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= Psychopathy =
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Introduction
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Psychopathy is traditionally a personality disorder characterized by
persistent antisocial behavior, impaired empathy and remorse, and
bold, disinhibited, and egotistical traits. It is sometimes
considered synonymous with sociopathy. Different conceptions of
psychopathy have been used throughout history that are only partly
overlapping and may sometimes be contradictory.
Hervey M. Cleckley, an American psychiatrist, influenced the initial
diagnostic criteria for antisocial personality reaction/disturbance in
the 'Diagnostic and Statistical Manual of Mental Disorders' (DSM), as
did American psychologist George E. Partridge. The DSM and
'International Classification of Diseases' (ICD) subsequently
introduced the diagnoses of antisocial personality disorder (ASPD) and
dissocial personality disorder (DPD) respectively, stating that these
diagnoses have been referred to (or include what is referred to) as
psychopathy or sociopathy. The creation of ASPD and DPD was driven by
the fact that many of the classic traits of psychopathy were
impossible to measure objectively. Canadian psychologist Robert D.
Hare later repopularized the construct of psychopathy in criminology
with his Psychopathy Checklist.
Although no psychiatric or psychological organization has sanctioned a
diagnosis titled "psychopathy", assessments of psychopathic
characteristics are widely used in criminal justice settings in some
nations and may have important consequences for individuals. The study
of psychopathy is an active field of research, and the term is also
used by the general public, popular press, and in fictional
portrayals. While the term is often employed in common usage along
with "crazy", "insane", and "mentally ill", there is a categorical
difference between psychosis and psychopathy.
Definition
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A person suffering from a chronic mental disorder with abnormal or
violent social behavior.
Concepts
==========
There are multiple conceptualizations of psychopathy, including
'Cleckleyan psychopathy' (Hervey Cleckley's conception entailing bold,
disinhibited behavior, and "feckless disregard") and 'criminal
psychopathy' (a meaner, more aggressive and disinhibited conception
explicitly entailing persistent and sometimes serious criminal
behavior). The latter conceptualization is typically used as the
modern clinical concept and assessed by the Psychopathy Checklist. The
label "psychopath" may have implications and stigma related to
decisions about punishment severity for criminal acts, medical
treatment, civil commitments, etc. Efforts have therefore been made to
clarify the meaning of the term.
The triarchic model suggests that different conceptions of psychopathy
emphasize three observable characteristics to various degrees.
Analyses have been made with respect to the applicability of
measurement tools such as the Psychopathy Checklist (PCL, PCL-R) and
Psychopathic Personality Inventory (PPI) to this model.
* Boldness. Low fear including stress-tolerance, toleration of
unfamiliarity and danger, and high self-confidence and social
assertiveness. The PCL-R measures this relatively poorly and mainly
through Facet 1 of Factor 1. Similar to PPI Fearless dominance. May
correspond to differences in the amygdala and other neurological
systems associated with fear.
* Disinhibition. Poor impulse control including problems with planning
and foresight, lacking affect and urge control, demand for immediate
gratification, and poor behavioral restraints. Similar to PCL-R Factor
2 and PPI Impulsive antisociality. May correspond to impairments in
frontal lobe systems that are involved in such control.
* Meanness. Lacking empathy and close attachments with others, disdain
of close attachments, use of cruelty to gain empowerment, exploitative
tendencies, defiance of authority, and destructive excitement seeking.
The PCL-R in general is related to this but in particular some
elements in Factor 1. Similar to PPI, but also includes elements of
subscales in Impulsive antisociality.
Measurement
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An early and influential analysis from Harris and colleagues indicated
that a discrete category, or taxon, may underlie PCL-R psychopathy,
allowing it to be measured and analyzed. However, this was only found
for the behavioral Factor 2 items they identified, child problem
behaviors; adult criminal behavior did not support the existence of a
taxon. Marcus, John, and Edens more recently performed a series of
statistical analyses on PPI scores and concluded that psychopathy may
best be conceptualized as having a "dimensional latent structure" like
depression.
Marcus et al. repeated the study on a larger sample of prisoners,
using the PCL-R and seeking to rule out other experimental or
statistical issues that may have produced the previously different
findings. They again found that the psychopathy measurements do not
appear to be identifying a discrete type (a taxon). They suggest that
while for legal or other practical purposes an arbitrary cut-off point
on trait scores might be used, there is actually no clear scientific
evidence for an objective point of difference by which to label some
people "psychopaths"; in other words, a "psychopath" may be more
accurately described as someone who is "relatively psychopathic".
The PCL-R was developed for research, not clinical forensic diagnosis,
and even for research purposes to improve understanding of the
underlying issues, it is necessary to examine dimensions of
personality in general rather than only a constellation of traits.
Personality dimensions
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Studies have linked psychopathy to alternative dimensions such as
antagonism (high), conscientiousness (low) and anxiousness (low).
Psychopathy has also been linked to high psychoticism�a theorized
dimension referring to tough, aggressive or hostile tendencies.
Aspects of this that appear associated with psychopathy are lack of
socialization and responsibility, impulsivity, sensation-seeking (in
some cases), and aggression.
Otto Kernberg, from a particular psychoanalytic perspective, believed
psychopathy should be considered as part of a spectrum of pathological
narcissism, that would range from narcissistic personality on the low
end, malignant narcissism in the middle, and psychopathy at the high
end.
Psychopathy, narcissism and Machiavellianism, three personality traits
that are together referred to as the dark triad, share certain
characteristics, such as a callous-manipulative interpersonal style.
The dark tetrad refers to these traits with the addition of sadism.
Criticism of current conceptions
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The current conceptions of psychopathy have been criticized for being
poorly conceptualized, highly subjective, and encompassing a wide
variety of underlying disorders. Dorothy Otnow Lewis has written
Half of the Hare Psychopathy Checklist consists of symptoms of mania,
hypomania, and frontal-lobe dysfunction, which frequently results in
underlying disorders being dismissed. Hare's conception of
psychopathy has also been criticized for being reductionist,
dismissive, tautological, and ignorant of context as well as the
dynamic nature of human behavior. Some have called for rejection of
the concept altogether, due to its vague, subjective and judgmental
nature that makes it prone to misuse.
Signs and symptoms
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Socially, psychopathy expresses extensive callous and manipulative
self-serving behaviors with no regard for others, and often is
associated with repeated delinquency, crime and violence. Mentally,
impairments in processes related to affect (emotion) and cognition,
particularly socially related mental processes, have been found in
those with the disorder. Developmentally, symptoms of psychopathy have
been identified in young children with conduct disorder, and is
suggestive of at least a partial constitutional factor that influences
its development.
Criminality
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In terms of simple correlations, the PCL-R manual states an average
score of 22.1 has been found in North American prisoner samples, and
that 20.5% scored 30 or higher. An analysis of prisoner samples from
outside North America found a somewhat lower average value of 17.5.
Studies have found that psychopathy scores correlated with repeated
imprisonment, detention in higher security, disciplinary infractions,
and substance misuse.
Psychopathy, as measured with the PCL-R in institutional settings,
shows in meta-analyses small to moderate effect sizes with
institutional misbehavior, postrelease crime, or postrelease violent
crime with similar effects for the three outcomes. Individual studies
give similar results for adult offenders, forensic psychiatric
samples, community samples, and youth. The PCL-R is poorer at
predicting sexual re-offending. This small to moderate effect appears
to be due largely to the scale items that assess impulsive behaviors
and past criminal history, which are well-established but very general
risk factors. The aspects of core personality often held to be
distinctively psychopathic generally show little or no predictive link
to crime by themselves. For example, Factor 1 of the PCL-R and
Fearless dominance of the PPI-R have smaller or no relationship to
crime, including violent crime. In contrast, Factor 2 and Impulsive
antisociality of the PPI-R are associated more strongly with
criminality. Factor 2 has a relationship of similar strength to that
of the PCL-R as a whole. The antisocial facet of the PCL-R is still
predictive of future violence after controlling for past criminal
behavior which, together with results regarding the PPI-R which by
design does not include past criminal behavior, suggests that
impulsive behaviors is an independent risk factor. Thus, the concept
of psychopathy may perform poorly when attempted to be used as a
general theory of crime.
Violence
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Studies have suggested a strong correlation between psychopathy scores
and violence, and the PCL-R emphasizes features that are somewhat
predictive of violent behavior. Researchers, however, have noted that
psychopathy is dissociable from and not synonymous with violence.
It has been suggested that psychopathy is associated with
"instrumental", also known as predatory, proactive, or "cold blooded"
aggression, a form of aggression characterized by reduced emotion and
conducted with a goal differing from but facilitated by the commission
of harm. One conclusion in this regard was made by a 2002 study of
homicide offenders, which reported that the homicides committed by
homicidal offenders with psychopathy were almost always (93.3%)
primarily instrumental, significantly more than the proportion (48.4%)
of those committed by non-psychopathic homicidal offenders, with the
instrumentality of the homicide also correlated with the total PCL-R
score of the offender as well as their scores on the Factor 1
"interpersonal-affective" dimension. However, contrary to the equating
of this to mean exclusively "in cold blood", more than a third of the
homicides committed by psychopathic offenders involved some component
of emotional reactivity as well. In any case, FBI profilers indicate
that serious victim injury is generally an emotional offense, and some
research supports this, at least with regard to sexual offending. One
study has found more serious offending by non-psychopathic offenders
on average than by offenders with psychopathy (e.g. more homicides
versus more armed robbery and property offenses) and another that the
Affective facet of the PCL-R predicted reduced offense seriousness.
Studies on perpetrators of domestic violence find that abusers have
high rates of psychopathy, with the prevalence estimated to be at
around 15-30%. Furthermore, the commission of domestic violence is
correlated with Factor 1 of the PCL-R, which describes the emotional
deficits and the callous and exploitative interpersonal style found in
psychopathy. The prevalence of psychopathy among domestic abusers
indicate that the core characteristics of psychopathy, such as
callousness, remorselessness, and a lack of close interpersonal bonds,
predispose those with psychopathy to committing domestic abuse, and
suggest that the domestic abuses committed by these individuals are
callously perpetrated (i.e. instrumentally aggressive) rather than a
case of emotional aggression and therefore may not be amenable to the
types of psychosocial interventions commonly given to domestic abuse
perpetrators.
Some clinicians suggest that assessment of the construct of
psychopathy does not necessarily add value to violence risk
assessment. A large systematic review and meta-regression found that
the PCL performed the poorest out of nine tools for predicting
violence. In addition, studies conducted by the authors or translators
of violence prediction measures, including the PCL, show on average
more positive results than those conducted by more independent
investigators. There are several other risk assessment instruments
which can predict further crime with an accuracy similar to the PCL-R
and some of these are considerably easier, quicker, and less expensive
to administer. This may even be done automatically by a computer
simply based on data such as age, gender, number of previous
convictions and age of first conviction. Some of these assessments may
also identify treatment change and goals, identify quick changes that
may help short-term management, identify more specific kinds of
violence that may be at risk, and may have established specific
probabilities of offending for specific scores. Nonetheless, the PCL-R
may continue to be popular for risk assessment because of its
pioneering role and the large amount of research done using it.
The Federal Bureau of Investigation reports that psychopathic behavior
is consistent with traits common to some serial killers, including
sensation seeking, a lack of remorse or guilt, impulsivity, the need
for control, and predatory behavior. It has also been found that the
homicide victims of psychopathic offenders were disproportionately
female in comparison to the more equitable gender distribution of
victims of non-psychopathic offenders.
Sexual offending
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Psychopathy has been associated with commission of sexual crime, with
some researchers arguing that it is correlated with a preference for
violent sexual behavior. A 2011 study of conditional releases for
Canadian male federal offenders found that psychopathy was related to
more violent and non-violent offences but not more sexual offences.
For child molesters, psychopathy was associated with more offences. A
study on the relationship between psychopathy scores and types of
aggression in a sample of sexual murderers, in which 84.2% of the
sample had PCL-R scores above 20 and 47.4% above 30, found that 82.4%
of those with scores above 30 had engaged in sadistic violence
(defined as enjoyment indicated by self-report or evidence) compared
to 52.6% of those with scores below 30, and total PCL-R and Factor 1
scores correlated significantly with sadistic violence. Despite this,
it is reported that offenders with psychopathy (both sexual and
non-sexual offenders) are about 2.5 times more likely to be granted
conditional release compared to non-psychopathic offenders.
In considering the issue of possible reunification of some sex
offenders into homes with a non-offending parent and children, it has
been advised that any sex offender with a significant criminal history
should be assessed on the PCL-R, and if they score 18 or higher, then
they should be excluded from any consideration of being placed in a
home with children under any circumstances. There is, however,
increasing concern that PCL scores are too inconsistent between
different examiners, including in its use to evaluate sex offenders.
Other offending
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The possibility of psychopathy has been associated with organized
crime, economic crime and war crimes. Terrorists are sometimes
considered psychopathic, and comparisons may be drawn with traits such
as antisocial violence, a selfish world view that precludes the
welfare of others, a lack of remorse or guilt, and blame
externalization. However, John Horgan, author of 'The Psychology of
Terrorism', argues that such comparisons could also then be drawn more
widely: for example, to soldiers in wars. Coordinated terrorist
activity requires organization, loyalty and ideological fanaticism
often to the extreme of sacrificing oneself for an ideological cause.
Traits such as a self-centered disposition, unreliability, poor
behavioral controls, and unusual behaviors may disadvantage or
preclude psychopathic individuals in conducting organized terrorism.
It may be that a significant portion of people with the disorder are
socially successful and tend to express their antisocial behavior
through more covert avenues such as social manipulation or white
collar crime. Such individuals are sometimes referred to as
"successful psychopaths", and may not necessarily always have
extensive histories of traditional antisocial behavior as
characteristic of traditional psychopathy.
Childhood and adolescent precursors
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The PCL:YV is an adaptation of the PCL-R for individuals aged 13-18
years. It is, like the PCL-R, done by a trained rater based on an
interview and an examination of criminal and other records. The
"Antisocial Process Screening Device" (APSD) is also an adaptation of
the PCL-R. It can be administered by parents or teachers for
individuals aged 6-13 years. High psychopathy scores for both
juveniles, as measured with these instruments, and adults, as measured
with the PCL-R and other measurement tools, have similar associations
with other variables, including similar ability in predicting violence
and criminality. Juvenile psychopathy may also be associated with more
negative emotionality such as anger, hostility, anxiety, and
depression. Psychopathic traits in youth typically comprise three
factors: callous/unemotional, narcissism, and
impulsivity/irresponsibility.
There is positive correlation between early negative life events of
the ages 0-4 and the emotion-based aspects of psychopathy. There are
moderate to high correlations between psychopathy rankings from late
childhood to early adolescence. The correlations are considerably
lower from early- or mid-adolescence to adulthood. In one study most
of the similarities were on the Impulsive- and Antisocial-Behavior
scales. Of those adolescents who scored in the top 5% highest
psychopathy scores at age 13, less than one third (29%) were
classified as psychopathic at age 24. Some recent studies have also
found poorer ability at predicting long-term, adult offending.
Conduct disorder
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Conduct disorder is diagnosed based on a prolonged pattern of
antisocial behavior in childhood and/or adolescence, and may be seen
as a precursor to ASPD. Some researchers have speculated that there
are two subtypes of conduct disorder which mark dual developmental
pathways to adult psychopathy. The DSM allows differentiating between
childhood onset before age 10 and adolescent onset at age 10 and
later. Childhood onset is argued to be more due to a personality
disorder caused by neurological deficits interacting with an adverse
environment. For many, but not all, childhood onset is associated with
what is in Terrie Moffitt's developmental theory of crime referred to
as "life-course- persistent" antisocial behavior as well as poorer
health and economic status. Adolescent onset is argued to more
typically be associated with short-term antisocial behavior.
It has been suggested that the combination of early-onset conduct
disorder and ADHD may be associated with life-course-persistent
antisocial behaviors as well as psychopathy. There is evidence that
this combination is more aggressive and antisocial than those with
conduct disorder alone. However, it is not a particularly distinct
group since the vast majority of young children with conduct disorder
also have ADHD. Some evidence indicates that this group has deficits
in behavioral inhibition, similar to that of adults with psychopathy.
They may not be more likely than those with conduct disorder alone to
have the interpersonal/affective features and the deficits in
emotional processing characteristic of adults with psychopathy.
Proponents of different types/dimensions of psychopathy have seen this
type as possibly corresponding to adult secondary psychopathy and
increased disinhibition in the triarchic model.
The DSM-5 includes a specifier for those with conduct disorder who
also display a callous, unemotional interpersonal style across
multiple settings and relationships. The specifier is based on
research which suggests that those with conduct disorder who also meet
criteria for the specifier tend to have a more severe form of the
disorder with an earlier onset as well as a different response to
treatment. Proponents of different types/dimensions of psychopathy
have seen this as possibly corresponding to adult primary psychopathy
and increased boldness and/or meanness in the triarchic model.
Cognition
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Dysfunctions in the prefrontal cortex and amygdala regions of the
brain have been associated with specific learning impairments in
psychopathy. Since the 1980s, scientists have linked traumatic brain
injury, including damage to these regions, with violent and
psychopathic behavior. Patients with damage in such areas resembled
"psychopathic individuals" whose brains were incapable of acquiring
social and moral knowledge; those who acquired damage as children may
have trouble conceptualizing social or moral reasoning, while those
with adult-acquired damage may be aware of proper social and moral
conduct but be unable to behave appropriately. Dysfunctions in the
amygdala and ventromedial prefrontal cortex may also impair
stimulus-reinforced learning in psychopaths, whether punishment-based
or reward-based. People scoring 25 or higher in the PCL-R, with an
associated history of violent behavior, appear to have significantly
reduced mean microstructural integrity in their uncinate
fasciculus�white matter connecting the amygdala and orbitofrontal
cortex. There is evidence from DT-MRI, of breakdowns in the white
matter connections between these two important areas.
Although some studies have suggested inverse relationships between
psychopathy and intelligence, including with regards to verbal IQ,
Hare and Neumann state that a large literature demonstrates at most
only a weak association between psychopathy and IQ, noting that the
early pioneer Cleckley included good intelligence in his checklist due
to selection bias (since many of his patients were "well educated and
from middle-class or upper-class backgrounds") and that "there is no
obvious theoretical reason why the disorder described by Cleckley or
other clinicians should be related to intelligence; some psychopaths
are bright, others less so". Studies also indicate that different
aspects of the definition of psychopathy (e.g. interpersonal,
affective (emotion), behavioral and lifestyle components) can show
different links to intelligence, and the result can depend on the type
of intelligence assessment (e.g. verbal, creative, practical,
analytical).
Emotion recognition and empathy
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A large body of research suggests that psychopathy is associated with
atypical responses to distress cues (e.g. facial and vocal expressions
of fear and sadness), including decreased activation of the fusiform
and extrastriate cortical regions, which may partly account for
impaired recognition of and reduced autonomic responsiveness to
expressions of fear, and impairments of empathy. The underlying
biological surfaces for processing expressions of happiness are
functionally intact in psychopaths, although less responsive than
those of controls. The neuroimaging literature is unclear as to
whether deficits are specific to particular emotions such as fear. The
overall pattern of results across studies indicates that people
diagnosed with psychopathy demonstrate reduced MRI, fMRI, aMRI, PET,
and SPECT activity in areas of the brain. Research has also shown that
an approximate 18% smaller amygdala size contributes to a
significantly lower emotional sensation in regards to fear, sadness,
amongst other negative emotions, which may likely be the reason as to
why psychopathic individuals have lower empathy. Some recent fMRI
studies have reported that emotion perception deficits in psychopathy
are pervasive across emotions (positives and negatives). Studies on
children with psychopathic tendencies have also shown such
associations. Meta-analyses have also found evidence of impairments in
both vocal and facial emotional recognition for several emotions
(i.e., not only fear and sadness) in both adults and
children/adolescents.
Moral judgment
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Psychopathy has been associated with amorality�an absence of,
indifference towards, or disregard for moral beliefs. There are few
firm data on patterns of moral judgment. Studies of developmental
level (sophistication) of moral reasoning found all possible
results�lower, higher or the same as non-psychopaths. Studies that
compared judgments of personal moral transgressions versus judgments
of breaking conventional rules or laws found that psychopaths rated
them as equally severe, whereas non-psychopaths rated the
rule-breaking as less severe.
A study comparing judgments of whether personal or impersonal harm
would be endorsed in order to achieve the rationally maximum
(utilitarian) amount of welfare found no significant differences
between subjects high and low in psychopathy. However, a further study
using the same tests found that prisoners scoring high on the PCL were
more likely to endorse impersonal harm or rule violations than
non-psychopathic controls were. The psychopathic offenders who scored
low in anxiety were also more willing to endorse personal harm on
average.
Assessing accidents, where one person harmed another unintentionally,
psychopaths judged such actions to be more morally permissible. This
result has been considered a reflection of psychopaths' failure to
appreciate the emotional aspect of the victim's harmful experience.
Cause
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Behavioral genetic studies have identified potential genetic and
non-genetic contributors to psychopathy, including influences on brain
function. Proponents of the triarchic model believe that psychopathy
results from the interaction of genetic predispositions and an adverse
environment. What is adverse may differ depending on the underlying
predisposition: for example, it is hypothesized that persons having
high boldness may respond poorly to punishment but may respond better
to rewards and secure attachments.
Genetic
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Genetically informed studies of the personality characteristics
typical of individuals with psychopathy have found moderate genetic
(as well as non-genetic) influences. On the PPI, fearless dominance
and impulsive antisociality were similarly influenced by genetic
factors and uncorrelated with each other. Genetic factors may
generally influence the development of psychopathy while environmental
factors affect the specific expression of the traits that predominate.
A study on a large group of children found more than 60% heritability
for "callous-unemotional traits" and that conduct problems among
children with these traits had a higher heritability than among
children without these traits.
Environment
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A study by Farrington of a sample of London males followed between age
8 and 48 included studying which factors scored 10 or more on the
PCL:SV at age 48. The strongest factors included having a convicted
parent, being physically neglected, low involvement of the father with
the boy, low family income, and coming from a disrupted family. Other
significant factors included poor supervision, harsh discipline, large
family size, delinquent sibling, young mother, depressed mother, low
social class, and poor housing. There has also been association
between psychopathy and detrimental treatment by peers. However, it is
difficult to determine the extent of an environmental influence on the
development of psychopathy because of evidence of its strong
heritability.
Brain injury
==============
Researchers have linked head injuries with psychopathy and violence.
Since the 1980s, scientists have associated traumatic brain injury,
such as damage to the prefrontal cortex, including the orbitofrontal
cortex, with psychopathic behavior and a deficient ability to make
morally and socially acceptable decisions, a condition that has been
termed "acquired sociopathy", or "pseudopsychopathy". Individuals with
damage to the area of the prefrontal cortex known as the ventromedial
prefrontal cortex show remarkable similarities to diagnosed
psychopathic individuals, displaying reduced autonomic response to
emotional stimuli, deficits in aversive conditioning, similar
preferences in moral and economic decision making, and diminished
empathy and social emotions like guilt or shame. These emotional and
moral impairments may be especially severe when the brain injury
occurs at a young age. Children with early damage in the prefrontal
cortex may never fully develop social or moral reasoning and become
"psychopathic individuals ... characterized by high levels of
aggression and antisocial behavior performed without guilt or empathy
for their victims". Additionally, damage to the amygdala may impair
the ability of the prefrontal cortex to interpret feedback from the
limbic system, which could result in uninhibited signals that manifest
in violent and aggressive behavior.
Evolutionary explanations
===========================
Psychopathy is associated with several adverse life outcomes as well
as increased risk of disability and death due to factors such as
violence, accidents, homicides, and suicides. This, in combination
with the evidence for genetic influences, is evolutionarily puzzling
and may suggest that there are compensating evolutionary advantages,
and researchers within evolutionary psychology have proposed several
evolutionary explanations. According to one hypothesis, some traits
associated with psychopathy may be socially adaptive, and psychopathy
may be a frequency-dependent, socially parasitic strategy, which may
work as long as there is a large population of altruistic and trusting
individuals, relative to the population of psychopathic individuals,
to be exploited. It is also suggested that some traits associated with
psychopathy such as early, promiscuous, adulterous, and coercive
sexuality may increase reproductive success. Robert Hare has stated
that many psychopathic males have a pattern of mating with and quickly
abandoning women, and thereby have a high fertility rate, resulting in
children that may inherit a predisposition to psychopathy.
Criticism includes that it may be better to look at the contributing
personality factors rather than treat psychopathy as a unitary concept
due to poor testability. Furthermore, if psychopathy is caused by the
combined effects of a very large number of adverse mutations then each
mutation may have such a small effect that it escapes natural
selection. The personality is thought to be influenced by a very large
number of genes and may be disrupted by random mutations, and
psychopathy may instead be a product of a high mutation load.
Psychopathy has alternatively been suggested to be a spandrel, a
byproduct, or side-effect, of the evolution of adaptive traits rather
than an adaptation in itself.
Psychological
===============
Some laboratory research demonstrate correlations between psychopathy
and atypical responses to aversive stimuli, including weak
conditioning to painful stimuli and poor learning of avoiding
responses that cause punishment, as well as low reactivity in the
autonomic nervous system as measured with skin conductance while
waiting for a painful stimulus but not when the stimulus occurs. While
it has been argued that the reward system functions normally, some
studies have also found reduced reactivity to pleasurable stimuli.
According to the response modulation hypothesis, psychopathic
individuals have also had difficulty switching from an ongoing action
despite environmental cues signaling a need to do so. This may explain
the difficulty responding to punishment, although it is unclear if it
can explain findings such as deficient conditioning. There may be
methodological issues regarding the research. While establishing a
range of idiosyncrasies on average in linguistic and affective
processing under certain conditions, this research program has not
confirmed a common pathology of psychopathy.
Neurological
==============
Thanks to advancing MRI studies, experts are able to visualize
specific brain differences and abnormalities of individuals with
psychopathy in areas that control emotions, social interactions,
ethics, morality, regret, impulsivity and conscience within the brain.
Blair, a researcher who pioneered research into psychopathic
tendencies stated, �With regard to psychopathy, we have clear
indications regarding why the pathology gives rise to the emotional
and behavioral disturbance and important insights into the neural
systems implicated in this pathology�. Dadds et al., remarks that
despite a rapidly advancing neuroscience of empathy, little is known
about the developmental underpinnings of the psychopathic disconnect
between affective and cognitive empathy.
A 2008 review by Weber et al. suggested that psychopathy is sometimes
associated with brain abnormalities in prefrontal-temporo-limbic
regions that are involved in emotional and learning processes, among
others. Neuroimaging studies have found structural and functional
differences between those scoring high and low on the PCL-R in a 2011
review by Skeem et al. stating that they are "most notably in the
amygdala, hippocampus and parahippocampal gyri, anterior and posterior
cingulate cortex, striatum, insula, and frontal and temporal cortex".
A 2010 meta-analysis found that antisocial, violent and psychopathic
individuals had reduced structure function in the right orbitofrontal
cortex, right anterior cingulate cortex and left dorsolateral
prefrontal cortex.
The amygdala and frontal areas have been suggested as particularly
important. People scoring 25 or higher in the PCL-R, with an
associated history of violent behavior, appear on average to have
significantly reduced microstructural integrity between the white
matter connecting the amygdala and orbitofrontal cortex (such as the
uncinate fasciculus). The evidence suggested that the degree of
abnormality was significantly related to the degree of psychopathy and
may explain the offending behaviors. Furthermore, changes in the
amygdala have been associated with "callous-unemotional" traits in
children. However, the amygdala has also been associated with positive
emotions, and there have been inconsistent results in the studies in
particular areas, which may be due to methodological issues.
Some of these findings are consistent with other research and
theories. For example, in a neuroimaging study of how individuals with
psychopathy respond to emotional words, widespread differences in
activation patterns have been shown across the temporal lobe when
psychopathic criminals were compared to "normal" volunteers, which is
consistent with views in clinical psychology. Additionally, the notion
of psychopathy being characterized by low fear is consistent with
findings of abnormalities in the amygdala, since deficits in aversive
conditioning and instrumental learning are thought to result from
amygdala dysfunction, potentially compounded by orbitofrontal cortex
dysfunction, although the specific reasons are unknown.
Proponents of the primary-secondary psychopathy distinction and
triarchic model argue that there are neurological differences between
these subgroups of psychopathy which support their views. For
instance, the boldness factor in the triarchic model is argued to be
associated with reduced activity in the amygdala during fearful or
aversive stimuli and reduced startle response, while the disinhibition
factor is argued to be associated with impairment of frontal lobe
tasks. There is evidence that boldness and disinhibition are
genetically distinguishable.
Biochemical
=============
High levels of testosterone combined with low levels of cortisol
and/or serotonin have been theorized as contributing factors.
Testosterone is "associated with approach-related behavior, reward
sensitivity, and fear reduction", and injecting testosterone "shift[s]
the balance from punishment to reward sensitivity", decreases
fearfulness, and increases "responding to angry faces". Some studies
have found that high testosterone levels are associated with
antisocial and aggressive behaviors, yet other research suggests that
testosterone alone does not cause aggression but increases
dominance-seeking. It is unclear from studies if psychopathy
correlates with high testosterone levels, but a few studies have found
psychopathy to be linked to low cortisol levels and reactivity.
Cortisol increases withdrawal behavior and sensitivity to punishment
and aversive conditioning, which are abnormally low in individuals
with psychopathy and may underlie their impaired aversion learning and
disinhibited behavior. High testosterone levels combined with low
serotonin levels are associated with "impulsive and highly negative
reactions", and may increase violent aggression when an individual is
provoked or becomes frustrated. Several animal studies note the role
of serotonergic functioning in impulsive aggression and antisocial
behavior.
However, some studies on animal and human subjects have suggested that
the emotional-interpersonal traits and predatory aggression of
psychopathy, in contrast to impulsive and reactive aggression, is
related to 'increased' serotoninergic functioning. A study by Dolan
and Anderson on the relationship between setotonin and psychopathic
traits in a sample of personality disordered offenders, found that
serotonin functioning as measured by prolactin response, while
inversely associated with impulsive and antisocial traits, were
positively correlated with arrogant and deceitful traits, and, to a
lesser extent, callous and remorseless traits. Bari� Yildirim
theorizes that the 5-HTTLPR "long" allele, which is generally regarded
as protective against internalizing disorders, may interact with other
serotoninergic genes to create a hyper-regulation and dampening of
affective processes that results in psychopathy's emotional
impairments. Furthermore, the combination of the 5-HTTLPR long allele
and high testosterone levels has been found to result in a reduced
response to threat as measured by cortisol reactivity, which mirrors
the fear deficits found in those afflicted with psychopathy.
Studies have suggested other correlations. Psychopathy was associated
in two studies with an increased ratio of HVA (a dopamine metabolite)
to 5-HIAA (a serotonin metabolite). Studies have found that
individuals with the traits meeting criteria for psychopathy show a
greater dopamine response to potential "rewards" such as monetary
promises or taking drugs such as amphetamines. This has been
theoretically linked to increased impulsivity. A 2010 British study
found that a large 2D:4D digit ratio, an indication of high prenatal
estrogen exposure, was a "positive correlate of psychopathy in
females, and a positive correlate of callous affect (psychopathy
sub-scale) in males".
Findings have also shown monoamine oxidase A to affect the predictive
ability of the PCL-R. Monoamine oxidases (MAOs) are enzymes that are
involved in the breakdown of neurotransmitters such as serotonin and
dopamine and are, therefore, capable of influencing feelings, mood,
and behavior in individuals. Findings suggest that further research is
needed in this area.
Psychopathy Checklist
=======================
Psychopathy is most commonly assessed with the 'Psychopathy Checklist,
Revised (PCL-R)', created by Robert D. Hare based on Cleckley's
criteria from the 1940s, criminological concepts such as those of
William and Joan McCord, and his own research on criminals and
incarcerated offenders in Canada. The PCL-R is widely used and is
referred to by some as the "gold standard" for assessing psychopathy.
There are nonetheless numerous criticisms of the PCL-R as a
theoretical tool and in real-world usage.
Psychopathic Personality Inventory
====================================
Unlike the PCL, the Psychopathic Personality Inventory (PPI) was
developed to comprehensively index personality traits without
explicitly referring to antisocial or criminal behaviors themselves.
It is a self-report scale that was developed originally for
non-clinical samples (e.g. university students) rather than prisoners,
though may be used with the latter. It was revised in 2005 to become
the PPI-R and now comprises 154 items organized into eight subscales.
The item scores have been found to group into two overarching and
largely separate factors (unlike the PCL-R factors),
Fearless-Dominance and Impulsive Antisociality, plus a third factor,
Coldheartedness, which is largely dependent on scores on the other
two. Factor 1 is associated with social efficacy while Factor 2 is
associated with maladaptive tendencies. A person may score at
different levels on the different factors, but the overall score
indicates the extent of psychopathic personality.
DSM and ICD
=============
There are currently two widely established systems for classifying
mental disorders�the 'International Classification of Diseases' (ICD)
produced by the World Health Organization (WHO) and the 'Diagnostic
and Statistical Manual of Mental Disorders' (DSM) produced by the
American Psychiatric Association (APA). Both list categories of
disorders thought to be distinct types, and have deliberately
converged their codes in recent revisions so that the manuals are
often broadly comparable, although significant differences remain.
The first edition of the DSM in 1952 had a section on sociopathic
personality disturbances, then a general term that included such
things as homosexuality and alcoholism as well as an "antisocial
reaction" and "dyssocial reaction". The latter two eventually became
antisocial personality disorder (ASPD) in the DSM and dissocial
personality disorder in the ICD. Both manuals have stated that their
diagnoses have been referred to, or include what is referred to, as
psychopathy or sociopathy, although neither diagnostic manual has ever
included a disorder officially titled as such.
Other tools
=============
There are some traditional personality tests that contain subscales
relating to psychopathy, though they assess relatively non-specific
tendencies towards antisocial or criminal behavior. These include the
Minnesota Multiphasic Personality Inventory (Psychopathic Deviate
scale), California Psychological Inventory (Socialization scale), and
Millon Clinical Multiaxial Inventory Antisocial Personality Disorder
scale. There is also the Levenson Self-Report Psychopathy Scale (LSRP)
and the Hare Self-Report Psychopathy Scale (HSRP), but in terms of
self-report tests, the PPI/PPI-R has become more used than either of
these in modern psychopathy research on adults.
Comorbidity
=============
As with other mental disorders, psychopathy as a personality disorder
may be present with a variety of other diagnosable conditions. Studies
especially suggest strong comorbidity with antisocial personality
disorder. Among numerous studies, positive correlations have also been
reported between psychopathy and histrionic, narcissistic, borderline,
paranoid, and schizoid personality disorders, panic and
obsessive-compulsive disorders, but not neurotic disorders in general,
schizophrenia, or depression.
Attention deficit hyperactivity disorder (ADHD) is known to be highly
comorbid with conduct disorder (a theorized precursor to ASPD), and
may also co-occur with psychopathic tendencies. This may be explained
in part by deficits in executive function. Anxiety disorders often
co-occur with ASPD, and contrary to assumptions, psychopathy can
sometimes be marked by anxiety; this appears to be related to items
from Factor 2 but not Factor 1 of the PCL-R. Psychopathy is also
associated with substance use disorders.
It has been suggested that psychopathy may be comorbid with several
other conditions than these, but limited work on comorbidity has been
carried out. This may be partly due to difficulties in using inpatient
groups from certain institutions to assess comorbidity, owing to the
likelihood of some bias in sample selection.
Sex differences
=================
Research on psychopathy has largely been done on men and the PCL-R was
developed using mainly male criminal samples, raising the question of
how well the results apply to women. Men score higher than women on
both the PCL-R and the PPI and on both of their main scales. The
differences tend to be somewhat larger on the interpersonal-affective
scale than on the antisocial scale. Most but not all studies have
found broadly similar factor structure for men and women.
Many associations with other personality traits are similar, although
in one study the antisocial factor was more strongly related with
impulsivity in men and more strongly related with openness to
experience in women. It has been suggested that psychopathy in men
manifest more as an antisocial pattern while in women it manifests
more as a histrionic pattern. Studies on this have shown mixed
results. PCL-R scores may be somewhat less predictive of violence and
recidivism in women. On the other hand, psychopathy may have a
stronger relationship with suicide and possibly internalizing symptoms
in women. A suggestion is that psychopathy manifests more as
externalizing behaviors in men and more as internalizing behaviors in
women.
Studies have also found that women in prison score significantly lower
on psychopathy than men, with one study reporting only 11 percent of
violent females in prison met the psychopathy criteria in comparison
to 31 percent of violent males. Other studies have also pointed out
that high psychopathic females are rare in forensic settings.
Clinical
==========
Psychopathy has often been considered untreatable. Its unique
characteristics makes it among the most refractory of personality
disorders, a class of mental illnesses that are already traditionally
considered difficult to treat. People afflicted with psychopathy are
generally unmotivated to seek treatment for their condition, and can
be uncooperative in therapy. Attempts to treat psychopathy with the
current tools available to psychiatry have been disappointing. Harris
and Rice's 'Handbook of Psychopathy' says that there is currently
little evidence for a cure or effective treatment for psychopathy; as
of yet, no pharmacological therapies are known to or have been trialed
for alleviating the emotional, interpersonal and moral deficits of
psychopathy, and patients with psychopathy who undergo psychotherapy
might gain the skills to become more adept at the manipulation and
deception of others and be more likely to commit crime. Some studies
suggest that punishment and behavior modification techniques are
ineffective at modifying the behavior of psychopathic individuals as
they are insensitive to punishment or threat. These failures have led
to a widely pessimistic view on its treatment prospects, a view that
is exacerbated by the little research being done into this disorder
compared to the efforts committed to other mental illnesses, which
makes it more difficult to gain the understanding of this condition
that is necessary to develop effective therapies.
Although the core character deficits of highly psychopathic
individuals are likely to be highly incorrigible to the currently
available treatment methods, the antisocial and criminal behavior
associated with it may be more amenable to management, the management
of which being the main aim of therapy programs in correctional
settings. It has been suggested that the treatments that may be most
likely to be effective at reducing overt antisocial and criminal
behavior are those that focus on self-interest, emphasizing the
tangible, material value of prosocial behavior, with interventions
that develop skills to obtain what the patient wants out of life in
prosocial rather than antisocial ways. To this end, various therapies
have been tried with the aim of reducing the criminal activity of
incarcerated offenders with psychopathy, with mixed success. As
psychopathic individuals are insensitive to sanction, reward-based
management, in which small privileges are granted in exchange for good
behavior, has been suggested and used to manage their behavior in
institutional settings.
Psychiatric medications may also alleviate co-occurring conditions
sometimes associated with the disorder or with symptoms such as
aggression or impulsivity, including antipsychotic, antidepressant or
mood-stabilizing medications, although none have yet been approved by
the FDA for this purpose. For example, a study found that the
antipsychotic clozapine may be effective in reducing various
behavioral dysfunctions in a sample of high-security hospital
inpatients with antisocial personality disorder and psychopathic
traits. However, research into the pharmacological treatment of
psychopathy and the related condition antisocial personality disorder
is minimal, with much of the knowledge in this area being
extrapolations based on what is known about pharmacology in other
mental disorders.
Legal
=======
The PCL-R, the PCL:SV, and the PCL:YV are highly regarded and widely
used in criminal justice settings, particularly in North America. They
may be used for risk assessment and for assessing treatment potential
and be used as part of the decisions regarding bail, sentence, which
prison to use, parole, and regarding whether a youth should be tried
as a juvenile or as an adult. There have been several criticisms
against its use in legal settings. They include the general criticisms
against the PCL-R, the availability of other risk assessment tools
which may have advantages, and the excessive pessimism surrounding the
prognosis and treatment possibilities of those who are diagnosed with
psychopathy.
The interrater reliability of the PCL-R can be high when used
carefully in research but tend to be poor in applied settings. In
particular Factor 1 items are somewhat subjective. In sexually violent
predator cases the PCL-R scores given by prosecution experts were
consistently higher than those given by defense experts in one study.
The scoring may also be influenced by other differences between
raters. In one study it was estimated that of the PCL-R variance,
about 45% was due to true offender differences, 20% was due to which
side the rater testified for, and 30% was due to other rater
differences.
To aid a criminal investigation, certain interrogation approaches may
be used to exploit and leverage the personality traits of suspects
thought to have psychopathy and make them more likely to divulge
information.
United Kingdom
================
The PCL-R cut-off for a label of psychopathy is 25 in the United
Kingdom, instead of 30 as it is in the United States.
In the United Kingdom, "psychopathic disorder" was legally defined in
the Mental Health Act (UK), under MHA1983, as "a persistent disorder
or disability of mind (whether or not including significant impairment
of intelligence) which results in abnormally aggressive or seriously
irresponsible conduct on the part of the person concerned". This term
was intended to reflect the presence of a personality disorder in
terms of conditions for detention under the Mental Health Act 1983.
Amendments to MHA1983 within the Mental Health Act 2007 abolished the
term "psychopathic disorder", with all conditions for detention (e.g.
mental illness, personality disorder, etc.) encompassed by the generic
term of "mental disorder".
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 to other patients and not responsive
to usual treatment methods this alternative to traditional
incarceration is often not used.
"Sexual psychopath" laws
==========================
Starting in the 1930s, before some modern concepts of psychopathy were
developed, "sexual psychopath" laws, the term referring broadly to
mental illness, were introduced by some states, and by the mid-1960s
more than half of the states had such laws. Sexual offenses were
considered to be caused by underlying mental illnesses, and it was
thought that sex offenders should be treated, in agreement with the
general rehabilitative trends at this time. Courts committed sex
offenders to a mental health facility for community protection and
treatment.
Starting in 1970, many of these laws were modified or abolished in
favor of more traditional responses such as imprisonment due to
criticism of the "sexual psychopath" concept as lacking scientific
evidence, the treatment being ineffective, and predictions of future
offending being dubious. There were also a series of cases where
persons treated and released committed new sexual offenses. Starting
in the 1990s, several states have passed sexually dangerous person
laws, including registration, housing restrictions, public
notification, mandatory reporting by health care professionals, and
civil commitment, which permits indefinite confinement after a
sentence has been completed. Psychopathy measurements may be used in
the confinement decision process.
Prognosis
======================================================================
The prognosis for psychopathy in forensic and clinical settings is
quite poor, with some studies reporting that treatment may worsen the
antisocial aspects of psychopathy as measured by recidivism rates,
though it is noted that one of the frequently cited studies finding
increased criminal recidivism after treatment, a 2011 retrospective
study of a treatment program in the 1960s, had several serious
methodological problems and likely would not be approved of today.
However, some relatively rigorous quasi-experimental studies using
more modern treatment methods have found improvements regarding
reducing future violent and other criminal behavior, regardless of
PCL-R scores, although none were randomized controlled trials. Various
other studies have found improvements in risk factors for crime such
as substance abuse. No study has of yet in a 2013 review examined if
the personality traits that form the core character disturbances of
psychopathy could be changed by such treatments.
Frequency
======================================================================
A 2008 study using the PCL:SV found that 1.2% of a US sample scored 13
or more out of 24, indicating "potential psychopathy". The scores
correlated significantly with violence, alcohol use, and lower
intelligence. A 2009 British study by Coid et al., also using the
PCL:SV, reported a community prevalence of 0.6% scoring 13 or more.
However, if the scoring was adjusted to the recommended 18 or more,
this would have left the prevalence closer to 0.1%. The scores
correlated with younger age, male gender, suicide attempts, violence,
imprisonment, homelessness, drug dependence, personality disorders
(histrionic, borderline and antisocial), and panic and
obsessive-compulsive disorders.
Psychopathy has a much higher prevalence in the convicted and
incarcerated population, where it is thought that an estimated 15-25%
of prisoners qualify for the diagnosis. A study on a sample of inmates
in the UK found that 7.7% of the inmates interviewed met the PCL-R
cut-off of 30 for a diagnosis of psychopathy. A study on a sample of
inmates in Iran using the PCL:SV found a prevalence of 23% scoring 18
or more. A study by Nathan Brooks from Bond University found that
around one in five corporate bosses display clinically significant
psychopathic traits - a proportion similar to that among prisoners.
In the workplace
==================
There is limited research on psychopathy in the general work populace,
in part because the PCL-R includes antisocial behavior as a
significant core factor (obtaining a PCL-R score above the threshold
is unlikely without having significant scores on the
antisocial-lifestyle factor) and does not include positive adjustment
characteristics, and most researchers have studied psychopathy in
incarcerated criminals, a relatively accessible population of research
subjects.
However, psychologists Fritzon and Board, in their study comparing the
incidence of personality disorders in business executives against
criminals detained in a mental hospital, found that the profiles of
some senior business managers contained significant elements of
personality disorders, including those referred to as the "emotional
components", or interpersonal-affective traits, of psychopathy.
Factors such as boldness, disinhibition, and meanness as defined in
the triarchic model, in combination with other advantages such as a
favorable upbringing and high intelligence, are thought to correlate
with stress immunity and stability, and may contribute to this
particular expression. Such individuals are sometimes referred to as
"successful psychopaths" or "corporate psychopaths" and they may not
always have extensive histories of traditional criminal or antisocial
behavior characteristic of the traditional conceptualization of
psychopathy. Robert Hare claims that the prevalence of psychopathic
traits is higher in the business world than in the general population,
reporting that while about 1% of the general population meet the
clinical criteria for psychopathy, figures of around 3-4% have been
cited for more senior positions in business. Hare considers newspaper
tycoon Robert Maxwell to have been a strong candidate as a "corporate
psychopath".
Academics on this subject believe that although psychopathy is
manifested in only a small percentage of workplace staff, it is more
common at higher levels of corporate organizations, and its negative
effects (for example, increased bullying, conflict, stress, staff
turnover, absenteeism, reduction in productivity) often causes a
ripple effect throughout an organization, setting the tone for an
entire corporate culture. Employees with the disorder are self-serving
opportunists, and may disadvantage their own organizations to further
their own interests. They may be charming to staff above their level
in the workplace hierarchy, aiding their ascent through the
organization, but abusive to staff below their level, and can do
enormous damage when they are positioned in senior management roles.
Psychopathy as measured by the PCL-R is associated with lower
performance appraisals among corporate professionals. The psychologist
Oliver James identifies psychopathy as one of the dark triadic traits
in the workplace, the others being narcissism and Machiavellianism,
which, like psychopathy, can have negative consequences.
According to a study from the University of Notre Dame published in
the 'Journal of Business Ethics,' psychopaths have a natural advantage
in workplaces overrun by abusive supervision, and are more likely to
thrive under abusive bosses, being more resistant to stress, including
interpersonal abuse, and having less of a need for positive
relationships than others.
In fiction
============
Characters with psychopathy or sociopathy are some of the most
notorious characters in film and literature, but their
characterizations may only vaguely or partly relate to the concept of
psychopathy as it is defined in psychiatry, criminology, and research.
The character may be identified as having psychopathy within the
fictional work itself, by its creators, or from the opinions of
audiences and critics, and may be based on undefined popular
stereotypes of psychopathy. Characters with psychopathic traits have
appeared in Greek and Roman mythology, Bible stories, and some of
Shakespeare's works.
Such characters are often portrayed in an exaggerated fashion and
typically in the role of a villain or antihero, where the general
characteristics and stereotypes associated with psychopathy are useful
to facilitate conflict and danger. Because the definitions, criteria,
and popular conceptions throughout its history have varied over the
years and continue to change even now, many of the characters
characterized as psychopathic in notable works at the time of
publication may no longer fit the current definition and conception of
psychopathy. There are several archetypal images of psychopathy in
both lay and professional accounts which only partly overlap and can
involve contradictory traits: the charming con artist, the deranged
serial killer and mass murderer, the callous and scheming
businessperson, and the chronic low-level offender and juvenile
delinquent. The public concept reflects some combination of fear of a
mythical bogeyman, the disgust and intrigue surrounding evil, and
fascination and sometimes perhaps envy of people who might appear to
go through life without attachments and unencumbered by guilt, anguish
or insecurity.
Etymology
===========
The word 'psychopathy' is a joining of the Greek words 'psyche' (��
�ή)
"soul" and 'pathos' (�άθο�) "suffering, feeling". The first documented
use is from 1847 in Germany as 'psychopatisch', and the noun
'psychopath' has been traced to 1885. In medicine, 'patho-' has a more
specific meaning of disease (thus 'pathology' has meant the study of
disease since 1610, and 'psychopathology' has meant the study of
mental disorder in general since 1847. A sense of "a subject of
pathology, morbid, excessive" is attested from 1845, including the
phrase 'pathological liar' from 1891 in the medical literature).
The term 'psychopathy' initially had a very general meaning referring
to all sorts of mental disorders and social aberrations, popularised
from 1891 in Germany by Koch's concept of "psychopathic inferiority"
(psychopathische Minderwertigkeiten). Some medical dictionaries still
define psychopathy in both a narrow and broad sense, such as
MedlinePlus from the U.S. National Library of Medicine. On the other
hand, Stedman's Medical Dictionary defines psychopathy only as an
outdated term for an antisocial type of personality disorder.
The term 'psychosis' was also used in Germany from 1841, originally in
a very general sense. The suffix -��ι� (-osis) meant in this case
"abnormal condition". This term or its adjective 'psychotic' would
come to refer to the more severe mental disturbances and then
specifically to mental states or disorders characterized by
hallucinations, delusions or in some other sense markedly out of touch
with reality.
The slang term 'psycho' has been traced to a shortening of the
adjective 'psychopathic' from 1936, and from 1942 as a shortening of
the noun 'psychopath', but it is also used as shorthand for psychotic
or crazed.
The media usually uses the term 'psychopath' to designate any criminal
whose offenses are particularly abhorrent and unnatural, but that is
not its original or general psychiatric meaning.
Sociopathy
============
The word element 'socio'- has been commonly used in compound words
since around 1880. The term 'sociopathy' may have been first
introduced in 1909 in Germany by biological psychiatrist Karl Birnbaum
and in 1930 in the US by educational psychologist George E. Partridge,
as an alternative to the concept of 'psychopathy'. It was used to
indicate that the defining feature is violation of social norms, or
antisocial behavior, and has often also been associated with
postulating social as well as biological causation.
The term is used in various different ways in contemporary usage.
Robert Hare stated in the popular science book 'Snakes in Suits' that
'sociopathy' and 'psychopathy' are often used interchangeably, but in
some cases the term 'sociopathy' is preferred because it is less
likely than is 'psychopathy' to be confused with psychosis, whereas in
other cases the two terms may be used with different meanings that
reflect the user's views on the origins and determinants of the
disorder. Hare contended that the term 'sociopathy' is preferred by
those that see the causes as due to social factors and early
environment, and the term 'psychopathy' preferred by those who believe
that there are psychological, biological, and genetic factors involved
in addition to environmental factors. Hare also provides his own
definitions: he describes psychopathy as not having a sense of empathy
or morality, but sociopathy as only differing from the average person
in the sense of right and wrong.
Precursors
============
Ancient writings that have been connected to psychopathy include
Deuteronomy 21:18-21, which was written around 700 BCE, and a
description of an unscrupulous man by the Greek philosopher
Theophrastus around 300 BCE.
The concept of psychopathy has been indirectly connected to the early
19th century with the work of Pinel (1801; "mania without delirium")
and Pritchard (1835; "moral insanity"), although historians have
largely discredited the idea of a direct equivalence. 'Psychopathy'
originally described any illness of the mind, but found its
application to a narrow subset of mental conditions when was used
toward the end of the 19th century by the German psychiatrist Julius
Koch (1891) to describe various behavioral and moral dysfunction in
the absence of an obvious mental illness or intellectual disability.
He applied the term 'psychopathic inferiority' (psychopathischen
Minderwertigkeiten) to various chronic conditions and character
disorders, and his work would influence the later conception of the
personality disorder.
The term 'psychopathic' came to be used to describe a diverse range of
dysfunctional or antisocial behavior and mental and sexual deviances,
including at the time homosexuality. It was often used to imply an
underlying "constitutional" or genetic origin. Disparate early
descriptions likely set the stage for modern controversies about the
definition of psychopathy.
20th century
==============
An influential figure in shaping modern American conceptualizations of
psychopathy was American psychiatrist Hervey Cleckley. In his classic
monograph, 'The Mask of Sanity' (1941), Cleckley drew on a small
series of vivid case studies of psychiatric patients at a Veterans
Administration hospital in Georgia to describe the disorder. Cleckley
used the metaphor of the "mask" to refer to the tendency of
psychopaths to appear confident, personable, and well-adjusted
compared to most psychiatric patients, while revealing underlying
pathology through their actions over time. Cleckley formulated sixteen
criteria to describe the disorder. The Scottish psychiatrist David
Henderson had also been influential in Europe from 1939 in narrowing
the diagnosis.
The diagnostic category of 'sociopathic personality' in early editions
of the 'Diagnostic and Statistical Manual' (DSM) had some key
similarities to Cleckley's ideas, though in 1980 when renamed
Antisocial Personality Disorder some of the underlying personality
assumptions were removed. In 1980, Canadian psychologist Robert D.
Hare introduced an alternative measure, the "Psychopathy Checklist"
(PCL) based largely on Cleckley's criteria, which was revised in 1991
(PCL-R), and is the most widely used measure of psychopathy. There are
also several self-report tests, with the Psychopathic Personality
Inventory (PPI) used more often among these in contemporary adult
research.
Famous individuals have sometimes been diagnosed, albeit at a
distance, as psychopaths. As one example out of many possible from
history, in a 1972 version of a secret report originally prepared for
the Office of Strategic Services in 1943, and which may have been
intended to be used as propaganda, non-medical psychoanalyst Walter C.
Langer suggested Adolf Hitler was probably a psychopath. However,
others have not drawn this conclusion; clinical forensic psychologist
Glenn Walters argues that Hitler's actions do not warrant a diagnosis
of psychopathy as, although he showed several characteristics of
criminality, he was not always egocentric, callously disregarding of
feelings or lacking impulse control, and there is no proof he could
not learn from mistakes.
See also
======================================================================
* Antisocial personality disorder
* Callous and unemotional traits
* Dark triad
* Macdonald triad
* Moral psychology
* Pathological lying
* Malignant narcissism
* Sadistic personality disorder
* Serial rapist
Bibliography
======================================================================
*
* Black, Will (2014) 'Psychopathic Cultures and Toxic Empires'
Frontline Noir, Edinburgh
* Blair, J. et al. (2005) 'The Psychopath - Emotion and the Brain'.
Malden, MA: Blackwell Publishing,
* Cleckley, Hervey M. '[
http://www.cassiopaea.org/cass/sanity_1.PdF
The Mask of Sanity:] An Attempt to Reinterpret the So-Called
Psychopathic Personality', 5th Edition, revised 1984, PDF file
download.
* Dutton, K. (2012) 'The Wisdom of Psychopaths' (e-book)
*
* Häkkänen-Nyholm, H. & Nyholm, J-O. (2012). Psychopathy and Law:
A Practitioners Guide. Chichester: John Wiley & Sons.
*
* Oakley, Barbara, Ph.D.,
[
https://web.archive.org/web/20080323125350/http://www.evilgenes.com/
'Evil Genes: Why Rome Fell, Hitler Rose, Enron Failed, and My Sister
Stole My Mother's Boyfriend.'] Prometheus Books, Amherst, NY, 2007, .
* Stone, Michael H., M.D. & Brucato, Gary, Ph.D., The New Evil:
Understanding the Emergence of Modern Violent Crime (Amherst, N.Y.:
Prometheus Books). .
* Thiessen, W Slip-ups and the dangerous mind: Seeing through and
living beyond the psychopath (2012).
* Thimble, Michael H.F.R.C.P., F.R.C. Psych. 'Psychopathology of
Frontal Lobe Syndromes'.
*
External links
======================================================================
*
[
https://books.google.com/books?id=OuNdrmHcJlgC&dq=psychopath+dsm-II&sou
rce=gbs_navlinks_s
Handbook of Psychopathy (2007)] on Google Books.
* [
http://www.cassiopaea.org/cass/sanity_1.PdF The Mask of Sanity, 5th
Edition], PDF of Cleckley's book, 1988
* [
http://www.hare.org Without Conscience] Official web site of Dr.
Robert Bae
*
[
http://philpapers.org/browse/psychopathy/?sort=pubYear&showCategories=on&am
p;hideAbstracts=&cn=psychopathy&new=1&limit=50&filterByAreas=&am
p;proOnly=on&cId=109956&freeOnly=&newWindow=on&categorizerOn=&am
p;onlineOnly=&langFilter=&start=0&sqc=&publishedOnly=&format
=html&jlist=&ap_c1=&ap_c2=
Philpapers Psychopathy]
* [
http://www.all-about-forensic-psychology.com/psychopath.html
Understanding The Psychopath: Key Definitions & Research]
* [
http://www.psychiatrictimes.com/display/article/10168/54411 The
Paradox of Psychopathy] Psychiatric Times, 2007 (nb: inconsistent
access)
*
[
https://web.archive.org/web/20090320111620/http://www.uiowa.edu/~c036090/abbott
pdf
Into the Mind of a Killer] 'Nature', 2001
*
*
[
http://www.scientificamerican.com/article.cfm?id=what-psychopaths-teach-us-abou
t-how-to-succeed
'What Psychopaths Teach Us about How to Succeed'] 'Scientific
American', October 2012
*
[
https://www.theatlantic.com/magazine/archive/2017/06/when-your-child-is-a-psych
opath/524502/
"When Your Child is a Psychopath"] in 'The Atlantic'
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