Vol. XXIX, No. 3
Summer 2017
Text Only Version
In This Issue
Regular Features
Editor's Note
President's Message
FAQ
Is pornography use safe for those convicted of a sexual offence?
Featured Articles
Prosocial Treatment Methods for Juveniles Who Sexually Offended
The Relationship between Implicit and Explicit Evaluations of Sexual Aggression and Sexually Aggressive Behavior
Child pornography offenders: Profiles of a complex group
Students' Voice
Processes Accounting for the Covariation Between Hypersexual and Psychopathic Traits
Book Review
Treatment of High-Risk Sexual Offenders: An Integrated Approach
ATSA News
Changing The Journal Name
Apply for the ATSA Fellow for 2017
2017 Election
ATSA International Committee: An introduction
2017 ATSA Conference: Exhibit and Support Opportunities
Win a Free Conference Registration
New ATSA Conference Event
Keeping up with the news
Legislative update
New ATSA Members
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Forum Team
David Prescott
Book Review Editor

Sarah Gorter
Production Editor

Forum Editor
Contact the editor or submit articles to:

Heather M. Moulden, Ph.D.
Forensic Program
St. Joseph's Healthcare
Hamilton, Ontario, Canada
E: hmoulden@stjoes.ca
P: (905) 522-1155 ext. 35539
Students' Voice
Processes Accounting for the Covariation Between Hypersexual and Psychopathic Traits
Franklyn Graham
Brandeis University

Last year I was awarded an ATSA Pre-Doctoral Research Grant to help fund my dissertation, a project that would not have been possible without the generosity of the ATSA organization. I am excited to have the opportunity to share an overview of what my research project entails.

My research interests center on the intersection between psychopathy and hypersexuality, two predictors of both the development of sexually aggressive behavior and later sexual recidivism (Knight & Sims-Knight, 2003, 2004; Hanson & Morton-Bourgon, 2005). Although Cleckley (1951) described the psychopath as disinhibited sexually and prone to seeking sexual gratification indiscriminately, he did not hypothesize that those high on psychopathic traits were oversexualized. In contrast, more recent empirical findings have suggested that psychopathic traits are correlated with a range of sexual behaviors that can broadly be defined as hypersexual (e.g., sexual drive, sexual compulsivity, sexual preoccupation, precocious sexuality, socio-sexuality; Graham, 2014; Harris et al., 2007; Kastner & Sellbom, 2012). In one study that examined the etiological pathways of sexual aggression, the correlation between psychopathic and hypersexual latent traits was so high that modification indices suggested combing the two constructs into a single latent trait (Knight, 2013; Knight & Sims-Knight, 2013).

Such consistent and high covariation between two hypothetical constructs suggests the possibility that common underlying processes may account for their co-occurrence. Unfortunately, few attempts have been made to explore such potential common etiological mechanisms. Identification of common mechanisms would be important for focusing the search for etiological models of sexual aggression and could generate more specific targets for treatment and assessment. The aim of this project is to identify and test potential common mechanisms.

Previous research has found that the covariation between hypersexual and psychopathic traits is largely due to manipulative and impulsive psychopathic traits (Harris et al., 2007; Knight & Sims-Knight, 2003). Unpublished data from our laboratory has found that only the Interpersonal and Lifestyle facets of the Psychopathy Checklist-Revised (PCL-R; Hare, 2003) were correlated with measures of hypersexuality as assessed by the Multidimensional Inventory of Development, Sex, and Aggression (MIDSA; see MIDSA, 2011) in a sample of 529 male sexual offenders. In a previous study using the three MIDSA scales that assess hypersexuality and MIDSA analog scales of the Interpersonal and Lifestyle facets of the PCL-R, we found that 47% of the variance in hypersexuality could be accounted for by the two psychopathy facets (Graham, 2014).

In the PCL-R the Interpersonal and Lifestyle facets load on two correlated, but distinct overarching factors. Interpersonal manipulativeness is a component of the Affective-Interpersonal Factor 1, associated with low anxiety/fear and the affective and interpersonal traits that are considered to be the “primary” features of psychopathy. In contrast, Lifestyle impulsivity is a part of a second overarching PCL-R factor, Lifestyle-Antisocial, which has been associated with negative emotionality and more generalized externalizing psychopathology (Hare, 2003; Verona, Edelyn, Patrick, & Joiner, 2001). These two factors show opposing correlates and are hypothesized to arise from different etiological pathways (Fowles & Dindo, 2006). Moreover, Newman and his colleagues have hypothesized distinct cognitive processing deficits that characterize those high on primary psychopathic traits versus externalizing traits (Baskin-Sommers & Newman, 2013; Newman & Baskin-Sommers, 2012). They have found evidence that the low anxiety, primary psychopathic traits are associated with an attentional bottleneck arising in early selective attention. This bottleneck is hypothesized to inhibit the processing of information peripheral to goal-directed behavior, resulting in a failure to modulate behavior in the face of new information (Newman & Baskin-Sommers, 2012). In contrast, disinhibited and externalizing traits have been shown to arise from deficits in executive functioning and a hyper-awareness of emotionally-valent stimuli, resulting in difficulties maintaining top-down cognitive control.

Although hypersexuality has traditionally been conceptualized as a univocal construct, more recent data have suggested that it, like psychopathy, might have important critical subcomponents. The issue of what phenotypic traits and developmental antecedes are core components of hypersexuality and hypersexual related constructs (e.g., sexual addiction, sexual impulsivity, sexual compulsivity) has sparked considerable controversy. One common conceptualization of hypersexuality has focused on the use of sexual behavior as a way of regulating negative affect (Kingston & Firestone, 2008). Self-report data have corroborated that this conceptualization covaries with alexithymia, neuroticism, anxiety, anger, and vulnerability to stress (Reid, Carpenter, Spackman, & Willes, 2008). The importance of negative affectivity in this conceptualization suggests that hypersexual traits and their covariation with psychopathy may be best understood as resulting from a common deficit in executive functioning.

Hypersexuality appears, however, to be a multifaceted phenomenon. Carvalho, Štulhofer, Vieira, and Jurin (2015) calculated a cluster analysis on a large sample of community members (n = 4,597) and found two clusters of hypersexual traits. The first cluster comprised 3% of the sample and was defined by items capturing sexual dyscontrol, such as failures to control sexual behavior and behavioral consequences. The second cluster included 22.4% of the sample and was defined by items measuring increased sexual drive and behavior. Assignment to the sexual dyscontrol cluster was associated with greater depression scores compared to members of the sexual drive/behavior cluster, suggesting greater negative affectivity. The two clusters suggest the presence of two distinguishable forms of hypersexuality--one associated with high sexual drive and engagement in sexual behavior and a second form more associated with disordered sexuality that includes a lack of control over sexual behavior and negative sexual consequences.

The differentiation between sexual dyscontrol, which encompasses the conceptualization of hypersexuality as the overuse of sexual behavior to cope with negative emotion, from high sexual drive and activity provides the possibility that the impulsive and manipulative psychopathic traits and their associated attentional deficits may be more strongly related to specific forms of hypersexuality. It is reasonable to speculate that both the impulsive, externalizing traits of psychopathy and sexual dyscontrol may share similar deficits in executive functioning and a hyper-reactivity to emotion stimuli.  

In contrast, manipulative psychopathic traits can be hypothesized to align more with the high sexual drive/behavioral components of hypersexuality, suggesting a common early attentional bottleneck resulting in an over-focus on reward and an inability to alter one’s focus on a goal, once such goal-directed behavior has been enacted. Both the high-drive conceptualization of hypersexuality and manipulative psychopathic traits also share potential neurological correlates. There is evidence that this high drive component may be related to a hyper-reactive dopaminergic response to potential reward.

The motivational aspect of sexual behavior, including the orienting to sexual stimuli and urges to express sexual behaviors are associated with activation of the mesolimbic dopaminergic pathway and is instrumental in the assignment of incentive salience to stimuli (Berridge & Robinson, 1998; Redoute et al., 2000; Stoléru, Fonteille, Cornélis, Joyal, & Moulier, 2002). Buckholtz et al. (2010) reported that the Impulsive-Antisocial (AI) factor of the Psychopathic Personality Inventory (PPI), also called the Self-Centered Impulsive factor, is associated with deficits in the mesolimbic DA system, with the presentation of rewarding stimuli resulting in increased DA release within the NAcc and Ventral Striatum. Meta-analysis of the PPI suggests that although the AI factor is closely aligned with externalizing traits and the second-factor psychopathic traits, it is also strongly related to total psychopathy scores and moderately correlated with the first-factor psychopathic traits (Miller & Lynam, 2012). Similarly, measures of the Behavioral Activation System are correlated with both psychopathy factors of self-report measures (Ross et al., 2007). This hyper-responsivity to reward can explain an exaggerated approach motivation and perceptual narrowing on rewarding stimuli that could account for the covariation between psychopathy in general and the sexual drive component of hypersexuality (e.g., excessive responsivity to sexual stimuli).

Taken together, these data suggest the possibility that there are two potentially interacting pathways that can account for the covariation among constructs. The first can be described as an attentional bottleneck that results in a common failure to attend to peripheral information and leads to an over-focus on rewarding stimuli and covaries with both the low anxiety, primary traits of psychopathy and the sexual drive components of hypersexuality. The second pathway involves a common failure in executive functioning and negative emotionality, that may account for the externalizing psychopathic traits and the sexual dyscontrol components of hypersexuality, resulting in an inability to maintain top-down cognitive control when faced with emotionally relevant (e.g. sexual) stimuli. Both paths can lead to an equifinal outcome of general hyper-responsivity to reward in both psychopathic and hypersexual individuals, resulting in an increased motivational salience and approach response towards potentially rewarding stimuli.

The present study is employing three behavioral tasks to measure both the two interacting pathways and the equifinal reward-focused outcome to explore the potential mechanisms accounting for the covariation between hypersexuality and psychopathy. I am using two tasks derived from the work of Sadeh and Verona (2008) and Lavie et al., (2004) to assess the relation between attentional deficits and the constructs of interest. The first task is a 2 x 3 flanker task that manipulates the congruence of distractors (congruent, incongruent) and the perceptual load of the task (low, medium, and high) to determine the impact of perceptual load on early attentional bottlenecks. Both psychopathic and hypersexual traits will be included as covariates in the model. It is expected that both high sexual drive and the manipulative traits of psychopathy will be associated with the presence of an earlier attentional bottleneck, as measured by faster responding to incongruent distractors at lower perceptual loads. The interference effect for each construct can then be used to determine whether an early attentional bottleneck mediates the relation between hypersexual and psychopathic traits.    

The second task uses a 2 x 2 flanker task in which cognitive load (low, high) and flanker congruence (congruent, incongruent) are manipulated to determine the impact of cognitive load on attentional control, as measured by the reaction time to incongruent versus congruent distractors. As in the first task, both psychopathic and hypersexual traits will be entered into the model as covariates predicting cognitive performance. It is expected that both sexual dyscontrol and the Impulsive/Antisocial externalizing traits of psychopathy will be more associated with greater interference effects from distractors under high load.

The Iowa Gambling Task (IGT; Bechara et al., 1994) will be used as a measure of reward responsivity. The IGT is often used as a measure of real world decision making, requiring participants to attempt to win as much fake money as possible by drawing from a series of decks of cards. Participants choose from among four decks. The first two decks are considered “disadvantageous” and are characterized by immediate high rewards and even higher later punishments. The second two decks are “advantageous” and include smaller immediate rewards, but also smaller punishments. To perform well on the task participants must learn which decks are more advantageous and focus on long-term gains over immediate rewards. It is hypothesized that poorer performance on this task will by correlated with both sets of psychopathic and hypersexual traits that are suggestive of increased sensitivity to reward.

Evidence supporting these hypotheses would provide information helpful to the understanding, assessment, and treatment of sexually aggressive behavior. Evidence of a covariation of high sex drive, early bottleneck cognitive deficit, and over-focus on rewarding stimuli would suggest that clients who exhibit manipulative, risk-taking psychopathic and sexual traits are experiencing an over-recruitment of dopaminergic activation in response to motivationally salient cues, implying high reward salience. At a fundamental level this would indicate a strong motivational draw toward rewards that are sexual in nature. Within the clinical realm this would imply the need for assessments that can assess reward motivation and reward responsivity. Therapeutic interventions for such offenders should, in turn, be tailored to the treatment of a high behavioral pursuit of reward. Evidence of an early attentional deficit in such offenders would increase our understanding of the arousal aspects of hypersexuality and would implicate neural areas tied to perceptual capacity (e.g., the septohippocampal system). This would encourage the development of assessment strategies that measure deficits in early selective attention.  It would suggest the creation of treatment modalities that enhance cognitive skills that foster attention to peripheral information (e.g., Baskin-Sommers & Newman, 2013).

Evidence of a covariation of high sexual dysfunction, an executive function deficit, over-distraction for rewarding stimuli, and externalizing symptoms would suggest that the offender suffers from problems of emotional and behavior control that would potentially be more responsive to interventions that specifically target this problem. Moreover, identification of a late attentional deficit in such offenders would imply impairments in executive functioning and working memory. Assessments that can determine the level of impairment in these systems would provide important information and direct the course of intervention toward treatment techniques that enhance concentration and working memory, enhance cognitive and inhibitory control, and improve emotional and behavior regulation.

I’m grateful to ATSA for helping to fund this project and look forward to sharing the results with the ATSA community.

References

Baskin-Sommers, A. R., & Newman, J. P. (2013). Differentiating the cognition-emotion interactions that characterize psychopathy versus externalizing. Handbook of Cognition and Emotion, 501-520.

Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition50, 7-15.

Berridge, K. C., & Robinson, T. E. (1998). What is the role of dopamine in reward: hedonic impact, reward learning, or incentive salience? Brain Research Reviews28, 309-369.

Carvalho, J., Štulhofer, A., Vieira, A. L., & Jurin, T. (2015). Hypersexuality and high sexual desire: Exploring the structure of problematic sexuality. The Journal of Sexual Medicine12, 1356-1367.

Cleckley, H. (1951). The mask of sanity; an attempt to reinterpret the so-called psychopathic personality.

Buckholtz, J. W., Treadway, M. T., Cowan, R. L., Woodward, N. D., Benning, S. D., Li, R., ... & Smith, C. E. (2010). Mesolimbic dopamine reward system hypersensitivity in individuals with psychopathic traits. Nature Neuroscience13, 419-421.

Fowles, D. C., & Dindo, L. (2006). A dual-deficit model of psychopathy. Handbook of Psychopathy, 14-34.

Graham, F. J. (2014, March). Gender Differences in the Association Between Callousness/Manipulativeness and Sexualization. In R. A. Knight (Chair). Exploring developmental antecedents, manifestations, and covariations of psychopathy and sexual sadism. Symposium presented at the meeting of Eastern Psychological Association, Boston, MA.

Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual offenders: a meta-analysis of recidivism studies. Journal of Consulting and Clinical Psychology73, 1154-1163.

Hare, R. D. (2003). Hare Psychopathy Checklist--Revised (PCL-R): 2nd Edition, Technical Manual. Toronto: Multi-Health Systems, Inc.

Harris, G. T., Rice, M. E., Hilton, N. Z., Lalumiere, M. L., & Quinsey, V. L. (2007). Coercive and precocious sexuality as a fundamental aspect of psychopathy. Journal of Personality Disorders21, 1-27.

Kastner, R. M., & Sellbom, M. (2012). Hypersexuality in college students: The role of psychopathy. Personality and Individual Differences53, 644-649.

Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction & Compulsivity15, 284-310.

Knight, R. A. (2013, September). New developments in the structural models of paraphilic coercion and rape. Paper presented at the 27th Annual Conference of the Society for Research in Psychopathology, Oakland, CA.

Knight, R. A., & Sims-Knight, J. E. (2003). Developmental antecedents of sexual coercion against women: Testing of alternative hypotheses with structural equation modeling. In R. A. Prentky, E. Janus, & M. Seto (Eds.), Sexual coercion: Understanding and management (pp. 72-85). New York: New York Academy of Sciences.

Knight, R. A., & Sims-Knight, J. E. (2004). Testing an etiological model for male juvenile sexual offending against females. Journal of Child Sexual Abuse, 13, 33-55.

Knight, R. A., & Sims-Knight, J. E. (2013, November). Tracking the antecedents and predictors of rape: Abuse, hypersexuality, callousness, antisociality, and PCD. Symposium presented at the 32rd Annual Conference of the Association for the Treatment of Sexual Abusers, Chicago, IL.

Lavie, N., Hirst, A., De Fockert, J. W., & Viding, E. (2004). Load theory of selective attention and cognitive control. Journal of Experimental Psychology: General133, 339-354.

Miller, J. D., & Lynam, D. R. (2012). An examination of the Psychopathic Personality Inventory's nomological network: a meta-analytic review. Personality Disorders: Theory, Research, and Treatment3, 305.

Multidimensional Inventory of Development, Sex, and Aggression (MIDSA). (2011). MIDSA clinical manual, 3rd ed. Bend, OR: Augur Enterprises. Available at www.midsa.us.

Newman, J. P., & Baskin-Sommers, A. R. (2012). Early selective attention abnormalities in psychopathy. Cognitive Neuroscience of Attention, 421-440.

Redouté, J., Stoléru, S., Grégoire, M. C., Costes, N., Cinotti, L., Lavenne, F., ... & Pujol, J. F. (2000). Brain processing of visual sexual stimuli in human males. Human Brain Mapping11, 162-177.

Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior. Journal of Sex & Marital Therapy34, 133-149.

Ross, S. R., Moltó, J., Poy, R., Segarra, P., Pastor, M. C., & Montañés, S. (2007). Gray’s model and psychopathy: BIS but not BAS differentiates primary from secondary psychopathy in noninstitutionalized young adults. Personality and Individual Differences43, 1644-1655.

Sadeh, N., & Verona, E. (2008). Psychopathic personality traits associated with abnormal selective attention and impaired cognitive control. Neuropsychology22, 669.

Stoléru, S., Fonteille, V., Cornélis, C., Joyal, C., & Moulier, V. (2012). Functional neuroimaging studies of sexual arousal and orgasm in healthy men and women: a review and meta-analysis. Neuroscience & Biobehavioral Reviews36, 1481-1509.

Sutherland, E. H. (1950). The diffusion of sexual psychopath laws. American Journal of Sociology56, 142-148.

Verona, E., Patrick, C. J., & Joiner, T. E. (2001). Psychopathy, antisocial personality, and suicide risk. Journal of Abnormal Psychology110, 462-470.

 

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