Psychopathy is a psychological construct that describes chronic immoral and antisocial behavior. The term is often used interchangeably with sociopathy. Psychopathy has been the most studied of any personality disorder. Today the term can legitimately be used in two ways. One is in the legal sense, "psychopathic personality disorder" under the Mental Health Act 1983 of the UK. The other use is as a severe form of the antisocial or dissocial personality disorder as exclusively defined by the Psychopathy Checklist-Revised (PCL-R). The term "psychopathy" is often confused with psychotic disorders. It is estimated that approximately one percent of the general population are psychopaths. They are overrepresented in prison systems, politics, law enforcement agencies, law firms, and in the media.
The psychopath is defined by a psychological gratification in criminal, sexual, or aggressive impulses and the inability to learn from past mistakes. Using Freudian terminology, the psychopathic personality occurs when the ego can't mediate between the id and the super-ego, thus allowing the id to run off the pleasure principle, and the super-ego has no control over the actions of the ego. In other words, individuals with this disorder gain satisfaction through their antisocial behavior as well as lacking a conscience.
Psychopathy is frequently co-morbid with other psychological disorders (particularly narcissistic personality disorder). The psychopath differs slightly from the sociopath, and may differ even more so from an individual with an antisocial personality disorder diagnosis. Nevertheless, the three terms are frequently used interchangeably. While nearly all psychopaths have antisocial personality disorder, only some individuals with antisocial personality disorder are psychopaths. Many psychologists believe that psychopathy falls on a spectrum of pathological narcissism, ranging from narcissistic personality disorder on the low end, malignant narcissism in the middle, and psychopathy on the high end.
An almost all-pervasive misconception is that psychopaths are doomed to a life of violence and crime; however, it is possible for psychopaths to become successful in many lines of work. Psychopathy is frequently mistaken with other similar personality disorders, such as dissocial personality disorder, narcissistic personality disorder, and schizoid personality disorder (as well as others).
Interest in features of what is now the antisocial personality disorder goes back to Theophrastus, a student of Aristotle, whose description of The Unscrupulous Man embodies the characteristics of the antisocial personality disorder.
Interest in the psychopathic personality pattern goes back to colonial times. In those times, a person with a mental illness such as psychopathy would be reasoned as a subject of demonic possession. In 1801, Philippe Pinel described patients who were mentally unimpaired but nonetheless engaged in impulsive and self-defeating acts. He saw them as la folie raisonnante ("insane without delirium") meaning that they fully understood the irrationality of their behavior but continued with it anyway. Pinel was one of the last to study psychopathic personalities without including a moral judgment in his diagnosis. By the turn of the century, Henry Maudsley had begun writing about the moral imbecile, and was arguing that such individuals could not be rehabilitated by the correctional system.
Maudsley included the psychopath's immunity to the reformational effects of punishment, owing to their refusal to anticipate further failure, and punishment . In 1904, Emil Kraepelin described four types of personalities similar to the antisocial personality disorder. By 1915 he had identified them as defective in either effect or volition, dividing the types further into categories only some of which correspond to the current descriptions of antisocial.
The Mask of Sanity by Hervey M. Cleckley, M.D., first published in 1941, is considered a seminal work and the most influential clinical description of psychopathy in the 20th century. The basic elements of psychopathy outlined by Cleckley are still relevant today. The title refers to the normal "mask" that conceals the mental disorder of the psychopathic person in Cleckley's conceptualization.
Otto Kernberg believed that psychopathy should fall under a spectrum of pathological narcissism, that ranged from narcissistic personality on the low end, malignant narcissism in the middle, and psychopathy at the high end. Because of the psychopath's inability to internalize superego precursors, they are typically unable to learn from past mistakes, and are completely devoid of a conscience.
Psychopaths (and others on the pathological narcissism scale) low in social cognition are more prone to violence against others, failure in occupational settings, and problems maintaining relationships. All psychopaths differ in their impulse control abilities, and overall desires. Psychopaths high in the pathological narcissism scale are more equipped to succeed, but pathological narcissism does not in any way guarantee success. Those that fall into the category of psychopath are vulnerable to a life of crime, poverty, and extremely poor interpersonal relationships.
Factor1: Aggressive narcissism
Factor2: Socially deviant lifestyle
Traits not correlated with either factor
In practice, mental health professionals rarely treat psychopathic personality disorders as they are considered untreatable and no interventions have proved to be effective. In England and Wales the diagnosis of dissocial personality disorder is grounds for detention in secure psychiatric hospitals under the Mental Health Act if they have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment this alternative to prison is not often used.
Because an individual's scores may have important consequences for his or her future, the potential for harm if the test is used or administered incorrectly is considerable. The test should only be considered valid if administered by a suitably qualified and experienced clinician under controlled conditions.
Hare wants the Diagnostic and Statistical Manual of Mental Disorders to list psychopathy as a unique disorder, saying that psychopathy has no precise equivalent in either the DSM-IV-TR, where it is most strongly correlated with the diagnosis of antisocial personality disorder, or the ICD-10, which has a partly similar condition called dissocial personality disorder. Both organisations view the terms as synonymous. But only a minority of what Hare and his followers would diagnose as psychopaths who are in institutions are violent offenders. The manipulative skills of some of the others are valued for providing audacious leadership. It is argued that psychopathy is adaptive in a highly competitive environment, because it gets results for both the individual and the corporations or, often small political sects that they represent. However, these individuals will often cause long-term harm, both to their co-workers and the organization as a whole, due to their manipulative, deceitful, abusive, and often fraudulent behaviour.
Hare describes people he calls psychopaths as "intraspecies predators who use charm, manipulation, intimidation, sex and violence to control others and to satisfy their own selfish needs. Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". "What is missing, in other words, are the very qualities that allow a human being to live in social harmony.
Early factor analysis of the PCL-R indicated that it consisted of two factors. Factor 1 captures traits dealing with the interpersonal and affective deficits of psychopathy (e.g. shallow affect, superficial charm, manipulativeness, lack of empathy) whereas Factor 2 dealt with symptoms relating to antisocial behaviour (e.g. criminal versatility, impulsiveness, irresponsibility, poor behaviour controls, juvenile delinquency). The two factors have been found by those following this theory to display different correlates. Factor 1 has been correlated with narcissistic personality disorder, low anxiety, low empathy, low stress reaction and low suicide risk but high scores on scales of achievement and well-being. In contrast, Factor 2 was found to be related to antisocial personality disorder, social deviance, sensation seeking, low socio-economic status and high risk of suicide. The two factors are nonetheless highly correlated and there are strong indications that they do result from a single underlying disorder. However, research has failed to replicate the two-factor model in female samples.
Recent statistical analysis using confirmatory factor analysis by Cooke and Michie indicated a three-factor structure, with those items from factor 2 strictly relating to antisocial behaviour (criminal versatility, juvenile delinquency, revocation of conditional release, early behavioural problems and poor behavioural controls) removed from the final model. The remain items divided into three factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience and Impulsive and Irresponsible Behavioural Style. In the most recent edition of the PCL-R, Hare adds a fourth antisocial behaviour factor, consisting of those Factor 2 items excluded in the previous model. Again, these models are presumed to be hierarchical with a single unified psychopathy disorder underlying the distinct but correlated factors.
In contemporary research and clinical psychiatric practice, the American Psychiatric Association use the DSM and European doctors use the ICD-10 and will use the term antisocial personality disorder. Psychopathy is most commonly assessed by those who subscribe to a separate idea of psychopathy with the PCL-R, which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale according to two factors. PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence. PCL-R Factor 1, in contrast, is associated with extroversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning). A psychopath will score high on both factors, whereas someone with APD will score high only on Factor 2.
Both case history and a semi-structured interview are used in the analysis.
According to Jay Ziskin any diagnosis that does not appear in DSM III is not a formal diagnoses for legal uses, as shown in a quote from Coping with Psychiatric and Psychological Testimony Vol II by Jay Ziskin which is a book for attorneys to shoot down psychiatric testimony in the United States.
Primary psychopathy was defined by those following this theory as the root disorder in patients diagnosed with it, whereas secondary psychopathy was defined as an aspect of another psychiatric disorder or social circumstances. Today, primary psychopaths are considered to have mostly Factor 1 traits from the PCL-R (arrogance, callousness, manipulativeness, lying) whereas secondary psychopaths have a majority of Factor 2 traits (impulsivity, boredom proneness, irresponsibility, lack of long-term goals).Secondary psychopaths show normal to above-normal physiological responses to (perceived) potential threats. Their crimes tend to be unplanned and impulsive with little thought of the consequences. Including to those using this theory, this type have hot tempers and are prone to reactive aggression. They experience normal to above-normal levels of anxiety but are nevertheless highly stimulus seeking and have trouble tolerating boredom. Their lifestyle may lead to depression and even suicide.
Mealey uses the term "primary psychopathy" to differentiate between psychopathy that is biological in origin and "secondary psychopathy" that results from a combination of genetic and environmental influences. Lykken prefers sociopathy to describe the latter.
Sellbom and Ben-Porath (2005) describe the distinction:
Joseph P. Newman et al, who use this concept of psychopathy, have validated David T. Lykken's conceptualization of psychopathy subtypes in relation to Gray's behavioral activation system and behavioral inhibition system. Newman et al. found measures of primary psychopathy to be negatively correlated with Gray's behavioral inhibition system, a construct intended to measure behavioral inhibition from cues of punishment or nonreward. In contrast, measures of secondary psychopathy to be positively correlated with Gray's behavioral activation system, a construct intended to measure sensitivity to cues of behavioral approach.
David T. Lykken proposes that psychopathy and sociopathy are two distinct kinds of antisocial personality disorder. He holds that psychopaths are born with temperamental differences such as impulsivity, cortical underarousal, and fearlessness that lead them to risk-seeking behavior and an inability to internalize social norms. Sociopaths, on the other hand, he believes to have relatively normal temperaments; their personality disorder being more an effect of negative sociological factors like parental neglect, delinquent peers, poverty, and extremely low or extremely high intelligence. Both personality disorders are, of course, the result of an interaction between genetic predispositions and environmental factors, but psychopathy leans towards the hereditary whereas sociopathy tends towards the environmental.
The criteria for the Antisocial Personality Disorder were derived from the Research Diagnositic Criteria developed by Spitzer, Endicott and Robbins (1978). There was concern in the development of DSM-IV that there was too much emphasis on research data and not enough on the more traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal. Field trial data indicated that some of these traits of psychopathy derived from the Psychopathy Checklist developed by Hare et al., 1992, were difficult to assess reliably and thus were not included. Lack of remorse is an example. The antisocial person may express genuine or false guilt or remorse and/or offer excuses and rationalizations. However, a history of criminal acts in itself suggests little remorse or guilt.
The American Psychiatric Association removed the word "psychopathy" or "psychopathic", and started using the term "Antisocial Personality" to cover the disorder in ''DSM-II.
The World Health Organization's stance in its ICD-10 refers to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder. Further, the DSM was meant as a diagnostic guide, and the term psychopath best fit the criteria met for antisocial personality disorder.
Psychopaths are over-represented in popular culture, almost always depicted as serial killers and mass murderers, despite the fact that in reality not all psychopaths commit violent crimes. Some examples of these fictional psychopaths include; the Joker from DC's Batman comics, American Psycho's Patrick Bateman, various James Bond villains, Doctor Septimus Pretorius, various Disney villains such as Jafar and Queen Narissa, Lord Cutler Beckett from Pirates of the Caribbean and Lord Voldemort from Harry Potter.
This extends into their pathological lying and willingness to con and manipulate others for personal gain or amusement. The prototypical psychopath's emotions are described as a shallow affect, meaning their overall way of relating is characterized by mere displays of friendliness and other emotion for personal gain; the displayed emotion need not correlate with felt emotion, in other words.
Shallow affect also describes the psychopath's tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts.
Most research studies of psychopaths have taken place among prison populations. This remains a limitation on its applicability to a general population.
It has been shown that punishment and behavior modification techniques do not improve the behavior of what Hare and other followers of this theory call a psychopath. They have been regularly observed to respond to both by becoming more cunning and hiding their behavior better. It has been suggested by them that traditional therapeutic approaches actually make psychopaths if not worse, then far more adept at manipulating others and concealing their behavior. They are generally considered to be not only incurable but also untreatable.
Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.
Children showing strong psychopathic precursors often appear immune to punishment; nothing seems to modify their undesirable behavior. Consequently parents usually give up, and the behavior worsens.
The following childhood indicators are to be seen not as to the type of behavior, but as to its relentless and unvarying occurrence. Not all must be present concurrently, but at least a number of them need to be present over a period of years:
The three indicators—bedwetting, cruelty to animals and firestarting, known as the MacDonald triad—were first described by J.M. MacDonald as indicators of psychopathy. The relevance of these indicators to serial murder etiology has since been called into question, and they are considered irrelevant to psychopathy.
The question of whether young children with early indicators of psychopathy respond poorly to intervention compared to conduct disordered children without these traits have only recently been examined in controlled clinical research. The empirical findings from this research have been consistent with broader anecdotal evidence, pointing to poor treatment outcomes.
In contrast, the PCL–R sets a score of 30 out of 40 for North American male inmates as its cut-off point for a diagnosis of psychopathy, however this is an abitrary cut-off and should not be taken to reflect any sort of underlying structure for the disorder.
In a 2002 experiment, Blair, Mitchell, et al. used the Vocal Affect Recognition Test to measure psychopaths' recognition of the emotional intonation given to connotatively neutral words. Psychopaths tended to make more recognition errors than controls with a particularly high rate of error for sad and fearful vocal affect.
A 2004 experiment tested the hypothesis of overselective attention in psychopaths using two forms of the Stroop color-word and picture-word tasks: with color/picture and word separated and with color/picture and word together. They found that in the separated Stroop tasks, psychopaths performed significantly worse than controls; however, on standard Stroop tasks, psychopaths performed equally well as controls.
When split into low-anxious and high-anxious groups, low-anxious psychopaths and low-anxious controls showed less interference on the separated Stroop tasks than their high-anxious counterparts; for low-anxious psychopaths, interference was very nearly zero. They conclude that the inability to integrate contextual cues depends on the cues' relationship to "the deliberately attended, goal-relevant information."