Antisocial and psychopathic personalities in a sample of addicted subjects: Differences in psychological resources, symptoms, alexithymia and impulsivity

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Antisocial and psychopathic personalities in a sample of addicted subjects:
Differences in psychological resources, symptoms, alexithymia
and impulsivity
Alessio Gori
a
, Giuseppe Craparo
b,
⁎, Giuseppe Iraci Sareri
c
, Vincenzo Caretti
d
,
Marco Giannini
a
, Patrizia Meringolo
a
a
University of Florence, Italy
b
Kore University of Enna, Italy
c
Cooperativa Incontro, Pistoia, Italy
d
University of Palermo, Italy
Abstract
Objective: Psychopathy and antisocial personality disorder (ASPD) are two constructs not interchangeable. Compared to the ASPD,
psychopathy is characterized by lack of anxiety, low withdrawal, and high levels of attention seeking.
Method: The sample of this study included 76 subjects with a substance use disorder. Subjects were aged between 18 and 59 years old (M = 32.87,
SD = 9.36). With respect to level of education 3 subjects are elementary school graduates, 49 have a middle school diploma, 21 own a high school
diploma, and 3 participants have a bachelor's degree. We administered the following measures: a) Psychopathic Personality Inventory-Revised
(PPI-R); b) Psychological Treatment Inventory (PTI); c) 20-Item-Toronto Alexithymia Scale (TAS-20); d) Barratt Impulsiveness Scale (BIS).
Results: Most of the significant correlations between the Psychopathic Index (PPI-R total score), and the measures administered are listed
below: PPI-R total score and Deviance (r = .482, p b.001), PPI-R total score and Hypomania (r = .369, p b.001), PPI-R total score and
Unresolved attachment (r = .293, p b.001), PPI-R total score and Manipulativeness (r = .550, p b.001), PPI-R total score and the TAS-20
total score (r = .230; p b.001), PPI-R total score and Difficulty in Identifying Feelings (DIF) factor (r = .250, p b.001), PPI-R total score
and Attentional Impulsiveness (r = .409, p b.001); PPI-R total score and Motor Impulsiveness (r = .526, p b.001). Results of MANOVAs
between the two groups also revealed significant differences on several variables analyzed.
Conclusions: Our study showed that addicted subjects with psychopathic tendencies are more likely to experience negative emotions and
have a peculiar cognitive style with respect to antisocial addicts. These results partially confirm those ones of previous studies underlining
that psychopathic population is generally characterized for a major need for stimulation, poor behavioral controls, lack of realistic long-term
goals, impulsivity, irresponsibility.
© 2014 Elsevier Inc. All rights reserved.
1. Introduction
In the recent psychiatric literature, psychopathy has been
distinguished by antisocial personality disorder (ASPD).
Although, for many authors the terms psychopathy and
antisocial personality disorder (ASPD) are not interchange-
able, this difference is not present in the Diagnostic and
Statistical Manual of Mental Disorders, 4th Edition (DSM-
IV). According to the DSM-IV, the essential feature of
ASPD is “a pervasive pattern of disregard for, and violation
of, the rights of others that begins in childhood or early
adolescence and continues into adulthood”[1]. Individuals
diagnosed with this disorder can exhibit a range of behaviors,
including irresponsibility, lack of remorse, pathological
lying, lack of empathy, and aggressiveness, to name a few.
Rogers et al. [22] had this to say about the situation: “DSM-
IV does considerable disservice to diagnostic clarity in its
equating of ASPD to psychopathy”(pp. 236–237). Unfor-
tunately, a diagnostic category of psychopathy is absent also
in the fifth version of the Diagnostic and Statistical Manual
of Mental Disorders, although the psychopathy has been
included as a subtype of ASPD [2].
Available online at www.sciencedirect.com
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⁎Corresponding author at: University of Enna Kore, via Cittadella
Universitaria, 94100, Enna, Italy. Tel.: +39 0935 536 536.
E-mail address: giuseppe.craparo@unikore.it (G. Craparo).
http://dx.doi.org/10.1016/j.comppsych.2014.05.023
0010-440X/© 2014 Elsevier Inc. All rights reserved.

Psychopathy is characterized by a constellation of affective,
interpersonal and behavioral traits including impulsivity, lack
of empathy and guilt, manipulativeness, lack of depth of
emotion, and a persistent violation of social norms [13].For
Hare, a significant contributor to the literature of psychopathy,
the failure “to differentiate between psychopathy and ASPD
can have serious consequences for clinicians and for society”,
in fact, most psychopaths meet the criteria for ASPD….most
individuals with ASPD are not psychopaths [14,15].
Compared to the ASPD, psychopathy (or “Primary
Psychopathy”) is characterized by lack of anxiety, low
withdrawal, and high levels of attention seeking. “High attention
seeking and low withdrawal capture the social potency
(assertive/dominant) component of psychopathy, whereas low
anxiousness captures the stress immunity (emotional stability/
resilience) component”[2].However,giventhelackofstudies
that analyze the differences between these two types of
personality structures, there is still a need for assessing the
differences in terms of psychological resources, attachment
styles, defense styles, and other psychopathological features
between these two domains. In particular this study wants to
examine the differences of these personality characteristics
between addicts with antisocial tendencies and addicts with
psychopathic tendencies. This study aims to assess if there are
psychological differences between two groups of addicts (with
psychopathic tendencies and with antisocial tendencies) with
regard to alexithymia, impulsiveness, defense mechanisms,
attachment styles, and symptoms. Expected hypotheses are:
a) higher scores on alexithymia, impulsiveness, deviance, and
hypomania in the group of addicts with psychopathic
tendencies; b) a greater level of traumatic experiences in
psychopathic addicts compared to antisocial addicts.
2. Method
2.1. Participants and procedure
The sample of this study included 76 subjects with a
substance use disorder. Subjects were aged between 18 and
59 years old (M=32.87,SD =9.36).Withrespecttothelevel
of education 3 subjects are elementary school graduates, 49 have
amiddleschooldiploma,21ownahighschooldiploma,and3
participants have a bachelor's degree. As regard to the
relationship status, 50 participants declared to be single, 4
declared to be engaged, 11 to be married, 10 to be divorced, and
1declaredtobewidower.Allparticipantswererecruitedatthe
Tuscan territorial unit of the National Health Service.
The study inclusion criteria included a diagnosis of
dependence in accordance to DSM-IV criteria. All subjects
of the sample have a history of antisocial behaviors and
claimed to have a criminal record. Exclusion criteria included a
co-morbid psychiatric disorder (eg, schizophrenia) and an
organic brain syndrome.
On the basis of the PPI-R total score, indexing global
psychopathic traits, participants were divided into two
groups: 1) addicted with antisocial tendencies; and
2) addicted with psychopathic tendencies. The group 1 was
composed of 51 subjects with a mean age of 34.5 years old
(SD = 8.06) and the group 2 was composed of 25 subjects
with a mean age of 29.56 years old (SD = 11.01).
The instruments listed below were administrated with a
separate form that allows to assess the information about
gender and age. The time for administration procedures was
about 90–120 minutes for each participant. All participants
filled the questionnaires voluntarily and completed an
informed consent after the intake assessment. This study was
approved and partially financed by the Tuscan Region (Italy).
2.2. Measures
Psychopathic Personality Inventory-Revised (PPI-R; [19]).
The Psychopathic Personality Inventory (PPI) is a self-report
to evaluate traits associated with psychopathy in adults
developed by Lilienfeld and Andrews [17].ThePPIwas
revised in 2005 to become the PPI-R and now comprises 154
items organized into eight subscales. This self-report yields a
total psychopathy index (PPI-R Total score) as well as scores
on eight content scales (i.e. Machiavellian Egocentricity,
Rebellious Nonconformity, Blame Externalization, Carefree
Nonplanfulness, Social Influence, Fearlessness, Stress Immu-
nity, Coldheartedness), two validity scales (i.e. Virtuous
Responding, Deviant Responding) and three factors (i.e.
Self-Centered Impulsivity, Fearless Dominance, Coldhearted-
ness). The items are rated on a 4-point Likert scale (1 = false,
2 = mostly false, 3 = mostly true, and 4 = true). The Italian
version showed good internal reliability for the content scales
ranging from α= .78 (Coldheartedness) to α= .87 (Social
Influence, Fearlessness), for the community sample (PPI-R
Total score, α=.92), and from α= .71 (Social Influence,
Fearlessness) to α= .83 (Machiavellian Egocentricity) for the
offender sample (PPI-R Total score, α=.
84) [16].
Psychological Treatment Inventory (PTI; [11,12]). The
Psychological Treatment Inventory is a measure for assessing
personality composed of two different questionnaires: a self-
report measure (client version) and a clinician scale (clinician
version). In this study, we used the PTI client version that is
composed of 268 items scored on a 5-point Likert scale (1 = not
at all, 2 = somewhat, 3 = moderately, 4 = a good deal, and
5=verymuch).ThePTIclientversioniscomposedofseveral
higher order scales grouped in four areas: (1) validity; (2)
resources that includes two clusters: psychological resources
and quality of life; (3) clinical, which includes two clusters
(symptomatology and psychological types). Symptomatology is
articulated into internalized symptoms scales and externalized
symptoms scales; (4) psychological treatment that is com-
posed of four clusters: (a) attachment styles; (b) predominant
defence styles; (c) negative treatment indicators; and (d)
psychological mindedness. The PTI showed good psycho-
metric properties (Giannini, Gori, De Sanctis & Schuldberg,
2010; [12]). Alpha coefficients indicate a good internal
reliability for the majority of the PTI scales. Test–retest
reliability showed good values ranging from .75 to .95. Each
2A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx

cluster showed a good construct validity, with robust
dimensions, verified with a series of exploratory and
confirmatory factor analysis. Some aspects of concurrent
validity were verified with the Millon Clinical Multiaxial
Inventory-III (MCMI-III; [20]), the Symptom Checklist-90-
Revised (SCL-90-R; [8]), the Psychopathic Personality
Inventory-Revised (PPI-R; [19]) and the Barratt Impulsiveness
Scale-11 (BIS-11; [21]).
20-Item-Toronto Alexithymia Scale (TAS-20; [3,4]). The
20-Item-Toronto Alexithymia Scale is a 20-item self-report
measure and a higher score indicates higher levels of
alexithymia. Items are rated on a 5-point Likert scale ranging
from 1 (strongly disagree) to 5 (strongly agree). In the TAS-20,
it is possible to distinguish three factors: 1) difficulty
modulating and identifying feelings (DIF), 2) difficulty
describing one's feelings to others (DDF), and 3) externally-
oriented thinking (EOT). Cut-off scores are as follow: ≤50 =
no alexithymia, 51–60 = borderline alexithymia, and ≥61 =
alexithymia. The TAS-20 has shown adequate validity and
reliability (α= .81; r = .77). Likewise, the Italian version [5]
presents a good internal reliability (Cronbach's α=0.81).
Barratt Impulsiveness Scale (BIS-11; [21]). The Barratt
Impulsiveness Scale-11 is a 30 item self-report questionnaire
designed to assess general impulsiveness taking into account
the multi-factorial nature of the construct. The structure of the
instrument allows the assessment of six first-order factors
(attention, motor, self-control, cognitive complexity, perse-
verance, cognitive instability) and three second-order factors:
attentional impulsiveness; motor impulsiveness (motor and
perseverance); non-planning impulsiveness (self-control and
cognitive complexity). A total score is obtained by summing
the first or second-order factors. The items are scored on a four
point scale (rarely/never =1, occasionally = 2, often = 3,
almost always/always = 4). The Italian version presents a
good internal reliability (Cronbach's α=.79)[9].
2.3. Data analysis
Descriptive statistics for all variables were examined and
statistical results of demographic variables based on percent-
ages, scale means and standard deviations presented. A series
of two-tailed Pearson linear correlations were conducted to test
relationships among the variables under investigation. Fur-
thermore, a series of MANOVAs were used in order to verify
the differences between the two groups. The statistical package
SPSS 18 for Windows was used for all the analyses (SPSS,
Chicago, IL).
3. Results
Frequencies for each group as regard to the substance of
first use and to the favorite substance were calculated and
reported in Table 1 (see Table 1).
Pearson's r coefficients show statistically significant
positive correlations between the Psychopathic Index (PPI-R
total score) and PTI Self-Esteem scale (r = .280; p b.001) and
between PPI-R total score and PTI CreativityTendencies scale
(r = .241; p b.001). Significant correlations were also found
between the Psychopathic Index (PPI-R total score) and the
following PTI Clinical scales: Obsessiveness (r = .217;
pb.001); Bizarre Thought (r = .217; p b.001); Deviance
(r = .482; p b.001); Impulsiveness (r = .372; p b.001);
Hypomania (r = .369; p b.001), and the “Cluster B”PTI
index (r = .457; p b.001). Other significant correlations were
found among the Psychopathic Index (PPI-R total score), the
PTI Attachment Styles, the Predominant Defence Styles, and
the Negative Treatment Indicators Clusters, particularly with
the following scale: Unresolved attachment style scale (r =
.293; p b.001); Immature defence style scale (r = .448;
pb.001); Alexithymia scale (r = .202; p b.001) and
Manipulativeness scale (r = .550; p b.001).
Pearson's r correlations among the Psychopathic Index
(PPI-R total score), TAS-20 and BIS are listed below: PPI-R
total score and the TAS-20 total score (r = .230; p b.001),
PPI-R total score and Difficulty in Identifying Feelings (DIF)
factor (r = .250, p b.001), PPI-R total score and Attentional
Impulsiveness (r = .409, p b.001); PPI-R total score and
Motor Impulsiveness (r = .526, p b.001).
A series of MANOVAs, performed with the PTI
Resources Area scales as dependent variables and the
group variable (Antisocial vs. Psychopathic) as the indepen-
dent variable, showed significant differences in mean scores
for the following scales: Work Interference (WI) and
Distress (D) belonging to the cluster quality of life. There
was an overall main effect of group, Wilks' λ.83 (p = .022),
F (5,70), partial η
2
= .168. The psychopathic group obtained
higher scores on Work Interference (WI) (p = .019) and
Distress (D) (p = .047). No differences between the two
groups were found as regard to the other scales of this area
(see Table 2).
The psychopathic group obtained higher scores on
Depressive Aspects (DA) (p = .038) and Bizarre Thought
(BT) (p = .057) of Internalizing scales and, on Deviance
(Dev) (p b.001), Impulsiveness (Imp) (p = .016), and
Table 1
Frequencies of variables Substance of first use and Favorite substance for
each group.
Substance of first use Favorite substance
Antisocial
group
Psychopathic
group
Antisocial
group
Psychopathic
group
Heroin 6 0 15 8
Amphetamines 0 21 1
Cocaine 3 0 12 2
Hallucinogens 0 11 4
Alcohol 6 3 11 3
THC 25 12 2 4
Heroin + Alcohol 1 01 0
Alcohol + Cocaine 3 03 1
THC + Alcohol 4 52 1
Other 3 23 1
Total 51 25 51 25
3A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx

Hypomania (Hy) (p = .023) scales. Mean scores and effect
of interactions are reported in Table 3 (see Table 3).
Regarding the attachment styles, the psychopathic group
obtained higher scores on Unresolved (U) (p = .019) scale, a
dimension of attachment style related to traumatic experiences.
Other two dimensions of PTI in which the Psychopathic group
reported higher scores were the Immature (Imm) scale (p =
.035), related to a primitive (and impulsive) defense modality,
and the Manipulativeness (Man) scale (p = .028) which refers
to manipulate others to take advantages. Mean scores and
effect of interactions are reported in Table 4 (see Table 4).
For what concerns the dimensions of TAS-20 there were no
significant differences between the two groups. However, in this
regard, the psychopathic group obtained higher scores on TAS-
20 total score (M = 58.46, SD = 10.44) with respect to the
antisocial group (M = 53.26, SD = 12.79): these scores are
very close to the borderline range of alexithymia (see Table 5).
As regard to the BIS dimensions, the psychopathic group
reported higher scores on Attentional Impulsiveness (A) and
Motor Impulsiveness (M) scales, respectively (p = .022 and
p = .006). There was an overall main effect of group, Wilks'
λ.87 (p = .018), F (3,72), partial η
2
= .13 (Table 6).
Table 2
Differences in the PTI Resourses Area mean scores (MANOVAs) between the two groups.
Antisocial group
(n = 51)
Psychopathic group
(n = 25)
M SD M SD DoF F p
Psychological Resources (RES)
Self-Efficacy (SEf) 18.98 4.82 18.44 4.11 5,70 .23 .630
Self-Esteem (SE) 12.58 2.61 12.68 3.29 5,70 .02 .889
Perceived Social Support (PSS) 17.05 5.08 17.92 4.48 5,70 .52 .471
Creative Tendencies (CT) 19.04 5.05 19.49 5.47 5,70 .13 .721
Self-Regulation (SR) 18.59 5.59 20.32 5.49 5,70 1.63 .206
Quality of Life (QoL)
Life Satisfaction (LS) 15.74 5.06 15.68 4.91 5,70 .003 .958
Work Interference (WI) 10.20 3.56 12.56 4.86 5,70 5.75 .019
Family Interference (FI) 11.53 4.69 13.36 4.75 5,70 2.53 .116
Social Introversion (SI) 10.19 3.99 9.56 3.37 5,70 .46 .498
Distress (D) 13.54 3.58 15.46 4.45 5,70 4.08 .047
1) RES main effect: Wilks' λ.94 (p = .474), partial η
2
= .06.
2) QoL main effect: Wilks' λ.83 (p = .022), partial η
2
= .168.
Table 3
Differences in the PTI Clinical Area mean scores (MANOVAs) between the two groups.
Antisocial group
(n = 51)
Psychopathic group
(n = 25)
M SD M SD DoF F p
Internalizing Scales(INT)
Depressive Aspects (DA) 10.86 4.30 13.48 6.38 10,65 4.46 .038
General Anxiety (GA) 11.88 4.94 13.08 5.85 10,65 .87 .354
Obsessiveness (O) 11.82 3.89 13.44 5.01 10,65 2.39 .126
Somatization (So) 8.70 3.49 9.68 5.11 10,65 .97 .327
Phobic Traits (PhT) 9.29 4.07 10.40 4.09 10,65 1.23 .271
Post-Traumatic Stress Disorder (PTSD) 15.37 6.89 16.14 8.31 10,65 .18 .673
Risk of Eating Disorder (RED) 16.83 7.63 18.20 8.92 10,65 .48 .488
Paranoid Ideation(PaI) 15.19 4.22 15.56 5.08 10,65 .11 .743
Bizarre Thought (BT) 10.51 4.97 13.13 6.61 10,65 3.73 .057
Sexual Discomfort (SD) 7.39 4.02 6.67 2.74 10,65 .66 .419
Externalizing Scales(EXT)
Deviance (Dev) 17.99 4.72 23.64 6.61 3,72 18.27 .001
Impulsiveness (Imp) 15.72 5.30 19.32 7.20 3,72 6.07 .016
Hypomania (Hy) 13.43 4.79 16.15 4.81 3,72 5.39 .023
Clusters of Personality Types (PTypes)
Cluster A of Personality Disorders 7.92 2.94 7.68 2.65 3,72 .12 .729
Cluster B of Personality Disorders 13.31 3.05 13.72 3.03 3,72 .29 .587
Cluster C of Personality Disorders 6.65 2.14 6.56 2.86 3,72 .02 .882
1) INT main effect: Wilks' λ.84 (p = .270), partial η
2
= .16.
2) EXT main effect: Wilks' λ.79 (p = .001), partial η
2
= .21.
3) PTypes main effect: Wilks' λ.99 (p = .874), partial η
2
= .01.
4A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx

4. Discussion
The aim of this study was to investigate the differences
between addicts with psychopathic tendencies and addicts with
antisocial tendencies with regard to psychological resources,
symptomatology, alexithymia, impulsivity, attachment styles
and defense styles.
Results showed that psychopathic addicts have a different
psychopathological profile respect to the antisocial addicts
group. Particularly, the psychopathic group obtained higher
scores on Work Interference (WI) (p = .019), Distress (D)
(p = .047), Depressive Aspects (DA) (p = .038) and Bizarre
Thought (BT) (p = .057). These aspects related to general
psychopathology indicate that, in the sample under investi-
gation, addicted subjects with psychopathic tendencies are
more likely to experience negative emotions and have a
peculiar cognitive style respect toantisocialaddicts.Besides,
psychopathy seems to be more related to greater levels of
Deviance (Dev) (p b.001), Impulsiveness (Imp) (p = .016),
and Hypomania (Hy) (p = .023). These results partially confirm
those ones of several studies underlining that psychopathic
population is generally characterized for a major need for
stimulation, poor behavioral controls, lack of realistic long-term
goals, impulsivity, irresponsibility [15,23].
In accordance with Snowden and Gray [24],withrespectto
antisocial addicts, we found in psychopathic addicts an increasing
impulsivity in the Attentional Impulsiveness (A) and Motor
Impulsiveness (M) domains. These two domains were also
associated with an alexithymic mental state, and in particular
with a difficulty to identifying feelings.
Interesting was the presence among psychopathic addicts
of the variable unresolved attachment style. As suggested by
Table 4
Differences in the PTI Psychological Treatment Area mean scores (MANOVAs) between the two groups.
Antisocial group
(n = 51)
Psychopathic group
(n = 25)
M SD M SD DoF F p
Attachment Styles(AS)
Secure (Sec) 17.39 3.95 17.92 4.17 4,71 .28 .596
Anxious/Preoccupied (A/P) 13.41 5.45 14.84 6.33 4,71 1.03 .313
Avoidant (Av) 11.78 4.55 13.92 5.86 4,71 3.04 .085
Unresolved (U) 7.91 2.96 10.28 5.66 4,71 5.72 .019
Predominant Defence Styles (PDS)
Mature (Mat) 17.59 4.06 18.56 3.61 4,71 1.01 .319
Intermediate Neurotic/Anxious (I/Anx) 12.24 4.04 13.56 4.96 4,71 1.50 .223
Intermediate Neurotic/Avoidant (I/Avo) 12.09 2.96 13.32 3.18 4,71 2.87 .095
Immature (Imm) 13.73 4.85 16.12 4.71 4,71 4.61 .035
Negative Treatment Indicators (NTI)
Alexithymia (Alx) 12.76 4.91 14.16 5.19 5,70 1.35 .257
Frustration Intolerance (FrI) 11.43 3.45 11.68 4.61 5,70 .07 .793
Negative Impression (NI) 12.09 4.85 14.48 6.68 5,70 3.14 .081
Resistance to Change (RC) 7.45 2.61 7.84 3.27 5,70 .31 .577
Manipulativeness (Man) 11.35 4.45 13.73 4.01 5,70 5.05 .028
Psychological Mindedness (PM)
Empathy (Emp) 18.53 5.13 19.88 4.87 3,72 1.18 .279
Propensity to Insight (PI) 18.14 3.84 18.36 4.09 3,72 .06 .813
Treatment Expectation (TE) 15.67 6.01 16.29 4.16 3,72 .22 .664
1) AS main effect: Wilks' λ.90 (p = .117), partial η
2
= .09.
2) PDS main effect: Wilks' λ.93 (p = .269), partial η
2
= .06.
3) NTI main effect: Wilks' λ.90 (p = .192), partial η
2
= .09.
4) PM main effect: Wilks' λ.98 (p = .748), partial η
2
= .02.
Table 5
Differences in the TAS-20 mean scores (MANOVA) between the two groups.
Antisocial group
(n = 51)
Psychopathic group
(n = 25)
M SD M SD DoF F p
Difficulty identifying feelings (DIF) 19.19 6.70 21.60 6.68 3,72 2.15 .146
Difficulty describing one’s feelings to others (DDF) 14.74 5.29 15.64 3.75 3,72 .71 .403
Externally-oriented thinking (EOT) 19.33 5.63 21.12 4.37 3,72 1.95 .167
TAS-20 Total Score 53.26 12.79 58.46 10.44 3,72 3.11 .082
1) TAS-20 main effect: Wilks' λ.95 (p = .323), partial η
2
= .05.
5A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx

several authors [6,7,10,25-27], this type of attachment style
is generally related to traumatic experiences. In this case it is
not clear if the trauma is linked with addictive behaviors or
with psychopathic traits.
In conclusion, results seem to indicate a condition of greater
severity of personality in the group of addicts with
psychopathic tendencies. In particular, it appears that addicts
with psychopathic tendencies seem to have a higher tendency
to externalization, to experience negative states, to use defense
mechanisms of the immature spectrum, and to declare
traumatic relational experiences (unresolved attachment style).
This study has several limitations that deserve attention.
First of all, the number of participants is restricted, also
because of the difficulty of recruiting subjects with these
characteristics. Nevertheless, the use of self-report instrument
to analyze psychological variables as psychopathy, may
induce some bias regarding to under-reporting the personality
conditions. In according to Lilienfeld and Fowler [18],there
are different disadvantages of using self-reports with psycho-
pathics, for example: a) dishonesty; b) to give a desirable
impression; c) loss of insight “into the nature and extent of their
psychological problems”(p. 109). Further studies are
required to better investigate the psychological and
psychopathological traits of these subjects using also a
semi-structured interview for psychopathy (e.g., Hare
Psychopathy Check-List-Revised): indeed, the PCL-R is widely
considered the “gold standard”measure for assessing the
interpersonal and affective variables of psychopathy [28,29].
References
[1] American Psychiatric Association. Diagnostic and statistical manual of
mental disorders. 4th ed. Washington, DC: American Psychiatry
Association; 1994.
[2] American Psychiatric Association. Diagnostic and statistical manual of
mental disorders. 5th ed. Washington, DC: American Psychiatry
Association; 2013.
[3] Bagby RM, Parker JDA, Taylor GJ. The twenty-item Toronto
Alexithymia Scale-I. Item selection and cross-validation of the factor
structure. J Psychosom Res 1994;38:23-32.
[4] Bagby RM, Taylor GJ, Parker JDA. The twenty-item Toronto
Alexithymia Scale-II. Convergent, discriminant, and concurrent
validity. J Psychosom Res 1994;38:33-40.
[5] Bressi C, Taylor G, Parker JDA, Bressi S, Brambilla V, Aguglia E, et
al. Cross validation of the factor structure of the 20-item Toronto
Alexithymia Scale: An Italian multicenter study. J Psychosom Res
1996;41:551-9.
[6] Bromberg P. Standing in the spaces: the multiplicity of self and the
psychoanalytic relationship. Contemp Psychoanal 1996;32:509-35.
[7] Craparo G, Schimmenti A, Caretti V. Traumatic experiences in
childhood and psychopathy: a study on a sample of violent offenders
from Italy. Eur J Psychotraumatol 2013;4:21471, http://dx.doi.org/
10.3402/ejpt.v4i0.21471.
[8] Derogatis LR. Symptom Checklist-90-R: Administration, scoring, and
procedures manual. 3rd ed. Minneapolis, MN: National Computer
Systems; 1994.
[9] Fossati A, Di Ceglie A, Acquarini E, Barratt ES. Psychometric
properties of an Italian version of the Barratt Impulsiveness Scale-11
(BIS-11) in nonclinical subjects. J Clin Psychol 2011;57:815-8.
[10] Giannini M, Gori A, De Sanctis E, Schuldberg D. A Comparative
analysis of Attachment: Psychometric Properties of the PTI Attach-
ment Styles Scale (ASS). J Psychother Integrat 2011;21:363-81.
[11] Gori A, Giannini M, Schuldberg D. Mind and body together? A new
measure for planning treatment and assessing psychotherapy outcome.
Paper presented at the SEPI XXIV Annual Meeting, Boston; 2008.
[12] Gori A, Giannini M, Schuldberg D. PTI - Psychological Treatment
Inventory. Manual and Questionnaires. Florence: Giunti OS-Organizza-
zioni Speciali; 2013 [PTI - Psychological Treatment Inventory. Manuale
e Questionari. Firenze: Giunti OS-Organizzazioni Speciali; 2013].
[13] Hare RD. The Psychopathy Checklist-Revised manual. Toronto,
Ontario, Canada: Multi-Health Systems; 1991.
[14] Hare RD. Psychopathy: a clinical construct whose time has come. Crim
Justice Behav 1996;23:25-54.
[15] Hare RD. The Psychopathy Checklist-Revised manual. 2nd ed.
Toronto, Ontario, Canada: Multi-Health Systems; 2004.
[16] La Marca S, Berto D, Rovetto F. PPI-R Psychopathic Personality Inventory–
Revised. Adattamento Italiano. Firenze: Giunti OS; 2008. p. 1-114.
[17] Lilienfeld SO, Andrews BP. Development and preliminary validation
of a self-report measure of psychopathic personality traits in
noncriminal populations. J Pers Assess 1996;66:488-524.
[18] Lilienfeld SO, Fowler KA. The self-report assessment of psychopathy.
Problems, pitfalls, and promises. In: & Patrick CJ, editor. Handbook of
psychopathy. New York: Guildford Press; 2006. p. 107-32.
[19] Lilienfeld SO, Widows MR. Psychopathic Personality Inventory-
Revised: Professional Manual. Lutz, Florida: Psychological Assess-
ment Resources, Inc; 2005.
[20] Millon T, Davis R, Millon C. MCMI-III, Millon Clinical Multiaxial
Inventory-III; 1997 [Tr. it. Giunti OS Organizzazioni Speciali,
Firenze, 2008].
[21] Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt
impulsiveness scale. J Clin Psychol 1995;51:768-74.
[22] Rogers R, Salekin RT, Hill C, Sewell KW, Murdock ME, Neumann
CS. The Psychopathy Checklist-Screening Version: an examination of
criteria and subcriteria in three forensic samples. J Asses 2000;7:1-15.
[23] Rutherford MJ, Cacciola JS, Alterman AI, McKay JR. Reliability and
validity of the Psychopathy Checklist in women methadone patients. J
Am Stat Assoc 1996;3:145-56.
Table 6
Differences in the BIS mean scores (MANOVA) between the two groups.
Antisocial group
(n = 51)
Psychopathic group
(n = 25)
M SD M SD DoF F p
Attentional Impulsiveness (A) 18.72 3.21 20.66 3.61 3,72 5.50 .022
Motor Impulsiveness (M) 25.82 4.99 29.36 5.29 3,72 8.11 .006
Non-planning Impulsiveness (Np) 27.57 5.05 29.56 4.67 3,72 2.74 .102
1) BIS main effect: Wilks' λ.87 (p = .018), partial η
2
= .13.
6A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx

[24] Sowden RJ, Gray NS. Impulsivity and psychopathy: associations
between the Barrett Impulsivity Scale and the Psychopathy Checklist
revised. Psych Res 2011;187:414-7.
[25] van der Kolk BA. Developmental trauma disorder. Towards a
rational diagnosis for chronically traumatized children. Psych An
2005;35:401-8.
[26] Craparo G, Gori A, Petruccelli I, Cannella V, Simonelli C. Intimate
partner violence: relationships between alexithymia, depression,
attachment styles, and coping strategies of battered women. J Sex
Med 2014;11:1484-94.
[27] Craparo G, Faraci P, Fasciano S, Carrubba S, Gori A. A factor analytic
study of the Boredom Proneness Scale (BPS). Clin Neuropsyc
2013;10:164-70.
[28] Schimmenti A, Passanisi A, Pace U, Manzella S, Di Carlo G, Caretti V.
The relationship between attachment and psychopathy: a study with a
sample of violent offenders. Curr Psychol, http://dx.doi.org/10.1007/
s12144-014-9211-z.
[29] Caretti V, Manzi GS, Schimmenti A, Seragusa L. The psychopathy
checklist-revised manual. Adattamento Italiano. Firenze: Giunti OS
2011:1-234.
7A. Gori et al. / Comprehensive Psychiatry xx (2014) xxx–xxx