Psychological Trauma: Theory, Research, Practice, and Policy 2015, Vol. 7, No. 4, 340 –347

© 2014 American Psychological Association 1942-9681/15/$12.00 http://dx.doi.org/10.1037/tra0000023

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Abuse in Childhood and Psychopathic Traits in a Sample of Violent Offenders Adriano Schimmenti

Giovanbattista Di Carlo

UKE – Kore University of Enna

University of Palermo

Alessia Passanisi

Vincenzo Caretti

UKE – Kore University of Enna

University of Palermo

A significant body of research underlines the link between the exposure to abuse in childhood and subsequent criminal behaviors. Research on the role played by childhood interpersonal trauma in the development of psychopathy, however, is still scant. The aim of this study was to explore the relationship between childhood experiences of abuse and psychopathic traits in a group of violent offenders from Italy. Seventy-eight inmates who were convicted of violent crimes participated in this study. Participants were administered the Traumatic Experience Checklist to assess childhood experiences of emotional, physical, and sexual abuse, and the Hare Psychopathy Checklist-Revised (PCL-R) to assess psychopathic traits. Almost two thirds of the participants reported either emotional, physical, or sexual abuse in childhood, with 17% having experienced all 3 types of abuse investigated in this study. Emotional abuse resulted in a positive predictor of PCL-R total scores and its Interpersonal-Affective and LifestyleAntisocial factors. This suggests that emotional abuse in childhood, in combination with neurobiological and temperamental vulnerabilities, can foster the development of psychopathic traits. Keywords: child abuse, emotional abuse, psychopathy, violent behavior, PCL-R

Lilienfeld, and Cale (2003; see also Poythress & Skeem, 2006) have proposed that the negative interpersonal and affective features of psychopathy might result from inborn vulnerabilities, whereas the antisocial lifestyle embedded in psychopathy might be more under the influence of environmental risk factors like childhood victimization, especially parental abuse and neglect. In fact, several studies have indicated that child abuse and neglect are associated with later antisocial behavior (e.g., Jaffee, Caspi, Moffitt, & Taylor, 2004; Lahey, Moffitt, & Caspi, 2003; Lang, af Klinteberg, & Alm, 2002; Margolin & Gordis, 2000), whereas the interpersonal and affective facets of psychopathy have been linked to genetic vulnerabilities (e.g., Blair, Peschardt, Budhani, Mitchell, & Pine, 2006; Decety, Chen, Harenski, & Kiehl, 2013; Fowler et al., 2009). However, there is an increasing number of studies convincingly showing that child abuse could even be related to the interpersonal and affective factors embedded in psychopathy (e.g., Campbell, Porter, & Santor, 2004; Craparo, Schimmenti, & Caretti, 2013; Graham, Kimonis, Wasserman, & Kline, 2012; Lang et al., 2002; Marshall & Cooke, 1999; Schimmenti, Passanisi, Pace, et al., 2014). According to other scholars (e.g., Pridmore, Chambers, & McArthur, 2005; Viding & McCrory, 2012), we believe that findings on the relationship between child abuse and psychopathic traits could be better appreciated in the light of a gene– environment interaction perspective. Neurobiological findings are consistent with the hypothesis that child abuse may foster the development of psychopathic traits in vulnerable individuals (Fallon, 2013; Khetrapal, 2009). For example, Glaser (2000) discussed the detrimental impact of childhood experiences of abuse on the

Psychopathy is a personality disorder defined by a constellation of interpersonal, affective, and behavioral characteristics. Psychopathic individuals show specific personality traits, such as emotional detachment, deceptiveness, manipulativeness, grandiosity, shallow affects, irresponsibility, impulsivity, parasitic lifestyle, lack of empathy, guilt, or remorse, together with the ready violation of social expectations and legal norms (Hare, 1998, 2003; Hare & Neumann, 2008). The link between child abuse and psychopathy remains controversial (DiLalla & Gottesman, 1991). Skeem, Poythress, Edens,

This article was published Online First December 22, 2014. Adriano Schimmenti, Faculty of Human and Social Sciences, UKE – Kore University of Enna; Giovanbattista Di Carlo, Department of Psychology, University of Palermo; Alessia Passanisi, Faculty of Human and Social Sciences, UKE – Kore University of Enna; Vincenzo Caretti, Department of Psychology, University of Palermo. The authors are grateful to Dr. Antonella Paloscia (DAP—Dipartimento di Amministrazione Penitenziaria, Italian Ministry of Justice), and to Lt. Col. Giorgio Stefano Manzi (Arma dei Carabinieri, Italian Ministry of Defence) for authorizing the study and providing expert criminological input. Thanks are also due to Professor Roberto Catanesi and Professor Felice Francesco Carabellese (University of Bari), and to Dr. Gianfranco Rivellini and Dr. Luca Castelletti (OPG Castiglione delle Stiviere), for their valuable advice. Correspondence concerning this article should be addressed to Adriano Schimmenti, Facolta` di Scienze dell’Uomo e della Societa`, UKE—Universita` Kore di Enna, Cittadella Universitaria, 94100 Enna, Italy. E-mail: [email protected] 340

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corpus callosum, and Raine and colleagues (2003) showed abnormal changes in the callosal white matter volume in psychopaths, with an increase in callosal length and decrease in callosal thickness. According to these authors, such abnormalities reflect atypical neurodevelopmental processes that can derive from early abuse and may be responsible for an abnormal transferring of information across the hemispheres, subsequently leading to affective deficits as shown by psychopaths. However, it is to be acknowledged that findings on the associations between specific types of abuse and specific facets of psychopathy (i.e., interpersonal, affective, lifestyle, and antisocial) are somewhat inconclusive. In a groundbreaking study by Weiler and Widom (1996) on a sample of 652 abused and neglected individuals who were processed through either the county juvenile or adult criminal court, and 489 matched controls who were also processed but were not victimized as children, those who were exposed to child abuse and neglect scored higher on psychopathy. In another retrospective study on 226 male and female adolescent offenders, Campbell et al. (2004) found that adolescents who scored higher in psychopathy were more likely than low scorers to have a specific history of childhood physical abuse. This result was mirrored in a more recent study by Kolla and colleagues (2013), which showed a predictive association between physical abuse in childhood and psychopathic scores in a group of 25 violent offenders. Poythress, Skeem, and Lilienfeld (2006) found that a history of child abuse or neglect related positively, but weakly, to global psychopathic features among 615 mixed offenders; in their study, they did not find significant associations between sexual abuse and psychopathy scores, whereas physical and emotional abuse (in the form of verbal abuse) were moderately related to the lifestyle features of psychopathy. Even Borja and Ostrosky (2013) found, in a sample of 193 inmates, that psychopathic participants presented a generally higher victimization level and were more exposed to emotional abuse in childhood than antisocial inmates. Schraft, Kosson, and McBride (2013) found that childhood trauma experienced in the household was combined with community victimization in predicting the lifestyle of psychopathy in a sample of 170 adolescent offenders incarcerated at a detention center for youth offenders. In contrast, Graham, Kimonis, Wasserman, and Kline (2012) found that childhood sexual abuse showed predictive associations with psychopathic traits such as grandiose and manipulative interpersonal style and impulsive and irresponsible lifestyle, along with antisocial behavior, in a sample of 223 convicted sex offenders. In another recent study, Schimmenti, Passanisi, Pace, and colleagues (2014) found, in a sample of 139 violent offenders, that seven of the 10 participants who showed the highest psychopathic traits suffered from severe and concurrent experiences of neglect and abuse during childhood. It is likely that some of these research findings are conflicting because of the different samples used (e.g., adolescents or adults, mixed offenders or specific offenders), and this may suggest that this kind of research needs more specificity. Moreover, few previous works have addressed the relationships between specific forms of abuse and specific components of psychopathy, and few prior studies specifically addressed these relationships in a sample of inmates who committed violent crimes. Therefore, the aim of this study was to investigate the prevalence of different experiences of child abuse (emotional, physical, and sexual) in a sample of violent convicted offenders and their relationships with psycho-

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pathic traits. It was postulated that individuals who experienced child abuse would have scored higher in psychopathy levels. Furthermore, because literature suggests a strong relationship between the caregivers’ emotional abuse and the development of a dysregulated response system (Porter, 1996; Schimmenti, 2012; Schimmenti & Caretti, 2014; Schore, 2009; Schore & Schore, 2008; Weiler & Widom, 1996; Widom, 1994), we hypothesized that among the different types of childhood abuse, emotional abuse would be the best predictor of psychopathy scores.

Method Participants The study involved 78 White male offenders aged between 20 and 71 years (mean age ⫽ 43.32; SD ⫽ 10.89). Participants had quite a low level of education, and about half of them were married before incarceration; at the time of the interview, they had served, on average, about 8 years of conviction (see Table 1 for further details). In this sample, the most common crime was murder (n ⫽ 56; 72%), more than one fifth (n ⫽ 16; 21%) had committed child sexual offenses, 10 participants (13%) committed adult rape, and 47 (60%) committed another violent crime, such as aggravated assault or wounding with intent.

Procedures Participants were recruited from seven Italian prisons as part of a larger study supported by the Italian Ministry of Justice (Department of Prison Administration) and the Italian Ministry of Defense (RaCIS-Raggruppamento Carabinieri Investigazioni Scientifiche, Arma dei Carabinieri). The study was aimed at the evaluation of psychopathic personality traits within the prison system (Caretti, Manzi, Schimmenti, & Seragusa, 2011; Schimmenti, Passanisi, Pace, et al., 2014). The participants were included in a list of 150 male inmates who had committed violent crimes and were serving

Table 1 Descriptive Statistics

Nominal level Marital status (married) Emotional abuse Physical abuse Sexual abuse Scale level Age Years of education Length of served sentence (years) PCL-R total score PCL-R Factor 1 PCL-R Factor 2 PCL-R Interpersonal PCL-R Affective PCL-R Lifestyle PCL-R Antisocial

n

%

38 40 36 17 M (SD)

48.7 51.3 46.2 21.8 Range

43.32 (10.89) 8.05 (3.54) 8.40 (5.80) 20.47 (7.83) 9.64 (4.14) 9.23 (4.55) 4.64 (2.53) 5.01 (2.36) 5.61 (2.89) 3.71 (2.74)

20–71 0–17 1–26 2–36 1–16 0–20 0–8 0–8 0–10 0–10

Note. PCL-R ⫽ Psychopathy Checklist-Revised; Factor 1 ⫽ Interpersonal/Affective; Factor 2 ⫽ Lifestyle/Antisocial.

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SCHIMMENTI, DI CARLO, PASSANISI, AND CARETTI

their sentences in the seven prisons. Participation was voluntary and the inmates did not receive any compensation for taking part in this study. The inmates were considered eligible for the study if they were born in Italy, if they had committed a violent crime, if they had been incarcerated for more than a year, and if they had not received any diagnosis of medical illness or mental disorder in the last year. All participants were introduced to the aim of the study. The researchers explained that data would be recorded according to a strict procedure to guarantee the confidentiality of information. They were assured that they were free to withdraw from the study at any time, and they had to sign an informed consent prior to undertaking the study. Among the offenders who were eligible for this study, 112 agreed to participate. Of those, 105 were interviewed on psychopathy (seven participants were excluded from the study because their sentences had ended before the interview), and 78 (74.3%) correctly and entirely compiled the self-report measure on child abuse. There were no differences among those who completed the child abuse questionnaire and those who did not in terms of age, t(103) ⫽ .45, p ⫽ .66, marital status (having been or being currently married vs. single status), ␹2(1) ⫽ 2.36, p ⫽ .13, years of education, t(103) ⫽ 1.48, p ⫽ .14, and psychopathy scores (PCL-R total scores: t[103] ⫽ .06, p ⫽ .96; all probabilities for factors and facet scores nonsignificant, ranging from p ⫽ .10 [PCL-R Interpersonal facet] to p ⫽ .99 [PCL-R Factor 2 scores]), but those who did not complete the child abuse questionnaire were serving less time than the other participants, t(103) ⫽ 3.14, p ⫽ .002. The study was ethically cleared by the Italian Ministry of Justice and by the ethics committees internal to the prisons. The measures were administered individually by highly trained researchers who had completed the accredited course for the administration, scoring, and interpretation of the measure on psychopathy used in this study. Participants were interviewed in a quiet room where inmates are usually interviewed by their educators. For safety reasons, a police officer was available nearby. Data were collected between June 2008 and June 2011.

Measures Psychopathy Checklist–Revised (PCL-R; Hare, 2003). The PCL-R is the most commonly used measure for the assessment of psychopathy in legal and forensic settings (Hare & Neumann, 2008). The PCL-R is a rating scale that uses a semistructured interview, case history information, collateral information, and predetermined scoring criteria to rate 20 items on a 3-point scale according to the extent to which they apply to a given individual. Eighteen of the items form four dimensions: Interpersonal (e.g., glibness/superficial charm), Affective (e.g., shallow affect), Lifestyle (e.g., need for stimulation/proneness to boredom), and Antisocial (e.g., criminal versatility). The Interpersonal/Affective dimensions and the Lifestyle/Antisocial dimensions comprise, respectively, the higher order PCL-R Factors 1 and 2. The remaining two items (i.e., promiscuous sexual behavior and many shortterm marital relationships) do not load on any facet but contribute to the total PCL-R score. Total PCL-R scores can vary from 0 to 40, reflecting the degree to which the individual matches the prototypical psychopath. In this study, PCL-R scores were obtained via the semistructured interview recommended by Hare (2003), together with a review of detailed collateral information

(e.g., criminal records, prison records, educators’ notes). Interviews lasted from about 45 min to almost 5 hr, depending on the participants’ communication style. Cronbach’s alpha was .85 for the PCL-R full scale, with alphas of Factor 1 and Factor 2 both being .80. To further check the reliability of PCL-R ratings in this study, two of the authors (AS and VC) independently rated 12 random cases (15.3%), obtaining an average intraclass coefficient correlation (ICC) for PCL-R total score of .91, with ICCs for Factor 1 and Factor 2 being .93 and .90, respectively. Traumatic Experiences Checklist (TEC; Nijenhuis, Van der Hart, & Kruger, 2002). The TEC is a self-report measure used in clinical practice and research that addresses 29 types of potentially traumatic events. The TEC has demonstrated an adequate reliability and a good convergent validity (Nijenhuis et al., 2002; van Duijl, Nijenhuis, Komproe, Gernaat, & de Jong, 2010), being associated with alleged reports and official records of traumatic experiences. To increase specificity in research examining the relationship between childhood trauma and psychopathy, in this study, we focused only on the TEC questions related to childhood experiences of abuse (emotional, physical, and sexual abuse). Specifically, the TEC key questions on the types of abuse (e.g., “Did it happen to you?”, followed by three items for each type of abuse) were considered valid only if they were consistent with the TEC control items on experiences of abuse, that is, only if participants consistently answered the two additional questions related to the details and contexts of the abuse (“How many people did this to you?”; “Please describe your relationship with each person mentioned in your answer to the previous question.”). Thus, like other studies that have effectively applied the same procedure for scoring the TEC items on abuse (e.g., Schimmenti, Passanisi, Gervasi, Manzella, & Fama`, 2014), with this criterion we were able to use more reliable indices of childhood experiences of emotional, physical, and sexual abuse on the basis of a subgroup of items related to the same domain. Furthermore, corroboration on the presence–absence of abuses in childhood was researched in PCL-R interviews (which entails the question “Were you ever physically, sexually, or emotionally abused?”) and in participants’ case files. Eighty-four of 93 (90.3%) of the cases on abuse had been corroborated either by PCL-R interview and/or official records. We provide an example for each type of abuse from PCL-R excerpts: 1.

“My family was weird . . . when my parents got angry, they locked me in a small dark closet for many hours. My mother sometimes passed behind the door and she yelled me that she would leave me forever in that closet . . . I remember I was scared, really scared of the dark, and I was afraid I would not leave that closet anymore. This usually lasted for many hours” (emotional abuse).

2.

“My father was an alcoholic, he used to hit me with fists and sticks when he got upset, I still have many scars for this reason, such as this one in my head” (physical abuse).

3.

“The abuse began when I was about 5 or 6, and lasted for almost 2 years, then I went to community care. I was abused by older peers even there, until I started to respond with violence to violence, I hit the head of one of

ABUSE IN CHILDHOOD AND PSYCHOPATHY

them with a stone, I became very aggressive. No one would touch me ever. Even my sister and my younger brother were sexually abused by my father” (sexual abuse).

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Statistical Analysis The PCL-R scores were examined in relation to childhood experiences of abuse. Descriptive statistics were computed for all of the observed variables. Student’s t test was used to assess differences between groups, Pearson’s chi square and pointbiserial correlations were used to investigate the associations between variables, and a series of regression analyses were used to explore whether childhood experiences of abuse were predictive of PCL-R scores. Age of participants, their level of education, marital status, and length of served sentence were used as control variables. A p value of 0.05 was set as the critical level for statistical significance.

Results The mean PCL-R score in the sample was 20.47 (SD ⫽ 7.83). Eight participants (10.3%) obtained a PCL-R score of 30 or more, thus showing a high level of psychopathy according to the most commonly used PCL-R scoring interpretation criteria (Hare, 2003). Almost two thirds of the participants (n ⫽ 50, 64%) experienced either emotional, physical, or sexual abuse in childhood; 17 of them (22%) experienced two types of abuse; and 13 (17%) experienced all the investigated abuses. Specifically, half of the participants experienced emotional abuse, with a slightly lower prevalence of physical abuse; the prevalence of sexual abuse in childhood was also quite high. Table 1 summarizes the results of the descriptive analyses. Having been exposed to any experience of abuse was not associated with level of education, t(76) ⫽ .59, p ⫽ .55, length of served sentence, t(76) ⫽ .17, p ⫽ .86, or marital status, ␹2(1) ⫽ .01, p ⫽ .97, in this sample. However, the experience of at least one kind of abuse in childhood was more frequent among younger inmates, t(76) ⫽ 2.80, p ⫽ .006. These results were explained by a higher prevalence of physical abuse among younger participants (r ⫽ ⫺.31, p ⫽ .005). No other differences were found in relation to sociodemographic variables. Pearson’s chi-square analysis showed that all the investigated abuses were interrelated. Specifically, emotional abuse was associated with physical, ␹2(1) ⫽ 15.05, p ⬍ .001, and sexual, ␹2(1) ⫽ 5.52, p ⫽ .019, abuse; likewise, an association was found between physical and sexual abuse, ␹2(1) ⫽ 20.12, p ⬍ .001.

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Correlational analyses showed that child abuse was associated with PCL-R total, factor, and facet scores (see Table 2). Specifically, although we found modest point-biserial correlations between having experienced any type of the investigated abuses and PCL-R scores, analyses on specific types of abuse showed that emotional abuse was linked to PCL-R total scores, PCL-R Factor 1 and Factor 2 scores, and the lifestyle and antisocial facet scores; physical abuse was associated with PCL-R Factor 2 scores and with the lifestyle and antisocial facet scores; and sexual abuse was associated with PCL-R Factor 2 scores and with the lifestyle facet scores. No significant correlations were found in relation to the interpersonal facet of psychopathy. The patterns of intercorrelations between the investigated variables remained consistent when the effects of potential confounding variables (age, education, marital status, length of served sentence) were partialed out. Finally, we performed a series of multiple linear regression analyses. Regression analyses were of particular relevance for this study because they removed the variance shared between predictors; thus, they allowed for a look at unique predictive associations between specific forms of child abuse and psychopathy scores. Therefore, the three types of child abuse were entered together as potential predictors, and the PCL-R total, factor, and facet scores were individually entered as dependent variables in each regression analysis. Emotional abuse resulted in the only significant predictor for PCL-R total scores (adjusted [adj.] R2 ⫽ .12, F[3,74] ⫽ 4.45, p ⫽ .006; model constant: t ⫽ 13.53, p ⬍ .001; Emotional Abuse contribution: ␤ ⫽ .36, 95% confidence interval [CI] [1.85, 9.25], t ⫽ 2.99, p ⫽ .004), Factor 1 scores (adj. R2 ⫽ .09, F[3,74] ⫽ 2.77, p ⫽ .048; model constant: t ⫽ 12.38, p ⬍ .001; Emotional Abuse contribution: ␤ ⫽ .33, 95% CI [.73, 4.58], t ⫽ 2.71, p ⫽ .008), and Factor 2 scores (adj. R2 ⫽ .15, F[3,74] ⫽ 5.59, p ⫽ .002; model constant: t ⫽ 9.45, p ⬍ .001; Emotional Abuse contribution: ␤ ⫽ .28, 95% CI [.47, 4.80], t ⫽ 2.43, p ⫽ .018). In detail, emotional abuse was a specific predictor of the affective (adj. R2 ⫽ .07; F[3,74] ⫽ 3.02, p ⫽ .035; model constant: t ⫽ 10.95, p ⬍ .001; Emotional Abuse contribution: ␤ ⫽ .35, 95% CI [.50, 2.79], t ⫽ 2.87, p ⫽ .005) and lifestyle (adj. R2 ⫽ .12 F[3,74] ⫽ 4.45, p ⫽ .006; model constant: t ⫽ 9.44, p ⬍ .001; Emotional Abuse contribution: ␤ ⫽ .32, 95% CI [.47, 3.20], t ⫽ 2.68, p ⫽ .009) facets of the PCL-R. Therefore, results of regression analyses showed that emotional abuse in this study had unique relationships with the overall levels of psychopathy, with its two factors, and with its affective and lifestyle components, even if the variance shared between different types of abuse was also predictive of these scores because the regression models were significant. Neither emotional nor other child abuses predicted the interpersonal and antisocial facets of the PCL-R. Other regression analyses

Table 2 Point-Biserial Correlations Between Childhood Experience of Abuse and PCL-R Scores PCL-R total score Any abuse Emotional abuse Physical abuse Sexual abuse

ⴱ

.28 .38ⴱⴱ .21 .17

PCL-R Factor 1 .17 .29ⴱ .05 .01

PCL-R Factor 2 ⴱⴱ

.33 .37ⴱⴱ .31ⴱⴱ .29ⴱ

Interpersonal .08 .17 .01 .02

Affective .20 .32ⴱⴱ .09 .03

Note. PCL-R ⫽ Psychopathy Checklist Revised; Factor 1 ⫽ Interpersonal/Affective; Factor 2 ⫽ Lifestyle/Antisocial. Two-tailed p-values: ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01. ⴱⴱⴱ p ⬍ .001.

Lifestyle ⴱⴱ

.36 .36ⴱⴱ .23ⴱ .25ⴱ

Antisocial .15 .23ⴱ .27ⴱ .20

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were then carried out to verify whether any of the sociodemographic variables investigated in this study (age, education, marital status, and length of served sentence) added to the predictions, which always resulted in nonsignificant outcomes for these variables. Figure 1 summarizes the relationship between emotional abuse in childhood and psychopathy scores in this sample.

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Discussion The findings of the study support the assumptions that childhood experiences of abuse may be involved in the development of psychopathic traits. Notably, almost two out of three participants in this sample of violent offenders suffered from child abuse— emotional, physical, and/or sexual. This prevalence is even higher than rates reported in many studies concerning at-risk samples as well as clinical populations, including studies on posttraumatic stress disorder and addictive behaviors (e.g., Bifulco, Moran, Baines, Bunn, & Stanford, 2002; Bifulco, Schimmenti, Jacobs, Bunn, & Rusu 2014; Tull, Gratz, Coffey, Weiss, & McDermott, 2013). Most of the participants suffered from emotional abuse, which mirrored the findings of other studies showing that experiences of emotional deprivation, exploitation, humiliation, and extreme rejection during childhood are common among violent offenders (Carli et al., 2013; Kolla et al., 2013). However, although experiences of emotional abuse seem to be a recurring theme in the childhoods of offenders, even the prevalence of physical and sexual abuse was higher than those observed in normal and clinical populations (Bifulco et al., 2014; Deblinger, McLeer, Atkins, Ralphe, & Foa, 1989; McFarlane, Groff, O’Brien, & Watson, 2003). Correlational analysis showed that PCL-R total scores were higher when emotional abuse occurred in childhood, and that the other experiences of abuse were significantly associated with the lifestyle and antisocial dimensions of psychopathy. These results are in line with research suggesting that child abuse generates a

Figure 1. Emotional abuse in childhood and psychopathy scores in a sample of violent offenders. PCL-R ⫽ Psychopathy Checklist Revised; Factor 1 ⫽ Interpersonal/Affective; Factor 2 ⫽ Lifestyle/Antisocial; Emotional abuse ⫽ positive answers to the child emotional abuse questions on the Traumatic Experience Checklist.

pattern of dysregulated responses, negatively affecting children’s developing brains, with overwhelming consequences to their mental health. This may also include reduced behavioral control (Fonagy, 2003; Fonagy et al., 1997; Schimmenti, 2012), as neurobiological research has recently demonstrated (De Bellis, 1999; Ford, Courtois, Steele, Hart, & Nijenhuis, 2005). Interestingly, in this study, emotional abuse showed unique predictive associations with PCL-R total, Factor 1, Factor 2, affective, and lifestyle scores. This result supported our hypothesis that emotional abuse in childhood would be the best predictor of psychopathy scores, and it may also suggest that this type of abuse can distort the affective development of children, as implied in the construct of malignant narcissism, which has been theoretically proposed as a crucial dimension for understanding the inflated self-representation and lack of empathy among criminals (Akhtar, 1992; Kernberg, 1975; Meloy, 1988). Emotional abuse is a specific form of abuse that should be differentiated from parental lack of cares (e.g., neglect or lack of supervision), although these types of child maltreatment often co-occur. In fact, emotional abuse involves phenomena such as degrading, terrorizing, isolating, corrupting, exploiting, and extremely rejecting the child (Bifulco & Moran, 1998), which implies that parents proactively commit an abuse rather than neglectfully omit needed care (Bifulco et al., 2002; Schimmenti & Bifulco, 2015; Schimmenti & Pace, 2012), usually for having power and control over their child (Moran, Bifulco, Ball, Jacobs, & Benaim, 2002; Thompson & Kaplan, 1996). To increase specificity of the study, we have focused on different types of child abuse rather than neglect; thus, TEC scores on emotional abuse reflect childhood experiences in which phenomena such as those described here were involved. Therefore, it is possible that the lack of empathy and other negative affective traits exhibited by psychopaths were generated, in some cases, by emotionally abusing relationships that were severely distressing for the child and resulted in a child’s reduced ability of mentalizing others’ feelings and taking others’ cognitive perspectives into account (Gergely & Watson, 1996; Jurist, 2005; Schimmenti & Caretti, 2014). Moreover, when childhood experiences of physical and sexual abuse (which are severely distressing, even at the brain level) are added to emotional abuse, it is likely that the reduced mentalizing abilities combine with affect dysregulation, thus resulting in a high level of impulsivity and reduced behavioral control in the developing individual. In fact, given the frequency with which different types of abuse co-occurred in our sample, and given the likelihood that some of the damaging effects of abuses occur regardless of their specific types, findings on the shared impact of maltreatment are also important and should be highlighted. For example, our result partly mirrors one of the findings in the previously mentioned study by Schraft et al. (2013), who found that combined scores of childhood trauma, rather than specific types of childhood trauma, predicted the lifestyle facet of psychopathy. Therefore, research suggests that the unique and combined effects of childhood trauma could relate with psychopathy, and could even precipitate violent behaviors, particularly when the individual is exposed to significant stressors (De Zulueta, 2008; Fonagy, 2003; Schimmenti, Passanisi, Pace, et al., 2014; van der Kolk, 2005). However, neither emotional nor other abuses in childhood predicted the interpersonal facet of psychopathy, which perhaps might be better explained by temperamental aspects such as the callous-unemotional traits (Frick, Cornell, Barry, Bodin, &

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Dane, 2003) and/or by inborn neurobiological vulnerabilities (e.g., Mitchell, Colledge, Leonard, & Blair, 2002). In summary, our results mirrored other findings that have shown a close relationship between childhood experiences of abuse and the development of psychopathic traits among violent offenders. Our results can be interpreted in the framework of both attachment theory (Bowlby, 1988) and social learning theory (Akers & Jensen, 2006) as a pattern of “violence generates violence” (Widom, 1989), a vicious cycle which requires the development of effective preventative measures and treatment programs in order to avoid its painful roots spreading into society. This study has several limitations that need to be acknowledged. First, the sample size is not overly large and includes only male inmates convicted of violent crimes. Further studies are needed to generalize these findings to the criminal and forensic populations. Second, although there was corroborating information in PCL-R interviews and official documents about the experienced abuses for the majority of the participants, the use of a self-report measure for assessing childhood trauma among criminals is questionable, even if the TEC has shown sound psychometric properties. Third, the presence of predictive associations between emotional abuse in childhood and psychopathy scores cannot allow one to conclude that emotional abuse leads to increased psychopathic traits, particularly because this relationship could be influenced by other variables that were not analyzed in this study (e.g., brain abnormalities, clinical disorders, other traumatic experiences in later life, community violence, and disrupted social contexts). However, even with these limitations, the present study can contribute to the efforts of clinicians and forensic practitioners in understanding how the experiences of abuse in childhood may force the individual to pass through disturbed developmental pathways and, in some cases, may also lead to the development of psychopathic traits.

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Received April 24, 2014 Revision received October 22, 2014 Accepted October 29, 2014 䡲

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