Psychopathy: A useful guide to everything you need to know

What does psychopathy mean? What are the signs and symptoms? What relationship does it have with personality? What are the causes? Is there a specific treatment? What is the prognosis? All of these aspects are covered in this useful guide. The definition of psychopathy has always been topic of discussion among psychologist and specialists. However, psychopathy has different signs and symptoms that are clearly defined. 

“I regularly comment on my desire to exploit my admirers or to kill babies and cute animals, and I don’t even need to laugh or smile for people to think I am joking.”

― M.E. Thomas, Confessions of a Sociopath: A Life Spent Hiding in Plain Sight

What is Psychopathy?

Psychopathy comes from the Greek word “psyche” meaning soul and “pathos” meaning suffering, feeling. However, in medicine “pathos” refers to disease, therefore pathology is the study of diseases. In 1847 psychopathology was established as the study of mental disorder. Psychopathy indicates that the source of behavior or disease is in the psyche rather than in the situation. This term is usually interchanged with sociopathy since in 1930 George. E Partridge  used it as a substitute. Nonetheless, Robert Hare, established that even though the terms were interchangeable, sociopathy is preferred due to it’s less likeliness to be confused with psychosis. He also stated that the root of the disorder could be questioned depending on the word you use, giving more importance to social factors when speaking about sociopathy, meanwhile psychopathy would be referring to the personality, biological and genetic factors.

Psychopathy is not having a sense of empathy or morality, but sociopathy is differing in sense of right and wrong from the average person – Robert Hare.

Definitions of psychopathy are hard to come by since many of them contradict each other, however traditionally it is defined as a personality disorder, characterized by persistent antisocial behavior, impaired empathy and remorse and bold, disinhibited, egotistical traits. Even though there seems no consensus on the definition, no psychological or psychiatric organization has sanction a diagnosis by this name and it’s widely used in research.

“Psychopath” has a related stigma and many implications in deciding punishment for crimes committed, medical treats, etc. One attempt in clarifying the definition in order to not have so many implications is the triarchic model.

It establishes that in psychopathy you can observe three characteristics to varying degrees.

• Disinhibition: Poor impulse control, problems with planning and anticipation. Lack of affect and urge control, there is a need for immediate gratification. It’s related to impairments in the frontal lobe of the brain that are involved in impulse control. Psychopathy is related to “blame externalization” where the person blames others for events that are their responsibility. When forced they may admit blame, however they have no sense of shame or remorse, and will not change their behavior.
• Boldness: Stress-tolerance, toleration of unfamiliarity and danger and reduced fear. They have high self-confidence and social assertiveness. May have to do with differences in the amygdala and other neurological systems associated with fear. Psychopathy is associated with narrowed attention, where the person is able to focus more on their objective. People with psychopathy tend to excel in test such as Stroop, since they don’t seem to be distracted by the discrepant color.
• Meanness: Lack of empathy and close relationship with others, use of cruelty to gain control, exploitative tendencies, defiance of authority and destructiveness. Caring is mainly emotional. Psychopathy has been associated with weak brain connections among the components its emotional system. These explain the psychopath’s inability to empathize and develop close relations. They are not good at detecting fear in other people’s faces since they themselves have a hard time feeling it. However, studies show they have a high threshold for emotions such as disgust.

Personality dimensions in Psychopathy

Personality is a broad and complicated category and to establish what aspects of it are central in psychopathy is a daunting task. There are studies that have linked it to high antagonism, low conscientiousness, and varying anxiousness. Robert Hare linked it to aggressive, hostile and tough tendencies or high psychoticism. He also related aspects such as lack of socialization and responsibility, impulsiveness, aggression and in some cases sensation-seeking and sadism.

Transference Focused Psychotherapy creator Otto Kernberg affirmed that psychopathy should be considered part of pathological narcissism. He proposed that narcissism is divided into a spectrum.

Even though, it was a good proposal, nowadays narcissism is seen as only one possible aspect of psychopathy.

Frequency of Psychopathology

The frequency is higher in convicted and incarcerated population where it’s estimated that 15-25% of prisoners are diagnosed. These results are not only for the US but also in the UK and Iran have found a prevalence of inmates scoring 7.7% and 23% accordingly.

Studies have found that in the US 1.2% of the population surveyed scored “potential psychopathy” and correlated with behaviours such as violence, alcohol use and lower intelligence. In the UK the score was 0.6% correlating with younger age, male gender, suicide attempts, violence, homelessness, drug abuse, personality disorders and obsessive- compulsive disorder.

Signs and Symptoms of Psychopathy

Due to the difficult definition for psychopathy and it’s close relationship with sociopathy , the DSM-5 decided to join both and name it the Antisocial Personality Disorder, the criteria are:

Disregard for and violation of others rights since age 15, as indicated by one of the seven sub features:

1. Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or would warrant criminal arrest
2. Lying, deception, and manipulation, for profit tor self-amusement,
3. Impulsive behavior
4. Irritability and aggression, manifested as frequently assaults others, or engages in fighting
5. Blatantly disregards safety of self and others,
6. A pattern of irresponsibility and
7. Lack of remorse for actions (American Psychiatric Association, 2013)

The other diagnostic Criterion are:

1. The person is at least age 18,
2. Conduct disorder was present by history before age 15
3. and the antisocial behavior does not occur in the context of schizophrenia or bipolar disorder (American Psychiatric Association, 2013).

For the person to be diagnosed he/she has to fit the criteria mentioned above. Even though these are the established criteria it’s important to mention in depth symptoms of psychopathy that are expressed over a wide range of settings of a person’s life

Social

Offending is a big part of psychopathy probably the reason why most inmates score positive for psychopathy diagnosis. Studies have shown that these psychopathy scores correlated with repeated imprisonment, detention in higher security, disciplinary infractions and substance misuse. Even though all these correlations were significant, evaluation of inmates with psychopathy did not predict well a re-offense after their release. Therefore, measuring levels of psychopathy is not a good variable when theorizing about crime. Psychopathy is related to very low tolerance to frustration and a low threshold for discharge of aggression, including violence. Even though many people might see both terms as synonyms they are not. Psychopathy is associated with predatory, proactive or colloquially known as cold-blooded aggression. This aggression is known for being emotionless and harm oriented. Studies show that psychopathic homicides are 93.3% more violent than non-psychopathic homicides. Other studies, including the (Federal Bureau of Investigation) FBI profilers show that psychopathy violence has some component of emotional reactivity, which can lead to serious victim injury or sexual assaults. On more specific violence, like domestic violence, it was found that 15-30% of the perpetrators have high rates of psychopathy. The FBI also reports that some serial killers have psychopathy traits such as lack of remorse, impulsiveness, control and predatory behavior. They also stated that victims of psychopathic behavior tend to be more female than male. Psychopathy has been correlated positively with organized crime and war crimes. Terrorists have traits such as antisocial violence, selfishness, blame externalization, lack of guilt, etc. There is a small percentage of psychopaths that are socially adequate and express their antisocial behavior through other outlets such as manipulation and even white-collar crimes.

Mental

Brain injuries have allowed for scientists to study what areas might be affected in psychopathy. Dysfunctions in prefrontal cortex and amygdala region of the brain have been linked to violent and psychopathic behavior. They are incapable of acquiring social and moral knowledge if it happens as a child, as an adult they are aware of the social norm however are unable to behave appropriately. Intelligence seems to be a controversial variable when related to psychopathy. Many establish the link between lower IQ’s with higher levels of psychopathy, however, scientist Cleckley and other clinicians have established that it depends on the type of intelligence assessment (eg. verbal, creative, emotional, analytical, etc.). Emotions are also complicated in psychopathy. Researchers have suggested that psychopathy is associated with atypical responses to stressful cues. There is decreased or no activation of the fusiform and extrastriate cortical regions, which impair response to expressions of fear and empathy per se. Happiness on the other hand remains intact in psychopathy, expression and recognition. People with psychopathy produce less brain activity in neuroimaging exams. Recent studies have come to the conclusion that psychopathic offenders can turn on empathy at will, which would make them both thick-skinned as well as charming. There has been studies that inmates with high-psychopathy have less activation in the ventromedial prefrontal cortex, amygdala and periaqueductal gray parts of the brain which may contribute to the lack of empathic concern. Simon Baron-Cohen, Cambridge professor in developmental psychopathology, says that psychopathy is related with cognitive empathy being intact while the affective empathy is impaired. This means the psychopathic person is capable of responding to social cues but does not have the ability to feel the suffering or pain of others. Children and people with autism are often lacking both types of empathy. Amorality is having no moral standards, restraints, or principles; which is tightly related to psychopathy and sociopathy. Several studies measuring judgement on moral patterns have established that psychopaths fail to appreciate the emotional aspect of a victim’s harmful experience which makes them endorse violent scenarios.

Developmental

Psychopathy can be traced to the late childhood to early adolescence. Psychopathic traits in youth typically comprise three factors: unemotional, narcissism, and impulsivity/irresponsibility. Usually, when speaking about these factors psychologists tend to mention a conduct disorder and oppositional defiant disorder. A conduct disorder is diagnosed when there is a prolonged pattern of antisocial behavior in childhood and/or adolescence, it is related to childhood aggression.  It is consider as a precursor for a diagnosis of antisocial personality disorder. Researchers, however, establish two subtypes of conduct disorder; conduct disorder in childhood, before 10 years old or conduct disorder in adolescence, from age 10 and later. If it’s childhood set (before 10 years) it’s considered to have a personality base caused by neurological deficits accompanied with an adverse environment. Meanwhile, the adolescent conduct disorder is more associated with short-term antisocial behavior.  The criteria for a conduct disorder according to DSM-5 is:

A repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the categories below, with at least one criterion present in the past 6 months:

Aggression to People and Animals

1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
4. Has been physically cruel to people.
5. Has been physically cruel to animals.
6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).
7. Has forced someone into sexual activity.

Destruction of Property

1. Has deliberately engaged in fire setting with the intention of causing serious damage.
2. Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft

1. Has broken into someone else’s house, building, or car.
2. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).
3. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

Serious Violations of Rules

1. Often stays out at night despite parental prohibitions, beginning before age 13 years.
2. Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.
3. Is often truant from school, beginning before age 13 years.
4. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
5. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

Clinicians have established a correlation between childhood ADHD, conduct disorder with possible psychopathy during adulthood. If you feel your child responds to these criteria, visit a specialist in order to get a professionals opinion on the matter.

Causes of Psychopathy

There are several theories on what causes psychopathy, we will look at each one individually.

Genetic: researchers based on the triarchic model believe that psychopathy is an interaction between an adverse environment and a series of genetic predispositions. The adverse environment will depend on the predisposition, therefore there is not only just one disadvantageous situation. Genetic studies have reported that signs such as fearless dominance and impulsive antisociality were influenced by genetic factor but had no correlation between themselves. Genetic factors influence the development of psychopathy while environmental factors modulate the expression of the genetic ones. Researchers believe that certain traits such as “unemotional” ones are inherited and may become susceptible to be modulated by the environment.

Environment: Studies show that having a convicted parent, being physically neglected, having low involvement in the child’s life, low family income and coming from a disrupted family might increase the risk of psychopathy. Detrimental treatment by peers such as bullying can contribute to the development of psychopathy, as well as, poor supervision, harsh discipline, large family size, etc.

Neurological:  Thanks to neuroimaging, Weber and other researchers, have suggested that psychopathy is related to brain abnormalities. In particular, they found abnormalities in the amygdala, hippocampus, parahippocampal gyri and frontal and temporal cortex.  A German neurologist has also claimed to have found the area of the brain where evil lurks in psychopaths. Bremen scientist Dr. Gerhard Roth says the ‘evil patch’ lies in the brain’s central lobe and shows up as a dark mass on X-rays. He discovered it when investigating violent convicted offenders over the years for German government studies. 

“The dark mass at the front of the brain appears in all scans of people with records for criminal violence, indicating a genetic predisposition to violence”- Roth

Biochemical: Other scientists suggest that high levels of testosterone with low levels of cortisol and serotonin are responsible for psychopathy. Studies have shown that high testosterone is associated with antisocial and aggressive behavior, however other studies show that it doesn’t increase aggression but instead increases dominance-seeking. Cortisol seems to play an important since it increases withdrawal behavior and sensitivity to punishment, which are usually very low in psychopathic people. These factors combined may influence psychopathic traits. Serotonin and other neurotransmitters have been researched and related them to psychopathy, specifically enzymes that break down serotonin and dopamine neurotransmitters such as monoamine oxidases (MAOs). These are capable of influencing feelings, mood and behavior in individuals, however, no concrete results have been made.

Evolutionary: There have been several hypotheses that several psychopathy traits are socially adaptive and it only works as long as the counterpart (trusting individuals) exist. Others assume that the sexual freedom of some psychopathic traits help increase reproduction and increment the chances of children inheriting a predisposition to psychopathy, however, this has not been scientifically proven. It was also suggested that psychopathy is the evolution of other adaptive traits rather than being an adaptation in itself.

Brain injury: In the 1980’s researchers linked psychopathy with traumatic brain injuries, including the prefrontal cortex and orbitofrontal cortex, like what happened to Phineas Gage. The psychopathic behavior resulting from an injury has been named pseudopsychopathy or acquired sociopathy. Children with early damage to the prefrontal cortex have difficulty developing social or moral reasoning, becoming, therefore, very aggressive when adults.This can also be accompanied with damage to the amygdala or limbic system making the aggressions even more violent.

Comorbidity with different disorders

As a personality disorder, psychopathy can be present with other mental disorders. Particularly it correlates with histrionic, narcissistic, borderline, paranoid and schizoid personality disorders, as well as panic and obsessive-compulsive disorders, schizophrenia, depression and substance use disorder.

Like mentioned before, ADHD is also highly related to conduct disorder which is a precursor for Antisocial Personality Disorder. Contrary to assumptions, it can sometimes be related to anxiety.

Treatment

Treating psychopathy is very tricky due to its unique characteristics. One of the main characteristics is that people with psychopathy are not motivated to seek treatment and can be very difficult in therapy. Even punishment and behavior modification techniques are ineffective since they are insensitive to punishment or threat. The treatment that appears to be effective to some extent is focusing the therapy on self-interest, emphasizing tangible, material value of positive social behavior with skills training on obtaining what the person wants through acceptable means. Pharmacological treatments for other disorders present may also help with different traits of psychopathy.

Prognosis

The projection for psychopathy is poor, due to it’s difficulty to in treatment. There have been a few studies that suggest that by eliminating substance abuse the person is capable of reducing certain aspects of psychopathy. However, other studies suggest that even after receiving therapy, the relapse rate increased drastically even worsening antisocial aspects of psychopathy. Results are contradictory making it difficult to predict a positive outcome.

10 Psychopaths throughout History

There are people who throughout history have exhibited psychopathy traits and even incurred into violent and aggressive crimes.

Earle Nelson

Known as the Gorilla Killer, when he was ten he was hit by a car and sustained major injuries. When he turned 20 he began strangling and killing women. He would indulge in necrophilia and then discard their bodies.

Ed Gein

He is the inspiration for the movie Texas Chainsaw Massacre. He lived in a shackled house where he had a collection of homemade relics fashioned from body parts.

Gary M. Heidnik

He held six young women captive and would sexually abuse them and torture them together. He would through each one at night into a ditch with sharp objects and wouldn’t get them out until daylight. He was even able to cook parts of their bodies once they passed away.

Joseph Mengele

Medical doctor referred to as the “Angel of Death”, who is responsible for the death of hundreds of men during world war II. He gave the order of killing Jews in Nazi concentration camps and selected other victims to perform inhumane medical experiments.

Adolf Hitler

There isn’t much to say to say which has not already been said. He murdered thousands of people and is considered one of the most evil leaders in human history.

Jack the Ripper

He terrorized a certain London district by stalking and murdering in the fog, a string of prostitutes. The murders usually happened during the holidays or weekends which indicated that he might be regularly employed, nonetheless, his identity was never discovered.

Jeffrey Dahmer

Eating other people is a definite sign to get you on this list. In the 1980’s this serial killer committed crimes of cannibalism and torture to 17 men and young boys throughout the United States. He was found legally sane during trial and was murdered in prison in 1994.

Ted Bundy

When the topic of psychopaths arises Ted Bundy’s name is always mentioned. He was a sociable, attractive man that killed at least 30 women. His killing rampage began after he broke it off with his girlfriend, and all his victims were her look-alikes.

Elizabeth Bathory

As female psychopaths, she is probably the most famous of all of them.  During the 1500’s in Hungary, she killed around 650 women in order to bathe in their blood, with the belief that it would keep her skin young. She would torture the girls before killing them, making them eat their own flesh, burning parts of them, etc. Even though many people testified to these horrific acts, she remained free due to her family’s noble title.

Leonarda Cianciulli

Another famous woman is Leonarda, even though she only killed three people. She came from a very difficult childhood and married poorly. She had about 17 pregnancies however only 4 children survived infancy. She killed three women and dismembered their bodies to make soap. She is considered one of Italy’s most vicious serial killers.

The following video is a trailer for a new series where psychopathy and psychopaths are trying to be deciphered.

https://www.youtube.com/watch?v=7gZCfRD_zWE

Further tips and conclusions

Psychopathy is a very difficult term to understand due to its complexities but I hope this article helped to clarify certain aspects. Remember to keep in mind that diagnosis is to be made by specialists but if you suspect anyone close to you might have certain traits visit your doctor. The fact that treatments have not proven to be effective doesn’t rule out there might be a solution. If your child has a conduct disorder with ADHD it doesn’t mean that in the future he will have an Antisocial Personality Disorder, what’s most important is giving him the support and therapies necessaries in order to change his behavior.

Hope you enjoyed the article. Feel free to leave a comment below!

References

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Edwards, J. The Hare Psychopathy Checklist’ (2016). The test that will tell you if someone is a sociopath. Business Insider. Posted November 24.

Garcia-Villamisar, D., Dattilo, J., Garcia-Martinez, M. (2016). Executive functioning in people with personality disorders. Current Opinion in Psychiatry. 30, 1- 36.

Hare Psychopathy Checklist. Encyclopedia of Mental Disorders.

Hare, R. and Neumann, D. (2008). Psychopathy as a clinical and empirical construct. Annual Reviews Clinical Psychology 4:217-46. doi: 10.1146/annurev.clinpsy.3.022806.091452.

Hare, Robert D. (1993). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York, NY: The Guilford Press.

Hare, R., Hart, S., and Harpur, T. (1991). Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of Abnormal Psychology, 100, 391–398.

Hirstein, W. What is a psychopath? Neuroscience of Psychopathy. Psychology Today. Posted January 30, 2013.

Tracy, N. Psychopathy. Healthy Place. Posted July 21, 2016.

Alejandra Salazar

Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.