psychopathy

psychopathy, personality disorder characterized by a set of dysfunctional interpersonal, emotional, lifestyle, and antisocial tendencies. Persons suffering from psychopathy—sometimes called psychopaths—commonly exhibit a lack of empathy or remorse and manifest impulsiveness, manipulativeness, and deceitfulness, among other negative traits and behaviours. In addition, psychopathy leads some persons to commit criminal offenses. In psychology and personality theory, psychopathy refers to one element of the so-called “dark triad” of related negative personality traits—the other two being Machiavellianism and narcissism.

Studies of psychopathy

There is a long history of interest in the combination of personality traits and behaviours thought to indicate psychopathy. Psychologists frequently refer to The Mask of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality (1941) by the American psychiatrist Hervey M. Cleckley as an early and careful description of the disorder. Early editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a publication of the American Psychiatric Association, used the terms “sociopathic personality disturbance,” “antisocial personality,” and “antisocial personality disorder” (ASPD) to classify traits and behaviours associated with psychopathy. The fifth edition of the manual, the DSM-5 (2013), identified psychopathy as a specific form of ASPD but did not list psychopathy itself as a clinical diagnosis. That approach reflects a lack of consensus on the definition of psychopathy, including its boundaries and features, as further manifested by the proliferation of competing methodologies for assessing, diagnosing, and treating the disorder. Indeed, psychologists have developed a variety of checklists that clearly define psychopathy for use in clinical, research, and criminal justice settings.

Experts in many fields are motivated to pursue research on psychopathy because it is a major public health problem. One study published in 2011 estimated the social costs of criminal psychopathic behaviour in the United States (including the costs of property damage and related expenditures for police, courts, prisons, and so on) at $460 billion per year in 2009 dollars. Such costs do not include those associated with health care for victims of psychopathic criminals.

Characteristics

Psychopathy is a disorder consisting of a suite of dysfunctional personality traits and behaviours that may include low levels of empathy, remorse, or inhibition and high levels of manipulativeness, superficial charm, and impulsiveness. Some people with psychopathy have a grandiose sense of self-worth and engage in pathological lying and promiscuity. Psychopathic behaviour can include criminal and violent acts, but this is not always the case. Psychologists note that psychopathic behaviours vary in intensity and frequency from one individual to another and over time. Moreover, there is a subclinical population that exhibits psychopathic traits and behaviours at a much lower level. Although the prevalence of psychopathy varies depending upon where and how it is measured, the disorder is estimated to affect 1 percent of the general population. Psychopathy is more common in men than in women.

Many psychologists support the model of psychopathy used in the Psychopathy Checklist–Revised (PCL-R), which groups psychopathic features into two broad factors—one centring on personality, the other on behaviour. The personality factor has an interpersonal facet (including superficial charm, deceitfulness, and manipulativeness) and an emotional facet (including remorselessness, emotional shallowness, and lack of empathy). The behavioral factor has a lifestyle facet (including thrill seeking, impulsiveness, and irresponsibility) and an antisocial facet (including poor self-control, early behavioral issues, and criminality).

However, a variety of other psychological models have focused on different key features of psychopathy. One important model is a three-tiered organizational framework associated with the Triarchic Psychopathy Measure (TriPM), which has been used to guide an understanding of psychopathy in the DSM-5. In this model, the core characteristics of psychopathy are clustered within categories of meanness, boldness, and disinhibition.

Psychopathy has a dramatic impact on those who suffer from it. Children at risk of developing the disorder may have behavioral problems that affect their family life, friendships, and education. Adults who suffer from psychopathy may have trouble holding jobs and maintaining personal relationships and can experience legal problems stemming from their reckless or criminal conduct. In addition, people with the disorder frequently develop health problems related to substance abuse.

Psychopathy increases the likelihood of criminal behaviours such as homicide and sadistic violence (not all individuals with the disorder are violent, however). Accordingly, the proportion of people with psychopathy in prison populations is far greater than the proportion in the general population. (Estimates of psychopathy in prison populations range from 16 to 25 percent among men and from 7 to 17 percent among women.) However, psychologists warn that the relationship between psychopathy and violence is complicated, which makes violent behaviour by individuals with the disorder difficult to predict.

Origins and development

Both genetic and environmental factors contribute to the development of psychopathy. Twin and adoption studies have shown that psychopathic traits are heritable. Many studies explore how candidate genes related to neurotransmitters such as serotonin or hormones such as oxytocin influence psychopathic traits, but there is no clear discrete set of genes that cause psychopathy.

Several areas of the brain have been found to be involved in the development of psychopathy. For example, abnormalities in the amygdala and hippocampus often occur in psychopathy. But the relation between psychopathy and brain development is complex and remains a subject of investigation.

A child’s home and social environments can have a major influence on the development of psychopathic traits. Growing up in a traumatic or stressful setting and being subject to harsh discipline or abuse have been correlated with increased levels of psychopathic behaviour. In contrast, growing up in a consistently warm environment with positive reinforcement can effectively extinguish some antisocial tendencies predicted by heredity.

Treatment

Psychotherapy, such as cognitive behaviour therapy, is often used to treat adults suffering from psychopathy. However, many psychologists consider the disorder to be extremely resistant to treatment. The current consensus is that the best way to treat it is to identify psychopathic tendencies in childhood, at which point intervention may be able to mitigate those tendencies and thus prevent psychopathic behaviours later in life.