1

Journal of Personality Disorders, 28, 2014, 167© 2014 The Guilford Press

A PrototyPicAlity VAlidAtion of the comPrehensiVe Assessment of PsychoPAthic PersonAlity (cAPP) model sPAnish Version

Gerardo Flórez, MD, PhD, Alfonso Casas, MD, Mette K. F. Kreis, PhD, Leonello Forti, MD, Joaquín Martínez, MD, Juan Fernández, MD, Manuel Conde, MD, Raúl Vázquez-Noguerol, MD, Tania Blanco, MD, Helge A. Hoff, PsyD, and David J. Cooke, PhD, DUniv, FBPsS, FRSE

The Comprehensive Assessment of Psychopathic Personality (CAPP) is a newly developed, lexically based, conceptual model of psychopathy. The content validity of the Spanish language CAPP model was evaluat-ed using prototypicality analysis. Prototypicality ratings were collected from 187 mental health experts and from samples of 143 health profes-sionals and 282 community residents. Across the samples the majority of CAPP items were rated as highly prototypical of psychopathy. The Self, Dominance, and Attachment domains were evaluated as being more prototypical than the Behavioral and Cognitive domains. These findings are consistent with findings from similar studies in other lan-guages and provide further support for the content validation of the CAPP model across languages and the lexical approach.

A new conceptual model of psychopathic personality disorder (PPD) has recently been proposed by Cooke and colleagues and focuses on personal-ity traits rather than on antisocial and criminal behavior; the Comprehen-sive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2004, 2012). The lexical hypothesis, the idea that the important dimensions of personality variation will be richly represented within natu-ral language, was used to provide a comprehensive and differentiated de-

This article was accepted under the editorship of Robert F. Krueger and John Livesley.

From Galician Forum for the Study of Personality, Vigo, Spain (G. F., A. C., L. F., J. M., J. F., M. C., R. V.-N.); Section of Clinical and Health Psychology, University of Edinburgh & NHS Forth Valley (M. K. F. K.); Psychiatry Service, Pontevedra University Hospital, Pontevedra, Spain (T. B.); Haukeland University Hospital, Centre for Research and Education in Forensic Psychiatry, Bergen, Norway (H. A. H.); and Section of Forensic Psychology, Glasgow Caledo-nian University (D. J. C.).

Address correspondence to Gerardo Flórez, Unidad de Conductas Adictivas, Hospital Santa María Nai, CHUO, Ramón Puga 52-56, 32005 Ourense, Spain; E-mail: gerardof@mundo-r.com

2 FLÓREZ ET AL.

scription of PPD (Ashton & Lee, 2005; Mollaret, 2009; Saucier, Goldberg, & Institute, 2001). The CAPP contains 33 items; each item is specified more precisely using three closely related trait-descriptive adjectives. The 33 items were grouped into six domains of personality functioning: Affec-tive, Behavioral, Cognitive, Dominance, Emotional, and Self (Cooke et al., 2012). A range of validation studies are currently being carried out (e.g., Hoff, Rypdalm, Mykletun, & Cooke, 2012; Kreis & Cooke, 2011; Kreis, Cooke, Michie, Hoff, & Logan, 2012). Some of these have used prototypi-cality analysis to test the relevance and robustness of the CAPP model to the construct of psychopathy in a number of languages: English (Hoff et al., 2012), Norwegian (Heinzen, Fittkau, Kreis, & Huchzermeier, 2011), German (Kreis et al., 2012), and Persian (S. V. Shariat, personal commu-nication, August 28, 2012). Prototypicality analysis is a method derived from cognitive psychology (Rosch, 1978). Several studies have previously employed prototypicality analysis in the evaluation of personality disor-ders, including psychopathy (Cruise, Colwell, Lyons, & Baker, 2003; Livesley, Reiffer, Sheldon, & West, 1987; Samuel & Widiger, 2004).

Prototypicality analysis is particularly useful in the content validation of a new conceptual model of psychopathy—such as the CAPP model— because it makes it possible to clarify which symptoms are relevant or ir-relevant to the PPD construct (Hoff et al., 2012). The approach has previ-ously been successfully used to evaluate the content validity of the original English language CAPP (Kreis et al., 2012) and the translated Norwegian version (Hoff et al., 2012). Support for the content validity of the CAPP model was found across language versions, expert and lay samples (Hoff et al., 2012; Kreis et al., 2012), and gender (Kreis & Cooke, 2011).

oBJectiVesThe current study was designed to evaluate the content validity of the CAPP Spanish version using prototypically analysis, and secondly to com-pare the Spanish results with the findings of previous studies of the Eng-lish and Norwegian language versions. To reduce method variance, we adopted the same methodology as in the aforementioned studies (Hoff et al., 2012; Kreis et al., 2012), particularly that used by Hoff et al. using both expert and lay samples. The prototypicality of the CAPP items was compared with a set of “foil” items considered not to be part of the concept of psychopathy. Following the lexical hypothesis, our a priori hypothesis was that there would be no significant prototypicality differences in the Spanish version of the CAPP relative to previously published work in the UK and Norway, knowing that Spain and these countries are European cultures that share some common ground but also have significant cul-tural and linguistic differences. Norwegian is, like English, a member of a West Germanic subgroup of the Indo-European language group; by con-trast, Spanish is a Romance language, derived from Vulgar Latin, although part of the Indo-European language family.

PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 3

methodPARTICIPANTS

Three samples of participants were selected on the basis of their knowl-edge of, and experience in dealing with, psychopathy. Participation in the study was completely voluntary.

Sample 1 was an expert sample, consisting of 187 mental health, foren-sic, and penitentiary staff (i.e., forensic medical officers, forensic psychol-ogists, psychiatrists, clinical psychologists, prison medical officers, and prison psychologists) recruited at their workplaces or at national confer-ences and workshops across Spain. All were highly trained in diagnosing and interacting with patients suffering from many types of mental illness, including psychopathy and other personality disorders. Only 10 experts refused to participate. Sample 2 consisted of 143 other health profession-als (i.e., general practitioners and nurses) with limited experience of men-tal disorders in general, and psychopathy in particular. Their recruitment took place at their workplace or at local workshops. Only 13 health profes-sionals refused to participate. In Sample 3 were 282 community residents (i.e., lay people) from diverse backgrounds (74 university students, 102 clerical staff from general hospitals, and 106 visitors to general hospitals) with no formal training in, or professional experience of, psychopathy. Their recruitment took place at various locations, including workplaces, training courses, universities, and public places. Only 61 community res-idents refused to participate.

Table 1 provides a summary of the demographic characteristics of the three samples.

TABLE 1. Sample Characteristics of Raters

Community Residents

Health Professionals Expert Group

Total 282 143 187

Men 68 (24.11%) 31 (21.68%) 78 (41.71%)Age 25 or below 127 (45.04%) 4 (2.80%) 0 (0%) 26–35 53 (18.79%) 69 (48.25%) 35 (18.7%2) 36–50 67 (23.76%) 47 (32.87%) 88 (47.06%) Above 50 35 (12.41%) 23 (16.08%) 64 (34.22%)Background Expert group Clinical psychologist 49 (26.21%) Forensic medical officer 26 (13.90%) Forensic psychologist 5 (2.67%) Prison medical officer 14 (7.49%) Prison psychologist 4 (2.14%) Psychiatrist 89 (47.59%) Years of experience 17.52 (M)Contact with psychopathy Expert group Daily 35 (18.72%) Weekly 42 (22.46%) Monthly 43 (22.99%) Quarterly 32 (17.11%) Rarely 35 (18.72%)

4 FLÓREZ ET AL.

PROCEDURE

The Spanish version of the CAPP was used to design a two-part question-naire based on the one developed by Kreis et al. (2012) and Hoff et al. (2012).The questionnaire included the 33 CAPP items plus nine foil items (see the first column of Table 2). The format of our questionnaire was the same as that used by Hoff et al. in the Norwegian language study.

Part 1 of the questionnaire was constructed as follows: (a) experts were asked to rate the 42 items according to how relevant they were to a spe-cific patient or inmate they had met during their practice and whom they thought was a typical psychopath; (b) the other two samples were asked to rate the 42 items according to how typical they thought these were of psy-chopathy in general. They were asked to think of someone who from their point of view was clearly psychopathic. In Part 2 of the questionnaire, par-ticipants from all samples had to rate the typicality of the 42 items to a specific patient or inmate (experts sample) or person (other samples) they definitely did not consider to be psychopathic. All ratings were on a 7-point Likert-type scale anchored at 1 (low typicality) and 7 (high typicality).

Demographic participant information was also collected, including the experts’ professional experience with, and frequency of assessment of, psychopathic patients or inmates.

ANALYSES

After conducting descriptive statistics for all symptoms, the CAPP items and domains were analyzed in relation to typicality of psychopathy. Like Hoff et al. (2012), a mean typicality rating of psychopathy between 4 and 5 was labeled as moderately typical and above 5 as highly typical (Rogers, Duncan, Lynett, & Sewell, 1994). We also analyzed the domains and items in relation to distinctiveness; the higher the difference in typicality rat-ings, psychopathic versus nonpsychopathic person, the more distinctive the item. A prototypical analysis was then conducted with these two anal-yses. As mentioned before, a prototype is a model created to test a con-cept. Analyzing the prototype is a way to evaluate and, if necessary, mod-ify the design based on the concept, in this case the Spanish version of the CAPP.

resUltsPROTOTYPICALITY OF THE INDIVIDUAL CAPP SYMPTOMS

Variability in typicality ratings across items was found (see Table 2). Across samples, the majority of the 33 CAPP items were rated as moder-ately to highly typical of psychopathy. For the Attachment domain, four items (Detached, Unempathic, Uncommitted, and Uncaring) were consid-ered as highly prototypical by the three groups (community residents,

5

TAB

LE 2

. Pro

toty

pica

lity

Eval

uati

ons

of C

APP

Ite

ms

and

Foils

Dom

ain/

Item

Com

mun

ity

Res

iden

ts V

ersu

s

Com

mun

ity

Res

iden

tsH

ealt

h Pr

ofes

sion

al V

ersu

s Pr

ison

Expe

rts

Ver

sus

Fore

nsic

Psy

chia

try

Psyc

hopa

thN

onps

ycho

path

Psyc

hopa

thN

onps

ycho

path

Psyc

hopa

thN

onps

ycho

path

MSD

MSD

MSD

MSD

MSD

MSD

Atta

chm

ent

5.43

/5.2

5(1

.11/

1.13

)1.

89/1

.63

(0.9

5/0.

94)

5.48

/5.2

4(1

.02/

1.12

)2.

11/2

.48

(1.0

0/1.

43)

5.74

/5.7

5(0

.85/

0.98

)2.

07/2

.73

(0.9

5/1.

24)

D

etac

hed

5.54

/4.9

8(1

.55/

1.68

)2.

03/1

.69

(1.2

1/1.

12)

5.64

/4.7

5(1

.40/

193)

2.01

/2.7

8(1

.09/

2.08

)5.

47/5

.25

(1.4

3/1.

58)

2.46

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1(1

.28/

1.72

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Une

mpa

thic

5.84

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6(1

.53/

1.38

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57/1

.56

(1.0

2/1.

09)

5.79

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6(1

.54/

1.39

)1.

60/2

.47

(1.0

0/1.

76)

5.86

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7(1

.50/

1.07

)1.

85/2

.37

(1.1

1/1.

44)

U

ncom

mitt

ed5.

14/4

.92

(1.6

4/1.

58)

2.04

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0(1

.26/

1.18

)5.

42/5

.19

(1.5

5/1.

38)

1.87

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8(1

.15/

1.41

)5.

78/5

.87

(1.2

1/1.

23)

2.51

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5(1

.47/

1.61

)

Unc

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g5.

19/5

.07

(1.6

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61)

1.93

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9(1

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1.10

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48/4

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(1.5

1/1.

40)

1.69

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1.46

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85/5

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59/4

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(1.3

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13)

2.53

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1.34

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74/4

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(0.8

7/0.

95)

2.43

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3(1

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1.26

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Dis

rupt

ive

4.44

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3(1

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1.69

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39/2

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(1.2

7/1.

44)

4.86

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1(1

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1.93

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99/2

.56

(1.0

7/1.

83)

4.98

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3(1

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1.44

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63/3

.04

(1.5

6/1.

67)

R

estle

ss4.

31/3

.81

(1.7

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75)

2.92

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8(1

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1.56

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09/4

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5/1.

48)

2.85

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1.85

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18/4

.55

(1.6

4/1.

59)

3.27

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8(1

.62/

1.95

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Unr

elia

ble

4.57

/4.6

2(1

.83/

1.76

)2.

07/1

.93

(1.2

2/1.

30)

4.79

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1(1

.90/

1.72

)1.

99/2

.56

(1.1

8/1.

48)

5.21

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7(1

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1.52

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55/2

.91

(1.5

6/1.

62)

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eckl

ess

3.49

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9(1

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1.77

)2.

63/2

.46

(1.3

7/1.

46)

4.09

/4.0

0(2

.07/

1.76

)2.

14/2

.69

(1.2

1/1.

89)

4.50

/4.5

4(1

.77/

1.69

)2.

87/2

.97

(1.6

0/1.

90)

La

cks

pers

ever

ance

3.35

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1(1

.90/

1.60

)2.

32/2

.44

(1.2

4/1.

43)

4.07

/2.7

2(1

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1.73

)2.

18/2

.88

(1.2

4/2.

00)

4.27

/4.2

0(1

.66/

1.87

)2.

95/3

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(1.6

4/1.

26)

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ggre

ssiv

e5.

29/5

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(1.5

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49)

1.61

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1.16

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64/4

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(1.4

6/2.

00)

1.47

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2(0

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1.56

)5.

52/5

.65

(1.2

3/1.

30)

2.25

/3.0

1(1

.29/

1.69

)C

ogni

tive

4.49

/4.3

6(0

.90/

0.91

)2.

37/2

.48

(0.9

6/1.

10)

4.48

/4.2

6(0

.87/

1.01

)2.

73/2

.99

(1.0

6/1.

50)

4.43

/5.0

1(0

.87/

0.95

)2.

73/3

.66

(1.0

9/1.

09)

In

flexi

ble

5.22

/5.2

7(1

.44/

1.47

)2.

75/2

.41

(1.3

7/1.

40)

5.35

/5.1

9(1

.51/

1.51

)2.

43/2

.56

(1.2

3/1.

83)

5.11

/5.5

3(1

.48/

1.43

)3.

23/3

.31

(1.4

4/1.

70)

La

cks

plan

fuln

ess

3.09

/2.7

5(1

.96/

1.67

)2.

55/2

.60

(1.5

2/1.

64)

3.15

/2.9

1(1

.86/

1.80

)2.

32/3

.41

(1.3

5/2.

11)

3.83

/4.3

9(1

.79/

1.84

)3.

17/4

.22

(1.6

0/1.

90)

Su

spic

ious

5.76

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9(1

.27/

1.47

)2.

45/2

.21

(1.3

6/1.

44)

5.62

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5(1

.36/

1.44

)2.

16/3

.06

(1.2

4/1.

81)

4.83

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0(1

.46/

1.45

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09/3

.66

(1.5

2/1.

81)

La

cks

conc

entr

atio

n3.

14/3

.21

(1.8

7/1.

74)

2.84

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5(1

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1.49

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13/3

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6/1.

51)

2.52

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2.06

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17/4

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9/1.

67)

3.29

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2(1

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1.74

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lera

nt5.

25/5

.17

(1.4

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50)

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75)

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1.76

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20/5

.59

(1.4

2/1.

44)

2.58

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1.52

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cont

inue

d

6

TAB

LE 2

. Con

tinu

ed

Dom

ain/

Item

Com

mun

ity

Res

iden

ts V

ersu

s

Com

mun

ity

Res

iden

tsH

ealt

h Pr

ofes

sion

al V

ersu

s Pr

ison

Expe

rts

Ver

sus

Fore

nsic

Psy

chia

try

Psyc

hopa

thN

onps

ycho

path

Psyc

hopa

thN

onps

ycho

path

Psyc

hopa

thN

onps

ycho

path

MSD

MSD

MSD

MSD

MSD

MSD

Dom

inan

ce5.

02/5

.40

(0.9

3/0.

88)

2.37

/2.1

1(0

.87/

0.95

)5.

40/5

.62

(0.9

0/0.

87)

2.48

/2.0

8(0

.99/

0.98

)5.

50/5

.71

(0.8

0/0.

84)

2.38

/2.4

6(1

.05/

1.04

)

Gar

rulo

us3.

35/4

.74

(1.9

9/1.

74)

3.83

/3.2

2(1

.44/

1.56

)3.

93/5

.63

(1.9

3/1.

58)

3.13

/2.2

5(1

.50/

1.24

)4.

45/5

.42

(1.6

2/1.

53)

3.24

/2.9

3(1

.41/

1.80

)

Dom

inee

ring

5.50

/5.9

5(1

.59/

1.33

)2.

43/2

.31

(1.2

6/1.

37)

5.87

/6.2

2(1

.32/

1.26

)2.

26/2

.28

(1.2

2/1.

44)

5.89

/5.9

9(0

.99/

1.24

)2.

59/2

.29

(1.2

8/1.

39)

A

ntag

onis

tic4.

65/4

.78

(1.6

8/1.

59)

2.05

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9(1

.20/

1.22

)5.

20/4

.59

(1.6

4/1.

83)

1.87

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8(1

.03/

1.21

)5.

26/5

.32

(1.2

8/1.

50)

2.53

/2.4

8(1

.43/

1.49

)

Insi

ncer

e5.

15/4

.99

(1.5

3/1.

67)

2.18

/1.9

1(1

.27/

1.30

)5.

52/5

.09

(1.4

7/1.

38)

2.14

/2.3

1(1

.26/

1.49

)5.

51/5

.57

(1.3

0/1.

39)

2.59

/2.2

2(1

.50/

1.38

)

Man

ipul

ativ

e5.

94/6

.37

(1.3

6/1.

11)

1.93

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3(1

.15/

1.20

)6.

27/6

.50

(1.0

8/0.

84)

1.97

/1.9

4(1

.25/

1.24

)6.

21/6

.34

(0.9

5/0.

89)

2.42

/2.5

9(1

.37/

1.74

)

Dec

eitfu

l5.

54/5

.58

(1.5

8/1.

41)

1.81

/1.7

1(1

.13/

1.22

)5.

64/5

.69

(1.5

5/1.

33)

1.77

/1.9

1(1

.05/

1.09

)5.

70/5

.62

(1.3

5/14

5)2.

25/2

.24

(1.3

1/1.

36)

Emot

iona

l4.

96/4

.99

(0.9

4/0.

88)

2.29

/2.1

6(0

.86/

0.99

)5.

11/5

.06

(0.8

7/1.

04)

2.48

/2.9

9(0

.95/

1.46

)5.

03/5

.27

(0.7

4/0.

79)

2.48

/3.2

5(0

.98/

1.01

)

Lack

s pl

easu

re4.

20/3

.31

(1.9

8/1.

73)

2.07

/2.3

5(1

.44/

1.62

)4.

67/4

.03

(1.9

4/1.

53)

2.03

/2.9

7(1

.45/

1.88

)3.

98/4

.00

(1.8

7/1.

74)

2.83

/3.6

4(1

.74/

1.79

)

Lack

s em

otio

nal d

epth

5.37

/5.4

3(1

.76/

1.72

)2.

03/1

.75

(1.3

6/1.

19)

5.52

/5.7

8(1

.69/

1.34

)1.

83/2

.75

(1.2

6/2.

08)

5.55

/5.5

4(1

.41/

1.63

)2.

42/3

.13

(1.5

4/1.

78)

La

cks

emot

iona

l sta

bilit

y5.

52/5

.73

(1.6

5/1.

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Not

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PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 7

health professionals, and experts). For the Behavioral domain, only one item (Aggressive) was considered as highly typical by the three groups, while three items (Disruptive, Restless, and Unreliable) were considered as either moderately or highly typical by all the groups. Another two items rated below 4 by the community residents (Reckless and Lacks Persever-ance) were rated as moderately typical by both health professionals and experts. For the Cognitive domain, two items were rated as highly typical by the three groups (Inflexible and Intolerant), one item considered as moderate or highly typical (Suspicious), and two were rated below 4 by all groups (Lacks Planfulness and Lacks Concentration). For the Dominance domain, four items were rated as highly typical by the three groups (Dom-ineering, Insincere, Manipulative, and Deceitful), one was considered as moderate or highly typical (Antagonistic), and one was rated below 4 by the community residents and health professionals but rated as moder-ately typical by the experts (Garrulous). In the Emotional domain, two items were rated as highly typical (Lacks Emotional Depth and Lacks Re-morse), one was considered as highly typical by the community residents and health professionals but only moderately typical by the experts (Lacks Emotional Stability), and one item was rated below 4 by the experts (Lacks Pleasure) but was rated as moderately typical by the community residents and the health professionals. Lacks Anxiety was rated as moderately typi-cal by the health professionals and the experts but below 4 by the com-munity residents. Finally, five Self domain items (Self-justifying, Sense of uniqueness, Self-aggrandizing, Sense of invulnerability, Sense of entitle-ment, and Self-centered) were rated as highly typical by all three groups, Self-aggrandizing was rated as moderately typical by the community resi-dents, and Unstable self-concept was rated below 4 by all three groups.

None of the foils were perceived as at least moderately typical of psy-chopathy for the three groups (Table 2). However, Perfectionist was per-ceived as moderately typical by the community residents and health pro-fessionals groups, as was Strange. Shy was perceived as moderately typical only by the community residents.

In order to check if the mean psychopath and nonpsychopath ratings of CAPP items differed across groups, a one-way analysis of variance (ANOVA) and Tukey’s multiple range test were applied at a significance level of .05. No significant difference in the mean of nonpsychopaths ratings was found in health professionals to community residents (p = .59), while significant differences were found in experts to community residents (p < .001) and health professionals to experts (p < .001). In the case of the psychopaths, no significant differences were found in the mean values of experts to community residents (p = .61) and health professionals to community res-idents (p = .26). Finally, in the case of health professionals to experts, the p value is not significant either, although considerably lower (p = .07) and close to the significance level.

Paired-sample t tests were conducted to examine whether the foils and CAPP items were rated differently with respect to psychopathy. Because

8 FLÓREZ ET AL.

an overall significance level of .05 was required and 123 comparisons were to be made (41 individual symptoms and 3 different comparisons: experts vs. health professionals, experts vs. community residents, and health pro-fessionals vs. community residents), a level of .0004 was needed in order to reject the null hypothesis and conclude that there is a difference be-tween the two means. In the community residents sample, most of the CAPP items were rated higher in the psychopaths than in the nonpsycho-paths with statistically significant p values, with only three exceptions: Lacks planfulness, t(282) = 3.32, p > .0004, Lacks concentration, t(282) = 2.13, p > .0004, and Garrulous, t(282) = 3.14, p > .0004. The same occurred with the foils, except Dependent, t(282) = 1.56, p > .0004, Restrained, t(282) = 1.83, p > .0004, and Cautious, (t(282) = 1.36, p > .0004. For the health professionals, all the CAPP and foil items were rated higher in the psychopaths with the exception of Lacks planfulness, t(143) = 2.34, p > .0004, Lacks concentration, t(143) = 0.50, p > .0004, Garrulous, t(143) = 3.41, p > .0004, Perfectionist, t(143) = 1.76, p > .0004, Dependent, t(143) = 0.55, p > .0004, Shy, t(143) = 0.033, p > .0004, and Self-Conscious, t(143) = 1.49, p > .0004. Finally, in the expert subsample, all the CAPP and foil items were rated higher in psychopaths with the exception of Lacks con-centration, t(187) = 0.72, p > .0004, Unstable self-concept, t(187) = 1.59, p > .0004, Strange, t(187) = 0.57, p > .0004, Perfectionist, t(187) = 1.86, p > .0004, and Shy, t(187) = 1.62, p > .0004.

PROTOTYPICALITY OF THE CAPP DOMAINS

The result of the ANOVA test, applied to the average value of the marks of the three categories of participants in the study without foils, showed that there are statistically significant differences in the mean values between at least two of the categories (p = .0009). Also, the use of the Tukey test with a confidence interval of the 95% for the three pairs of categories (com-munity residents vs. health professionals, health professionals vs. ex-perts, and experts vs. community residents) leads us to the result that the average value of the mark of community residents was lower than the av-erage of experts and health professionals, the average difference in whose marks cannot be considered as statistically significant.

As presented in Table 2, the means and standard deviations show that all domains were rated as moderately to highly typical of psychopathy. Considering the average value of each domain, the most prototypical do-main across the groups was the Attachment domain, followed by the do-mains of Dominance, Self, Emotional, Behavioral, and Cognitive.

Finally, paired-sample t tests were conducted in order to verify that for the three groups of raters, the values of the domains Attachment, Domi-nance, and Self were larger than Emotional, Behavioral, and Cognitive. The results, taking into account that an overall significance level of .05 is re-quired and 54 comparisons were made (3 raters groups, psychopaths and general population, and a total of 3 domains compared with another 3)

PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 9

mean that a level of .0009 is needed in order to reject the null hypothesis. All the comparisons performed are under the aforementioned level with the exception of the Self domain compared with Emotional evaluated by health professionals, t(143) = 2.57, p > .0009, and in the community resi-dents for Dominance compared with Emotional, t(282) = 0.91, p > .0009, and Self compared also with Emotional, t(282) = 2.33, p > .0009, all three in psychopaths.

discUssionThe aim of this study was to measure the content validity of the Spanish version of the CAPP using prototypical analysis, and to compare the re-sults with the previous studies of the English and Norwegian language versions. The primary findings were these:

(1) CAPP items: The large majority of these were evaluated as prototypi-cal of psychopathy, and on average more prototypical than the foils.

(2) CAPP domains: The descriptive analysis showed that certain aspects related to Attachment, Dominance, and Self were judged as relatively more central (typical) and distinctive (prototypical) of psychopathy than Emotional, Behavioral, and Cognitive.

(3) Community residents sample: The way the CAPP was rated in this case was only slightly different from the two other samples, which adds support to the lexical hypothesis.

It is important to point out that the overall pattern of prototypicality was highly consistent with those of the similar prototypicality studies previ-ously mentioned; the English one (Kreis et al., 2012) and specially the one in Norwegian (Hoff et al., 2012) were the samples most similar to those in our study. The findings suggest that the CAPP model in the Spanish trans-lation has good overall content validity. This lends further support to the hypothesis that the model can be generalized from the English version.

What can our findings add to the debate on what is and what is not pro-totypical of psychopathy? Since Cleckley (1988), many authors have in-sisted that the core of psychopathy is better structured around superficial charm, lack of remorse, pathological egocentrism, and emotional poverty than around antisocial and criminal behavior (Blackburn, 2007; Lilien-feld, 1994; Skeem & Cooke, 2010). Our study lends some support to this idea because the Attachment, Dominance, and Self domains were perceived by all samples as a better way to conceptualize psychopathy than the Be-havioral domain. What can we learn by examining the items that appeared systematically weak in the prototypicality evaluation? Two out of the six items in the Behavioral domain were found to be among the least proto-typical (Lacks perseverance, Reckless). From the Cognitive domain, Lacks concentration and Lacks planfulness were considered as not prototypical, and the same was the case with Garrulous from the Dominance domain.

10 FLÓREZ ET AL.

These five items share common ground; they have a robust association with the construct of impulsivity (Patton, Stanford, & Barratt, 1995); the weakness shown by impulsivity-related items in our prototypicality evalu-ation also suggests that impulsivity might not be the cardinal feature of psychopathy that it has previously always been seen as (Hart & Dempster, 1997; Poythress & Hall, 2001).

Across lay and expert samples, Unstable self-concept was judged as the least prototypical item from the Self domain. Moreover, unstable self- concept is within the current International Statistical Classification of Dis-eases, Injuries, and Causes of Death (ICD ) and Diagnostic and Statistical Manual of of Mental Disorders (DSM ) diagnostic criteria for borderline per-sonality disorder.

Lacks pleasure was one of the items from the Emotional domain that was perceived as not prototypical. The first CAPP prototype study in Eng-lish (Kreis et al., 2012) also described Lacks pleasure as one of the least prototypical items, something that was also replicated in the Norwegian study (Hoff et al., 2012). The other item in our sample from the Emotional domain that was also perceived not to be prototypical was Lacks anxiety. Taken together, the lack of prototypicality of these two items might indi-cate that the participants in our study do not see psychopaths as people without any emotions at all, but simply as people without the correct emo-tional repertoire toward others (e.g., K. S. Blair et al, 2006; R. J. R. Blair, 2008; R. J. R. Blair & Mitchell, 2009; Lorenz & Newman, 2002; Reidy, Zeichner, & Seibert, 2011).

LIMITATIONS

Translation is a difficult process; a degree of linguistic bias in the findings cannot be ruled out. Nonetheless, the high degree of similarity between our results and the ones obtained in the Norwegian study (Hoff et al., 2012), a language that is totally dissimilar linguistically to Spanish, seemed to confirm that the lexical approach to personality used by the CAPP authors was the correct one.

Another possible limitation is that professional training and experience biased the expert sample. Did PCL-R training (Hare, 2003) condition the answers given by the expert sample? However, PCL-R training has not been as systematic in Spain as in other countries, and the most proto-typical symptoms found in our study are poorly operationalized in the PCL-R, and thus bias is unlikely. The great similarity between the profes-sional and lay ratings—the latter not having been contaminated by PCL-R training—also tends to rule out that explanation.

Another limitation might be the influence on the community residents sample of “psychopaths” who appear in movies and television series (e.g., Dexter Morgan). This might explain why items such as Perfectionist, Strange, and Shy were rated by community residents as more typical of psychopaths than of nonpsychopaths. A similar result was also obtained

PROTOTYPICALITY VALIDATION OF THE CAPP SPANISH VERSION 11

for Perfectionist with the health professionals sample. It should be kept in mind that these “psychopaths” are presented as highly intelligent serial killers who play “mind games” with the police officers who try to arrest them. They are thus portrayed to the public as extremely perfectionist. Further research into this topic is needed to test this hypothesis properly.

Another limitation is that psychopathy is, as current evidence points out, a dimensional construct rather than a categorical one, and although the CAPP model follows this line of evidence, the way of conducting proto-typicality analysis is fundamentally categorical.

Sampling can be another limitation. The sampling approach used in this research may be considered as consecutive because in the case of the three samples, all available people located in certain places at certain times were reached. We cannot fully guarantee that our sample is totally representative.

Despite these limitations, we conclude, as in previous research, that the current study clearly suggests that the CAPP model has good overall con-tent validity. The correspondence in ratings between the community resi-dents, the health professionals, and the expert samples lends support to the lexical hypothesis. Important psychopathic attributes have been en-coded and can be retrieved from natural language, not only in the source language (English) but also across languages (Norwegian and Spanish). Finally, we would like to remark that from our point of view, the validation of a construct is never complete. As has also been discussed in previous research, validation is important not only for theoretical reasons, but also in practice (Cooke, Michie & Skeem, 2007).

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