What’s Psychopathy ?

Psychopaths have been described as “social predators who charm, manipulate, and ruthlessly plow their way through life… completely lacking in conscience and feeling for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret”. Theories on psychopathic personality disorder have a rich historical tradition, and strong empirical base, though curiously the standard psychiatric classification and diagnostic system (i.e., Diagnostic and Statistical Manual (DSM)) only provides a crude approximation of the psychopathy diagnosis, which is largely disconnected from the strong research literature. Despite the questionable validity of the DSM conceptualization of antisocial personality disorder (ASPD) (which, in the DSM is not regarded as distinct from psychopathy), a theoretical model of psychopathy has emerged from research using sophisticated statistical methods and very large samples of offenders, psychiatric patients, individuals from the general community, as well as corporate samples. This model of psychopathy proposes that the disorder can be best understood in terms of four dimensions which reflect disturbances in interpersonal and emotional functioning, as well as impulse control and social functioning. More specifically, psychopathy refers to a pathological personality style that is interpersonally deceptive, affectively cold, behaviorally reckless, and often overtly anti social.

Despite the media’s portrayal and the general public’s perception of the psychopath as inhuman and fundamentally unlike most people, the empirical evidence from large scale studies suggest that some degree of psychopathic traits are evident in individuals living in the general community, or the corporate world, and therefore, these features are not limited to offender or forensic samples of individuals. Although there is a clinical threshold that must be reached for a formal diagnosis of psychopathic personality, sub clinical features of the disorder can range from low to high (somewhat akin to blood pressure and by extension, hyper-tension) among a diversity of individuals. In line with these findings, genetic studies have documented that all four of the psychopathy domains are linked to common genetic and environmental factors. In addition, studies of individuals living in the general community have found that psychopathic traits are linked to elevated levels of violence and alcohol use, criminal offenses, and other pathological behavior. These traits have also been associated with problematic corporate behavior. In addition, findings from a worldwide sample (of over 30 000 participants) indicate that psychopathic traits are present in persons across the globe and these traits are negatively associated with a host of negative social cultural attributes such as increased infant mortality

Psychopathy versus Antisocial Personality Disorder

According to the Diagnostic and Statistical Manual – IV (DSM-IV), ASPD ‘has also been referred to as psychopathy, sociopathy, or dissocial personality disorder,’ a statement repeated in the DSM-IV-TR, a more recent psychiatric diagnostic manual (APA, 2000). This apparent equating of ASPD with the traditional understanding of the nature of psychopathy has generated a considerable amount of discussion among clinicians and researchers. Part of the confusion is due to the fact that psychopathy as measured by the PCL-R, and ASPD have several (mostly antisocial) features in common. For example, both groups often engage in criminal or impulsive behavior, and are deceitful. However, ASPD and psychopathy are not synonymous terms or disorders. For example, the diagnosis of ASPD is based primarily on observable behaviors. However, a diagnosis of psychopathy emphasizes essential dis social features of a person’s personality (e.g., manipulative and callousness). Psychopathic individuals not only engage in antisocial behaviors, but are also characterized by the interpersonal and affective features listed previously. Additionally, while most individuals with ASPD demonstrate a normal range of emotion, psychopathic individuals have a limited range primarily consisting of rage and anger. Because these differences exist, the PCL-R can be used to distinguish psychopathy from other antisocial behavior. In forensic populations the prevalence of ASPD is at least two or three times higher than the prevalence of psychopathy, as measured by the PCL-R. Most offenders with a high PCL-R score meet the criteria for ASPD, but most of those with ASPD do not have high PCL-R scores.

Treatment of Psychopathy

Unlike most other individuals, people with psychopathy appear to suffer little personal distress, see little wrong with their attitudes and behavior, and seek treatment only when it is in their best interests to do so, such as when seeking probation or parole. They appear to derive little benefit from prison treatment programs that are emotion-based, involve talk therapy, are psychodynamic or insight oriented, or are aimed at the development of empathy, conscience, and interpersonal skills. This is a marked difference from the effect of therapy on individuals with ASPD, who improve in therapy focused on increasing empathy and interpersonal skills. Some authors recently have argued for programs primarily geared toward a reduction in risk for reoffending and violence for individuals with psychopathic traits. Wong and colleagues have proposed that such risk management and harm reduction programs should involve an integration of relapse-prevention techniques and risk needs responsivity principles with elements of the best available cognitive-behavioral correctional programs. The programs should be less concerned with developing empathy and conscience or effecting changes in personality than with convincing participants that they alone are responsible for their behavior, and that there are more prosocial ways of using their strengths and abilities to satisfy their needs and wants.

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Psychopathy by CS Neumann, K Weber, and H Lasslett.

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