What Is… Psychopathy

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.