|Processes Accounting for the Covariation Between Hypersexual and Psychopathic Traits|
|Franklyn Graham |
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 Unpublished data from our laboratory has found that only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
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
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.
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.
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.
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).
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
grateful to ATSA for helping to fund this project and look forward to sharing
the results with the ATSA community.
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. Cognition, 50, 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
Reviews, 28, 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 Medicine, 12,
H. (1951). The mask of sanity; an attempt to reinterpret the so-called
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
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.
K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent
sexual offenders: a meta-analysis of recidivism studies. Journal of Consulting and Clinical
Psychology, 73, 1154-1163.
R. D. (2003). Hare Psychopathy Checklist--Revised (PCL-R): 2nd
Edition, Technical Manual. Toronto: Multi-Health Systems, Inc.
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 Disorders, 21, 1-27.
M., & Sellbom, M. (2012). Hypersexuality in college students: The role of
psychopathy. Personality and
Individual Differences, 53,
D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of
conceptualization and diagnosis. Sexual
Addiction & Compulsivity, 15,
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:
General, 133, 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 Treatment, 3,
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,
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 Mapping, 11,
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
Therapy, 34, 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 Differences, 43,
Sadeh, N., & Verona, E. (2008). Psychopathic personality
traits associated with abnormal selective attention and impaired cognitive
control. Neuropsychology, 22, 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
Sutherland, E. H. (1950). The diffusion of sexual psychopath
laws. American Journal of
Patrick, C. J., & Joiner, T. E. (2001). Psychopathy, antisocial
personality, and suicide risk. Journal
of Abnormal Psychology, 110,