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Psychopathy
Specialty	Psychology

Psychopathy is a three-faceted (in the current most accepted analyses) personality disorder involving interpersonal, affective, and behavioral dimensions:

• Interpersonally, psychopaths are manipulative, grandiose, egocentric, deceitful, and forceful.
• affectively, they are shallow and nonempathetic; they do not experience empathy, guilt, or remorse.
• Behaviorally, they are impulsive, irresponsible, and sensation seeking.

Psychopathy or antisocial personality disorder

The DSM-IV-TR's conceptualization of psychopathy is known as antisocial personality disorder, although there is some dispute over the theoretical and practical equivalence of the two constructs (with psychopathy being measured on the Hare Psychopathy Checklist - Revised). The ICD-10 names it dissocial personality disorder.

Diagnostic criteria (PCL-R test)

In contemporary research and clinical practice, psychopathy is most commonly assessed with the Hare Psychopathy Checklist- Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and a semi-structured interview. The items are as follows:

Factor 1: Aggressive narcissism

• Glibness/superficial charm
• Grandiose sense of self-worth
• Pathological lying
• Conning/manipulative
• Lack of remorse or guilt
• Shallow affect
• Callous/lack of empathy
• Failure to accept responsibility for own actions

Factor 2: Socially deviant lifestyle

• Need for stimulation/proneness to boredom
• Parasitic lifestyle
• Poor behavioral controls
• Early behavioral problems
• Lack of realistic, long-term goals
• Impulsivity
• Irresponsibility
• Juvenile delinquency
• Revocation of conditional release

Traits not correlated with either factor

• Promiscuous sexual behavior
• Many short-term marital relationships
• Criminal versatility

Score 0 if the trait is absent, 1 if it is possibly or partially present and 2 if it is present. The item scores are summed to yield a total score ranging from 0 to 40 which is then considered to reflect the degree to which they resemble the prototypical psychopath. A score higher than 30 supports a diagnosis of psychopathy. Forensic studies of prison populations have reported average scores of around 22 on PCL-R; control "normal" populations show an average score of around 5.

A note of caution: the test must be administered by a trained mental health practitioner under controlled conditions for it to have any validity.

A Three-Factor Model of Psychopathy

Cooke and Michie eliminated criteria related to criminal incarceration and juvenile delinquency and statistically analyzed three factors of psychopathy. This allows for a conception of the psychopathic personality that is better applicable outside forensic populations.

Arrogant/Deceitful Interpersonal Style

• Glibness/superficial charm
• Egocentricity/Grandiose sense of self-worth
• Pathological lying
• Conning/Manipulative

Deficient Affective Experience

• Lack of remorse or guilt
• Callous/Lack of empathy
• Shallow affect
• Failure to accept responsibility for own actions

Impulsive/Irresponsible Behavioral Style

• Need for stimulation/Proneness to boredom
• Parasitic lifestyle
• Lack of realistic, long-term goals
• Impulsivity
• Irresponsibility

(Cooke, Mitchie 2001)

Portrayal of psychopaths in the media

Psychopaths in popular fiction and movies generally possess a number of standard characteristics which are not necessarily as common amongst real-life psychopaths. The traditional "Hollywood psychopath" is likely to exhibit some or all of the following traits which make them ideal villains.

• High intelligence, and a preference for intellectual stimulation (music, fine art etc.)
• A somewhat vain, stylish, almost "cat-like" demeanor
• Prestige, or a successful career or position
• A calm, calculating and always-in-control attitude

It is this last feature which is probably most at odds with the typical real-life psychopath: an individual with APD is much more likely to be impulsive, disorganised and short-tempered rather than the smooth-talking, self-disciplined characters portrayed by Anthony Hopkins (Hannibal Lecter in The Silence of the Lambs), Christian Bale (Patrick Bateman in American Psycho), and Kiefer Sutherland (in Phone Booth). Perhaps more accurate portrayals of psychopaths are Don Logan (Ben Kingsley in Sexy Beast), Doyle Hargrave (Dwight Yoakam in Sling Blade), and Frank Booth (Dennis Hopper in Blue Velvet), all of whom are crude, impulsive characters who relentlessly torment other people.

In popular culture, "psychopath" is often used interchangeably with "serial killer" (such as the characters in slasher films) though the terms are not synonymous. It is, however, true that most serial killers are also psychopaths.

Psychopathy's relationship with other mental health disorders

Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder. PCL-R Factor 1 is correlated with narcissistic personality disorder and histrionic personality disorder. PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality.

PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence. PCL-R Factor 1, in contrast, is associated with extroversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).

Potential warning signs

As a child, three warning signs are often found in individuals with Antisocial Personality Disorder when diagnosed by a psychiatrist. These are a longer-than-usual period of bedwetting, cruelty to animals, and pyromania. Obviously, not all children who exhibit these signs grow up to be psychopaths, but these signs are found in significantly higher proportions than in the general population.

See also

• Antisocial personality disorder
• Narcissistic personality disorder

Citations

• Cooke D.J., Michie C. "Refining the construct of psychopathy: Towards a hierarchical model." Psychological Assessment, 2001, 13 (2), 171-188.

• Personality disorders