships between criminal conduct and ASPD alone or
100.00 50.000.00 -50.00 -100.00
ASPD + PSY
Emotion Facilitation (ms)
Number Charges for Nonviolent Crimes
offenses. ASPD ? antisocial personality disorder.
Group ? Affective Facilitation interaction in prediction of the number of charges for nonviolent
COMORBID PSYCHOPATHY IN MALE OFFENDERS WITH ASPD
ASPD plus psychopathy should be interpreted with caution
until these findings are replicated in prospective studies.
Laboratory findings showing different patterns of results for
ASPD inmates with psychopathy and those without psychopathy
suggest that different psychological mechanisms characterize these
two subgroups of ASPD offenders. Compared with ASPD-only
inmates and with controls without ASPD or psychopathy, ASPD ?
PSY inmates were relatively insensitive to emotional cues; they
exhibited no affective facilitation in judging the lexicality of words
when using the right hand. These findings are consistent with a
growing body of evidence that inmates with psychopathy display
a variety of performance-related deficits under conditions that
would be expected to place differential demands on left hemi-
sphere resources (Bernstein et al., 2000; Kosson, 1996, 1998;
Llanes & Kosson, 2006; Suchy & Kosson, 2005).
Moreover, the finding that the degree of affective facilitation
was differentially related to both the number of charges for non-
violent offenses and the number of different kinds of offenses
committed suggests that there may be distinct kinds of emotional
pathology in the two groups. Whereas the degree of affective
facilitation correlated inversely with criminal activity in inmates
with ASPD ? PSY, the degree of affective facilitation correlated
nonsignificantly (positively) with criminal activity in ASPD-only
One possibility consistent with the present pattern of results is
that the emotion processing deficits seen in inmates with ASPD
and comorbid psychopathy may contribute directly to the antiso-
cial behavior that is often the focus of attention in studies of
psychopathy. Consistent with other prominent perspectives on
psychopathy (Blair, Jones, Clark, & Smith, 1997; Hare, 1998;
Lykken, 1995; Patrick, 1994), Newman and Lorenz (2003) have
proposed that the disinhibited, antisocial behavior of individuals
with psychopathy is associated with a deficiency in using emo-
tional and other contextual information to regulate behavior. From
this perspective, increasing sensitivity to contextual emotion cues
(i.e., emotion facilitation) in these individuals could be associated
with fewer criminal charges being filed against them.
In contrast, the criminal behavior of individuals with ASPD only
was not significantly correlated with degree of affective facilita-
tion. Although the correlation between affective facilitation and
criminal versatility (r ? .26) was not significant in this group, the
moderate effect size suggests that it might prove significant in a
larger sample. Nevertheless, the direction of the correlation is
opposite to the association found for the ASPD ? PSY group.
Thus, if anything, this nonsignificant correlation is consistent with
research reported by others suggesting that much of the impulsive
antisocial behavior seen in ASPD individuals without psychopathy
may reflect the disinhibiting effects of excessive negative affective
arousal (cf. Krueger et al., 1994; MacCoon & Newman, in press;
Wallace & Newman, 1997). In any case, it appears likely that
different psychological processes underlie the antisocial behavior
of individuals with ASPD alone and those with ASPD and psy-
chopathy, and clarifying the nature of these processes may have
important implications for developing more specific and effica-
cious therapeutic interventions.
In summary, current results are consistent with the possibility
that distinct syndromes characterize offenders with ASPD and
comorbid psychopathy versus offenders with ASPD but without
comorbid psychopathy. Current findings are not consistent with
the argument that the validity of ASPD is dependent on the
comorbidity between ASPD and psychopathy. Nor are current
findings entirely consistent with the perspective that these two
syndromes simply reflect different levels of the same underlying
pathological process. Such an argument might be raised with
respect to the criminal activity findings, with the implication that
individuals with psychopathy are characterized by a more severe
form of ASPD than are individuals with nonpsychopathic ASPD.
However, the finding that individuals with severe ASPD but not
psychopathy exhibited less criminal activity than individuals with
psychopathy suggests that the severity of the ASPD is not the sole
reason for group differences. More important, this perspective
cannot explain observed differences in the processing of emotional
information or the different relation between emotional processing
and antisocial behavior observed in the two groups.
At the same time, because the current study is the first to
distinguish ASPD with psychopathy from ASPD without psychop-
athy in this way, results should be regarded as preliminary pending
replication in other samples and with other analytic strategies and
measures. Indeed, given the wide variety of performance deficits
and physiological anomalies reported in prior research with indi-
viduals with psychopathy as well as in prior research with indi-
viduals with ASPD, it should be straightforward to examine
whether the current pattern of findings can be replicated using
measures in other domains of functioning.
In addition, some limitations of the current study should be
emphasized. First, the current study was limited to a sample of
inmates. Thus, although this sample was relatively large and
appeared representative in many respects of samples used in most
prior studies of psychopathy and ASPD, a general limitation of
most of this research is that correctional samples may not be
representative of offenders in general. In addition, because some
behavioral deficits identified in European American offenders with
psychopathy, including the affective processing deficit examined
in this study, do not replicate in African American offenders with
psychopathy (Donnellan, Ge, & Wenk, 2000; Kosson et al., 1990;
Lorenz & Newman, 2002a, 2002b; Thornquist & Zuckerman,
1995), the current analysis was limited to European Americans.
Thus, it remains possible that the differential relationships ob-
served between emotional processing anomalies and antisocial
behavior, like some behavioral deficits themselves, would not
generalize to samples of African American offenders. In addition,
given the overrepresentation of ethnic minorities in U.S. prisons, it
is important to examine whether differences between ASPD with
psychopathy and ASPD without psychopathy generalize to African
American and other ethnic minority populations. Finally, an addi-
tional weakness of the supplementary analysis being limited to
men meeting 5 or more of the 7 DSM–IV adult criteria for ASPD
should be noted. Given that the DSM–IV criteria for ASPD and the
PCL–R items differ in the number of items and may also differ in
the difficulty of the items, our analysis does not ensure that the
severe ASPD-only and the ASPD ? PSY groups were comparable
in their severity.
At the same time, current findings are provocative. Given the
substantial construct validity of both ASPD and psychopathy and
given that the current (albeit limited) literature suggests that adult
inmates with ASPD and psychopathy may be less amenable to
treatment than those with ASPD alone (Cacciola, Alterman, Ruth-
erford, & Snider, 1995; Hare, Clark, Grann, & Thornton, 2000; but
KOSSON, LORENZ, AND NEWMAN
see also Skeem, Monahan, & Mulvey, 2002), additional studies
addressing the heterogeneity of ASPD are important and could be
useful in determining whether comorbid psychopathy serves to
identify a more etiologically homogeneous ASPD subtype with
differential treatment needs.
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Received December 12, 2005
Revision received May 8, 2006
Accepted May 18, 2006 ?
KOSSON, LORENZ, AND NEWMAN