Intro
Psychopathy is a personality disorder characterized by an abnormal lack of empathy combined with strongly amoral conduct, masked by an ability to appear outwardly normal. Neither psychopathy, nor the similar concept of sociopathy, are nowadays defined in international diagnostic manuals, which instead describe a category of antisocial/dissocial personality disorder. However, researcher Robert Hare, whose Hare Psychopathy Checklist is widely used, describes psychopaths as "intraspecies predators" as does R.I. Simon. Elsewhere Hare and others write that psychopaths "use charisma, manipulation, intimidation, sexual intercourse and violence" to control others and to satisfy their own needs. Hare states that: "Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse. He previously stated that: "What is missing, in other words, are the very qualities that allow a human being to live in social harmony"
According to Hare, many psychopaths are superficially charming, and can be excellent mimics of normal human emotion; some psychopaths can blend in, undetected, in a variety of surroundings, including corporate environments. According to some, there is neither a cure nor any effective treatment for psychopathy; there are no medications that can instil empathy, while psychopaths who undergo traditional talk therapy only become more adept at manipulating others. However, other researchers suggest that psychopaths may benefit as much as others from psychological treatment, at least in terms of effect on behavior. According to Hare, the consensus among researchers in this area is that psychopathy stems from a specific neurological disorder which is biological in origin and present from birth although this was not what was reported by a 2008 review which instead indicated multiple causes and variation between individuals. It has been estimated by some that less than one percent of the general population are psychopaths.
Characteristics
The prototypical psychopath has deficits or deviances in several areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions. Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath's tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.
Facial affect recognition
In a 2002 study, David Kosson and Yana Suchy, et al. asked psychopathic inmates to name the emotion expressed on each of 30 faces; compared to the control group, psychopaths had a significantly lower rate of accuracy in recognizing disgusted facial affect but a higher rate of accuracy in recognizing anger. Additionally, when "conditions designed to minimize the involvement of left-hemispheric mechanisms" (i.e. sadness) were used, psychopaths had more difficulty accurately identifying emotions. This study did not replicate Blaire, et al. (1997)'s findings that psychopaths are specifically less sensitive to nonverbal cues of fear or distress.
Vocal affect recognition
In a 2002 experiment, Blair, Mitchell, et al. used the Vocal Affect Recognition Test to measure psychopaths' recognition of the emotional intonation given to connotatively neutral words. Psychopaths tended to make more recognition errors than controls with a particularly high rate of error for sad and fearful vocal affect.
Stroop Tasks
A 2004 experiment tested the hypothesis of overselective attention in psychopaths using two forms of the Stroop color-word and picture-word tasks: with color/picture and word separated and with color/picture and word together. They found in the separated Stroop tasks, psychopaths performed significantly worse than controls; however, on standard Stroop tasks, psychopaths performed equally well as controls. When split into low-anxious and high-anxious groups, low-anxious psychopaths and low-anxious controls showed less interference on the separated Stroop tasks than their high-anxious counterparts; for low-anxious psychopaths, interference was very nearly zero. They conclude the inability to integrate contextual cues depends on the cues' relationship to "the deliberately attended, goal-relevant information."
Causes
One twin study suggests that psychopathy has a strong genetic component. The study demonstrates that children with anti-social behavior can be classified into two groups: those who were also callous acquired their behavior by genetic influences, and those who were not callous acquired it from their environment. "The amygdala is crucial for stimulus–reinforcement learning and responding to emotional expressions, particularly fearful expressions that, as reinforcers, are important initiators of stimulus–reinforcement learning. Moreover, the amygdala is involved in the formation of both stimulus–punishment and stimulus–reward associations. Individuals with psychopathy show impairment in stimulus–reinforcement learning (whether punishment or reward based)and responding to fearful and sad expressions. It is argued that this impairment drives much of the syndrome of psychopathy"(Blair, 2008).
Pathophysiology
Recent studies have triggered theories on determining whether there is a biological relationship between the brain and psychopathy. One theory suggests that psychopathy is associated with both the amygdala, which is associated with emotional reactions and emotion learning, and the prefrontal cortex, associated with impulse control, decision-making, emotional learning and behavioral adaptation. Some studies have shown there is less "gray matter" in these areas in psychopaths than in non-psychopaths. There is DT-MRI evidence of breakdowns in the white matter connections between these two important areas in a small British study of 9 criminal psychopaths. This evidence suggests that the degree of abnormality was significantly related to the degree of psychopathy and may explain the offending behaviors. A 2008 review found various abnormalities (based on group differences from average) reported in the literature, centred on a prefrontal-temporo-limbic circuit — regions that are involved in emotional and learning processes, as well as many other processes. However, the authors report that the people classed as "psychopathic" cannot in fact be seen as a homogeneous group (i.e. as all having the same characteristics), and that the associations between structural changes and psychopathic characteristics do not enable causal conclusions to be drawn. They conclude that psychopathic characteristics involve multifactorial processes including neurobiological, genetic, epidemiological, and sociobiographical (the person's life in society) factors.
Diagnosis
Currently, there are no diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders for psychopathy. Labeling a person as a psychopath involves forensic measurement, using a diagnostic tool such as the Hare Psychopathy Checklist (PCL-R). The PCL-R is widely considered the "gold standard" for assessing psychopathy. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder (ASPD), and the ICD-10 antisocial personality disorder and dissocial personality disorder (DPD). However, the PCL-R criteria for identifying a psychopath are stricter than the diagnostic criteria for ASPD or DPD; psychopaths represent a subset of those with ASPD, and psychopaths' traits are more severe. One issue related to the assessment of individuals who may exhibit affective, interpersonal, and behavioral features associated with psychopathy is the ability to overcome gender myths when the psychopathy features are present in females. The Hare Psychopathy Checklist-Revised has both percentiles and T-score tables for male and female offenders.
Hare Psychopathy Checklist
Psychopathy is most commonly assessed with the PCL-R, which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale according to two factors. PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence.
PCL-R Factor 1, in contrast, is associated with extraversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of non‑deviant social functioning). A psychopath will score high on both factors, whereas someone with ASPD will score high only on Factor 2. Both case history and a semi-structured interview are used in the analysis.
Because an individual's scores may have important consequences for his or her future, the potential for harm if the test is used or administered incorrectly is considerable. The test can only be considered valid if administered by a suitably qualified and experienced clinician under controlled conditions.
PCL-R items
The following findings are for research purposes only, and are not used in clinical diagnosis. These items cover the affective, interpersonal, and behavioral features. Each item is rated on a score from zero to two. The sum total determines the extent of a person's psychopathy.
Factor 1
1. Aggressive narcissism
2. Glibness/superficial charm
3. Grandiose sense of self-worth
4. Pathological lying
5. Cunning/manipulative
6. Lack of remorse or guilt
7. Emotionally shallow
8. Callous/lack of empathy
9. Failure to accept responsibility for own actions
Factor 2
1. Socially deviant lifestyle
2. Need for stimulation/proneness to boredom
3. Parasitic lifestyle
4. Poor behavioral control
5. Promiscuous sexual behavior
6. Lack of realistic, long-term goals
7. Impulsiveness
8. Irresponsibility
9. Juvenile delinquency
10. Early behavioral problems
11. Revocation of conditional release
Traits not correlated with either factor
1. Many short-term marital relationships
2. Criminal versatility
Comorbidity
Psychopaths may have various mental conditions, although, in contrast to people with antisocial personality disorder, comorbidity among psychopaths is generally found to be low.
Substance abuse has been associated with psychopathy, particularly Factor 2 (anti-social behaviour), but not Factor 1 (emotional) scores of the PCL-R. Conduct disorder and ADHD have both been associated with psychopathy; which may be explained by disruption to dorsolateral prefrontal cortex. This area is associated with executive function, which is affected in all three disorders.
There is some evidence of an association between ASPD and other personality disorders (i.e. histrionic, narcissistic and borderline personality disorders), however, evidence for a link with psychopathy is more tentative.
Anxiety may be associated positively with antisocial behaviour, but it is inversely associated with Factor 1 (emotional) scores on the PCL-R. Depression is inversely associated with psychopathy. Although violence may be associated with schizophrenia, there is no conclusive evidence for a link between psychopathy and schizophrenia.
It has been suggested that psychopathy may be comorbid with several other diagnoses than these, however limited work on comorbidity has been carried out. This may be because of difficulties in using inpatient groups from certain institutions to assess comorbidity, owing to the likelihood of some bias in sample selection. Furthermore, comorbidity may be more reflective of poor discriminant validity of categories in the DSM-IV than reflective of underlying aetiologically separate conditions.
No evidence for propensity to sexually-oriented murder
No clinical definition of psychopathy indicates that psychopaths are especially prone to commit sexually-oriented murders, and scientific studies do not suggest that a large proportion of psychopaths have committed these crimes. Although some claim a large proportion of such offenders have been classified as psychopathic, this evidence comes from a single, unrepeated research study using the Rorschach Inkblot Test, an invalid test for psychopathy and for sex offenders, references not considering psychopathy, and studies concerning sexual homicide, a somewhat different population than the general class of sex offenders and not from meta-studies combining repeatable results.
Psychopathy is a personality disorder characterized by an abnormal lack of empathy combined with strongly amoral conduct, masked by an ability to appear outwardly normal. Neither psychopathy, nor the similar concept of sociopathy, are nowadays defined in international diagnostic manuals, which instead describe a category of antisocial/dissocial personality disorder. However, researcher Robert Hare, whose Hare Psychopathy Checklist is widely used, describes psychopaths as "intraspecies predators" as does R.I. Simon. Elsewhere Hare and others write that psychopaths "use charisma, manipulation, intimidation, sexual intercourse and violence" to control others and to satisfy their own needs. Hare states that: "Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse. He previously stated that: "What is missing, in other words, are the very qualities that allow a human being to live in social harmony"
According to Hare, many psychopaths are superficially charming, and can be excellent mimics of normal human emotion; some psychopaths can blend in, undetected, in a variety of surroundings, including corporate environments. According to some, there is neither a cure nor any effective treatment for psychopathy; there are no medications that can instil empathy, while psychopaths who undergo traditional talk therapy only become more adept at manipulating others. However, other researchers suggest that psychopaths may benefit as much as others from psychological treatment, at least in terms of effect on behavior. According to Hare, the consensus among researchers in this area is that psychopathy stems from a specific neurological disorder which is biological in origin and present from birth although this was not what was reported by a 2008 review which instead indicated multiple causes and variation between individuals. It has been estimated by some that less than one percent of the general population are psychopaths.
Characteristics
The prototypical psychopath has deficits or deviances in several areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions. Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath's tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts. Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.
Facial affect recognition
In a 2002 study, David Kosson and Yana Suchy, et al. asked psychopathic inmates to name the emotion expressed on each of 30 faces; compared to the control group, psychopaths had a significantly lower rate of accuracy in recognizing disgusted facial affect but a higher rate of accuracy in recognizing anger. Additionally, when "conditions designed to minimize the involvement of left-hemispheric mechanisms" (i.e. sadness) were used, psychopaths had more difficulty accurately identifying emotions. This study did not replicate Blaire, et al. (1997)'s findings that psychopaths are specifically less sensitive to nonverbal cues of fear or distress.
Vocal affect recognition
In a 2002 experiment, Blair, Mitchell, et al. used the Vocal Affect Recognition Test to measure psychopaths' recognition of the emotional intonation given to connotatively neutral words. Psychopaths tended to make more recognition errors than controls with a particularly high rate of error for sad and fearful vocal affect.
Stroop Tasks
A 2004 experiment tested the hypothesis of overselective attention in psychopaths using two forms of the Stroop color-word and picture-word tasks: with color/picture and word separated and with color/picture and word together. They found in the separated Stroop tasks, psychopaths performed significantly worse than controls; however, on standard Stroop tasks, psychopaths performed equally well as controls. When split into low-anxious and high-anxious groups, low-anxious psychopaths and low-anxious controls showed less interference on the separated Stroop tasks than their high-anxious counterparts; for low-anxious psychopaths, interference was very nearly zero. They conclude the inability to integrate contextual cues depends on the cues' relationship to "the deliberately attended, goal-relevant information."
Causes
One twin study suggests that psychopathy has a strong genetic component. The study demonstrates that children with anti-social behavior can be classified into two groups: those who were also callous acquired their behavior by genetic influences, and those who were not callous acquired it from their environment. "The amygdala is crucial for stimulus–reinforcement learning and responding to emotional expressions, particularly fearful expressions that, as reinforcers, are important initiators of stimulus–reinforcement learning. Moreover, the amygdala is involved in the formation of both stimulus–punishment and stimulus–reward associations. Individuals with psychopathy show impairment in stimulus–reinforcement learning (whether punishment or reward based)and responding to fearful and sad expressions. It is argued that this impairment drives much of the syndrome of psychopathy"(Blair, 2008).
Pathophysiology
Recent studies have triggered theories on determining whether there is a biological relationship between the brain and psychopathy. One theory suggests that psychopathy is associated with both the amygdala, which is associated with emotional reactions and emotion learning, and the prefrontal cortex, associated with impulse control, decision-making, emotional learning and behavioral adaptation. Some studies have shown there is less "gray matter" in these areas in psychopaths than in non-psychopaths. There is DT-MRI evidence of breakdowns in the white matter connections between these two important areas in a small British study of 9 criminal psychopaths. This evidence suggests that the degree of abnormality was significantly related to the degree of psychopathy and may explain the offending behaviors. A 2008 review found various abnormalities (based on group differences from average) reported in the literature, centred on a prefrontal-temporo-limbic circuit — regions that are involved in emotional and learning processes, as well as many other processes. However, the authors report that the people classed as "psychopathic" cannot in fact be seen as a homogeneous group (i.e. as all having the same characteristics), and that the associations between structural changes and psychopathic characteristics do not enable causal conclusions to be drawn. They conclude that psychopathic characteristics involve multifactorial processes including neurobiological, genetic, epidemiological, and sociobiographical (the person's life in society) factors.
Diagnosis
Currently, there are no diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders for psychopathy. Labeling a person as a psychopath involves forensic measurement, using a diagnostic tool such as the Hare Psychopathy Checklist (PCL-R). The PCL-R is widely considered the "gold standard" for assessing psychopathy. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder (ASPD), and the ICD-10 antisocial personality disorder and dissocial personality disorder (DPD). However, the PCL-R criteria for identifying a psychopath are stricter than the diagnostic criteria for ASPD or DPD; psychopaths represent a subset of those with ASPD, and psychopaths' traits are more severe. One issue related to the assessment of individuals who may exhibit affective, interpersonal, and behavioral features associated with psychopathy is the ability to overcome gender myths when the psychopathy features are present in females. The Hare Psychopathy Checklist-Revised has both percentiles and T-score tables for male and female offenders.
Hare Psychopathy Checklist
Psychopathy is most commonly assessed with the PCL-R, which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point (0, 1, 2) scale according to two factors. PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence.
PCL-R Factor 1, in contrast, is associated with extraversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of non‑deviant social functioning). A psychopath will score high on both factors, whereas someone with ASPD will score high only on Factor 2. Both case history and a semi-structured interview are used in the analysis.
Because an individual's scores may have important consequences for his or her future, the potential for harm if the test is used or administered incorrectly is considerable. The test can only be considered valid if administered by a suitably qualified and experienced clinician under controlled conditions.
PCL-R items
The following findings are for research purposes only, and are not used in clinical diagnosis. These items cover the affective, interpersonal, and behavioral features. Each item is rated on a score from zero to two. The sum total determines the extent of a person's psychopathy.
Factor 1
1. Aggressive narcissism
2. Glibness/superficial charm
3. Grandiose sense of self-worth
4. Pathological lying
5. Cunning/manipulative
6. Lack of remorse or guilt
7. Emotionally shallow
8. Callous/lack of empathy
9. Failure to accept responsibility for own actions
Factor 2
1. Socially deviant lifestyle
2. Need for stimulation/proneness to boredom
3. Parasitic lifestyle
4. Poor behavioral control
5. Promiscuous sexual behavior
6. Lack of realistic, long-term goals
7. Impulsiveness
8. Irresponsibility
9. Juvenile delinquency
10. Early behavioral problems
11. Revocation of conditional release
Traits not correlated with either factor
1. Many short-term marital relationships
2. Criminal versatility
Comorbidity
Psychopaths may have various mental conditions, although, in contrast to people with antisocial personality disorder, comorbidity among psychopaths is generally found to be low.
Substance abuse has been associated with psychopathy, particularly Factor 2 (anti-social behaviour), but not Factor 1 (emotional) scores of the PCL-R. Conduct disorder and ADHD have both been associated with psychopathy; which may be explained by disruption to dorsolateral prefrontal cortex. This area is associated with executive function, which is affected in all three disorders.
There is some evidence of an association between ASPD and other personality disorders (i.e. histrionic, narcissistic and borderline personality disorders), however, evidence for a link with psychopathy is more tentative.
Anxiety may be associated positively with antisocial behaviour, but it is inversely associated with Factor 1 (emotional) scores on the PCL-R. Depression is inversely associated with psychopathy. Although violence may be associated with schizophrenia, there is no conclusive evidence for a link between psychopathy and schizophrenia.
It has been suggested that psychopathy may be comorbid with several other diagnoses than these, however limited work on comorbidity has been carried out. This may be because of difficulties in using inpatient groups from certain institutions to assess comorbidity, owing to the likelihood of some bias in sample selection. Furthermore, comorbidity may be more reflective of poor discriminant validity of categories in the DSM-IV than reflective of underlying aetiologically separate conditions.
No evidence for propensity to sexually-oriented murder
No clinical definition of psychopathy indicates that psychopaths are especially prone to commit sexually-oriented murders, and scientific studies do not suggest that a large proportion of psychopaths have committed these crimes. Although some claim a large proportion of such offenders have been classified as psychopathic, this evidence comes from a single, unrepeated research study using the Rorschach Inkblot Test, an invalid test for psychopathy and for sex offenders, references not considering psychopathy, and studies concerning sexual homicide, a somewhat different population than the general class of sex offenders and not from meta-studies combining repeatable results.
