Incarcerated individuals: Stronger associations for disinhibition with substance use problems, self-harm, and staff ratings of prison misbehavior among females compared to males

Testing for Sex Differences in the Nomological Network of the Triarchic Model of Psychopathy in Incarcerated Individuals. Claudio Sica, Emily R. Perkins, Keanan J. Joyner, Corrado Caudek, Gioia Bottesi, Maria Caruso, Paolo Giulini, Marta Ghisi & Christopher J. Patrick. Journal of Psychopathology and Behavioral Assessment, Jul 16 2021. https://link.springer.com/article/10.1007/s10862-021-09897-w

Abstract: The triarchic model of psychopathy conceptualizes variants of this clinical condition as expressions of three distinct biobehavioral dispositions, termed boldness, meanness, and disinhibition. As a trait-oriented model, the triarchic model situates psychopathy within a broader nomological network of personality and psychopathology, and has proven useful for characterizing how psychopathy relates to variables in these domains as well as to biological and behavioral variables. The current study was the first to examine sex differences in the external correlates of psychopathic traits as described by the triarchic model in a prison sample. Results were generally consistent with hypotheses: The triarchic traits related to measures of personality and psychopathology in patterns that were largely consistent across sex, but with some notable differences between males and females, in the correlates of disinhibition in particular. These included stronger associations for disinhibition with substance use problems, self-harm, and staff ratings of prison misbehavior among females compared to males. Findings from this study support the value of the triarchic model for understanding similarities and differences in the nomological network of psychopathy in incarcerated males and females.

Discussion

This study sought to elucidate sex differences in the nomological network of the triarchic model of psychopathy among incarcerated individuals, adding to scientific understanding about the model’s external validity. Findings generally complement and extend prior work comparing males and females in non-incarcerated populations and overcome an important limitation of the existing literature: a reliance on the PCL-R and related measures, which emphasize crime-related aspects of psychopathy to the exclusion of adaptive features. The triarchic model of psychopathy is designed to capture dispositional characteristics that may be expressed in a variety of phenotypes, including engagement in crime. The current study examined other manifestations of the triarchic traits — i.e., patterns of relations to other relevant constructs, such as personality and psychopathology — within a sample characterized by elevated engagement in crime, as well as investigating sex differences in these patterns.

The Triarchic Model in a Prison Sample

The current results advance scientific understanding of the triarchic model in a prison sample. Broadly, findings were consistent with hypotheses based on previous studies. Consistent with the theoretical conceptualization of boldness and with prior research (e.g., Sica et al., 2015), we found in this mixed-sex prison sample that TriPM Boldness was negatively associated with certain maladaptive constructs such as neuroticism and hopelessness, suggesting it adequately represents some aspects of psychological resilience against distress in an incarcerated sample (see Gottfried et al., 2019). Interestingly, and contrary to hypotheses, boldness was unrelated to self-harm in this sample; it may that this trait is less closely tied to behavioral expressions of distress than to the psychological experience itself. Importantly, despite its generally negative relations with distress measures, boldness was predictive of greater substance use problems and lower staff ratings of prison behavior and reintegration prognosis following release. These results are in line with other findings suggesting that boldness does not merely index positive adjustment (Lilienfeld et al., 2012, 2018; cf. Miller & Lynam, 2012). Multiple studies have found positive associations between boldness and various forms of maladaptive behavior (e.g., Anestis et al., 2018; Baroncelli et al., in press; Coffey et al., 2018; Hicks et al., 2014), including in prison samples (Sellbom et al., 2018). Notably, however, a previous study of incarcerated males found boldness to be associated with lower structured clinical judgments of risk for future violence (Sellbom et al., 2018), in contrast to the present results regarding current prison behavior and reintegration prognosis. Further research is needed to understand boldness and behavior in correctional settings.

Relations between TriPM Meanness and FFM traits were generally consistent with expectations, particularly the strong negative association with agreeableness. In this prison sample, as in non-incarcerated samples, triarchic meanness is closely linked to the FFM construct of antagonism (i.e., low agreeableness; see Poy et al., 2014). Interestingly, and contrary to hypotheses, meanness was uniquely associated with low conscientiousness, even after accounting for its relationship with disinhibition. It may be that the uncaring, detached features of meanness are expressed as disregard for personal responsibilities in the prison context; however, this association did not appear to extend to overt disciplinary problems, given the null correlation between meanness and staff ratings of prison behavior. Finally, meanness was positively associated with all facets of hopelessness but was unrelated to substance problems or self-harm. Meanness includes a prominent element of cynicism that may result in elevated hopelessness scores (e.g., Berg et al., 2013; Sellbom et al., 2018) despite null relations with other distress-related problems.

Consistent with its nomological net, disinhibition was uniquely associated with high neuroticism, low conscientiousness, and low agreeableness. Further, as expected, disinhibition was positively related to substance use problems, hopelessness, and self-harm. This finding is consistent with prior evidence that disinhibition constitutes a liability factor for myriad forms of psychopathology that involve poor emotional or behavioral control (Buchman-Schmitt et al., 2017; Patrick et al., 2013a, b; Perkins et al., 2019). Finally, negative associations were noted for disinhibition with staff ratings of prison behavior and reintegration prognosis. These are consistent with a prior study using structured risk assessments (Sellbom et al., 2018) and may reflect the persistently unrestrained, irresponsible tendencies exhibited by those high in disinhibition both inside and outside the prison setting.

Sex Differences in External Correlates of the Triarchic Traits

Regarding the central theme of the current paper, the main result was that the similarities between sexes outnumbered the differences. First, males and females did not differ in mean scores on TriPM Boldness or Meanness. This finding accords with some prior prison studies utilizing the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996), another personality-based measure of psychopathy, which have found few mean-level differences between males and females on fearless dominance (akin to boldness; e.g., Sellbom et al., 2017). However, our result is in contrast to the literature for undergraduates and forensic mental health evaluees reviewed above, in which higher boldness and meanness scores have typically been reported for males as compared to females. One explanation may be that females in our unselected prison sample were less affected by normative gender socialization forces over development than community females, contributing to their engagement in crime as well as their relatively elevated boldness and meanness (see Letendre, 2007; Scott & Mikell, 2019). Relatively similar levels of boldness and meanness across sexes would plausibly be observed in an unselected prison sample such as ours, containing individuals with and without mental illness, but not in a forensic sample (Anestis et al., 2019; Sellbom et al., 2017), in which mental illness may have played a greater role than gender socialization in females’ engagement in crime (Blanchette & Brown, 2019; Fazel & Grann, 2006; Flynn et al., 2011).

As expected, participant sex did not moderate observed relations of boldness with most criterion variables. Boldness is theorized to involve reduced sensitivity of the brain’s defensive reactivity system to cues signaling threat or punishment (e.g., Patrick et al., 2019; Yancey et al., 2016). Operating from this perspective, it appears that dispositional fearlessness manifested similarly for males and females in the current study — except in terms of its impact on staff ratings of behavior within the prison and social connections outside, where in each case associations for boldness were more negative in females than in males. One potential interpretation of this unanticipated result is that some aspects of boldness may be viewed by others as adaptive in males but maladaptive in females; for example, social dominance may be seen by raters as either “leadership” or “pushiness,” depending on the sex of the evaluee. Another possibility is that boldness may be expressed more in terms of manipulativeness or erratic behaviors in incarcerated females than in males. For instance, the affective-interpersonal (Factor 1) features of psychopathy are closely linked to borderline personality disorder symptoms in females, but not males (Verona et al., 2012). Females high in boldness might rely on manipulation or relational aggression to achieve their goals to a greater extent than high-bold males (see also Crick & Grotpeter, 1995; Robbins et al., 2003). These behaviors could plausibly result in poorer social relationships and more disciplinary issues inside the prison. However, since this finding was not hypothesized, it requires replication and should be interpreted with caution until replicated.

Based on the literature, we anticipated that sex would moderate the expression of meanness in particular with regard to distress symptomatology and personality. As meanness involves dysfunction in affective and affiliative systems (Palumbo et al., 2020; Viding & McCrory, 2019), its expression was hypothesized to be influenced by gender norms and females’ socialization to be warm and cooperative (Eagly, 2009). Although no Sex x Meanness interaction effects were significant in this sample, some approached significance, with meanness tending to relate more strongly to increases in BHS Lack of Motivation and decreases in DSHI Versatility in females than males. Although the former effect would be consistent with hypotheses, further research is needed with larger samples to achieve adequate power.

The majority of points of divergence between sexes concerned the trait of disinhibition. First, mean levels of disinhibition were higher for females than males in this prison sample. This finding contrasts with prior research in a forensic mental health sample that demonstrated higher disinhibition among males (Anestis et al., 2019), and with undergraduate samples that showed similar levels across sex (e.g., Drislane & Patrick, 2017). Higher levels of disinhibition may need to be present, on average, for females to engage in crime, given that socialization processes may otherwise inhibit such behavior (Leve et al., 2005).

Sex differences were also observed in the associations of disinhibition with other variables. In particular, TriPM Disinhibition in females was more closely associated with self-harm than in males. Consistent with these findings, impulsivity, aggression, and hostility — constructs central to the nomological network of disinhibition — are more often manifested as self-directed violence and self-harm in females than in males (Sadeh et al., 2011). Related concepts of emotion dysregulation, affective instability, and ineffective emotion regulation strategies are also elevated among females high in psychopathy relative to their male counterparts (de Vogel & Lancel, 2016; Kreis & Cooke, 2011; Sica et al., 2015; Verona et al., 2012). Females may be socialized to express problems through emotional dysregulation (internalizing; Keenan & Shaw, 1997). Another possible explanation involves the fact that disinhibition is influenced by the early environment (Tuvblad et al., 2019) and is correlated with a history of abuse (Gottfried et al., 2019; Graham et al., 2012; Verona et al., 2005). Given that trauma is extremely common among incarcerated females (DeHart et al., 2014; Lynch et al., 2012), such experiences could play a role in the sex-differentiated expression of disinhibition as emotion dysregulation. This explanation could also account for our finding that disinhibition was associated with greater increases in substance use among females than males, as the association between post-traumatic stress and substance use depends on the presence of emotion dysregulation (Tull et al., 2015), especially among women (Bornovalova et al., 2009). Although our substance use results contrast with findings from a forensic mental health clinic sample (Anestis et al., 2019), it is possible that the lower rate of comorbid serious mental illness in our unselected prison sample resulted in clearer sex differences in the degree to which substance use is driven by distress. Nevertheless, as with other mechanistic possibilities offered throughout this paper, these inferences remain to be explicitly tested.

Disinhibition also predicted staff ratings of misbehavior in prison to a greater degree in females than in males. Such a result is particularly important given that among incarcerated females, PCL-R scores do not predict violent behavior, verbal aggression, or noncompliance within the prison setting (Salekin et al., 1997). In this respect, as a trait-based approach rooted in models of personality, the triarchic model may hold promise for improving risk assessment among incarcerated females. However, this result requires replication.

Strengths, Limitations, and Directions

A notable strength of the current study is its use of a mixed-sex prison sample and the examination of external correlates considered to be of particular importance to this population (e.g., substance problems, self-harm, institutional behavior problems). This design allowed us to undertake, for the first time in an unselected prison sample, direct comparisons of the external correlates of the triarchic model across males and females. In addition, our sample was composed of individuals charged with serious crimes and who had several prior convictions; thus, the crime-history profile of our participants was distinctly severe.

The current study also has certain limitations. First, our sample consisted of incarcerated individuals from the nation of Italy, and thus our results may not generalize to individuals from other cultures and ethnic backgrounds. In addition, although the inclusion of staff-rated criterion variables was a strength, the psychometric properties of these measures are unknown, and it is unclear to what degree gender bias may have played a role in ratings. However, the incorporation of multiple sources of data in these ratings (e.g., police reports) may mitigate these concerns somewhat. Finally, although the focus of this study was on external validation, there is also a need for research on the internal psychometric properties of the TriPM in prison samples. This work will require larger samples of incarcerated females in particular (here, n=83) and could include structural analysesFootnote3 and examinations of measurement invariance across sexes. A larger sample would also allow for an examination of the interactive and configural effects of triarchic dimensions (e.g., variants of psychopathy) in predicting important clinical criteria across sex.