Structural Equation Modelling of Primary and Secondary Vulnerability of Psychopathic Disorder Based on Behavioral Brain Systems in Medical Students

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Extended Abstract
Background
Cleckley introduced psychopathy as a type of personality disorder in his book "The mask of sanity". Psychopathy includes chronic behavioral disorders, emotional and interpersonal defects, as well as some positive and adaptive characteristics. In this regard, Karpman also identified phenotypic similarities such as self-centeredness, cruelty, and anti-socialism. Karpman coined the term "idiotapic psychopathy", which specifically refers to people with inherited emotional deficits that prevent the formation of a conscience and, thus, lead to a predatory and fearless personality. In contrast, he used the term "symptomatic psychopathy" to refer to those who become psychopathic due to peripherally acquired emotional disorder, which distorts the formation of conscience and, thus, results in deeper neurotic conflicts.In an experimental study on the Karpman hypothesis, Ronald Blackburn identified two subgroups of psychopaths that resembled idiopathic and symptomatic groups. He called the psychopathic group with low levels of neuroticism “primary psychopathy”, and the other group with high levels of anxiety and depression "secondary psychopathy".Fowles, whose insights are based on Gary’s biopsychological theory of personality, described the concepts of primary and secondary psychopathy. According to this theory, humans have two opposite motivational effects. One is the effect of an inhibition system which refers to a behavior that acts to increase arousal against signs of punishment, inhibition, non-rewarding behavior, or occurrence of such conditions (e.g., passive avoidance). Another system is called the Behavioral Activator System, which works to increase arousal against anticipated rewards.Therefore, the present study aimed to examine the relationship between personality traits for predicting psychopathy in normal people. To this end, the present study attempted to answer the question “what is the role of behavioral brain systems in psychopathic disorder?” based on the structural equation modelling.
Methods
This correlational research study was conducted based on structural equation modelling. The statistical population of the study included all medical students of Tabriz University of Medical Sciences in the academic year 2018-2019. A total of 284 students were selected through convenience sampling method according to the year of university entrance, and the number of participants was determined based on Krejcie and Morgan table. To test the hypotheses, the structural equation modelling of the LISREL software was used. For data collection, two scales of Levenson Self-Report Psychopathy Scale and Carver and White scale-behavioral systems scale were used.
Results
When testing the research hypotheses, the structural equation modelling revealed that behavior activation system and behavior inhibition system played a major role in primary and secondary psychopathy. According to the results from the descriptive statistical analysis, the primary psychopathy was found to be below the average in the study sample with mean score of 11.63±34.33 and so was the secondary psychopathy with mean score of 23.3±7.36. Behavior inhibition system as well as behavior activation system were both found to be below the average in the study sample with mean of 17.36±4.46 and 31.18±6.36, respectively.When examining the relationships between variables, the results of Pearson correlation test showed that there was a significant negative relationship between behavioral inhibition systems with a coefficient of -0.39 and primary psychopathy (P<0.01). A significant direct relationship was also detected between behavior activation systems with a coefficient of 0.55 and primary psychopathy (P<0.01). There was a significant negative relationship between behavioral inhibition systems with a coefficient of -0.47 and secondary psychopathy (P<0.01). A significant direct relationship was also observed between behavior activation systems with a coefficient of 0.52 and secondary psychopathy (P<0.01).
Conclusion
The activity level of behavioral brain systems was one of the factors contributing to the occurrence or persistence of these psychopathic behaviors. Studying the biological characteristics of personality in normal people may have helped the researchers and clinicians to identify the community-based protective and preventive factors and, therefore, prevent the occurrence of psychopathic behaviors.