From Wikipedia, the free encyclopedia
Psychopathy, sometimes considered synonymous with
sociopathy, is traditionally defined as a
personality disorder[1] characterized by persistent
antisocial behavior, impaired
empathy and
remorse, and
bold,
disinhibited, and
egotistical traits. Different conceptions of psychopathy have been used throughout
history that are only partly overlapping and may sometimes be contradictory.
[2]
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.
[3] 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.
[4][2][5][6][7] Canadian psychologist
Robert D. Hare later repopularized the construct of psychopathy in criminology with his
Psychopathy Checklist.
[2][5][8][9]
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.
[9][10] While the term is often employed in common usage along with "crazy", "
insane", and "mentally ill", there is a distinction between those with
psychosis and psychopathy.
[11]
Definition
A person suffering from a chronic mental disorder with abnormal or violent social behavior.
Concepts
There are multiple conceptualizations of psychopathy,
[2] 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.
[2]
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.
[2]
The triarchic model
[1]
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
Psychopathy Checklist (PCL, PCL-R) and
Psychopathic Personality Inventory (PPI) to this model.
[1][2]
- 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.[1][2]
- 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.[1][2]
- Meanness.
Lacking empathy and close attachments with others, defiance of
authority. 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.[1][2]
Measurement
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.
[12] 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.
[13]
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.
[citation needed] 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".
[2]
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.
[2][14]
Personality dimensions
There are different views as to which personality dimensions are more central in regard to psychopathy.
[citation needed]
Besides dimensions described elsewhere in this article, studies have
linked psychopathy to alternative dimensions such as antagonism (high),
conscientiousness (low) and
anxiousness (low, or sometimes high).
[citation needed] 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.
[15][16][17]
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.
[17] However, narcissism is generally seen as only one possible aspect of psychopathy as broadly defined.
[citation needed]
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.
[citation needed] The
dark tetrad refers to these traits with the addition of
sadism.
[18][19][20][21][22][23]
Criticism of current conceptions
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
[24]
"The concept and subsequent reification of the diagnosis
“psychopathy” has, to this author’s mind, hampered the understanding of
criminality and violence... According to Hare, in many cases one need
not even meet the patient. Just rummage through his records to determine
what items seemed to fit. Nonsense. To this writer’s mind, psychopathy
and its synonyms (e.g., sociopathy and antisocial personality) are lazy
diagnoses. Over the years the authors’ team has seen scores of offenders
who, prior to evaluation by the authors, were dismissed as psychopaths
or the like. Detailed, comprehensive psychiatric, neurological, and
neuropsychological evaluations have uncovered a multitude of signs,
symptoms, and behaviors indicative of such disorders as bipolar mood
disorder, schizophrenia spectrum disorders, complex partial seizures,
dissociative identity disorder, parasomnia, and, of course, brain
damage/dysfunction."
Half of the Hare Psychopathy Checklist consists of symptoms of mania,
hypomania, and frontal-lobe dysfunction, which frequently results in
underlying disorders being dismissed.
[25]
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.
[26]
Some have called for rejection of the concept altogether, due to its
vague, subjective and judgmental nature that makes it prone to misuse.
[27]
Signs and symptoms
Psychopathy is a
personality disorder which has symptoms expressed over a wide range of settings.
[citation needed]
Socially, it expresses extensive callous and manipulative self-serving
behaviors with no regard for others, and often is associated with
repeated delinquency, crime and violence, but may also present itself in
other, maybe even successful social settings.
[citation needed] Mentally, impairments in processes related to
affect (emotion) and
cognition,
particularly socially related mental processes, have been found in
those with the disorder which suggest that their destructive social
behavior is borne from these aberrant mental processes.
[citation needed] 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.
[28]
Offending
Criminality
Psychopathy is strongly correlated with crime, violence, and antisocial behavior.
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.
[29][30]
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.
[2][31]
Violence
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.
[2][32]
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.
[33][34]
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.
[35]
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.
[2]
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.
[34][36]
Some clinicians
[who?] 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.
[citation needed]
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.
[2][37][38][39][40][41][42]
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.
[43]
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.
[35]
Sexual offending
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.
[citation needed] For
child molesters, psychopathy was associated with more offences.
[44]
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.
[45][46]
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.
[44]
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.
[47]
There is, however, increasing concern that PCL scores are too
inconsistent between different examiners, including in its use to
evaluate sex offenders.
[48]
Other offending
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.
[citation needed] 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.
[49][50]
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.
[51]
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 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.
[2][52][53] Juvenile psychopathy may also be associated with more negative emotionality such as anger, hostility, anxiety, and depression.
[2][54]
Psychopathic traits in youth typically comprise three factors:
callous/unemotional, narcissism, and impulsivity/irresponsibility.
[55][56]
There is positive correlation between early negative life events of the ages 0-4 and the emotion-based aspects of psychopathy.
[57]
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.
[2][58]
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.
[2][59][60]
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.
[2]
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
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.
[2]
The
DSM-5 includes a specifier for those with conduct disorder who also display a
callous, unemotional interpersonal style across multiple settings and relationships.
[57]
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.
[2][61]
Mental traits
Cognition
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.
[62][63][64][65][66]
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).
[10][32][67]
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.
[28]
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.
[68]
Some recent fMRI studies have reported that emotion perception deficits
in psychopathy are pervasive across emotions (positives and negatives).
[69][70][71][72][73] Studies on children with psychopathic tendencies have also shown such associations.
[73][74][75][76][77][78]
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.
[79]
Moral judgment
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.
[80]
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.
[80]
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.
[81]
Etiology
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.
[1][2]
Genetic
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.
[2][67][82]
Environment
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.
[83] There has also been association between psychopathy and detrimental treatment by peers.
[84]
However, it is difficult to determine the extent of an environmental
influence on the development of psychopathy because of evidence of its
strong heritability.
[85]
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".
[70] 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.
[86]
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.
[62][63][64][72]
Other theories
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.
[82][87]
It is also suggested that some traits associated with psychopathy such
as early, promiscuous, adulterous, and coercive sexuality may increase
reproductive success.
[82][87]
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.
[2][84][88]
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. Empirical evidence regarding the suggested
reproductive success is lacking.
[2]
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.
[2][82]
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.
[82] 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.
[87][89]
Mechanisms
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.
[90]
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.
[2]
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.
[91]
Neurological
Dysfunction of the
orbitofrontal cortex, among other areas, is implicated in the mechanism of psychopathy.
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”.
[72]
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.
[92]
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.
[93]
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".
[2] 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.
[1]
The amygdala and frontal areas have been suggested as particularly important.
[65]
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.
[66]
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.
[2]
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.
[72][94]
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.
[95]
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.
[2]
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.
[96] Several animal studies note the role of
serotonergic functioning in impulsive aggression and antisocial behavior.
[97][98][99][100]
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.
[101][102][103][104]
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.
[105] Bariş 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.
[106] 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.
[107]
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).
[96]
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.
[108] 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".
[109]
Findings have also shown
monoamine oxidase A to affect the predictive ability of the PCL-R.
[110]
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.
[111] Findings suggest that further research is needed in this area.
[112][113]
Assessment
Tools
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.
[67][114][115] The PCL-R is widely used and is referred to by some as the "gold standard" for assessing psychopathy.
[116] There are nonetheless numerous criticisms of the PCL-R
as a theoretical tool and in
real-world usage.
[117][118][119][120][121]
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.
[122]
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.
[2]
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.
[2]
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.
[citation needed]
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.
[citation needed]
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.
[2][5][8]
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.
[2]
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.
[30][123][124][125][126]
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.
[123] 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.
[citation needed] Psychopathy is also associated with
substance use disorders.
[32][123][125][127][128]
It has been suggested that psychopathy may be comorbid with several other conditions than these,
[128]
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.
[123]
Further considerations
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.
[2]
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.
[2]
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.
[129] Other studies have also pointed out that high psychopathic females are rare in forensic settings.
[130]
Management
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.
[131][132] People afflicted with psychopathy are generally
unmotivated to seek treatment for their condition, and can be uncooperative in therapy.
[116][131] 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.
[133] 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.
[133][134]
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.
[135][136]
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.
[131]
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.
[137][138]
To this end, various therapies have been tried with the aim of reducing
the criminal activity of incarcerated offenders with psychopathy, with
mixed success.
[131]
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.
[139]
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.
[2][5][8][140][141] 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.
[142]
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.
[131][143]
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.
[2]
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.
[2]
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.
[144]
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.
[2][4]
In the United Kingdom, "psychopathic disorder" was legally defined in the Mental Health Act (UK), under MHA1983,
[4][145]
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".
[146]
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.
[147]
United States
"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.
[148][149][150]
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.
[150] Psychopathy measurements may be used in the confinement decision process.
[2]
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.
[2][116]
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.
[2][151]
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.
[32]
A 2009 British study by Coid et al., also using the PCL:SV, reported a
community prevalence of 0.6% scoring 13 or more. 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.
[152]
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.
[70]
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.
[30] A study on a sample of inmates in Iran using the PCL:SV found a prevalence of 23% scoring 18 or more.
[153] 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.
[154]
Society and culture
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.
[155]
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, low 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.
[155]
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.
[51]
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.
[2][156][157][page needed] Hare considers newspaper tycoon
Robert Maxwell to have been a strong candidate as a "corporate psychopath".
[158]
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.
[159][page needed] 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.
[160][page needed][161][page needed] Psychopathy as measured by the PCL-R is associated with lower performance appraisals among corporate professionals.
[162] 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.
[163][page needed]
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.
[164][165][166]
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.
[167] Characters with psychopathic traits have appeared in Greek and Roman mythology, Bible stories, and some of Shakespeare's works.
[168]
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.
[2]
History
Etymology
The word
psychopathy is a joining of the
Greek words
psyche (ψυχή) "soul" and
pathos (πάθος) "suffering, feeling".
[169] The first documented use is from 1847 in
Germany as
psychopatisch,
[170] and the noun
psychopath has been traced to 1885.
[171] 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,
[172] 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.
[173] On the other hand,
Stedman's Medical Dictionary defines psychopathy only as an outdated term for an antisocial type of personality disorder.
[174]
The term
psychosis
was also used in Germany from 1841, originally in a very general sense.
The suffix -ωσις (-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.
[175]
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,
[176] but it is also used as shorthand for psychotic or crazed.
[177]
The label
psychopath has been described as nonspecific but probably persisting because it indicates that the source of behavior lies in the
psyche
rather than in the situation. The media usually uses the term to
designate any criminal whose offenses are particularly abhorrent and
unnatural, but that is not its original or general psychiatric meaning.
[178]
Sociopathy
The word element
socio- has been commonly used in compound words since around 1880.
[179][180] 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.
[179] 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.
[181][182][183][184]
The term is used in various different ways in contemporary usage.
Robert Hare stated in the popular science book entitled
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.
[84]
Hare also provides his own definitions: he describes psychopathy as not
having a sense of empathy or morality, but sociopathy as only differing
in sense of right and wrong from the average person.
[185][186]
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.
[168]
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.
[187] 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.
[2][188]
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.
[2]
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.
[2] The Scottish psychiatrist
David Henderson had also been influential in Europe from 1939 in narrowing the diagnosis.
[189]
The diagnostic category of
sociopathic personality in early editions of the
Diagnostic and Statistical Manual (DSM)
[190]
had some key similarities to Cleckley's ideas, though in 1980 when
renamed Antisocial Personality Disorder some of the underlying
personality assumptions were removed.
[5] 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),
[191][192] and is the most widely used measure of psychopathy.
[193] There are also several
self-report tests, with the Psychopathic Personality Inventory (PPI) used more often among these in contemporary adult research.
[2]
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,
[194][195] non-medical
psychoanalyst Walter C. Langer suggested
Adolf Hitler was
probably a psychopath.
[196] 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.
[197]