In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is psychopathy.
Psychopathy is a cluster of personality characteristics. It is sometimes described as a personality disorder or a neuropsychiatric disorder, but it’s not a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnosis that comes the closest is antisocial personality disorder, but they’re not the same thing.
While the words psychopathic and psychotic sound similar, they refer to entirely different things.
The Hare Psychopathy Checklist
Psychopathy is characterized by shallow emotions, lack of empathy, impulsivity, and an increased likelihood of antisocial behaviour. The Hare Psychopathy Checklist (PCL-R), developed by Canadian psychologist Dr. Robert Hare, is the most commonly used tool to assess for psychopathy in forensic contexts. It involves an extensive review of an individual’s history and an evaluation for the following elements:
- Interpersonal factors:
- Glibness/superficial charm
- Grandiose sense of self-worth
- Pathological lying
- Conning/manipulative
- Affective factors:
- Lack of remorse/guilt
- Shallow affect
- Callous/lack of empathy
- Failure to accept responsibility
- Lifestyle factors:
- Need for stimulation
- Parasitic lifestyle
- No realistic long-term goals
- Impulsivity
- Irresponisibility
- Antisocial factors:
- Poor behavioural controls
- Early behavioural problems
- Juvenile delinquency
- Revocation of conditional release
- Criminal versatility
Prevalence
Psychopathy occurs in about 1% of the general adult population, but about 20% of the adult prison population. Among homicide offenders, more than 1/4 are psychopaths, on average. Psychopathy is more common in males than females, and it occurs more commonly in North American prison populations than in European prison populations.
Subclinical psychopathy refers to a milder version with lower levels of antisociality, and it’s part of the dark triad of personality traits, along with subclinical narcissism and Machiavellianism. In this post, I’ll use the term psychopath to refer to individuals who meet the criteria for psychopathy at the level of the PCL-R rather than subclinical psychopathy.
In non-prison populations, people with high levels of psychopathy are more likely to be found in certain occupations, including managers, executives, advertising workers, investors, lawyers, and surgeons.
Factors contributing to psychopathy
Genetic, neurobiological, and developmental factors appear to play an important role in the development of psychopathy. Psychopathic traits typically start to appear by age 10, and they may appear as young as age 3. This isn’t a matter of someone choosing to be a horrible person; their brains just don’t work the same way as other people’s do.
Emotional deficits
The emotional deficits are a key element that distinguishes psychopathy from antisocial personality disorder. These deficits are thought to be an issue of lack of capacity. Some studies have shown that the capacity is not missing entirely, but it’s not automatically activated the way that it is for most people.
Some researchers have suggested that it’s the emotional processing stage where certain areas of the brain aren’t connecting properly. That would mean that these people are capable of having emotional reactions, but the brain’s not able to make sense of what that reaction is.
Neurobiology
One possibility is that the amygdala, the structure in the brain that handles the fear response, doesn’t properly process emotional cues, so there is a diminished fear response. As a result, there would be less concern about the negative consequences of behaviours. Changes in amygdala function have been observed on functional MRI in psychopathic individuals.
Deficits have also been observed in the area of the prefrontal cortex that’s involved in learning related to reinforcement and punishment. These deficits can be seen from a young age. Structural and functional deficits have also been seen in a number of other regions of the brain related to emotion processing and behavioural control and inhibition.
Research has also suggested that abnormalities in glucose metabolism in the brain or the endogenous opioid system may play a role. Changes in the expression of several genes have been observed, affecting neurons in the brain’s cortex as well as astrocytes, which are support cells in the brain.
Mentalization
Psychopathic individuals also have impairments in the affective component of theory of mind reasoning, or mentalization. This means they have difficulty imagining the emotional states of others.
Normally, pain in others is aversive, and children learn to control their behaviour accordingly to minimize this. In psychopaths, this process is disrupted. Psychopaths also have deficits in responding to emotionally provocative images, including facial expressions.
Consequences of psychopathy
People with high levels of psychopathy are prone to violence. They’re more likely to re-offend after release from prison, and in particular, they’re more likely to re-offend violently. This increased recidivism has been seen across different cultures.
As a consequence of their behaviours, psychopaths pose high costs to society; in 2010, this was estimated to be $400 billion in the US. There is no known treatment, and therapy can sometimes make things worse by teaching people how to game the system. Focusing on behaviour change may be more useful than trying to develop the capacity for empathy.
I can only think of one person I’ve ever encountered who would probably have met the PCL-R criteria for psychopathy. This individual was very violent, very deliberate about his violence, and a very smooth talker. He had managed to talk his way into a psychotic disorder diagnosis, but there was no disconnect from reality; he knew exactly what he was doing. Having a conversation with him was like a chess game; it was a surreal experience.
Do you think you’ve ever encountered a psychopath?
References
- Anderson, N. E., & Kiehl, K. A. (2014). Psychopathy: developmental perspectives and their implications for treatment. Restorative Neurology and Neuroscience, 32(1), 103-117.
- Hare, R. D. (2016). Psychopathy, the PCL-R, and criminal justice: Some new findings and current issues. Canadian Psychology, 57(1), 21.
- Pujol, J., Harrison, B. J., Contreras-Rodriguez, O., & Cardoner, N. (2019). The contribution of brain imaging to the understanding of psychopathy. Psychological Medicine, 49(1), 20-31.
- Sanz-García, A., Gesteira, C., Sanz, J., & García-Vera, M. P. (2021). Prevalence of psychopathy in the general adult population: A systematic review and meta-analysis. Frontiers in Psychology, 3278.
- Tiihonen, J., Koskuvi, M., Lähteenvuo, M., Virtanen, P. L., Ojansuu, I., Vaurio, O., … & Lehtonen, Š. (2020). Neurobiological roots of psychopathy. Molecular Psychiatry, 25(12), 3432-3441.
- van Dongen, J. D. (2020). The empathic brain of psychopaths: From social science to neuroscience in empathy. Frontiers in Psychology, 11, 695.
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
Yeah, my mother and elder male sibling. What do you call people who exhibit 98% of those traits, knows the difference between right and wrong and just doesn’t give a shit because lying, hurting people, physically and emotionally is just so much fun…and of course the manipulating, the outer-directedness – it’s never THEIR fault – and on and on…
Yikes.
I’ve encountered several non-violent people who fit many of the other criteria, especially lack of empathy and manipulative behavior. I know one woman like this, and she’s pretty, so men don’t see her as a bad person, just needy. She isn’t needy; she is a user. The rest have been men from dating sites 🤮
Blech. Good riddance to them.
Note personally, but someone close to me has. Psychopathy is unlike anything most people have seen. Totally jacked.
Yeah, it’s pretty bizarre.
I almost thought the Hare Checklist was your Table of Contents and tried to keep scrolling eagerly at the end of your post! This is so fascinating. Also interesting how the slang word “psycho” is associated with this more than any other ‘psycho’-logical condition… there are so many terms. I wonder if stigma is the cause or the effect?
One of the major mental illness stereotypes is that it makes people violent, so I think that’s part of it. I think that there’s also the idea that someone who perpetrates serious violence must be mentally ill to do such a thing. And then psychopathy seems to join it all together, but I think the core issue is that the notion of psychopathy in the public imagination fits very nicely with long-standing stigmatized views of mental illness.
Thanks for explaining. That’s very neatly put.
I often wonder if my father is. He is a narcissist for sure✔️ Lacks empathy✔️ Superiority complex ✔️ psychologically abusive ✔️ anger problem sometimes violent✔️ charismatic ✔️
I am not trying to out humor anything, however, I’ve questioned this for awhile now.
Out him*
Ugh, not good.
Yes, when I was in a state hospital. I’m sure I’ve met a few on the outside, too!
I didn’t stumble across any information about the prevalence of psychopathy in psychiatric hospitals, but I’m guessing it’s probably higher than in the general population.
This has H.G. Tudor – The Ultra written all over it.
If you need to know what one is …you have one right there in action.
A Narcissistic Psychopath. Highly intelligent, dark triad, and knows exactly what he is doing.
A lot of these types are actually in high-up government/leader positions believe it or not.
The world is largely run by this sort of person. They are the ones that want all the power. And know how to get to the top with massive amounts of charm/charisma, lies deceit, manipulation etc . And they don’t care what they have to do or who they have to trample on and hurt in the process to get there. It’s all fair game to them.
Other humans, or should I say “objects” as that is what the rest of us are to them. Or targets. They see as as lesser creatures to control and please them and they are the gods.
As soon as we get out of line, they have any number of machinations, both psychological, emotional, mental that they can use against us. They usually know the systems well and can exploit them and take full advantage of them.
They are though very efficient and machine-like in how they work. And often very good at what they do.
They are several steps in front of you….always.
They have already thought and planned way ahead of all the modes along on the chess board.
Many of them live secret lives, double lives, have other identities as it were. They will have a matrix of relationships… and are heavily often involved in the dark Web and such like.
Because of their charm/charisma and often confident, super-ego and having no fear… they can get into places where us ordinary would not be able to go.
Very interesting but dangerous people.
If you’ve been involved with one…on a personal level, you usually know because they would have crushed you, and taken you over the edge of sanity, because that is what they do, and feel no remorse.
They don’t want you dead, they want you alive, but they will make you wish you were dead.
You will not know yourself after they have finished with you.
I hadn’t heard of H.G. Tudor before, but from a quick poke around, it seems rather ironic that someone who says he’s a narcissistic psychopath is getting attention and followers and making money for talking about narcissism.
Yeah… I can’t really go into it too much on an open platform.
There is much I could say on the subject… much…
I believe I have met some people who have all or most of those characteristics. Mostly they have been users of methamphetamine.
Meth does awful things to the brain.
It seems to, yeah. Of course I don’t know exactly what it does neurologically but it definitely warps the psyche.
It’s a neurotoxin, so it actually damages brain cells.
Is marijuana a neurotoxin?
“What is not” is so important to understand properly. Thanks a lot for this post! Regards!
Thanks!