ArticlePDF AvailableLiterature Review

Abstract and Figures

The character Hannibal "the Cannibal" Lecter, best known from the motion picture The Silence of the Lambs from 1991, has become a cultural icon and model for later portrayals of seriously disturbed offenders. He displays key characteristics of the Psychopathy Checklist-Revised, such as arrogance, manipulation, callousness, and lack of remorse. From a clinical point of view, one of the most fascinating aspects with Lecter is his display of a variety of capacities alternating between cold-blooded predatory behavior, affection toward FBI special agent Starling, and mourning of the loss of his sister Mischa. Many authors have described the ruthless characteristics of the psychopath. Through the lens of object relations theory, this review systematically examines case descriptions of severely psychopathic offenders published between 1980 and March 2009. In contrast to the prevalent opinion, case material ( n = 11) demonstrates that severely psychopathic offenders do suffer from psychological pain.
Content may be subject to copyright.
http://ijo.sagepub.com/
Criminology
Therapy and Comparative
International Journal of Offender
http://ijo.sagepub.com/content/55/3/350
The online version of this article can be found at:
DOI: 10.1177/0306624X10362659
2010
2011 55: 350 originally published online 22 AprilInt J Offender Ther Comp Criminol
Aina Sundt Gullhaugen and Jim Aage Nøttestad
Research
Looking for the Hannibal Behind the Cannibal: Current Status of Case
Published by:
http://www.sagepublications.com
can be found at:Criminology
International Journal of Offender Therapy and ComparativeAdditional services and information for
http://ijo.sagepub.com/cgi/alertsEmail Alerts:
http://ijo.sagepub.com/subscriptionsSubscriptions:
http://www.sagepub.com/journalsReprints.navReprints:
http://www.sagepub.com/journalsPermissions.navPermissions:
http://ijo.sagepub.com/content/55/3/350.refs.htmlCitations:
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Articles
International Journal of
Offender Therapy and
Comparative Criminology
55(3) 350 –369
© 2011 SAGE Publications
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/0306624X10362659
http://ijo.sagepub.com
Looking for the Hannibal
Behind the Cannibal:
Current Status of
Case Research
Aina Sundt Gullhaugen1,2 and
Jim Aage Nøttestad1,2
Abstract
The character Hannibal “the Cannibal” Lecter, best known from the motion picture The
Silence of the Lambs from 1991, has become a cultural icon and model for later portrayals
of seriously disturbed offenders. He displays key characteristics of the Psychopathy
Checklist–Revised, such as arrogance, manipulation, callousness, and lack of remorse.
From a clinical point of view, one of the most fascinating aspects with Lecter is his
display of a variety of capacities alternating between cold-blooded predatory behavior,
affection toward FBI special agent Starling, and mourning of the loss of his sister Mischa.
Many authors have described the ruthless characteristics of the psychopath. Through
the lens of object relations theory, this review systematically examines case descriptions
of severely psychopathic offenders published between 1980 and March 2009. In contrast
to the prevalent opinion, case material (n = 11) demonstrates that severely psychopathic
offenders do suffer from psychological pain.
Keywords
psychopathy, PCL-R, psychological pain, object relations, defense
Introduction
We cannot treat, except empirically, what we do not understand and we cannot prevent,
except fortuitously, what we do not comprehend.
Brittain, 1970, p. 206
1St. Olavs University Hospital, Trondheim, Norway
2The Norwegian University of Science and Technology (NTNU), Trondheim, Norway
Corresponding Author:
Aina Sundt Gullhaugen, Forensic Department Broset, Center for Research and Education in Forensic
Psychiatry, St. Olavs University Hospital, P.O. 1803 Lade, Trondheim, Norway, N-7440
Email: aina.gullhaugen@svt.ntnu.no
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 351
A problem facing clinical personnel working with psychopathic offenders has been the
view that these individuals cannot be treated (see Gacono, Nieberding, Owen, Rubel,
& Bodholdt, 1997, and Salekin, 2002, for a review of the literature). One reason for
this may originate from research where personality is described as a stable condition
(Roberts & DelVecchio, 2000). Psychopathy in this context is a static personality dis-
order variable in risk assessment (Webster, Douglas, Eaves, & Hart, 1997). Furthermore,
studies using interventions that are neither sufficient nor necessary for personality
disorder issues (Harris, Rice, & Cormier, 1991) have influenced today’s understand-
ing of psychopathy to a disproportionate degree. However, the single most decisive
reason for the pessimistic stance on treatment probably stems from intuitively appeal-
ing and enduring notions such as psychopaths do not suffer (in the words of Cleckley,
1988: “Mature, wholehearted anger, true or consistent indignation, honest solid grief,
sustaining pride, deep joy, and genuine despair are reactions not likely to be found
within this scale,” p. 348) and thus have no motivation to change. As a consequence,
many clinicians abandoned the curative treatment model, and the psychopath became
“the least loved patient” (Strasburger, 1986, p. 191).
Considering the fact that we lack an integrated understanding of and an empirically
supported treatment for psychopathy, we should be searching for new ways of address-
ing the problem. And because some of the most interesting research comes from
hypotheses that challenge what we believe today (Popper, 1963), it seems relevant to
dispute that psychopathy and suffering are mutually exclusive constructs. But how
and where to look for psychological vulnerability and pain in psychopaths?
The approach must be different from earlier research comparing psychopaths and
nonpsychopaths in experimental and artificial settings (capturing the physiological
hyporeactivity or callousness of the psychopath; Stanford, Houston, & Barrat, 2007),
and comorbidity ratings, where results are mixed (Hale, Goldstein, Abramowitz,
Calamari, & Kosson, 2004). Furthermore, one would have to omit the biogenetic
concept of callousness (Blair, Mitchell, & Blair, 2005), because this concept, and the
interpretation of it, rests on a static idea of personality. Looking for vulnerability and
pain in psychopaths implies searching for some sort of “subjective discomfort” (cf.
World Health Organization [WHO] general criteria for personality disorder; WHO,
1993) that does not necessarily meet the specificity of the psychiatric nomenclature,
nor reflect the usual conceptions of vulnerability and pain. Finally, a sound theoretical
understanding of how vulnerability and pain might manifest itself in the psychopathic
individual will need to be presented.
The Psychopath in Interpersonal Relations
Examining case information with a theoretical anchor in the object relations’ tradition
provides a naturalistic and interpersonal framework for analyzing vulnerability and
pain in individuals often characterized as lacking in profound relationships (Psychopathy
Check List–Revised [PCL-R], Item 17; Hare, 2003). Generally speaking, personality
disorder is characterized by stable states and behavioral patterns that seem to express
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
352 International Journal of Offender Therapy and Comparative Criminology 55(3)
a person’s typical lifestyle and way of relating toward oneself and others (WHO,
1993). The observed rigidness often attracts more attention than the interpersonal
dynamics of the disease. But symptoms will never be purely static, as we are always
what we are in relation to something. We should ask: Is the psychopath nothing but an
isolated and unaffected antisocial organism, or is he or she rather immersed in and
influenced by a relational web of human interaction, just like anyone else? With a
“mask of sanity that Cleckley saw and others now recognize hides the psychopath’s
pathology, which is a source not only of consternation for others but also of pain and
sadness for him” (Reid, 1986, p. X). This clinical experience by Reid differs markedly
from the view of Cleckley (1988), has never been tested, and may be easily dismissed
as clinical anecdotes and theoretical speculations (Weiss, 1987). Through the lens of
object relations’ theory, this article reviews case descriptions of severely psychopathic
offenders to test whether these individuals suffer and experience psychological pain in
interpersonal relations. For additional illustrative purposes, author Tomas Harris’s
fictitious character “Hannibal Lecter” is used to highlight this important aspect of the
psychopath’s functioning.
Lecter is a gifted and highly educated health professional, and a cunning murderer,
sometimes torturing and cannibalizing his victims without regret. Behind a well-
articulated, impressive appearance lurks a ruthless character that has been referenced
in scientific articles (Gacono, 1992; Gregory, 2002; Patrick & Zempolich, 1998) and
has become a cultural icon influencing later portrayals of seriously disturbed offend-
ers. He is callous, arrogant, manipulative, and lacks empathy and remorse. These are
central items in today’s gold standard for assessing psychopathy, the PCL-R (Hare,
2003). Confer the ICD-10 F60.2 Dissocial personality disorder (WHO, 1994) for the
closest we get to a diagnostic description of the disorder.
Thomas Harris has not revealed to what extent he researched the psychopathic
personality in the process of creating Hannibal Lecter. According to an electronic
article by author Anthony Bruno (n.d.), Harris did research at the FBI’s Behavioral
Science Unit and “learned the specifics of serial murderers and their habits from real
profilers.” Bruno establishes as probable that the fictional Lecter character is a com-
posite of many of the characteristics of real murderers by illustrating how the character
resembles real-life serial killers such as Jeffrey Dahmer, who was profiled by the FBI,
and by referring to Sexton (2001), who reports that Harris at some point told a librar-
ian in his hometown of Cleveland, Mississippi, that Lecter was inspired by a local
murderer named William Coyne, whose crimes included acts of cannibalism.
An examination of Harris’s four novels about Lecter (1981, 1988, 1999, 2006)
makes it evident that the character fulfils 8 of 10 items of the PCL-R Factor 1 criteria
(the interpersonal and affective domain) and also 4 of 10 items of the criteria from
Factor 2 (the behavioral domain), which gives the character a PCL-R total score of 24
(Max = 40). In addition, his lack of intimate relationships may indicate a limited
attachment capacity that corresponds to a tendency to engage in many short-term rela-
tionships (PCL-R, Item 17) and hence may describe a symptom not accounted for by
the PCL-R but included in risk assessment instruments (Webster et al., 1997). Lack of
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 353
intimate relationships still makes sense according to the interpersonal and affective
core of the psychopathy concept (Boyd, 2003; Cook, Michie, Hart, & Clark, 2005;
Schrum & Salekin, 2006). As a consequence, the term psychopath could be applicable
to individuals with the observed interpersonal and affective disturbance, without the
behavioral criteria necessary to reach PCL-R’s North American (30) or European
(25) cutoff for severe psychopathy. This interpersonal and affective core lies at the
heart of object relations theory.
Object Relations Theory
Object relations theory is a collective term for theories focusing on how early interper-
sonal interaction, or object relations, construct psychological structure (an inner
experience of a self and an other; St. Claire, 2000), which serves as a foundation for
future relationships. In normal object relations, experiences are characterized by the
capacity to regard others as multifaceted individuals with separate needs (whole
objects), a well-modulated capacity for self- and affect-regulation, and mature emo-
tions such as empathy and reciprocal pleasure (St. Claire, 2000). In short, well-developed
psychological structures indicate a psychologically balanced individual who is able to
appreciate himself or herself and others for who they are.
According to this theory, “narcissism and disorders of the self imply that the very
central structures of the personality (inner experiences of self and others) are defective”
(St. Claire, 2000, p. 139). In the PCL-R, narcissism is covered by Item 2: Grandiose
sense of self-worth, and research has demonstrated that the PCL-R Factor 1 (the inter-
personal and affective domain) is correlated with narcissistic personality disorder
(Harpur, Hare, & Hakstian, 1989). Individuals with defective personality structure/
pathologically developed object relations are distinguished by a tendency to define
others as one-dimensional need-satisfying objects (part–objects), deviances in self- and
affect regulation, primitive feelings such as anxiety and rage, and projection and split-
ting as primitive defense (St. Claire, 2000). The theory has proved relevant with
different approaches and measures in samples of psychopathic offenders (Brody &
Rosenfeld, 2002; Frodi, Dernevik, Sepa, Philipson, & Bragesjø, 2001; Hartmann,
Nørbech, & Grønnerød, 2006; Meloy & Gacono, 1998).
Vulnerability, Pain, and Object Relations Theory
In general terms, vulnerability can be defined as “a capability of being physically or
emotionally wounded” or “openness to attack or damage,” and pain as “acute mental
or emotional distress or suffering” (Merriam-Webster’s Online Dictionary, n.d.). In
this, it is implicitly stated that pain, or “acute mental or emotional distress or suffering,”
is something that is inflicted on us (and hence requires differentiation between a self
and an other), and that in order to feel something, you must be “capable” or “open.” In
traditional diagnostics, we count symptoms and may lose the interpersonal drama of an
individual’s disease. In object relations theory, vulnerability and pain are of relational
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
354 International Journal of Offender Therapy and Comparative Criminology 55(3)
character and have a developmental origin. Following Hughes (2006), infants’ and
young children’s first interest is the interpersonal world. Theory and observations point
to the fact that infants are specifically receptive to subjective states in other persons
(Trevarthen & Aitken, 2001), and that children discover a sense of self in the eyes, face,
voice, gestures, and touch of their caretakers (Hughes, 2006). Attachment is mediated
through the infant’s instinctive behaviors, “organized and maintained through proximity-
seeking behavior toward the mother” (Bowlby, 1969, in Meloy, 1998, p. 54).
According to theory, psychopaths have acquired the capacity for differentiating between
a self and an object, or a dyadic object-relational world (Meloy, 2001). The psychopathic
character formation “crystallizes toward the later sub-phases of separation-individuation
with the failure of object constancy,” “deactivation of a need for attachment (Bowlby,
1980),” and “primary narcissistic attachment to the grandiose self-structure” to “subserve
individual survival” (Meloy, 1998, p. 54). Meloy (1998) argues that “instead of the child’s
emergence into the third and fourth year of life with internally stable, affectively gratify-
ing, and clearly delineated self- and object representations” (object constancy), what we
see is the defensive workings of “fused self- and objects concepts within the grandiose self
structure” (p. 56). As a consequence, psychopaths are potentially vulnerable in their capac-
ity for differentiation of objects (on a perceptive and not conceptive level; Meloy, 1998)
but in the process of deactivation of the need for attachment become more or less incapable
of, or closed to, normal variants of psychological pain (acute mental or emotional distress
inflicted by others). Yet the psychopath is not unaffected by others. Meloy (2002) asks: “If
psychopaths are so emotionally detached, why must they continually aggress against other
people in such hurtful and destructive ways?” (p. 84).
Psychopathy, or “The Search for a Painless Freedom From Object Relations”
Because of the failure of object constancy, the psychopath will be caught between the
strong need for relationship with other objects, and anxiety arising from efforts trying
to fulfill this need. This developmental conflict has interpersonal and affective implica-
tions, as can be identified in the psychopathic “struggle” with keeping others at a
distance, and the anger arising as a reaction to separation (Bowlby, 1973, in Meloy,
1998). In the psychopathic “search for a painless freedom from object relations” lies
both tragedy and hope, because implicit in this concept is the idea that “painless free-
dom from object relations can never be found in humans and must remain an abstract”
(Halleck, 2001, p. 160). As a consequence, looking for vulnerability and pain in psy-
chopaths requires interpersonal variables, and one way to systematize such data is
through the hallmarks of object relations theory. Do we find this pattern in the instru-
mental character Dr. Lecter?
Hannibal and the Making of Hypotheses
Hannibal was orphaned under extremely brutal conditions in Lithuania during the
Second World War. Placed in an orphanage, he was an object of abuse and started
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 355
living inside his own head, until rescued by his uncle and aunt. Hannibal’s uncle soon
died, which forced him to live with his aunt under reduced circumstances (T. Harris,
2006). After some time, Hannibal developed a special relationship with his aunt. One
day at the local market, a male butcher insulted her. This is described to trigger his
underlying vulnerability, and shortly after the attack, young Hannibal went out on a
mission hunting the men who had previously killed and eaten his sister.
In Hannibal Rising (T. Harris, 2006), the young Hannibal is torn by anger and
tortured by dreams. The fact that he is somewhat drawn and attracted to his aunt
seems not enough to keep him from reaching a state of detachment, which Harris
poetically describes as, “He dined alone and he was not lonely. Hannibal had entered
his heart’s long winter. He slept soundly, and was not visited in dreams as humans
are” (p. 310). As an adult, Hannibal’s interpersonal relations are centered on the sat-
isfaction of his needs (part–object relations). Before being convicted, he manages to
give the impression of leading a normal life by being extremely controlled and by
using primitive defense to rid him of his strong destructive urges (Table 1). In Han-
nibal (1999), Harris states that Lecter kills to show his contempt for those who
exasperate him. When interrogated by agent Starling in The Silence of the Lambs, a
strongly upset Lecter reveals: “discourtesy is unspeakably ugly to me,” as if his own
killings somehow cleanse him from other forms of discourtesy (T. Harris, 1988, p.
25). Both examples illustrate the primitive affect (Meloy & Gacono, 1998) of the
Table 1. Hannibal Lecter PCL-R Score, Current Offense, Early Relations, Part Objects,
Regulation, Feelings, and Defense
T. Harris (1981, 1988, 1999, 2006)
PCL-R 24
Current offense Serial killing.
Early relations Suffered several extreme traumas at 11 years. After this, he was raised
and abused in an orphanage, and lived in a pseudo-romantic relationship
with his aunt/caretaker.
Characteristics Male, born in 1933. Highly intelligent. Post-traumatic stress disorder.
Part objects Attempts on establishing a relationship with agent Starling, based on
a reunion fantasy as regards idealized sister. Detached, but longings
for love. Difficulties in maintaining consistent boundaries between
people. Superficially charming. Extremely manipulative. Grandiose
behavior. Lying/different aliases. Fixation with cannibalism and torture.
Degradation of victims. No remorse. Good to animals.
Regulation Hypervigilant, especially for smells and odors. Extremely controlled, but
strongly activated under certain circumstances.
Feelings A need for revenge. Rage. Persecutory anxiety. Pleasure derived from
dominance over victims.
Defense Rationalization, dissociation, splitting, projective identification and
delusions (cf. Gregory, 2002).
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
356 International Journal of Offender Therapy and Comparative Criminology 55(3)
psychopath, in this case filtered through a more sophisticated lens than what you
would hear from most offenders.
After the movie The Silence of the Lambs (1991), the question was raised of
whether Lecter earned a romantic interest in Starling? The answer is probably no, as
we get the impression that his intense attraction is of a more primitive character. This
becomes evident in the end of Hannibal (T. Harris, 1999), when the Lecter character
kidnaps Starling and attempts to “transform her” to get back his beloved sister
Mischa. At this time, he has developed into a full-born psychopath yet still not unaf-
fected by others and very much in need of remedy for his awakening pain. Hannibal
is fiction. Do we find this pattern in real-life, severely psychopathic offenders, or is
psychopathy and “suffering” mutually exclusive constructs? According to object
relations theory, two hypotheses will be tested:
Hypothesis 1: Early interpersonal relations are unstable and insecure.
Hypothesis 2: Vulnerability and pain can be identified through part-object relations,
deviant self- and affect regulation, primitive feelings, and primitive defense.
Method
Sample of Studies
This review systematically examines all English-language case reports of severely
psychopathic adult offenders (PCL-R 30, PCL:SV 18; Hart, Cox, & Hare,
1995) published between 1980 and March 2009, with the aim of identifying vul-
nerability and pain according to object relations theory. Excluded were child and
adolescent offenders because of their ongoing personality development. Excluded
also were nonoffending populations and cases with a PCL-R score lower than 30,
to secure inclusion of only the most psychopathic offenders who fit the affective
and interpersonal core, and who are often described as indifferent to psychological
vulnerability and pain.
The databases PsycINFO and PubMed were searched with a combination of the
terms psychopath/y and case, in any field. The search produced 1,431 hits, of which
eight studies describing a total of 11 severely psychopathic offenders could be
included. The reference lists of the included articles were examined for information
about potentially relevant cases.
Coding the Studies
Information from the eight papers was systematized according to the object relations
categories described above: early relations, part–objects, deviant self- and affect regu-
lation, primitive feelings, and primitive defense. The information was placed in the
different categories according to the judgment of the first and second author of this
article. The direct wording was excerpted from the original texts.
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 357
Results
All offenders have experienced gross instability, neglect, and/or abuse in their family
of origin (Table 2). All cases demonstrate part–object relations, in that the offenders
ruthlessly use other individuals to satisfy their needs. Their interpersonal relationships
are further characterized as unstable and intense (Studies 1, 3, 5, 6, 7, 8, 9, and 11). As
regards to self- and affect regulation, case descriptions include individuals who are
always on edge (Studies 5 and 9), with intense mood swings (Studies 2, 4, 5, 9, 10, and
11), a deficiency in the ability to set or maintain long-term goals (Study 3), and recur-
rent self-mutilation, suicidal, and impulsive behavior acted out while experiencing
intense feelings (Studies 6, 2, 9, and 10). Several offenders are characterized with
primitive feelings such as anxiety, sadism, and especially rage (Studies 1, 3, 4, 8, 9, 10,
and 11), and some reportedly rely on the primitive mechanisms of splitting, projection,
dissociation, and denial as psychological defense (Studies 4, 5, and 8). Oddities of
thoughts, cognitive and perceptual distortion, identity disturbance, and poor reality
testing under stress were also reported (Studies 4, 5, 8, 9, 10, and 11).
All but one offender (Study 7) are diagnosed with symptom- and/or character disor-
ders, according to the diagnostic manuals. The majority have a substance and/or drug
disorder (Studies 1, 3, 5, 8, 10, and 11) and some comorbid personality disorders (Stud-
ies 2, 4, 5, and 10). Three offenders were diagnosed with symptom disorders, including
diagnosable anxiety and depression and schizophreniform disorder (Studies 2, 5, and 9).
Explicit, self-reported indications of vulnerability and pain (direct wording by the
authors) were auditory hallucinations; mood swings and tension, which are relieved
by acting out; desire to exact revenge for the pain endured throughout life; derealiza-
tion; powerful feelings of isolation; “edginess” and anger; depression and suicidal
thoughts and plans: perceptions of being unfairly treated; a tendency to compare one-
self negatively to others; and uncomfortableness with care.
Explicit, author-reported indications of vulnerability and pain were frantic efforts
to avoid real or imagined abandonment; feelings of emptiness and longings for love;
dysphoria; fear; self-mutilation; abnormally undervalued sense of self, seeing perse-
cution and abandonment where there is none; unstable and intense interpersonal
relations; intense mood swings; recurrent suicidal behavior; identity disturbance with
unstable self-image; reality-testing deficits; a tendency toward both isolation and
dependency on others; defensive against own affect; and a deeply felt sense of being
injured and damaged.
Discussion
The present review used object relations theory to examine whether psychopathy
and suffering (vulnerability, pain) are mutually exclusive constructs. The detailed
descriptions of the 11 psychopaths in the eight studies that were identified suggest
vulnerability and pain in accordance with the theory as well as Reid’s (1986) con-
ceptualization of sadness and pain. The results are incongruent with Cleckley’s
(text continues on page 364)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
358 International Journal of Offender Therapy and Comparative Criminology 55(3)
Table 2. Vulnerability and Pain According to Object Relations Theory: Early Relations, Part
Objects, Deviant Self- and Affect Regulation, Primitive Feelings, and Primitive Defense
Study 1 Beasley (2004)
PCL-Ra38
Current offense Serial killing.
Early relations Extremely unstable early life. Alcoholic, cold, and distant mother
with multiple marriages. Fought with and often beaten by
stepfather. Foster home and juvenile detention center. Ran
away from home at 13. Lived for several years with an older
homosexual man and engaged in sexual relations with him.
Characteristics Male. 32 years. Substance abuse.
Part objects Sexually promiscuous. Engaged in homosexual activity to make
money from the men. Extremely manipulative. Professed to be
mostly interested in what he could obtain of monetary value
from his victims. Degradation of victims. Grandiose behavior. No
remorse. After the second or third murder, he was beginning to
“enjoy” what he was doing. Conceded to have no feelings for
those he killed. He forcible shoved objects or debris into some
victims’ mouths after death.
Regulation Little control over behavior.
Feelings Generalized anger and rage. A need to exact revenge on “all the
people who have ruined my life.” Finds relish in the attention he
gets from his murders. Stated motives: anger, retaliation, revenge.
Defense Not reported.
Method Standardized protocol interview. Detailed case material.
Study 2 Bruce-Jones & Coid (1992)
PCL-Rb37
Current offense Intending to destroy or damage property.
Early relations Emotionally cold and socially isolated family home. The father,
who she believed was her grandfather, was troubled by frequent
illnesses. Her mother was cold, showing little affection and
infantilized her. Harsh discipline during childhood. Shy and isolated
at school.
Characteristics Female. 21 years. Full-scale IQ of 105. Genderless appearance.
A fragmented personality shifting between four different
personalities. Claimed to have five different identities.
Auditory hallucinations. Bizarre behavior. Antisocial,
borderline, and narcissistic personality disorder.
Schizophreniform disorder. Possible atypical bipolar disorder.
Pyromania.
Part objects Lying. Using different identities. Absence of a stable sense of identity.
Regulation Mood swings and tension, which are relieved by acting out.
Disinhibition. Self-mutilation from age 11.
(continued)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 359
Table 2. (continued)
Feelings Not reported.
Defense Regressive behavior (wearing children’s clothes, smearing feces,
attachment to soft toys).
Method CT;c EEG;d DSM-III-R.e
Study 3 Beasley (2004)
PCL-Ra36
Current offense Serial killing.
Early relations Highly unstable upbringing. Frequent verbal and physical abuse
by father.
Characteristics Male. 35 years. Drug abuse. Divorced. Intense hatred of women.
Part objects Extremely manipulative. Limited remorse. Superficially charming.
Voyeuristic: excited by peering into windows.
Regulation Lacks ability to set and maintain long-term goals. Impulsive.
Continuous need for stimulation.
Feelings Rage-filled view of the world. Anger. Choice of weapon derived
from desire to exact revenge for the pain he had endured
throughout his life. Wanted to offend those who found his victims.
Defense Related that he was influenced by a “force” in the form of an
imaginary person (which allowed him to dissociate himself from
his actions).
Method Standardized protocol interview. Detailed case material.
Study 4 Gacono (1992)
PCL-Ra34
Current offense Sexual homicide.
Early relations A family history of alcoholism, psychiatric problems, instability of
residence, and physical and mental abuse. Abandoned by father.
Negative relationships with male caretaker figures and dominant
biological mother. Absence of role models. Perceptions of being
unfairly treated. “I was going to kill someone for what was done
to me (referring to his being abused as a child).
Characteristics Male. 31 years. Antisocial, borderline, narcissistic, and histrionic
personality disorder. A history of depression and suicidal
thoughts and plans: “I had planned to kill myself on that day, but
after I picked the girl up I killed her instead.
Part objects Narcissistic, primitive, and borderline object relations. Emotionally
and interpersonally detached. Callous lack of empathy.
Egocentricity.
Regulation Affective dysregulation. Rage and erotic arousal temporarily
dissipate his depression. Increasing rehearsal fantasies prior to
the murder. Poor control of anger.
Feelings Aggression and sadism. Chronic dysphoria.
(continued)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
360 International Journal of Offender Therapy and Comparative Criminology 55(3)
Table 2. (continued)
Defense Reality-testing deficits. Identity disturbance. Derealization: “It was
like watching a film in slow motion.” Rationalization: “It was
like a mercy killing. I thought that if she lived she would be a
veg.” Splitting, idealization, devaluation, projective identification,
omnipotence, dissociation, and denial.
Method SILS;f MMPI;g MCMI;h DSM-III-R;e Rorschach.j Reliability testing.
Study 5 Leach & Meloy (1999)
PCL-Ra34
Current offense Sexual homicides
Early relations Absent father. Sexual and physical abuse by mother, stepfather, and
neighbor. Witness to adult sex and violent pornography. Safe
attachment to grandmother.
Characteristics Male. 22 years. Borderline and mild mental retardation. Diagnosable
anxiety and depression at various times. Antisocial and schizoid
personality disorder. Substance abuse. Enuretic until age 16.
Generally compares himself negatively to others.
Part objects Pleasure derived from dominance over victims. A tendency toward
both isolation and dependency on others. Capacity to represent
others as whole objects.
Regulation Characterizes the homicides as “an urge that I had to do.
Defensive against own affect, but when felt it is explosively
expressed. Hypervigilant, searching the stimulus field for relevant
details.
Feelings A deeply felt sense of being injured and damaged. A lack of any real
affectionate connection with others.
Defense Defensive against own affect. Psychotic reality testing when
sexual or aggressive imagery is evoked. Fantasies that have
never changed (reflected in his crimes). Grandiose ideational
compensation for very low self-esteem.
Method Complete review of records; DSM-III-R;e Rorschach;j MCMI-III;h
WAIS-R;k PPVT-R;i B-GT;l MMPI-II.g PCL-R consensus rating.
Study 6 Beasley (2004)
PCL-Ra33
Current offense Serial killing.
Early relations Highly unstable home. Verbally abused by father. Extremely isolated.
Characteristics Male. 34 years. IQ of 68. Speech impediment.
Part objects Motives of profit and revenge. Chronic lying. No remorse.
Regulation Impulsiveness.
Feelings Proneness to boredom.
Defense Not reported.
Method Standardized protocol interview. Detailed case material.
(continued)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 361
Table 2. (continued)
Study 7 Beasley (2004)
PCL-Ra33
Current offense Serial killing.
Early relations Family instability. Some supervision from grandmother, who
eventually died. Everything went “downhill after that.” Powerful
feelings of isolation. When frustrated as a child he went off by
himself to release his pent-up feelings, brooding silently, avoiding
contact with others.
Characteristics Male. 40 years.
Part objects Fantasies about, and starting to blend the needs for, sexual
gratification and inflicting violence and pain in others. Parasitic
lifestyle. Enormously manipulative. Lacks remorse. Voyeuristic.
Sexually aroused through violence alone.
Regulation Few behavioral controls.
Feelings Not reported.
Defense Not reported.
Method Standardized protocol interview. Detailed case material.
Study 8 Porcerelli, Abramsky, Hibbard, & Kamoo (2001)
PCL-Ra33
Current offense Serial killing.
Early relations Gross neglect and abuse. Raised in foster homes and state
institutions. Always felt “second rate.” His only stable bond
was with his brother. Sexual relationship with institution staff.
Characteristics Male. 24 years. Drug abuse. Low-average to average intelligence.
Part objects Difficulty in maintaining consistent boundaries between people.
Superficial relationships, organized around a need-gratifying
mode of relatedness. Limited investment in people. Feelings of
emptiness and longings for love were pervasive in descriptions
of interactions. Reunion fantasy as regards idealized mother
(in jail). Deficits in capacity to experience pleasure via mutual
relatedness.
Regulation Extremely oppositional in school.
Feelings Rage. Dysphoria. Blurring aggressive and libidinal feelings. Feeling
empty and unloved.
Defense Projection and denial to rid himself of aggressive and sadistic
impulses. Mild to gross impairment in attributions of others’
thoughts, feelings, and behavior.
Method MMPI-II;g SCORS;m DMM.n Independent coding on two measures.
Study 9 Brown (1996)
PCL-Ra32
Current offense Possession of an illegal substance.
(continued)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
362 International Journal of Offender Therapy and Comparative Criminology 55(3)
Table 2. (continued)
Early relations Moving every year. Alcoholic father. Physically abusive and always
angry mother. Ran away from home at 6 with her mother’s
blessing. Mother also tried to get rid of her at age 11 through
court. Rejected, slept outside under bushes.
Characteristics Female. 38 years. Symptoms of major depression.
Part objects A multitude of aliases and social security numbers. Living with
others, who paid her living expenses. Detached. Becomes
uncomfortable when others tell her that they care. Does not
expect cooperation from others. Intelligence in the low-average
range. Remorse. Longing for a connection with others.
Regulation Always on edge, scanning her environment in a hasty manner, often
missing crucial information. Impulse-based decisions acted out
in moments of anger, frustration, grief, or fear. When intense
feelings surface, she has difficulty controlling her behavior.
Frequent intense emotional disruptions and explosiveness that
make social adjustment difficult. Self-mutilation in moments of
anger and fear. Abnormally undervalued sense of self.
Feelings Sees persecution and abandonment where there is none. Everything
turns into anger for her. Easily bored. Does not avoid emotions in
herself or others.
Defense Poor reality testing under stress. Denial. Projective identification.
Oddities of thoughts. Perceptual distortion.
Method Historical information; MMPI-II;g MCMI-III;h BORRTI;o Rorschach.j
Consensus rating.
Study 10 Myers, Gooch, & Meloy (2005)
PCL-Ra32
Current offense Serial killing.
Early relations Several losses. Emotionally and physically abused by grandparents.
Early childhood attachment disruptions.
Characteristics Female. 34 years. Antisocial and borderline personality disorder.
Hearing and visual problems. IQ of 81. Drug abuse.
Part objects Conning/manipulative. Multiple aliases. Lack of remorse, guilt, or
empathy. Parasitic lifestyle. Unstable and intense interpersonal
relations alternating between idealization and devaluation. Stole
from victims.
Regulation Cold and unemotional. Intense mood swings. Difficulty in controlling
anger. Recurrent suicidal behavior. Need for stimulation. Poor
behavioral control. Identity disturbance with unstable self-image.
Impulsivity.
Feelings Inappropriate, intense anger. Proneness to boredom.
Defense Frantic efforts (manipulation, suicide attempts) to avoid real or
imagined abandonment.
Method Extensive file review. Clinical interview. DSM- IV-TR.e Consensus scoring.
(continued)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 363
Table 2. (continued)
Study 11 Whitehead & Collie (2007)
PCL-SVp 18
Current offense Aggravated robbery.
Early relations Raised in a family where he was exposed to violence and sexual
abuse. Alternated between living with parents and grandfather,
and often chose to live with his grandfather to avoid severe
physical punishment from his parents. Left home in his teenage
years. Acceptance by gang associates.
Characteristics Male. 28 years. Abuse of alcohol and cannabis.
Part objects A pattern of serial-rape activity, beginning at 12 years of age (self-
report). An attitude that sex was a commodity that could be
bought with money or forcefully taken by those with greater
physical power. Early modelled and experiential exposure to
forced sex accompanied with feelings of sexual excitement,
dominance, and peer approval appeared likely to have severely
limited his capacity for developing loving, intimate, and equal
relationships.
Regulation Displays aggression when other people challenge his worldview.
Offense-related sexual arousal.
Feelings The enjoyment he derived from using violence sometimes resulted
in a desire to be drug and alcohol free so as to enjoy the
experience more.
Defense Believed that rape only occurred if a woman verbally said “no,
which resulted in further forced sex occurring under the context
of unspoken threat.
Method File review. Clinical interview. RoC × RoIq
Note: The cases are ranked according to PCL-R score, current offense, characteristics, and quality of
reviewed papers.
a. PCL-R cut off for severe psychopathy is 30.
b. The authors report to have used the Hare 22-item psychopathy scale.
c. Computer tomography.
d. Electroencephalogram.
e. Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) (DSM-III-R; American Psychiatric
Association [APA], 1987) and DSM-IV-TR (APA, 2000).
f. Shipley Institute of Living Scale (Shipley, 1940) Zachary, 1986
g. Minnesota Multiphasic Personality Inventory–Second Edition (Butcher, Dahlstrom, Graham, Tellegen, &
Kaemmer, 1989).
h. Millon Clinical Multiaxial Inventory–III (Millon, 1994).
i. Peabody Picture Vocabulary Test–Revised (Dunn & Dunn, 1981).
j. Rorschach (Exner, 1990, 1993).
k. Wechsler Adult Intelligence Scale–Revised (Wechsler, 1981).
l. Bender–Gestalt Test (Bender, 1946)
m. Social Cognition and Object Relations Scale (Westen, Lohr, Silk, & Kerber, 1989).
n. Defense Mechanisms Manual (Cramer, 1991).
o. Bell Object Relations Reality Testing Inventory (Bell, 1995).
p. PCL-SV cutoff for severe psychopathy is 18 (Hart, Cox, & Hare, 1995).
q. Risk of Conviction × Risk of Imprisonment (Bakker, O’Malley, & Riley, 1999).
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
364 International Journal of Offender Therapy and Comparative Criminology 55(3)
(1988) description of general poverty in major affective reactions, illustrating the
close tie between primitive early relations and the presence of intense primitive
affect. In some of the psychopaths, vulnerability and pain could be identified at a
diagnostic level, which is in accordance with the type of suffering that can be identi-
fied in the normal and in other patient populations. The cases form a heterogeneous
group, and at the same time are similar on important variables, in that most of the
self- and author-reported difficulties are of relational (to self or other) nature. The
results indicate that all psychopaths were raised in severely dysfunctional early
relations. These dysfunctional early relations seem to replicate themselves in the
psychopath’s current instable and intense relationships, and their primitive urges
and defense. These results are in accordance with empirical studies demonstrating
primitive object relations (Gacono, Meloy, & Berg, 1992); regulatory deficits; prim-
itive affect (Meloy & Gacono, 1998); and primitive defense (Gacono, 1990; Gacono
& Meloy, 1992; Meloy, 2002) in severely psychopathic offenders. The state of con-
tinued interpersonal stress described in these cases is a nondiagnostic indication of
vulnerability and pain. Like in Harris’s description of Lecter, this is explicitly stated
in two of the included cases (Brown, 1996; Leach & Meloy, 1999), where the psycho-
paths are described as hypervigilant, always on edge, and scanning the environment
in a hasty manner.
In the Leach and Meloy (1999) case, the psychopath characterizes his homicides as
“an urge that I had to do.” Following Klein (in Gregory, 2002), there is a “causal connec-
tion between a child’s fear and its aggressive tendencies.” Furthermore, a person’s
“anxiety will serve to increase its own sadistic impulses by urging it to destroy those
hostile objects so as to escape their onslaughts.” The Porcerelli, Abramsky, Hibbard, and
Kamoo (2001) case further illustrates the close tie between instrumental violent behav-
ior and the underlying reactive–affective and interpersonal aspect of the situation: After
a developmental history of neglect and abuse, and being raised in foster homes and insti-
tutions, this psychopath’s only relatively stable bond was with his brother. He was one
day forced to move out from his brother’s house, where he was currently living because
of a period of good behavior. He committed a sexual homicide shortly after this. This
pattern was also reported in Leach and Meloy (1999) and Beasley (2004).
Further indications of interpersonal vulnerability and pain in psychopaths are pro-
vided by Porcerelli et al. (2001) in their description of an individual who developed a
reunion fantasy with an idealized mother, currently in jail. This psychopath’s feelings
of emptiness and longings for love were pervasive in reports of interactions during
testing, which is comparable to T. Harris’s (1999) description of Hannibal’s delusional
wish for time to reverse and run backwards, to bring Mischa back to life. Bruce-Jones
and Coid (1992) describe a psychopath having a childish attachment to soft toys.
Leach and Meloy (1999) report a tendency toward both isolation and dependency on
others, and Beasley (2004) reports powerful feelings of isolation in one of the included
cases. As for the rest, we just know that they come from backgrounds where they have
been abused and alone.
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 365
Following Kohut (in St. Claire, 2000), “narcissistic investment sees objects in
terms of their relation to the self—that is experienced as part of the self or performing
functions for the self that the self is not yet able to do” (p. 13). In object relations
theory, part–object relations characterize a natural stadium in child development.
Hence, part objects in adults are probably not related to callousness but rather to defi-
ciency, vulnerability, and pain. Lack of empathy can be explained from the observed
need for symbiotic relationships. Symbiotic drives signalize a defect in the develop-
ment of a self, which correlates with the psychopathic display of mainly basic emotions
(rage and fear) and less self-aware emotions, such as shame and guilt. According to St.
Claire (2000), “healthy development means that the infant distorts relationships less
by rage, love and greed” (p. 39). The results demonstrate that in 7 of 11 cases included
in this review, it is explicitly stated that the psychopaths are characterized with rage
and intense anger. One individual, with a PCL-R score of 32 (Brown, 1996), reports
that everything turns into anger for her. She reports being angry when her father passed
away. She cared about her father. As a consequence, the observed rage and anger is
attachment related and possible expressions of vulnerability and pain.
Given that the degree of psychopathy can be explained as variations in pathologic
relationships, the presence of suffering in individuals with primitive object relations
points to the existence of vulnerability and pain in individuals with more mature or
higher levels of object relations. This is supported by research identifying antisocial
personality disorder and comorbid symptom disorders (Goodwin & Hamilton, 2003).
Furthermore, high levels of psychopathology, as in severe psychopathy, correspond to
high, and not low, levels of suffering. If through the process of deactivation of the need
of attachment, the psychopath becomes incapable or closed to normal, ego-dystonic
variants of psychological pain, this leaves us with an unknown entity, or suffering in
an alternate, ego-syntonic form, which fuels the psychopathic behavior but is difficult
to catch sight of with traditional methods.
“Until the Lion Learns to Speak, the Tales of
Hunting Will Be Weak” (Adage)
In accordance with this article’s opening words by Brittain (1970), laying hands on a
theoretical model that fit the problem, we are one step closer to treating the disorder. But
this task is not an easy one. As health providers, it is deeply rooted in us that when some-
one expresses pain, we must help. This comes with the understanding that the effort will
be appreciated. But what if pain is not clearly communicated (e.g., through part objects
and rage), and if helping implies a risk? How do we get from part objects to whole objects,
or create an inner world that is capable of acknowledging others for who they are?
According to the theory, this can gradually be accomplished “as the individual
internalizes aspects of the therapist and builds new inner structures” (St. Claire, 2000,
pp. 152-153). If symbiosis (as measured by the presence of part–object relations) is
the psychopath’s only option with relationships, then the psychopathic individual is
unable to handle the fluctuations that characterize normal relationships (i.e., a partner’s
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
366 International Journal of Offender Therapy and Comparative Criminology 55(3)
independent interests and relationships). Normal relationships are impossible, as
normal partners cannot hold the symbiosis over time. But this can be a significant
ingredient in a therapeutic relationship. A necessary precursor for this is that the thera-
pist is able to see through the psychopathic defense and empathize with the suffering
individual. Acknowledging that the psychopath feels this kind of pain provides a target
for intervention, and gives the strength to continue with empathic intervention in the
midst of psychopathic tumults. It is all about the individual behind the symptoms, or
finding the Hannibal behind the Cannibal.
Declaration of Conflicting Interests
The authors declared no conflicts of interest with respect to the authorship and/or publication of
this article.
Funding
The authors disclosed receipt of the following financial support for the research and/or author-
ship of this article: This study was supported by a grant from “The National Program for
Integrated Clinical Specialist and PhD-training for Psychologists,” a national recruitment pro-
gram for positions which requires dual competence in psychology funded by the Ministry of
Education and Research and the Ministry of Health and Care Services.
References
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disor-
ders (3rd ed., rev.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disor-
ders (4th ed., text rev.). Washington, DC: Author.
Bakker, L., O’Malley, J., & Riley, D. (1999). Risk of reconviction: Statistical models which
predict four types of re-offending. Christchurch, New Zealand: Department of Corrections.
Beasley, J. O. (2004). Serial murder in America: Case studies of seven offenders. Behavioral
Sciences & the Law, 22, 395-414.
Bell, M. (1995). Bell Object Relations and Reality Testing Inventory (BORRTI) manual. Los
Angeles: Western Psychological Services.
Bender, L. (1946). Instruction for the use of the Visual Motor Gestalt Test. New York: American
Orthopsychiatry Association.
Blair, J., Mitchell, D., & Blair, K. (2005). The psychopath: Emotion and brain. Oxford, UK:
Blackwell.
Boyd, A. R. (2003). Psychopathy and sex offender treatment: PCL-R total and factor scores
and their relation to treatment completion and admission of offense behavior. Dissertation
Abstracts International: Section B. Sciences and Engineering, 64(5-B), 2379.
Brittain, R. (1970). The sadistic murderer. Medical Science and the Law, 10, 198-207.
Brody, Y., & Rosenfeld, B. (2002). Object relations in criminal psychopaths. International
Journal of Offender Therapy and Comparative Criminology, 46, 400-411.
Brown, B. M. (1996). An examination of severe psychopathy in a female offender. Dissertation
Abstracts International. (UMI No. 9706012)
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 367
Bruce-Jones, W., & Coid, J. (1992). Identity diffusion presenting as multiple personality disor-
der in a female psychopath. British Journal of Psychiatry, 160, 541-544.
Bruno, A. (n.d.). All about Hannibal Lecter. Facts and fiction. Retrieved from http://www.trutv
.com/library/crime/serial_killers/weird/lecter/1.html
Butcher, J., Dahlstrom, W., Graham, J., Tellegen, A., & Kaemmer, B. (1989). MMPI-2 manual
for administration and scoring. Minneapolis: University of Minnesota.
Cleckley, H. M. (1988). The mask of sanity: An attempt to clarify some issues about the so-
called psychopathic personality (5th ed.). St. Louis, MO: Mosby.
Cook, D., Michie, C., Hart, S. D., & Clark, D. (2005). Searching for the pan-cultural core of
psychopathic personality disorder. Personality and Individual Differences, 39, 283-295.
Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabulary Test-Revised. Circle Pines,
MN: American Guidance Service.
Exner, J. E. (1990). The Rorschach: A comprehensive system. Volume 2: Interpretation (2nd ed.).
New York: Wiley.
Exner. J. E. (1993). The Rorschach: A comprehensive system. Volume 1: Basic foundations
(3rd ed.). New York: John Wiley and Sons.
Cramer, P. (1991). The development of defense mechanisms: Theory, research, and assessment.
New York: Springer-Verlag.
Frodi, A., Dernevik, M., Sepa, A., Philipson, J., & Bragesjø, M. (2001). Current attachment
representations of incarcerated offenders varying in degree of psychopathy. Attachment and
Human Development, 3, 269-283.
Gacono, C. B. (1990). An empirical study of object relations and defensive operations in antiso-
cial personality disorder. Journal of Personality Assessment, 54, 589-600.
Gacono, C. B. (1992). Sexual homicide and the Rorschach: A Rorschach case study of sexual
homicide. British Journal of Projective Psychology, 37, 1-21.
Gacono, C. B., & Meloy, J. R. (1992). The Rorschach and the DSM-III-R antisocial personality:
A tribute to Robert Lindner. Journal of Clinical Psychology, 48, 393-406.
Gacono, C. B., Meloy, J. R., & Berg, J. L. (1992). Object relations, defensive operations, and
affective states on narcissistic, borderline, and antisocial personality disorder. Journal of
Personality Assessment, 59, 32-49.
Gacono, C. B., Nieberding, R. J., Owen, A., Rubel, J., & Bodholdt, R. (1997). Treating conduct
disorder, antisocial, and psychopathic personalities. In J. Ashford, B. D. Sales, & W. H. Reid
(Eds.), Treating adult and juvenile offenders with special needs (pp. 99-129). Washington,
DC: American Psychology Association.
Goodwin, R. D., & Hamilton, S. P. (2003). Lifetime comorbidity of antisocial personality disor-
der and anxiety disorders among adults in the community. Psychiatry Research, 117, 159-166.
Gregory, B. (2002). Hannibal Lecter: The honey in the lion’s mouth. American Journal of Psy-
chotherapy, 56, 100-114.
Hale, L. R., Goldstein, D. S., Abramowitz, C. S., Calamari, J. E., & Kosson, D. S. (2004). Psy-
chopathy is related to negative affectivity but not to anxiety sensitivity. Behaviour Research
and Therapy, 42, 697-710.
Halleck, S. (2001). Psychopathy, freedom and criminal behavior. In J. R. Meloy (Ed.), The mark
of Cain: Psychoanalytic insight and the psychopath. Hillsdale, NJ: The Analytic Press.
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
368 International Journal of Offender Therapy and Comparative Criminology 55(3)
Hare, R. D. (2003). Manual for the Revised Psychopathy Check List (2nd ed.). Toronto, Ontario,
Canada: Multi-Health Systems.
Harpur, T. J., Hare, R. D., & Hakstian, A. R. (1989). Two-factor conceptualization of psy-
chopathy: Construct validity and assessment implications. Psychological Assessment, 1,
6-17.
Harris, G., Rice, M., & Cormier, C. (1991). An evaluation of a maximum security therapeu-
tic community for psychopaths and other mentally disordered offenders. Law and Human
Behavior, 16, 399-412.
Harris, T. (1981). Red dragon. New York: Penguin Putnam.
Harris, T. (1988). The silence of the lambs. New York: St. Martin’s.
Harris, T. (1999). Hannibal. New York: Delacorte.
Harris, T. (2006). Hannibal rising. New York, NY: Delacorte.
Hart, S. D., Cox, D. N., & Hare, R. D. (1995). The Hare Psychopathy Checklist Screening
Version (PCL:SV). New York: Multi-Health Systems.
Hartmann, E., Nørbech, P. B., & Grønnerød, C. (2006). Psychopathic and non-psychopathic
violent offenders on the Rorschach: Discriminative features and comparisons with schizo-
phrenic inpatient and university student samples. Journal of Personality Assessment, 86,
291-305.
Hughes, D. A. (2006). Building the bonds of attachment: Awakening love in deeply troubled
children. Lanham, MD: Jason Aronson.
Leach, G., & Meloy, J. R. (1999). Serial murders of six victims by an African-American male.
Journal of Forensic Sciences, 44, 1073-1078.
Meloy, J. R. (1998). The psychopathic mind: Origins, dynamics, and treatment. Lanham, MD:
Rowman & Littlefield.
Meloy, J. R. (2001). Introduction to section 1. In Meloy, R. (Ed.). The mark of Cain. Psycho-
analytic insight and the psychopath (pp. 3-24). New York: The Analytic Press/Taylor &
Francis Group.
Meloy, J. R. (2002). Violent attachments. Lanham, MD: Rowman & Littlefield.
Meloy, J. R., & Gacono, C. B. (1998). The internal world of the psychopath. In T. Millon,
E. Simonsen, M. Birket-Smith, & R. D. Davis (Eds.), Psychopathy: Antisocial, criminal,
and violent behavior (pp. 95-109). New York: Guilford.
Merriam-Webster’s Online Dictionary. (n.d.). Retrieved from http://www.merriam-webster
.com/dictionary/pain http://www.merriam-webster.com/dictionary/vulnerability
Millon, T. (1994). Millon Clinical Multiaxial Inventory-III manual. National Computer Sys-
tems, Inc.
Myers, W. C., Gooch, E., & Meloy, J. R. (2005). The role of psychopathy and sexuality in a
female serial killer. Journal of Forensic Sciences, 50, 652-657.
Patrick, C., & Zempolich, K. A. (1998). Emotion and aggression in the psychopathic personal-
ity. Aggression and Violent Behavior, 3, 303-338.
Popper, K. (1963). Conjectures and refutations. London, UK: Routledge.
Porcerelli, J. H., Abramsky, M. F., Hibbard, S., & Kamoo, R. (2001). Object relations and
defense mechanisms of a psychopathic serial sexual homicide perpetrator: A TAT analysis.
Journal of Personality Assessment, 77, 87-104.
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
Gullhaugen and Nøttestad 369
Reid, W. H. (1986). Introduction: Assaulting the mask. In W. H. Reid, D. Dorr, J. I. Walker,
& J. W. Bonner III (Eds.), Unmasking the psychopath: Antisocial personality and related
syndromes (pp. 159-190). New York: Norton.
Roberts, B. W., & DelVecchio, W. F. (2000). The rank-order consistency of personality traits
from childhood to old age: A quantitative review of longitudinal studies. Psychological Bul-
letin, 126, 3-25.
Salekin, R. (2002). Psychopathy and therapeutic pessimism: Clinical lore or clinical reality.
Clinical Psychology Review, 22, 79-112.
Schrum, C. L., & Salekin, R. T. (2006). Psychopathy in adolescent female offenders: An item
response theory analysis of the Psychopathy Checklist: Youth Version. Behavioral Sciences
& the Law, 24, 39-63.
Sexton, D. (2001). The strange world of Thomas Harris: Inside the mind of the creator of Han-
nibal Lecter. London, UK: Faber & Faber.
Shipley, W. C. (1940). A self-administering schedule of measuring intellectual impairment and
deterioration. Journal of Psychology, 9, 371-377.
Stanford, M. S., Houston, R. J., & Barrat, E. S. (1997). Psychophysiological correlates of
psychopathic disorders. In A. R. Felthous & H. Sass (Eds.), International handbook on
psychopathic disorders and the law (Vol. 1., pp. 83-102). West Sussex, UK: Wiley.
St. Claire, M. (2000). Object relations and self-psychology: An introduction (3rd ed.). Pacific
Grove, CA: Brooks/Cole.
Strasburger, L. H. (1986). Treatment of antisocial syndromes: The therapist’s feelings. In
W. H. Reid, D. Dorr, J. I. Walker, & J. W. Bonner III (Eds.), Unmasking the psychopath:
Antisocial personality and related syndromes (pp. 191-207). New York: Norton.
Trevarthen, C., & Aitken, K. J. (2001). Infant intersubjectivity: Research, theory and clinical
applications. Journal of Child Psychology and Psychiatry, 42, 3-48.
Webster, S. D., Douglas, K. S., Eaves, D., & Hart, S. D. (1997). HCR-20: Assessing risk for
violence. Burnaby, British Columbia: Mental Health, Law, and Policy Institute, Simon Fra-
ser University.
Wechsler, D. (1981). WAIS-R manual: Wechsler Adult Intelligence Scale-Revised. New York:
Psychological Corporation.
Weiss, J. M. A. (1987). Book reviews. Journal of Nervous and Mental Disease, 175, 246.
Westen, D., Lohr, N., Silk, K., & Kerber, K. (1989). Measuring object relations and social cog-
nition using the TAT: A scoring manual. Unpublished manuscript, University of Michigan,
Ann Arbor.
World Health Organization. (1993). International statistical classification of diseases and
related health problems (10th rev.). Geneva, Switzerland: Author.
Zachary, R. (1986). Shipley Institute of Living Scale: Revised manual. Los Angeles: Western
Psychological Services.
at NTNU - Trondheim on April 28, 2011ijo.sagepub.comDownloaded from
... The authors concluded that offenders and outpatients with personality disorders share a common borderline level of organisation characterised by primitive defence mechanisms such as splitting, denial, omnipotence/grandiosity, disavowal, rationalisation, aggressive acting out, and projection. Gullhaugen and Nøttestad (2011) carried out a systematic review of eleven published case studies of severely psychopathic offenders (PCL-R score 30 or higher) with the aim of identifying psychic vulnerability and defence mechanisms. In all cases, they found evidence for psychic vulnerability as all of them were raised in severely dysfunctional early relations (e.g. ...
... Our reliance on a semistructured interview format to generate offence narratives might have prevented the emergence of deeper unconscious anxieties and conflicts. This might explain why we did not encounter a lot of the borderline and psychotic defence level mechanisms in both psychopathic and non-psychopathic offenders (Gacono et al.,1992;Gullhaugen & Nøttestad, 2011, 2012. However, it is important to point out that this study is not a depth psychological study into the defence mechanisms that underpin psychopathic personality disorder. ...
Article
The literature on crime narratives has demonstrated the relevance of studying offenders’ personal perspectives on crime as a means to gain insight in criminal behaviour. In this exploratory study, we examine the presence of defence mechanisms in crime narratives produced by violent offenders with psychopathic traits. The Defence Mechanism Rating Scale (DMRS) is used to assess defence mechanisms in crime narratives produced by 36 male inmates. The Psychopathy Checklist-Revised (PCL-R) is used to assess psychopathic traits. Statistical analyses demonstrate the increased presence of obsessional defences (intellectualisation). The affective and lifestyle traits of psychopathy are positively associated with rationalisation. Our results indicate that psychopathic offenders tend to describe their violent crime in general and abstract terms and represent themselves as rational actors whose behaviour is normal and well-founded given the abnormal or irrational environment. We conclude that the narrative strategies deployed by offenders with psychopathic traits are characterised by defence mechanisms to deal with threats to the self.
... Hence, according to this view, psychopathy development is contingent on environmental adversity affecting a dynamical state marked by high responsiveness to result in a subsequent dynamical state marked by low responsiveness. Gullhaugen and Nøttestad (2011) sketch a theory of psychopathy based on object relations theory, which emphasizes how early interactions with caregivers serve as foundations for future relationships with others. The influence of harsh caregiving on the subsequent development of psychopathy is contingent on it occurring at an early stage in infancy, when the schemas for future relationships are still being internalized and before the sense of object constancy has been acquired. ...
... A particular role that developmental systems theory could have in advancing these therapeutic approaches is to emphasize the influence of the developmental context on the effect of any intervention. As noted earlier, parenting interventions appear to be most beneficial when implemented in early childhood, which could be explained by their effects being dependent on the developmental system's being at a stage when the schemas for future relationships are still being internalized (Gullhaugen & Nøttestad, 2011). By highlighting the context sensitivity of the developmental process, developmental systems theory can inspire more longitudinal therapeutic approaches which focus on how the developmental trajectories leading to psychopathy may be offset by interventions that make changes at particular developmental stages. ...
Article
Full-text available
Is psychopathy born or made? Contemporary psychopathy research shows that there is much wrong with this question. It is increasingly accepted that the development of psychopathy is dependent on multiple causal factors interacting with one another. However, there remains the major theoretical challenge of understanding the relations between these multiple causal factors in the developmental process. In this paper, I argue that the conventional picture of gene-environment interactionism does not offer an adequate account of psychopathy development. Instead, I propose that a theoretical framework from the philosophy of biology, namely developmental systems theory, can facilitate a better understanding of psychopathy development that captures the contingent and dynamic relations between multiple causal factors. Some practical implications of a developmental systems theory approach to psychopathy are also explored.
... The research in this area is still ongoing. It is not entirely clear what the exact causal matrices are, but there is solid evidence at this point in time that early learning, early experiences and early conditioning, as well as an array of neurochemicals, brain structure, and brain functioning, are all at play to one extent or another (Castle & Hensley, 2002;Gowin et al, 2013;Gullhaugen & Nottestad, 2011;Langevin & Curnoe, 2014;St. Clair, 2004). ...
... He explained that early and severe trauma may act as a triggering mechanism that has the effect of causing the individual to be unable to deal with stress, rejection, frustration, anger, etc. (Hickey, 2015). Other scholars have also found early relations and experiences to play a major role in violent adolescent and adult offending (DeLisi et al., 2018;Gullhaugen & Nottestad, 2011;Lyons & Martin, 2019;Ray, 2018). Although early childhood trauma and abuse is a significantly correlated factor in subsequent violent offending it is not sufficient and is not the only factor that explains why someone would go on to become a cruel and violent repeat offender (DeLisi et al., 2018;Gowin et al., 2013;Hickey, 2015). ...
... Frykt, håpløshet eller en opplevelse av å bli manipulert er vanlige reaksjoner i møte med disse menneskene (Meloy, 1988). Gruppens psykopatologi er komplisert og lite forstått (Gullhaugen & Nøttestad, 2011;Gunn, 1998;McGauley, Adshead & Sarkar 2007), og psykopatiske individer fremstiller seg ofte uten egne problemer og lidelse (Cleckley, 1976). Med PCL (Hare, 1991) fikk vi en felles standard for måling av psykopati, som åpnet for sammenligning på tvers av studier. ...
... «Dagens kliniske begrep tu es på den lidelse psykopatens kulde og hensynsløshet påfører andre framfor selvopplevde vansker hos psykopaten» Selv om det er relativt sterk faglig konsensus om de deskriptive trekkene ved psykopati (Hare & Neumann, 2008) vil vi i likhet med Salekin (2002) påpeke at feilslått behandling ikke kun skyldes psykopatens natur, men også vår manglende forståelse av underliggende mekanismer og etiologi (Brody & Rosenfeld, 2002;Gullhaugen & Nøttestad, 2011). Slik vi ser det, bidrar dagens biodeterministiske modeller til at vi distanserer oss fra denne gruppen, en distanse som paradoksalt nok beskrives som et av hovedtrekkene ved avviket (Gunn, 1988). ...
Article
Full-text available
The Dark Triad of socially aversive personality traits (narcissism, Machiavellianism, and psychopathy) may be linked with emotional deficits, including the use of less effective emotion regulation processes. In this meta-analysis, we identify 20 sources (n = 23 samples, k = 83 effect sizes, NTotal = 4,487) examining the association of the Dark Triad domains and facets with emotion regulation processes of reappraisal (thought to be effective) and expressive suppression (thought to be ineffective). In line with our hypotheses, we found that both primary and secondary psychopathy were significantly associated with lower use of reappraisal (ρ = -.18 and -.29 respectively, k = 3 to 4), and higher use of expressive suppression (ρ = .23 and .19 respectively, k = 9 to 10). There were no significant associations of either regulation process with Machiavellianism, total narcissism, or grandiose narcissism. However, vulnerable narcissism was significantly associated with higher use of expressive suppression (ρ = .37, k = 2), as hypothesized. Results are discussed in relation to how they may inform our understanding of the emotional deficits of the dark triad, and we emphasize the importance of considering dark personality at the facet rather than the domain level.
Presentation
Full-text available
Emotions, and the ability to regulate emotions play an important part of daily functioning but the way these emotions are regulated tends to differ between individuals. While there is a substantial literature investigating the relationship between emotion regulation and standard personality models, there is limited literature examining emotion regulation in the darker personality traits. The dark triad is a set of socially aversive personality traits comprising narcissism, psychopathy, and Machiavellianism. To clarify the state of existing literature the purpose of this meta-analysis was to examine the relationship, and the extent of the relationship between reappraisal, suppression, and the dark triad. A total of 2953 participants with a mean age of 23.65 were included across 14 studies. Primary, secondary and total psychopathy were positively related to suppression, but not reappraisal. Grandiose narcissism was positively related to reappraisal (n.s.) but not suppression. There was only one study including Machiavellianism in this meta-analysis which reported a positive relationship between Machiavellianism and reappraisal. Three studies reporting the relationship between Machiavellianism and suppression was more complex. Overall these meta-analytic findings highlight the necessity for additional research in this area to enable examination of the underlying emotional mechanisms of the dark triad personality traits.
Article
This paper looks at violence and sadism in child and adolescent patients. Psychoanalytic and developmental ideas are brought together to make sense of these children’s presentations and the clinical challenges of therapeutic work with them. Differences are outlined between cold and hotter forms of aggression. The contribution of Glasser and his concept of the core complex is central to the paper, as is an understanding of addictive processes often seen in aggression, including sexual aggression.
Chapter
The chapter examines psychopathy and its relation to the criminal justice system. The chapter argues that psychopathy explains the generally poor responsiveness to correctional treatment and punishment displayed by serious offenders. A general rule of thumb is that 70 percent of prisoners will be re-incarcerated within three years of release; thus for serious offenders, the criminal career is characterized by a revolving door of criminal justice system involvement. This is particularly true among psychopathic offenders who display aberrant fear conditioning which contributes to deficits in learning from punishment. The affective displays of psychopathic offenders, especially the remorselessness and failure to acknowledge responsibility for their crimes, are also examined. The state of the treatment literature and psychopathy is also examined.
Article
\textquotedblleft{}There could be no fairer destiny for any. . . theory than that it should point the way to a more comprehensive theory in which it lives on, as a limiting case.\textquotedblright ALBERT EINSTEIN..
Article
It is a widely held belief that psychopathic individuals are extremely difficult to treat, if not immune to treatment. This therapeutic pessimism is pervasive and undermines motivation to search for effective modes of intervention for psychopathic individuals. A review of 42 treatment studies on psychopathy revealed that there is little scientific basis for the belief that psychopathy is an untreatable disorder. Three significant problems with regard to the research on the psychopathy–treatment relation cast doubt on strident conclusions that deem the disorder untreatable. First, there is considerable disagreement as to the defining characteristics of psychopathy. Second, the etiology of psychopathy is not well understood. Third, there are relatively few empirical investigations of the psychopathy–treatment relationship and even fewer efforts that follow up psychopathic individuals after treatment. Psychologists are encouraged to investigate the psychopathy–treatment relation from multiple perspectives as well as to conduct long-term follow-up studies to establish a modern view of the psychopathy–treatment relation.