Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets.

The National Institute of Mental Health Research Domain Criteria initiative (Insel et al., 2010) calls for a focus on biologically meaningful dimensional constructs in the study of clinical problems. Examples are needed of how Research Domain Criteria constructs can be linked to clinical problems. We examined how two such constructs, threat sensitivity (THT+) and weak inhibitory control (INH−), operationalized using scale measures of fear/fearlessness and inhibition/disinhibition dimensions from established structural models, predicted symptoms of multiple Diagnostic and Statistical Manual of Mental Disorders (4th edition) clinical disorders in 471 community adults. Robust relationships with internalizing disorder symptoms were evident for both trait variables, with THT+ more predictive of fear disorder symptoms and INH− more predictive of distress disorder symptoms. For substance-related problems, prediction was evident only for INH−. Additionally, interactive effects of THT+ and INH− were found for distress disorders, and to a lesser extent, fear disorders. Given their well-established physiological correlates, these dispositional variables represent prime targets for combined psychometric–neurophysiological assessment of broad liabilities to multiple forms of psychopathology.

Clarifying the nature and origins of psychopathy is crucial to establishing effective methods for treating this severe form of pathology. The Triarchic Model of Psychopathy (Patrick, Fowles, & Krueger, 2009) is presented as a framework for resolving historic debates regarding the nature of psychopathy, and for guiding research on neurobiological influences contributing to its characteristic symptom picture. Evidence is reviewed for two distinct processes underlying "boldness" and "disinhibition" components of psychopathy in particular: underreactivity of the brain's defensive motivational system, and impairment in fronto-cortical regulatory circuitry. A third symptomatic facet, "meanness" (or callous-unemotionality) is theorized to reflect dysfunction in brain systems important for emotional empathy, and in endogenous neuromodulators such as oxytocin and vasopressin. We discuss how this variegated perspective on the nature and etiology of psychopathy can inform approaches to treatment. Specifically, focusing on feedback-based response modification and attentional retraining approaches as examples, we describe how specific neurobiologically-informed interventions might be developed to address distinct symptomatic components of psychopathy.

Threat sensitivity (THT) and weak inhibitory control (or disinhibition; DIS) are trait constructs that relate to multiple types of psychopathology and can be assessed psychoneurometrically (i.e., using self-report and physiological indicators combined). However, to establish that psychoneurometric assessments of THT and DIS index biologically-based liabilities, it is first important to clarify the etiologic bases of these variables and their associations with clinical problems. The current work addressed this important issue using data from a sample of identical and fraternal adult twins (N = 454). THT was quantified using a scale measure and three physiological indicators of emotional reactivity to visual aversive stimuli. DIS was operationalized using scores on two scale measures combined with two brain indicators from cognitive processing tasks. THT and DIS operationalized in these ways both showed appreciable heritability (.45, .68), and genetic variance in these traits accounted for most of their phenotypic associations with fear, distress, and substance use disorder symptoms. Our findings suggest that, as indices of basic dispositional liabilities for multiple forms of psychopathology with direct links to neurophysiology, psychoneurometric assessments of THT and DIS represent novel and important targets for biologically-oriented research on psychopathology.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) bridges a significant gap in psychiatric nosology by providing trait-based characterizations of psychopathy along with antisocial personality disorder within the Section III alternative model for personality disorders (AMPD). However, the representation of psychopathy in the AMPD has met with some criticisms (Crego & Widiger, 2014; Few, Lynam, Maples, MacKillop, & Miller, 2015). The current study was undertaken to establish an improved means for characterizing psychopathy in DSM–5 Section III terms, by creating scale measures of triarchic psychopathy dimensions using items from the best-established assessment instrument for the AMPD, the Personality Inventory for DSM–5 (PID-5). Using data from a sample of community adults (N = 210), we employed a construct rating and psychometric refinement approach to develop item-based PID-5 Triarchic scales for measuring psychopathy dimensions of boldness, meanness, and disinhibition. The validity of the PID-5 Triarchic scales was then evaluated in relation to criteria including other scale measures of the triarchic constructs and psychopathy, self-reported antisocial behavior and substance use, empathy, internalizing and other clinical problems, and personality within the development sample and a separate independent sample of adults (N = 240) recruited to have elevated psychopathic traits. Results of this work provide a foundation for improved characterization of psychopathy in terms of the AMPD trait system and provide a mechanism for future research oriented toward clarifying the developmental interface between childhood conduct disorder and psychopathy, as well as identifying neurobiological correlates of dimensions of psychopathy.