Self-esteem and styles of coping with stress versus strategies of

planning in people with psychopathic personality disorders

Beata Pastwa-Wojciechowska,A,B,C,D,E,F,G Maria KaŸmierczak,A,B,C,D,E,F,G and Magdalena BłażekA,B,C,D,E,F,G

Author information ► Article notes ► Copyright and License information ►

Summary

Go to:

Background

Due to its multitude of meaning and diversity of description in psychiatric and psychological
literature the notion of psychopathy has become one of the most controversial and the subject
of numerous scientific and clinical studies [1]. Analysing global reports in literature, as well
as clinical and forensic practice, it may be noticed that both DSM (Diagnostic and Statistical
Manual of Mental Disorders), and ICD (International Classification of Diseases) suggest
different terminology and diagnostic criteria to determine the personality types commonly
presumed to be identical in clinical practice (antisocial, dissocial, sociopathic and
psychopathic personality). Blackburn [1] believes that psychopathy is close, by definition, to
several other personality disorders as described in DSM. It is underlined that both
discrepancies in the terminology and conceptualisation of these personality types result to a
great extent from the difference of models they are described in. The medical model prefers a
taxonomic approach, while the psychological model emphasises the psychopathology of
adjustment mechanisms and mechanisms of mental regulation [2–9].

Contrary to the trend prevalent in the Polish literature on the subject to use modern
terminology recommended by diagnostic books, both DSM and ICD, in this paper we will use
the notion of psychopathy understood according to the concept of Robert D. Hare [3,4]. The
operational definition of psychopathy by Robert D. Hare [3,4] is to a great extent identified
with the scale used to measure this type of personality, which is the Psychopathy Checklist-
Revision (PCL-R), allowing for the measurement of two factors, each described by 10 items.
Thus, Factor 1 describes a constellation of psychopathic traits considered by many clinicians
to be basic for this type of personality, that is, factors concerning the interpersonal, emotional
and verbal style of functioning [1) Glibness and superficial charm, 2) Grandiose sense of self-
worth, 3) Need for stimulation and increased susceptibility to boredom, 4) Pathological lying,
5) Conning/manipulative, 6) Lack of remorse or guilt, 7) Shallow affect, 8) Callousness and
lack of empathy, 9) Parasitic lifestyle, 10) Poor behavioural controls]. This factor correlates
positively with clinical determinants of psychopathy, especially with narcissistic and
histrionic personality disorders and measures of Machiavellianism. On the other hand, it
correlates negatively with the measures of empathy and fear. Factor 2 describes types of
behaviour indicating impulsiveness, lack of stability and antisocial lifestyle [11) Promiscuous
sexual behaviour, 12) Early behaviour problems, 13) Lack of realistic, long-term goals, 14)
Impulsivity, 15) Irresponsibility, recklessness, 16) Failure to accept responsibility for one’s
own actions, 17) Many, short-term relationships, 18) Juvenile delinquency, 19) Revocation of
conditional release, 20) Criminal versatility]. Variables contained in this factor correlate with
the criteria of antisocial personality disorders [3,4]. Walters and Duncan [10] concluded that
Factor 2 was a stronger determinant of recidivism than was Factor 1. Furthermore, Factor 2
and PCL-R total score were linked to disciplinary problems amongst inmates [11]. Studies on
the factor structure of psychopathy prove that the isolated factors can be related to individual
types of control; in other words some researchers [8,12,13,15] refer to the notion of control
processes, while analysing the factor structure. Thus, the affective factor is related to
emotional control, the behavioural factor to behavioural control, and the interpersonal factor,
including cognitive functioning, to cognitive control. It is assumed that control processes
concerning various areas of human behaviour aim at directing and optimising the purposeful
activity, as all purposeful actions of a person may be a source of information needs, which in
turn remain strictly related to other types of needs, conditioning the performance of co-
dependent goals. A failure to fulfil the needs (standards of regulation) leads to a disturbed
functioning of personality, inhibition of its development and even disintegration [7].
Moreover, all types of incoherence and conflict are sources of mental discomfort, which
motivates people to reduce them. In the case of psychopathic personality disorders it turns out
that both the orientation and ability to act purposefully may be disturbed [8,14], which results
from “the inhibition of development of personality as a system” (7, p.123). In other words, the
inhibition of personality development reveals itself mostly in a low level of system structure
development, especially cognitive structures, which is reflected in the incorrect functioning of
the system. Due to that an analysis of personality disorders must be at the same time a
structural (internal) and functional (external) description. Undoubtedly in psychopathic
personality disorders we are dealing with an underdevelopment of cognitive structures, which
results in the continuing functional dominance of emotional mechanisms [3,4,8,16,17]. The
abovementioned theses are confirmed in numerous studies. Roberts and Coid [18] found that
psychopathy is associated with criminal acts committed early in life as well as with the history
of imprisonment amongst male and female offenders. Mokros et al. [19] emphasize that
callousness/lack of empathy (emotional dysfunctions in general) is a psychopathic
characteristic that is closely connected with sexually sadistic disorders. Vess, Murphy and
Arkowitz [20] found that sexually violent predators – rapists are often psychopathic (almost
50% of the examined group of offenders), in contrary to child molesters. Putkonen et al. [21]
explored psychopathy amongst murderers of children. They conclude that this group obtain
lower psychopathy scores than other murderers. However, they display problems with
expressing emotions, which in PCL-R are described by such characteristics as lack of remorse
and empathy, shallow affect, problems with behavioural control or an accepting of
responsibility. Lee, Klaver and Hart [22] compared psychopathic and non-psychopathic
offenders in their tendency to lie. Their research indicate that psychopathic offenders provide
more details when they tell a false story comparing to the non-psychopathic ones (with no
differences between groups when offenders tell the truth). What is interesting, psychopaths
told less coherent stories, which were spontaneously corrected when lying. They were not
viewed as credible when telling their stories. Therefore, Lee et al. [22] believe that
psychopathic behavioural style (indicating confidence) as well as detailed narratives make
them effective in deception. Porter and Woodworth [23] add that psychopathic murderers
have a greater tendency than non-psychopaths to emphasize the reactivity (impulsivity, lack
of planning) of their acts. However, homicides perpetuated by psychopaths are usually
instrumental (intentional).

In looking for elements of psychopathic personality determining the functioning of these

people, it is necessary to consider the notion of self-esteem as one of the elements of an ego
structure which is fairly stable. Also R.D. Hare, S.D. Hart and T.J. Harpur [24] in performing
a theoretical, empirical and clinical analysis of the notion of psychopathy noticed that one out
of the ten most diagnostic traits of such a personality is inadequate and grandiose self-esteem.
Thus the authors not only noticed the importance of self-esteem, but also emphasised its
influence on the functioning of psychopaths. It is underlined that psychopathic people have a
great need to maintain their high self-esteem, which determines their level of activity and
experienced emotions. Thus it can be concluded that in the affective aspect self-esteem
reflects the level of experiencing emotions and managing them, and therefore can be related to
styles of stress (emotion) management. The affective (emotional) aspect may be two-fold:
positive (we react with positive emotions to what we do, say and are) and negative (we react
with negative emotions to ourselves). Studies on correlates of self-esteem show that high
(meaning more positive) self-esteem is accompanied by other variables, including undertaking
various activities, and their related efficacy and undertaking more effective (more adaptive)
ways of handling stress. In the aspect of person’s activity, higher self-esteem will be related to
a high general feeling of one’s own efficacy, and in consequence – control over one’s own
actions. Thus beliefs concerning efficacy influence the evaluation of one’s own resources in a
stressful situation [25].

The aim of the study

Considering the data from the literature presented above we decided to form and empirically
verify a hypothesis that people with psychopathic personality disorders are characterised by
high self-esteem, unconstructive strategies of planning actions and non-adaptive styles of
coping with stress.

Go to:

Material and Methods

Study participants

The group of participants included 30 people at the age of 22–36 convicted with a legally
binding sentence. Moreover, all participants had to fulfil the following clinical criteria: a) be
diagnosed by a psychiatrist with dissocial, asocial, psychopathic or sociopathic personality
disorders and b) obtain a result in the PCL-R test equal or higher than 30. The tests were
consented to by all participants, as well as the directors of the prison that they were in.
Method

The following psychological study methods were used in the studies:

 1. The Psychopathy Checklist-Revision (PCL-R) by Hare in the Polish adaptation by

Pastwa-Wojciechowska.

PCL-R (3) is commonly accepted as the most powerful instrument to detect and
measure psychopathy, and there is a wide consensus that, for the moment, there is no
other procedure that can be so accurate and so well-correlated with antisocial
variables. PCL-R encompasses a unidimensional measure of the disorder with two
correlated factors, one related to personality traits and the other portraying an
antisocial lifestyle. Items are scored from 0 (the characteristic is not present) to 1
(some features are present but not the whole description) and 2 (the characteristic is
fully present), through the combination of the results of a long semi-structured
interview with file consultation in different institutional sources. According to Hare
(1991), total scores can be divided into three groups: less than 20: non-psychopaths;
20–29 mild psychopaths, and 30 or more: psychopaths.

 2. Antisocial Personality Questionnaire, APQ by Blackburn and Fawcett in the Polish

adaptation by Pastwa-Wojciechowska.

APQ is a 125-item multi-trait, self-report inventory which measures cognitive,

affective and behavioural dispositions of relevance to antisocial population. Eight
factors extracted were identified as Self-Control, Self-Esteem, Avoidance, Paranoid
Suspicion, Resentment, Aggression, Deviance and Extraversion. Short scales
constructed to measure these have a satisfactory reliability (α), and correlations with
measures of personality disorder, observer ratings of interpersonal style, and criminal
career data supporting their construct validity. Scale intercorrelations yield two higher-
order dimensions of hostile impulsivity and social withdrawal that reflect orientations
towards others and the self, respectively. The APQ provides comprehensive coverage
of the deviant traits implicated in personality disorder and antisocial behaviour [26].

Coping Inventory for Stressful Situations (CISS) by Endler and Parker in the Polish
adaptation by Szczepanik, Wrześniewski and Strelau [27].

CISS is comprised of 48 items, which describe various behaviours in stressful

situations. Participants answered on a scale which reflects the frequency of behaviours
displayed in difficult, stressful situations. The questionnaire has three dimensions:
SSZ – Task-oriented coping; SSE – Emotion-oriented coping; SSU – Avoidance
coping (which includes: ACZ – Distraction and PKT – Social Diversion).

 4. Generalised Self- Efficacy Scale, GSES by Schwarzer et al. in the Polish adaptation
by Schwarzer, Jerusalem, and Juczyński [25].
 GSES is composed of 10 items. The scale is unidemensional. GSES measures the
general self-efficacy regarding coping in difficult situations and dealing with
obstacles.

Go to:

Results

First of all we would like to present the results of participants in the PCL-R scale, describing
the intensity of psychopathic traits (Table 1). All participants obtained 30 points in the test,
which according to the concept of Robert D. Hare (1991) means a diagnosis of psychopathy.
In Factor 1 participants obtained on average 17.17 (out of 20) points, and in Factor 21 – 3.82
points, which means that Factor 1 (describing the constellation of psychopathic personality
traits) was dominant over Factor 2 (describing antisocial behaviour).

Table 1
Average results in the PCL-R test of participants with psychopathic personality disorders.

The variable identified with self-esteem in the PCL-R test is item 2 – a grandiose sense of
self-worth. According to the rules of administering the scale, a participant can obtain a
maximum of 2 points for the item. Participants obtained an average result of 1.83 points
(Table 2) for this item.

Table 2
Average result for item 2 in factor 1 in the PCL-R test in the studied group.

Then the structure of personality of the participants was described by means of the Antisocial
Personality Questionnaire (APQ), which allows not only for a diagnosis, but also describes
the functioning of participants in the dimension of behaviour control and social functioning
(dominance – submission and hostility – affiliation). The participants obtained high levels in
scales reflecting the emotional style of functioning, which is visible in Factor 1
(Impulsiveness). The obtained results are presented in Table 3.
Table 3
Average results in the Antisocial Personality Questionnaire (APQ).

In the Generalised Self- Efficacy Scale (GSES) participants obtained an average result of
35.83 points, which indicates a high level of self-efficacy (Table 4).

Table 4
Average result in the Generalised Self-Efficacy Scale (GSES).

Relating the PCL-R scale results to the efficacy of the actions of psychopaths (Table 5) it can
be observed that they are characterised by a lack of realistic goals (item 13), irresponsibility,
recklessness (item 15) and a lack of responsibility for undertaken actions (item 16).

Table 5
Average result for items 13, 15 and 16 in factor 2 in the PCL-R test in the studied group.

An analysis of the average results obtained by the participants in the Coping Inventory of
Stressful Situations revealed the dominance of style focused on emotions and avoidance,
especially distraction (Table 6).

Table 6
Average results in the coping inventory for stressful situations in the studied group.

In the PCL-R scale (Table 7) the analysis covered such variables as shallow affect (item 7)
and poor behavioural control (item 10), which describe the style of the emotional functioning
of participants.

Table 7
Average result for items 7 and 10 in Factor 1 in the PCL-R test in the studied group.

Go to:
Discussion

The paper is based on the psychopathy concept of Hare [3], thus this author’s scale was used
to study the discussed variable (The Psychopathy Checklist-Revision PCL-R). Hare assumes
that we are dealing with the dimension of psychopathy, from the lack of psychopathic traits
(result 0–9) through insignificant symptoms (result 10–19), and moderate symptoms (result
20–29) to psychopathy itself (result 30–40). The obtained results unequivocally indicate that
according to the scale’s assumptions the participants should be diagnosed as psychopaths.
Moreover, the factor analysis of the scale (dominance of Factor 1 above 2) additionally
confirms such a diagnosis. Then, in considering the analysis of individual scale items, it was
noticed that participants reveal a grandiose sense of self-worth, and in consequence, act to
support it at any price, especially devaluating other people. Such an approach is compliant
with literature data on the subject, which is found in the opinions of such authors as Hare
[3,4], Cooke et al. [28], Pospiszyl [6], Pastwa-Wojciechowska [8], Millon, Davis [9]. The
Antisocial Personality Questionnaire revealed a decreased estimation of self in psychopaths
with increased self-control, and indicated an impulsive style of functioning. Based on the
analysis of results of the APQ questionnaire we can diagnose the participants as primary
psychopaths, thus confirming the PCL-R diagnosis. According to Blackburn [12] primary
psychopaths are characterised by high extraversion and dominance (scales of extraversion and
avoidance), aggressiveness and impulsiveness (scales of aggression and self-control),
suspicion (scale of resentment), they have earlier had experiences related to the violation of
legal norms (deviance scale) and do not reveal anxiety and self-criticism (self-esteem scale).

The result in the Generalised Self-Efficacy Scale showed that psychopaths consider
themselves as people of high efficacy; however, an analysis of the PCL-R test indicated that
their activities are characterised by the lack of realistic goals, irresponsibility, recklessness
and lack of responsibility for undertaken actions. In other words, psychopaths consider
themselves to be effective, but it rather seems to be a defence mechanism, which aims at the
maintenance of high self-esteem. In reality psychopaths cannot set goals that they could fully
implement in a responsible manner [3,4,6,8].

The stress coping style as a constant disposition of a person to cope with stressful situations in
a certain manner showed that psychopaths prefer a style focused on emotions and avoidance.
On one hand, in stressful situations psychopaths show a tendency to concentrate on
themselves, especially their own experiences, such as anger and a tendency for wishful
thinking and dreaming; on the other they avoid thinking, feeling and experiencing stressful
situations. This result may seem contradictory. It is well documented in the subject literature
that psychopaths are egocentric, focused on their own experiences, and react with aggression
to any obstacles and frustration [3–6,8]. Avoiding confrontation with reality, they use their
fantasy, which sometimes takes the form of pseudologia fantastica (pathological lying). Such
a process resembles the phenomenon of egocentric deviation in the empathising described by
Hoffman [29]. A person experiences emotions in response to the observed discomfort of
others, but starts focusing on their own experiences and the emphatic process is discontinued
[cf. 30]. The disturbed effective empathising, as well as incoherent, non-adaptive reactions to
stress among psychopaths may be related to the emotional dysfunctions characterising this
group mentioned in the theoretical part [cf. 8]. This problem is undoubtedly worthy of further
analysis.

Go to:

Conclusions

As a result of the conducted studies we formulated the following conclusions concerning

people with psychopathic personality structure:

1. They are characterised by high self-esteem.

2. They show unconstructive strategies of activity planning: lack of realistic goals,
irresponsibility, recklessness.
3. They have high self-efficacy.
4. In the area of self-regulation related to coping with stress, they use mostly a style
focused on emotions and avoidance.

Go to:

Footnotes
Source of support: Departmental sources

Go to:

References
1. Blackburn R. Personality disorder and psychopathy: conceptual and empirical
integration. Psychology, Crime & Law. 2007;13(1):7–18.

2. Hare RD. Psychopathy: Theory and Research. New York: Willey; 1970.

3. Hare RD. The Hare Psychopathy Checklist-Revised Manual. Toronto: Multi-Health

Systems; 1991.

4. Hare RD. Psychopathy: A clinical construct whose time has come. Criminal Justice and
Behavior.1996;23:25–54.

5. Cleckley H. The mask of sanity. 5th. St. Louis: Mosby; 1976.

6. Pospiszyl K. Psychopatia [Psychopathy] Warsaw: Wydawnictwo Żak; 1985/2000. [in

Polish]

7. Jakubik A. Zaburzenia osobowości [Personalisty disorders] Warsaw: Wydawnictwo

Lekarskie PZWL; 1997. [in Polish]

8. Pastwa-Wojciechowska B. Naruszanie norm prawnych w psychopatii. Analiza

kryminologiczno-psychologiczna. [Psychopathy and lawbreaking. Criminological and
psychological analysis]. Gdańsk: Wydawnictwo Uniwersytetu Gdańskiego; 2004. [in Polish]
9. Millon T, Davis R. Zaburzenia osobowości we współczesnym świecie. [Personality
disorders in modern life]. Warsaw: Instytut Psychologii Zdrowia; 2005. [in Polish]

10. Walters GD, Duncan SA. Use of the PCL-R and PAI to predict release outcome in
inmates undergoing forensic evaluation. The Journal of Forensic Psychiatry &
Psychology. 2005;16(3):459–76.

11. Walters GD, Duncan SA, Geyer MD. Predicting disciplinary adjustment in inmates
undergoing forensic evaluation: a direct comparison of the PCL-R and the PAI. The Journal
of Forensic Psychiatry & Psychology. 2003;14(2):382–93.

12. Blackburn R. Psychopathy and personality disorder: Implications of interpersonal theory.

In: Cooke DJ, Forth AE, Hare RD, editors. Psychopathy: Theory, research, and implications
for society. Dordrecht, The Netherlands: Kluwer; 1998. pp. 269–301.

13. Hare RD. Psychopathy: A clinical of forensic overview. Psychiatr Clin North
Am. 2006;29(3):709–24.[PubMed]

14. Pastwa-Wojciechowska B. Psychopathy and Gender Differences. From Norm to

Pathology. In: Chybicka A, KaŸmierczak M, editors. Appreciating diversity – gender and
cultural issues. Kraków: Oficyna Wydawnicza Impuls; 2008. pp. 381–414.

15. Serin RC, Brown ShL. Social cognition in Psychopaths: Implications for Offender
Assessment and Treatment. In: McMurran M, McGuire J, editors. Social problem solving and
offending: Evidence, evaluation and evolution. New York, NY, US: John Willey and Sons
Ltd; 2005. pp. 249–64.

16. Baumeister RF, Heatherton TF, Tice DM. Utrata kontroli. Jak i dlaczego tracimy zdolność
samoregulacji. [Losing Control: How and Why People Fail at Self-Regulation]. Warsaw:
Państwowa Agencja Rozwiązywania Problemów Alkoholowych; 2000. [in Polish]

17. Blair J, Mitchell D, Blair K. The Psychopath Emotion and the brain. Blackwell
Publishing; 2005.

18. Roberts ADL, Coid JW. Psychopathy and offending behaviour: findings from the national
survey of prisoners in England and Wales. The Journal of Forensic Psychiatry &
Psychology. 2007;18(1):23–43.

19. Mokros A, Osterheider M, Hucker SJ, Nitschke J. Law and Human Behavior, Online
First™. Apr 15, 2010. Psychopathy and sexual sadism.

20. Vess J, Murphy C, Arkowitz S. Clinical and demographic differences between sexually
violent predators and other commitment types in a state forensic hospital. J of Forensic
Psychiatry & Psychology.2004;15(4):669–81.

21. Putkonen H, Weizmann-Henelius G, Lindberg N, et al. Differences between homicide and

filicide offenders; results of a nationwide register-based case-control study. BMC
Psychiatry. 2009;9(1):1–8.[PMC free article] [PubMed]
22. Lee Z, Klaver JR, Hart SD. Psychopathy and verbal indicators of deception in
offenders. Psychology, Crime & Law. 2008;14(1):73–84.

23. Porter S, Woodworth M. A Comparison of The Official and Self-Reported Homicide

Descriptions of Psychopaths and Non- Psychopaths Law Hum Behav. 2006;31(1):91–
107. [PubMed]

24. Hare RD, Hart SD, Harpur TJ. Psychopathy and the DSM-IV criteria for antisocial
personality disorder.J AbnormPsychol. 1991;100(3):391–98. [PubMed]

25. Juczyński Z. Skala Uogólnionej Własnej Skuteczności. In: Juczynski Z, editor. Narzędzia
Pomiaru w promocji i psychologii zdrowia. [Methods of psychological measurement in
promotion and health psychology]. Warsaw: Pracownia Testów Psychologicznych PTP; 2001.
pp. 93–98. [in Polish]

26. Blackburn R, Fawcett DJ. Manual for the Antisocial Personality Questionnaire
(APQ) University of Liverpool; 1996. Unpublished Manuscript.

27. Strelau J, Jaworowska A, Wrześniewski K, Szczepaniak P. CISS Kwestionariusz

Radzenia Sobie w Sytuacjach Stresowych. [CISS Coping Inventory for Stressful Situations].
Warsaw: Pracownia Testów Psychologicznych PTP; 2005. [in Polish]

28. Cooke DJ, Forth AE, Hare RD. Psychopathy: Theory, research and implication for
society. Dordrecht: Kluwer; 1998.

29. Hoffman ML. Empathy and moral development Implications for caring and
justice. Cambridge University Press; New York: 2003.

30. KaŸmierczak M. Oblicza Empatii w Relacjach Małżeńskich. Perspektywa

Psychologiczna. [Faces of empathy in marriage. Psychological perspective]. Gdańsk: Wyd.
UG; 2008. [in Polish]

Articles from Medical Science Monitor : International Medical Journal of Experimental and Clinical
Researchare provided here courtesy of International Scientific Literature, Inc.