A STUDY OF ANXIETY IN THE SOCIOPATHIC PERSONALITY1

DAVID T. LYKKEN University of Minnesota

HE concept of the psychopathic personality includes so heterogeneous a group of behavior disorders as to be at least two steps removed from the level of useful psychiatric diagnosis. Sociopathic personality is a more recent designation (1) which refers to a subgroup of these disorders in which the pathognomic characteristics are impulsiveness, antisocial tendencies, immorality, and a seemingly self-destructive failure to modify this pattern of behavior in spite of repeated painful consequences. This category may be regarded as a genus composed of phenotypically similar, but etiologically distinct, subtypes such as the dissocial and the neurotic sociopaths. A third species has been described (3, 12, 13, 14, 17), which may be called primary sociopathy, in which neither neurotic motivations, hereditary taint, nor dissocial nurture seem to be determining factors. Cleckley (3) has reported the chief clinical characteristic of this group as a lack of the normal affective accompaniments of experience. If this observation is correct, it would point the way toward accurate diagnostic isolation of primary sociopathy as well as guiding research into the question of its etiology. Classification according to the presence or absence of defective emotional reactivity, therefore, satisfies one criterion of useful diagnosis in that it shows promise of relationship to the as yet unknown origins of the disorders to be distinguished. The other requirement for useful diagnosis is that the criteria of classification must be objective. Clinical assessment of the "normality of the affective accompaniments of experience" is subjective and unreliable. In consequence, Cleckley's work has had as yet little real impact on psychiatric practice. By expressing this putative defect of the primary sociopath in terms of the anxiety construct of experimental psychology (18, 19, 20, 21, 22),
1 Drawn from a thesis submitted to the University of Minnesota in partial fulfillment of the requirements for the degree of Doctor of Philosophy. The author is indebted to his adviser, Professor Ephraim Rosen, and to others whose assistance aided in the completion of this research.

it becomes susceptible to quantification and empirical test. An experimental hypothesis may now be formulated. Among persons conventionally diagnosed as psychopathic personality, those who closely resemble the syndrome described by Cleckley are (a) clearly defective as compared to normals in their ability to develop (i.e. condition) anxiety, in the sense of an anticipatory emotional response to warning signals previously associated with nociceptive stimulation. Persons with such a defect would also be expected to show (b) abnormally little manifest, anxiety in life situations normally conducive to this response, and to be (c) relatively incapable of avoidance learning under circumstances where such learning can only be effected through the mediation of the anxiety response. METHOD The Sample
The extreme heterogeneity, even on the crudest descriptive level, of persons diagnosed as psychopathic personalities in various clinical or institutional settings complicated the selection of an appropriate experimental sample. The institution psychologists2 were given a list of 14 criteria drawn from Cleckley (3, pp. 355-392) and were asked to compare against these criteria those inmates diagnosed as psychopathic personality. Inmates who, in their opinion, best fitted the Cleckley prototype were listed as candidates for experimental Group I, the primary sociopathic group. Inmates who they felt did not meet the criteria in important respects were listed as candidates for experimental Group II, designated as the neurotic sociopathic group. In this selection process, the psychologists were asked to reaffirm the original diagnosis, discarding from consideration for either group those inmates who, in their present opinion, would not be diagnosed as psychopathic personality at all. A control Group III of 15 "normals," roughly comparable in age, intelligence, and socioeconomic background, was selected from the University General College and a local high school. Group I, composed of 12 males and 7 females, had a
2 The writer is indebted to the administrators and to the psychologists of the Minnesota State Reformatory, St. Cloud, Minnesota; the Minnesota State Reformatory for Women, Shakopee, Minnesota; the State Home for Girls, Sauk Centre, Minnesota; and the St. Peter State Hospital, St. Peter, Minnesota.

A STUDY or ANXIETY IN THE SOCIOPATHIC PERSONALITY

mean age of 21.6 years (SD = 4.3), and a mean IQ of 109.2 (SD = 10.7). Group II included 13 males and 7 females, had a mean age of 24.S years (SD = 5.4), and a mean IQ of 104.5 (SD = 8.8). For the 10 male and 5 female normals, the mean age was 19.07 (SD = 3.2), and the mean IQ 100.4 (SD - 10.2). None of these group differences were significant. shocking electrode was attached to 5's nondominant hand, the GSR electrodes being already in place on the dominant hand. The S was told that after the blindfold had been replaced, he was to sit as quietly as possible for the next 30 to 40 minutes, during which time he would periodically hear a buzzer (which was then demonstrated) and occasionally receive a brief electric shock. When the S was seated comfortably and relaxed insofar as possible, the recording apparatus was started and the conditioning series (CS) begun. Two buzzers were used which were distinguishably different in timbre rather than in pitch, the difference being one not easily labeled (to minimize verbal mediation of a discrimination between them). Buzzer No. 1 was used as the CS and was the only one reinforced; buzzer No. 2 was used to test for generalization effects. In all cases, stimuli of the conditioning series were presented as soon as GSR activity from preceding stimuli had subsided, the intertrial interval being therefore not constant within or between 5s, but averaging between 20 and 60 seconds. (This method of stimulus timing automatically eliminates temporal conditioning.) When turned on, the buzzers sounded for a period of 5 seconds, controlled by an automatic timer. The reinforcing stimulus or UnCS was an electric shock from a 700-volt AC supply through two 68,000ohm series resistors, presented automatically for about 100 milliseconds just before the termination of the CS (buzzer No. 1). The shock was applied between an electrode on the palm of one hand and the GSR ground electrode on the palmar tip of the middle finger of the opposite hand. The shock sensation was felt mainly on the richly innervated finger tip and was a decidedly unpleasant stimulus, producing in most cases a pronounced startle reaction and in all cases a strong GSR. The sequence of trials or stimulus presentations was as follows: 1. To permit the adaptation of unconditioned GSR to the buzzers themsel-vea,_gtimuli were first presented without shock reinforcement for a total of 10 trials in the order 2, 1] 2, 1, S, 2, 2, 1, 1, 1, 1. A single preliminary shock was given in the series at the point S, separated by at least 30 seconds from the buzzers occurring before and after it. 2. Seven consecutive shock-reinfptced presentations of the CS were given as the conditioning series, followed by four more reinforcements interspersed with four unreinforced trials with buzzer No72tiT~the order 1, 1, 1, 1, 1, 1, 1, 2, 1, 2, 2, 1, 2, 1, 1. 3. A total of 24 extinction trials was then given, the two buzzer stimuli being presented in the order 1, 2, 1, 1, 2, 1, 2, 1, 1, 2, 1, 1, 1, 1, 2, 2, 1, 2, 1, 1, 2, 1, 1, 1. Considering only the CS, buzzer No. 1, the series therefore consisted of 6 prereinforcement trials, 11 reinforced conditioning trials, and 16 extinction trials. Skin resistance was measured by a modification of a circuit suggested by Flanders (6) which passed an electronically regulated constant DC current of 40 microamperes through S. The electrodes were curved discs of Monel metal, 15 mm. in diameter, applied to the palmar surface of the distal phalange of the first, second, and third fingers of the same hand. The skin surface was first scrubbed with alcohol and then coated with Sanborn electrode paste. The exosomatic current was applied between the first and third fingers, which were

The Measures and Testing Procedure

It was necessary to do the testing at the several institutions under varying conditions. In all cases, however, the apparatus was arranged on a large table, the experimenter on one side and the subject (S) seated comfortably opposite. The S was told that he was assisting in a psychological experiment having no bearing on his personal record and that his performance would be treated with strict anonymity. An attempt was made throughout to keep the testing on an informal basis. As an indicant of manifest anxiety as referred to in hypothesis b, an "Anxiety Scale" was constructed expressly for this study to supplement the Taylor scale and Anxiety Index which appear to be more strongly loaded on a factor of neurotic self-description. In this new scale, each of the thirty-three items involves two statements of activities or occurrences, matched for general unpleasantness or unclesirability according to a modified Thurstone scaling procedure utilizing 15 college student judges. One activity of each pair is unpleasant, presumably because of its frightening or embarrassing character (e.g., "making a parachute jump" or "knocking over a glass in a restaurant"). The paired activity is intended to be onerous but not frightening (e.g., "digging a big rubbish pit" or "cleaning up a spilled bottle of syrup"). The 5 is required to choose that member of each pair which he would prefer as a lesser of evils. The degree to which the "frightening" alternatives are rejected is interpreted as an index of the extent to which anxiety determines behavior choices within the range of life situations sampled by this test. The booklet form of the MMPI was used and the answer sheets scored and ^-corrected in the usual way (10). The Anxiety Index, or AI, was calculated according to the formula given by Welsh (23). The Heineman form (11) of the Taylor scale was given and scored by subtracting the number of "anxiety" items rejected as "least applies to me" from the number endorsed as "most applies to me." An avoidance learning test was given to determine whether there were group differences in capacity to learn on the basis of anxiety reduction (hypothesis c). It involved an elaborate, electrically operated mental maze which the S was given 20 trials to learn (the "manifest task"). At each of the 20 choice points in this maze, choice of one of the 4 possible alternatives (always an error alternative) gave an electric shock. It was intended that social and ego rewards should reinforce performance in the manifest task. Performance on the "latent task," which was to avoid the shocked alternativesto err instead on the unshocked alternativeswas presumably reinforced only through anxiety reduction. The measure of anxiety conditionability (hypothesis a) employed the GSR as the dependent variable. A

DAVID T. LYKKEN
also connected to the push-pull input grids of a Sanborn Model 126 DC amplifier, driving a Sanborn Model 127 recording milliameter. The electrode on the second finger was connected to amplifier and external ground. The instrument was calibrated before each use and provided a linear record of resistance and resistance change, accurate to less than 50 ohms. All GSRs were recorded in terms of resistance change. A variety of transformations was then applied and tested against the usual criteria of normality of distribution, correlation with basal resistance, and homogeneity of variance across people with respect to several test stimuli (2, 8, 9, 16). The result of this analysis was that each resistance change was expressed as the logarithm of the ratio of that change to the mean resistance change produced by the first sbc electric shocks. This unit expresses the galvanic CR as a proportion of the individual's UnCR and, for a conditioning study, seems quite appropriate for individual comparisons. Three GSR indices were derived from the protocols of the conditioning series: (a) GSR Reactivity, which is the mean GSR to the CS. during the fourth through seventh conditioning trials; (6) GSR Conditioning, which is equal to (a) minus the mean GSR to the last three preconditioning trials and the last three extinction trials (this index measures essentially the slope of the conditioning curve or the increment actually produced by the reinforced trials); (c) GSR Generalization, the ratio of the mean GSR to buzzer No. 2 during early extinction trials 18, 20, 21, 23 to the mean GSR to buzzer No. 1 during trials 17, 19, 22, 24. The testing sequence was as follows: (a) Anxiety scale; (i) GSR Conditioning series; (c) Avoidance Learning test; (d) MMPI (given during the week following the foregoing individual testing); (e) Taylor Manifest Anxiety Scale, forced-choice form given later with the MMPI.

RESULTS AND DISCUSSION Scores on all measures were converted for easier comparison to a standard score form with each distribution having a grand mean of
TABLE 1 GROUP MEANS ON ALL MEASURES: SIGNIFICANCE TESTS* Group
Measure d-Test

II 556 557 511 547 501 494 483 542

ill 462 464 529 395 558 534 1 551 490

prob.t
.01 .01

Taylor Scale Anxiety Index Anxiety Scale MMPI PJ-Scale Avoidance Learning GSR Reactivity GSR Conditioning Generalization

471 472 470 532 461 498 478 473

.05 .05 .01 .05 .05 '

* All measures converted to a scale having an over-all mean of 500 and SD of 100. t Probabilities given are for significance of largest difference (e.g., Ill I for GSR Conditioning). Significance test was Festinger's distribution-free 'd* test (5).

500 and a standard deviation of 100. Group means on all measures, together with significance test results, are given in Table 1. It would clearly be too much to expect of the judgments based upon the Cleckley criteria that they should have perfectly separated the psychopathic sample into a "primary" species in Group I, and a neurotic or dissocial species in Group II. That the separation was reasonably good, however, is supported by the finding that Group II scored significantly higher than the normals on the Taylor scale, a great deal of evidence having accumulated (4, 7, 15) to indicate that this scale is primarily a measure of neurotic maladjustment or neuroticism rather than of anxiety level or anxiety reactivity per se. On the MMPI Anxiety Index, which like the Taylor scale is unquestionably polydimensional with a heavy loading on neuroticisrn, Group II again has the highest mean, with Group I again only slightly higher than Group III. In contrast, the Anxiety scale, which was designed for this study and which is not loaded on neuroticisrn and only negligibly correlated with the Taylor scale or the AI, separated the groups in a different order. On this test, the primary types of Group I show the least anxiety reactivity, significantly less than the normals, with Group II falling in between but rather nearer to the Group III mean. This result appears to support hypothesis b of this study, that the subset of primary sociopaths show abnormally little manifest anxiety, i.e., anxiety reactivity to the real-life anxiety stimuli referred to in the questionnaire. Both sociopathic groups scored significantly higher than the normals on the Pd scale of the MMPI, but this measure, which differentiates at the phenotypic or genus level, does not distinguish between the types or species of sociopathy represented in Groups I and II. Schedule difficulties unfortunately led to a reduction in the number of iSs to whom the avoidance learning test could be given. With nearly half of the total group, the available testing time was too short to cover all of the procedures; in such cases the avoidance test, requiring nearly an hour to give, was passed over. Even on the residual sample of 34 Ss, however, rather clear-cut differences exist. As a crude, overall index of avoidance learning, the avoidance scores (shock errors divided by

A STUDY OF ANXIETY IN THE SOCIOPATHIC PERSONALITY unshocked errors) were averaged for all but the first of the 20 trials; this is the basis of the mean scores entered under "avoidance" in Table 1. The distribution was reversed to make high values represent greater avoidance of the shock. It is impossible, of course, to summarize adequately a complex learning process by a single numerical index of this sort, but in spite of these limitations, it is striking that Group I (primaries) shows the least avoidance as expected, Group II (neurotics) next, and Group III (normals) the most. The Group I versus Group III, and Group II versus Group III differences are significant by Festinger's d-test (5), and the actual distribution of scores shows the groups to be remarkably well separated (only 17 per cent overlap between Groups I and III). This result supports hypothesis c of this study, that the primary sociopath demonstrates defective avoidance learning. Results of the GSR Conditioning Series Of all the tests employed here, principal emphasis should be laid on GSR conditioning. The various difficulties attending the interpretation of GSR data are well known, but one fact stands out with relative certainty: given certain necessary conditions, if an S does not produce a GSR to a stimulus, one can be sure that he has not "reacted emotionally" to that stimulus. The two numerical indices which were derived as alternative ways of representing in a single value the conditioning indicated by the GSR protocols (anticipatory GSR to the buzzer after several pairings with shock) have already been described. As shown in Table 1, the group means are in the expected order on both indicants, with Group . I .^significantly lower than Group III on GSR.Reactivity and GSR Conditioning (.05 level, <Z-test). ~" A somewhat more meaningful comparison is obtained by contrasting the reactivity by trials for the three groups. Group I shows the least GSR reaction to the CS in 14 out of the 16 double trials. Group II is significantly higher (.02 level) than Group I at the end of the extinction trials. The positions of Group II and Group III interchange during the series with Group II beginning to show greater reactivity during the extinction trials, suggesting a perseveration (failure of extinction) of the anxiety response in the neurotic group. This trend was tested for statistical reliability by correlating the differences between Group II and Group III with the ordinal position in the conditioning series at which the difference was taken. The quadrant sign test (24) shows this association to be significant at the .01 level. This result supports hypothesis a of this study, that the primary sociopath is defective in his ability to condition the anxiety response. The generalization scores were leptokurtically distributed, the group differences being determined by a few deviant 5s. Group II shows the highest mean generalization score, but the differences are not significant. SUMMARY Forty-nine diagnosed psychopaths were divided into two groups according to the descriptive criteria of Cleckley. Fifteen normals served as controls. A battery of tests related to anxiety reactivity or anxiety conditionability were administered. As compared with normals, the Cleckley, or "primary" sociopaths, showed significantly less "anxiety" on a questionnaire device, less GSR reactivity to a "conditioned" stimulus associated with shock, and less avoidance of punished responses on a test of avoidance learning. The "neurotic" sociopaths scored significantly higher on the Taylor Anxiety Scale and on the Welsh Anxiety Index.
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