A Primer On Psychopathy

by David S. Kosson and Robert D. Hare

The concept of psychopathy or psychopathic personality has been around for a long time under a variety of different names and with several different but overlapping definitions. The first conceptualization usually linked to the modern concept of the disorder was Philippe Pinel’s description of manie sans delire, which is loosely translated as “insane but not delirious.” (Delirium refers to a state of severe mental agitation and confusion).

The modern view of the psychopathic individual as suffering from a specific personality disorder originated in the clinical descriptions of several psychiatrists during the first half of the twentieth century, particularly those provided by Hervey Cleckley in his book, The Mask of Sanity, (1941/1976).

Cleckley postulated that psychopathy involves difficulty in understanding the meaning and significance of human behavior and leads to a pervasive deficit in the experience of emotion. The title of the book conveys Cleckley’s view that psychopathic individuals do not appear insane in the usual sense of the word.

Contemporary Measures of Psychopathy

The contemporary clinical assessment of psychopathy is based primarily on the Psychopathy Checklist-Revised (PCL-R), developed by Robert Hare (Hare, 2003). The PCL-R is widely regarded as the “gold standard” for psychopathy assessment in clinical and forensic populations (Acheson, 2005, pp. 429-431). It consists of 20 items selected on the basis of an integration of several sources of information, including the clinical writings of Cleckley and other early clinicians, and the research and applied literature.

The specific traits are not easy to diagnose.

In fact, it requires substantial training to reliably assess psychopathy using the PCL-R. One of the reasons that the PCL-R is difficult to use is that it requires raters to integrate information across multiple sources of information (statements by the person himself or herself, official records or other people who know the person and provide collateral information, and the observations and impressions of an interviewer) and across multiple domains of behavior (behavior during childhood and adolescence, behavior in school, on jobs, in one’s family of origin, behavior towards friends and relationship partners, antisocial behavior, and recreational interests and hobbies).

However, when trained raters have access to both interviews and collateral sources, they are routinely able to achieve very high reliability in research settings. Since the development of the PCL-R, there has been a dramatic increase in research on psychopathy. A variety of other instruments have been developed to assess psychopathic features. The Psychopathy Checklist: Youth Version (PCL: YV) was developed for assessing psychopathic traits in adolescents (Forth, Kosson, & Hare, 2003). The Psychopathy Checklist: Screening Version (PCL: SV) permits assessment of psychopathic traits in psychiatric patients and in the general population (Hart, Cox, & Hare, 1995). As with the PCL-R, these measures require extensive training and use of collateral sources of information to provide clinical assessments of psychopathy.

In addition, because we know very little about the long-term stability of psychopathic features in youth, the PCL: YV manual emphasizes that nobody should ever label a child or adolescent a “psychopath.” The term has many negative connotations, and there is evidence that labels like “psychopath” or “mentally ill” can hurt the way that youth are treated by parents, teachers, and peers. However, there is substantial evidence that both the PCL: YV and the PCL: SV are reliable and valid ways of identifying adolescents and adults with psychopathic features.

There are several other measures that sometimes are used in research contexts to screen individuals for psychopathic traits. One such measure is the Antisocial Processes Screening Device (APSD) used in research on the early precursors and development of psychopathy (Frick & Hare, 2003). There are also several self-report measures available for assessing psychopathic traits. However, because scores on these measures are not highly correlated with the PCL-R or its derivatives, they may be measuring, to some extent, different aspects of personality problems. Additional research is necessary to establish the degree to which the different measures converge on the psychopathy construct.

Research on Psychopathy

Individuals with psychopathic traits have been demonstrated to exhibit specific kinds of emotional and cognitive deficits and specific physiological anomalies in several different laboratory situations. These findings provide important clues to mechanisms underlying psychopathic personality, and may help us to understand the causes of psychopathy and to treat individuals with psychopathic traits. In addition, research has established that individuals with many psychopathic traits commit more crimes and more violent crimes than individuals without such traits, and are more likely to violate institution rules, as well as the terms of probation and parole. Psychopathy is also a potent predictor of future violent crime.

These findings show that identifying individuals with psychopathic traits can be very useful for criminal justice professionals in predicting which people are likely to violate rules and get into trouble. However, psychopathy is not a perfect predictor of violence or crime, and there is increasing evidence that some people with psychopathic traits do not break the law or that they learn to function in an adaptive way. The “Links” page provides links to websites that list research articles and the “Bookstore” suggests books on psychopathy.

Additional research findings on psychopathy may be posted on this website over time.

Use of this Resource

Because improper use of the PCL-R could lead people to misdiagnose psychopathy when it is not present, we do not present the PCL-R items in this article, and we urge you to avoid the temptation to diagnose psychopathy in people you know. Nevertheless, because individuals with many psychopathic traits often behave in ways that are confusing and hurtful, and, in some cases, dangerous, we recognize that people may want to have an informal basis for judging whether they may be in relationships with individuals with psychopathic traits. Moreover, although there are few large sample epidemiological studies of the prevalence of psychopathy in community settings, the available data suggest that the disorder may be more common than was previously thought and may afflict as many as 1% of adult males as well as an unknown (but probably smaller) percentage of adult females.

The features of psychopathy can be grouped together into dimensions that can be useful in understanding and predicting behavior. We provide here brief definitions of these dimensions. However, we emphasize that psychopathy is not simply one of these dimensions. A person can be said to have psychopathic traits to the extent that they exhibit the qualities embodied in all or most of these dimensions on a regular basis, across situations. (General descriptions of items similar to those in the PCL: SV are provided in Hare’s 1999 book, Without Conscience.

Early analyses by Harpur, Hare and Hakstian (1989) identified two related clusters of items, or factors, underlying PCL total scores, the first (Factor 1) reflecting affective and interpersonal traits of psychopathy, and the second (Factor 2) reflecting the lifestyle and antisocial features of the disorder. More recent factor analytic studies have proposed a four-factor model of psychopathy as measured by the PCL-R (Hare, 2003, Neumann, Hare, & Newman, 2007),the PCL: SV (Vitacco, Neumann, & Jackson, 2005), and the PCL: YV Neumann, Kosson, Forth, & Hare, 2005). In this model, each of the original factors is divided into two dimensions: Interpersonal, Affective, Lifestyle, and Antisocial). A three-factor model in which the antisocial dimension is omitted also has been proposed (Cooke, Michie, Hart, & Clark, 2004).

To aid visitors to this website, we provide here a basic summary of the four factors, with the caveat that not all researchers agree about the centrality of the antisocial factor.

The Interpersonal Dimension:

Individuals with psychopathic traits are commonly characterized by a smooth interpersonal style and an ability to effectively manipulate others. Although they may be quite straightforward and direct at times, they are prone to use deception under a variety of circumstances and may be quite adept at fooling others, getting out of trouble, and persuading others to do what they want. Such individuals also tend to be interpersonally dominant and even arrogant, at times exuding tremendous self-confidence and an exaggerated sense of their abilities or influence. Even so, just as there are many different ways to influence an impression, different individuals with psychopathic traits may differ widely in their usual interpersonal style, and the same individuals may differ substantially in their presentation to different people in different situations.

The Affective Dimension:

Although often not obvious at first, the behavior of individuals with psychopathic traits frequently suggests that they are less impacted by emotional experiences than are others. Part of what makes this lack of emotional reactivity difficult to detect is that everyone displays emotion in different ways. Some people show emotion on their faces and in their voices; some respond with physical signs of arousal, and some do not. Moreover, although some individuals with psychopathic features may tell you directly that they do not care about other people, others will indicate that they are very upset upon learning that a friend or relative has experienced stress, failure, injury, or illness. However, there may be few signs that they are slowed down, preoccupied, or distracted by such events. In fact, some individuals with psychopathic traits will argue that interpersonal relationships are very important to them:they demonstrate their lack of attachment only through their actions, deceiving and hurting those who appear closest to them with little appreciation for the impact of their behavior on others. Moreover, when things go wrong, they are often adept at explaining the chain of events in a way that leaves them with no responsibility for negative outcomes.

The Lifestyle Dimension:

People with psychopathic traits often neglect their commitments and responsibilities to others. Sometimes, they may decide to change partners or jobs impulsively or even act in ways that seem to undercut their own priorities. In other cases, they consistently verbalize commitment to others, but their behavior suggests otherwise. They may have difficulty resisting exciting opportunities or an irresistible need for stimulation that somehow eclipses prior promises or plans, or they may have difficulty tolerating mundane jobs or sticking with routines. In some cases, individuals with psychopathic traits may demonstrate an unwillingness to support themselves financially. Regardless of the reasons, they tend over time to fail to meet commitments (e.g., paying bills, contributing resources, honoring marital and business contracts) and behave in ways that put others at risk either willfully, recklessly, or through inattention to the needs of others.

The Antisocial Dimension:

The antisocial dimension is associated not with criminal behavior per se, but with early, versatile, and persistent antisocial behavior that often is extremely distressing and frustrating for others. However, individuals with psychopathic features are more likely than others to commit offenses, including violent offenses. Their criminal activities tend to be persistent and generalized, not confined to only one type of offense. In addition, although some of their criminal activities may involve substantial planning, some of their crimes often seem impulsive or even careless.

Part of the reason for such crimes is that many psychopathic offenders display poor frustration tolerance and difficulty controlling their anger. They are likely to over-react to provocations and to obstacles that block their immediate goals, and this reactivity represents an important caveat to the above description of a lack of emotional reactivity; their general lack of emotionality should not be construed as suggesting that individuals with psychopathic qualities are necessarily easy-going or immune to frustrations.

In addition, several studies suggest that psychopathic offenders are more prone than other offenders to violate the rules of probation, parole, and correctional and treatment facilities. Their persistent rule-violations and criminal activity appear quite useful in identifying psychopaths within offender samples. Although there have been few studies addressing the importance of these features in non-offender samples, the available research is consistent with clinical lore about individuals with psychopathic personalities who do not break the law.

References

Acheson, S.K. (2005). Review of the Hare Psychopathy Checklist-Revised, 2nd edn.). In R.A. Spies & B.S. Plake (eds.) (2005). The Sixteenth Mental Measurements Yearbook (pp. 429? 31). Lincoln, NE: Buros Institute of Mental Measurements.

Cooke, D. J., Michie, C., Hart, S. D., & Clark, D. A. (2004). Reconstructing psychopathy: Clarifying the significance of antisocial and socially deviant behavior in the diagnosis of psychopathic personality disorder. Journal of Personality Disorders, 18, 337-357.

Forth, A. E., Kosson, D. S., & Hare, R. D. (2003). The Hare Psychopathy Checklist: Youth Version: Technical Manual. Multi-Health Systems, North Tonawanda, New York.

Hare, R.D. (2003). Manual for the Psychopathy Checklist-Revisited, 2nd Edition. Toronto, Ontario, Canada: Multi-Health Systems. Hare, R. D. (1999). Without Conscience: The disturbing world of the psychopaths among us. New York: Guildford Press.

Hart, S. D., Cox, D. N., & Hare, R. D. (1995). The Hare Psychopathy Checklist: Screening Version (PCL: SV). Toronto, Canada: Multi-Health Systems, North Tonawanda, New York.

Neumann, C. S., Hare, R. D., & Newman, J. P. (2007). The super-ordinate nature of the psychopathy checklist-revised. Journal of Personality Disorders, 21, 102-107.

Neumann, C. S., Kosson, D. S., Forth, A. E., & Hare, R. D. (2006). Factor structure of the Hare Psychopathy Checklist: Youth Version in incarcerated adolescents. Psychological Assessment, 18, 142-154.

Vitacco, M. J., Neumann, C. S., & Jackson, R. L. (2005). Testing a Four-Factor Model of Psychopathy and Its Association With Ethnicity, Gender, Intelligence, and Violence. Journal of Consulting and Clinical Psychology, 73, 466-476.

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