a person suffering from chronic mental disorder with abnormal or violent social behavior.
psychopathic |ˌsīkəˈpaθik| adjective
psychopathically |ˌsīkəˈpaθik(ə)lē| adverb
Psychopathy (/saɪˈkɒpəθi/) (or sociopathy /ˈsoʊsiəˌpæθi/) is traditionally defined as a personality disorder characterized by enduring antisocial behavior, diminished empathy and remorse, and disinhibited or bold behavior. It may also be defined as a continuous aspect of personality, representing scores on different personality dimensions found throughout the population in varying combinations. The definition of psychopathy has varied significantly throughout the history of the concept; different definitions continue to be used that are only partly overlapping and sometimes appear contradictory.
Hervey M. Cleckley, an American psychiatrist, probably 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, stating that these have been referred to (or include what is referred to) as psychopathy or sociopathy. Canadian psychologist Robert D. Hare later repopularised 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 term is also used by the general public, in popular press, and in fictional portrayals.
Researchers have noted that there appear to be at least two different conceptions of psychopathy, each with differing policy implications. Jennifer L. Skeem et al. distinguished Cleckleyan psychopathy (named after Hervey Cleckley’s early conception of psychopathy, entailing bold, disinhibited behavior, low anxiety and “feckless disregard”) and criminal psychopathy (a “meaner, more aggressively disinhibited conception of psychopathy that explicitly entails persistent and sometimes serious criminal behavior,” typically operationalized with the Hare Psychopathy Checklist). Due to the profound implications that a label of “psychopath” can have—including in terms of decisions about punishment severity, treatment, etc.—efforts have been made to clarify the meaning of the term, e.g. by reconciling seemingly disparate conceptions such as those mentioned.
The triarchic model, formulated by Christopher J. Patrick et al., suggests that different conceptions of psychopathy emphasize three observable characteristics to varying degrees. Analyses have been made with respect to the applicability of measurement tools such as the Hare 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 Coldheartedness but also includes elements of subscales in Impulsive antisociality. Meanness may possibly be caused by either high boldness or high disinhibition combined with an adverse environment. Thus, a child with high boldness may respond poorly to punishment but may respond better to rewards and secure attachments which may not be available under adverse conditions. A child with high disinhibition may have increased problems under adverse conditions with meanness developing in response.
A crucial issue regarding the concept of psychopathy is whether it identifies a distinct condition that can be separated from other conditions and “normal” personality types, or whether it is simply a combination of scores on various dimensions of personality found throughout the population in varying combinations.
An early and influential analysis from Harris and colleagues indicated a discrete category may underlie PCL-R psychopathy, but this was only found for the behavioral Factor 2 items. Marcus, John, and Edens more recently performed a series of statistical analyses on PPI scores and concluded 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 call 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 this constellation of traits.
Psychopathy represents different personality dimensions found throughout the general population to varying degrees. There are different views as to which dimensions are more central in regard to psychopathy.
Besides dimensions described elsewhere in this article, some studies have linked psychopathy to alternative dimensions, such as antagonism (high), conscientiousness (low) and anxiousness (low, or sometimes high). 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. However, narcissism is generally seen as only one possible aspect of psychopathy as broadly defined.
Signs and symptoms
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. However, 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. Thus 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. The concept of psychopathy may perform poorly when attempted to be used as a general theory of crime.
Studies have suggested a strong correlation between psychopathy scores and violence, and the PCL-R emphasizes features that are somewhat predictive of violent behavior. Additionally, 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. Researchers, however, have noted that psychopathy is dissociable from and not synonymous with violence.
It has been suggested that psychopaths tend to commit more “instrumental” violence than “reactive” violence. One conclusion in this regard was made by a 2002 study of homicide offenders, which reported that the homicides committed by psychopaths were almost always (93.3%) primarily instrumental, while about half (48.4%) of those committed by non-psychopaths were. However, contrary to the equating of this to mean “in cold blood”, more than a third of the homicides by psychopaths involved emotional reactivity as well. In addition, the non-psychopaths still accounted for most of the instrumental homicides, because most of these murderers were not psychopaths. 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-psychopaths on average than by psychopaths (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.
Although psychopathy is associated with an increased risk of violence, it is difficult to know how to manage the risk. 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 administrate. 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.
See also: “Sexual psychopath” laws
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. It is purported that high-psychopathy offenders (both sexual and non-sexual offenders) are about 2.5 times more likely to be granted conditional release compared to non-psychopathic offenders.
Some researchers have argued that psychopaths have a preference for violent sexual behavior. A study examining 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.
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 than 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.
Researchers have discussed the possibility of psychopathy being associated with organised crime, economic crime and war crimes. Terrorists are sometimes called psychopaths, 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. It has also been noted that coordinated terrorist activity requires organization, loyalty and ideology, and that traits such as a self-centered disposition, unreliability, poor behavioral controls, and unusual behaviors may be disadvantages.
It has been speculated that some psychopaths may be socially successful, due to factors such as low disinhibition as defined in the triarchic model, in combination with other advantages such as a favorable upbringing and good intelligence. However, there is little research on this, in part because the PCL-R does not include positive adjustment characteristics, and most researchers have used the PCL-R on confirmed criminals. Some research using the PPI report that some interpersonal and affective traits associated with psychopathy, and boldness and/or meanness as defined in the triarchic model, can exist in non-criminals and correlate with stress immunity and stability. 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 senior business managers contained some significant elements of personality disorders, particularly those referred to as the “emotional components” of psychopathy.
Childhood and adolescent precursors
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 6–13 year olds or it can be self-administered by 13–18 years olds. 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.
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. In one study, predictive ability was found to be not better than unaided clinical judgment.
Juvenile psychopathy appears to be associated with more negative emotionality such as anger, hostility, anxiety, and depression.
Main article: Conduct disorder
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 have deficits in behavioral inhibition similar to adult psychopaths. 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 adult psychopaths. 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 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.
Dysfunctions in the prefrontal cortex and amygdala regions of the brain are 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 DT-MRI evidence of breakdowns in the white matter connections between these two important areas.
Studies also suggest inverse relationships between psychopathy and intelligence, including with regards to verbal IQ. 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 also depend on the type of intelligence assessment (e.g. verbal, creative, practical, analytical). However, Hare and Neumann state that a large literature demonstrates at most only a weak association between psychopathy and IQ. They consider 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 state 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.”
Emotion recognition and empathy
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. Studies on children with psychopathic tendencies have also shown such associations. 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. Some recent fMRI studies have reported that emotion perception deficits in psychopathy are pervasive across emotions (positives and negatives).
A study in which psychopathic criminals were brain-scanned while they watched videos of a person harming another individual found that the psychopaths’ empathic reaction initiated the same way it did for controls when they were instructed to empathize with the harmed individual, and that the area of the brain relating to pain was activated when the psychopaths were asked to imagine how the harmed individual felt. The research suggests how psychopaths could switch empathy on at will and would enable them to be both callous and charming. Professor Simon Baron-Cohen suggests that, unlike the combination of both reduced cognitive and affective empathy often seen in those with classic autism, psychopaths are associated with intact cognitive empathy, implying non-diminished awareness of another’s feelings when they hurt someone.
However, subsequent work conducted by Professor Jean Decety with large samples of incarcerated psychopaths challenge this view. In one study, psychopaths were scanned while viewing video clips depicting people being intentionally hurt. They were also tested on their responses to seeing short videos of facial expressions of pain. The participants in the high psychopathy group exhibited significantly less activation in the ventromedial prefrontal cortex, amygdala and periaqueductal gray parts of the brain, but more activity in the striatum and the insula when compared to control participants. In a second study, individuals with psychopathy exhibited a strong response in pain-affective brain regions when taking an imagine-self perspective, but failed to recruit the neural circuits that are were activated in controls during an imagine-other perspective, in particular the ventromedial prefrontal cortex and amygdala, which may contribute to their lack of empathic concern.
Psychopaths have been considered notoriously amoral – an absence of, indifference towards, or disregard for moral beliefs. There are few firm data on patterns of moral judgment, however. 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 psychopaths and non-psychopaths. 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-psychopaths were. Psychopaths 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.
Cleckley’s clinical profile
In his book The Mask of Sanity, Hervey Cleckley described 16 (21 in the first edition) “common qualities” he thought were characteristic of the individuals he termed psychopaths.
Cleckley stated in the first edition of The Mask of Sanity (p. 257) that those he was calling psychopaths were “frankly and unquestionably psychotic”, but in later editions suggested that they are not psychotic according to prevailing definitions. He did not on the whole describe them as particularly hostile or aggressive, contrary to more sinister depictions that others later developed. In addition, he proposed the existence of a milder and extremely common form of the condition: “If we consider, in addition to these patients (nearly all of whom have records of the utmost folly and misery and idleness over many years and who have had to enter a psychiatric hospital), the vast number of similar people in every community who show the same behavior pattern in milder form but who are sufficiently protected and supported by relatives to remain at large, the prevalence of this disorder is seen to be appalling.”
Despite possible discrepancies, Cleckley’s work on psychopathy may have influenced the PCL-R and the initial diagnostic criteria for antisocial personality reaction/disturbance in the DSM and some researchers continue to consider Cleckley’s clinical profile to be a prominent model of psychopathy.