ChapterPDF Available

Assessing Psychopathy in Women

Chapter

Assessing Psychopathy in Women

Chapter 9: Assessing Psychopathy in Women
Ted B. Cunliffe, Ph.D., Carl B. Gacono, Ph.D., Jason M. Smith, Psy.D., Aaron J. Kivisto, Ph.D.,
J. Reid Meloy, Ph.D., & Enna E. Taylor, M.S.
In C.B. Gacono, The Clinical and Forensic Assessment of Psychopathy, 2nd edition.
(forthcoming 2016). Routledge/Taylor Francis.
Despite increases in the numbers of incarcerated women over the past 20 years, State and
Federal inmates remain predominately male (93%; Carson & Golinelli, 2013). Among male
inmates, psychopaths are responsible for a disproportionate number of serious behavioral
problems (Hare & McPherson, 1984), are difficult to manage within correctional and forensic
hospital settings (Gacono, Meloy, Sheppard, Speth & Roske, 1995; Gacono, Meloy, Speth, &
Roske, 1997; Ogloff, Wong, & Greenwood, 1990; Rice, 1997; Rice, Harris, & Cormier, 1992)
and commit a greater number of offenses compared to non-psychopathic offenders (Hare, 2003;
see chapter ? this text). While male psychopaths have been studied extensively over the past 60
years, less is known about female psychopathy (Cunliffe & Gacono, 2008; Gacono, 2000;
Verona & Vitale, 2006). As the number of incarcerated females continues to grow, it will become
increasingly important to identify psychopathic female offenders and to recognize the distinct
manifestations of this condition in females.
Preliminary research suggests that male and female psychopaths differ in several
important ways. Female psychopaths have been found to be more prone to affective rather than
predatory violence (Cunliffe & Gacono, 2005; Meloy, 2006), to offend against intimates and
associates (relational violence; Greenfeld & Snell, 1999), and to have higher rates of
Assessing Psychopathy in Women 2
psychopathology and to experience greater maladjustment to correctional and forensic
psychiatric facilities compared to non-psychopathic women (Loucks, 1995). The appropriate
management, assessment, and treatment of the female psychopath necessitate a comprehensive
understanding of their personality functioning and interpersonal behavior. In this chapter, we
present our research findings and discuss their implications for conceptualizing and assessing
female psychopathy.
Female Psychopathy & the PCL-R
Although the Psychopathy Checklists have been used extensively with male offenders,
there has been less research with women (Cunliffe, Gacono, Meloy, & Taylor, 2013; Nicholls,
Odgers, & Cooke, 2007; Verona & Vitale, 2006). Additionally, there are a number of concerns
related to the assessment and research of psychopathy with females:
1) Despite preliminary evidence that suggests some of the PCL-R criteria
conceptualized, developed and validated with male samples are inappropriate to be
used to diagnose the syndrome in females, it appears that other items may be
adequate (Bolt et al., 2005. Cunliffe et al., 2013).
2) Although gender has long been considered an important variable in the assessment of
individual differences, male and female expressions of the syndrome have been
viewed as equivalent.
3) Gender linked differences in the base rates for specific DSM-5 personality disorders
and antisocial, criminal and violent behavior suggest that the expression of
psychopathy varies as a function of gender.
4) The diagnostic and forensic utility of the current conceptualization of female
psychopathy remains uncertain (Cunliffe et al., 2013; Forouzan & Cooke, 2005).
Although not a PCL-R study, Kries and Cooke (2011) used the Comprehensive Assessment of
Psychopathic Personality (CAPP) to assess female psychopathy. Emotional instability, unstable
Assessing Psychopathy in Women 3
self-concept, manipulative behavior, dependency, and shyness were more prototypical of female
psychopaths than their male counterparts. Female psychopaths were also less grandiose and
physically aggressive, providing support for findings reported by Cunliffe and colleagues
(Cunliffe, 2002; Cunliffe & Gacono, 2005, 2008; Cunliffe et al., 2013; Smith, 2013, Smith,
Gacono, Cunliffe, Kivisto, & Taylor, submitted).
The psychopathy checklists (PCL-R; Hare, 2003; PCL: SV; Hart, Cox, & Hare,
1995; PCL: YV; Forth, Kosson & Hare, 2003) were developed, normed, and validated
exclusively on males. Although recent data has suggested that some of the PCL-R items
may be accurate for use with females (Bolt, Hare, Vitale, & Newman, 2004), some
investigators have suggested that some of the item descriptions do not sufficiently capture
the syndrome in women (Cunliffe & Gacono, 2005; Cunliffe et al., 2013; Grann, 2000).
Although male and female psychopaths display many similar behaviors and share a
comparable interpersonal style, both Rorschach research and other findings suggest that
the syndrome is not equivalent across gender (Cunliffe, 2002; Cunliffe & Gacono, 2005,
2008; Gacono & Meloy, 1994; Kries & Cooke, 2011; Forouzan & Cooke, 2005; Verona
& Vitale, 2006). Biological, behavioral, developmental and personality findings suggest
that some of the items would be expected to manifest differently in female populations
and, as a result, measures such as the PCL-R may require revisions to adequately capture
these distinctions (Cunliffe et al., 2013).
Psychopathy may be considered an extreme variant of behavioral and personality
variables seen in all people (Gacono & Meloy, 1994; Meloy, 1988) and it is expected that
psychopathy would present differently as a function of gender. However, despite key
gender linked differences between men and women in attachment (Gilligan, 1982),
Assessing Psychopathy in Women 4
socialization (Block, 1983, Feingold, 1990, 1991, 1992, 1994), gender role (Chodorow,
1975), conduct problems and aggression (Jang, Livesley, and Vernon, 1997; Pollack &
Gilligan, 1982), self-concept (Bem, 1981; Lazare & Klerman, 1968), and personality
disorders (Alnaes, & Torgersen, 1988; Grilo, Becker, Fehon, & Walker, 1996; Jang et al.,
1997), male and female psychopathy have generally been considered identical.
Nevertheless, empirical psychopathy findings reveal that rather than the cold or detached,
remorseless, and callous outward presentation seen in males (Gacono, 2000; Gacono &
Meloy, 1994), psychopathic women display increased interpersonal interest, connection,
and group affiliation (Cunliffe et al., 2013; Kries & Cooke, 2011).
Female psychopathy appears to be characterized by increased contact and
approval from others rather than the arrogant, solitary detachment and isolation described
for male psychopaths (Gacono & Meloy, 1994; Hare, 2003). These findings are consistent
with expected gender differences and are reflected in their criminal and interpersonal
behaviors. For example, it is common for female psychopaths to enlist the assistance of
an aggressive male ally or co-defendant to accomplish her criminal or antisocial goals, to
offend against those in their social milieu (intimates, children and associates), and to
present with a friendly, fragile, and seemingly less malevolent interpersonal style than
males. However, when her claims are checked or her actions are carefully scrutinized, she
is likely to be found to be every bit as dangerous and lacking in empathy as her male
counterpart despite her outward appearance.
Since the early 1990s, there have been approximately 21 dissertations and 35
published articles/book chapters about female psychopathy. However, 42 of the existing
studies included methodological flaws that limit their usefulness (see Table 1; Cunliffe et
Assessing Psychopathy in Women 5
al., 2012; Cunliffe et al., 2013; Gacono & Gacono, 2006; Gacono, Loving, & Bodholdt,
2001; Gacono, Loving, Evans, & Jumes, 2002; Smith, 2013). Among the methodological
limitations seen in the studies reviewed, 14 utilized the PCL: SV (Screening Version;
Hart et al., 1995) or the PPI-R (Lilienfeld & Widows, 2005) to
_______________
Insert Table 1
________________
designate “psychopathy” despite the fact that neither the PCL:SV or the PPI-R were
designed to make a categorical designation (Bodholdt, Richards, & Gacono, 2000;
Gacono et al., 2001; see Chapter 1 this text); 14 used lowered PCL-R cut scores resulting
in few psychopaths (PCL-R ≥ 30) being included in their samples; 13 studies did not
provide the number of females who had PCL-R scores ≥ 30 or the means, standard
deviations, or ranges of scores; and one study (Shipley & Arrigo, 2004) discussed ASPD
and psychopathy as synonymous constructs and attempted to discuss specific items on the
PCL-R as indicative of psychopathy. This “psychopathic traits” approach marks a return
to research practices prior to the PCL-R and has been sharply criticized (Gacono, 2000,
2013; Gacono & Gacono, 2006; chapter ? this text; Hare, 2003).
Findings with male psychopaths or females ASPDs may not generalize to female
psychopathy (Cunliffe & Gacono, 2005, 2008, Cunliffe et al., 2013; Gacono et al., 2001). Unlike
their male counterparts, the female psychopaths’ seemingly more empathic and caring
presentation may influence PCL-R Factor 1 scores (Strachan, 1993) and lead to lower PCL-R
total scores. Gender bias may be present during the PCL-R clinical interview, documentation
contained in official records, file review process, and within the individual PCL-R items
Assessing Psychopathy in Women 6
themselves leading to increased scores for men and women on specific PCL-R items (Men; 7, 8,
14, 16, 18, and 20; Women; 11 and 15; Grann, 2000). Differential item functioning for a number
of PCL-R items with women have been found: 5 (Conning/ Manipulative), 12 (Early Behavioral
Problems), 18 (Juvenile Delinquency), and 20 (Criminal Versatility) (Bolt et al., 2004).
Although the majority of the PCL-R studies with females are flawed, a number of
significant conclusions may be drawn from the methodologically sound studies that exist:
1. Female psychopaths tend to have more criminal convictions, higher numbers of
disciplinary infractions and new convictions while incarcerated, more violence, and
recidivism rates than non-psychopathic women (Loucks, 1995; Salekin, Rogers,
Ustad, & Sewell, 1998; Vitale, Smith, Brinkley, & Newman, 2002).
2. Women with elevated PCL-R scores stayed in treatment for lesser periods of time,
had more violent and disruptive behavior, avoided urinary analyses, and spent fewer
days in the community prior to the commission of a new offense than non-
psychopaths (Richards, Casey, & Lucente, 2003);
3. Female Psychopathy is positively correlated with Antisocial, Narcissistic, Histrionic,
Borderline, Paranoid, and Schizotypal Personality Disorders (Warren et al., 2003).
4. PCL-R Factor 2 is positively correlated with suicide but no relationship has been
found with PCL-R Total Score (Verona, Hicks, & Patrick, 2005)
5. The factor structure of female psychopathy is not well defined since facet estimates
across studies varies widely (see Smith, 2013 for a discussion of PCL-R factor
structure and females).
Female Psychopathy and the Rorschach
_________________
Insert Table 2 here
Assessing Psychopathy in Women 7
____________________
We began our study of female psychopathy with the hypothesis that while male and
female psychopaths differ, they display similar behaviors and share a comparable personality
organization (borderline or psychotic; Cunliffe, 2002; Cunliffe & Gacono, 2005, 2008; Gacono
& Meloy, 1994; Smith, 2013). Rorschach findings with male psychopaths suggest a grandiose
(Gacono, 1988; Gacono, Meloy, & Heaven, 1990; Gacono & Meloy, 1994; Meloy, 1988),
detached, narcissistic, interpersonal style (Kernberg, 1975; Millon & Davis, 1996) correlated
with several of the DSM-IV-TR (APA, 2000) Cluster B Personality Disorders, specifically
Narcissistic (NPD), Histrionic (HPD), and Antisocial (ASPD; Gacono & Meloy, 1994; Hare,
2003). Although fewer methodologically sound PCL-R and Rorschach studies with females exist
compared to males (see Table 2), a clearer picture of the female psychopath has begun to emerge.
We have hypothesized that in female psychopaths, hysteria, rather than narcissism, is the
predominate comorbid character style (Cunliffe, 2002; Cunliffe & Gacono, 2005, 2008; Gacono
& Meloy, 1994; Smith, 2013).
Gacono and Meloy (1994) studied ASPD women on the Rorschach and predicted some of
the current female psychopathy findings. They identified problems with modulation of affect, a
negative sense of self (self-criticism), identification with the prey/victim, avoidance of
emotionally toned situations, and problems with reality testing in ASPD women. Despite the fact
that the sample did not contain a high number of psychopaths (PCL-R ≥ 30), the authors
provided an important case study of a female psychopath (Karen; see Gacono and Meloy, 1994,
pp 117-140) that evidenced poor perceptual accuracy, poor reality testing, dysphoric affect,
heightened interpersonal interest, and negative self-criticism. These findings would anticipate
later empirical findings and set the stage for further study.
Assessing Psychopathy in Women 8
Cunliffe and colleagues (Cunliffe, 2002; Cunliffe & Gacono, 2005, 2008; Cunliffe et al.,
2013) compared ASPD female psychopaths (PCL-R ≥ 30) with non-psychopathic ASPD females
(PCL-R ≤ 24). They identified the difficulties female psychopaths experience with poor controls,
negative sense of self/dysphoric affect, poor interpersonal relatedness, and reality testing deficits
(see Table 3). The female psychopath’s malignant hysterical style was evidenced in her
diminished psychological resources (EA, M = 7.30), reduced stress tolerance (CDI > 4 = 36%, D
score=0, 54%, Adj D = 0, 43%), chronic self criticism/negative sense of self (V>0; MOR>2),
pathological self-focus in the absence of grandiosity (Fr + rF=0 and 3 r + (2)/R> .44), anger
(S>2), interpersonal dependency (COP, Fd), and poor reality testing (X+%<.61, X-%>.15).
These findings mirror studies with BPD individuals, who evidence poor distress tolerance
(Linehan, 1993), mood reactivity and difficulties controlling their anger (APA, 2013), and
excessive reactivity to negative social cues (Koenigsberg et al., 2009).
____________________
Insert Table 3 here
_____________________
Poor controls, problems managing affect, and unconventional and distorted thinking all
contributed to a negative evaluation of self (3r+(2)/R<.33=43%) in almost half of the protocols
in the data set. This finding is expected since healthy self-esteem is unlikely without emotional
mastery. The similar frequencies for Reflection responses in both the psychopaths and non-
psychopaths argues against the presence of the grandiose self-structure (Gacono et al., 1990;
Loving & Russell, 2000; Smith, Gacono, & Kaufman, 1995; Young, Justice, Erdberg, & Gacono,
2000).1 Rather, the female psychopath appears to desire attention and acceptance from others
1 Female offenders have been found to be four times as likely to produce a Reflection
response when compared to non-patient females (Gacono & Meloy, 1994; Peaslee, 1993);
however, they produce fewer Reflections than male psychopaths. Gender differences
Assessing Psychopathy in Women 9
(Millon & Davis, 1996) in order to mediate the effects of chronic dissatisfaction and self-
criticism. Their increased COP, V, Fd, and T combined with larger proportions of spoiled COP
and part T responses highlight the tenuous pattern of reliance on others to regulate self-esteem
and mood. In addition to the negative self-image and limited capacity for introspection (FD>1;
P-ASPD=15%, NP-ASPD=28%, X2=7.89, p<.001), female psychopaths appear to experience
more dysphoric affect and negative, oppositional feelings due to character pathology rather than
true depression. Consistent with theory (Gacono & Meloy, 1994; Lazare & Klerman, 1968), the
chronically self-critical stance evident in the female psychopaths in the Cunliffe et al. data
supports the assertion that their regulatory mechanisms fail to bolster self-esteem. This may
represent an important gender difference between male and female psychopaths.
Smith and colleagues (Smith, 2013; Smith et al., submitted) used a subset of the Cunliffe
et al. female psychopathic Rorschachs (PCL-R ≥ 30; N = 14) to further examine the
psychodynamics of the female psychopath (see Table 4). Their findings confirmed the proposed
malignant hysterical character (Cunliffe, 2002; Cunliffe & Gacono, 2005, 2008; Gacono &
___________________________
Insert Table 4 Here
___________________________
Meloy, 1994) present in female psychopathy organized at the borderline level of personality
functioning as evidenced by their reliance on the defenses of repression, isolation, devaluation,
have also been observed with adolescents; whereby, males were found to produce more
animal than human Reflection responses and females produced Reflections involving
more scenes, mirrors, and trees (Ames, Metraux, & Walker, 1959).
Assessing Psychopathy in Women 10
dissociation (TCI; Armstrong & Lowenstein, 1990) and projection. Additionally, Rorschach data
with female psychopaths suggests a preoccupation with somatic complaints as well as strong
dependency needs, both consistent with a hysterical style.
The presence of ASPD was supported by the high rates of violent symbiosis (72%) and
aggressive content (AgC> 0 = 93%) responses, both of which are suggestive of high degrees of
ego-syntonic interpersonal aggression. The female psychopaths’ elevation of AgPast rather than
AgPot (5:1 ratio) revealed a strong identification with the victim/prey and masochistic
aggression (Gacono & Meloy, 1994). These findings suggest a tendency in the female
psychopath toward attempting to elicit sympathy from others as means of gaining attention,
acceptance and approval and are consistent with Yochelson and Samenow’s (1977) description of
the ‘victim stance’ (pathological self focus). The females’ elevated production of Sado-
Masochistic responses (anxiety-infused sadism; SM > 0 = 43%), combined with a damaged
sense of self, suggests pleasure in hurting others in order to satisfy unmet needs or to ‘repair’
their sagging self-esteem.
All of these findings considered together suggest that female psychopaths differ from
their non-psychopathic ASPD counterparts in a number of areas: self-perception, interpersonal
relatedness, and reality testing. Compared to non-psychopathic-ASPDs, the psychopaths
experience marked disturbances in self-perception (negative self-image), dysphoric affect, poor
self-regard, limited capacity for introspection, poor interpersonal relatedness (superficial
interpersonal relations), limited understanding of the motivations of others, a lack of empathy,
and poor reality testing (cognitive distortion and unconventionality). Based upon our review of
the female psychopathy literature, clinical observations, and above research, we developed a
conceptual model of female psychopathy (see Smith, 2013; Figure 1)
Assessing Psychopathy in Women 11
_________________
INSERT FIGURE 1
_______________________
Female Psychopaths vs. Male Psychopaths
The current conceptualization of male psychopathy is an amalgam of a self-centered,
grandiose, and narcissistic personality along with an antisocial/criminal lifestyle. The female
psychopath, in contrast, shows less arrogance and self-aggrandizement, more interest in others,
and in some situations, less violence (more limited opportunity than males due to reduced
physical dominance). Both genders do, however, exhibit similar degrees of conning and
manipulative behavior (PCL-R Item 5), pathological lying (Item 4), antisocial (Items 3, 9, 10, 14
& 15) and criminal activity (Items 18-20). This picture of the female psychopath suggests that
although it might first appear that she is more interested in relations with others, this interest is
likely to be superficial and immature.
Psychopathic women perceive themselves as ‘damaged’ (MOR, M= 2.39,
MOR>2=39%), and although they possess a corresponding level of self-focus compared to
males, the quality of the self-perception is characterized by poor self-regard and chronic self-
criticism (3r + (2)/R < .33 = 43%; 3r + (2)/R >.33 and Fr + rF =0; SumV, M=2.04). The numbers
of female psychopathic ASPDs who produce elevated Egocentricity Ratios without a Reflection
is noteworthy. Although increased Egocentricity Ratios suggest an inordinate self-focus, high
ratios without Reflection indicate a sense of displeasure (poor self-regard; Weiner, 1998). In
contrast, male psychopaths tend to look at themselves with a sense of exaltation, self-admiration
and grandiosity (high Reflections, high Egocentricity Ratio). In contrast, female psychopaths
appear to experience distress while engaging in the same process. Individuals with a pattern of
Assessing Psychopathy in Women 12
no Reflections, high Egocentricity Ratios, and Vistas, possess a situation-specific type of self-
criticism not related to a true sense of remorse or guilt (Weiner, 1998). This pattern suggests
chronic self-criticism and shame. Rather than remorse or guilt, the self-critical, unhappy, and
dissatisfied presentation of the female psychopath may be viewed as an insidious negative self-
image arising from longstanding frustration over unmet needs for attention and contact with
others.
Gender differences are also reflected in the differing patterns of aggression and
violence displayed by men and women. Women serving a sentence for a violent offense
have been found to be two times more likely to have committed their offense against an
acquaintance compared to men (Greenfeld & Snell, 1999). Again, this indicates the
importance of others in the lives of female criminals. Heightened interpersonal
dependency, poor understanding of others, and a limited capacity for introspection all
increase the female psychopath’s risk of offending against her family, friends, and
acquaintances. Female violence appears to be related to a lack of emotional control
(affective violence) and concerns about disapproval and loss of group membership. Male
psychopaths, on the other hand, exhibit a detachment from others reflected in their acts of
violence against strangers (Hare & McPherson, 1984) and contempt for others.
Integration of cross-sectional studies of aggression suggest that male violence is
frequently driven by narcissism (Gacono & Meloy, 1994). Although Factor 2 (Antisocial
lifestyle) PCL-R scores may decline slightly over the life span, Factor 1 scores
(Narcissism or Affective Deficiency; Harpur & Hare, 1994) do not.
Implications for Assessing Women with the PCL-R
Assessing Psychopathy in Women 13
Based upon empirical findings, our extensive clinical/forensic experience, and our
research findings with female psychopaths, we identified 11 PCL-R items that may require
special consideration when the measure is used with females. These are include: 1)
Glibness/Superficial Charm, 2) Grandiose Sense of Self Worth, 5) Conning/Manipulative, 6)
Lack of Remorse, 8) Callous/Lack of Empathy, 9) Parasitic Lifestyle, 11) Promiscuous Sexual
Behavior, 12) Early Behavioral Problems, 18) Juvenile Delinquency, 19) Revocation of
Conditional Release, and 20) Criminal Versatility. Six of these items could be easily rewritten
(see Table 1) while others maybe more accurately captured by the modification of the scoring
and interpretation procedure (Promiscuous Sexual Behavior, Early Behavioral Problems,
Juvenile Delinquency, Revocation of Conditional Release, and Criminal Versatility).
______________
Insert Table 5 here
_______________
Glibness/Superficial Charm: Females are likely to be characterized by a coy,
coquettish, and seductive interpersonal style designed to lure or charm unsuspecting or naïve
victims or evaluators. Rather than the more physically and interpersonally dominant behavior of
the male psychopath, the female would be more likely to present as a “damsel in distress.”
Combined with fewer indicators of dominance, she is less prone to physical control and
intimidation and more likely to manipulate others through dramatic, demure, and seductive
displays. The seduction on her part would be more likely to manifest as an attempt to elicit
sympathy or pity rather than the self-assured, slick and smooth “used car salesman” type of
presentation intended to impress and cajole male evaluators. The clinician is advised to be on
guard for the female’s efforts to present as inadequate, weak or psychiatrically/physically
Assessing Psychopathy in Women 14
disabled as a means of mobilizing the other person’s natural instincts for caregiving and
compassion for those less fortunate.
“Chloe,” an incarcerated female psychopath who took part in our studies provided a good
example of what might be expected for a high score on this item. Throughout the interview, she
attempted to charm and manipulate the male examiner via frequent sexualized verbal and non-
verbal behavior (winking, eye contact and touching). During the interview, she stated, “I like
you, you’re kinda cute, I only wanted somebody, a good man to take care of me.” At another
point, she referred to herself as “I’m just not that strong and I just need a good man to care for
me, that’s why I fell in love with that nice male nurse at the work camp, he was fun (giggled and
winked at the examiner while pushing her upper torso forward).” However, a careful record
review revealed the predatory nature of her interactions with others whereby she had become
sexually involved with a number of male and female staff and found guilty of extorting money,
drugs and preferential treatment (orderly job in the Assistant Warden’s office) in payment for her
silence. Similarly, when ‘Mercedes’ was first called to participate in the study, she was not aware
she would be meeting with a male researcher and was dressed in her prison issue uniform
without makeup or other accoutrements. When she arrived to the initial interview, she asked for a
minute to “fix” her hair in the hallway. She attended the next session with her hair recently
coiffed, makeup applied and wore jewelry. Like ‘Chloe,’ her record revealed she had multiple
disciplinary violations for pursuing relationships with staff. During the interview she initially
stated that one of the male staff was “nice and doing his job”; however, by the end of the
interview she candidly offered that the same person was “gullible and fell for it.”
Grandiose Sense of Self Worth: Although male psychopaths frequently present with
bravado designed to impress the examiner or take control of the interview (dominance, contempt
Assessing Psychopathy in Women 15
for others), females are more likely to use subtle glances or seductive body movements to lure
the object of their attention. Interpretation of this item should be less focused on the arrogant,
grandiose, and haughty behavior described by Hare (2003) for males in the PCL-R manual, but
rather, clinicians should assess behavioral and interpersonal indicators of a preoccupation with
how she is perceived by others, a tendency toward self-dramatization, and impressionistic
(lacking in detail) speech. A female psychopath would not be expected to present as “self-
assured, opinionated, and cocky” (Hare, 2003, p. 36) but instead would be more likely to engage
the examiner in a more passive, subdued way. However, the clinician should not be surprised by
a defensive, hostile reaction displayed by the female psychopath when her “grandiosity”
(manifest in fabricated stories and direct lying) is confronted. A failure to consider how this item
might manifest differently in a female would likely result in a lower score on the item. For
example, ‘Johanna’ denied working as a prostitute. However, when the examiner raised the fact
that she had three convictions for prostitution, she became upset, shook her head, moved around
in her seat and stated “that’s wrong . . . that’s not correct . . . no way.” This response is also
noteworthy because it provides an excellent example of how female psychopaths are consumed
with approval from others.
Psychopathic men and women share a pathological self-focus but the construct is
expressed differently as a function of gender. Rather than self-adulation and conceit (males), the
female experiences discomfort and dysphoria during self-examination (sense of self as
‘damaged’) and displays a self preoccupation driven by a desire to understand and possibly
overcome her perceived shortcomings. ‘Mary’ provided a good example of high score on this
item. When asked who was responsible for her current predicament and how she understood
what led to her incarceration, she stated “things have always been hard for me, I’ve always felt
Assessing Psychopathy in Women 16
misunderstood, I get depressed about it sometimes but I get over it fast, people never get me but
hey, I’m really fun! (giggles).” When she was asked what she meant by “depressed” and how she
typically dealt with the experience, she reported “I would feel down, like nobody cared but then,
I would get around other people, start having fun and it would just go away real quick.” It is
clear from her comments that she is preoccupied with a negative self-image and dysphoric affect
when she is not the center of attention. However, the presentation is not that of the grandiose
Narcissist consumed by fantasies of power and adulation (males) but rather is that of a hysterical
individual who feels down and rejected when she fails to capture the fascination and approval of
others.
Conning/Manipulative: Hare (2003) described Item 5 as “the use of deceit and
deception to cheat, bilk, defraud, or manipulate others…use of schemes and scams motivated by
a desire for personal gain…carried off in a cool, self-assured, and brazen manner” (p. 37). The
female presentation is likely to occur in a much more subtle form due to lower levels of agency
and a greater likelihood of an active-dependent orientation (active solicitation of attention;
Millon & Davis, 1996).
Consider the sexual misconduct committed by ‘Chloe’ (see item 1 above this section)
whereby she became involved in relationships with staff on multiple occasions. However, when
she was questioned about these transgressions, she commented “I wasn’t taken advantage of, I
need certain things in here and this was a way to get them and I did what I had to do, not because
I wanted to or even enjoyed it...relationships have always been like that for me, all women do
that, use sex.” At no point did she relate concerns about the effect these “relationships” might
have on others but rather, she viewed this behavior as a means to an end. Additionally,
‘Mercedes’ was very proud of her conning/manipulative behavior and remembered the staff
Assessing Psychopathy in Women 17
member she conned with a sense of accomplishment and sentimentality. She reported she could
“sell anything . . . junk to others or make them believe it was worth something” and spoke with
pride about the ease with which she could attract men to her “flirtatious personality,”
commenting that she had “hustled pimps out of money … because I like to make money.”
Lack of Remorse and Callous/Lack of Empathy: Item 6 describes a person who
“experiences a general lack of concern for the negative consequences that his actions, both
criminal and noncriminal have on others” (Hare, 2003, p.37), while item 8 is defined as
“attitudes and behavior [that] indicate a profound lack of empathy and callous disregard for the
feelings, rights, and welfare of others…he is cynical and selfish” (p. 39). The female
psychopath’s increased needs for affiliation and contact (albeit superficial due to increased
dependency) may be easily misconstrued as evidence of a genuine connection to other people.
‘Francine’ provided a particularly illuminating example of how a lack of remorse and
callousness might manifest in a female psychopath. She related an incident which occurred in the
several months before her arrest for drug trafficking and kidnapping. At the time, she was
engaged to be married to a man whom she had known for a number of years. She commented,
“he went off to the night shift at the saw mill and I was left alone, I was lonely and bored, so I
went down to my favorite bar. I met this guy there and we had a great time that night (hahaha).”
She recounted that she and this individual were drinking heavily, snorting cocaine and having
sex in the bar restroom on a number occasions throughout the night. She reported “so, then he
tells me he is going to South Carolina to go roofing the next day and asked if I would like to go..
we were in Chico, CA at the time.. and I said sure! sounds like fun!” When she was questioned in
detail about the incident by the female examiner, she became agitated by the look of dismay and
shock evident upon the face of the woman conducting the interview and stated “What? He’s OK,
Assessing Psychopathy in Women 18
now…it was no big deal, he is married now and has two kids, I did him a favor, I’m not a bad
person.” Although her replies are illustrative of a number of PCL-R items, the callous disregard
she displays for the feelings and painful experiences suffered by the man she intended to marry
combined with an outward appearance of concern for his welfare is a prototypical example of
how a female psychopath might present on this item. Rather than the contempt for others
characteristic of male psychopaths, she professes a concern for this man’s welfare and even goes
so far as to suggest that she was committing an altruistic act.
As the example above demonstrates, the female psychopath is driven by a desire for
acceptance and will frequently characterize herself as a “good mother” or a “good person” in the
interests of maintaining her status within the larger group of women (group orientation).
However, consider if the children have been placed on the individual’s visiting list, the frequency
of the visits, letters received, and their behavior toward others in their social milieu (behavior in
court, statements about their crime/victims, conduct in the institution, and past relationships)
when making this determination. In some cases, the female psychopath may use the separation
from her children as a means of garnering sympathy from others and drawing attention to herself.
Upon more careful investigation, it will likely be revealed that she has little interest in her
children or their activities nor made any significant attempts to maintain contact with them. The
female’s heightened impression management is also likely to affect the scoring of this item since
her increased, yet superficial and self-serving, interest in others may cause less experienced or
naïve clinicians to misinterpret or project their own feelings brought about by empathizing with
the situation presented. That is, clinicians less familiar with female psychopathy may overvalue
the quality or depth of her affective life and interpersonal relationships resulting in an
overestimation of the inmate’s capacity for empathy.
Assessing Psychopathy in Women 19
Parasitic Lifestyle: The scoring and interpretation of this item in women is complicated
by a number of factors: 1) financial dependence may prove to be difficult to accurately assess in
women, 2) traditional female gender roles may influence interpretation, and 3) the nature of the
offenses they commit. However, depending upon the quality and level of detail present in the
record review material, these issues can be resolved. For these reasons, particular attention to
detail and careful discernment of the data present in available records and third party information
is necessary.
Given the female psychopath’s increased levels of ‘pseudo-dependency,’ concern about
presenting herself in a positive light, and desire to be accepted or approved by others, the
examiner must carefully assess the quality of the record review information. For example, an
individual who receives money from family or social assistance for childcare should be assessed
as to whether the funds were spent for the purpose intended rather than on their own, often
selfish, needs. A revocation of benefits due to inappropriate spending practices could be seen as a
data point for this item. ‘Mercedes’ provided a good example for item 9. The record review
revealed that she was incarcerated for failure to pay thousands of dollars in child support to her
mother. However, she was unable to explain why she had not paid child support and was angry
that her mother would not bring her children to visit. Additionally, she displayed significant
problems understanding how her incarceration affected her mother or her children other than
they were “missing out of having a mother.”
Traditional female gender roles are related to the adoption of a primary caregiver or
homemaker function within a traditional home (Gilligan, 1982). In our clinical experience with
this population, it is common for a female psychopath to characterize herself as “traditional” or
as “stay at home Mom” in the interests of providing a seemingly plausible explanation for her
Assessing Psychopathy in Women 20
parasitic behavior. A careful examination of the quality of the relationship with her children and
other family members could be instructive and give clues to the extent to which she may have
been using those in her immediate social milieu as a means of garnering financial support. In
situations in which this detailed information is not available, the item should be omitted since
interview data is likely to be less important or helpful when scoring the item.
Promiscuous Sexual Behavior and Early Behavioral Problems: Promiscuous Sexual
Behavior (item 11) is described as “sexual relations with others are impersonal, casual, or
trivial… indiscriminate sex partners.” (Hare, 2003, p. 41) and Early Behavioral Problems (item
12) as “serious behavioral problems as a child…persistent lying, cheating, theft, robbery, fire-
setting, disruption of classroom activities…violence, bullying, running away from home” (Hare,
2003, p. 41). Although the male psychopath would be likely to present the type of behaviors
described in these items with a sense of pride (due to heightened narcissism), the female
psychopath would be less likely to endorse them due to their pseudo-dependent character style,
need to be seen in a positive light, and use of traditional gender roles as a means of rationalizing
behavior. Anecdotally, interview data from our sample revealed that both the psychopathic and
non-psychopathic females tended to view discussions around sexual activity and deviant
behavior with a sense of embarrassment or reticence.
Consider ‘Chloe’s’ response when asked about her sexual history. She commented “why
do you want to know about that? (giggles), I wouldn’t want to commit myself (laughs and avoids
eye contact diverting her gaze to the floor in a demure fashion).” When the examiner persisted
she stated “what do you want to know? How many? A good girl doesn’t talk out of school…what
would people think? (laughs).” After several attempts to avoid the issue, the examiner reminded
her of the goal of the interview and that the research would assist scientists and clinicians to
Assessing Psychopathy in Women 21
better understand incarcerated women. She responded “yeah well, I want to help, it would help
other girls like me…let’s see….I can’t really think of how many, a lot…I was into the swinging
lifestyle, free sex, the whole thing…probably more than a 100, a lot more even... Nobody is
going to know this right? You said I couldn’t be identified?” Throughout the interaction, her need
to be seen in a positive light and concern about how she is being perceived is clear.
‘Susan’ provided a good example of a high score on time 12. She reported that her long
history of antisocial behavior began at age 9. The court records revealed that she had a history of
assaulting teachers, admitting to making false sexual allegations against teachers and camp
counselors, stealing, lying and routinely breaking rules set by her parents and the school system
throughout her childhood. When asked about her past behavior she stated “it wasn’t my fault,
nobody ever took the time to talk to me about anything, my parents and adults were always
getting in my way so I said and did those things to get what I wanted.” Additionally, she
commented later in the interview, “I don’t want you to get the wrong idea, I came from a good
home and I was a good kid, I just wanted to do my own thing, I’m still like that (laughs)…
nobody cared about me so I made my own fun…I’ve always liked to live life fast and hard.”
Although ‘Susan’ did not avoid talking about her past, she did exhibit a heightened concern for
how she was being perceived by her female interviewer as evidenced by frequent rationalizations
for her past behavior and diffusion of responsibility.
Juvenile Delinquency, Revocation of Conditional Release, and Criminal Versatility:
The PCL-R (Hare, 1991, 2003) considers a number of criminal history variables: Juvenile
Delinquency (serious antisocial behavior or arrests as an adolescent), Revocation of Conditional
Release (violation of conditional release or escape), and Criminal Versatility (charges and
convictions for a variety of offenses). Female offenders have been found to have lower rates of
Assessing Psychopathy in Women 22
incarceration and arrests than male samples (Carson & Golinelli, 2013). However, it is unclear if
these findings are due entirely to lower base rates of criminal activity or to lower rates of arrest
and adjudication for antisocial and illegal behaviors. Careful record review is necessary to
determine the exact circumstances of arrest, presence of co-defendants, and courtroom behavior.
Although female offenders may be less likely to be the direct perpetrator of violent acts (due to
less physical strength), they are more likely to enlist the assistance or accompany a violent,
dominant male co-defendant (bystander crime). Therefore, the criminal offense data used for the
PCL-R record review must be carefully evaluated when administering the measure to female
offenders in order to correctly assess their history of convictions. It is suggested that the rater
carefully examine the circumstances of the offenses, the female offender’s involvement in all
aspects of the crime (i.e. planning, commission, and evasion of prosecution), presence of a co-
defendant, and court decisions since some offenses may have been dismissed or lessened due to a
court’s leniency related to the sources of bias.
Conclusion
Contrary to previous suggestions (see Peaslee, 1993), female psychopaths can and should
be identified by a PCL-R cut score > 30 (also see Cunliffe, 2002; Cunliffe et al., 2012, 2013,
Smith, 2013; Smith et al., submitted) for creating psychopathic groups (Gacono & Gacono,
2006) and identifying female psychopathy clinically. Several caveats are suggested by our work
with female psychopaths:
1. The female psychopath’s experience of dysphoric affect and chronic self-criticism
should be carefully evaluated and not necessarily be interpreted as evidence of a
deeper, longer lasting depression.
2. Given the female psychopath’s heightened needs for approval and attention from
others, an empathic and supportive interview style is recommended.
Assessing Psychopathy in Women 23
3. Although eliminating or minimizing sources of bias are important in any
assessment, the clinician should be particularly on guard against the effects of
political correctness and a number of different types of bias.
4. Meticulous review of records is an important aspect of the assessment of
psychopathy in women.
The naïve or inexperienced rater should not interpret the presence of dysphoric affect (as
reflected in Rorschach data) or reported “depression” as evidence against a number of hallmark
PCL-R items (Lack of Empathy, Shallow Affect, Grandiose Sense of Self and Callous/Lack of
Remorse). As always, accurate scoring requires a full exploration of the nature of the reported
symptoms (Gacono, 2000, 2005). A chronic negative sense of self, shame, and dissatisfaction are
distinct from the experience of a true depression or remorse. These latter affective states involve
a sense of guilt for past behavior and vegetative symptoms (longer lasting depressive episodes,
sleep/appetite disturbances, and anhedonia). It is suggested that the female psychopath’s affective
displays are more akin to trait based rumination, sense of self as inadequate or damaged, and
self-pity than true remorse or depressive disorder. Scoring errors may also be compounded when
the examiner discovers a history of treatment for “depression” or “suicide attempts” noted in
medical or mental health records and mistakes these behavioral markers as indicators of actual
depression or suicidality. A careful exploration of the history is essential to distinguish between
possible cutting behavior for the purposes of escaping dysphoric affect and rumination, feigned
suicidal behavior for the purposes of secondary gain (institutional transfer, avoid disciplinary
action, or to develop “a mental health case” in order to receive disability benefits upon release)
and bona fide suicide attempts, whereby the individual suffers severe depression, guilt, or
remorse for her past actions. That is, the examiner must take care to discriminate true depressive
symptoms from the experience of inner emptiness and reactive mood experienced by a
Assessing Psychopathy in Women 24
chronically unhappy and dissatisfied person frustrated by failed attempts to elicit attention from
others.
Since the female psychopath would be expected to be more likely to “play the sympathy
card” as a function of their increased need for contact and positive evaluation by others, the
clinician or rater must be particularly on guard against a number of sources of clinical bias: 1)
affective, availability, and representativeness heuristics (Gilovich, Griffin, & Kahneman, 2002),
2) illusory correlation (Chapman & Chapman, 1967), and 3) confirmatory bias (Garb, 1998).
Special care must be taken when evaluating antisocial behavior in women to guard against errors
in clinical judgment since a number of investigators have identified evidence of gender bias in
relation to ASPD, Borderline and Histrionic Personality Disorders (APA, 2013; Jane, Oltmanns,
South, & Turkheimer, 2007; Flanagan & Blashfield, 2003; Skodol & Bender, 2003). Bias has
also been found to occur when evaluating violence and criminal behavior in female samples with
a lower likelihood of females being removed from the home in post-adjudicative dispositions
(Espinoza, Belshaw, & Osho, 2008) and a tendency for female offenders to be handled more
informally at the entry level of the justice system (McDonald & Chesney-Lind, 2001) compared
to males.
As with all PCL-R administrations, it is important to gain as much record information as
possible before the structured interview portion of the measure is conducted (Gacono & Hutton,
1994; Gacono, 2000, 2005). Given their high needs for impression management, approval and
praise from others, the self-report of female psychopaths is likely be very unreliable despite her
presentation as an earnest participant in the interview. A focus upon intensive record review or
third party interviews is likely to be a more reliable and valid means for scoring/interpreting the
PCL-R and serves to limit potential sources of bias inherent in the evaluation of psychopathic
Assessing Psychopathy in Women 25
women. Additionally, a non-direct, less face valid and conversational interview style is suggested
in order to better assess the PCL-R items. Given her heightened interpersonal sensitivity and
levels of impression management, the female psychopath may be more likely to withdraw or
terminate the interview if she perceives that she is being viewed as deviant or disordered (loss of
approval). Therefore, a more engaging, supportive, and empathic method of data gathering may
be more successful in eliciting the information.
Female psychopaths may be distinguished from their male counterparts by their negative
self-image, dysphoric emotion, heightened needs for approval and attention, seductive/dramatic
behavior and poor interpersonal relatedness. These differences between male and female
psychopathy affect PCL-R scoring and interpretation. However, despite previous
recommendations for lowering PCL-R cut scores, female psychopathy can and should be
identified by a PCL-R cut score > 30 for research and clinical purposes. When the PCL-R is
administered and scored with female offenders, raters should make concerted efforts to limit
sources of bias which are present in the scientific literature, the items themselves and society as
whole. Although a detailed, carefully considered record review and clinical interview is essential
for any psychopathy assessment, it appears that alterations to some of the PCL-R item
descriptions, record review method and interview procedure are needed in order to enhance
accurate assessment.
Although the knowledge base is increasing, the study of female psychopathy is in its
infancy. Based on our empirical and clinical work with female offenders (Cunliffe, 2002;
Cunliffe & Gacono, 2005, 2008; Cunliffe et al., 2013; Gacono & Meloy, 1994; Smith, 2013;
Smith et al., submitted), the presentation of female psychopathic offenders is different than that
described by Hare (2003) and others (Cooke, Forth, & Hare, 1998; Gacono & Meloy, 1994;
Assessing Psychopathy in Women 26
Meloy, 1988; Patrick, 2006) for males. Although a well-informed knowledge of base rates for
behavior is necessary to assess symptoms present in any clinical population, the assessment of
psychopathy in women is complicated by the paucity of well-designed and methodologically
sound studies, less developed scientific literature, and a lack of knowledge or clinical exposure to
the female offender population as a whole by many evaluators.
References
Alnæs, R., & Torgersen, S. S. (1988). DSM-III symptom disorders (Axis I) and personality disorders
(Axis II) in an outpatient population. Acta Psychiatrica Scandinavica, 78(3), 348-355.
doi:10.1111/j.1600-0447.1988.tb06346.x
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders
(4th ed, text revision.). Washington, D. C.: American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, D. C.: American Psychiatric Association.
Ames, L., Metraux, R., & Walker, R. (1959).Adolescent Rorschach Responses. New York:
Hoeber.
Assessing Psychopathy in Women 27
Anton, M. E., Baskin-Sommers, A. R., Vitale, J. E., Curtin, J. J., & Newman, J. P. (2012).
Differential effects of psychopathy and antisocial personality disorder symptoms on
cognitive and fear processing in female offenders. Cognitive, Affective & Behavioral
Neuroscience, 12(4), 761-776.
Armstrong, J., & Loewenstein, R. (1990). Characteristics of patients with multiple personality
and dissociative disorders on psychological testing. The Journal of Nervous and
Mental Disease, 178(7), 448-454.
Baird, S. (2009). A Rorschach investigation of psychopathy in a sample of incarcerated females.
Unpublished doctoral dissertation, Pacific University School of Professional Psychology,
Hillsboro, OR.
Bem, S. L. (1981). Gender schema theory: A cognitive account of sex typing. Psychological Review,
88(4), 354-364.
Berardino, S. D., Meloy, J., Sherman, M., & Jacobs, D. (2005). Validation of the Psychopathic
Personality Inventory on a female inmate sample. Behavioral Sciences & the Law, 23(6),
819-836.
Block, J. H. (1983). Differential Premises Arising from Differential Socialization of the Sexes: Some
Conjectures. Child Development, 54(6), 1335-1354. doi:10.1111/1467- 8624.ep12418464
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
Disorders: Theory, Research, and Treatment, 3, 406 - 414.
Bodholdt, R. H., Richards, H. R., & Gacono, C. B. (2000). Assessing psychopathy in adults: The
psychopathy checklist-revised and screening version. In C. B. Gacono (Ed.), (2000).The
clinical and forensic assessment of psychopathy: A practitioner’s guide (pp.55-86).
Mahwah, NJ: Erlbaum.
Bolt, D. M., Hare, R. D., Vitale, J. E. & Newman, J. P. (2004). A multigroup item
response theory analysis of the psychopathy checklist-revised. Psychological
Assessment, 16 (2), 155-168.
Assessing Psychopathy in Women 28
Carson, E.A. & Golinelli, D. (2013). Prisoners in 2012 – Advance Courts (Bureau of Justice
Bulletin). Washington, DC: U.S. Department of Justice.
Chapman, L. J., & Chapman, J. P. (1967). Genesis of popular but erroneous diagnostic
observations. Journal of Abnormal Psychology, 72, 193-204.
Chodorow, N. J. (1975, July). Family structure and feminine personality: The reproduction of
mothering. Dissertation Abstracts International, 36, Retrieved from EBSCOhost.
Cooke, D. J., Forth, A. E. & Hare, R. D. (1998). Psychopathy: Theory, research and
implications for society. Dordrecht, Netherlands: Kluwer Academic Publishers.
Cooper, S. H., Perry, J., & Arnow, D. (1988). An empirical approach to the study of defense
mechanisms: I. Reliability and preliminary validity of the Rorschach Defense scales.
Journal of Personality Assessment, 52(2), 187-203.
Cunliffe, T.B. (2002).A Rorschach investigation of incarcerated female psychopaths.
Unpublished doctoral dissertation, Pacific Graduate School of Psychology, Palo Alto,
CA.
Cunliffe, T.B., & Gacono, C.B. (2005). A Rorschach investigation of incarcerated Antisocial
Personality Disordered Female Offenders. International Journal of Offender Therapy
and Comparative Criminology, 49, 530-547.
Cunliffe, T. B. & Gacono, C. B. (2008). A Rorschach understanding of antisocial and
psychopathic women. In C. B. Gacono, F. B. Evans, N. Kaser-Boyd, and L. A. Gacono
(Eds.). The Handbook of Forensic Rorschach Assessment (pp. 361-378). New York, NY:
Routledge.
Cunliffe, T.B., Gacono, C.B., Meloy, J.R., Smith, J.M., Taylor, E.E., & Landry, D. (2012).
Psychopathy and the Rorschach: A response to Wood et al. (2010). Archives of
Assessment Psychology, 2(1), p. 1-31.
Cunliffe, T.B., Gacono, C.B., Meloy, J.R., & Taylor, E.E. (2013). Are male and female
psychopaths equivalent? A Rorschach study. In J. Helfgott (Ed.). Criminal psychology
(Vol. 2) (pp. 423-460). Westport, CT: Praeger Publishers.
Assessing Psychopathy in Women 29
Daoust, S. W. (2008). Psychopathy in female offenders: A neuropsychological investigation.
Unpublished doctoral dissertation, University of Virginia, Charlottesville, VA.
Davis, C. (2010). The affective features of psychopathy in incarcerated women. Dissertation Abstracts
International, 71 (3-B), 2043.
Espinosa, E. M., Belshaw, S. H., Osho, G. S. (2008). Justice by gender: Understanding
the role of gender in disposition decisions involving out of home placement for
juvenile offenders. American Journal of Criminal Justice, 33 (2), pp. 267-281.
Feingold, A. (1990). Gender differences in effects of physical attractiveness on romantic attraction: A
comparison across five research paradigms. Journal of Personality and Social Psychology,
59(5), 981-993. doi:10.1037/0022-3514.59.5.981
Feingold, A. (1991). Sex differences in the effects of similarity and physical attractiveness on
opposite-sex attraction. Basic and Applied Social Psychology, 12(3), 357-367.
doi:10.1207/s15324834basp1203_8
Feingold, A. (1992). Gender differences in mate selection preferences: A test of the parental
investment model. Psychological Bulletin, 112(1), 125-139. doi:10.1037/0033-
2909.112.1.125
Feingold, A. (1994). Gender differences in personality: A meta-analysis. Psychological Bulletin, 116(3),
429-456. doi:10.1037/0033-2909.116.3.429.
Fingerson, S. (2008). The relationships among trauma, dissociation and psychopathy in women.
Unpublished doctoral dissertation, Idaho State University, Pocatello, ID.
Forouzan, E., & Cooke, D. J. (2005). Figuring out la femme fatale: Conceptual and assessment
issues concerning psychopathy in females. Behavioral Sciences and the Law, 23, 765-
778.
Flanagan, E. H., & Blashfield, R. K. (2003). Gender bias in the diagnosis of personality
disorders: The roles of base rates and social stereotypes. Journal of Personality
Assessing Psychopathy in Women 30
Disorders, 17 (5), 431-446.
Floyd, M. (1999). MMPI-2 and PCL-R characteristics of female prison inmates. Unpublished
doctoral dissertation, University of North Carolina, Chapel Hill, NC.
Forth, A., Kosson, D., & Hare, R.D. (2003). The Hare Psychopathy Checklist: Youth Version.
New York, NY: Multi-Health Systems, Inc.
Gacono, C. B. (1988). A Rorschach interpretation of object relations and defensive
structure and their relationship to narcissism and psychopathy in a group of
antisocial offenders. Unpublished doctoral dissertation, United States International
University, San Diego, CA.
Gacono, C. B. (Ed.). (2000). The clinical and forensic assessment of psychopathy: A
practitioner’s guide. Mahwah, NJ: Erlbaum.
Gacono, C. (2005). A clinical and forensic interview schedule for the Hare Psychopathy
Checklist-Revised and Screening Version. Mahwah, NJ: Erlbaum.
Gacono, C.B. (2013). Guidelines for the evaluation and interpretation of psychopathy research
findings. In J. Helfgott (Ed.). Criminal psychology (vol. 2) (pp 341-353). Westport, CT:
Praeger Publishers.
Gacono, C.B., & Gacono, L.A. (2006). Some caveats for evaluating the research o
psychopathy. The Correctional Psychologist, 38(2), 7-9.
Gacono, C. B., Gacono, L. A., & Evans, F. (2008). The Rorschach and antisocial personality
disorder. In C. Gacono, F. Evans, N. Kaser-Boyd, & L. Gacono (Eds.), The Handbook of
Forensic Rorschach Assessment (pp. 323-359). New York, NY US: Routledge/Taylor &
Francis Group.
Gacono, C. B., & Hutton, H. E. (1994). Suggestions for the clinical and forensic use of the Hare
Psychopathy Checklist—Revised (PCL—R). International Journal of Law And
Psychiatry, 17(3), 303-317.
Gacono, C. B., Loving, J. & Bodholdt, R. (2001). The Rorschach and psychopathy:
Toward a more accurate understanding of the research findings. Journal of
Personality Assessment, 77(1), 16-38.
Gacono, C.B., Loving, J., Evans, B., & Jumes, M. (2002). The Psychopathy checklist-
Revised: PCL-R testimony and forensic practice. Journal of Forensic Psychology
Practice, 2(3), 33-53.
Gacono, C. B., Meloy, J. R. & Heaven, T. R. (1990). A Rorschach investigation of
narcissism and hysteria in antisocial personality disorder. Journal of Personality
Assessment, 55, 270-279.
Gacono, C. B. & Meloy, J. R. (1994).The Rorschach assessment of aggressive and
psychopathic personalities. Hillsdale, NJ: Erlbaum.
Assessing Psychopathy in Women 31
Gacono, C. B., Meloy, J. R., Sheppard, K., Speth, E., & Roske, A. (1995). A clinical
investigation of malingering and psychopathy in hospitalized insanity acquittees.
Bulletin of the American Academy of Psychiatry and the Law, 23(3), 387-397.
Gacono, C. B., Meloy, J. R., Speth, E., & Roske, A. (1997). Above the law: Escapes from
a maximum security forensic hospital and psychopathy. Journal of the American
Academy of Psychiatry and the Law, 25, 547-550.
Garb, H. N. (1998). Studying the clinician: Judgment research and psychological assessment.
Washington, DC: American Psychological Association.
Gilligan, C. (1982). In a different voice: Psychological theory and women's development.
Cambridge, MA US: Harvard University Press.
Gilovich, T., Griffin, D. W. & Kahneman, D. (Eds.). (2002). Heuristics and biases: The
psychology of intuitive judgment. New York: Cambridge University Press.
Grann, M. (2000). The PCL–R and gender. European Journal of Psychological Assessment,
16(3), 147-149.
Greenfeld, L.A, & Snell, T.L. (1999). Women Offenders (Bureau of Justice Statistics Bulletin).
Washington, DC: U.S. Department of Justice.
Grilo, C. M., Becker, D. F., Fehon, D. C., & Walker, M. L. (1996). Gender differences in personality
disorders in psychiatrically hospitalized adolescents. The American Journal of Psychiatry,
153(8), 1089-1091. Retrieved from EBSCOhost.
Hare, R. D. (1991).The Hare psychopathy checklist-revised. Toronto, Canada:
Multi-Health Systems.
Hare, R. D. (2003).The Hare psychopathy checklist-revised (2nd edition).Toronto,
Canada: Multi-Health Systems.
Hare, R. D. & McPherson, L. M. (1984). Violent and aggressive behavior by criminal
psychopaths. International Journal of Law and Psychiatry, 7, 35-50.
Harpur, T. J. & Hare, R. D. (1994). Assessment of psychopathy as a function of age. Journal of
Abnormal Psychology, 103 (4), 604-609.
Hart, S. D., Cox, D. N., & Hare, R. D. (1995).Manual for the Psychopathy Checklist:
Screening Version (PCL: SV). Toronto: Multi-Health Systems.
Hicks, B. M., Vaidyanathan, U., & Patrick, C. J. (2010). Validating female psychopathy
subtypes: Differences in personality, antisocial, and violent behavior, substance
abuse, trauma, and mental health. Personality Disorders, Theory, Research, and
Treatment, 1 (1), 38-57.
Assessing Psychopathy in Women 32
Jang, K. L., Livesley, W., & Vernon, P. A. (1997). Gender-specific etiological differences in alcohol and
drug problems: A behavioural genetic analysis. Addiction, 92(10), 1265- 1276.
doi:10.1111/j.1360-0443.1997.tb02846.x
Kalinian, H. (2002). Executive function performance and psychopathy in female parolees.
Unpublished doctoral dissertation, Pacific Graduate School of Psychology, Palo Alto,
CA.
Kalinian, H., & Wisniewski, A. W. (2007). Abnormal findings revealed in female criminal
psychopaths using the sorting test. Journal of Forensic Neuropsychology, 4(4), 33-48.
Kane, M. (2000). The psychological profile of the psychopathic female. Unpublished doctoral
dissertation, New School University, New York, NY.
Kendall, S. J. (2006). Borderline personality disorder and psychopathy in jail inmates: Gender
differences in item functioning of the PAI Borderline Personality Scales and the PCL-SV
using Rasch analysis. Unpublished doctoral dissertation, George Mason University,
Fairfax, VA.
Kernberg, O. (1975). Borderline conditions and pathological narcissism. New York: Aronson.
Koenigsberg, H. W., Fan, J., Ochsner, K. N., Lui, X., Guise, K. G., Pizzarello, S.,
Dorantes, C., Guerreri, S., Tecuta, L., Goodman, M., New, A. and Siever, L. J.,
(2009). Neural correlates of the use of psychological distancing to regulate responses
to negative social cues: A study of patients with borderline personality disorder.
Biological Psychiatry, 66 (9), 854-863.
Kreis, M. K. F., & Cooke, D. J. (2011). Capturing the psychopathic female: A prototypicality
analysis of the Comprehensive Assessment of Psychopathic Personality (CAPP) across
gender. Behavioral Sciences & the Law, 29(5), 634-648.
Kreis, M. K. F., & Cooke, D. J. (2012). The manifestation of psychopathic traits in women: An
exploration using case examples. International Journal of Forensic Mental Health, 11(4),
267-279.
Assessing Psychopathy in Women 33
Kwawer, J. (1980). Primitive interpersonal modes, borderline phenomena, and Rorschach
content. In J. Kwawer, A. Sugarman, P. Lerner, & H. Lerner (Eds.),Borderline
phenomena and the Rorschach Test (pp. 89-105). New York: International Universities
Press.
Jane, J., Oltmanns, T. F., South, S. C., & Turkheimer, E. (2007). Gender bias in diagnostic
criteria for personality disorders: An item response theory analysis. Journal of Abnormal
Psychology, 116(1), 166-175.
Lazare, A. & Klerman, G. L. (1968). Hysteria and depression: The frequency and significance of
hysterical personality features in hospitalized depressed women. American Journal of
Psychiatry, 124(11), 48-56.
Lehmann, A., & Ittel, A. (2012). Aggressive behavior and measurement of psychopathy in
female inmates of German prisons: A preliminary study. International Journal of Law
and Psychiatry, 35(3), 190-197.
Lilienfeld, S. O., & Widows, M. R. (2005). Psychopathic Personality Inventory-Revised:
Professional Manual. Lutz, Florida: Psychological Assessment Resources, Inc.
Linehan, M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder.
New York, NY: Guilford Press.
Livingston, H.M. (1997). The assessment of violence potential in female offenders. Unpublished
doctoral dissertation, The Union Institute, Brattleboro, VT.
Logan, C., & Blackburn, R. (2009). Mental disorder in violent women in secure settings:
Potential relevance to risk for future violence. International Journal of Law and
Psychiatry, 32(1), 31-38.
Loucks, A. (1995). Criminal behavior, violent behavior, and prison maladjustment in federal female
offenders. Unpublished doctoral dissertation, Queen’s University, Kingston, Canada.
Louth, S. M., Hare, R. D., & Linden, W. W. (1998). Psychopathy and alexithymia in female offenders.
Canadian Journal of Behavioural Science, 30(2), 91-98.
Loving, J., & Russell, W. (2000). Selected Rorschach variables of psychopathic juvenile
offenders. Journal of Personality Assessment, 75, 126-142.
Masling, J., Rabie, L., & Blondheim, S. H. (1967). Obesity, level of aspiration, and Rorschach
and TAT measures of oral dependence. Journal of Consulting Psychology, 31(3), 233-
239.
Assessing Psychopathy in Women 34
McDonald, J. M. & Chesney-Lind, M. (2001). Gender bias and juvenile justice revisited: A
multiyear analysis. Crime and Delinquency, 47(2), 173-195.
Meloy, J.R. (1988). The psychopathic mind. Northvale, NJ: Aronson.
Meloy, J.R. (2006). The empirical basis and forensic application of affective and predatory
violence. Australian & New Zealand Journal of Psychiatry, 40, 539-547.
Millon, T. & Davis, R. (1996).Disorders of personality: DSM-IV and beyond. New
York: Wiley.
Muntz, A. (1999). Object relations and defense mechanisms of psychopathic and
nonpsychopathic female offenders: A descriptive study. Unpublished doctoral
dissertation, California School of Professional Psychology, Fresno, CA.
Neary, A. (1990). DSM-III and psychopathy checklist assessment of antisocial
personality disorder in black and white female felons. Unpublished doctoral
dissertation, University of Missouri, St. Louis.
Nicholls, T., Odgers, C. & Cooke, D. (2007). Women and girls with psychopathic
characteristics. In: A. Felthous & H. Sass, eds., International handbook on
psychopathic disorders and the law, volume 1. New York: Wiley, pp. 347-366.
Nicholls, T. L., Ogloff, J. P., & Douglas, K. S. (2004). Assessing risk for violence among male
and female civil psychiatric patients: The HCR-20, PCL: SV, and VSC. Behavioral
Sciences & the Law, 22(1), 127-158.
Ogloff, J., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a
therapeutic community program. Behavioral Sciences and the Law, 8, 81-90.
Patrick, C. J. (2006). Handbook of psychopathy. New York, NY: Guilford Press
Peaslee, D. (1993). An investigation of incarcerated females: Rorschach indices and
Psychopathy Checklist scores. Unpublished doctoral dissertation, California School of
Professional Psychology, Fresno, CA
Phillips, M. I. (2007). Semantic and emotional processing in psychopathic female inmates:
Results of a lexical decision task. Unpublished doctoral dissertation, Idaho State
University, Pocatello, ID.
Pollak, S., & Gilligan, C. (1982). Images of violence in Thematic Apperception Test stories.
Assessing Psychopathy in Women 35
Journal of Personality and Social Psychology, 42(1), 159-167. doi:10.1037/0022- 3514.42.1.159
Rice, M. E. (1997). Violent offender research and implications for the criminal justice
system. American Psychologist, 52, 414-423.
Rice, M. E., Harris, G., & Cormier, C. (1992). An evaluation of a maximum security
therapeutic community for psychopaths and other mentally disordered offenders. Law
and Human Behavior, 16, 399-412.
Richards, H. J., Casey, J. O., & Lucente, S. W. (2003). Psychopathy and treatment response in
incarcerated female substance abusers. Criminal Justice and Behavior, 30(2), 251-276.
Richards, H. J., Casey, J. O., Lucente, S. W., & Kafami, D. (2003). Differential Association of Hare
Psychopathy Checklist Factor and Facet Scores to HIV Risk Behaviors in Incarcerated Female
Substance Abusers. Individual Differences Research, 1(2), 95-107.
Rogers, R., Jordan, M. J., & Harrison, K. S. (2007). Facets of psychopathy, Axis II traits, and
behavioral dysregulation among jail detainees. Behavioral Sciences & the Law, 25(4),
471-483.
Rutherford, M. J., Cacciola, J. S., & Alterman, A. I. (1999). Antisocial personality disorder and
psychopathy in cocaine-dependent women. The American Journal of Psychiatry, 156(6),
849-856.
Salekin, R., Rogers, R., & Sewell, K. (1998). Construct validity of psychopathy in a female
offender sample: A multitrait-multimethod evaluation. Journal of Abnormal Psychology,
106, 576-585.
Salekin, R.T., Rogers, R., Ustad, K.L., & Sewell, K.W. (1998). Psychopathy and recidivism
among female inmates. Law and Human Behavior, 22(1), 109-128.
Sargeant, M. N., Daughters, S. B., Curtin, J. J., Schuster, R., & Lejuez, C. W. (2011). Unique
roles of antisocial personality disorder and psychopathic traits in distress tolerance.
Journal of Abnormal Psychology, 120(4), 987-992.
Schoenleber, M., Sadeh, N., & Verona, E. (2011). Parallel syndromes: Two dimensions of
narcissism and the facets of psychopathic personality in criminally involved individuals.
Personality Disorders: Theory, Research, and Treatment, 2(2), 113-127.
Assessing Psychopathy in Women 36
Sellbom, M., & Phillips, T. R. (2013). An examination of the triarchic conceptualization of
psychopathy in incarcerated and nonincarcerated samples. Journal of Abnormal
Psychology, 122(1), 208-214.
Shipley, S. L., & Arrigo, B. A. (2004).The female homicide offender: Serial murder and the case
of Aileen Wuornos. Upper Saddle River, NJ: Prentice Hall.
Siegel, L. (1998). Executive functioning characteristics associated with psychopathy in
incarcerated females. Unpublished doctoral dissertation, California School of
Professional Psychology, San Diego, CA.
Silbaugh, D.L. (1992). The cognitive style questionnaire: A cross-validation study, utilizing the
MMPI and the Hare psychopathy checklist with a population of incarcerated females.
Unpublished doctoral dissertation, California School of Professional Psychology, Fresno,
CA.
Skodol, A. E., & Bender, D. S. (2003). Why are women diagnosed borderline more than men?.
Psychiatric Quarterly, 74(4), 349-360.
Smith, A., Gacono, C.B., & Kaufman, L. (1995). A Rorschach comparison of psychopathic and
nonpsychopathic conduct disordered adolescents. Journal of Clinical Psychology, 53,
289-300.
Smith, J.M. (2013). Female psychopathy: A Rorschach investigation of personality structure,
Unpublished doctoral project, Carlos Albizu University, Miami, FL.
Smith, J.M., Gacono, C.B., Cunliffe, T.B., Kivisto, A., & Taylor, E.E. (submitted).
Psychodynamics in the female psychopath: A PCL-R/Rorschach investigation. Violence
and Gender.
Spironelli, C., Segre, D., Stegagno, L., Angrilli, A. (2014). Intelligence and psychopathy: A
correlation study on insane female offenders. Psychological Medicine, 44, 111-116.
Sprague, J., Javdani, S., Sadeh, N., Newman, J., & Verona, E. (2012). Borderline personality
disorder as a female phenotypic expression of psychopathy?. Personality Disorders, 3(2),
127-139.
Strachan, C. (1993). The assessment of psychopathy in female offenders. Unpublished doctoral
dissertation, Department of Psychology, University of British Columbia, Vancouver,
Canada.
Assessing Psychopathy in Women 37
Strand, S., & Belfrage, H. (2005). Gender differences in psychopathy in a Swedish offender
sample. Behavioral Sciences & the Law, 23(6), 837-850.
Sturek, J. C., Loper, A. B., & Warren, J. I. (2008). Psychopathy in female inmates: The SCID-II
Personality Questionnaire and the PCL-R. Psychological Services, 5(4), 309-319.
Sullivan, H. S. (1953). The interpersonal theory of psychiatry. W. W. Norton &
Company: New York.
Turnbull, S. (1996). Personality pathology and adult attachment in female offenders.
Unpublished doctoral dissertation, Simon Fraser University, Burnaby, Canada.
Vablais, C. (2007). Toward a new model of psychopathy in women: A qualitative analysis of the
Psychopathy Checklist - Revised and the construct of psychopathy in female offenders.
Unpublished doctoral dissertation, Fielding Graduate University, Santa Barbara, CA.
Verona, E., Bresin, K., & Patrick, C. J. (2013). Revisiting psychopathy in women: Cleckley/Hare
conceptions and affective response. Journal of Abnormal Psychology, 122, 1088-1093.
Verona, E., Hicks, B. M., & Patrick, C. J. (2005). Psychopathy and Suicidality in Female
Offenders: Mediating Influences of Personality and Abuse. Journal of Consulting and
Clinical Psychology, 73(6), 1065-1073.
Verona, E., Sprague, J., & Javdani, S. (2012). Gender and factor-level interactions in
psychopathy: Implications for self-directed violence risk and borderline personality
disorder symptoms. Personality Disorders, 3(3), 247-262.
Verona, E. & Vitale, J. (2006).Psychopathy in women. In: C. Patrick, ed., Handbook of
psychopathy. New York: Guilford, pp. 415-436.
Vitale, J. E., Brinkley, C. A., Hiatt, K. D., & Newman, J. P. (2007). Abnormal selective attention
in psychopathic female offenders. Neuropsychology, 21(3), 301-312.
Vitale, J. E. & Newman, J. P. (2001). Response perseveration in psychopathic Women.
Journal of Abnormal Psychology, 110 (4), 644-647.
Vitale, J. E., Smith, S. S., Brinkley, C. A., & Newman, J. P. (2002). The Reliability and validity
of the Psychopathy Checklist-Revised in a sample of female offenders. Criminal Justice
and Behavior, 29 (2), 202-231.
Warren, J. I., Burnette, M. L., South, S. C., Chauhan, P., Bale, R., Friend, R., & Van Patten, I.
Assessing Psychopathy in Women 38
(2003). Psychopathy in women: Structural modeling and comorbidity. International
Journal of Law and Psychiatry, 26(3), 223-242.
Warren, J. I., & South, S. C. (2006). Comparing the constructs of antisocial personality
disorder and psychopathy in a sample of incarcerated women. Behavioral Sciences &
the Law, 24(1), 1-20.
Weiner, I. B. (1998). Principles of Rorschach interpretation. Mahwah, NJ: Erlbaum.
Yochelson, S., & Samenow, S. (1977). The criminal personality, vol. 2: The change process.
New York: Jason Aronson.
Young, M.H., Justice, J.V., Erdberg, P.S., & Gacono, C.B. (2000). The incarcerated
psychopath in psychiatric treatment: Management of Treatment? (pp.313-332). In
Gacono, C. B. (Ed.), The clinical and forensic assessment of psychopathy: A
practitioner’s guide. Mahwah, NJ: Erlbaum.
Weizmann-Henelius, G. (2006). Violent female perpetrators in Finland: Personality and life
events. Nordic Psychology, 58(4), 280-297.
Weizmann-Henelius, G., Viemerö, V., & Eronen, M. (2004). Psychopathy in violent female
offenders in Finland. Psychopathology, 37(5), 213-221.
Table 1
PCL-R Studies & Women
Study N Mean PCL-R
Score
N = PCL-R ≥ 30 Population Other Info
Neary (1990) 120 21.1 13 Missouri
Correctional Sample
None
Silbaugh (1992) 63 21.5 8 Wyoming
Correctional Sample
None
Strachan (1993) 75 24.49 23 Canadian
Incarcerated/Probate
d Sample
None
Loucks (1995) 100 18 11 Federal Canadian
Sample
None
Louth, Hare, &
Linden (1998)
37 24.1 11 Incarcerated
Canadian Sample
None
Vitale and Newman
(2001)
112 N/A 11 Wisconsin
Correctional Sample
None
Warren et al. (2003) 138 22.5 24 US Maximum
Security Correctional
Sample
None
Verona, Hicks, &
Patrick (2005)
226 20.7 29 US Federal
Correctional Sample
None
Blonigen, Sullivan,
Hicks, & Patrick
(2012)
226 20.7 29 US Federal
Incarcerated Sample
None
Turnbull (1996) 50 N/A N/A Incarcerated
Canadian Sample
Used PCL:SV
Livingston (1997) 7 15.57 1 Women on Probation
or Parole
Qualitative Study
Salekin, Rogers, &
Sewell (1998)
103 N/A 16 Texas Jail Sample Did not provide
mean PCL-R scores
Siegel (1998) 100 N/A N/A California
Correctional Sample
Used PCL:SV
Study N Mean PCL-R
Score
N = PCL-R ≥ 30 Population Other Info
Rutherford, Cacciola,
& Alterman (1999)
137 14.2 2 Women seeking
methadone treatment
Used cut score of 25
Floyd (1999) 100 14.75 N/A North Carolina
Correctional Sample
Correlational Study
Kalinian (2002) &
Kalinian &
Wisniewski (2007)
54 N/A N/A California Parole
sample
Used PCL:SV
Richards, Casey,
Lucente, & Kafami
(2003)
126 14.7 5 Maryland
Correctional Sample
Low number of
Psychopaths
Nicholls, Ogloff, &
Douglas (2004)
90 N/A N/A Canadian Civil
Psychiatric Sample
Used PCL: SV
Weizmann-Henelius,
Viemerö, & Eronen
(2004)
58 15.60 5 Finnish Incarcerated
Sample
Used cut score of 25
Berardino, Meloy,
Sherman, & Jacobs
(2005)
102 21.85 14 California
Correctional Sample
Also used PPI
Strand & Belfrage
(2005)
129 N/A N/A Swedish Forensic
Psychiatric Sample
Used PCL:SV
Kendall (2006) 97 N/A N/A Virginia Jail Sample Used the PCL:SV
Warren & South
(2006)
137 N/A 24 Max Security US
Sample
Used cut score of 25
Phillips (2007) 81 21.5 N/A Idaho Correctional
Sample
Used cut score of 27
Rogers, Jordan, &
Harrison (2007)
46 11.13 N/A Texas Jail Population Used cut score of 25
Vablais (2007) 18 18.77 7 US Incarcerated
sample
Qualitative Study
Vitale, Brinkley,
Hiatt, & Newman,
(2007)
285 18.85 N/A Wisconsin
Correctional Sample
Used cut score of 24
Study N Mean PCL-R
Score
N = PCL-R ≥ 30 Population Other Info
Daoust (2008) 77 N/A N/A Virginia Correctional
Sample
Used PCL:SV
Fingerson (2008) 101 21.46 11 Idaho Incarcerated
Sample
Also used PPI
Sturek, Loper, &
Warren (2008)
138 22.6 N/A US Incarcerated
Sample
Used cut score of 25
Logan & Blackburn
(2009)
95 18.65 1 English Incarcerated
Sample
Low amount of
Psychopaths
Hicks, Vaidyanathan,
& Patrick (2010)
226 20.7 29 US Federal
Incarcerated Sample
Used cut score of 25
Davis (2010) 71 24.11 N/A Kansas Correctional
Sample
Correlational Study
Sargeant, Daughters,
Curtin, Schuster, &
Lejuez (2011)
16 N/A N/A Residential
Treatment Facility
Used the PPI-R
Schoenleber, Sadeh,
& Verona, (2011)
112 N/A N/A US County Jail
Sample
Used PCL:SV
Anton, Baskin-
Sommers, Vitale,
Curtin, & Newman,
(2012)
84 21.50 N/A Wisconsin
Correctional Sample
Used cut score of 25
Kreis & Cooke
(2012)
2 (case studies) N/A N/A English Incarcerated
Sample
Used PCL:SV
Lehmann & Ittel
(2012)
60 16.15 3 German Incarcerated
Sample
Used cut score of 25
Sprague, Javdani,
Sadeh, Newman, &
Verona, (2012)
488 N/A N/A Wisconsin
Incarcerated Sample
Did not provide
mean PCL-R score
Verona, Sprague, &
Javdani, (2012)
160 N/A N/A US Jail Sample Used PCL:SV
Sellbom & Phillips
(2013)
209 N/A N/A US Correctional
Sample
Used PPI-R
Study N Mean PCL-R
Score
N = PCL-R ≥ 30 Population Other Info
Verona, Bresin, &
Patrick (2013)
48 12.1 N/A US Federal
Incarcerated Sample
Used cut score of 25
Spironelli, Segre,
Stegagno, & Angrilli
(2014)
56 N/A 21 Italian Forensic
Psychiatric Sample
No mean PCL-R
score
* Studies in Bold are Methodologically Sound Studies
Table 2
PCL-R/Rorschach Studies with Women
Study N Mean PCL-R N = PCL-R ≥ 30 Population Other Info
Gacono & Meloy
(1994)
38 N/A N/A Wyoming
Incarcerated Sample
& California
Correctional Sample
All had PCL-R ≥ 20
Cunliffe (2002) &
Cunliffe & Gacono
(2005, 2008)
45 27.80 27 US Federal
Incarcerated Sample
None
Gacono, Gacono,
& Evans (2008)
69 N/A 28 US Incarcerated
Sample
None
Smith (2013) 14 32.77 14 US Federal
Incarcerated Sample
None
Peaslee (1993) 47 N/A N/A Wyoming
Incarcerated Sample
Used cut score of 27
Muntz (1999) 48 23.12 9 US Federal
Incarcerated Sample
Poor administration
of Rorschach (poor
inquiry)
Kane (2000) 40 21.30 N/A Connecticut
Incarcerated Sample
Used cut score of 20
Weizmann-Henelius
(2006)
61 15.6 5 Finnish Incarcerated
Sample
Used cut score of 25
Study N Mean PCL-R N = PCL-R ≥ 30 Population Other Info
Baird (2009) 77 N/A N/A Oregon Incarcerated
Sample
Used PPI-R
* Studies in Bold are Methodically Sound Studies
Table 3: Select Structural Variables for Psychopathic and Non-Psychopathic Incarcerated Females (Cunliffe & Gacono, 2005, 2008)
Psychopaths (n=27) Non-Psychopaths (n=18)
Self Perception
M SdFreq M SdFreq Effect
Size (r)
P Value
Fr/rF .44 .79 8 .72 1.03 7 ns <.001
PER 18 14 ns ns
(2) >10 5 1 .32 <.001
Ego >.44
Fr/rF=0
5 2 .10 <.001
MOR>2 10 4 .11 .006
V>0 11 3 .11 <.001
FD>1 4 5 .19 <.001
Interpersonal Relationships
M SdFreq M SdFreq Effect
Size (r)
P Value
T=0 15 14 .26 <.001
T=1 8 3 .26 <.001
T>2 4 1 .27 <.001
Prt Obj T 5 0 .28 <.001
COP 27 18 .18 .003
COP > 2 13 4 ns ns
COP (spoil) 27 11 .20 <.001
COP (good) 9 8 .10 <.001
Fd 6 1 .33 .020
HEV -.20 1.41 7 -.24 2.09 8 .24 ns
Reality Testing
M SdFreq M SdFreq Effect
Size (r)
P Value
X+% <.61 .51 .14 21 .57 .14 10 .23 .029
X-% >.15 .24 .15 6 .16 .89 2 .29 .057
X +% <.61 +
X-% >.15
18 4 .27 <.001
Table 4
Smith (2013) Additional Female Psychopath (PCL-R ≥ 30) Rorschach Data Analyses (N = 14)
Variable Value
Gacono & Meloy (1994) Extended Aggression Scores
AgC > 0 93%
AgPast > 0 79%
AgPot > 0 36%
AgPast: AgPot 1.79: 0.36 (5:1)
SM > 0 43%
Rorschach Oral Dependency Scale (Masling, Rabie, &
Blondheim, 1967)
M = 0.26
Kwawer (1980) Primitive Modes of Relating 93%
Violent Symbiosis 71%
Boundary Disturbance 64%
Malignant Internal Processes 57%
Trauma Content Index (TCI) (Armstrong &
Lowenstein, 1990)
M = 0.37
Cooper, Perry, & Arnow (1988) Rorschach Defense
Scales
Projection 93%
Devaluation 93%
Isolation 86%
Repression 79%
Intellectualization 71%
Table 5
Proposed PCL-R Item Descriptions
Item 1 describes a coy, coquettish, seductive individual who presents herself in a positive light to garner attention and sympathy. At
times, she will attempt to evoke a traditional female gender role in order to offer explanations for her behavior or elicit caregiving or
supportive behavior from others. She is eager to initially charm new associates with enthusiasm, apparent openness, expressions of
empathy for others, or flirtatiousness. However, upon further reflection these statements and behavior will be exposed as lacking in
genuineness and superficial. She uses glances and seductive body postures to impress or take control of interactions.
____________________________________________________________________________________________________________
Item 2 (Pathological Self-Focus) describes a female who desires to be the center of attention or ‘life of the party.’ She has a tendency
toward self-dramatization. She is excessively self-centered, self-focused and lacking insight as reflected by increased use of
rationalization, excuses, and statements suggestive of a victim stance. Her pathological self-focus is expressed through fabricated
stories and direct lying. Rather than the arrogant, contemptuous, and self-aggrandizing presentation seen in males, the central feature
in females is a sense of self as damaged accompanied by increased interpersonal dependency. She is not embarrassed about or
concerned about her past criminal and interpersonal behavior and attempts to portray herself as a victim, dependent on others, unable
to fend for herself, and will thereby attempt to deflect responsibility.
___________________________________________________________________________________________________________
Item 5. She tends to use sexuality and seductiveness to deceive others. She may present as a ‘damsel in distress’ as a means to
manipulate others. Conning/manipulative behaviors include sexual comments and behaviors toward others and presenting as someone
in need of assistance and nurturance. As a result, they tend to prey on the innate instincts of others toward caring, protective, and
supportive behavior. High scorers on this item will not overtly present elaborate schemes in a bold or brazen manner (males) but rather
their cunning plans are more likely to be subtle and sophisticated. Typically, she expresses herself as a victim as a means of
manipulation or someone who has no other choice given her dire circumstances created by virtue of being a woman. Commonly, she
will reference or use her children as a means of manipulating others. However, the astute clinician will often discover that either she
does not have children or she had lost contact with them many years before. Commonly, high scorers will present themselves as a
traditional female in order to defraud, cheat, or take advantage of others for material gain. Often, their plans will involve sex if
directed at male or lesbian targets or helplessness in the case of hetero-sexual female or gay male victims.
_________________________________________________________________________________________________________
Item 6. This item in women describes a woman who displays a marked lack of concern for the effect her actions, both criminal and
non-criminal, have had upon others. Although she would be very unlikely to admit that she is sorry for things she has done, she would
be expected to “play the victim card” in order to receive sympathy from others, rationalize her behavior, or provide excuses for her
past transgressions. Her self statements tend to be self-critical but not indicative of true guilt or remorse. These tend to be
accompanied by emotional expressions; however, there are likely to be incongruent with statements, behavioral observations, and the
facts. Additionally, the emotional displays are likely to be superficial and lacking in genuineness leaving others with the impression
she is “play acting” rather than genuinely regretful about past behaviors. Therefore, clinicians are encouraged to focus less on her
statements and protestations and more on her behaviors such as attempts to make restitution, changes in behavior toward others, and
efforts to make amends with those she has harmed.
____________________________________________________________________________________________________________
Item 8. Callous/Lack of Empathy describes an individual who displays a callous disregard for the rights, interests and welfare of
others characterized by a significant disinterest or inability to identify the mental and emotional experiences of another person. She
tends to not present in a cynical and selfish manner and will rarely if ever state she is concerned with ‘Number 1’ (males). Rather, she
tends to present in a gentle and friendly manner and give the impression that she is concerned about her family, children, and her
victims. However, consideration of her statements and behavior will suggest otherwise. Therefore, adequate file review is essential for
this item. When asked about her crimes and the effects it has had on her victims, statements such as “it has hurt them” or they are
“mad” or “sad” are common; however, when asked to elaborate, she is not able to provide more nuanced descriptions of the emotional
experience of the affected person and her explanations tend to be unconvincing and lacking in detail. Though she may deny mocking
others, careful record view will reveal verbal assaults and threats (i.e., relational aggression) toward family, friends, or other
incarcerated inmates. Further record review is be needed to identify callous and/or sadistic treatment of others, as she will tend to
minimize and/or deny that she engages in these behaviors due to impression management concerns about disapproval from others.
Additionally, although she may deny stealing from family and/or friends, records show that she does not discriminate in her thefts and
manipulations.
____________________________________________________________________________________________________________
Item 9. Due to cultural and societal influences, females may tend to adopt a traditional primary caregiver or homemaker role which
may make this item difficult to score. Although the individual may attempt to present herself in this light, it is very unlikely that
individuals exhibiting antisocial behavior would adopt this role. Therefore, an individual who receives money from family or social
assistance for childcare should be assessed as to whether the funds were spent for the purpose intended rather than on their own needs.
A revocation of benefits due to inappropriate spending practices would also be possible grounds for a high score on the item. The
quality of the relationship with her children should be fully assessed since she may have been using her children as a means of
garnering financial support. Additionally, she may enlist the help of a dominant male to achieve her interpersonal and criminal goals
and once caught, maintain that she was controlled or abused by him. Claims of abuse and being dominated by male accomplices
should be carefully investigated. In situations in which detailed information is not available, the item should be omitted since
interview data is likely to be less important or helpful when scoring the item.
... Comparatively little is known about female psychopathy. Research to date suggests that both male and female psychopaths share the following overlapping traits: Conning and manipulative behavior, pathological lying, and antisocial and criminal activity (Cunliffe et al. 2015). However, as explained by Cunliffe and colleagues (2015), male and female psychopaths diverge in levels of violence, self-image, need for approval and attention from others, and in their victim selection. ...
... Perhaps because of their ''insidious'' (p. 176) negative self-image, female psychopaths have a strong desire for attention, approval, and praise from others (Cunliffe et al. 2015). Part of gaining that approval involves a seductive and flirtatious interaction style. ...
... Part of gaining that approval involves a seductive and flirtatious interaction style. It is also common for them to claim to be victims of sexual assault and domestic violence and sometimes feign suicidal gestures to obtain secondary gain (Cunliffe et al. 2015). Female psychopaths are also more likely to commit an offense against someone they know, whereas males are more likely to target strangers. ...
Article
Jodi Arias killed her ex-lover Travis Alexander in 2008. He was shot, stabbed, and nearly decapitated. She was sentenced to life in prison. For 2 years after the murder, Mr. Arias claimed that two masked intruders broke into the home and killed Mr. Alexander. Later, she admitted that the intruder story was a complete fabrication and changed her story to that of self-defense. Through the lens of psychopathy, this case study examines the behaviors and deceptions generated by Ms. Arias. This case should be of clinical interest to professionals studying deceptive behavior.
... Self-report measures (i.e., Psychopathic Personality Inventory-Revised [PPI-R; Lilienfeld & Widows, 2005]) or the Psychopathy Checklist: Screening Version (PCL:SV; Hart et al., 1995) have not been appropriate for creating psychopathic or non-psychopathic groups Gacono et al., 2001;Hare, 2003;Smith et al., 2014. A total PCL-R score of 30 or higher has been suggested for an appropriate categorical psychopathic group for both males and females (Cunliffe et al., 2016;Gacono, 2016;Hare, 2003;Nørbech et al., 2018;Smith et al., 2021). Numerous forensic studies with male and female populations have noted the predictive power of the PCL-R total score related to both violent and nonviolent crimes and infractions (Gray & Snowden, 2016;Hare et al., 2020;Kennealy et al., 2010;Olver et al., 2020;Warren et al., 2005;Smith et al., 2021). ...
... Pathological narcissism characterized the male psychopath (narcissistic self-focus; grandiosity) as they tend to be cold, detached, and non-emotional (Gacono & Meloy, 1994). Female psychopaths presented with a malignant hysterical style (borderline/histrionic traits), and they tend to want interpersonal contact for admiration/manipulation, presented with more emotional lability, and with a pathological self-focus characterized by self-criticism (Cunliffe & Gacono, 2005Cunliffe et al., 2016;Forouzan & Cooke, 2005;Gacono & Meloy, 1994;Kreis & Cooke, 2011, 2012Smith et al., 2021). ...
... Psychopathic women have been found to be more prone to engage in affective (a lack of emotional control) rather than predatory violence as evidenced by their higher base rates of violence toward intimates (Cunliffe & Gacono, 2005Cunliffe et al., 2016;Hicks et al., 2010;Meloy, 2006;Smith et al., 2021). Women with higher PCL-R 1 scores displayed more verbal relational/ affective violence (a form of indirect violence) driven by revenge/jealousy (de Vogel & Lancel, 2016;Mansfield-Green, 2017;Selenius et al., 2016;Thomson et al., 2019). ...
Article
Full-text available
Managing the incarcerated population is the primary task within correctional settings. Using psychological assessment to predict institutional behavior, the psychologist has a unique set of skills essential to the management of prisoners. PCL-R, PAI, and Rorschach data were compared with institutional infractions (total, physical, verbal, non-aggressive) among 126 incarcerated women. Multiple binary logistic regression analyses were used which found significant correlations between PCL-R total score, PAI scales (BOR, ANT, VPI), and Rorschach variables (ROD, EGOI, TCI, AgPot, AgPast, SumV, SumC’, MOR) with total, verbal, physical, and nonviolent incident reports. Each of these measures adds incrementally to the assessment and understanding of institutional misbehavior for incarcerated women. Clinical implications of the findings were presented.
... Discussion of the literature on sex differences in the external correlates of the PCL-R and its derivatives is beyond the scope of this article. Detailed analyses and reviews are available elsewhere (Salekin et al., 1998;Cale and Lilienfeld, 2002;Vitale et al., 2002;Hare, 2003;Richards et al., 2003;Warren et al., 2003;Verona and Vitale, 2006;Warren and South, 2006;McKeown, 2010;Lehmann and Ittel, 2012;Book et al., 2013;Forth et al., 2013;Hare et al., 2013;Warren and Burnette, 2013;Tuente et al., 2014;Cunliffe et al., 2016). In general, the psychometric properties and external correlates of the PCL-R and its derivatives are similar for women and men. ...
... A caveat regarding the use of lowered cut-off scores for females warrants mentioning. Specifically, some commentators (see Cunliffe et al., 2015) believe that female psychopaths can and should be identified with a PCL-R score ⩽30. Clearly, there is a need for ongoing research in this area as differences in factor structure and item functioning (c.f. ...
Article
There is a paucity of research about personality pathology among female offenders. This study aims to address this gap in the forensic psychology empirical base by examining the relationship between female psychopathy, as measured by the Psychopathy Checklist–Revised, and personality disorders, as measured by the Millon Clinical Multiaxial Inventory-III in a South African forensic context. Participants included 108 purposively sampled female offenders incarcerated in South Africa. The Kruskal–Wallis H test and Mann–Whitney U test revealed a number of significant differences in levels of personality pathology between groups. Importantly, the results support international findings that significantly higher rates of Cluster B personality pathology are found among psychopathic offenders compared to non-psychopathic offenders.
Chapter
Psychopathy is an essential construct for research and applied usage (Gacono, 2016). The Psychopathy Checklist-Revised (PCL-R; Hare, 2003) is the only valid method for assessing the Cleckley psychopath. In this chapter, we discuss theoretical and empirical roots of psychopathy and provide clinical and forensic guidelines for use of the PCL-R. We rely on our extensive PCL-R research and clinical experience in discussing gender differences among psychopaths. Although males show a malignant narcissistic style, the female variant is characterized by a malevolent type of hysteria (Cunliffe & Gacono, 2005, 2008; Gacono & Meloy, 1994; Smith, Gacono, & Cunliffe, 2018). Gender differences are highlighted and guidelines for the assessment of psychopathic and nonpsychopathic female offenders are provided.
Chapter
Long before psychology, bias has existed in science. From the beginning, concerns have been raised about the reliability, validity, and accuracy of social science research (Meehl, 1954). In this chapter, we define and discuss the origins of bias and how it can erode the scientific method. We focus specifically on bias in psychological research, theory, assessment, and treatment. We discuss the range of common misconceptions and misinformation that permeates the female offender literature. Finally, we conclude with ten myths about female offenders and offer guidelines for identifying bias and how to avoid it.
Chapter
Despite the perception that women do not commit sexual offenses, female offenders engage in sexual homicide, sexually assault their students or their own children, and, at times, work with co-perpetrators to sexually aggress against their victims. Few studies have used psychological tests to psychometrically map the personality of female sexual offenders. In this chapter, we use the PCL-R, PAI, and Rorschach in studying a sample of female sexual offenders with offenses against minors (N = 39). These women evidenced (1) borderline reality testing, defenses, & thinking; (2) a damaged sense of self (entitlement & victim stance); (3) abnormal bonding and pseudo-dependency (maladaptive neediness); (4) affective instability; (5) impulsivity; and (6) chronic anger couched within a malignant hysterical style that masks an underlying paranoid position. Descriptive personality measure data and two case examples are presented to highlight the dynamics of their offending behavior.
Chapter
Historically, the cornerstone of the psychologist’s identity rested on providing competent in-depth psychological assessment (Rapaport, Gill, & Schafer, 1946). The ability to utilize a battery of assessment methods to elucidate complex issues makes the psychologist unique among other mental health professionals. Recent trends, however, have tarnished that cornerstone. Not surprisingly, the movement away from proficiency in psychological assessment has led to a decline in the need for psychologists. In this chapter, we discuss these harmful trends, define psychological assessment, offer a model for assessing female offenders, and provide examples of how record review, clinical interview, the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach Inkblot test can be useful with female offenders. We discuss the interpersonal aspects of the assessment process, evaluate gender specific patterns for several PCL-R criteria (also see Appendices A & B), and provide caveats for assessing female offenders. We conclude with a case study.
Chapter
In this chapter, we provide a theoretical and empirically based understanding of antisocial and psychopathic women. We begin by clarifying the differences between psychopathy, sociopathy, and ASPD, and then provide a historical perspective of hysteria. While the underlying personality of the female psychopath is paranoid, malignant hysteria is their predominant personality style (Gacono & Meloy, 1994). Overviews of the Hare Psychopathy Checklist-Revised (PCL-R), Personality Assessment Inventory (PAI), and Rorschach are offered as a refresher for those experienced clinicians and as a resource for those that are not. Finally, we present group PAI and Rorschach data (also Trauma Symptom Inventory-2 [TSI-2]) for 337 female offenders including subsets of psychopathic (N = 124) and non-psychopathic (N = 57) females. We make note of the differences between female and male psychopaths.
ResearchGate has not been able to resolve any references for this publication.