Psychopathic personality disorder

DEFINITION: Psychological disorder characterized by egotistical, self-centered, impulsive, and exploitative behaviors, lack of remorse, and emotional callousness.

SIGNIFICANCE: Psychopathic offenders can be among the most physically violent, aggressive, and dangerous perpetrators of crimes. Although they make up only a small percentage of all offenders, they commit a disproportionate number of offenses and are often responsible for the most heinous of criminal acts. The ability to identify psychopaths accurately is thus critical to the protection of law-abiding citizens and the reduction of crime. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) uses the diagnosis of antisocial personality disorder (ASPD) for both psychopathy and sociopathy. Individuals with ASPD who exhibit certain traits may be described as having psychopathic personality disorder.

One of the most important and most influential treatises on psychopathic personality disorder was set forth in 1941 by Hervey Cleckley in his book The Mask of Sanity: An Attempt to Reinterpret the So-Called Psychopathic Personality. Cleckley outlined sixteen different core personality traits that define a psychopath, including pathological lying, superficial charm, lack of empathy, and egocentricity. Since the first edition of Cleckley’s book was published, a wealth of research has examined a number of different issues germane to psychopathic personality disorder, including the potential causes and correlates of psychopathy, ways to assess and diagnose psychopathy, and how psychopathic personality disorder relates to violent offending. This line of research has shown that psychopathic criminals are qualitatively and quantitatively different from non-psychopathic offenders.

Psychopathic criminals inflict more damage and commit more crimes than any other group of criminal offenders. Given their frequent involvement in antisocial behaviors, psychopaths are also at risk for being incarcerated for lengthy periods of time. Once imprisoned, they do not refrain from committing crimes; rather, they engage in a constellation of violent behaviors, ranging from assaulting other inmates to victimizing prison staff. Incarcerated psychopaths are frequently identified as the worst inmates in prison populations. When released from prison, psychopaths usually begin to offend again immediately.

Not all psychopaths are criminals. Some find success in businesses that benefit from cutthroat practices; others make their way in the world as smooth-talking philanderers.

Like autism, psychopathy and sociopathy fall along a spectrum. All people exhibit some degree of the relevant traits at some time, but those with psychopathy have high degrees of the traits. Researchers say in the United States, about 1.2 percent of adult men and from 0.3 to 0.7 percent of adult women have clinically significant levels of these traits. About 25 to 30 percent of people with ASPD also have psychopathy. Psychopathy exists throughout society regardless of culture, gender, race, or socioeconomic status.

Assessment and Diagnosis

One of the more difficult issues facing clinicians is how to determine accurately whether an individual meets the criteria for being considered a psychopath. The most reliable and valid method of diagnosing psychopathy involves the use of some type of standardized actuarial assessment tool.

Although a number of different instruments are available, the most widely used is the Hare Psychopathy Checklist–Revised (PCL-R), developed by Robert D. Hare. The PCL-R is administered by a doctoral-level clinician who conducts a face-to-face interview with the person being assessed for psychopathy. During the interview, which can last up to two hours, the clinician rates the person on twenty traits. Each trait is assigned a value ranging from zero to two, with higher scores indicating a greater likelihood that the person possesses that characteristic. A score of zero on a trait means that the person does not display the trait; a score of two means that the person definitely possesses the trait. When the interview is completed, the clinician tabulates the scores for all twenty traits; a person who receives a total score of thirty or higher is considered to be a psychopath. Overall, criminal offenders have an average PCL-R score of about twenty-two; non-offenders, in contrast, have an average score of about five.

The twenty items that make up the PCL-R measure two different dimensions of psychopathy. Some items are designed to assess the personality traits of psychopaths, such as short-temperedness and impulsiveness; others indicate the extent to which the person leads an antisocial and unstable lifestyle, for example taking advantage of others or committing acts of cruelty for which the person feels no remorse. Usually, a person who scores high on one dimension also scores high on the other, but that is not always the case. In terms of the behaviors associated with these two dimensions, individuals who score high on the personality dimension are at much greater risk for becoming involved in acts of serious physical violence. The fact that psychopaths typically score high on both dimensions indicates their heightened propensity to engage in violent criminal acts and other types of antisocial behaviors. Studies show people with psychopathy are from 15 to 25 times more likely to commit crimes and go to prison.

Only adults can be diagnosed with ASPD. Among children who exhibit antisocial traits, the diagnosis is conduct disorder. Hare also developed a psychopathy checklist for adolescents ages twelve to eighteen, the Psychopathy Checklist: Youth Version (PCL:YV), which uses a semistructured interviewing platform to determine the extent to which an adolescent interviewee exhibits an array of psychopathic traits. Similar to the PCL-R, the PCL:YV is made up of twenty different items that tap behavioral, emotional, affective, and interpersonal traits often displayed by psychopathic adults. The PCL:YV has been shown to be a reliable and valid way of measuring psychopathy in samples of adolescents.

Prevalence and Offending Frequency

It is somewhat difficult to establish the prevalence of psychopathy in the general US population because researchers studying psychopaths usually draw their samples from forensic populations. Some scholars, however, have calculated estimates of psychopathy in the adult population of the United States and have asserted that approximately 1 to 4 percent of the adult population—1 to 3 percent of male adults and about 1 percent of all female adults—would meet the criteria for psychopathy.

The exploitative and aggressive behaviors displayed by psychopathic criminals are also relatively stable over long swaths of the life course. Psychopaths tend not to change their behaviors; youth who exhibit these traits usually continue to do so as they mature into adulthood. This is especially true for those who score high on the personality dimension of the PCL-R.

While psychopaths are a statistical aberration among the general public, they are much more prevalent in prison populations. Although estimates vary, the general consensus, as put forth by Kent A. Kiehl and Morris B. Hoffman in a 2011 article in the journal Jurimetrics, is that psychopaths constitute about 15 to 25 percent of all incarcerated American male prisoners and an even larger percentage of prisoners incarcerated for serious, violent crimes. In addition to committing a disproportionate percentage of the most serious acts of predation, psychopathic criminal offenders perpetrate crimes at much higher rates than do non-psychopathic offenders. The difference between people with ASPD who would be called sociopaths and those who are classified as having psychopathic personality disorder is that the former tend to be impulsive, which may lead to aggression, while those with psychopathy have good control over their thoughts and are likely to plan out aggression and do not react much to either stress or punishment.

Research has found that about 90 percent of prisoners with psychopathy who were released committed a violent crime within two decades, while those with low scores in psychopathy committed a violent act in the same time frame. Furthermore, more than half of police officers who die in the line of duty are killed by people with psychopathy. In short, although psychopaths make up only a relatively small percentage of all offenders, they account for the majority of all criminal acts.

Causes and Treatment

The origins of psychopathy have long baffled scholars. Although it was once believed that social factors and environmental conditions were solely responsible for individuals’ development of psychopathy and psychopathic traits, leading researchers generally agree that biological and genetic factors play a large role in the process. Research has revealed, for example, that certain core psychopathic personality traits, such as impulsivity and callousness, are under significant genetic control. Evidence also suggests that brain abnormalities, such as problems with the amygdala, neuropsychological deficits, and a malfunctioning prefrontal cortex, may be important factors in the etiology of psychopathy. One study, published in 2013, tested the neural responses of eighty incarcerated male offenders to depictions of individuals undergoing intentional harm or displaying pain. Offenders who had scored high for psychopathy using standard measures displayed markedly different neural processes than did non-psychopathic offenders.

Given the amount of death and destruction caused by psychopathic criminals, great interest exists in whether treatment programs can have any impact on the violent behavioral patterns evinced by psychopaths. In general, violent and aggressive psychopaths are extremely nonresponsive to treatment efforts. Although some rehabilitation programs have reported success in reducing aggressive behaviors among psychopaths, this appears to be the exception rather than the rule. Psychopaths in treatment settings are known for resisting treatment, manipulating staff members, and victimizing fellow patients. Psychopathic criminals often leave treatment programs before completion, and even those who successfully complete such programs tend to have extremely high rates of recidivism. Some experts have argued that the only way to control psychopathic offenders is through incarceration. However, researchers contend that if children with psychopathic traits receive help, they may improve.

Bibliography

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