Journal of Personality Disorders, Volume 30, 1-20, 2016

© 2016 The Guilford Press

LIMITED PROSOCIAL EMOTIONS
EDENS ET AL.

“A PSYCHOPATH BY ANY OTHER NAME?”:

JUROR PERCEPTIONS OF THE DSM-5 “LIMITED
PROSOCIAL EMOTIONS” SPECIFIER
John F. Edens, PhD, Elyse N. Mowle, BS, John W. Clark, PhD,
and Melissa S. Magyar, PhD

DSM-5 recently added the specifier “Limited Prosocial Emotions” (LPE) to

the Conduct Disorder (CD) diagnosis, yet little is known about how these
traits will affect attitudes toward CD youth. Laypersons attending jury duty
(N = 326) were randomly assigned to one of four case vignette conditions
in which a male juvenile offender was identified as having (a) CD symptoms
only, (b) CD symptoms plus a diagnostic label, (c) CD symptoms plus a
diagnostic label and description of LPE traits, or (d) CD symptoms plus a
description of LPE traits and a “psychopath” label. LPE traits led to more
negative perceptions of the youth (e.g., more dangerous, evil, and psycho-
pathic) and adding the psychopath label to the LPE specifier resulted in
somewhat stronger support for punishment and mandated treatment. The
LPE specifier may provide useful diagnostic information, but these findings
raise serious concerns that it will stigmatize youth in the legal system.

The release of the fifth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-5; American Psychiatric Association, 2013) has
been met with a considerable amount of debate and controversy (e.g., Fran-
ces, 2013; Krueger, 2013; more generally, see Markon, 2013). Among the
litany of concerns that have been expressed is that various new and revised
diagnostic categories have considerable potential for misuse and abuse, par-
ticularly in relation to the legal system (Frances & Halon, 2013; Knight &
Thornton, 2011). Conduct disorder (CD), characterized by behaviors that
involve the violation of societal rules and the rights of others, was left un-
changed in terms of the diagnostic criteria in DSM-5. Because research over
the years has highlighted the heterogeneity of youth conduct problems, how-
ever, a distinct subtype of CD was added to this edition that reflects “cal-
lous and unemotional” (CU) characteristics (Frick, Ray, Thornton, & Kahn,
2014). The four defining features of this subgroup of CD youth—who would
receive the specifier “with limited prosocial emotions” (LPE) as a means of
identifying those who exhibit these CU traits—are lack of remorse or guilt,
From Department of Psychology, Texas A&M University (J. F. E., E. N. M.); Department of Criminal
Justice, Legal Studies, and Homeland Security, Northeastern State University, Tahlequah, Oklahoma (J.
W. C.); and Department of Psychology and Philosophy, Sam Houston State University (M. S. M.).
The authors have no conflicts of interest to report regarding this research.
Address correspondence to John F. Edens, PhD, Department of Psychology, Texas A&M University,
TAMU 4235, College Station, TX 77843-4235. E-mail: johnedens@tamu.edu

1
2 LIMITED PROSOCIAL EMOTIONS

callousness or lack of empathy, lack of concern for their performance, and

shallow affect.
The traits described by the LPE specifier are phenotypically similar to
the characteristics associated with adult psychopathy (Hare, 2003; Pardini
& Fite, 2010). Both conduct problems and callousness in adolescents mod-
estly predict adult measures of psychopathy (Burke, Loeber, & Lahey, 2007;
Lynam, Caspi, Moffitt, Loeber, & Stouthamer-Loeber, 2007), and research
suggests that CU characteristics are associated with greater severity of anti-
social behavior (Frick, Stickle, Dandreaux, Farrell, & Kimonis, 2005; Par-
dini & Fite, 2010) and stronger genetic influence on children’s behavior (Vid-
ing, Blair, Moffitt, & Plomin, 2005) than CD alone. Research also suggests
relatively distinctive neurological and biological correlates for youth with
CU traits, including reduced amygdala response to fearful faces and reduced
startle responses to aversive sounds, both of which are associated with low
emotional reactivity (Jones, Laurens, Herba, Baker, & Viding, 2009; Marsh
et al., 2008; Syngelaki, Fairchild, Moor, Savage, & van Goozen, 2013).
Based on the developing literature, it seems that the LPE specifier for CD
may provide important diagnostic information in research, clinical, and fo-
rensic/correctional contexts. There are, however, various concerns that have
been expressed about the use of this particular specifier in applied settings,
as well as the application of psychopathic traits to youth more generally
(Seagrave & Grisso, 2002). For example, this categorical specifier—like most
of the DSM (Krueger, 2013)—is based on a false dichotomy suggesting that
youth either do or do not exhibit these traits. One early taxometric study did
suggest that there were qualitative differences between youth high and low
on CU traits (Vasey, Kotov, Frick, & Loney, 2005). More recent research,
however, indicates that such characteristics occur on a continuum (Edens,
Marcus, & Vaughn, 2011; Murrie et al., 2007), similar to adult psychopathic
traits and other personality disorders (Haslam, Holland, & Kuppens, 2012).
Another more pragmatic concern about the LPE specifier is whether it
will be useful in applied settings for identifying youth at increased risk for ad-
verse outcomes (e.g., violence, recidivism). Although some research suggests
that, compared to other CD youth, children identified with CU traits engage
in more instrumental and premeditated aggression and commit more antiso-
cial behavior into adulthood (Frick et al., 2014; McMahon, Witkiewitz, &
Kotler, 2010), not all studies have been able to replicate such effects (Colins
& Vermeiren, 2013; Pardini, Stepp, Hipwell, Stouthamer-Loeber, & Loeber,
2012). In a related line of research, meta-analyses of the youth version of
the Psychopathy Checklist-Revised (PCL:YV; Forth, Kosson, & Hare, 2003)
suggest that its Factor 1 items—which are highly similar to the LPE specifier
traits—generally are not as predictive of general and violent misconduct as
are the Factor 2 items that tap antisocial and criminal history items (Edens
& Campbell, 2007; Edens, Campbell, & Weir, 2007; see also Asscher et al.,
2011; Cauffman, Kimonis, Dmitrieva, & Monahan, 2009).
Another major concern about this specifier is that numerous recent stud-
ies have called into question the interrater reliability of the assessment of
psychopathic personality traits with adult offenders in forensic contexts (De-
Matteo et al., 2013; Edens, Cox, Smith, DeMatteo, & Sörman, 2015; Mur-
EDENS ET AL. 3

rie, Boccaccini, Guarnera, & Rufino, 2013), particularly those interpersonal

and affective traits most consistent with the LPE specifier (Edens, Boccaccini,
& Johnson, 2010; Miller, Kimonis, Otto, Kline, & Wasserman, 2012; Sturup
et al., 2014). Although not widely researched to date, the limited data col-
lected thus far in DSM-5 field trials (Regier et al., 2013) offer little support
for the position that the assessment of LPE traits will be particularly reliable
(κ = .28, CI [−.05, .54]) in applied settings (Lahey, 2014). If this specifier
cannot be reliably assessed in the field, then it is difficult if not impossible to
envision that it will have a beneficial impact on legal decision-making among
youthful offenders.
Another prominent concern about the inclusion of LPE traits in DSM-5
is that the ramifications of youth being labeled with this new specifier have
yet to be examined in relation to important mental health, legal, and public
policy outcomes. DeMatteo et al. (2014) recently reported that adult psy-
chopathy scales appear to be widely used to inform legal decision-making in
criminal cases (e.g., parole determinations) and civil cases (e.g., sexually vio-
lent predator civil commitment), and adolescent scales are being used more
frequently as well (Edens & Vincent, 2008; Viljoen, MacDougall, Gagnon,
& Douglas, 2010). Survey research suggests that the label “psychopath” is
rarely invoked in juvenile cases, with less than 3% of experts reporting the
use of that specific term to describe youthful offenders (Viljoen, MacDou-
gall, & Vincent, 2010). However, it is common practice for mental health
experts to describe individual youths as having “characteristics associated
with psychopathy” (29%), and references to specific psychopathic traits
(without linking those traits directly to the term psychopathy) are exceed-
ingly common (46%). Given (a) the apparent widespread acceptance of the
use of psychopathic traits in the assessment of juvenile offenders and (b) the
fact that the legal system tends to view the DSM as “the bible” of psychiatric
diagnosis (Slovenko, 2011), it seems almost a foregone conclusion that the
LPE specifier will have a significant impact on forensic decision-making and
the adjudication of youth for the foreseeable future.
Although numerous publications have discussed the potential impact
and relevance of the new LPE specifier on etiological research (e.g., Lahey,
2014) and clinical assessment and treatment (e.g., Barry, Golmaryami, Rive-
ra-Hudson, & Frick, 2013), our literature review identified very little schol-
arly discussion of how the application of this specifier to real-world cases
might adversely affect youth, particularly those involved in the legal system.
According to Scheepers, Buitelaar, and Matthys (2011), various concerns
were expressed regarding the potentially stigmatizing effects of CU charac-
teristics during the developmental phases of DSM-5, but the term conduct
disorder was thought to be comparably prejudicial in relation to possible
labeling effects (Frick & Moffitt, 2010). Similarly, although acknowledg-
ing that no direct research on the potentially stigmatizing effects of the LPE
specifier had been conducted thus far, Frick and Nigg (2012) claimed that ex-
tant published research supported the opinion that “the term ‘psychopathy’
… does not have any more negative effects than using the term ‘conduct dis-
order’ itself” (p. 97) to describe children who engage in antisocial behavior.
4 LIMITED PROSOCIAL EMOTIONS

Would labeling a youth with the LPE specifier lead to stigmatization?

Although the LPE specifier itself has not been the focus of research to date,
a small but growing body of research has addressed the effects of ascribing
conduct disordered, psychopathic, and antisocial traits to adult and youthful
offenders. In terms of specific legal outcomes, identifying adult offenders as
psychopathic results in less support for insanity verdicts (Rendell, Huss, &
Jensen, 2010), greater perceived risk for future crime and violence (Edens,
Desforges, Fernandez, & Palac, 2004; Filone, Strohmaier, Murphy, & De-
Matteo, 2014), greater support for civil commitment among sex offenders
(Guy & Edens, 2006), and greater support for death sentences in capital
cases (Edens, Colwell, Desforges, & Fernandez, 2005). Juror support for
execution largely seems to be driven by perceptions of the affective and inter-
personal traits of psychopathy displayed by the defendant, such as lack of re-
morse, egocentrism, and manipulativeness (Edens, Davis, Fernandez Smith,
& Guy, 2013; see also Cox, Clark, Edens, Smith, & Magyar, 2013)—traits
that are very similar to those contained in the LPE specifier.
A few studies have investigated the influence of evidence concerning psy-
chopathy specifically on attitudes regarding juvenile offenders. Similar to
the adult literature, simulation studies indicate that compared to nonpsy-
chopathic youth, juveniles identified as psychopathic receive more restrictive
and punitive sanctions (e.g., Vidal & Skeem, 2007), such as death sentences
in mock capital murder trials (Edens, Guy, & Fernandez, 2003). In research
comparing the effects of a psychopathy label versus a CD diagnosis, Boc-
caccini, Murrie, Clark, and Cornell (2008) found that referring to a juve-
nile specifically as “a psychopath” led jurors to believe that the defendant
showed a greater risk for future crime and deserved greater punishment, not
only in comparison to defendants who were described with the diagnostic
criteria for CD, but also in comparison to youth described as “meeting cri-
teria for psychopathy.” However, a recent study comparing the effects of no
diagnosis, conduct disorder, and psychopathy diagnoses on verdicts, treat-
ment, and risk ratings found no significant differences between the conduct
disorder and psychopathy conditions (Blais & Forth, 2014), supporting the
Frick and Nigg (2012) claim that a diagnosis of psychopathy would have no
more impact than a diagnosis of conduct disorder.
These differential findings across studies may reflect differences in the
stimulus materials used. For example, relative to Boccaccini et al. (2008), the
description of conduct disorder used by Blais and Forth (2014) was relatively
more severe (see p. 134) and included characteristics such as violating social
norms, threatening to harm others, bullying, initiating fights, lying to get
what the defendant wants, and significant impairment in social and academic
functioning. In contrast, Boccaccini et al. defined conduct disorder more sim-
ply as being “characterized by a repetitive, persistent pattern of violating the
rights of others or age-appropriate social norms” (p. 510).
In addition to using somewhat differing definitions of relevant disorders,
much of the research in this area unfortunately has not included manipula-
tion checks to ascertain whether differing experimental conditions actually
have the intended effect of changing how participants view the mental health
status of the defendant (cf. Edens et al., 2005; Vidal & Skeem, 2007). It is
EDENS ET AL. 5

widely known that jurors view mental health evidence and mental health ex-
perts with skepticism (e.g., Boccaccini, Turner, Murrie, Henderson, & Che-
valier, 2013; Turner, Boccaccini, Murrie, & Harris, 2015), and it is therefore
conceivable that manipulations of diagnostic status may not have the in-
tended effects—which would subsequently diminish the likelihood of finding
differences in outcome measures (e.g., verdicts) across these groups.
Including ratings of how psychopathic a defendant is perceived to be
is useful not only for examining whether experimental manipulations have
had the intended effect; they also allow for an examination of whether such
attitudinal ratings actually predict criterion measures (e.g., juror decision-
making). Several simulation studies have found that attributions made about
psychopathic traits correlate with mock juror decision-making independent
of expert evidence (Cox et al., 2013; Edens et al., 2005; Edens, Davis, et al.,
2013; Guy & Edens, 2006). That is, jurors who perceive adult or juvenile
defendants to have psychopathic traits have more punitive attitudes toward
them, regardless of whether an expert witness or other source of informa-
tion specifically labeled or described them as psychopathic (see also Sundby,
1998).
In addition to supporting harsher legal sanctions, there is some evidence
that the perception of criminal defendants as being psychopathic in simula-
tion studies is relatively strongly associated with beliefs that they are also
evil (Edens, Clark, Smith, Cox, & Kelley, 2013). This is not particularly
surprising, given that jurors tend to identify individuals such as Ted Bun-
dy, Charles Manson, and Jeffrey Dahmer when asked who they first think
of as a prototypical psychopath (Edens, Clark, et al., 2013). Such findings
raise concerns that this label may conflate evidence concerning an ostensible
mental disorder with moral judgments about a defendant’s character in the
minds of legal decision-makers (Cavadino, 1998; Gunn, 1998). Although
some commentators have argued that mental health experts should opine
about concepts such as evil and depravity, most authorities argue that such
concepts are beyond the scope of expertise of the forensic mental health field
(for extended discussions of the problems associated with attempting to as-
sess “evil” in such settings, see Knoll, 2008; Simon, 2003).

THE CURRENT STUDY

Given the addition of the LPE specifier to the CD diagnosis in DSM-5 and
the similarity of the features of LPE to psychopathy, in this study we exam-
ined the effects of this specifier and the label “psychopath” on juror per-
ceptions of a juvenile defendant. On the basis of the preceding literature
review, we predicted that the addition of the traits comprising the LPE speci-
fier would result in a juvenile diagnosed with CD being perceived as more
psychopathic, dangerous, and evil than when these traits were not present.
We also tested the hypothesis that replacement of the label “limited prosocial
emotions” with the label “psychopath” would result in even more negative
perceptions of the juvenile, with the individual being seen as more psycho-
pathic, dangerous, and evil than when this label was not used to describe the
6 LIMITED PROSOCIAL EMOTIONS

person. Finally, because juror perceptions of psychopathic traits have cor-

related with punitive attitudes toward offenders in earlier studies (Cox et al.,
2013; Edens et al., 2005; Edens, Davis, et al., 2013; Guy & Edens, 2006),
we also examined whether a similar effect would be evident in our sample. In
particular, we expected that how psychopathic jurors rated the hypothetical
defendant in our study would predict the extent to which the jurors would
support more punitive legal sanctions.

METHOD

PARTICIPANTS

Participants were 326 community members summoned for jury duty in a

large metropolitan county in the southwestern United States, ranging in age
from 19 to 72 years (M = 46.39, SD = 13.44). More than half of the sample
was female (59.20%). Based on self-identified racial/ethnic background, the
sample was composed primarily of European Americans (64.10%), followed
by African Americans (17.50%), Hispanics (11.70%), Asians (4.30%), and
“other” ethnicities (2.50%). The demographics of the sample are consistent
with other jury research conducted at this site.

STIMULUS MATERIALS

Case Vignette

Participants reviewed a two-page vignette, with case information adapted

from stimulus materials used in previous research on the effects of label-
ing youth as conduct disordered or psychopathic (Boccaccini et al., 2008).
The summary information indicated that a 16-year-old male allegedly had
injured another youth in a fight to the extent that the victim required hospi-
talization. The case materials did not explicitly indicate that the defendant
was being tried in adult court, although the type of crime and facts of the
case were such that the defendant easily could have been facing adult charges
(Griffin, 2003; Schubert et al., 2010).1
Following the background information, testimony by a psychiatrist re-
tained to evaluate the defendant’s mental and physical health was presented.
During this testimony, the expert witness detailed numerous adverse life
events experienced by the defendant that are typically present in juvenile
offender populations, including his unstable living arrangements, economic

1. An alleged offense by a juvenile may be tried in adult criminal court through transfer, automatic file for
certain kinds of charges (e.g., murder), or at prosecutorial discretion, depending on state statutes (Heilb-
run, Leheny, Thomas, & Huneycutt, 1997). Most jurisdictions, including 30 states and the federal system,
state that youth are eligible for transfer beginning at age 14. Statutes regarding juvenile transfer specify
circumstances that must be satisfied to try a juvenile as an adult, including factors such as characteristics
of the offense, risk assessment, treatment amenability, and mental health diagnosis. The National Center
for Juvenile Justice estimated that in 2007 juvenile courts waived jurisdiction in approximately 8,500
cases (Griffin, Addie, Adams, & Firestine, 2011), indicating that it is a relatively common occurrence in
the legal system.
EDENS ET AL. 7

strife, single-parent home, learning difficulties, and below-average academic

performance. In terms of his mental health, the defendant was described as
not suffering from any serious mental illness that would distort his reality
testing or require psychotropic medication.
The description of the youth’s antisocial history identified three features
of CD, which consisted of shoplifting, vandalism, and numerous fights, none
involving serious injury (prior to the offense for which he was arrested). All
of these symptoms were described as having occurred for a year or more, and
the overall level of severity of the youth’s behavior problems was categorized
as “moderate” by the expert witness.
Experimental Manipulations

All of the preceding case information was held constant across the four ex-
perimental conditions. The remainder of the trial transcript contained the
experimental manipulation of the presentation of LPE and psychopathy evi-
dence:

Conduct Disorder/Limited Prosocial Emotions (CD/LPE). In this condition,

after reviewing the CD symptoms, the expert witness opined that the de-
fendant “has what we would call a Conduct Disorder. Conduct Disorder is
characterized by a repetitive, persistent pattern of violating the rights of oth-
ers or violating age-appropriate social rules or norms.” When queried by the
attorney about any additional information, the witness also opined that the
defendant “has what we would refer to professionally as limited prosocial
emotions.” This statement was followed by brief testimony detailing what
the four specific symptoms were (i.e., lacks remorse or guilt, callous and
lacks empathy, unconcerned about performance, shallow emotions).

Conduct Disorder/Psychopath (CD/Psychopath). To investigate the effects

of the psychopathy label, another condition was included in this study in
which the description of these symptoms was identical to the CD/LPE con-
dition. The only difference in this condition was that the statement that the
defendant had “limited prosocial emotions” was replaced with a statement
by the expert that the defendant was “what we would refer to professionally
as a psychopath.” Otherwise, these two vignettes were identical.

Conduct Disorder Only (CD Only). Identical to the previous two condi-
tions, in this condition the expert opined that the defendant had a CD diag-
nosis and provided a brief definition of it. However, no information concern-
ing LPE symptoms or labels of psychopathy were included in this condition.
To maintain vignette length comparable to the two preceding experimental
conditions that described LPE symptoms, the remainder of the expert’s testi-
mony in the CD Only condition focused on a separate physical health condi-
tion experienced by the defendant. The defendant was described as having
asthma, with brief symptom-related testimony that was approximately the
same length as the description of LPE symptoms to ensure that each condi-
tion was comparable in terms of the amount of verbiage reported. The expert
8 LIMITED PROSOCIAL EMOTIONS

concluded at the end of his testimony that this health problem was not rel-
evant to the defendant’s history of behavior problems or his legal case.
Prior to the initiation of this study, the testimony concerning asthma
was pilot tested with 99 undergraduate students. A multivariate analysis of
variance (MANOVA) was performed comparing participants randomly as-
signed to the asthma condition (n = 51) to participants randomly assigned
to a vignette in which no health-related information was provided about
the defendant (n = 48) across a subset2 of the outcome measures described
below. The omnibus F statistic was nonsignificant, F(4, 94) = 1.25, p = n.s.,
and explained a small amount of variance (partial h2 = .04), indicating that
the asthma testimony had little or no effect on how participants responded
to the defendant. (More detail concerning the results of this pilot testing is
available from the first author upon request.)

No Diagnosis. Although our main interest was in potential differences across

the three conditions described above, we included a fourth condition in
which no diagnostic label for CD was provided in relation to the defendant’s
past antisocial acts. This condition was identical to the CD Only condition
(inclusive of the testimony concerning the defendant having asthma symp-
toms), except that when queried about any mental health diagnostic catego-
ries, rather than respond with the CD label and brief definition, the expert
simply opined that “there is no specific diagnosis that really applies.”

DEPENDENT MEASURES

After reviewing the case vignette, participants responded to a series of 12

statements about the defendant using 6-point Likert scales. Several of these
items have been used in earlier research concerning perceptions of youthful
offenders (Blais & Forth, 2014; Boccaccini et al., 2008; Murrie, Cornell,
& McCoy, 2005; Rockett, Murrie, & Boccaccini, 2007), whereas several
new items were written specifically for this study. Several items assessed the
jurors’ support for various possible judicial dispositions for the defendant
(e.g., “This youth should be tried as an adult in adult court”). Jurors rated
additional questions that focused on their perceptions of the defendant, such
as how psychopathic, violence-prone, evil, and mature they perceived him to
be (see Table 1 for a listing of specific items and descriptive statistics). Prelim-
inary data analyses indicated that responses for some variables were signifi-
cantly skewed (Items 4–8). Before the main analyses were conducted, to nor-
malize their distributions, a square root transformation was performed on
Item 4, a logarithmic transformation was performed on Item 5, and square
transformations were performed on Items 6–8.

PROCEDURE

Regarding data collection procedures, participants completed the paper-

and-pencil survey material at the county courthouse during initial juror ori-
2. Only four criterion measures were included because at the time the pilot data were collected, the com-
plete list of outcome measures for the main study had not been finalized.
EDENS ET AL. 9

TABLE 1. Results of Exploratory Factor Analysis of Outcome Measures

Outcome Measures
Factor Loadings
Item # M (SD) Factor 1 Factor 2 Factor 3
Psychopathic, Evil, and Dangerous
8) Overall, how likely is this youth to be a criminal as an adult? 4.71 (1.13) .77
7) Overall, how likely is this youth to pose a risk of violence to 4.82 (.96) .73
others?
9) Overall, how likely is it that this youth is a psychopath? 3.05 (1.50) .59
12) Overall, how evil does this youth seem? 2.11 (1.06) .57
Punishment
4) The court should require this youth be incarcerated (locked up) 2.18 (1.54) .79
in a prison-like setting for youth.
3) The court should require this youth be placed in a secure 2.81 (1.64) .58
(locked-up) group home for delinquents.
2) The court should require this youth to receive intensive super- 4.18 (1.69) -.48
vision with probation (but no time behind bars).
5) This youth should be tried as an adult in adult court instead of 1.82 (1.31) .45
as a juvenile in juvenile court.
Treatment
1) The court should require this youth to receive psychological 4.36 (1.72) .72
treatment.
6) Overall, how likely is this youth to benefit from psychological 4.27 (1.32) .70
treatment?
Items Not on Factors
11) Overall, how mature does this youth seem? 2.11 (1.06) — — —
10) Overall, how likely is it that this youth grows up to be a psy- 3.25 (1.48) — — —
chopath as an adult?
Note. No cross-loadings greater than .40 were identified for any of these items.

entation sessions. A research team member was first introduced by a juror

services representative to all attending jurors, who were awaiting a deter-
mination of whether they would be assigned to a specific trial that day. The
research team member explained informed consent, study procedures, and
instructions, indicating that participants were under no obligation to par-
ticipate and could choose to decline. A waiver of documentation of consent
was obtained from the Institutional Review Board due to the nature of the
data collection process (i.e., anonymous surveys). Surveys were distributed
randomly, and completed surveys were obtained from all jury pool members
who elected to participate (72%). Surveys took approximately 20 minutes to
complete. Participants received no monetary compensation for their involve-
ment. Of an initial 346 protocols returned, a small percentage (5.8%) failed
a three-question comprehension check at the end of the survey in which
they were queried about basic case facts. Although jurors in actual cases
often misperceive important case information (e.g., Luginbuhl & Burkhead,
1994), to maximize internal validity and ensure greater comprehension of
the stimulus materials, any participant who incorrectly answered one (or
more) of these questions was dropped from our analyses (final n = 326).
10 LIMITED PROSOCIAL EMOTIONS

ANALYTIC PLAN

We first conducted planned comparisons using independent samples t tests to

examine our specific hypotheses regarding expected differences between the
CD Only and CD/LPE groups and between the CD/LPE and CD/Psychopath
groups. Given the a priori, directional nature of these predictions, we used
one-tailed p values in these analyses. Following these analyses, we conducted
a more exploratory MANOVA comparing all four conditions in our study
on our criterion measures. Prior to this MANOVA, we conducted an explor-
atory factor analysis (EFA) on the 12 criterion measures described earlier in
an attempt to identify a smaller number of dimensions and reduce the num-
ber of variables for analysis. Finally, to investigate the extent to which rat-
ings of psychopathy would predict punitive sanctions, we computed Pearson
correlations both for the total sample and for each experimental condition.

RESULTS

PLANNED COMPARISONS

As predicted, compared to persons in the CD Only group, those in the CD/

LPE group rated the juvenile as more likely to be a psychopath, t(178) =
4.57, p < .001, Cohen’s d = .69 (95% CI [.39, .99]), and as more evil, t(178)
= 3.49, p < .001, Cohen’s d = .52, (95% CI [.23, .82]). Also, even though the
defendant was presumed to be relatively dangerous in all conditions, those
in the CD/LPE group rated him as more likely to pose a risk of violence to
others than those in the CD Only group, t(178) = 1.88, p < .05, Cohen’s d
=.28 (95% CI [.01, .58]).
Regarding our remaining planned analyses comparing participants in
the CD/LPE and CD/Psychopath conditions, there was a significant differ-
ence in terms of perceived psychopathic traits, with those in the CD/Psycho-
path condition rating the juvenile as appreciably higher on this item, t(149)
= 3.72, p < .001, Cohen’s d = .61 (95% CI [.28, .94]). Those in the CD/
Psychopath condition did not, however, rate the defendant as any more evil
(Cohen’s d = −.01, 95% CI [−.33, .31]) or more likely to be violent (Cohen’s
d = .09, 95% CI [−.23, .41]) than did those participants in the CD/LPE con-
dition (p values > .05).

MULTIGROUP EXPLORATORY ANALYSES

In an attempt to reduce the total number of criterion measures examined in

this study, we first conducted an EFA using principal axis factoring (varimax
rotation) on all 12 of our outcome variables. Results initially failed to con-
verge after 25 iterations, largely due to two items representing highly redun-
dant variance (whether the juvenile was currently a psychopath and whether
he would likely be a psychopath as an adult: r = .91) and one item failing
to load on any factor (“How mature is this defendant?”). Recomputing the
EFA after eliminating the adult psychopath and maturity items resulted in a
clear three-factor solution, based on the scree plot and the number of factors
EDENS ET AL. 11

TABLE 2.Group Differences in Standardized (Z Scores) Factor-Derived Outcome Measures

Study Conditions n PED Punishment Treatment
No Diagnosis 74 −.30 (.75)a −.20 (.73) a −.21 (.85) a
CD Only 99 −.19 (.83) a −.08 (.75) a −.13 (.83) a
CD/LPE 79 .23 (.89)b .06 (.90) a, b −.01 (.79) a
CD/Psychopath 70 .33 (.87) b .26 (.99) b .41 (.74) b
Note. PED = Psychopathic, Evil, and Dangerous. CD = Conduct Disorder. LPE = Limited Prosocial Emotions. Groups
that share a subscript do not significantly differ from each other at p < .05 (Bonferroni-corrected).

with eigenvalues greater than 1. These factors explained 62.29% of the total
variance across these 10 ratings and seemed readily interpretable (see Table
1). The first factor (34.08% of the variance) was composed of the four items
tapping participant perceptions of the juvenile’s violence risk and his poten-
tial to be an adult criminal, as well as the extent to which he was perceived
as psychopathic and evil. For sake of brevity, we labeled this factor “PED”
(Psychopathic, Evil, and Dangerous). The remaining two factors were largely
consistent with factors identified in earlier simulation studies using very simi-
lar items (e.g., Boccaccini et al., 2008). The second factor (16.77% of the
variance) included all four of the items related to potential legal sanctions
(e.g., should be put in secure residential facility for delinquents) and was
subsequently labeled “Punishment.” The third factor (11.44% of the total
variance) was composed of the remaining two items related to treatment
and, as such, was labeled “Treatment.”
Next, a MANOVA was conducted across our four groups of partici-
pants with these three factors entered as dependent variables, with a Bonfer-
roni correction used to adjust for multiple post hoc comparisons. Descriptive
statistics (z scores) for these analyses are summarized in Table 2. A signifi-
cant multivariate effect was noted, F(9, 769.21) = 7.56, p < .001, partial
h2 = .07, and significant group differences were evident across all three of
the dependent measures (all univariate F values > 4.03, ps < .01). For the
PED factor, Bonferroni-corrected post hoc tests indicated that participants
in the CD/Psychopath condition rated the juvenile as significantly higher on
this dimension than those in the CD Only (Cohen’s d = .62, 95% CI [.31,
.94]) and the No Diagnosis (Cohen’s d = .78, 95% CI [.45, 1.13]) condi-
tions. Similarly, participants in the CD/LPE condition rated the juvenile as
significantly higher on this dimension than those in the CD Only (Cohen’s d
= .50, 95% CI [.18, .83]) and the No Diagnosis (Cohen’s d = .65, 95% CI
[.32, .98]) conditions. However, the CD Only and No Diagnosis conditions
did not differ from each other (Cohen’s d = .13, 95% CI [−.16, .43]), nor did
the participants in the CD/LPE and CD/Psychopath conditions differ signifi-
cantly from each other (Cohen’s d = .12, 95% CI [−.21, .44]), even though,
as noted earlier in relation to the planned comparisons, they did differ on the
individual “psychopathy” item that was one of the four items comprising
this factor.
Results for the Punishment variable (Table 2) indicated that participants
in the CD/Psychopath group rated the juvenile significantly higher on this
dimension than did those in the CD Only (Cohen’s d = .40, 95% CI [.09,
.71]) and No Diagnosis (Cohen’s d = .53, 95% CI [.20, .87]) groups, who
12 LIMITED PROSOCIAL EMOTIONS

again did not differ from each other (Cohen’s d = .16, 95% CI [−.17, .49]).
Those in the CD/LPE condition did not differ from those in the CD Only
condition (Cohen’s d = .17, 95% CI [−.16, .50]), whereas the CD/LPE and
No Diagnosis group difference approached but did not quite achieve signifi-
cance (Cohen’s d = .32, 95% CI [−.01, .65]). The CD/LPE group ratings did
not differ significantly on this dimension compared to ratings of participants
in the CD/Psychopath condition (Cohen’s d = .21, 95% CI [−.11, .55]).
For the Treatment variable (Table 2), participants in the CD/Psychopa-
thy condition rated the juvenile as significantly higher on this dimension
than each of the other three groups: CD/LPE Cohen’s d = .55 (95% CI [.22,
.89]); CD Only Cohen’s d = .68 (95% CI [.35, 1.03]); No Diagnosis Cohen’s
d = .78 (95% CI [.44. 1.12]). The remaining three groups did not differ
significantly from each other. Although the two items comprising this factor
relate to treatment, the item content focuses on somewhat different concepts
(i.e., whether treatment should be required versus whether the defendant was
likely to benefit from such treatment). As such, for exploratory purposes, we
conducted an ANOVA separately for the two individual items. There were
no significant differences across conditions in terms of perceived benefit of
treatment, F(3, 321) = 2.17, p = n.s. For the required treatment variable,
however, there was a significant effect, F(3, 321) = 7.33, p < .001, with the
CD/Psychopathy group providing significantly higher ratings compared to
the CD Only group (Cohen’s d = .62, 95% CI [.31, .93]) and the No Diagno-
sis group (Cohen’s d = .73, 95% CI [.40, 1.07]). No other significant group
differences emerged from this analysis.

CORRELATIONS WITH PSYCHOPATHY RATINGS

The Pearson correlation for the individual item “Overall, how likely is it
that this youth is a psychopath?” and the Punishment factor was r = .32 (p
< .001) for the total sample. There was some relatively minor variability in
this association across the four conditions, with this effect being greatest in
the CD Only group (r = .35, p < .001), intermediate in the CD/LPE (r = .27,
p < .05) and CD/Psychopath (r = .25, p < .05) groups, and weakest in the No
Diagnosis group (r = .15, p = n.s.). Raw scores on both variables in the latter
condition suggested some evidence of floor effects, with mean psychopathy
and punishment ratings being low and having relatively smaller standard de-
viations. For example, the mean score for the psychopathy rating in the No
Diagnosis group was only 2.28 (on a 1–6 scale) and only ranged from 1 to 4.

DISCUSSION

Although various concerns have been expressed regarding potential misuses

of the DSM-5 in forensic contexts, relatively little research thus far has di-
rectly investigated the effects of changes to the diagnostic system in terms of
how certain disorders may be viewed by legal decision-makers and the gen-
eral public (Filone et al., 2014). As such, our research appears to be the first
to investigate how the new LPE specifier might influence community percep-
EDENS ET AL. 13

tions of CD youth. Our planned analyses suggest that CD youth involved in

the juvenile justice system who are described as having “limited prosocial
emotions” may be perceived much more negatively (e.g., evil, dangerous,
psychopathic) than those who are not described with such features.
Interestingly, the addition of the label “psychopath” to this LPE speci-
fier did not have a major impact on exacerbating these negative perceptions
of the defendant, although it did result in him being perceived specifically
as more psychopathic. The stronger endorsement that the defendant was
psychopathic in this condition serves as evidence that the experimental ma-
nipulation was successful, which is not particularly surprising given that the
defendant was specifically described as “a psychopath” by the expert wit-
ness. However, the fact that the defendant was perceived as just as evil and
dangerous without the psychopathy label (CD/LPE condition) suggests that
the traits associated with the LPE specifier have a pronounced impact on the
degree to which the defendant was viewed negatively that is independent of
the psychopath label itself (cf. Boccaccini et al., 2008). That is, consistent
with other recent research findings (Edens, Davis, et al., 2013), defendants
do not need to be specifically labeled as “psychopaths” for jurors to attri-
bute prejudicial characteristics (e.g., evil, dangerous) to them that the jurors
also believe are typical of psychopaths. Consistent with this interpretation,
the differences in effect sizes for the dangerousness item across the CD/LPE
condition versus the No Diagnosis (Cohen’s d = .40) and CD Only (Cohen’s
d = .28) conditions were relatively pronounced in our study. This was even
more the case in terms of the ratings of evil, in which the differences in the
effect sizes for the CD/LPE condition versus the No Diagnosis and CD Only
conditions were more than half a standard deviation apart (Cohen’s ds = .55
and .57, respectively).
The results from our more exploratory group analyses revealed several
interesting findings. For example, there were no significant differences across
the No Diagnosis and CD Only groups on any of the three-factor analyti-
cally derived outcome measures. Identifying the juvenile’s behavioral devi-
ance as “conduct disordered” did not result in any appreciable changes in
how participants perceived him relative to participants who were not given
this description. This finding generally runs counter to the claim that a CD
diagnosis might in isolation have the same detrimental effect as identifying a
youth as psychopathic (Frick & Nigg, 2012; Scheepers et al., 2011). Despite
being informed of the diagnostic label and being presented with a brief defi-
nition of it, participants were no more affected by this additional informa-
tion than they were by the information concerning past misconduct in the
No Diagnosis condition.
In relation to the Treatment factor, participants did rate the defendant
specifically labeled as a psychopath higher on this dimension, suggesting a
greater perceived need for some type of intervention. This result runs counter
to findings reported for a relatively small sample of mental health practitio-
ners who participated in a somewhat similar type of simulation study. Rock-
ett et al. (2007) reported no significant group differences across conduct
disorder and psychopathy conditions in regard to their treatment ratings,
14 LIMITED PROSOCIAL EMOTIONS

although the sample sizes for the cells in the various conditions they exam-
ined were very small (ranging from 9 to 13 participants).
Although in some regards our finding might be construed as an osten-
sible benefit of being labeled as psychopathic, it is important to note that
public support for mandatory treatment for mentally disordered youth stems
mostly from fears of their potential for violence (Pescosolido, Fettes, Martin,
Monahan, & McLeod, 2007). As such, recommendations for treatment may
not necessarily be driven by particularly altruistic or beneficent motivations.
The fact that our jurors were more supportive of punitive legal sanctions
in the CD/Psychopath group compared to the CD Only and No Diagnosis
groups offers additional indirect support for this interpretation. Also sup-
porting this interpretation, when separately examining the two questions
comprising this factor, participants in the CD/Psychopath condition more
strongly endorsed the need for required treatment compared to participants
in the CD Only and No Diagnosis groups, but it was not because they viewed
the youth labeled as psychopathic to be any more likely to actually benefit
from treatment. These results are generally similar to multivariate analyses
reported by Murrie et al. (2005), who found that among juvenile proba-
tion officers, psychopathic traits incrementally predicted recommendations
for psychological services beyond antisocial history variables. However, they
detected no such effects in regard to perceptions that psychopathic youth
would be more likely to benefit from treatment.
In regard to treatment attitudes, it is interesting to note that there are
case examples of psychopathy evidence being used by expert witnesses and/
or attorneys to argue that offenders will not benefit from treatment (Viljoen,
MacDougall, et al., 2010). No such testimony was provided in our vignette,
but one wonders whether such information might result in jurors being less
supportive of providing treatment for youth described as psychopathic. Fu-
ture research examining this topic would be highly informative about the
malleability of layperson attitudes concerning the treatment of ostensibly
psychopathic youth. There is some evidence that stigmatization toward cer-
tain mental disorders (e.g., borderline personality disorder) can be reduced
among laypersons if they are exposed to information suggesting that individ-
uals with these disorders can be treated effectively (Lebowitz & Ahn, 2012),
raising the possibility of a similar effect if evidence of effective interventions
for psychopathic youth (Caldwell, 2011) were provided to jurors.
The results of our exploratory factor analyses of the 12 criterion mea-
sures used in this study are also informative in their own right. In particular,
the PED factor that emerged consisted of an amalgam of negative character-
istics (psychopathic, violent, future criminal, evil) that are generally consis-
tent with a global dimension of “badness” (Edens, Clark, et al., 2013). The
two violence risk and future criminal items have consistently converged on
a latent dimension in prior simulation studies (e.g., Boccaccini et al., 2008)
that have not included items specifically addressing perceptions of the defen-
dant as “a psychopath” and “evil.” Our identification of this factor tends to
converge with other research examining the association among these con-
cepts in relation to juvenile offenders. For example, Salekin, Rogers, and
Ustad (2001) and Salekin, Yff, Neumann, Leistico, and Zalot (2002) found
EDENS ET AL. 15

that a “psychopathic personality traits” factor was associated with ratings

of dangerousness among both psychologists and juvenile court judges who
were considering whether a hypothetical youth should be transferred to adult
court. The fact that the PED scores for the CD/LPE and CD/Psychopath
conditions did not differ on this factor—but were appreciably higher than
the other two conditions that did not include the specifier—offers further
support for the argument that ascribing LPE traits to youth with CD will
lead to negative global perceptions of them. This finding runs directly coun-
ter to suggestions (e.g., Frick & Nigg, 2012) that labels such as “conduct
disordered” and “psychopath” are largely equivalent and will have similar
prejudicial effects on perceptions of juvenile offenders.
A final result worth highlighting was the association between ratings
of psychopathy by our jurors (regardless of the type of testimony they re-
viewed) and their level of support for punitive sanctions against the defen-
dant. A similar effect has been reported in other simulation studies examin-
ing support for capital punishment (Edens, Davis, et al., 2013) and civil
commitment of sex offenders (Guy & Edens, 2006). Jurors of course are not
bound by the opinions and conclusions of experts and are free to form their
own beliefs about the psychological characteristics of defendants. As such,
it is not surprising that perceptions of a defendant’s personality influence
jurors’ attitudes about appropriate punishments for that defendant separate
from any particular mental health evidence to which the jurors are exposed.
Although our results suggest that the LPE specifier can have a prejudicial
effect on jurors, is this effect evidence of undue prejudice? That is, are the
consequences of being labeled with this specifier likely to cause more harm
than good? We would preface our thoughts on this topic with the caveat
that these are not simple questions with yes or no answers because there
are multiple types and levels of potential “good” (e.g., improved treatment
matching) and “harm” (e.g., excessive criminal sanctions) that could result
from the use of this specifier in applied settings that were not addressed
in our study. We would suggest, however, that if a youth described as CD
along with the LPE specifier is perceived as half a standard deviation more
“evil” than a youth described only with CD, it is difficult not to see this as
problematic evidence of stigmatization in the context of criminal or juvenile
justice proceedings. As noted in the Introduction, psychiatric diagnoses and
other types of mental health evidence should not be conflated with moral
judgments about a youth (Knoll, 2008; Simon, 2003).
Is the perception that a youth with the LPE specifier is more danger-
ous evidence of undue stigmatization? There is some evidence to suggest
that CU traits may be modestly associated with violence risk (Asscher et al.,
2011). Such results would suggest that viewing CD youth with LPE traits
as more dangerous than CD only youth would not be unduly prejudicial, in
the sense that it reflects a legitimate correlate of LPE traits. That said, some
recent studies have provided more equivocal results regarding the prediction
of future “bad outcomes” (Colins & Vermeiren, 2013; Pardini et al., 2012),
and predictive validity is of course predicated on the reliable assessment of
LPE traits in applied settings. Whether adequate field reliability will be dem-
16 LIMITED PROSOCIAL EMOTIONS

onstrated remains to be seen, but the extant research thus far has not been
encouraging (Miller et al., 2012; Murrie et al., 2013; Regier et al., 2013).
Limitations of this research should be noted, which may inform future
work in this area. First, we did not include an “LPE Only” condition in our
study, largely because there is no such diagnostic category within DSM-5;
application of the specifier is contingent on a CD diagnosis. As such, our
results do not address the potential impact of this specifier in the absence of
CD symptoms. Second, our sample, although representative of the jurisdic-
tion in which the data were collected, is not necessarily representative of all
persons who attend jury duty throughout the United States. Additionally,
there are multiple other contexts in which one could manipulate the presence
of the LPE specifier (e.g., involuntary hospitalization of a minor), the facts
of the case (e.g., a more or less severe form of conduct problems than the
“moderate” level of severity described in our vignette), or the presence of a
rebuttal expert witness, all of which might lead to different results regarding
the impact of the specifier on attitudes and decision-making. That said, the
general similarity of our findings to other research on the stigmatizing effects
of psychopathic personality characteristics (e.g., remorselessness) using dif-
ferent stimulus materials and different samples (Blais & Forth, 2014; Cox et
al., 2013; Edens et al., 2003, 2005; Edens, Davis, et al., 2013; Guy & Edens,
2006; Rendell et al., 2010; Vidal & Skeem, 2007) suggests that our results
are unlikely to be unique to the specific vignette we chose or jurisdiction in
which our data were collected.
Another limitation is that, being a vignette study, our research obviously
did not directly examine the disposition of real-world cases in which youth
with CD are described with the LPE specifier. Future field-based research
examining the consequences of being labeled as such will be important to
undertake in a variety of contexts (e.g., civil psychiatric, juvenile/criminal
justice). It is conceivable that the use of this specifier may result in more tar-
geted interventions and improved clinical decision-making for this particular
subgroup of CD youth, which was the hope of those who worked to have
it included in DSM-5 (Barry et al., 2013). Whether its inclusion ultimately
results in better outcomes for individual youth (e.g., improved treatment re-
sponse) and for society at large (e.g., reduced criminal recidivism) remains
to be determined.
We would conclude by reiterating that our results indicate that this
specifier has the potential to detrimentally affect how youth with CD are
viewed, particularly among legal decision-makers. When considered along
with concerns about the reliability of the assessment of these types of traits in
applied settings (Miller et al., 2012; Murrie et al., 2013, Regier et al., 2013),
we would urge considerable caution when using this specifier outside of re-
search contexts. These concerns notwithstanding, we should also state that
we do not believe our results should in any way discourage further empirical
research on the utility of the LPE specifier.
EDENS ET AL. 17
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