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frontpage. A comprehensive developmental view of psychopathic personalities. David X. Swenson PhD LP Gerald Henkel-Johnson PsyD LP. MnATSA Conference April 6, 2006 Minneapolis, MN. objectives. Agenda. Why this workshop? Meet the psychopath (video vignettes)

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Frontpage
frontpage

A comprehensive developmental view of psychopathic personalities

David X. Swenson PhD LP

Gerald Henkel-Johnson PsyD LP

MnATSA Conference

April 6, 2006

Minneapolis, MN


Objectives
objectives

Agenda

  • Why this workshop?

  • Meet the psychopath (video vignettes)

  • Diagnostic criteria for ASP & the “antisocial spectrum”

  • Incidence of antisocial behavior

  • Family attachment

  • Developmental pathways

  • Brain research

  • The cost of antisocial behavior


Drivers
Drivers

Current Issues in ASP Diagnosis

  • Drivers of the Psychopathy Model

  • Popularity of psychopathic media themes

  • Need to distinguish between low and high risk offenders, especially if violent; Crisis in prediction of “super-predators,”

  • Prevent juvenile exposure to adult sanctions epidemic of juvenile violence; grounds for transfer to adult system

  • Origins of condition (possible organic bases); fMRI

  • Available diagnostic test to distinguish (e.g., PCL-R, PCL-YV)

  • Risks

  • Remanding youth to the court prematurely

  • Giving up on the youth as incorrigible

  • Inconclusive data supporting psychopathic diagnosis in youth

  • Risk that psychopathic label is not used to indicate need for further assessment, but are used for disposition of adults

Laurence Steinberg, The Juvenile: fads, fictions, & facts about identification and treatment of serious juvenile offenders.


Defining

Antisocial

Spectrum

"When I'm good, I'm very good. When I'm bad, I'm better." (Mae West)


DSM

  • The DSM-IV, describes Antisocial Personality Disorder (301.7) as a pervasive pattern of disregard for and violation of the rights of others, as indicated by three (or more) of the following:

  • failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;

  • deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;

  • impulsivity or failure to plan ahead;

  • irritability and aggressiveness, as indicated by repeated physical fights or assaults;

  • reckless disregard for safety of self or others; .

  • consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;

  • lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

  • The individual is at least 18 years, there is evidence of Conduct Disorder with onset before age 15 years, and the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.


The Family of Antisocial Personalities

Character Neurosis

Super-Ego Lacunae

Primary Psychopath

Common Sociopath

Alienated Sociopath

Aggressive Sociopath

Dyssocial Sociopath

Punishment Seekers

Secondary Psychopath

Adolescent Rebellion

Distempered Psychopath

Paranoid Personality

Charismatic Psychopath

Inadequate Personality

“A rose by any other name…”

Sociopathic Personality

Psychopathic Personality

  • Epileptic Equivalent

  • Choleric Type

  • Hypersexed Type

  • Pathological Cravings

  • Hysterical Type

  • Disaffiliated Type

  • Disempathetic Type

  • Hostile Type

  • Cheated Type

Lykken, D. T. (1995). The antisocial personalities.


Hare characteristics
Hare characteristics

Hard core: The psychopathic personality (PCL-R)

  • Glibness/superficial charm (1)

  • Grandiose sense of self-worth (1)

  • Pathological lying (1)

  • Cunning/manipulative (1)

  • Lack of remorse or guilt (1)

  • Shallow affect (1)

  • Callous/lack of empathy (1)

  • Failure to accept responsibility for own actions (1)

  • Need for stimulation/proneness to boredom (2)

  • Parasitic lifestyle (2)

  • Poor behavioral controls (2)

  • Early behavior problems (2)

  • Lack of realistic, long-term plans (2)

  • Impulsivity (2)

  • Irresponsibility (2)

  • Juvenile delinquency (2)

  • Revocation of conditional release (2)

  • Promiscuous sexual behavior (T)

  • Many short-term relationships (T)

  • Criminal versatility (Hare, 1986) (T)

Factor 1: Callous emotional and interpersonal detachment; unrelated to environmental factors (e.g., dysfunctional family), lifetime stability; correlated with narcissistic, histrionic personality & machiavellianism, negatively correlated with anxiety and empathy

Factor 2: Chronic and unstable lifestyle; socially deviant antisocial behaviors; tends to extinguish about age 40; correlated with criminal behavior


Psychopathy & APD in Offender Populations (Hare, 2006)

All offenders (100%)

APD (50%+)

PCL-R

Psychopaths

(10-20%)

White Collar “Successful Psychopaths” ?

Many treatable with current programs

Difficult to treat with current programs


Pcl yv
PCL-YV

Psychopathy Checklist: Youth Version

Factor 1

Factor 2


1% PDD

1-20% ADHD

1% FAS/FAE

4-6% Bipolar

2-8% LD

Antisocial “Spectrum”

40-50% of CD becomes ASP

2-16%

6-16% boys

2-9% girls

3% males

1% females

PDD

ADHD

FAS/FAE

Bipolar

LD

etc…

1%

Oppositional Defiant Disorder

Antisocial

Personality

Disorder

Psychopathic

Personality

Disorder

Conduct

Disorder

Stimulus seeking

Lack goals

Parasitic

Predatory

Violent

Criminal acts

Impulsiveness

Disregard safety

Irresponsibility

Lack remorse

Aggression

Destruction

Deceitfulness

Rule violation

Manipulation

Hostile

Defiant

Negative

Inattention

Poor social skills

Learning deficits

80% of kids with ADHD as children carried it into adolescence, and 60% of those had developed ODD or CD. 100% of antisocial personality disorder have Dx as CD as youth.


Oppositional Defiance

Conduct Disorder

Psychopathy

  • Glibness/superficial charm (1)

  • Grandiose sense of self-worth (1)

  • Failure to accept responsibility for own actions (1)

  • Pathological lying (1)

  • Cunning/manipulative (1)

  • Lack of remorse or guilt (1)

  • Shallow affect (1)

  • Callous/lack of empathy (1)

  • Parasitic lifestyle (2)

  • Poor behavioral controls (2)

  • Early behavior problems (2)

  • Lack of realistic, long-term plans (2)

  • Impulsivity (2)

  • Irresponsibility (2)

  • Need for stimulation/proneness to boredom (2)

  • Juvenile delinquency (2)

  • Revocation of conditional release (2)

  • Promiscuous sexual behavior (T)

  • Many short-term relationships (T)

  • Criminal versatility (Hare, 1986) (T)

  • Bullies, threatens, & intimidates

  • Initiates physical fights

  • Used weapon that can cause serious physical harm

  • Physically cruel to people

  • Physically cruel to animals

  • Stolen while confronting victim

  • Forced sexual activity

  • Deliberately engaged in fire setting with intentional damage

  • Deliberately destroyed property

  • Broken into someone’s house, building, car

  • Lies to obtain goods or favors or avoid obligations

  • Stolen nontrivial items without confronting victim

  • Stays out at night despite parental prohibitions

  • Run away from home overnight twice while living in parent/surrogate home

  • Truant from school

  • Loses temper

  • Argues with adults

  • Actively defies or refuses to comply with adults requests or rules

  • Deliberately annoys people

  • Blames others for his/hers mistakes

  • Touchy or easily annoyed

  • Angry or resentful

  • Spiteful or vindictive


Incidence
incidence

Incidence of Psychopathy

  • ASP M=3%, F=1%; Psychopathy = 1% gen. population

  • 15-20% of prisoners

  • Across all races, cultures & ethnic groups

  • Common among drug dealers, spouse and child abusers, swindlers and con men, high-pressure salesmen and stock promoters, gang members, mercenaries, corrupt politicians, unethical lawyers and doctors, terrorists, cult leaders, and black marketeers.

  • Recidivism 2x other offenders; violent recidivism 3x

  • 4x more likely to commit violent offense after treatment release from intensive treatment community

  • Treated psychopaths are more likely than untreated to commit crime (develop better manipulations & deceptions)

  • Court mandated therapy for spouse abusers are ineffective for 25-35% who are psychopaths

  • Base rates of psychopaths among is 6-10% for pedophiles, 35% for rapists, and 64% for those who sexually perpetrate against both children and adults


What we know about

antisocial behavior among youth

  • Persistent aggression after third grade (age 8) is predictive of continued aggressiveness; its stability is similar to that of intelligence; the more severe the more stable

  • 40% of 8 year-olds with conduct disorder are repeatedly convicted of theft, vandalism, & assault in adolescence

  • Conduct problems can be predicted with 80% accuracy 5 years later based on social skills, negative/aggressive behavior, and disciplinary contacts

  • Drop-out rate is 12% for at-risk youth and 62% for antisocial youth

  • Three years after leaving school, 70% of antisocial youth have been arrested at least once.

  • Forty percent of the offenders who victimized children under age 6 were juveniles

  • ½ of all adult offenders had at least one deviant interest before age 18


Student risk screening
Student risk screening

  • Stealing

  • Lying, cheating, sneaking

  • Behavior problems

  • Peer rejection

  • Low academic achievement

  • Negative attitude

  • Aggressive behavior

Student Risk Screening Scale


Developmental

Considerations


Development arrow
Development arrow

Development of behavior disorders in youth

  • Infancy

  • Prematurity

  • low birth weight

  • brain injury

  • FAS/FAE

  • ADHD

  • attachment

  • hyperreactive

  • “colicky”

  • unhealthy

  • disability

  • pain

  • multiple placements

  • Environmental

  • pop. density

  • poor housing

  • mobile residents

  • discrimination

  • media violence

  • cultural norms

  • no support svc.

  • discrimination

  • crime rate

  • Peers

  • delinquent/deviant peers

  • antisocial sibs

  • bullying

  • rejection by norm group

  • attention/recognition

  • belonging

  • act out

  • revenge

PROBABLE OFFENSE

  • Family

  • cohesion

  • flexibility

  • poor boundaries

  • inconsistent discipline

  • poor supervision

  • marital relationship

  • handle emotions

  • poor role modeling

  • criminality

  • physical, emotional,

  • sexual abuse

  • explicit sexuality

  • disorganization

  • cold, rejecting

  • large family

  • father absence

  • long unemployment

  • Personality-- What prevents you from offending?

  • values (“It’s wrong”)

  • empathy (“it would hurt others”)

  • consequences (“I’d get in trouble”)

  • ego dystonic (“that’s not me”)

  • shame/embarrassment (“what would other think”)

  • esteem (I’d feel awful”)

  • identification (“wouldn’t want that to happen to me”)

  • personal responsibility (“I would be responsible”)

  • self monitoring & control (“I’d stop myself”)

  • coping (“other ways to deal with tension”)

  • Pre-family

  • poverty

  • single

  • unwanted

  • MI (depression)

  • AODA

  • teen/immature

  • abused

  • antisocial

  • divorce

  • assortative mating

  • transgenerational problems


Nature nurture
Nature nurture

Nature or nurture?– yes!

  • heritability of ASP (as well as prosocial behavior) estimated at 50%

  • trauma modifies the risk

  • incompetent parenting further modifies the risk


Attachment
~~Attachment~~

Family Considerations:

Attachment Theory & Offender Development


Normal attachment
Normal attachment

Normative Healthy Attachment

  • eye contact

  • cooing

  • crying

  • smiling

  • reaching

  • grasping

  • approaching

  • following

  • discomfort

  • hot/cold

  • hungry

  • happy

  • afraid

  • angry

  • tired

  • wet

Availability

Sensitivity

Responsiveness

Consistency

  • prolonged gazing

  • kissing

  • cuddling

  • fondling

  • high voicing

  • rocking

  • rhythmic contact

  • seek closeness & reciprocity

  • frustration tolerant

  • high intimacy

  • long lasting relationships

  • high levels of commitment

  • high relationship satisfaction

  • stress resilient

  • fewer physical & psychological problems

  • less aggressive, more cooperative

  • high belonging

  • Secure attachment

  • trust

  • safe/secure

  • regularity

  • easier to comfort

  • more affectionate


Poor attachment
Poor attachment

  • mental illness

  • postpartum depression

  • attachment disordered

  • chemical abuse

  • physical illness

  • multiple caretakers

  • frequent moves

  • criminal behavior

  • preoccupation

  • separation/divorce

  • death

  • PDD

Attachment Problems

  • Unresponsive to Comforting

  • severe illness

  • premature birth

  • surgeries/pain

  • hyperactive

  • hospitalizations

  • colicky

  • autistic

  • FAS/FAE

  • physical abuse

  • domestic violence

  • absence

  • neglect

  • inconsistency

  • over/under stimulate

  • over/under attentive

  • rejecting

  • Insecure Attachment

  • untrusting

  • fearful

  • angry


Effects of multiple caretakers
Effects of multiple caretakers

The effects of multiple caregivers

  • Insecure attachment– unstable image of caregiver

  • Confusion over different caregiver & household rules

  • Poor, variable boundaries

  • Conflicted guilt over attachment to foster parents vs. parents

  • Mistrust, caution (due to previous abuse)

  • Displace anger onto new caregivers from past resentments

  • Learn superficial charm to manipulate others

  • Play people off against each other

  • Continuous testing to see if they are rejected

  • Fear of removal, loss, grief; closeness means pain

  • Preoccupation with fantasy of returning to family of origin


Self

_

+

+

Others

_

Adjustment: low self efficacy, low confidence, emotionally expressive & labile, intense, too close too fast, inconsistent, dominating, controlling, unsatisfactory intimacy, jealousy, obsessive, compulsive, idealizing, oversensitive, shame prone, deficient problem solving, dislike authority & rules, self-defeating,

Offenders: nonthreatening, seek immature victims, groom over time, quasi-romantic relationships, (borderlines, bipolar)

Internal Working Model & Types of Attachment

Preoccupied

Anxious- Ambivalent

Secure

Available, responsive, nurturing, consistent

Neglecting, avoidant, indifferent

Avoidant-

Dismissive

Avoidant-

Fearful

Ambivalent, inconsistent, over/under responsive

Violent, abusive, threatening, punitive, rejecting

Adjustment: self blame, not seek or accept help, fear rejection, fear disclosure & closeness, lack trust, emotionally aware but unexpressive, passive, superficial intimacy, not recall childhood, hypervigilant (depressive, schizoid)

Offendersengage in impersonal, single contact sex, acquaintance rape, cruising

Adjustment: uncaring, avoid closeness, non-disclosing, high confidence, aloof, indifferent, impatient, shallow, vain, hostile, arrogant, grandiose, reject treatment, selfish, controlling, AODA, vengeful (narcissistic, psychopathic)

Offenders: coercive & assaultive, no guilt, remorse, shame

(Bartholomew, Shaver, et al.)



Cd odd
CD ODD

Destructive

A

Property Violations

B

Aggression

Animal

Cruelty

Assault

Stealing

Spiteful

Blaming

Cruel

Vandalism

Fighting

Fire setting

Lying

Bullying

Covert

Overt

Annoying

Swearing

Temper

Runaway

Defiance

Rule

Breaking

ODD

Truancy

Arguing

Angry

Stubborn

Substance

use

Touchy

C

Status Violations

D

Oppositional

Nondestructive

CD

ODD



Neurological

Research



Phineas gage

The case of Phineas Gage

Phineas gage

  • Gage was a railroad construction supervisor in 1848 when a tamping rod was driven through his skull by an explosion

  • The tamping rod severed the connections in the frontal area

  • Prior to the accident he was a moral, hardworking, sensitive, conscientious, intelligent, and well liked

  • Following the accident, his personality changed: lying, swearing, fighting, drinking, extravagance, seizure prone, and antisocial


Pruning mri
Pruning MRI

Time-lapse imagery of brain age 5 to 20

Use it or lose it!

Note: red shows more gray matter while blue shows less gray matter. Gray matter wanes as the brain matures and neurons are pruned. Areas for basic function mature early; higher executive functions later.


Stroop color word test
Stroop color word test

Undersocialized subjects have more difficulty than control subjects in naming the color, suggesting frontal lobe involvement (Waid & Orne, 1982)


Frontal brain
Frontal brain

Brain “CEO”: Forebrain or Prefrontal Area

  • Planning

  • Attention

  • Judgment

  • Reflection

  • Prioritizing

  • Self control

  • Strategizing

  • Sequencing

  • Anticipation

  • Organization

  • Impulse control

  • Second thought

  • Working memory

  • Modulating mood

  • Response flexibility

  • Goal-directed behavior

  • Foresee consequences


Stress
Stress

Effects of Stress & Trauma on the Brain

  • Long term exposure to stress & violence produces high level of fear hormone, cortisol (reduces connections & may shrink hippocampus)

  • High stress homes, & multitasking technology (computer games) more often produce short attention (ADHD)

  • Verbal abuse (repeated yelling, scolded, criticized) has adverse effects on the limbic (emotional) system, likely through stress pathways

  • Physical and/or sexual abuse increases limbic system dysfunction including olfactory hallucinations, visual disturbances, déjà vu, jamais vu

  • Repeated recollection and obsessing can intensify the stress effects

  • Physical/sexual abuse or neglect is associated with decrease in the size of the hippocampus (working memory) in adulthood

  • Stress tends to short-circuit frontal lobe processing (what little there is) and switch to emotional processing (resulting in over-sensitivity)

  • Such impairments may make the challenges of school even more stressful– a vicious cycle


Reading emotion
Reading emotion

Reading Emotion—

Normal Youth

  • Youth seem to do nothing but socialize, yet are poor readers of emotion

  • Undeveloped prefrontal cortex plays role in assessment of social relations, planning, and impulse control in social relations

  • Compared with adults (100%), teens (50%) have greater difficulty correctly identifying emotional facial expression

  • This confusion may lead to misinterpretation & inappropriate reaction

  • Girls somewhat more accurate than boys; boys misinterpret cues

  • Deep emotional relationships comes from ability to read subtle cues

  • When one observes a close friend receiving a shock, although the sensory cortex does not activate, the emotional one does

When reading emotion, teens (left) rely more on the amygdala, while adults (right) rely more on the frontal cortex.

  • Conduct Disordered Youth:

  • Errors in evaluating motive and intent

  • Misinterpret social cues

  • Attribute hostile intentions

  • Tease others but respond negatively to others

  • Abnormal standards and expectations regarding own behavior


Psychopath brain
Psychopath brain

The Brain of the Psychopath

  • 64% of violent people have abnormal frontal lobes, 50% brain atrophy, 40% EEG abnormalities

  • 84% victims of severe physical or sexual abuse

  • Ratio of brain abnormalities of violent to normals is 31:1

  • Normal people blink to a startling noise when viewing an unpleasant picture compared to a pleasant one– psychopaths don’t

  • Brains may not be able to construct an emotional facsimile (empathy) of others’ discomfort

  • Less able to process deep semantic meaning of words & emotional significance of events

  • Show less response to startle, lower GSR to expected painful stimuli, less fear of common hazards, higher pain thresholds, less avoidance of shock-punished errors in learning task


Brain serotonin
Brain serotonin

Antisocial behavior & the brain

  • Impulsive, violent emotions appears to be a failure of emotional regulation

  • ASP shows impairment in the orbito-frontal cortex (impulse control, judgment, tact) and its connections with anterior cingulate cortex (conflict coping) & amygdala (fear & anger)

  • Abnormalities in serotonin function

  • Early neglect (sensory deprivation) trauma & abuse affects the development of the brain

  • During 1st three years the brain grows rapidly, later “prunes” unused areas

  • Result: poor impulse control, lack of socialization, poor empathy, reactivity



Lykken study startle
Lykken study startle

Normal people show fear, startle, and avoidance reactions to painful stimuli– psychopaths don’t




Less easily-socialized youth require more competent parenting to avoid personality disorders


Moral self core
Moral self core parenting to avoid personality disorders

Essential Components of a Moral Self Core

Empathy (2-7 yrs): see from other’s perspective

Sympathy: sorrow for another person’s distress

Remorse: regret & sadness at one’s role in another’s pain

Guilt (3-4 yrs): signal to repress impulses so not to offend or upset another; includes regret over actions

Anxiety (5-11 yrs): apprehension about violation of other’s standards

Shame (1-2 yrs): Inner sense of not meeting expectations

Embarrassment (3 yrs): expansion of shame involving standards of others and fear of judgment


Development of empathy
Development of empathy parenting to avoid personality disorders

Development of Empathy

  • Year 1: Global Distress

  • chain reaction when other infants cry

  • Year 1-2: Egocentric Empathy

  • Imitative distress & behavior of another child; concern for others & try to comfort them

  • Year 2-3: Empathy for Other’s Feelings

  • Empathy with distress, disappointment, fear, surprise, sadness, anger, enjoyment

  • Year 3-8: Empathy for Other’s Life Conditions

  • Imagine pain/pleasure of remote persons & groups


Emotional intelligence
Emotional intelligence parenting to avoid personality disorders

Emotional Intelligence Skills (Goleman)

  • Self Awareness: Knowing one’s internal states, resources, and limitations

    • Emotional awareness: recognizing one’s emotions and their effects

    • Accurate self assessment: knowing one’s strengths and limits

    • Self confidence: strong sense of self worth and capabilities

  • 2.Self Regulation: Managing one’s internal states, impulses and resources

    • Self control: keeping disruptive emotions and impulses in check

    • Trustworthiness: Maintaining standards of honesty and integrity

    • Take responsibility for personal performance

    • Adaptability: Flexibility in handling change

    • Innovation: Being comfortable with new ideas

  • 3.Motivation: Emotional tendencies that guide or facilitate reaching goals

    • Achievement drive: striving to improve

    • Commitment: aligning with the goals of the agency or group

    • Initiative: Readiness to act on opportunities

    • Optimism: Persistence in pursuing goals


Emo iq cont d
Emo IQ cont’d parenting to avoid personality disorders

  • 4. Empathy: Awareness of others’ feelings, needs, perceptions and concerns

    • Understanding others: Sensing others’ feelings and concerns

    • Identifying their development needs: bolstering their abilities

    • Service orientation: recognizing and meeting users’ needs

    • Political awareness: Reading a group’s emotional currents and powerrelationships

  • 5. Social Skills: Ability to induce desirable responses in others

    • Influence: ability to persuade

    • Communication: listening openly

    • Conflict management: negotiating and resolving disagreements

    • Change catalyst: Initiating and managing change

    • Building bonds: nurturing key relationships

    • Collaboration and cooperation: working with others towards shared goals

    • Team capabilities: Creating group energy in pursuing collective goals


System map of traits
System map of traits parenting to avoid personality disorders

Possible pathways among traits

Stimulation seeking

Low fear, anxiety

High pain threshold

Low motivation to anticipate consequences

Opportunist

(versatility)

Inability to anticipate, learn, insight

Poor planning, present orientation, unrealistic

Predatory

Limited cognitive capacity, inattention

Impulsiveness

Early behavior problems

Poor identification with others

Parasitic

Irresponsible

Aggressive

Callous

No remorse, shame, guilt, embarrassment

Narcissism

grandiosity

Poor social attachment

Superficiality

Promiscuity

Short term relations

Charm

glibness

Verbal fluency

Manipulation

Lying


The cost of antisocial behavior parenting to avoid personality disorders

  • Young people who represent only 20% of the population produce 40% of reported crimes

  • Out of district juvenile placement can cost about $200,000/year

  • By the time youth are finally referred to day treatment programs they have already cost $250,000 in services

  • By age 28, the costs for public service for individuals with conduct disorder were 10 times higher than non-CD persons, especially related to crime (Scott, et al., 2001)

  • Antisocial persons have longer and more periods of unemployment

  • The cost of incarceration per prisoner per year is $20,000-$50,000

  • Recurrent or lifetime incarceration costs about $3 million per person NOT counting the indirect costs of adjudication, damage to victims, and related costs over the years

  • Execution is more expensive than lifetime incarceration: Execution can be from $2.1 (CA) to 3.2 million (FL), and incarceration from $600K (FL) to $1.4 million (CA)

  • Net annual direct & indirect cost of criminal behavior in the US is estimated at $1 trillion (Journal of Law & Economics, 1999)

  • High quality early childhood development programs have high cost-benefit ratios of $3 for every $1 invested (Lynch, 2004)

  • early invention programs can prevent as many as 250 crimes per $1 million spent while the same amount spent in prisons would prevent only 60 such crimes a year(Rand Corp, 1997)


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