Psychopathy
In 1941, American psychiatrist Hervey M. Cleckley published a book titled The Mask of Sanity that described patients at a Veterans Administration hospital in Georgia. He used the metaphor of a mask to explain how these individuals appeared confident and well-adjusted on the outside while hiding deep pathology through their actions over time. Cleckley formulated sixteen criteria for psychopathy based on his clinical observations of these specific patients. His work influenced the initial diagnostic criteria for antisocial personality reaction or disturbance in the Diagnostic and Statistical Manual of Mental Disorders. Later theorists referred to psychopaths as fearless or thick-skinned because they lacked nervousness and neurotic disorders. This early description set the stage for modern controversies about the definition of the condition.
Canadian psychologist Robert D. Hare introduced an alternative measure called the Psychopathy Checklist in 1980 which was revised in 1991 to become the PCL-R. In 2001, David J. Cooke and Christine Michie proposed a three-factor model of this checklist that has seen widespread application in other measures like the Youth Psychopathic Traits Inventory. Arrogant and deceitful interpersonal style includes impression management or superficial charm along with inflated self-worth and pathological lying. Deficient affective experience covers lack of remorse or guilt plus shallow affect and callousness without empathy. Impulsive and irresponsible lifestyle encompasses impulsivity, sensation-seeking, risk-taking, and financial parasitism. An average score of 22.1 has been found in North American prisoner samples while 20.5 percent scored 30 or higher. Studies have found that psychopathy scores correlated with repeated imprisonment and detention in higher security facilities.
Dysfunctions in the prefrontal cortex and amygdala regions of the brain have been associated with specific learning impairments in psychopathy since the 1980s. Damage to the ventromedial prefrontal cortex leads to common characteristics where individuals appear incapable of acquiring social and moral knowledge. People scoring 25 or higher on the PCL-R with an associated history of violent behavior show significantly reduced mean microstructural integrity in their uncinate fasciculus. This white matter connects the amygdala and orbitofrontal cortex according to evidence from DT-MRI studies. Research also shows that an approximate 18 percent smaller amygdala size contributes to a significantly lower emotional sensation regarding fear and sadness. High levels of testosterone combined with low levels of cortisol or serotonin have been theorized as contributing factors to these biological mechanisms. Testosterone is associated with approach-related behavior and reward sensitivity while decreasing fearfulness.
A 2002 study of homicide offenders reported that homicides committed by those with psychopathy were almost always primarily instrumental accounting for 93.3 percent of cases compared to 48.4 percent for non-psychopathic offenders. The prevalence of psychopathy among domestic abusers indicates rates estimated to be around 15 to 30 percent. Studies suggest a strong correlation between psychopathy scores and violence though researchers note it is dissociable from and not synonymous with violence itself. One conclusion was made by a 2002 study which found that more than a third of homicides committed by psychopathic offenders involved some component of emotional reactivity as well. FBI profilers indicate that serious victim injury is generally an emotional offense at least concerning sexual offending. A large systematic review and meta-regression found that the PCL performed the poorest out of nine tools for predicting violence on average.
The PCL:YV is an adaptation of the PCL-R for individuals aged 13 to 18 years done by a trained rater based on interviews and examination of records. Conduct disorder is diagnosed based on a prolonged pattern of antisocial behavior in childhood or adolescence and may be seen as a precursor to ASPD. Some researchers have speculated that two subtypes of conduct disorder mark dual developmental pathways to adult psychopathy. Childhood-onset is argued to be more due to a personality disorder caused by neurological deficits interacting with an adverse environment. In one study, most of the similarities were on the Impulsive- and Antisocial-Behavior scales among adolescents who scored in the top 5 percent highest psychopathy scores at age 13. Less than one-third or 29 percent of those adolescents were classified as psychopathic at age 24. There is evidence that this group has deficits in behavioral inhibition similar to those of adults with psychopathy.
Research on psychopathy has largely been done on men and the PCL-R was developed using mainly male criminal samples raising questions about how results apply to women. Men score higher than women on both the PCL-R and the PPI and on both of their main scales though differences tend to be somewhat larger on the interpersonal-affective scale. One study reported only 11 percent of violent females in prison met the psychopathy criteria compared to 31 percent of violent males. For girls, 75 percent of the variance in severe callous and unemotional traits was attributable to environmental factors while just 0 percent was attributable to genetic factors. In boys, the link was reversed showing substantial gender differences in etiology. It has been suggested that psychopathy manifests more as externalizing behaviors in men and more as internalizing behaviors in women regarding symptom expression.
Harris and Rice's Handbook of Psychopathy says there is currently little evidence for a cure or effective treatment for psychopathy as yet no pharmacological therapies are known to alleviate emotional deficits. Patients with psychopathy who undergo psychotherapy might gain skills to become more adept at manipulation and deception of others and be more likely to commit crime. Some studies suggest that punishment and behavior modification techniques are ineffective at modifying behavior since they are insensitive to threat. Although core character deficits are likely highly incorrigible to current methods, antisocial and criminal behavior may be more amenable to management through self-interest focused interventions. Various therapies have been tried with mixed success aiming to reduce criminal activity of incarcerated offenders by developing skills to obtain what patients want out of life in prosocial ways rather than antisocial ones.
Common questions
When did Hervey M. Cleckley publish The Mask of Sanity?
Hervey M. Cleckley published the book titled The Mask of Sanity in 1941 at a Veterans Administration hospital in Georgia.
What is the average score for psychopathy found in North American prisoner samples?
An average score of 22.1 has been found in North American prisoner samples while 20.5 percent scored 30 or higher on the Psychopathy Checklist Revised.
How does brain structure differ in individuals with high psychopathy scores?
People scoring 25 or higher on the PCL-R show significantly reduced mean microstructural integrity in their uncinate fasciculus and an approximate 18 percent smaller amygdala size compared to others.
What percentage of homicides committed by those with psychopathy were primarily instrumental according to a 2002 study?
A 2002 study reported that almost all homicides committed by those with psychopathy were primarily instrumental accounting for 93.3 percent of cases compared to 48.4 percent for non-psychopathic offenders.
Why do researchers question how psychopathy results apply to women?
Research on psychopathy has largely been done on men and the PCL-R was developed using mainly male criminal samples raising questions about how results apply to women.