CQ No. 25 SA Crime Quarterly no 36 • June 2011 31 In 2010 the South African Police Service (SAPS) reported a slight decrease in most crime categories from previous years. However, it is disquieting that over 70% of all offenders are currently incarcerated because of violent crimes.1 The social factors related to violent crime have been identified as poverty-related variables, urbanisation and the influx of illegal immigrants, as well as a lack of policing and economic inequality.2 South Africans have also been criticised for adopting a ‘culture of violence’, implying the acceptance of violence in conflict resolution and everyday life.3 Despite social factors that contribute to the incidence of crime, there is little research regarding intrapersonal factors (such as personality characteristics) that could contribute to violent crime. The identification of a distinct criminal personality type has been fraught with methodological problems and complexities associated with personality formation. However, several studies have determined a significant link between violent crime and antisocial personalities, including psychopathy, antisocial personality disorder (ASPD) and dissocial personality disorder (DPD).4 Studies have also shown that offenders who meet psychopathic or ASPD criteria have greater criminogenic needs, commit more violent crimes, and tend to recidivate more than non-psychopathic offenders.5 Regrettably, disagreements surrounding the classification of the antisocial personalities have hindered the identification of individuals who meet the diagnostic criteria of an antisocial personality. As a result the possibility of an antisocial personality disorder is not taken into account when planning and implementing treatment and rehabilitation strategies. For this reason, the present study focuses on differentiating between the various antisocial personalities in order to determine their prevalence in a South African offender sample. Antisocial personalities Measuring prevalence among offenders in South Africa lootss@ufs.ac.za, louwda@ufs.ac.za The identification of offenders who meet the criteria for psychopathy, antisocial personality disorder or dissocial personality disorder could be of significant value to help address the violent crime crisis in South Africa. A sample of 500 male maximum security offenders was selected to determine the prevalence of these disorders among South African offenders. Results for the incidence of psychopathy and dissocial personality disorder indicate a similar trend to that found in other countries; whereas the prevalence of antisocial personality disorder contradicts international findings. Sonja Loots* and Dap Louw** * Loots is a postdoctoral fellow at the University of the Free State and is conducting research on cross-cultural psychopathy. ** Louw is a senior professor in the Psychology Department at UFS. He specialises in Forensic Psychology. CQ No. 36 - June 2011 7/5/11 10:24 AM Page 35 ANTISOCIAL PERSONALITIES Since the early 1800s, the various antisocial personalities have been referred to as madness without distinguishing between psychotic features: moral insanity, psychopathy, sociopathy, antisocial personality disorder and dissocial personality disorder.6 The concept of psychopathy evolved from earlier descriptions of the disorder and finally expanded into a modern clinical portrait with a set of characteristics associated with the psychopathic personality.7 Among others, the characteristics included superficial charm, intelligence and unreliability, a lack of remorse, antisocial behaviour, pathological egocentricity, and impersonal sexual relations. The American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders (DSM) incorporated Cleckley’s characteristics into their formulation of diagnostic criteria for antisocial reaction, one of six personality disturbances under the broader sociopathic personality disorder.8 In a failed attempt to minimise confusion among clinicians and to promote the effective communication of mental disorders, the APA replaced the term ‘sociopathic personality disorder’ with ASPD in the third publication of the DSM.9 While personality traits played a central role in the original construct of psychopathy, the diagnostic criteria for ASPD focus more on the behaviours that typify the disorder.10 According to the most recent APA guidelines, the DSM-IV-TR, ASPD can only be diagnosed when the individual is 18 years old and has a proven history of conduct disorder before the age of 15. Other prerequisites include the presence of three or more of the following criteria: a disregard for social norms and the safety of others, deceitfulness, impulsivity, aggressiveness, irresponsibility, and a lack of remorse.11 The APA also stipulates the manifestation of these criteria in behavioural terms. The reasoning behind moving away from the original personality-focused criteria was that behaviour, unlike personality traits, can, arguably, be more reliably measured.12 In response to the adaptation, Hare contends that ASPD fails to assess the interpersonal factors that maintain antisocial behaviour. Widiger, Frances and Trull,13 in agreement with Hare, argue that a specific personality trait may cause a variety of behaviours and that a specific behaviour could reflect more than one personality trait. Basing his study on Cleckley’s original personality-based criteria for psychopathy, Robert Hare set out to discriminate between ASPD and psychopathy. He developed a set of measurable criteria, the Hare Psychopathy Checklist (PCL),14 to assess the extent to which psychopathic traits are present in certain individuals. Studies have found that only 15% to 38% of individuals who are diagnosed with ASPD meet the revised version of the PCL criteria for psychopathy, while around 80% to 90% of psychopathic offenders also meet the ASPD criteria.15 Adding to the confusion surrounding the diagnosis of psychopathy and ASPD, the 10th edition of the World Health Organisation’s International Classification of Diseases (ICD-10), uses the term ‘dissocial personality disorder’ to conceptualise a set of symptoms also based on psychopathic personality traits. In contrast with ASPD, the diagnostic criteria for DPD focus more on the traditional concept of psychopathy, but emphasise the lack of affect or expressed emotion rather than the presence of specific personality traits or behaviours.16 Unlike psychopathy, which has been the most researched of the antisocial personalities by far, very few studies have focused exclusively on DPD. Despite overlapping concepts, it is clear that the criteria for psychopathy, ASPD and DPD emphasise the presence or absence of different characteristics, thereby encouraging the notion of three distinct, but related, disorders. METHODOLOGY Participants and procedure Permission for the current study was granted by two ethics committees representing the Department of Psychology and the Faculty of the Humanities at the University of the Free State. Furthermore, an independent review of this research proposal was 32 Institute for Security Studies CQ No. 36 - June 2011 7/5/11 10:24 AM Page 36 SA Crime Quarterly no 36 • June 2011 33 conducted by the Department of Correctional Services. A non-experimental quantitative research approach was employed to acquire data at Mangaung Correctional Centre (MCC), a maximum security correctional facility located near Bloemfontein, housing approximately 3 000 male offenders. A randomised sample of 500 offenders representing various ethnicities and types of crime was selected through the MCC database. The selected offenders were asked to sign a consent form, thereby agreeing to take part in the study and granting permission for the use of the information. Measures Along with a biographical questionnaire, the following self-report measures were used in this study: 1) The Psychopathic Personality Inventory – Revised (PPI-R).17 The PPI-R is a self-report inventory designed to identify a continuum of psychopathic traits and attitudes. It consists of 154 items and eight content scales: Machiavellian Egocentricity (ME), Rebellious Nonconformity (RN), Blame Externalisation (BE), Carefree Nonplanfulness (CN), Social Influence (SOI), Fearlessness (F), Stress Immunity (STI), and Coldheartedness (C). It also consists of four validity scales, including Deviant Responding (DR), Virtuous Respond- ing (VR), and two Inconsistent Responding (IR-15; IR-40) scales. The DR and VR scales are used to identify faking bad and faking good responses respectively, whereas the IR scales eliminate careless or random responses.18 2) To measure antisocial and dissocial personality disorders The DSM-IV and ICD- 10 Personality Questionnaire (DIP-Q)19 was used. The DIP-Q is derived from the ICD-10 and DSM-IV classification of mental disorders. Preliminary validation of the relevant DIP-Q subscales did not render sufficient reliability coefficients for either the DPD or the ASPD subscales.20 However, findings from a pilot study in the present project did deliver sufficient reliability scores, with alpha coefficients of 0,81 and 0,63 for the ASPD and DPD subscales respectively. No studies administering the PPI-R or DIP-Q in South African samples could be found to corroborate the mentioned psychometric properties. Administration of questionnaires The Mangaung Correctional Centre houses offenders from a variety of different cultures and ethnicities. Administering the measures raised challenges such as language and comprehension difficulties. Translators were employed to assist with the correct interpretation of the questions as well as to explain the use of English jargon context- ally. Ten translators, including the researcher, assisted with the paper and pencil administration of the instruments. In some cases participants were illiterate and responded to the questions verbally. Participants were divided into small groups (one to five) and were allocated a translator who spoke the same language as the group. Each translator then translated item by item while those in the group marked the relevant answers. Statistical analysis SAS Version 9.1.3 and SPSS Version 18 were employed to analyse the data. Recent taxometric analyses report that both antisocial personality disorder and psychopathy are more dimensional in nature than categorical, and should therefore rather be measured on a continuum.21 The DIP-Q, how- ever, only allows for categorical responses; thus the results for the prevalence of ASPD and DPD traits will mainly be portrayed as such. On the other hand, the PPI-R allows for the dimensionality of psychopathy to be incorporated. The participants’ total PPI-R scores were divided into four groups representing scores ranging from 60-69 (low psychopathy), 70-79 (moderate psychopathy), ≥80 (high psychopathy), and non-psychopaths. RESULTS AND DISCUSSION Table 1 presents the sample’s demographic characteristics. Most participants were aged CQ No. 36 - June 2011 7/5/11 10:24 AM Page 37 Table 1: Demographic characteristics 34 Institute for Security Studies between 36 and 55 years and Sesotho was the most spoken home language. The various crimes were grouped into violent, sexual and economic offences. Sexual crimes are often included in the violent crime category; however, the high rate of sexual crimes in South Africa deserves individual attention. For this reason sexual crimes, including violent crimes of a sexual nature, and violent crimes unrelated to sex are portrayed as separate categories. Violent crimes represented almost half of the sample, while sexual and economic crimes represented almost a third and a quarter of the sample respectively. Most of the participants are serving 11 to 40 year sentences, with 20% serving life sentences, and less than 10% serving either more than 40 years or less than 10 years. Psychopathic traits The reliability of the PPI-R in the current study indicated internal consistency estimates for the original content scales that ranged from 0,52 to 0,73. After conducting exploratory and confirmatory factor analyses, several items producing low factor loadings were omitted to increase the instrument’s psychometric properties. The alpha coefficients after omission of the items indicated a moderate increase in reliability (0,60 to 0,75). Table 2 discloses the prevalence of antisocial personalities in the current sample. The total percentage of offenders who met the criteria for psychopathy represented 27% of the sample. This figure is similar to other reports of psychopathic traits among offenders, which fluctuate from 15% to 25% in American samples. British samples, on the other hand, reveal a much lower account of psychopathy.22 Reasons for the dissimilarity in psychopathy scores could be cultural differences and the possibility of co- morbid disorders. It should also be noted that the majority of psychopathy studies do not include the PPI-R, which increases the possible influence methodological differences could have on the reported prevalence of psychopathy. The probability of malingering should also be taken into account. ASPD traits Similar to the results of the pilot study, the ASPD subscale showed good internal consistency (_=0,84), while the DPD subscale indicated a lower score (_=0,65). The prevalence of ASPD in this sample represented 17% (Table 2). This finding is inconsistently low when compared to other studies where ASPD represented between Age (N=439) 18-35 174 40 36-55 251 57 56+ 14 3 Language (N=439) Sesotho 152 35 Afrikaans 124 28 Xhosa 66 15 Tswana 50 11 Zulu 31 7 English 11 3 Northern Sotho 5 1 Education (N=429) None 28 7 Some primary 195 45 Some secondary 170 40 Tertiary 36 8 Current crime classification (N=431) Violent/aggressive 198 46 Sexual 129 30 Economic 104 24 Length of sentence (N=411) Less than 10 years 19 5 11-40 years 294 71 More than 40 years 17 4 Life 81 20 Characteristic Total sample (N=442) % Table 2: Prevalence of antisocial personalities Psychopathy: Total 114 27% Low psychopathy (60-69) 25 6% Moderate psychopathy (70-79) 58 14% High psychopathy (≥80) 31 7% Antisocial personality disorder 77 17% Dissocial personality disorder 185 38% N = 442 N = 414 (PPI-R psychopathy) Total % of total N CQ No. 36 - June 2011 7/5/11 10:24 AM Page 38 SA Crime Quarterly no 36 • June 2011 35 38% and 49% of the offender population.23 Estimations of the prevalence of ASPD among offender populations are as high as 80%.24 However, another South African study similar to this research indicates a prevalence of ASPD of only 12% among an unsentenced offender sample.25 The prerequisite of conduct disorder in the diagnosis of ASPD could influence the low prevalence of the disorder among offenders in South Africa. Most South African cultures still advocate a collectivistic way of living, with extended families and community engagement central to children’s upbringing. Children are not necessarily involved in antisocial behaviour from a young age, but poverty-related issues, unemployment, and the effects of HIV/AIDS might influence future antisocial behaviour and increase the allure of crime. DPD traits The number of participants meeting the criteria for DPD represented 42% of the total sample (Table 2). Although slightly higher, this finding seems to confirm other reports of DPD, ranging from 20% to 40% in offender samples.26 Smal and Louw27 reported a much lower incidence (5%) of DPD among an unsentenced offender sample in South Africa. The discrepancy in prevalence of DPD could be attributed to the lack of a culture- specific standardised measure to assess traits related to DPD, as well as the lack of sufficient research studies to compare results. In addition, the relatively low reliability of the DIP-Q’s DPD subscale could impact on the results of the current study. CONCLUSION This study aimed to contribute to the ongoing battle against crime in South Africa by refocusing attention beyond the known social factors that contribute to criminal and antisocial behaviour. The main findings indicate a similar prevalence of traits associated with psychopathy and dissocial personality disorder to those found in international studies. Together with reaffirming the dimensionality of psychopathy, this finding also supports the notion of differing cross- cultural expressions of antisocial traits. However, additional research on the topic is needed. The significantly lower prevalence of antisocial personality disorder also emphasises the need for additional research concerning cultural influences on the manifestation of mental disorders. However, this study is not without limitations. Comprehension and language differences were evident throughout the study. Even though the use of translators aided with the interpretation of the measures, differences in comprehension in terms of the context were still evident. The lack of comprehension of certain concepts could also affect the reliability of the measure. In addition, the measuring instruments used to identify ASPD and DPD criteria did not allow for the dimensional nature of these disorders. Against this background it is recommended that the exploration of antisocial personalities in the South African context be extended to include other vulnerable populations, including female offenders, youth offenders, as well as the community in general. To comment on this article visit http://www.issafrica.org/sacq.php NOTES 1. Department of Correctional Services, Annual Report for the 2008/2009 Financial Year, 2009, http://www.dcs. gov.za; South African Police Service, Annual Report, 2010, www.saps.gov.za. 2. G Demombynes and B Ozler, Crime and local inequality in South Africa, Journal of Development Economics, 76, 2005, 265-292; SAPS, Annual Report, 2010. 3. DCS Annual Report, 2009; A Louw, Crime and perceptions after a decade of democracy, Social Indicators Research, 81, 2007, 235-255. 4. M Dolan and M Doyle, Psychopathy: Diagnosis and implications for treatment, Psychiatry, 6(10) (2007), 404-408; RD Hare, SD Hart and TJ Harpur, Psychopathy and the DSM-IV criteria for antisocial personality disorder, Journal of Abnormal Psychology, 100, (1991), 391-398; S Porter and M Woodworth, Psychopathy and Aggression, in CJ Patrick (ed.), Handbook of Psychopathy, New York: Guilford Press, 2006, 481-494; RJ Snowden, NS Gray, J Smith, M Morris and MJ MacCulloch, Implicit affective associations to violence in psychopathic murderers, The Journal of Forensic Psychiatry and Psychology, 15(4) (2004), 620-641. CQ No. 36 - June 2011 7/5/11 10:24 AM Page 39 36 Institute for Security Studies 5. P Babiak and RD Hare, Snakes in suits: When psychopaths go to work, New York: Harper Collins Publishers Inc., 2006; JF Hemphill, RD Hare and S Wong, Psychopathy and recidivism: A review, Legal and Criminological Psychology, 3, (1998), 141-172; DJ Simourd and RD Hoge, Criminal psychopathy: A risk- and-need perspective, Criminal Justice and Behaviour, 27(2) (2000), 256-272; NJ Wilson, New Zealand high- risk offenders: Who are they and what are the issues in their management and treatment? New Zealand: Department of Corrections Psychological Service, 2004; S Wojciechowski, Criminogenic risk/need and responsivity: The psychopathic offender, Paper presented at Probation and Community Corrections: Making the Community Safer Conference, convened by the Australian Institute of Criminology and the Probation and Community Corrections Officers’ Association Inc. Perth, Australia, 23-24 September 2002. 6. American Psychiatric Association, The Diagnostic and Statistical Manual of Mental Disorders, Washington, DC: APA, 1952; 2nd ed., 1968; 3rd ed., 1980; 4th ed., 1994; American Psychiatric Association, The Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text revision). Washington DC: APA, 2000; H. Cleckley, The mask of sanity, St. Louis: Mosby, 1941. 7. H. Cleckley, The mask of sanity, 1941. 8. APA, The Diagnostic and Statistical M anual of Mental Disorders, 1952; 2nd ed., 1968. 9. APA, The Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., 1980. 10. RD Hare, Psychopathy and antisocial personality disorder: a case of diagnostic confusion, Psychiatric Times, 13, 1996, 39-40. 11. APA, The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision, 2000. 12. Hare, Psychopathy and antisocial personality disorder, 1996, 39-40. 13. TA Widiger, AJ Frances and TJ Trull, Personality disorders, in RJ Craig (ed.), Clinical and diagnostic interviewing (221-236), New Jersey: Jason Aronson, 1989. 14. RD Hare, A research scale for the assessment of psychopathy in criminal populations, Personality and Individual Differences, 1, 1980, 111-119; RD Hare, The Hare Psychopathy Checklist-Revised, Canada: Multi- Health Systems, 1991; RD Hare, The Hare Psychopathy Checklist-Revised (PCL-R; 2nd ed.), Ontario: Multi- Health Systems, 2003. 15. Dolan and Doyle, Psychopathy: Diagnosis and implications for treatment, 2007, 404-408; Hare, The Hare Psychopathy Checklist-Revised (PCL-R; 2nd ed.), 2003; M Hildebrand and C de Ruiter, PCL-R psychopathy and its relation to DSM-IV Axis I and II disorders in a sample of male forensic psychiatric patients in the Netherlands, International Journal of Law and Psychiatry, 27, 2004, 233-248. 16. JRP Ogloff, Psychopathy/antisocial personality disorder conundrum, Australian and New Zealand Journal of Psychiatry, 40, 2006, 519-528. 17. SO Lilienfeld and MR Widows, Professional manual for the Psychopathic Personality Inventory-Revised, Florida: Psychological Assessment Resources, 2005. 18. The items are answered using a 4-point Likert-type scale. International studies have reported satisfactory construct, convergent and discriminant validity, and Cronbach’s alpha coefficients have been found to range from 0,71 to 0,84, and 0,91 in an American offender sample and a Belgian community sample respectively. Lilienfeld and Widows, Professional manual for the Psychopathic Personality, 2005; K Uzieblo, B Verschuere, E van den Bussche and G Crombez, The Validity of the Psychopathic Personality Inventory-Revised in a Community Sample, Assessment, 17(3) (2010), 334-346. 19. H Ottosson, O Bodlund, L Ekselius, E Lindström, L Von Knorring, G Kullgren and S Söderberg, The DSM- IV and ICD-10 Personality Questionnaire (DIP-Q): Construction and preliminary validation, Nordic Journal of Psychiatry, 49, 1995, 285-291. The question-naire consists of 140 true/false items and encompasses all of the eight ICD-10 and all of the ten DSM-IV personality disorders’ criteria. Only the two subscales measuring DPD and ASPD were used in this study. 20. Ibid. 21. DK Marcus, SL John and JF Edens, A taxometric analy- sis of psychopathic personality, Journal of Abnormal Psychology, 113(4) (2004), 626-635; DK Marcus, SO Lilienfeld, JF Edens, and NG Poythress, Is antisocial personality disorder continuous or categorical? A taxometric analysis, Psychological Medicine, 36, (2006), 1571-1581. 22. J Coid and M Yang, The epidemiology of psychopathy, Presented at the 6th Annual International Association of Forensic Mental Health Services Conference, Amsterdam, 14-16 June 2006, http://www.iafmhs.orgiafmhs.asp?pg= pastconf; Hare, Psychopathy and antisocial personality disorder, 39-40; RD Hare, D Clark, M Grann and D Thornton, Psychopathy and the predictive validity of the PCL-R: An international perspective. Behavioral Sciences and the Law, 18, 2000, 623-645; ML Lalumière, GT Harris and ME Rice, Psychopathy and developmental instability, Evolution and Human Behaviour, 22, 2001, 75-92. 23. APA, The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text revision, 2000; S Fazel and J Danesh, Serious mental disorders in 23 000 prisoners: A systematic review of 62 surveys, Lancet, 359, 2002, 545-550; LS Guy, NG Poythress, KS Douglas, JL Skeem and JF Edens, Correspondence between self-report and interview-based assessments of antisocial personality disorder, Psychological Assessment, 20(1) (2008), 47-54; N Singleton, H Meltzer and R Gatward, Psychiatric Morbidity among Prisoners in England and Wales, London: Office for National Statistics, 1998. 24. Hare, The Hare Psychopathy Checklist-Revised (PCL-R; 2nd ed.), 2003. 25. M Smal and DA Louw, Psychopathy, Antisocial Personality Disorder and Dissocial Personality Disorder in a Group of Unsentenced Prisoners, Manuscript submitted for publication, 2009. 26. R Ille, F Lahousen, F Rous, P Hofmann and HP Kapfhammer, Personality profile and psychic deviations in offenders examined for psychiatric-forensic appraisal, Nervenarzt, 76, 2005, 52-60; S Ullrich, P Borkenau and A Marneros, Personality disorders in offenders: categorical versus dimensional approaches, Journal of Personality Disorders, 15, 2001, 442-449. 27. Smal and Louw, Psychopathy, Antisocial Personality Disorder and Dissocial Personality Disorder, 2009. CQ No. 36 - June 2011 7/5/11 10:24 AM Page 40