Psychopathy

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**Dissocial personality disorder**
*Classifications and external resources*
ICD-10	F60.2
ICD-9	301.7

Psychopathy (pronounced /ˈsaɪkoʊˌpæθi/ in General American) is a term derived from the Greek psyche (soul) and pathos (suffering), and was once used to denote any form of mental illness. These days, psychopathy is defined in psychiatry as a condition characterised by lack of empathy or conscience, poor impulse control and manipulative behaviors. Though in widespread use as a psychiatric term, psychopathy has no precise equivalent<ref name=hare1>Hare, R. D. Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion, Psychiatric Times, February 1996, XIII, Issue 2 Accessed June 26, 2006</ref> in either the DSM-IV-TR, where it is most strongly correlated with antisocial personality disorder, or the ICD-10, where it is correlated with dissocial personality disorder.

In current clinical use, psychopathy is most commonly diagnosed using Robert D. Hare's Psychopathy Checklist-Revised (PCL-R). Hare describes psychopaths as "intraspecies predators who use charm, manipulation, intimidation, and violence to control others and to satisfy their own selfish needs. Lacking in conscience and in feelings for others, they cold-bloodedly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret."<ref name=hare2>Hare, Robert D, Psychopaths: New Trends in Research. The Harvard Mental Health Letter, September 1995</ref>

To the layperson, the term psychopathy can take on broader meanings, often being confused with psychosis, particularly by the use of the abbreviation psycho. People commonly take "psychopath" to be interchangeable with their personal perception of an evil person.

1 Legal definitions
2 What is a psychopath?
- 2.1 Diagnostic criteria (PCL-R test)
3 Psychopathy's relationship with other mental health disorders
- 3.1 Pseudopsychopathic personality disorder
4 Childhood precursors
5 See also
6 References
7 Further reading
8 External links

[edit] Legal definitions

It is important to note that psychopathy also has various, quite separate legal and judicial definitions that should not be confused with the medical definition. Various states and nations have at various times enacted laws specific to dealing with psychopathic offenders, and many of these laws are active, on statute, today:

Washington State Legislature<ref name=washington>Washington State Legislature Revised Code of Washington (RCW) Accessed June 26, 2006</ref> defines a "Psychopathic personality" to mean "the existence in any person of such hereditary, congenital or acquired condition affecting the emotional or volitional rather than the intellectual field and manifested by anomalies of such character as to render satisfactory social adjustment of such person difficult or impossible".
In 1939, California enacted a psychopathic offender law <ref name=california>Statutes and Amendments to the Codes of California 1939, page 1783, ch. 447, enacted June 6, 1939</ref> that defined a psychopath solely in terms of offenders with a predisposition "to the commission of sexual offenses against children." A 1941 law <ref>Statutes and Amendments to the Codes of California 1941, page 2462, ch. 884, enacted June 28, 1941.</ref> attempted to further clarify this to the point where anyone examined and found to be psychopathic was to be committed to a state hospital and anyone else was to be sentenced by the courts.
"Psychopathic Disorder" is legally defined in the The Mental Health Act (uk) <ref name=ukmha>The Mental Health Act (uk) Reforming The Mental Health Act, Part II, High risk patients Accessed June 26, 2006</ref> as, "a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned".

[edit] What is a psychopath?

A psychopath is defined as having no concerns for the feelings of others and a complete disregard for any sense of social obligation. They seem egocentric and lack insight and any sense of responsibility or consequence. Their emotions are thought to be superficial and shallow, if they exist at all. They are considered callous, manipulative, and incapable of forming lasting relationships, let alone of any kind of love.

Love being a very subjective experience, it is difficult to determine whether psychopaths do not experience it at all or experience it in a way foreign to conventional experiences. For instance, many define love through corresponding actions, not just words. Since psychopaths cause harm through their actions it is assumed that they are not attached to the people they harm; however, according to the Checklist, psychopaths are also careless in the way they treat themselves by failing to alter their behavior in a way that would prevent them from enduring future discomfort. This makes it difficult to fathom how they can have "a grandiose sense of self worth" yet repeatedly put themselves at risk through their own behavior. Dr. Joseph Newman contends that the behavior displayed by psychopaths is the result of "an inability to process contextual cues," which makes it difficult to label all their emotions as "shallow" rather than opaque beneath the plethora of bad behavior. [1]

It is thought that any emotions which the true psychopath exhibits are the fruits of watching and mimicking other people's emotions. They show poor impulse control and a low tolerance for frustration and aggression. They have no empathy, remorse, anxiety or guilt in relation to their behavior. In short, they truly are devoid of conscience.

Most studies of the psychopath have taken place among prison populations, though it has often been suggested that the psychopath is just as likely to sit on a Board of Directors as behind bars, concealing his true nature behind a well crafted "Mask of Sanity" (also the title of one of the first definitive studies of psychopathy, written by Hervey M. Cleckley in 1941.)

Cleckley defined psychopathy thus:<ref name=mask>Cleckley, H, 1941 The Mask of Sanity (pdf Download 1.38mb)</ref>

Superficial charm and average intelligence.
Absence of delusions and other signs of irrational thinking.
Absence of nervousness or neurotic manifestations.
Unreliability.
Untruthfulness and insincerity.
Lack of remorse or shame.
Antisocial behavior without apparent compunction.
Poor judgement and failure to learn from experience.
Pathological egocentricity and incapacity to love.
General poverty in major affective reactions.
Specific loss of insight.
Unresponsiveness in general interpersonal relations.
Fantastic and uninviting behavior with drink, and sometimes without.
Suicide threats rarely carried out.
Sex life impersonal, trivial, and poorly integrated.
Failure to follow any life plan.

It has been shown that punishment and behavior modification techniques do not improve the behavior of a psychopath. They have been regularly observed to respond to both by becoming more cunning and hiding their behavior better. It has been suggested that traditional therapeutic approaches actually make them, if not worse, then far more adept at manipulating others and concealing their behavior. They are generally considered to be not only incurable but also untreatable.

Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.

[edit] 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 (0, 1, 2) scale according to specific criteria through file information and a semi-structured interview.

[edit] 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).

[edit] Pseudopsychopathic personality disorder

It has been suggested that people can suffer apparently psychopathic personality changes from lesions or damage of the brain's frontal lobe. This is sometimes called Pseudopsychopathic personality disorder or Frontal lobe disorder.

One well-known and dramatic case was that of Phineas Gage, a railroad work supervisor. According to Renato M. E. Sabbatini, an explosive charge was set. When it detonated, a steel rod was accidentally driven through Gage's skull from his left cheek to above the right brow.<ref name=sabatini>Sabbatini, Renato M.E. The Psychopath's Brain Accessed June 26, 2006</ref>

Incredibly, he survived for many years. According to the common account, his personality changed completely. He became abusive, aggressive, deceitful, irresponsible and incapable of insight and planning (a poor sense of consequence). Computerised reconstruction of the possible brain damage suggest that, from his known injuries he seemed likely to have had a lesion on the ventromedial frontal cortex.

However, Malcolm Macmillian's recent research into the Gage case<ref name=macmillan> Macmillan, Malcolm, An Odd Kind of Fame: Stories of Phineas Gage, MIT Press, 2000</ref> shows evidence that many of the so-called "psychopathic" features were never documented by physician John Harlow, the primary source, or the Harvard physicians who examined him intensively in Boston. No police records or newspaper accounts can be founds for Gage's alleged, drunken behavior or violence, nor any record of his mother complaining to Dr. Harlow, despite being in contact for years.

Macmillan suggests that claims of deceitfulness, social coarsening and loutish behavior, in Harlow's report to the medical society, lack justification. His research also showed that Gage was able to hold steady work in two locations. His drifting from job to job happened at the end of his life when he developed seizures, eventually succumbing to status epilepticus in front of his family. Macmillan concluded that, at worst, Gage was probably guileless and lacked social skills. A hotel guest, basically a stranger, convinced him to travel to Chile and manage a Concord stagecoach, a difficult cognitive-motor task, which he apparently mastered.

[edit] Childhood precursors

Psychopathy is not normally diagnosed in children or adolescents, and some jurisdictions explicitly forbid diagnosing psychopathy and similar personality disorders in minors. Psychopathic tendencies can sometimes be recognized in childhood or early adolescence and, if recognised, are diagnosed as conduct disorder. It must be stressed that not all children diagnosed with conduct disorder grow up to be psychopaths, or even disordered at all, but these childhood signs are found in significantly higher proportions in psychopaths than in the general population.

Children showing strong psychopathic precursors often appear immune to punishment; nothing seems to modify their undesirable behavior. Consequently parents usually give up, and the behavior worsens.<ref name=ramsland> Ramsland, Katherine, The Childhood Psychopath: Bad Seed or Bad Parents? </ref>

The following childhood indicators are to be interpreted not as to the type of behavior, but as to its relentless and unvarying occurrence. It is not necessary for every single one to exist concurrently, but at least a number of them need to be present over a period of years.

A longer-than-usual period of bedwetting past the preschool years, (unless that is due to medical problems that could be corrected)
Cruelty to animals which extends beyond an angry outburst, extending into a coldblooded remoteness in execution and including torture and painful extended death.
Firesetting and other vandalism. Playing with matches as a preschooler is very common and an unfortunate cause of many fatal housefires. What is indicated here is the deliberate setting of intentionally destructive fires with total immunity regarding consequences to the property and lives of others.
Lies where the deceptions extend beyond a child's normal impulse to not be punished. Lies are so extensively utilized that it is truly never possible to know what is lie and what is truth. Lies are not at all necessarily linked to discernable objectives.
Truancy -
Theft -
Aggression to peers - There are all kinds of aggressive abuse, relatively few of them related to the physical. It can include getting others into trouble or a campaign of psychological torment.
Defiance of authority.

For more indicators, (see conduct disorder).

The three indicators, bedwetting, cruelty to animals and firestarting, known as the MacDonald triad, were first described by J.M. MacDonald as indicators of psychopathy<ref name=macdonald> J. M. MacDonald "The Threat to Kill". American Journal of Psychiatry, 125-130, 1963</ref>. Though the relevance of these indicators to serial murder etiology has since been called into question, they are considered relevant to psychopathy.

The question of whether young children with early indicators of psychopathy respond poorly to intervention compared to conduct disordered children without these traits has only recently been examined in controlled clinical research. The findings from this research are consistent with broader evidence - pointing to poor treatment outcomes. <ref name=hawes> Hawes, D. J., & Dadds, M. R. (2005). The treatment of conduct problems in children with callous-unemotional traits. Journal of Consulting and Clinical Psychology, 73(4), 737-741. [2] </ref>

[edit] See also

[edit] References

[edit] Further reading

Cooke D.J., Michie C. "Refining the construct of psychopathy: Towards a hierarchical model." Psychological Assessment, 2001, 13(2), 171-188.
Hare, Robert D Without Conscience.
Hare, Robert D with Paul Babiak Snakes in Suits: When Psychopaths Go to Work (2006)
Hill, C. D., Neumann, C. S., & Rogers, R. (2004). "Confirmatory Factor Analysis of the Psychopathy Checklist: Screening Version (PCL:SV) in Offenders with Axis I Disorders." Psychological Assessment, 16, 90-95.
Neumann, C. N., Vitacco, M. J., Hare, R .D., & Wupperman, P. (in press). "Deconstructing the 'Reconstruction' of Psychopathy: A Comment on Cooke, Michie, Hart, & Clark." Journal of Personality Disorders.
Patrick, Christopher J. (2006) Handbook of Psychopathy.
Michael H. Thimble, F.R.C.P., F.R.C. Psych. Psychopathology of Frontal Lobe Syndromes.